Diagnosis Of Human Immunodeficiency Virus Infection Research Articles

Conjunctival Kaposi’s sarcoma in Acquired Immunodeficiency Syndrome (AIDS) patient: a case report

Background: Kaposi’s sarcoma (KS) is malignant neoplasm of the vascular endothelium, caused by Human Herpes Virus 8 (HHV 8). Clinical variants consist of classic KS, iatrogenic KS, and AIDS KS. The manifestation of KS in the eye may occur in the eyelids, the lacrimal sac or gland, the orbit and bulbar or palpebral conjunctiva. This case study aims to demonstrate the incidental finding of conjunctival Kaposi sarcoma (KS) leading to acquired immunodeficiency syndrome (AIDS) diagnosis.Case Presentation: A 34-years old male patient presented with a three-month history of progressively growing reddish mass in bulbar conjunctiva of the left eye. A mass with notable aggressive tumor characteristics heightened the suspicion for KS and comprehensive assessments were done accordingly. The patient was found to suffer from human immunodeficiency virus (HIV)/AIDS. Multistep approach treatment was commenced to treat AIDS-related KS and prevent recurrence in this case.Conclusion: Patients with undiagnosed HIV infection would benefit from early diagnosis initiated by AIDS-defining illnesses such as KS. Given early identification and comprehensive management, KS abridged the time to diagnosis of HIV infection.

Vital Signs: Deaths Among Persons with Diagnosed HIV Infection, United States, 2010-2018.

BackgroundLife expectancy for persons with human immunodeficiency virus (HIV) infection who receive recommended treatment can approach that of the general population, yet HIV remains among the 10 leading causes of death among certain populations. Using surveillance data, CDC assessed progress toward reducing deaths among persons with diagnosed HIV (PWDH).MethodsCDC analyzed National HIV Surveillance System data for persons aged ≥13 years to determine age-adjusted death rates per 1,000 PWDH during 2010–2018. Using the International Classification of Diseases, Tenth Revision, deaths with a nonmissing underlying cause were classified as HIV-related or non–HIV-related. Temporal changes in total deaths during 2010−2018 and deaths by cause during 2010–2017 (2018 excluded because of delays in reporting), by demographic characteristics, transmission category, and U.S. Census region of residence at time of death were calculated.ResultsDuring 2010–2018, rates of death decreased by 36.6% overall (from 19.4 to 12.3 per 1,000 PWDH). During 2010–2017, HIV-related death rates decreased 48.4% (from 9.1 to 4.7), whereas non–HIV-related death rates decreased 8.6% (from 9.3 to 8.5). Rates of HIV-related deaths during 2017 were highest by race/ethnicity among persons of multiple races (7.0) and Black/African American persons (5.6), followed by White persons (3.9) and Hispanic/Latino persons (3.9). The HIV-related death rate was highest in the South (6.0) and lowest in the Northeast (3.2).ConclusionEarly diagnosis, prompt treatment, and maintaining access to high-quality care and treatment have been successful in reducing HIV-related deaths and remain necessary for continuing reductions in HIV-related deaths.

Suboptimal medication adherence in young women living with HIV infection: a Korean nationwide claims study

ABSTRACT The epidemiological characteristics of women living with human immunodeficiency virus (HIV) infection have gained little attention as the numbers are small compared with men living with HIV in the Republic of Korea. However, these data are important to achieve effective HIV infection control and to consider the influence of socioeconomic status on HIV transmission. This study utilized the claims database of the Korean National Health Insurance system to analyze women with a newly diagnosed HIV infection during the period 2009–2016. Adherence to antiretroviral agents was calculated using the medication possession ratio. Among 677 women with a newly diagnosed HIV infection, 219 (32.4%) were over 50 years of age; 291 (43.0%) were identified as having acquired immune deficiency syndrome (AIDS). A total of 99 women (14.6%) were National Medical Aid beneficiaries. Optimal medical adherence >95% was found in 62.2% of subjects. Teenage years (odds ratio(OR) 14.9, 95% confidence interval (95CI) 4.9-44.8), AIDS (OR 1.7, 95CI 1.2-2.3), and low economic status requiring National Medical Aid (OR 3.0, 95CI 2.0-4.6) were associated to adherence. Diagnosis prior to 2012 was also associated with poor adherence. In women, particularly young patients with low economic status, extra attention is required to enhance adherence to prescribed medication.

Echocardiographic abnormalities in children and adolescents living with human immunodeficiency virus on highly active antiretroviral treatment.

The availability and use of highly active antiretroviral treatment (HAART) has turned human immunodeficiency virus (HIV) into a chronic disease, allowing patients to live much longer. To report asymptomatic cardiac abnormalities in children and adolescents based on both conventional and tissue Doppler imaging (TDI) echocardiography. One hundred and fifty-one patients on HAART were recruited. Demographic and clinical variables were collected through patient interviews and medical record reviews. Conventional echocardiography and TDI were performed on each patient. Mean age was 13.0 ± 3.2 (4.0-19.0) years. Eightythree patients (55%) were female. Age at diagnosis of HIV infection was 5.7 ± 3.3 years. Age at initiation of HAART was 7.34 ± 3.54 years, while duration of HAART was 59 ± 39.1 months. On conventional echocardiography, three cases of left ventricular (LV) systolic dysfunction, two of pulmonary hypertension and one of minimal pericardial effusion were identified. Calculation of myocardial mass index (MMI) revealed that 16 patients had abnormal values. Twenty-seven (17.9%) patients had evidence of LV diastolic dysfunction and 18 (11.9%) had right ventricular (RV) diastolic dysfunction. Nineteen (12.6%) patients had tricuspid annular systolic velocity of < 9.5 cm/s, indicating asymptomatic RV systolic dysfunction. While few patients had abnormalities such as reduced LV ejection fraction, pulmonary hypertension and minimal pericardial effusion detectable on conventional echocardiography, a larger proportion of patients had subtle abnormalities such as increased MMI, LV diastolic dysfunction on TDI, RV dysfunction and abnormal myocardial performance index. Such patients may need routine screening and cardiac follow up.

Barriers to Antiretroviral Therapy Adherence Among HIV-Positive Hispanic and Latino Men Who Have Sex with Men -United States, 2015-2019.

During 2018, estimated incidence of human immunodeficiency virus (HIV) infection among Hispanic and Latino (Hispanic/Latino) persons in the United States was four times that of non-Hispanic White persons (1). Hispanic/Latino men who have sex with men (MSM) accounted for 24% (138,023) of U.S. MSM living with diagnosed HIV infection at the end of 2018 (1). Antiretroviral therapy (ART) adherence is crucial for viral suppression, which improves health outcomes and prevents HIV transmission (2). Barriers to ART adherence among Hispanic/Latino MSM have been explored in limited contexts (3); however, nationally representative analyses are lacking. The Medical Monitoring Project reports nationally representative estimates of behavioral and clinical experiences of U.S. adults with diagnosed HIV infection. This analysis used Medical Monitoring Project data collected during 2015-2019 to examine ART adherence and reasons for missing ART doses among HIV-positive Hispanic/Latino MSM (1,673). On a three-item ART adherence scale with 100 being perfect adherence, 77.3% had a score of ≥85. Younger age, poverty, recent drug use, depression, and unmet needs for ancillary services were predictors of lower ART adherence. The most common reason for missing an ART dose was forgetting; 63.9% of persons who missed ≥1 dose reported more than one reason. Interventions that support ART adherence and access to ancillary services among Hispanic/Latino MSM might help improve clinical outcomes and reduce transmission.

Trends in Diagnosis of HIV Infection, Linkage to Medical Care, and Viral Suppression Among Men Who Have Sex with Men, by Race/Ethnicity and Age - 33 Jurisdictions, United States, 2014-2018.

During 2018, gay, bisexual, and other men who have sex with men (MSM) accounted for 69.4% of all diagnoses of human immunodeficiency virus (HIV) infection in the United States (1). Moreover, in all 42 jurisdictions with complete laboratory reporting of CD4 and viral load results,* percentages of MSM linked to care within 1 month (80.8%) and virally suppressed (viral load <200 copies of HIV RNA/mL or interpreted as undetected) within 6 months (68.3%) of diagnosis were below target during 2018 (2). African American/Black (Black), Hispanic/Latino (Hispanic), and younger MSM disproportionately experience HIV diagnosis, not being linked to care, and not being virally suppressed. To characterize trends in these outcomes, CDC analyzed National HIV Surveillance System† data from 2014 to 2018. The number of diagnoses of HIV infection among all MSM decreased 2.3% per year (95% confidence interval [CI]=1.9-2.8). However, diagnoses did not significantly change among either Hispanic MSM or any MSM aged 13-19 years; increased 2.2% (95% CI=1.0-3.4) and 2.0% (95% CI=0.6-3.3) per year among Black and Hispanic MSM aged 25-34 years, respectively; and were highest in absolute count among Black MSM. Annual percentages of linkage to care within 1 month and viral suppression within 6 months of diagnosis among all MSM increased (2.9% [95% CI=2.4-3.5] and 6.8% [95% CI=6.2-7.4] per year, respectively). These findings, albeit promising, warrant intensified prevention efforts for Black, Hispanic, and younger MSM.

Low bone mineral density in HIV-positive young Italians and migrants.

Human immunodeficiency virus (HIV) infected individuals may have osteoporosis. We aimed to evaluate the bone mineral density (BMD) in naïve antiretroviral (ARV) treated HIV positive patients comparing native Italian group (ItG) to a Migrants group (MiG) upon arrival in Italy. We conducted a cross-sectional study on 83 HIV patients less than 50 years old. We used the dual-energy X-ray absorptiometry (DXA) within six months from the HIV diagnosis. Participants were categorized as having low BMD if the femoral neck or total lumbar spine Z-score was- 2 or less. MiG showed low BMD more often than ItG (37.5% vs.13.6%), especially for the female gender (16.7% vs. 0.0%). A low CD4 rate (<200 cells/μl) was most often detected in MiG than ItG. In particular, we found most often male Italians with abnormal CD4 than male migrants (67.8% vs. 33.3%) and vice versa for females (30.5% vs. 66.7%). We found an abnormal bone mineral density at the lumbar site. Low BMD at the lumbar site was more frequently observed in female migrants than female Italians. Both male and female migrants had a Z-score value significantly lower than male and female Italians, respectively. By logistic regression low vitamin-D level was positively correlated to low BMD in ItG only. All data were verified and validated using a triple code identifier. Both DXA and vitamin-D evaluation should be offered after the diagnosis of HIV infection. Lumbar site low BMD is an initial condition of bone loss in HIV young patients, especially in female migrants. Vitamin D levels and supplementation may be considered after HIV diagnosis independently of age to improve bone health. This study evaluates the frequency of bone mineral density in HIV positive patients naive to antiretroviral therapy. It compares the density of the native Italian population with that of HIV Migrants upon arrival in Italy. The results show that HIV positive migrants, even if younger than 50 years of age, are at risk for osteoporosis, especially if they are female.

Perinatal outcomes of twenty-five human immunodeficiency virus-infected pregnant women: Hacettepe University experience

Objective:To evaluate perinatal outcomes in human immunodeficiency virus (HIV) infected pregnant women in Turkey.Material and Methods:Maternal characteristics, pregnancy complications, laboratory findings including HIV load, CD4 cell count, CD4/CD8 ratio, neonatal features and final HIV status of the baby were retrospectively analyzed.Results:The sample included 26 singleton pregnancies, from 25 HIV-infected women. The ethnicities were Turkish (n=18), East European (n=4), Asian (n=2) and African (n=2). The majority (76.9%) was aware of their HIV status before becoming pregnant. Four cases (15.3%) were diagnosed during pregnancy and two (7.8%) at the onset of labor. The results for median HIV viral load, CD4 count, and CD4/CD8 ratio at birth were 20 copies/mL (0-34 587), 577/mm3 (115-977), and 0.7 (0.1-1.9), respectively. The HIV viral load rate was 5.5% in eighteen women taking anti-retroviral treatment. The rates of gestational diabetes mellitus, gestational hypertension, intrauterine growth restriction, and preterm delivery were 3.8%, 3.8%, 7.6%, and 8% (numbers are 1;1;2;2), respectively. The mean gestational week at birth was 38 weeks and mean birthweight is 2972±329 g. Two babies were congenitally infected with HIV (infection rate of 8.3%). There was one needle-related accident during surgery.Conclusion:Timely diagnosis of HIV infection during pregnancy is important for preventing mother to child transmission. HIV infected women may give birth to HIV negative babies with the help of a multidisciplinary team, composed of perinatology, infectious diseases, and pediatrics specialists.

Development and optimization of thermal contrast amplification lateral flow immunoassays for ultrasensitive HIV p24 protein detection

Detection of human immunodeficiency virus (HIV) p24 protein at a single pg/ml concentration in point-of-care (POC) settings is important because it can facilitate acute HIV infection diagnosis with a detection sensitivity approaching that of laboratory-based assays. However, the limit of detection (LOD) of lateral flow immunoassays (LFAs), the most prominent POC diagnostic platform, falls short of that of laboratory protein detection methods such as enzyme-linked immunosorbent assay (ELISA). Here, we report the development and optimization of a thermal contrast amplification (TCA) LFA that will allow ultrasensitive detection of 8 pg/ml p24 protein spiked into human serum at POC, approaching the LOD of a laboratory test. To achieve this aim, we pursued several innovations as follows: (a) defining a new quantitative figure of merit for LFA design based on the specific to nonspecific binding ratio (BR); (b) using different sizes and shapes of gold nanoparticles (GNPs) in the systematic optimization of TCA LFA designs; and (c) exploring new laser wavelengths and power regimes for TCA LFA designs. First, we optimized the blocking buffer for the membrane and running buffer by quantitatively measuring the BR using a TCA reader. The TCA reader interprets the thermal signal (i.e., temperature) of GNPs within the membrane when irradiated by a laser at the plasmon resonance wavelength of the particle. This process results in higher detection and quantitation of GNPs than in traditional visual detection (i.e., color intensity). Further, we investigated the effect of laser power (30, 100, 200 mW), GNP size and shape (30 and 100 nm gold spheres, 150 nm gold-silica shells), and laser wavelength (532, 800 nm). Applying these innovations to a new TCA LFA design, we demonstrated that 100 nm spheres with a 100 mW 532 nm laser provided the best performance (i.e., LOD = 8 pg/ml). This LOD is significantly better than that of the current colorimetric LFA and is in the range of the laboratory-based p24 ELISA. In summary, this TCA LFA for p24 protein shows promise for detecting acute HIV infection in POC settings.

Adherence among HIV-positive injection drug users undergoing methadone treatment in Taiwan

AimsThe study aims were to investigate adherence to methadone maintenance treatment (MMT) and to identify associated clinical factors in patients who inject drugs diagnosed with human immunodeficiency virus (HIV) infection in Taiwan.MethodsData were from the National Health Surveillance System on HIV and the National Drug Treatment System on MMT. HIV-positive people who inject drugs (HIVPWID) were defined as the study population. Information obtained included age, sex, education, marital status, employment, methadone dose, and date of diagnosis of HIV infection. Adherence was defined as taking methadone for the past 90, 180 and 365 days, then categorized as high (> 90%), moderate (51 to 90%), or low (<=50%) adherent respectively.ResultsOf 1641 HIVPWID registered in the datasets from 2007 to 2012, 961 (58.56%) had received MMT. For HIVPWID evaluated at 90 days (n = 951), 271 (28.5%), 382 (40.2%), and 298 (31.3%) were classified as high, moderate, and low adherent respectively. For HIVPWID evaluated at 180 days (n = 936), 190 (20.3%), 349 (37.3%), and 397 (42.4%) were classified as high, moderate, and low adherent respectively. For HIVPWID evaluated at 365 days (n = 919), 133 (14.5%), 271 (29.5%), and 515 (56.0%) were classified as high, moderate, and low adherent respectively. After controlling for sociodemographics, results showed that methadone dose, location of MMT clinic, and date of HIV diagnosis were significantly associated with MMT adherence.ConclusionsStudy findings underscore the importance to MMT adherence of methadone dosage, early diagnosis of patient’s HIV infection, and area of patient residence.

HIV Testing Trends at Visits to Physician Offices, Community Health Centers, and Emergency Departments - United States, 2009-2017.

In 2019, the U.S. Department of Health and Human Services launched the Ending the HIV Epidemic: A Plan for America (EHE) initiative to end the U.S. human immunodeficiency virus (HIV) epidemic by 2030. A critical component of the EHE initiative involves early diagnosis of HIV infection, along with prevention of new transmissions, treatment of infections, and response to HIV outbreaks (1). HIV testing is the first step in identifying persons with HIV infection who need to be engaged in treatment and care as well as persons with a negative HIV test result and who are at high risk for infection and can benefit from HIV preexposure prophylaxis (PrEP) and other prevention services. These opportunities are often missed for persons receiving clinical services in ambulatory care settings (2). Data from the 2009-2016 National Ambulatory Medical Care Survey (NAMCS) and 2009-2017 National Hospital Ambulatory Medical Care Survey (NHAMCS) were analyzed to estimate trends in HIV testing at visits by males and nonpregnant females to physician offices, community health centers (CHCs), and emergency departments (EDs) in the United States. HIV tests were performed at 0.63% of 516 million visits to physician offices, 2.65% of 37 million visits to CHCs, and 0.55% of 87 million visits to EDs. The percentage of visits with an HIV test did not increase at visits to physician offices during 2009-2016, increased at visits to CHC physicians during 2009-2014, and increased slightly at visits to EDs during 2009-2017. All adolescents and adults should have at least one HIV test in their lifetime (3). Strategies that reduce clinical barriers to HIV testing (e.g., clinical decision supports that use information in electronic health records [EHRs] to order an HIV test for persons who require one or standing orders for routine opt-out testing) are needed to increase HIV testing at ambulatory care visits.

Survival and HIV-Free Survival Among Children Aged ≤3 Years - Eight Sub-Saharan African Countries, 2015-2017.

Although mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) is preventable through antiretroviral treatment (ART) during pregnancy and postpartum, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 160,000 new HIV infections occurred among children in 2018 (1). Child survival and HIV-free survival rates* are standard measures of progress toward eliminating MTCT† (2). Nationally representative Population-based HIV Impact Assessment (PHIA)§ survey data, pooled from eight sub-Saharan African countries¶ were used to calculate survival probability among children aged ≤3 years by maternal HIV status during pregnancy and HIV-free survival probability among children aged ≤3 years born to women with HIV infection, stratified by maternal ART** status during pregnancy. Survival probability was significantly lower among children born to women with HIV infection (94.7%) than among those born to women without HIV infection (97.6%). HIV-free survival probability of children born to women with HIV infection differed significantly by the timing of initiation of maternal ART: 93.0% among children whose mothers received ART before pregnancy, 87.8% among those whose mothers initiated ART during pregnancy, and 53.4% among children whose mothers did not receive ART during pregnancy. Focusing on prevention of HIV acquisition and, among women of reproductive age with HIV infection, on early diagnosis of HIV infection and ART initiation when applicable, especially before pregnancy, can improve child survival and HIV-free survival.

Impact of sickle cell disease on presentation and progression of paediatric HIV: a retrospective cohort study.

HIV and sickle cell disease (SCD) are significant causes of morbidity and mortality in sub-Saharan Africa. Given their separate roles in immune dysregulation, our objective was to characterise the impact that SCD has on the presentation and progression of paediatric HIV. The study was a retrospective cohort study (study period 2004-2018). Cases of HIV+and SCD-afflicted patients (HIV+/SCD+) were obtained via electronic chart review from a paediatric HIV clinic in Kampala, Uganda and matched 1:3 with HIV+controls without SCD (HIV+/SCD-). Thirty-five HIV+/SCD+subjects and 95 HIV+/SCD- controls were analysed (39% female (51/130), age 3.6years (SD3.9)). At baseline, WHO clinical stage (64% total cohort Stage III/IV) and nutritional status (9.4% severe acute malnutrition) were similar for both groups, whereas HIV+/SCD+had higher though non-significant baseline CD4 count (1036 (SD713) vs 849 (SD638) cells/microlitre, P=0.20, two-tailed t-test). There were 19 deaths, 6 (17%) HIV+/SCD+and 13 (14%) HIV+/SCD-, with unadjusted/adjusted models showing no significant difference. Nutritional progression and clinical stage progression showed no significant differences between groups. Kaplan-Meier analysis showed a slower rate of treatment failures in the HIV+/SCD+cohort (P=0.11, log-rank survival test). Trajectory analysis showed that in the time period analysed, the HIV+/SCD+cohort showed a more rapid rise and higher total CD4 count (P=0.012, regression analysis). The study suggests that SCD does not adversely affect the progression of HIV in patients on ART. Further, HIV+/SCD+achieved higher CD4 counts and fewer HIV treatment failures, suggesting physiological effects due to SCD might mitigate HIV progression.

Management of HIV-positive pregnant women: a Singapore experience.

Perinatal transmission remains one of the important causes of transmission of the human immunodeficiency virus (HIV). Over the years, with better knowledge and awareness of HIV infection, the perinatal transmission rate has been significantly reduced. We previously reported on the pregnancy outcomes of HIV-positive mothers from 1997 to 2007 in our institution. This article aimed to review the standards of care of HIV-positive pregnant women since then. A retrospective study reviewed 84 HIV-positive women who delivered in a tertiary centre from January 2008 to December 2015. Patient demographics and antenatal, intrapartum, postnatal and immediate neonatal data were analysed. A total of 97 deliveries with 98 neonates were recorded; 12 women delivered more than once, and there was one set of twins. The mean maternal age at diagnosis of HIV infection was 27.8 years. Of the study population, 63.1% of women were non-Singaporeans. 56 women were known to have HIV infection on presentation and 90.7% were on antiretroviral therapy during pregnancy. 88.7% of the women received intrapartum intravenous zidovudine, and 93.1% of women with detectable and 58.7% with undetectable viral load underwent Caesarean sections. All neonates were HIV-negative. The high standards of care for HIV-positive women have successfully reduced our perinatal transmission rate to zero.

HIV Testing Outcomes Among Blacks or African Americans - 50 Local U.S. Jurisdictions Accounting for the Majority of New HIV Diagnoses and Seven States with Disproportionate Occurrences of HIV in Rural Areas, 2017.

Identifying persons with human immunodeficiency virus (HIV) infection who are unaware of their status and linking them to care are critical steps in achieving viral suppression and reducing the risk for transmitting HIV (1). In 2017, 43% of new diagnoses of HIV infection were among persons who self-identify as blacks or African Americans (blacks) (2), who represent 13% of the U.S. population (3). Fewer blacks, compared with whites, were linked to HIV medical care within 90 days of diagnosis, retained in care, or virally suppressed (4). Ending the HIV Epidemic (EHE) is an initiative intended to reduce new HIV infections by 90% from 2020 to 2030 (5). EHE's Phase 1 is focused on 50 jurisdictions* that accounted for >50% of new diagnoses during 2016-2017 and seven states† with disproportionate HIV prevalence in rural areas (5). The purpose of this analysis was to examine HIV testing outcomes among blacks in high prevalence EHE jurisdictions, using CDC's 2017 National HIV Prevention Program Monitoring and Evaluation data. Blacks accounted for 43.2% of CDC-funded tests and 49.1% of new diagnoses of HIV infection. Seventy-nine percent of blacks with newly diagnosed HIV infection were linked to HIV medical care within 90 days (below the 2010 National HIV/AIDS Strategy goal of 85%), 71.4% interviewed for partner services, and 81.8% referred to prevention services. To achieve the goals of EHE, HIV prevention programs should focus on locally tailored evidence-based§ testing strategies to enhance and overcome barriers for linkage to and retention in care and reduce onward HIV transmission and HIV-related disparities.

HIV Partner Service Delivery Among Transgender Women - United States, 2013-2017.

Transgender women* in the United States are disproportionately affected by human immunodeficiency virus (HIV) infection because of multiple factors, including stigma related to gender identity, unstable housing, limited employment options, and high-risk behaviors, such as sex work, unprotected receptive anal intercourse, and injection drug use, that tend to increase their vulnerability to becoming infected with HIV (1,2). In a recent meta-analysis of 88 U.S. studies conducted during 2006-2017, the mean estimated laboratory-confirmed prevalence of HIV infection among transgender women was 14.2%, and the mean self-reported prevalence estimate was 21.0% (3). The Ending the HIV Epidemic initiative calls for accelerating the implementation of evidence-based strategies in the right geographic areas targeted to the right persons to end the HIV epidemic in the United States (4). HIV partner services are effective strategies offered by public health workers to persons with a diagnosis of HIV infection (index persons) and their sex or needle-sharing partners (partners), who are notified of potential HIV exposure and offered HIV testing and related services. CDC analyzed HIV partner services data submitted by 61 health departments† during 2013-2017. Among 208,304 index persons, 1,727 (0.8%) were transgender women. Overall, 71.5% of index transgender women were interviewed for partner services, which was lower than that for all index persons combined (81.1%). Among 1,089 transgender women named as partners by index persons, 71.2% were notified of potential HIV exposure, which was lower than that for all partners combined (77.1%). Fewer than half (46.5%) of notified transgender women partners were tested for HIV, and approximately one in five (18.6%) of those who were tested received a new diagnosis of HIV infection, slightly higher than for all partners combined (17.6%). Additional efforts are needed to effectively implement partner services among transgender women and identify those whose infection with HIV is undiagnosed, provide timely prevention and care services, reduce HIV transmission, and contribute to ending the HIV epidemic.

Neural Tube Defects in Pregnancies Among Women With Diagnosed HIV Infection - 15 Jurisdictions, 2013-2017.

In May 2018, a study of birth defects in infants born to women with diagnosed human immunodeficiency virus (HIV) infection in Botswana reported an eightfold increased risk for neural tube defects (NTDs) among births with periconceptional exposure to antiretroviral therapy (ART) that included the integrase inhibitor dolutegravir (DTG) compared with other ART regimens (1). The World Health Organization* (WHO) and the U.S. Department of Health and Human Services† (HHS) promptly issued interim guidance limiting the initiation of DTG during early pregnancy and in women of childbearing age with HIV who desire pregnancy or are sexually active and not using effective contraception. On the basis of additional data, WHO now recommends DTG as a preferred treatment option for all populations, including women of childbearing age and pregnant women. Similarly, the U.S. recommendations currently state that DTG is a preferred antiretroviral drug throughout pregnancy (with provider-patient counseling) and as an alternative antiretroviral drug in women who are trying to conceive.§ Since 1981 and 1994, CDC has supported separate surveillance programs for HIV/acquired immunodeficiency syndrome (AIDS) (2) and birth defects (3) in state health departments. These two surveillance programs can inform public health programs and policy, linkage to care, and research activities. Because birth defects surveillance programs do not collect HIV status, and HIV surveillance programs do not routinely collect data on occurrence of birth defects, the related data have not been used by CDC to characterize birth defects in births to women with HIV. Data from these two programs were linked to estimate overall prevalence of NTDs and prevalence of NTDs in HIV-exposed pregnancies during 2013-2017 for 15 participating jurisdictions. Prevalence of NTDs in pregnancies among women with diagnosed HIV infection was 7.0 per 10,000 live births, similar to that among the general population in these 15 jurisdictions, and the U.S. estimate based on data from 24 states. Successful linking of data from birth defects and HIV/AIDS surveillance programs for pregnancies among women with diagnosed HIV infection suggests that similar data linkages might be used to characterize possible associations between maternal diseases or maternal use of medications, such as integrase strand transfer inhibitors used to manage HIV, and pregnancy outcomes. Although no difference in NTD prevalence in HIV-exposed pregnancies was found, data on the use of integrase strand transfer inhibitors in pregnancy are needed to understand the safety and risks of these drugs during pregnancy.

Performance evaluation of HIV infection diagnostic tests

ABSTRACT Introduction: Many factors can impact the performance of diagnostic assays for the human immunodeficiency virus (HIV) infection, affecting the results of population surveys. Objective: The objective of this study was to evaluate the performance of point-of-care rapid tests (RT) used for HIV diagnosis as compared to conventional tests in blood samples from a population of transvestites and transsexual women. Methods: A total of 1,385 samples with HIV RT results were submitted to Instituto Adolfo Lutz for evaluation by conventional laboratory tests. Results: HIV positivity was confirmed by conventional laboratory tests in 100% of the 240 (17.3%) samples with reactive RT. However, 1,145 (82.7%) samples with non-reactive RT results were evaluated; three (0.3%) tested positive and one (0.1%), indeterminate for HIV. Although a proportion of discordant results were found, the point-of-care RTs showed a high confirmation rate when compared to the serological tests. Conclusion: The data of this study corroborate the importance of adopting effective management tools to ensure quality of HIV infection diagnosis.

Cutaneous manifestations of human immunodeficiency virus/acquired immunodeficiency syndrome: A comprehensive review

Background: Cutaneous manifestations of human immunodeficiency virus (HIV) may be among the initial signs of HIV-related immunosuppression. As such, recognizing HIV-related cutaneous manifestations may lead to the early diagnosis of HIV infection, enabling the prompt initiation of antiretroviral therapy. Purpose: The objective of this article is to discuss the disease history, clinical findings, serologic findings, and treatment options of cutaneous manifestations of HIV. Methods: A nonsystematic review of the literature was performed using PubMed/MEDLINE and Scopus from which relevant articles were analyzed and summarized in the article. Results: There are a number of dermatologic conditions associated with HIV infection, which can be grouped into various categories: acute HIV infection, bacterial infections, viral infections, fungal infections, parasitic infections, papulosquamous dermatoses, eczematous dermatoses, and miscellaneous disorders. Skin-related disorders observed in HIV may result from the viral infection itself or from opportunistic infections or skin disorders secondary to the immunocompromised state inherent to the infection. Many associated skin diseases are more severe in HIV-infected patients, particularly those with severe immunosuppression as seen in acquired immunodeficiency syndrome. Conclusion: Prompt recognition of these skin manifestations is critical to the initiation of disease-modifying antiretroviral therapy.

Clinical manifestations leading to a diagnosis of human immunodeficiency virus infection: a case report

Background In the United States, of the approximately 1.1 million people age 13 years and older living with human immunodeficiency virus (HIV) infection, an estimated 162,500 remain undiagnosed. Numerous clinical manifestations of HIV infection have been reported, but these have declined in prevalence since the advent of highly active antiretroviral therapy. Here, we present a case of a previously undiagnosed patient presenting with multiple supportive clinical manifestations that led to a confirmed diagnosis of HIV infection. Case Summary A 22-year-old male was referred to the Missouri School of Dentistry & Oral Health, A.T. Still University, with the chief complaint of a 6-month history of painful gingivae. Intraoral examination revealed ulcerated, hemorrhagic, and necrotic gingivae, with blunted papillae, associated bone loss, and fetid odor consistent with necrotizing ulcerative periodontitis (NUP). Extraoral examination revealed fingernail hyperpigmentation, cervical lymphadenopathy, and multiple smooth-surfaced, sessile, umbilicated papules of the mid-face area, suggestive of molluscum contagiosum. Biopsy of the skin lesions and histopathology confirmed the clinical impression. Despite the patient's denial of high-risk behaviors, undiagnosed HIV infection was suspected, given the combination of extra- and intraoral manifestations. The patient was prescribed chlorhexidine, metronidazole, and penicillin for NUP and advised to present to his physician the same day for HIV testing. At follow-up, intraoral examination revealed pseudomembranous candidiasis and resolving NUP lesions. When presented with the suggestive clinical findings and upon further questioning regarding his sexual history, the patient reported unprotected sexual intercourse with an HIV-positive partner 2 years earlier. Consequently, the patient was referred for rapid HIV testing at a local infectious diseases clinic, and the results came back positive for HIV infection. Conclusions This case demonstrates some of the various intraoral and extraoral presentations of HIV infection, including NUP, fingernail hyperpigmentation, cervical lymphadenopathy, molluscum contagiosum, and pseudomembranous candidiasis. Although the patient's chief complaint was painful gingivae, the presence of other lesions led to a suspected, and later confirmed, diagnosis of HIV infection. Therefore, it is important that clinicians know the various manifestations of HIV infection, especially in patients who are undiagnosed. The possibility of undiagnosed HIV infection should be suspected, and a referral for appropriate testing should be made.