Mode Of HIV Transmission Research Articles

Sex work, syndemic conditions and condomless anal intercourse among men who have sex with men who engage in sex work in Latin America.

Background In Latin American countries and Suriname, sexual transmission is one of the most common modes of HIV transmission, and men who have sex with men (MSM) who engage in sex work constitute a key population. Methods In a sample of MSM (N =53,166) from the Latin American Internet Survey (2018) across 18 countries, we examined how sex work engagement is associated with syndemic conditions (multidrug use, homophobic abuse, depression/anxiety, alcohol dependency (CAGE alcohol questionnaire) and internalised homonegativity) and condomless anal intercourse with non-steady male partners using separate logistic regressions. We then used a structural equation model to determine if and how syndemic conditions mediate the relationship between sex work engagement and non-steady male partners. Results We found that getting paid for sex was associated with less condom use for anal intercourse with non-steady male partners and particular syndemic conditions, such as multidrug use, homophobic abuse and alcohol dependency. In our structural equation model, the results showed that the direct relationship between sex work engagement and non-steady male partners was positive and significant, and syndemic conditions partially mediated this relationship. Conclusion Our results highlight the continuing need for including MSM who engage in sex work and those who experience syndemic conditions in the prevention strategies targeted to MSM in Latin America and Suriname, to prevent the transmission of HIV.

Knowledge and Awareness of Risk Factors for HIV Infection and about HIV Testing among Medical Students in Warsaw.

The number of late diagnoses of HIV remains very high in Poland, leading to a high proportion of patients developing and dying of HIV-related diseases. The main reason for this is the very low utilization of HIV testing. Our analyses aimed to investigate knowledge about the indications for HIV testing among medical university students, as well as identify their own HIV testing experiences. A cross-sectional survey study was designed to collect information on the students' demographics and their experiences of HIV testing, as well as their knowledge of virus transmission and the indications for testing. Data were collected as part of the HIV_week@WUM project conducted at the Medical University of Warsaw in parallel with the 18th European AIDS Conference, which took place in Warsaw between 18 and 21 October 2023. In total, 545 questionnaires were collected. The median age of the study participants was 20 (interquartile range (IQR): 19-22 years). The majority of respondents were as follows: women (67.5%), born in Poland (97.8%), and were attending the medical faculty (56.7%). Only 114 (21.43%) participants had ever been tested for HIV. For all modes of HIV transmission, most of the respondents overestimated the risk of acquiring HIV, but, at the same time, they had never been tested for HIV. Only one in five health sciences students has ever had a test for HIV, which is less than estimates for the general population of Warsaw. There is an ongoing need to popularize testing among future health care providers in order to address both the indications for testing for individuals and the better use of HIV testing in clinical practice.

HIV/AIDS-related knowledge, attitudes and perceptions of urban Ghanaian pregnant women: Results of a qualitative study

IntroductionKnowledge, attitudes, and perceptions (KAPs) regarding HIV/AIDS is one of the cornerstones in the fight against the disease. Mortality and morbidity among HIV-infected pregnant or postpartum women are reported to be eight times higher than their HIV-uninfected counterparts. Preventing mother-to-child transmission (PMTCT) strategies can be more effective if women, particularly pregnant women, have comprehensive knowledge about HIV/AIDS. MethodsThis qualitative study was designed to explore the knowledge, attitudes, and perceptions of HIV/AIDS among 18 pregnant women attending antenatal care in a health facility in Accra, Ghana. Data was collected through individual in-depth interviews, transcribed and thematically analysed using the six steps identified by Braun and Clarke. ResultsThree themes emerged from the analysis: (a) Pregnant women’s knowledge of the causes and transmission of HIV/AIDS, (b) Attitude towards HIV/AIDS and HIV testing, and (c) Perceptions about pregnant women living with HIV. We found the knowledge of the causes and mode of HIV transmission among the pregnant women to be relatively high. However, testing to determine their HIV status was low, owing to factors such as fear of testing positive, the stigma, discrimination, and prejudice associated with HIV/AIDS, and misconceptions some had about how the virus could be contracted (spiritually), which necessitated spiritual assistance before, during, and after testing. ConclusionThe findings underscore the need for health professionals to address myths and superstitions about HIV/AIDS during antenatal care visits to encourage and improve testing uptake among pregnant women.

Identifying risk factors for anal cancer in people with HIV in Spain: a multicentre retrospective cohort study nested in the PISCIS cohort

People with HIV have a substantially higher risk of anal cancer than the general population. We aimed to identify risk factors associated with the development of anal cancer among people with HIV to implement more effective and targeted screening strategies. We conducted a multicentre retrospective cohort study in 16 hospitals across Catalonia and the Balearic Islands, Spain, between Jan 1, 1998, and Dec 31, 2022. Treatment-naive people with HIV nested in the PISCIS cohort aged 16 years and older with biopsy-proven squamous cell carcinoma of the anus or anal canal were eligible for inclusion. Data were retrieved from every hospital registry and were centrally validated in the PISCIS cohort and the Public Data Analysis for Health Research and Innovation Program. The primary outcome was the incidence rate (IR) of histologically confirmed anal cancer. We used Poisson regression to examine the association between the following risk factors and incidence of anal cancer: age, mode of HIV transmission, nadir CD4 cell count, and time period of HIV diagnosis. Among 14 238 people with HIV, 107 (0·8%) developed anal cancer, with an overall IR of 72·5 cases per 100 000 person-years (95% CI 59·4-87·6) and median follow-up of 9·5 years (IQR 4·4-15·7). Of these patients with anal cancer, 37 (34·6%) died, of which 24 (64·9%) deaths were related to anal cancer. Incidence was highest among people with HIV with historical nadir CD4 counts of less than 200 cells per μL (IR 105·0 person-years, 95% CI 82·0-132·5) and lowest among those with counts of more than 350 cells per μL (2·9 person-years, 0·1-16·0). Among men who have sex with men (MSM), the IR was 211·5 person-years (95% CI 151·1-211·7) among those with a CD4 count of less than 200 cells per μL, 37·6 person-years (16·2-74·1) among those with a count of 200-350 cells per μL, and 4·8 person-years (0·1-26·9) among those with a count of more than 350 cells per μL. Among people with HIV younger than 30 years, there were no cases of anal cancer among women or men who do not have sex with men, and one case among MSM with a nadir CD4 count of more than 350 cells per μL (IR 4·8 person-years, 95% CI 0·1-26·9). In the multivariable analysis, people with HIV with nadir CD4 counts of more than 350 cells per μL had the lowest risk of developing anal cancer, compared with people with HIV with counts of less than 200 cells per μL (adjusted IR ratio 0·03, 95% CI 0·00-0·25; p=0·0010) or 200-350 cells per μL (0·30, 0·17-0·55; p<0·0001). Compared with people with HIV younger than 30 years, people with HIV aged 60 years and older had an adjusted IR ratio of 27·6 (3·7-206·9; p=0·0010) and people with HIV aged 45-59 years of 21·6 (3·0-156·4; p=0·0020). Compared with individuals diagnosed after 2015, a diagnosis of HIV before 1998 had an adjusted IR ratio of 33·0 (7·9-137·5; p<0·0001). A nadir CD4 count threshold below 350 cells per μL, particularly less than 200 cells per μL, has the potential to identify people with HIV at heightened risk of developing anal cancer. Customised screening strategies that prioritise screening for individuals at high risk with this surrogate marker could maximise available resources. External validation of these data with other cohorts is required before screening recommendations can be updated. Catalan Health Department, Generalitat de Catalunya.

HIV Care in Ukrainian Migrants in Two European Countries: All the Same?

Introduction: War in Ukraine prompted an enormous refugee influx into Europe, including approximately 4200 people with HIV. The unique healthcare features of Ukrainian refugees living with HIV were compared between two infectious disease departments in Bonn, Germany, and Szczecin, Poland. Methods: This is a retrospective study on 161 people living with HIV (PLWH) refugees from Ukraine seeking care in Bonn (n = 30) and Szczecin (n = 131) between April 2022 and May 2023. Demographic, virologic, immunologic, and coinfection data were analyzed. Results: The majority of the studied individuals were female: 64% (n = 84) in Szczecin and 60% (n = 18) in Bonn. The main HIV transmission mode was heterosexual sex in 73.5% (n = 114). All were on combined antiretroviral therapy (cART) on arrival, primarily on the TLD regimen (TDF/3TC/DTG) (68.4%, n = 106). In Germany, cART was most frequently switched to BIC/TAF/FTC in 83.4% (n = 25); in Poland, the most common combination was TDF/FTC + DTG (58%, n = 76). A prevalence of replicating hepatitis C was in 11.7% (n = 15), and that for chronic hepatitis B (HBV) was in 4.7% (n = 4). History of past tuberculosis was reported in 16.9% (n = 14, Poland, and n = 7, Germany). Follow-up after 6 months showed immunological reconstitution with a mean increase of CD4+ of 10 (IQR: -69.5-120.5) cells/µL in Poland and 51.5 (IQR: -22.5-135.5) cells/µL in Germany; p = 0.04. Virologic suppression (<40 HIV-RNA/mL) was high in care entry (n = 62; 98%) for Poland, and n = 26 (92.6%) for Germany, and suppression was achieved in the majority of patients in the 6-month control (89.7% in Poland vs. 95.7% in Germany). Conclusions: Health challenges posed by war migration extend beyond HIV to coinfections as HBV, HCV, and tuberculosis give an indication for a broader search for coinfections, often less common in the new country.

Breakthrough COVID-19 Infections after Booster SARS-CoV-2 Vaccination in a Greek Cohort of People Living with HIV during the Delta and Omicron Waves.

Currently approved SARS-CoV-2 vaccines have been proven effective in protecting against severe COVID-19; however, they show variable efficacy against symptomatic infection and disease transmission. We studied the breakthrough COVID-19 infection (BTI) after booster vaccination against SARS-CoV-2 in people living with HIV (PWH). This was a retrospective, single-center, descriptive cohort study involving PWH, who were followed in the HIV Clinic of "Attikon" University Hospital in Athens, Greece. A BTI was defined as a case of laboratory-confirmed COVID-19 occurring at least 14 days after the third (booster) vaccine dose. We studied 733 PWH [males: 89%, mean age: 45.2 ± 11.3 years, mean BMI: 26.1 ± 4.1, HIV stage at diagnosis (CDC classification): A/B/C = 80/9/11%, MSM: 72.6%] with well-controlled HIV infection. At least one comorbidity was recorded in 54% of cases. A history of ≥1 vaccination was reported by 90%, with 75% having been vaccinated with ≥3 vaccines. Four hundred and two (55%) PWH had a history of COVID-19 and 302 (41.2%) had a BTI, with only 15 (3.7%) needing hospitalization. Only one patient was admitted to the ICU, and no death was reported. Regarding BTI after booster dose, increased age (OR = 0.97, 95% CI: 0.96-0.99, per 1-year increase), and COVID-19 infection prior to booster dose (OR = 0.38, 95% CI: 0.21-0.68) were associated with a lower likelihood for BTI, whereas higher BMI (OR = 1.04, 95% CI: 1.01-1.08) and MSM as a mode of HIV transmission were associated with increased risk (OR = 2.59, 95% CI: 1.47-4.56). The incidence rate of total COVID-19 and BTI followed the epidemic curve of the general population, with the highest incidence recorded in June 2022. A significant proportion of PWH with well-controlled HIV infection experienced a BTI, with the majority of them having mild infection. These data, which include the period of Omicron variant predominance, confirm the importance of vaccination in the protection against severe COVID-19.

Differences in socio-demographics status, risk behaviours, healthcare uptake and HIV/ sexually transmitted infections (STIs) between brothel-based and street-based female sex workers in Yunnan, China.

Heterosexual contact is the primary mode of HIV transmission in China and commercial sex is thought to play a crucial role in China's epidemic. Female sex workers (FSWs) in China tend to be either brothel-based (BSWs) or street-based (SSWs), but few studies have investigated the differences between these important segments of this difficult-to-reach, high-risk population. Our aim was to explore the differences between SSWs and BSWs in terms of socio-demographic characteristics, sexual and risky practices, HIV/STI-related knowledge, health services, HIV/STI prevalence and other aspects. A cross-sectional survey was conducted in Yunnan Province of China in partnership with a local FSW-friendly non-governmental organization. Face-to-face interviews using a structured questionnaire were conducted to collect data on socio-demographic characteristics, sex work history, sexual behaviours, HIV/STI-related knowledge, HIV testing history, and healthcare services uptake. Blood samples were taken for HIV and syphilis testing, and urine samples for gonorrhea and chlamydia testing. Descriptive statistics were used to evaluate differences between SSWs and BSWs. A total of 185 BSWs and 129 SSWs were included in the study. SSWs were older and less educated, had more dependents and more clients, lower condom use and accessed fewer healthcare services. Moreover, 37.2% of SSWs and 24.9% of BSWs were found to have HIV/STI infection. Unfortunately, the awareness related to STIs was relatively low in both groups, especially SSWs. Our study provides evidence that confirms the disproportionately high vulnerability of SSWs to HIV and other STIs, underscoring the urgent need for the Chinese health and public health sectors to prioritize outreach to SSWs. Awareness and educational programs, condom distribution, testing and health check-ups should be included in a comprehensive strategy for HIV/STI prevention in this high-risk population.

High-risk sexual behavior among Malaysian adolescents who use drugs: a mixed-methods study of a sample in rehabilitation

ABSTRACT Background The high-risk sexual behaviors of drug-using adolescents in Malaysia is an under-researched topic. Methods Eighty adolescents undergoing rehabilitation participated in this mixed-methods study. Results The sample was mostly males (70%), and the mean age was 18.2 years (SD = 1.40). More than three-fifths (63%) had used only methamphetamine and the mean duration of all drug use was 3.15 years. Sixty-nine percent reported previous sexual experience. High-risk sexual behaviors include having unprotected sex (11%), sex with more than one person (84%), and sex under the influence of drugs (94%). About 44% of the sample had intimate partners who use drugs. Most respondents (64%) were aware of the advantages of safe sex and were familiar with HIV transmission modes (74%). Results from multivariate logistic analysis indicate that females had significantly higher odds of engaging in unprotected sex and having intimate partners who use drugs, relative to males; males were, however, more likely to have sex under the influence of drugs. Responses from the interviews suggest that adolescents who use drugs engage in high-risk sexual behaviors primarily because drugs are used to enhance sex. Conclusions A comprehensive sex education program tailored for drug-using adolescents should be made an integral part of rehabilitation.

High-fat diet feeding exacerbates HIV-1 rectal transmission.

High-fat diet (HFD) is well known to impact various aspects of gut health and has been associated with many diseases and inflammation. However, the impact of HFD feeding on HIV-1 rectal transmission has not yet been well addressed. With an increasing threat of HIV-1 infection in men who have sex with men (MSM), where the rectal route is the primary mode of infection, it is imperative to understand the impact of HFD on gut microbiota and inflammation and consequently, its effect on HIV-1 rectal transmission. Here, we utilized our double humanized bone marrow, liver, thymus (dHu-BLT) mouse model to assess the impact of HFD feeding on the host's susceptibility to HIV-1 rectal transmission. We found that feeding an HFD successfully altered the gut microbial composition within 3 weeks in the dHu-BLT mouse model. In addition, levels of inflammatory mediators, specifically IL-12p70, IP-10, ICAM-1, and fecal calprotectin, were significantly higher in HFD-fed mice compared to control mice on a regular chow diet. We also observed that significantly different inflammatory markers (IL-12p70 and ICAM-1) were negatively correlated with the number of observed ASVs, Shannon diversity, and Faith's diversity in the HFD-fed group. Notably, when repeatedly challenged with a low dose of HIV-1 via a rectal route, mice receiving an HFD were significantly more susceptible to HIV-1 rectal infection than control mice. Together, these results underscore the impact of HFD feeding on the gut microbiota and inflammation and suggest the significance of diet-induced gut microbial dysbiosis and inflammation in promoting viral infection.IMPORTANCEHFD induces gut microbial dysbiosis and inflammation and has been associated with many infections and disease progression; however, its impact on HIV-1 rectal transmission is largely unknown. Given the increasing threat of HIV-1 incidence in men who have sex with men (MSM), it has become crucial to comprehend the impact of factors associated with gut health, like HFD consumption, on host susceptibility to HIV-1 rectal transmission. This is particularly important since anal intercourse remains the primary mode of HIV transmission within the MSM group. In this study, utilizing our unique mouse model, featuring both the human immune system and gut microbiota, we showed that HFD feeding led to gut microbial dysbiosis, induced inflammation, and increased HIV-1 rectal transmission. Collectively, our study highlights the significant impact of HFD on gut microbiota and inflammation and suggests an HFD consumption as a potential risk factor for promoting HIV-1 rectal susceptibility.

Sociodemographic correlates of discrimination against PLHIV in High HIV prevalence states of India, NFHS 2016–21

This study investigates the socio-demographic correlates of HIV discrimination among individuals aged 15–49 years. This study also aims to assess the change in discriminatory attitudes towards PLHIV in high HIV prevalence states from 2016 to 2021 using data from the national Demographic Health Survey (4th and 5th). To identify factors associated with discriminatory attitudes, a multivariable logistic regression analysis was performed. Further, predicted probabilities and average marginal effects were computed, and the difference in discriminatory attitudes across both rounds was examined using a non-linear Fairlie decomposition. Mass media exposure, improved wealth index, and comprehensive knowledge significantly reduced the discriminatory attitudes towards PLHIV. Fairlie decomposition indicated that comprehensive knowledge, knowledge of mother-to-child transmission, and mass media exposure was significant contributor to the differences observed in the discriminatory attitude towards PLHIV across survey rounds. This study emphasizes the importance of spreading accurate information about HIV transmission modes and reinforces existing programmes and policies aimed at reducing stigma and discrimination against PLHIV. These programmes' efficiency and effectiveness can be ensured by linking them with community-level programmes and activities organized by Self Help Groups (SHGs), which have resulted in a paradigm shift in empowering women in India.

Effect of non-adherence to ARV therapy on 3-year life of HIV/AIDS patients: a cohort retrospective study

Background: Antiretroviral drug Therapy (ART) has dramatically reduced the morbidity and mortality of People Living with HIV/AIDS (PLWHA). However, adherence to antiretroviral therapy has become a challenge due to a lifetime of therapy. Adherence to antiretroviral therapy is one determining factor in the success of treatment. &#x0D; Method: This study aimed to determine the influence of medication non-adherence on the 3-year survival of patients with HIV/AIDS. The study design used a retrospective cohort and calculated survival estimates using Cox regression. All HIV/AIDS patients in the RSPI-SS from 2010 – April 2012, totaling 164 patients, were obtained from medical records, a summary of treatment and ART (follow-up), pharmacy data, and ARV therapy monitoring books at the RSPI-SS. Data analysis using cox regression.&#x0D; Results: The cumulative survival probability of patients with HIV/AIDS at RSPI Prof. dr. Sulianti Saroso in the second year (24th month) was 95.6% and in the third year (in the 36th) was 91%. Multivariate analysis with Cox regression showed the factors that affected the 3-year survival of patients with HIV/AIDS are non-adherence to ART after being controlled by initial CD4 count (aHR = 7.608; 95% CI: 1.664 to 34.790) and non-compliance appointments after controlled by opportunistic infection, age and initial CD4 count (aHR = 2.456; 95% CI: 0.802 to 7.518). Among patients' non-adherence to ART, non-compliance appointments affected the 3-year survival of patients with HIV/AIDS after controlled by initial CD4 count, sex, CPT, modes of HIV transmission, WHO clinical stage, opportunistic infection, and age (aHR = 4.517; 95%CI: 0.729 to 27.987). &#x0D; Conclusion: Non-adherence to ART may cause a failure to suppress HIV viral, thus increasing the possibility of HIV mutations that can lead to drug-resistant and ultimately increase the risk of death. Patients who do not adhere to medication and do not adhere to their medication appointments show a higher risk of dying than those who adhere to HIV/AIDS. Non-adherence to taking medication in the first year can be used as a marker to monitor medication adherence and the patient's health condition in the future. Therefore, it is essential to monitor adherence to taking the medication regularly through ARV therapy surveillance activities.

The estimation of long and short term survival time and associated factors of HIV patients using mixture cure rate models

BackgroundHIV is one of the deadliest epidemics and one of the most critical global public health issues. Some are susceptible to die among people living with HIV and some survive longer. The aim of the present study is to use mixture cure models to estimate factors affecting short- and long-term survival of HIV patients.MethodsThe total sample size was 2170 HIV-infected people referred to the disease counseling centers in Kermanshah Province, in the west of Iran, from 1998 to 2019. A Semiparametric PH mixture cure model and a mixture cure frailty model were fitted to the data. Also, a comparison between these two models was performed.ResultsBased on the results of the mixture cure frailty model, antiretroviral therapy, tuberculosis infection, history of imprisonment, and mode of HIV transmission influenced short-term survival time (p-value < 0.05). On the other hand, prison history, antiretroviral therapy, mode of HIV transmission, age, marital status, gender, and education were significantly associated with long-term survival (p-value < 0.05). The concordance criteria (K-index) value for the mixture cure frailty model was 0.65 whereas for the semiparametric PH mixture cure model was 0.62.ConclusionThis study showed that the frailty mixture cure models is more suitable in the situation where the studied population consisted of two groups, susceptible and non-susceptible to the event of death. The people with a prison history, who received ART treatment, and contracted HIV through injection drug users survive longer. Health professionals should pay more attention to these findings in HIV prevention and treatment.

Association between premarital HIV testing and ability to negotiate sexual relations among married women in Ethiopia: a population-based study

ABSTRACT HIV/AIDS prevalence in sub-Saharan Africa remains an issue of concern and young women are disproportionately affected by the disease. Premarital HIV testing is one of the key strategies used in HIV prevention since heterosexual sex remains the primary mode of HIV transmission in sub-Saharan Africa. This study uses the 2016 Ethiopia Demographic and Health Survey to examine the association between premarital HIV testing and the ability to negotiate sexual relations among married women aged 15 to 49 years (N = 3,672). Women's ability to negotiate sexual relations was measured using two variables: the ability to refuse sex and the ability to ask for a condom during intercourse. Descriptive statistics, bivariate, and multiple logistic regression analyses were performed. Only 24.1% of the women had premarital HIV testing. Approximately 46.5% and 32.3% of women reported that they could refuse sexual intercourse and ask their partner to use a condom, respectively. In the multivariable model, having a premarital HIV test was positively associated with the ability to refuse sex odds ratio (95% confidence interval) 1.82 (1.38, 2.41; p < 0.001) and the ability to ask for a condom 2.30 (1.55, 3.41; p < 0.001). Premarital HIV testing can improve women's sexual negotiation ability and possibly prevent future HIV infection.

Poor HIV-Related Outcomes In Older Adults Newly Diagnosed with HIV: A Four-Year Retrospective Analysis from A Single Site in Asia.

In resources limited settings, HIV-related services are often targeted to younger key populations though increasing reports have found adults ≥50 years now account for among the highest increase in new HIV diagnosis. We assessed the proportion of new HIV infections among older adults (≥50 years) and compared their socio-demographics, risk behaviours and HIV-related outcomes to newly diagnosed younger adults (<50 years). This retrospective analysis included all new HIV diagnosis from 2016-2019 at University of Malaya Medical Centre, Malaysia. Trends of HIV diagnosis was assessed using joinpoint regression analysis and characteristics between the older and younger adults were compared using χ2 test or Mann-Whitney U test. Kaplan-Meier analysis and log-rank test were used to compare the survival probability in both age groups. From a total of 594 new HIV diagnosis between 2016-2019, 11.5% (N=68) were among older adults with an annual percent increase of 5.50%. Older adults were more likely ethnic Indians (p<0.001), acquired HIV via heterosexual contact (p=0.001), had late presentation to care (p=0.003), and multimorbidity (p<0.001). Immunological responses after 12 months on ART were comparable in both groups. Older adults had a higher probability of death compared to younger adults (aHR 1.81, 95% CI 1.02-3.23, p=0.043) after adjusting for sex, mode of HIV transmission, late presentation to care, ART initiation and multimorbidity. Older adults diagnosed with HIV were associated with late care presentation and increased mortality. There is an urgent need to enhance uptake of HIV testing and linkage to care among older individuals in our setting.

Transfusion Transmission of Syphilis and HIV from Earlobe Piercing in Tattoo Clinic – A Case Study from the Coal Capital of India

The practices of body piercing and tattoos have gained popularity, but, they also pose a risk of transmitting diseases. This article details a case of a young male individual who acquired HIV subsequent to undergoing earlobe piercing at a nearby tattoo parlour. A 28-year-old male, who was in good condition overall, received a diagnosis of HIV following testing positive for treponema pallidum hemagglutination assay (TPHA) after frontal palmar rashes. The diagnosis of syphilis and HIV was incongruous with his stated behaviour, and the stated reasons were not acknowledged by the counsellors. The patient was notified about our research emphasis in the Department of Community Medicine and requested our aid in identifying the underlying reason for his HIV and TPHA positive. The patient and his parents had a thorough history assessment, which eliminated all recognised potential modes of HIV transmission. After ruling out all other possible means of transmission, it was determined that the patient’s HIV and TPHA positivity may be attributed to the use of a tattoo gun for earlobe piercing to insert diamond studs at a local tattoo parlour. The widespread establishment of tattoo parlours throughout the nation presents a potential hazard to adolescents, who may acquire HIV without participating in activities associated with the high risk of transmission. Tattoo parlours must provide education to their clients, adhere to strict hygienic and sterile protocols and undergo government inspections to verify compliance with hygiene and sterilisation regulations.

1411. Missed HIV Clinic Visits among Youth Living with HIV in Alabama

Abstract Background Adolescents and young adults with HIV consistently account for about one-fifth of new infections in the United States. YLWH have lower rates of testing, diagnosis, treatment engagement, and viral suppression than adults with HIV. YLWH are particularly challenged with missing medical appointments. Few studies have been published on youth living with HIV (YLWH)’s missed clinic visits and risk factors. Therefore, this study was designed to explore: 1). if the missed visits have significant associations with HIV treatment outcomes (more than 50 counts of CD4 counts drop, viral load increment, and viral suppression) in YLWH; 2). What factors are associated with missed visits for YLWH? 3) Are these factors different from the risk factors of all PLWH? Methods A retrospective study using data records from UAB Family Clinic was designed. The study used the records from March 1st 2020 to August 31st, 2021. Patients aged 16-24 were considered as YLWH. The primary outcomes are missed visits and treatment outcomes. CD4 change, Viral suppression and VL change during the study period were investigated for identifying the association between missed visit and treatment outcome. Age, gender, race, HIV transmission mode, insurance type and the viral suppression in index record were used as factors to predict missed visits. Chi-square test and logistic regression have been conducted in SAS 9.4. Results YLWH with missed visits had more viral load rebound compared to those without missed visits (p=0.04). For YLWH, gender and viral suppression in the index record have significant associations with missed visits (Gender: p=0.03, Viral suppression in index record: p=0.04). In tests among all PLWH, Race (p=0.03), Insurance type (p=0.01) and viral suppression in index record (p=0.001) are associated with missed visits. Table 1.Viral load change by missed visits.Table 2.Risk factors associated with missed visits among YLWH (n=101).Table 3.Risk factors associated with missed visits among PLWY (n=296). Conclusion Missed visits are significantly associated with viral load maintenance, and missed visits have adverse effects on treatment outcomes. Also, the risk factors for YLWH of missed visits are not identical with the risk factors for PLWH from the same cohort. Disclosures All Authors: No reported disclosures.

Real world efficacy of dolutegravir plus lamivudine in people living with HIV with undetectable viral load after previous failures

Dolutegravir (DTG) +lamivudine (3TC) combination has been found to be as effective as triple therapies, and has been extensively prescribed in clinical practice as a maintenance therapy. We aimed to investigate the effect of previous virological failures (VFs) on virological efficacy. The analysis included data of people living with HIV (PLWH) with HIV-RNA ≤50 copies/mL enrolled in an Italian retrospective multicohort study who were switching to DTG+3TC. Primary endpoint was viral rebound (VR; confirmed HIV-RNA ≥50 copies/mL or single HIV-RNA ≥50 copies/mL followed by change of antiretroviral therapies [ART]). Kaplan-Meier curves were used to estimate probabilities of VR based upon histories of previous VFs (single HIV-RNA ≥1000 copies/mL or confirmed HIV-RNA ≥50 copies/mL). A weighted Cox regression model was fitted to estimate the causal hazard ratio (HR) of history of failure on the risk of VR. A total of 966 PLWH were included; 20.1% had a history of previous VF. VR was detected in 23 PLWH. The one-year probability was 1.2% (95% confidence interval [CI], 0.2%-2.2%) in PLWH without previous VF and 3.3% (95% CI, 0.4%-6.2%) in those with ≥1 VF (log-rank P = 0.042). By multivariate analysis adjusted for CD4+ cell count at nadir, duration of virological suppression, and mode of HIV transmission, PLWH with ≥1 previous VF had a higher risk of virological rebound than those without previous VF (adjusted hazard ratio 3.06 [95% CI, 1.00-9.44], P = 0.051). Despite the low absolute one-year risk in both groups, real-world data confirmed that PLWH with a previous failure have an increased risk of viral rebound.

Delayed HIV diagnosis during the COVID-19 pandemic in Poland: A call for targeted HIV testing for those under suspicion of SARS-CoV-2.

The aim of this study was to analyse patients newly diagnosed with HIV who were originally admitted to hospitals with suspicion of COVID-19. This was a retrospective case series undertaken at four sites. Only adults with new HIV diagnosis and COVID-19 exclusion hospitalized in 2020-2021 were included. Demographic, clinical and laboratory data were collected from medical records. Twenty-five patients were included in the analysis: 19 men (76%), 11 of Ukrainian origin (44%). The median age was 38.5 years (range 25-59). The mode of HIV transmission was heterosexual for 11 (44%) patients, eight (32%) were men who have sex with men and three (12%) were people who inject drugs. The median duration of symptoms prior to hospital presentation was 20.6 days (range 3-90). The median number of SARS-CoV-2 tests per patient was 2.62 (range 1-7). All SARS-CoV-2 tests were negative. Screening for HIV was performed on average on the 18th day of hospitalization (range 1-36 days). Twenty-three patients (92%) were late presenters, 22 (88%) had advanced disease, and 19 (76%) were in the AIDS stage. The median CD4 T-cell count was 72 cells/μL (range 3-382). The rate of positive HIV testing at the two sites where it was available for people with suspected COVID-19 was 0.13% (7/5458 during the study period). We strongly recommend introducing the HIV screening test in the diagnostic algorithm for every patient suspected of having COVID-19, presenting with clinical and/or radiological pulmonary symptoms.

A cross-sectional study of demographic and clinical profile of HIV patients at ART center of tertiary care hospital

Background: India has the third largest number of people living with HIV/Acquired immunodeficiency syndrome (AIDS). It is important to understand the presentation of HIV disease in the local context and culture. Aims and Objectives: The present study is aimed at identifying the socio-demographic characteristics, clinical presentations of HIV/ AIDS patients, opportunistic infections (OI), and the possible risk factors for acquiring HIV infection. Materials and Methods: A descriptive cross-sectional study was conducted on HIV patients from September 2021 to December 2021. The HIV-positive patients of all age groups and all categories were included in the study. However, the clinical staging was done according to the World Health Organization (WHO) classification of HIV/AIDS. Data were expressed as mean and percentage proportion with chi square test for measuring statistically significance. Results: Among 140 HIV patients 88 (62.9%) were males. More than half were 101 (72.1%) in the reproductive age group 18–40 years with mean age 35±11.5 years. The commonest mode of HIV transmission was heterosexual 114 (81.4%). Maximum belonged to social Class IV 51 (36.4%) and Class III 47 (33.6%) of socioeconomic status. Fever 92 (65.7%), weight loss 82 (58.7%), and cough 68 (48.6%) were the common presenting. Pulmonary tuberculosis and diarrhea were the most predominant secondary OI accounting for 46 (32.9%) and 35 (25.0%), respectively. More than half 82 (58.6%) of patients were in the WHO clinical Stage II of HIV disease. CD4 counts of the patients were significantly inversely correlated with the number of symptoms and the number of OI. Conclusion: There was a high frequency of behavioral risk factors, together with unawareness among HIV patients, socio- demographic, and clinical profile of study participants reflects an impact of early case detection and timely institution of highly active antiretroviral therapy.

An exploratory transmission mode of HIV/AIDS among older people based on data from multiple sources in China

The HIV/AIDS cases and proportion in older people are continuously and rapidly increasing in China, especially in males. However, the transmission mechanism is not well understood. This study aims to explore the transmission mechanism of HIV/AIDS and potential ways to prevent or control HIV/AIDS transmission in a city in southwestern China. Data from multiple sources, including HIV/AIDS case reports in 2010–2020, a survey of HIV/AIDS cases in 2020, and sentinel surveillance data of female sex workers (FSWs) in 2016–2020 were analyzed. We explored the transmission mechanism of HIV/AIDS cases aged 50 years and older. In this city, the number of newly reported HIV/AIDS cases aged 50 years and older increased from 2010 to 2019, and decreased in 2020. The number of male and female cases aged 50 years and older both increased rapidly in 2017–2019, though the number of male cases was larger than that of female. The survey data showed that 84.7% of older male cases reported commercial sexual behavior, among whom 87.7% reported never using condom and 37.6% reported more than 10 times of commercial sexual behaviors in 1 year. In terms of price of sexual behavior, 68.3% of older male cases sought low-tier FSWs among whom the HIV/AIDS positive rate was 5.4% from the sentinel surveillance data. These results suggested HIV transmission between older men and low-tier FSWs through commercial sexual behavior. Among female cases aged 50 years and older, most reported non-marital and non-commercial heterosexual (60.5%) or regular sexual partner (31.4%) transmission, suggesting that they were infected by their spouse/regular sexual partner. Data of matched couples showed that most male cases had both marital sexual behavior and commercial sexual behavior, or acquired HIV through commercial sexual behavior, while most female cases had only marital sexual behavior. Based on these findings, we proposed a transmission mode of that local older male people and FSWs are transmitting bilaterally through commercial sexual behavior, and local older male people are spreading to local older female people through spouse or regular sexual partner route. By studying data from multiple sources, we explored the HIV transmission mode among older people. In the meantime, we found that marital status had a different impact on male and female old people in their sex behaviors.