Human Immunodeficiency Virus Cases Research Articles

Prevalence of Tuberculosis and Human Immunodeficiency Virus (HIV) in Ikere-Ekiti, Ekiti State Southwestern Nigeria

Tuberculosis (TB) and human immunodeficiency virus (HIV) are major devastating infectious diseases African countries and other regions of the world. TB is a potentially serious infectious bacterial disease that mainly affects the lungs. While HIV is a virus that attacks the body's immune system; which if left untreated, can lead to acquired immunodeficiency syndrome (AIDS). Thus, this study was carried out to monitor the prevalence of tuberculosis and human immunodeficiency virus (HIV) situation in Ikere-Ekiti, Ekiti State Southwestern Nigeria. A total of 191 participants were enrolled in this study. Blood and sputum samples were used in screening of HIV and Mycobacterium tuberculosis respectively. 102(53.4%) participants were confirmed HIV positive cases and 89(46.6%) participants were confirmed as M. tuberculosis-positive cases. The rate of tuberculosis was higher among women than among men and prevalence of HIV was slightly higher among men than among female. The study shows that age group 26 – 30 years have the highest rate of tuberculosis and age group 36 – 40 years have the highest rate of HIV cases while the highest number of TB with HIV co-infection 34 (17.8%) were gotten from the age group 36 – 40years. The rate at which the prevalence of tuberculosis, HIV and their co-infection are rising is due to various challenges facing its eradication. Adequate resource mobilization and effective spending is needed to achieve success. In addition, efforts should be made to improve the surveillance system.

Study of association of urine albumin to creatinine ratio with endothelial dysfunction in HIV patients on HAART

Background: In HIV (Human immunodeficiency virus) positive patients several factors have been proposed to explain the cardiovascular (CV) risk, which include pro-athero-thrombotic viral effect, infection-mediated immune dysfunction and possible effects of HAART(Highly active antiretroviral therapy). Presence of endothelial dysfunction, an early CV risk marker, in HIV-infected patients on long-term HAART. Endothelial dysfunction can be measured by bFMD (Brachial artery flow mediated vasodilatation). Urine albumin to creatinine ratio (UACR) is frequent in HIV patients and is predictor of cardiovascular risk. UACR and endothelial dysfunction are positively associated in HIV affected patients thereby increased UACR might help to identify endothelial dysfunction in HIV patients on HAART.
 Aims and Objectives: • To measure urine albumin to creatinine ratio in HIV patients on HAART. • To find out correlation between UACR and bFMD.
 Materials and Methods: Study was conducted on HIV Patients admitted to hospital, considering the inclusion and exclusion criteria. Detailed clinical history, examination and Blood investigations were done. Endothelial function was assessed by brachial artery flow mediated vasodilatation(bFMD).
 Results: Among 100 HIV patients, 14% had UACR <30 and 86% had UACR >30 and mean UACR is 90 ±06. Mean BFMD was 8.44 ± 7.65. We identified a significant Negative correlations were found between bFMD and UACR(r=- 0.832, P=<0.001).
 Conclusion: Use of urine albumin to creatinine ratio (UACR) as a routine screening tests in those who are HIV positive on HAART can be used to find out those cases of HIV who are progressing towards cardiovascular impairment so that newer approaches can be used in them to prevent further cardiovascular involvement.

SARS-CoV-2 and Human Immunodeficiency Virus: Pathogen Pincer Attack.

Paramount efforts worldwide are seeking to increase understanding of the basic virology of SARS-CoV-2, characterize the spectrum of complications associated with COVID-19, and develop vaccines that can protect from new and recurrent infections with SARS-CoV-2. While we continue learning about this new virus, it is clear that 1) the virus is spread via the respiratory route, primarily by droplets and contact with contaminated surfaces and fomites, as well as by aerosol formation during invasive respiratory procedures; 2) the airborne route is still controversial; and 3) that those infected can spread the virus without necessarily developing COVID-19 (ie, asymptomatic). With the number of SARS-CoV-2 infections increasing globally, the possibility of co-infections and/or co-morbidities is becoming more concerning. Co-infection with Human Immunodeficiency Virus (HIV) is one such example of polyparasitism of interest. This military-themed comparative review of SARS-CoV-2 and HIV details their virology and describes them figuratively as separate enemy armies. HIV, an old enemy dug into trenches in individuals already infected, and SARS-CoV-2 the new army, attempting to attack and capture territories, tissues and organs, in order to provide resources for their expansion. This analogy serves to aid in discussion of three main areas of focus and draw attention to how these viruses may cooperate to gain the upper hand in securing a host. Here we compare their target, the key receptors found on those tissues, viral lifecycles and tactics for immune response surveillance. The last focus is on the immune response to infection, addressing similarities in cytokines released. While the majority of HIV cases can be successfully managed with antiretroviral therapy nowadays, treatments for SARS-CoV-2 are still undergoing research given the novelty of this army.

Human Immunodeficiency Virus and Severe Acute Respiratory Syndrome Coronavirus 2 Coinfection: A Systematic Review of the Literature and Challenges.

The concurrence of infection with human immunodeficiency virus (HIV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), presents an intriguing problem with many uncertainties underlying their pathogenesis. Despite over 96.2 million cases of COVID-19 worldwide as of January 22, 2021, reports of patients coinfected with HIV and SARS-CoV-2 are scarce. It remains unknown whether HIV patients are at a greater risk of infection from SARS-CoV-2, despite their immunocompromised status. We present a systematic review of the literature reporting cases of HIV and SARS-CoV-2 coinfection, and examine trends of clinical outcomes among coinfected patients. We systematically compiled 63 reports of HIV-1 and SARS-CoV-2 coinfection, published as of January 22, 2021. These studies were retrieved through targeted search terms applied to PubMed/Medline and manual search. Despite scattered evidence, reports indicate a favorable prognosis for HIV patients with strict adherence to combined antiretroviral therapy (cART). However, the presence of comorbidities was associated with a poorer prognosis in HIV/SARS-CoV-2 patients, despite cART and viral suppression. Studies were limited by geographic coverage, small sample size, lack of patient details, and short follow-up durations. Although some anti-HIV drugs have shown promising in vitro activity against SARS-CoV-2, there is no conclusive evidence of the clinical efficacy of any anti-HIV drug in the treatment of COVID-19. Further research is needed to explain the under-representation of severe COVID-19 cases among the HIV patient population and to explore the possible protective mechanisms of cART in this vulnerable population.

Challenges and Promise of Human Immunodeficiency Virus Remission.

Antiretroviral therapy effectively controls human immunodeficiency virus (HIV) replication but it is unable to fully eradicate the HIV reservoir and treatment must be life-long. Progress toward a strategy for HIV remission will require overcoming key hurdles to fill gaps in our understanding of HIV persistence, but the identification of individuals who have attained sterilizing or functional HIV cure show that such a goal is achievable. In this review, we first outline challenges in targeting the HIV reservoir, including difficulties identifying HIV-infected cells, ongoing work elucidating the complex intracellular environment that contribute to HIV latency, and barriers to reactivating and clearing the HIV reservoir. We then review reported cases of HIV sterilizing cure and explore natural models of HIV remission and the promise that such HIV spontaneous and posttreatment controllers may hold in our search for a broadly-applicable strategy for the millions of patients living with HIV.

Análise epidemiológica em prontuários de clientes soropositivos

O estudo tem o objetivo de avaliar o perfil epidemiológica das pessoas soropositivas residentes no interior do Rio de Janeiro, Brasil. As pessoas soropositivas são aquelas portadoras do Vírus da Imunodeficiência Humana (HIV), a doença teve seu ápice no início da década de 80, desde então é considerada uma pandemia, segundo os dados da OMS, já matou mais de 40 milhões de pessoas em todo o mundo. Estima-se 37,9 milhões de pessoas em todo o mundo vivendo com HIV em 2019 (UNAIDS). No Brasil, de acordo com o “Boletim Epidemiológico HIV/Aids”do Ministério da Saúde (DIAHV/SVS/MS), em 2018, foram diagnosticados 42,4 mil novos casos de HIV. Trata-se de um estudo transversal, com critérios de inclusão prontuários de 2018, ambos os sexos, maiores de 18 anos de idade. Estudo aprovado pelo Comitê de Ética em Pesquisa do Centro Universitário de Volta Redonda - UniFOA, sob o registro de CAAE nº14393118.2.0000.5237. Analisados 154 (100%) prontuários com predomínio de homens, solteiros, gays, entre 20 a 49 anos, ensino fundamental completo. A maioria das fichas de notificações anexas ao prontuário constatava o não uso de drogas, entretanto as anotações médicas discordavam dessa informação. Não obstante, esse trabalho permite comparar a realidade encontrada na região com levantamentos epidemiológicos comparando com o Brasil, a região Sudeste e o estado do Rio de Janeiro, dos casos de infecção pelo HIV. A pesquisa poderá contribuir para medidas de educação em saúde com ênfase na prevenção e melhoria da qualidade de assistência à população.

HIV in Canada-surveillance report, 2019.

Human immunodeficiency virus (HIV) is a global public health issue. HIV has been nationally notifiable in Canada since 1985. The Public Health Agency of Canada (PHAC) monitors trends in new HIV diagnoses. The objective of this surveillance report is to provide an overview of the epidemiology of reported HIV cases in 2019 in Canada. The report highlights 10-year trends (2010-2019). Data on HIV diagnosed through Immigration Medical Exams (IME) and trends in perinatal transmission of HIV are also presented. PHAC monitors HIV through the HIV/AIDS Surveillance System, a passive, case-based system that collates non-nominal data submitted voluntarily by all Canadian provinces and territories. Descriptive analyses were conducted on national data. IME data were obtained from Immigration, Refugees and Citizenship Canada (IRCC), and data on HIV-exposed pregnancies were obtained through the Canadian Perinatal HIV Surveillance Program. In 2019, a total of 2,122 HIV diagnoses were reported in Canada (5.6 per 100,000 population). Saskatchewan reported the highest provincial diagnosis rate at 16.9 per 100,000 population. The 30 to 39-year age group had the highest HIV diagnosis rate at 12.7 per 100,000 population. While the rates for both males and females fluctuated in the past decade, since 2010 the rates among males decreased overall, while the rate among females increased slightly. As in previous years, the diagnosis rate for males in 2019 was higher than that for females (7.9 versus 3.4 per 100,000 population, respectively). The highest proportion of all reported adult cases with known exposure were gay, bisexual and other men who have sex with men (gbMSM, 39.7%), followed by cases attributed to heterosexual contact (28.3%) and among people who inject drugs (PWID, 21.5%). The number of migrants who tested positive for HIV during an IME conducted in Canada was 626. The one documented perinatal HIV transmission related to a mother who had not received antepartum or intrapartum antiretroviral therapy prophylaxis. The number and rate of reported HIV cases in Canada has remained relatively stable over the last decade, with minor year-to-year variations. As in previous years, the gbMSM and PWID populations represent a high proportion of HIV diagnoses, although a sizable number of cases were attributed to heterosexual contact. It is important to routinely monitor trends in HIV in light of pan-Canadian commitments to reduce the health impact of sexually transmitted and blood-borne infections by 2030.

Microelimination or Not? The Changing Epidemiology of Human Immunodeficiency Virus-Hepatitis C Virus Coinfection in France 2012-2018.

The arrival of highly effective, well-tolerated, direct-acting antiviral agents (DAA) led to a dramatic decrease in hepatitis C virus (HCV) prevalence. Human immunodeficiency virus (HIV)-HCV-coinfected patients are deemed a priority population for HCV elimination, while a rise in recently acquired HCV infections in men who have sex with men (MSM) has been described. We describe the variations in HIV-HCV epidemiology in the French Dat'AIDS cohort. This was a retrospective analysis of a prospective cohort of persons living with HIV (PLWH) from 2012 to 2018. We determined HCV prevalence, HCV incidence, proportion of viremic patients, treatment uptake, and mortality rate in the full cohort and by HIV risk factors. From 2012 to 2018, 50 861 PLWH with a known HCV status were followed up. During the period, HCV prevalence decreased from 15.4% to 13.5%. HCV prevalence among new HIV cases increased from 1.9% to 3.5% in MSM but remained stable in other groups. Recently acquired HCV incidence increased from 0.36/100 person-years to 1.25/100 person-years in MSM. The proportion of viremic patients decreased from 67.0% to 8.9%. MSM became the first group of viremic patients in 2018 (37.9%). Recently acquired hepatitis represented 59.2% of viremic MSM in 2018. DAA treatment uptake increased from 11.4% to 61.5%. More treatments were initiated in MSM in 2018 (41.2%) than in intravenous drug users (35.6%). In MSM, treatment at the acute phase represented 30.0% of treatments in 2018. A major shift in HCV epidemiology was observed in PLWH in France from 2012 to 2018, leading to a unique situation in which the major group of HCV transmission in 2018 was MSM. Clinical Trials Registration. NCT02898987.

Prevalence of Vitamin B12deficiency in antiretroviral therapy naïve adults with human immunodeficiency virus infection in a human immunodeficiency virus treatment center in Lagos, Nigeria

Background: Vitamin B12 deficiency is reportedly higher in human immunodeficiency virus (HIV) infection, according to reports from developed countries and is associated with worsening anemia, progressing immunodeficiency (reduced CD4 count), and reduced survival rates. The status in Nigerians with HIV has not been extensively studied. The objective of the study was to determine the frequency and correlates of Vitamin B12 deficiency in HIV-positive antiretroviral therapy (ART) naive patients attending an outpatient HIV clinic in Lagos, Nigeria. Specifically, the study compared HIV-positive ART-naïve patients to age- and gender-matched HIV-negative controls and determined the relationship between B12 status and HIV disease severity (CD4 count) and hemoglobin (Hb). Methodology: The study was a descriptive study of the prevalence of Vitamin B12 deficiency and its correlation with disease severity in HAART-naïve newly diagnosed HIV infection. Seventy-five ART naïve, HIV-positive patients and 75 controls fulfilling the study criteria were included. Baseline hematologic (Hb, white blood cell, platelets, and CD4 count) and Vitamin B12 levels were measured. Vitamin B12 levels were measured using urine methylmalonic acid (MMA) on spot urine normalized for urine creatinine. B12 deficiency was defined as urine MMA >3.6 mmol/mol urinary creatinine. CD4 count (cells/μL) was categorized as <200, 200–499, and >500. Results: The frequency of B12 deficiency was 29.3% (22/75) in HIV-positive cases and 0% (0/75) in controls (P < 0.001). There was no difference in the frequency of anemia in HIV cases with or without B12 deficiency (54.5% vs. 58.5%; P = 0.75). There was no significant difference in the proportions of HIV cases with or without B12 deficiency in the CD4 categories 1 (>500), 2 (200-499) and 3 (<200), (1: 31.8% vs. 24.5%; 2: 40.9% vs. 50.9%; 3: 27.5% vs. 24.5%, respectively; P = 0.71). Neither severity of HIV infection nor Hb levels was found to be associated with B12 status (P > 0.05). Conclusion: Vitamin B12 deficiency was more prevalent in HIV-positive ART naïve cases compared to age- and gender-matched HIV-negative controls. However, the presence of B12 deficiency was not associated with anemia or the severity of HIV infection in this study.

A study of prothrombotic factors in human immunodeficiency virus-infected patients

Introduction: Human immunodeficiency virus (HIV) infection has been described as a hypercoagulable state. Some studies suggest that thrombotic events may be 2–10 times more prevalent in this group than in the general population. Subjects and Methods: This was a single-center, cross-sectional case–control study. Thirty confirmed HIV cases of age group 20–60 years were enrolled. A similar number of age- and sex-matched healthy volunteers were taken as controls. CD4 cell count, protein C, protein S, antithrombin III (AT III), anticardiolipin antibody, and highly sensitivity C-reactive protein (hs-CRP) estimation was done and correlated with the CD4 counts. Results: Among HIV cases, 40% were protein C deficient, while 10% were deficient in control group (P = 0.015). One-third (33%) were AT III deficient in HIV-infected group, while none were observed AT III deficient in control group (P < 0.001). Protein C and antithrombin levels did not correlate with CD4 count. Protein S levels were normal in all the HIV-infected cases. Anticardiolipin antibody was not detected in any patient among HIV group. Mean hs-CRP levels in cases and controls were 20.18 ± 12 mg/dl and 3.32 ± 5.13 mg/dl, respectively (P < 0.0005). Conclusion: Protein C deficiency and AT III deficiency were found to be significantly associated with HIV infection. The hs-CRP levels were significantly elevated in HIV-infected patients' protein C deficiency, increased level of hs-CRP, and AT III deficiency did not correlate with CD4 cell count.

Pattern of Sexually Transmitted Infections: A Retrospective Study from a Tertiary Care Hospital in Central India

Introduction: Sexually Transmitted Infections (STIs) pose a major health, social and economic problem worldwide, predominantly in developing countries like India. It is essential to understand the current patterns of STIs in the various regions of the country in order to plan and implement strategies to control the spread of infection. Aim: To study the pattern of STIs among patients attending the STI clinic. Materials and Methods: This was a cross-sectional study of data obtained retrospectively from case records over last seven years (January 2013-December 2019) from STI clinic at a tertiary care hospital at Nagpur. The demographic details, detailed history, clinical findings were noted and relevant investigations were performed. The patients were diagnosed as per syndromic approach and subjected to serologic tests for syphilis and Human Immunodeficiency Virus (HIV). The data was analysed by using MS Excel and Epi Info software, and percentage, mean, standard deviation and proportions were calculated. Results: Out of the total 4471 cases, 2807 (62.8%) were males and 1664 (37.2%) were females. The most commonly observed STI was balanoposthitis, followed by cervico-vaginal discharge, Genital Ulcerative Disease- Herpetic (GUD-H), anogenital warts, molluscum contagiosum, GUD-nonherpetic, urethral discharge, lower abdominal pain and inguinal bubo. The proportion of viral STIs was 33.5% (1495 cases) and bacterial STIs were 4.3% (191 cases). The most commonly observed STI was balanoposthitis in males and cervico-vaginal discharge in females. Newly diagnosed cases of HIV were 1.4% (61 cases) of total cases. Conclusion: The proportion of viral STIs was higher compared to bacterial STIs. The prevalence of HIV among study population was 3.9%. Since STIs are indicators of high risk sexual behaviour in the community and a major health burden with risk of development of HIV, prompt diagnosis and adequate treatment of STIs is necessary.

A case of HIV associated cholangiopathy (CAS) - A case report

Diseases of the liver and biliary tree have been described with significant frequency among patients with human immunodeficiency virus (HIV), and its advanced state, acquired immunodeficiency syndrome (AIDS). Through a variety of mechanisms, HIV/AIDS has been shown to affect hepatic parenchyma and biliary tree, leading to liver inflammation and biliary strictures. One of the potential hepatobiliary complications of this viral infection is AIDS cholangiopathy, a syndrome of biliary obstruction and liver damage due to infection-related strictures of the biliary tract. AIDS cholangiopathy is highly associated with opportunistic infections and advanced immunosuppression in AIDS patients, and due to the increased availability of highly active antiretroviral therapy, is now primarily seen in instances of poor access to anti-retroviral therapy and medication non-compliance. Current published literature describes well the clinical, biochemical, and endoscopic management of AIDS-related cholangiopathy. We present a case of 23 year male, presented with the complains of jaundice and severe abdominal pain associated with vomiting which on further investigations and imaging work up turned out to be AIDS cholangiopathy.

Sex Differences in HIV Testing - 20 PEPFAR-Supported Sub-Saharan African Countries, 2019.

Despite progress toward controlling the human immunodeficiency virus (HIV) epidemic, testing gaps remain, particularly among men and young persons in sub-Saharan Africa (1). This observational study used routinely collected programmatic data from 20 African countries reported to the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) from October 2018 to September 2019 to assess HIV testing coverage and case finding among adults (defined as persons aged ≥15 years). Indicators included number of HIV tests conducted, number of HIV-positive test results, and percentage positivity rate. Overall, the majority of countries reported higher HIV case finding among women than among men. However, a slightly higher percentage positivity was recorded among men (4.7%) than among women (4.1%). Provider-initiated counseling and testing (PITC) in health facilities identified approximately two thirds of all new cases, but index testing had the highest percentage positivity in all countries among both sexes. Yields from voluntary counseling and testing (VCT) and mobile testing varied by sex and by country. These findings highlight the need to identify and implement the most efficient strategies for HIV case finding in these countries to close coverage gaps. Strategies might need to be tailored for men who remain underrepresented in the majority of HIV testing programs.

Clinical profile, anatomical features and long-term outcome of acute coronary syndromes in human immunodeficiency virus-infected patients.

Long-term prognosis of acute coronary syndromes (ACS) in human immunodeficiency virus (HIV)-infected patients is unknown. To compare outcomes after ACS in HIV-infected and uninfected patients. Retrospective observational study. HIV cases were matched with two HIV-uninfected controls for age, sex and type of ACS. In 92 HIV patients (mean age 51.3 ± 9.0 years, 7.6% women), the prevalence of cardiovascular risk factors was high (smoking 71.7%; hypertension 41.3%; diabetes 14.1%); dyslipidaemia was more frequent (53 (57.6%) vs 79 (42.9%), P = 0.02) and obesity less common (8 (8.7%) vs 41 (22.3%), P = 0.002) than in controls. Eighty-seven (94.6%) HIV patients had undetectable viral load and 85 (92.4%) were under anti-retroviral therapy. Multivessel disease was more common in HIV patients than in controls (44 (47.8%) vs 71 (39.1%); P = 0.05) as was Killip class 3-4 on admission (9 (9.8%) vs 6 (3.3%); P = 0.04). The rate of in-hospital mortality was similar in both groups (2%), and there were no significant differences in 3-year mortality (10.2% vs 5.7%; P = 0.27). Non-cardiovascular readmissions at 3 years were more frequent in HIV patients than in controls (36.5% vs 7.4%; P < 0.001). Multivariate analysis identified previous coronary artery disease as the strongest predictor of mortality in HIV patients (hazard ratio 4.7, 95% confidence interval 1.4-15.7, P = 0.01), whereas HIV infection was not associated with prognosis. HIV patients with ACS had more frequent multivessel disease and heart failure than matched controls. However, in-hospital and long-term mortality was similar in both groups. Non-cardiovascular re-hospitalisations were more common in HIV patients.

Evaluation of diagnostic microbiology capacity and barriers in testing for HIV and TB at peripheral hospital-based laboratories in Oyo-state, Nigeria

Background: Tuberculosis (TB) and human immunodeficiency virus (HIV) are two interrelated infectious diseases that continue to threaten public health in several parts of the world. In Nigeria, a maximum of 52,000 people died from HIV and TB in 2017 which suggests that the two diseases are still a burden on the nation's health. This study sought to evaluate the diagnostic microbiology capacity and barriers in testing for HIV and TB at peripheral government-owned secondary hospital-based laboratories in Oyo State, Nigeria. Methods and materials: This study used a descriptive cross-sectional design to evaluate 17 government-owned secondary hospital-based laboratories in Oyo State. A WHO laboratory assessment tool was used to evaluate the study laboratories. Diagnostic capacity was measured on a scale of 100-point in which scores ≤49% were rated low, fair (50–79%), and good (≥80%). A score of 0, 50 and 100 were assigned to no, partial and yes responses respectively and the average score was calculated. Results: Evaluation of diagnostic capacity showed that 11 (64.7%) and 6 (35.3%) of the laboratories had ‘low’ and ‘fair’ capacity respectively to test sputum or cerebrospinal fluid for TB. For HIV, 14 (82.4%) of the laboratories had ‘low capacity’ and 3 (17.6%) had ‘fair capacity’ to test serum for HIV antigen and blood for viral load. Analysis of the type of assay performed at the laboratories indicated that 9 (52.9%) of the laboratories could carry out acid-fast bacilli (AFB) smear using Ziehl-Neelsen stain, 8 (47.1%) Rhodamine/Auramine stain and no laboratory could perform AFB culture and sensitivity. Seven (41.2%) of the laboratories could carry out a serological test for HIV and 3 (17.6%) could test blood for viral load. More than 50% of the laboratories reported that unavailable testing kits/reagents for HIV/TB and lack of culture facilities for AFB were the diagnostic barriers responsible for the ‘low’ and ‘fair’ capacity observed in the laboratories. Conclusion: The low capacity of laboratories in this state underscores the need for interventions to improve the supply of testing kits, reagents and culture facilities which will enhance prompt detection of HIV and TB cases.

Spatial and temporal analysis of the human immunodeficiency virus in an area of social vulnerability in Northeast Brazil.

Human Immunodeficiency Virus (HIV) infection still represents an important public health problem, because it involves clinical, epidemiological, social, economic and political issues. We analyzed the temporal and spatial pattern of the HIV incidence in an area of social inequality in northeast Brazil and its association with socioeconomic indicators. An ecological study was carried out with a focus on all HIV cases reported in Alagoas State, Northeast Brazil from 2007 to 2016 using its 102 municipalities as the units of our analysis. Data from the Brazilian information systems were used. Georeferenced data were analyzed using TerraView 4.2.2 software, QGis 2.18.2 and GeoDa 1.14.0. Time trend analyses were performed by the Joinpoint Regression software and the spatial analyses included the empirical Bayesian model and Moran autocorrelation. Spatial regression was used to determine the influence of space on HIV incidence rate and socioeconomic inequalities. There was an increasing trend of HIV rates, especially in the municipalities of the interior. Significant spatial correlations were observed with the formation of clusters with emphasis on the coast of the state and in tourist regions. Spatial regression explained 46% of the dependent variable. The HIV incidence rate was positively influenced by rate of primary health care units (P=0.00), and negatively by Gini index (P=0.00) and proportion of heads of household without or low education (P=0.02). We conclude that the relationship found between indicators of better socioeconomic conditions and HIV infection suggests unequal access to the diagnosis of infection. Prevention and control strategies can be established according to each epidemiological reality.

The Role of Targeted HIV Screening in the Emergency Department: A Scoping Review.

Human immunodeficiency virus (HIV) infection continues to expand worldwide, and a significant proportion of infection is still undiagnosed. Recent studies have addressed the impact and feasibility of 'opt-out' HIV screening in Emergency Departments (EDs) in urban settings at high HIV prevalence, whereas little is known about the yield of implementing 'targeted' HIV testing, especially in low-prevalence areas. The present study undertakes a scoping review of research carried out on the implementation of targeted HIV screening of adult in EDs to determine the impact, feasibility and acceptability of HIV testing in different HIV prevalence settings. Online databases (EMBASE, MEDLINE) were used to identify papers published between 2000 to 2020. A three-concept search was employed with HIV (HIV, Human immunodeficiency virus infection, HIV infections), targeted testing (Target, screening or testing) and emergency medicine (Emergency Service, emergency ward, A&E, accident and emergency or Emergency Department) (28th February 2020). Only full-text articles written in English, French, Spanish or Italian and using impact and/or feasibility and/or acceptability of the program as primary or secondary outcomes were analysed. The search provided 416 articles. Of these, 12 met inclusion criteria and were included in the final review. Most of the included studies were carried out in the United States (n=8; 67%) and in areas of high HIV prevalence (n=11; 92%). Three (20%) were randomized control studies. While the rate of newly diagnosed HIV cases varied widely (0.03-2.2%), likely due to methodological heterogeneity between studies, the linkage of new HIV diagnosis was often high (80-100%) and median CD4+ cell count was always greater than 200 cells per microliter. Targeted HIV screening was found to be cost-effective (out of 2 studies) and well accepted by participants (out 2 studies). Targeted HIV screening at the ED can be impactful, feasible and well accepted, but often requires extra funding and staff. Most previous work has focused on areas of high disease prevalence.

A Review of the Use of Biological Agents in Human Immunodeficiency Virus Positive Patients With Rheumatological Diseases.

After approval, initial biologics etanercept, infliximab, and adalimumab became useful in the therapeutic armamentarium to treat rheumatoid arthritis (RA) patients who had an inadequate response to disease-modifying anti-rheumatic drugs (DMARDs). However, all phase-III clinical trials submitted to the FDA, by design, excluded patients who were human immunodeficiency virus (HIV) positive. They are another subset of patients with low immunity due to their HIV-positive status. Very little information is available about the use of biologics in this new group of patients if they fail to respond to DMARDS. The available literature is limited to case reports about HIV-positive RA patients with reported side effects. These side effects range from no opportunistic infections (OIs) in some to acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulopathy (DIC) reported in others. Some HIV cases may initially present with rheumatological manifestations. With growing epidemiologic evidence of frequent joint manifestations in HIV-positive patients, HIV testing should be done more frequently in patients with RA, even those who deny risk factors for HIV. This review may help develop future guidelines on how to manage HIV-positive RA patients.

HIV prevalence among 338,432 infertile individuals in Hunan, China, 2012-2018: A cross-sectional study.

BackgroundThe prevalence of human immunodeficiency virus (HIV) varies markedly among different risk groups in China, spreading fromhigh-risk populations to the general population. Indeed, China is in a critical period of HIV/acquired immunodeficiency syndrome (AIDS) prevention and control; however, data regarding HIV testing, infection and coinfection among infertile couples are lacking. This study aimed to estimate the HIV/AIDS prevalence to identify risk factors among infertile couples in Hunan, China.MethodsA cross-sectional hospital-based study was conducted to evaluate the prevalence of HIV/other infections (hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, and Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium (MG) infections) among 338,432 infertile individuals in Hunan, China, from 2012 to 2018. We calculated linear trends in prevalence using bivariate linear regression.ResultsThe overall prevalence rates of HIV, chlamydia, gonorrhea, MG, syphilis, and HBV and HCV antibody positivity in this study were 0.04%, 1.73%, 0.05%, 2.60%, 2.15%, 12.01% and 0.56%, respectively. The predominant infection was HBV, followed by MG, syphilis, and chlamydia. Only 1.13% of the participants (382/338432) reported sexually transmitted disease (STD) signs and symptoms suggesting genital tract infection. However, from 2012–2018, the variation in HIV prevalence was not significant (β = 0.000, PTREND = 0.907). The characteristics of the HIV-infected infertile population have not shifted dramatically, with women accounting for 32.56% of HIV cases in China. Overall, 87.60% of HIV-infected individuals have a relatively low education. In total, 37.98% of HIV-positive patients engage in high-risk behaviors.ConclusionsThis study expands upon existing knowledge of HIV prevalence in the infertile Chinese population. However, much work is needed to achieve popularization of prevention knowledge and change concept. Routine HIV screening is urgently needed for all adults with high-risk behaviors.

FACTORS RELATED TO THE INCIDENCE OF HIV/AIDS AMONG SHEMALE IN SURABAYA, INDONESIA

Background: Acquired Immunodeficiency Syndrome (AIDS) is one of the diseases that cause death in the world caused by the Human Immunodeficiency Virus (HIV). Since it was first discovered in 1987 until December 2017, the number of person with AIDS was 102,667, and the number of person with HIV infections was 280,623. HIV/AIDS cases in East Java occupy the second highest position in Indonesia. Surabaya is the first city in East Java with 934 HIV cases in 2017. Shemale is one of the groups at risk of getting HIV/AIDS with prevalence was 24.82%. Objective: The purpose of this study was to analyze the factors that influence shemale related to the incidence of HIV/AIDS in Surabaya. Materials and Methods: This study was an analytic research using a cross sectional approach. The subject was 80 shemale respondents. Data were collected using questionnaires then analyzed using Chi-square test, with α=0.05. Results: The highest age group was 42-46 years (22.5%), the last level of education was dominated by high school (41.3%), and the most types of work were private employees (47.4%). There was no correlation between predisposing factors in the form of knowledge about HIV/AIDS and respondent's HIV status (p=0.729), there was no correlation between enabling factors in the form of condoms and respondent's HIV status (p=0.624), there was no correlation between the reinforcing factor in the form of family support with the HIV status of the respondent (p=0.674) and there was no correlation between preventive behavior and the HIV status of the respondent (p=0.540). Conclusion: The need for support between shemales for the dangers of HIV/AIDS and shemale should be more aware of their own health and environment with their social patterns.