Positive Human Immunodeficiency Virus Test Research Articles

A rare case of trigeminal trophic syndrome with periorbital cellulitis and full-thickness upper eyelid defect in an undiagnosed patient with human immunodeficiency virus: a case report

BackgroundTrigeminal trophic syndrome is a rare cranial and facial condition caused by damage to the central or peripheral branches of the trigeminal nerve. This syndrome consists of a triad of anesthesia, paresthesia, and crescent-shaped facial ulcer involving the ala nasi and sometimes extending to the upper lip. Although previous screening for human immunodeficiency virus in some patients with trigeminal trophic syndrome was negative, we present a unique case of trigeminal trophic syndrome who tested positive for human immunodeficiency virus with eye complications.Case presentationWe present a rare case of trigeminal trophic syndrome in a 44-year-old Black African woman who tested positive for human immunodeficiency virus. She presented with a 6-week history of progressive, persistent, and painless left sided facial and scalp ulcerations that started as small skin erosion. Diagnosis of trigeminal trophic syndrome was made on clinical grounds based on the triad of anesthesia, paresthesia, and unilateral crescent-shaped ulcer in the trigeminal dermatome and her past medical history. The ulcer healed completely after counseling and pharmacological therapy, but she later developed left periorbital cellulitis and left upper eyelid full-thickness defect.ConclusionThis is by far the first documented case of trigeminal trophic syndrome with a positive human immunodeficiency virus test. Testing for human immunodeficiency virus in patients with trigeminal trophic syndrome is necessary as this can help improve clinical management and treatment outcomes. Seeking the services of specialists remotely in resource constraint settings is beneficial for managing complications associated with trigeminal trophic syndrome.

Predictive ability of the health belief model in HIV testing and counselling uptake among youth aged 15–24 in La-Nkwantanang-Madina Municipality, Ghana

BackgroundMajority of new Human Immunodeficiency Virus (HIV)-positive persons in Ghana are aged 15–24. HIV prevalence among persons aged 15–24 years, a proxy for new infections, remained stable at 1.5% for 2017 and 2018, making it a significant public health concern. Yet only 26.4% of females and 8.6% of males aged 15–24 years know their HIV status. This study determined the predictive ability of the Health Belief Model (HBM) in HIV testing and counselling (HTC) uptake among youth (15–24 years) in the La-Nkwantanang Madina Municipality, Ghana.MethodsA cross-sectional design was adopted for the study, using a multistage sampling method to select 415 youth aged 15–24. Data were collected using a structured interviewer-administered questionnaire, and analysed using binomial logistic regression with STATA software version 16.0 at p < 0.05 significance level and at 95% confidence interval.ResultsHTC uptake was 29.2%. Perceived susceptibility, perceived barriers, and perceived self-efficacy predicted HTC uptake. Youths with a high-risk perception for contracting HIV [OR = 3.03; 95% CI = 1.46, 6.30, p = 0.003], who perceived that they can contract HIV if not protected [OR = 3.69; 95% CI = 1.47, 9.22, p = 0.005], and worry about getting HIV [OR = 3.03, 95% CI = 1.61, 5.69, p < 0.001] (perceived susceptibility) were more likely to uptake HTC. Youths who had no trust issues with health workers [OR = 3.53; 95% CI = 1.46, 8.53, p = 0.005] and those who were not afraid of positive HIV test results [OR = 5.29; 95% CI = 2.66, 10.51, p,0.001] (perceived barriers) were more likely to uptake HTC. Youths who had no difficulties in turning up for appointments (perceived self-efficacy) had higher odds of HTC uptake [OR = 11.89, 95% CI = 6.73, 20.98, P < 0.001]. For the modifying factors, being married [OR = 2.96; 95% CI = 1.65–5.33], and having knowledge of HTC [OR = 9.10; 95% CI = 2.16–38.3], significantly influenced HTC uptake.ConclusionHealth promotion interventions to increase HTC uptake should focus on heightening the perception of susceptibility to HIV, reducing the barriers to HTC uptake, and increasing the self-efficacy for HTC uptake. The interventions should also target the significant modifying factors.

Chapitre 3. Inégalités dans le dépistage et la prévention du VIH/SIDA

Despite progress in the detection and treatment of the Human Immunodeficiency Virus (HIV), major challenges remain in developing countries due to insufficient resources and infrastructure. The number of people living with HIV who do not know their serostatus has fallen worldwide. However, a number of existing obstacles stand in the way of better results. The socio-cultural context in Africa hampers knowledge and understanding of the disease, leading to stigmatizing attitudes, reluctance to undergo screening and poor access to treatment.Inequalities also exist within the countries of the North, as in the case of the French West Indies, which benefit from a policy to combat HIV/AIDS, with results that fall short of those in mainland France. For this reason, we have chosen to compare the situation in the West Indies with that in Benin, in the context of African culture.Our analysis takes stock of the issues and prospects linked to the accessibility and use of screening care in sub-Saharan Africa and the French Departments of America (DFA).In both cases, fear of the disease, stigmatization, fear of a positive HIV test result and fear of disclosing the test result limit preventive and treatment actions for an effective fight against HIV.In sub-Saharan Africa, women are more likely to accept a screening test than men. Certain populations, including adolescents and homosexuals, are in a vulnerable position. The comparison reveals similar attitudes and suggests actions or recommendations in both countries that have produced results.Innovative strategies and specific programs must be implemented to turn the tide in the fight against the HIV epidemic.

Pneumocystis jirovecii pneumonia: a case report

Introduction and importancePneumocystis jirovecii (PJP) pneumonia is a serious life-threatening condition in immunocompromised individuals and is often associated with human immunodeficiency virus (HIV) + patients. We describe a case of PJP pneumonia which provided a diagnostic challenge in a patient who presented with no known risk factors leading to a delay in initiation of appropriate antibiotic therapy.Case presentationA 71-year-old previously healthy white/Caucasian male presented with subacute hypoxic respiratory failure due to multifocal pneumonia with diffuse bilateral ground glass opacities with consolidations despite prior treatment with antibiotics and steroids. He was admitted and started on intravenous broad-spectrum antibiotics but continued to deteriorate, eventually requiring intubation and transfer to the ICU. Bronchoscopy revealed PJP and treatment was initiated, but the patient developed refractory shock and multiorgan failure, and ultimately died. It was later discovered that he was HIV-1 positive.Clinical discussionPJP, as a potential cause of his presentation, was not considered given that our patient lacked any overt risk factors for PJP pneumonia. He continued to worsen despite broad spectrum antibiotic therapy and hence bronchoscopy was pursued. His clinical profile, in hindsight, was suspicious for PJP pneumonia and early PJP-directed antibiotic therapy may have prevented a fatal outcome, as in this case. There was an element of cognitive bias across multiple providers which may have contributed to the delay in treatment despite his rapid clinical decline while on conventional pneumonia treatment protocol. His diagnosis was later evident when his BAL-DFA grew PJP in addition to his low levels of CD4 and CD8 cells. He was found to be HIV-1 positive five days after his death; there was a delay in this diagnosis since all positive HIV tests from the hospital are reported as ‘pending’ until the presumptive positive sample goes to the Connecticut Department of Public Health State laboratory for the confirmatory test. PJP-targeted therapies were initiated later in our patient’s hospital course when the infection had progressed to refractory septic shock with multiorgan failure and eventual death.ConclusionPJP pneumonia is a fatal disease if not recognized early in the course of illness, and the patient usually undergoes multiple antibiotic regimens before they are diagnosed and receive appropriate clinical care. The gold standard of diagnostic testing for PJP is by obtaining bronchial washings through a flexible bronchoscopy and the turnaround time for such results may take a few days to result. A significant proportion of patients may not have any overt risk factors of immunosuppression and early empiric treatment for PJP may be clinically appropriate as the delay in diagnosis may be associated with significant morbidity and mortality risk.

Increased PrEP uptake and PrEP-RN coincide with decreased HIV diagnoses in men who have sex with men in Ottawa, Canada.

We sought to evaluate if increased uptake of HIV pre-exposure prophylaxis (PrEP) correlated to population-level changes in human immunodeficiency virus (HIV) epidemiology, in a setting with an integrated PrEP delivery system centred on a public health nurse-led PrEP clinic and referral process. This study was conducted in Ottawa, Canada, where all positive HIV test results are reported to the public health units. Risk factor information is also collected by nurses and subsequently entered into a provincial database. We extracted these data for Ottawa from 2017 to 2021 and restricted our analyses to first-time diagnoses. We identified 154 persons with a new HIV diagnosis. Over this period, the number of new diagnoses among men who have sex with men, the group most targeted for PrEP, decreased by 50%-60%. We did not identify changes in the number of new diagnoses based on race, intravenous drug use or among women. Increasing PrEP uptake in Ottawa in 2017 to 2021 coincided with a significant decrease in new HIV diagnoses among men who have sex with men. PrEP uptake in Ottawa, particularly by those most at risk, is likely supported by an integrated approach via PrEP-RN, a nurse-led public health program where individuals diagnosed with syphilis or rectal gonorrhea or chlamydia receive an automatic offer of PrEP. While these findings cannot causally link PrEP-RN or PrEP with this reduction in new HIV diagnoses, these changes in HIV epidemiology in Ottawa occurred exclusively among the group targeted for PrEP. These data highlight the efficacy and importance of PrEP.

False-positive fourth-generation HIV test result in a woman with Plasmodium malariae malaria.

False positive results on fourth-generation human immunodeficiency virus (HIV) diagnostic tests have previously been reported in infections with Plasmodium falciparum and Plasmodium ovale but not with Plasmodium malariae. We report a false positive fourth-generation HIV test result in a patient with P. malariae infection. The patient's symptoms improved rapidly with antimalarial treatment and the confirmatory and repeated HIV tests were eventually negative. False positive results may add a variety of unnecessary burden. One must be aware of false positive results even with fourth-generation tests in patients with malaria, including P. malariae malaria.

Evaluating the Impact of the COVID-19 Pandemic on Accessing HIV Services in South Africa: A Systematic Review.

Progress has been made towards controlling the Human Immunodeficiency Virus (HIV) epidemic in South Africa. However, the emergence of coronavirus disease 2019 (COVID-19) has disrupted access to health care. This systematic review aims to evaluate the impact of the pandemic on accessing HIV services at a primary health care (PHC) level in South Africa. HIV services that have been significantly impacted are highlighted, and recommendations for future public health emergencies are made. Three databases were searched in January 2022. The studies included were those that reported on HIV services at a PHC level in South Africa. From the searches, 203 papers were identified, of which 34 full texts were screened. Eleven studies met the inclusion criteria and were included in this review. Overall, decreases in HIV testing, positive HIV tests, and initiation of antiretroviral therapy (ART) were reported. Resilience of ART provision was reported, meaning that adherence to treatment was sustained throughout the pandemic. The findings showed that HIV services at private PHC facilities were unaffected, however, an overall decrease in HIV services at public PHC facilities was reported, excluding antenatal care which showed resilience.

Characteristics of Human Immunodeficiency Virus (HIV) Seroconversions in a Large Prospective Implementation Cohort Study of Oral HIV Preexposure Prophylaxis in Men Who Have Sex with Men (EPIC-NSW).

Most human immunodeficiency virus (HIV) seroconversions in people who have initiated preexposure prophylaxis (PrEP) occur in the context of insufficient adherence. We describe participants who seroconverted after being dispensed PrEP in a large PrEP implementation study in Australia. Expanded PrEP Implementation in Communities in New South Wales was an implementation study of daily oral PrEP in individuals aged ≥18 years at high risk for acquiring HIV. HIV seroconversions were defined as a positive HIV test by either antigen, antibody, or detectable HIV viral load after enrollment. Insufficient adherence, measured by dispensing logs or participant self-report, was defined as <4 PrEP doses per week. A total of 9596 participants were enrolled and dispensed PrEP between 1 March 2016 and 30 April 2018; 30 were diagnosed with HIV by 31 March 2019. The median (interquartile range [IQR]) age was 31 (25-38) years, all identified as male, 29 (97%) identified as gay or homosexual, and 20 (69%) lived in a postcode with a low concentration of gay male residents. The median (IQR) days from first PrEP dispensing to diagnosis was 409 (347-656). There was no evidence that participants who seroconverted had been sufficiently adherent to PrEP. Nineteen (63%) participants who seroconverted were diagnosed with chlamydia, gonorrhoea, syphilis, or new hepatitis C infection. One participant had resistance to emtricitabine (M184V mutation) at diagnosis. Participants who seroconverted were insufficiently adherent to PrEP despite being at high risk for acquiring HIV. Understanding the reasons for poor PrEP adherence in individuals who subsequently acquire HIV is critical to improving PrEP effectiveness.

Prevalencija sifilisa i HIV infekcije među muškarcima koji imaju seksualne odnose sa muškarcima testiranim u jednoj nevladinoj organizaciji u Beogradu

Introduction/Aim: In Belgrade, syphilis and human immunodeficiency virus (HIV) infection most often occur among men who have sex with men who are often stigmatized and discriminated and hesitate to come to health institutions for testing for these diseases. The aim of this study was to assess prevalence of syphilis and HIV infection among men who have sex with men who were tested in the "check-point" center of the association "Potent" in Belgrade. Methods: This cross-sectional study included 993 participants tested for HIV and 860 participans tested for syphilis by rapid screening tests HEXAGON SYPHILIS and HEXAGON HIV. The results of rapid HIV tests were confirmed by a positive Western-Blot test at the Infectious Diseases Clinic of the Clinical Center of Serbia, and for syphilis by positive serological tests (VDRL - Venereal Disease Research Laboratory and TPHA - Treponema Pallidum Haemagglutination Assay) at the City Institute for Skin and Venereal Diseases in Belgrade. Proportions, percentages and the ch2 test were used in the statistical analysis of the data. Results: A positive test for HIV was recorded in 11 (1.1%), and a positive test for syphilis in 34 participants (3.9%). The youngest newly diagnosed HIV positive case was 22 years old and the oldest 46 years old, while the youngest case with a positive test for syphilis was 19 years old and the oldest 68. Conclusion: Strategies for testing for syphilis and HIV among men who have sex with men should be diverse, including community testing conducted by non-government organization in cooperation with health facilities.

Guillain-Barr\xe9 syndrome as the first presentation of human immunodeficiency virus infection

AimAntiretroviral therapy (ART) development has reduced the severity of neurological complications of the human immunodeficiency virus (HIV), but they remain prevalent and need prompt recognition. Acute inflammatory demyelinating polyneuropathy (AIDP) is a rare complication of human immunodeficiency virus (HIV) infection that may appear at any stage of the disease. In this case, AIDP represents a late presentation of HIV infection.MethodsDescriptive study. Patient data were collected from their medical records and by health assessment interviews.ResultsWe report a case of a 52-year-old male with acute lower limb weakness. Given the suggestive clinical presentation of AIDP and a positive HIV test, intravenous immunoglobulin (IVIG) was administered along with antiretroviral therapy. Progressive weakness to the upper limbs, autonomic dysfunction, and pain was observed. The second regimen of IVIG plus corticosteroids was administered. Muscle strength improved after three weeks.ConclusionsScreening for HIV in a patient with AIDP may provide a better outcome because of the early start of ART with good central nervous system penetration in HIV-infected patients.

Significant Impact of Coronavirus Disease 2019 (COVID-19) on Human Immunodeficiency Virus (HIV) Care in Hospitals Affecting the First Pillar of the HIV Care Continuum.

During COVID-19 lockdown, the in-hospital number of HIV indicator conditions decreased disproportionally compared to other non-COVID-19 diseases which was accompanied by reduced HIV testing rates, number and proportion of positive HIV tests, and new HIV referrals with more late presentation after lockdown cessation, indicating a significantly impacted HIV care continuum.

Infection prevention and control lapse involving medical equipment reprocessing at a family medicine clinic in Ottawa, Ontario, 2018.

In April 2018, Ottawa Public Health identified a large-scale infection prevention and control (IPAC) lapse spanning 15 years related to inadequate reprocessing of reusable critical medical equipment used in a family medicine clinic. To describe the public health response to, and estimate the risk of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) transmission from, this IPAC lapse. Patients who underwent a procedure of concern (during which reusable equipment may have been used) at this clinic were identified using Ontario Health Insurance Plan data and individually notified. Testing for HBV, HCV and HIV at the Public Health Ontario Laboratory was recommended, and the odds of infection were estimated. Of 4,495 patients possibly exposed to improperly reprocessed equipment, 1,496 (33.3%) underwent testing within six months of notification. The prevalence of HBV, HCV and HIV infection in this group was lower than in the general Canadian population. Among patients first diagnosed with HBV after a procedure of concern, the odds of HBV transmission were not increased when the procedure occurred within seven or 28 days of another patient with a positive HBV test result (OR7 days, age-adjusted=0.59, 95% CI: 0.14-2.51; OR28 days, age-adjusted=1.35, 95% CI: 0.62-2.93). The odds of HCV and HIV transmission could not be estimated because no patient was diagnosed with HCV or HIV after having a procedure of concern within 28 days of another patient with a positive HCV or HIV test result. We found no evidence of HBV, HCV or HIV transmission associated with this IPAC lapse. However, transmission cannot be ruled out conclusively because only a third of possibly exposed patients underwent testing.

Patterns of Sexual Assault victims presenting to the University Teaching Hospital in Lusaka, Zambia: a Cross-Sectional Study

Background: Sexual assault, which encompasses defilement and rape, is a public health and public safety problem with the majority of victims being women and children. The consequences of sexual assault include physical injuries, psychological trauma, depression, suicide or suicide attempt and post-traumatic stress disorder (PTSD) as a long-term consequence. Others are unwanted pregnancies and risk of acquiring sexually transmitted infections including the Human Immunodeficiency Virus (HIV). There is little information about the conditions under which sexual assault occurs. The aim of this study was to determine the patterns of sexual assault victims presenting to the University Teaching Hospital (UTH). Materials and Methods: This was a cross-sectional study that was carried out on sexual assault victims who presented to UTH over a period of four months from December 2013 to April 2014. A total of 160 participants were recruited, 59 from the Gynaecology admission ward (C03) and 101 from the Paediatric Centre of Excellence Child Sexual Assault (PCOE-CSA). Participants were interviewed using an interviewer-administered questionnaire while some data was extracted from victims’ files including documented HIV status. Frequency tables were constructed and characteristics of sexual assault were compared between victims aged below 16 years and those aged 16 years and above. Data analysis was done using SPSS version 20. Results: The age of 160 victims ranged from 2 to 34 years and the most affected age group was 11-15 years (n=91; 56.9%). Victims were mostly single (n=149; 93.1%), had attained primary education or none (n=102; 63.8%) were unemployed (n=149; 93.1%) and resided in high-density areas (n=144; 90%). Only 7.5% (n=12) of victims tested HIV positive. A positive HIV test occurred 14 times more frequently in victims aged 16 years and above (OR = 14.32, CI = 2.35 – 87.22, P-value &lt; 0.01). Majority of the incidents took place in residential homes (n=110; 68.8%) and these were significantly less common among victims aged 16 years and above (OR = 0.33, CI = 0.11 – 0.98, P-value = 0.05). The majority of perpetrators were known to the victims (n= 119; 74.4%). Sexual assault perpetrated by strangers affected victims aged 16 years and above more than those aged below 16 years (50.0% versus 17.5%; P &lt;0.01). About half of victims (n=84; 52.5%) reported to UTH within 72 hours of assault and these were 4.5 times more likely to be aged 16 years and above (OR = 4.53, CI = 1.23 - 16.73, P-value = 0.02). Genital injuries were present in 70% of victims. The absence of genital injuries was 8 times more in victims aged 16 years and above (OR = 8.46, CI = 2.78 – 25.77, P-value &lt;0.01). Conclusion: The majority of sexual assault victims were younger (&lt;16 years). Younger victims were mostly assaulted by perpetrators known to them, mainly in residential homes while older victims were mostly assaulted by strangers in isolated places. Compared to older victims, younger victims presented more to UTH later than 72 hours the following the assault and sustained genital injuries more. Patters of sexual assault are therefore different in younger victims compared to adults.

Human immunodeficiency virus testing and psychosocial outcomes: a scoping review protocol.

The proposed scoping review will identify psychosocial outcomes immediately following human immunodeficiency virus (HIV) testing and their measurements, specifically among individuals with a new negative or positive test result. No systematic study has described psychosocial outcomes and their measurements in persons immediately following HIV testing. Also, to our knowledge, there is no consensus on a core set of psychosocial outcomes and measurements following HIV diagnosis, which are essential for quality improvement. All study designs will be considered. Participants with a new positive or negative HIV test result, regardless of sex or age, in any setting will be included. Any measured beneficial or harmful outcomes in the mental and social domains following a new diagnosis will be included. Psychosocial outcomes of participants undergoing treatment and care will be excluded. The databases Ovid MEDLINE, Embase and PsycINFO will be searched, and published articles in English from 2007 to the present date will be included. The methods for scoping reviews outlined by the Joanna Briggs Institute will be followed. Data will be extracted from included studies by two reviewers. Any disagreements between the two reviewers will be solved through discussion in a team of five members. To define the specific concepts or outcome (sub)-domains and their measurements, the models proposed by the Outcome Measures in Rheumatology initiative and the Core Outcome Measures in Effectiveness Trials initiative, respectively, will be used. To analyze the data, this study will rely on a multi-level social-ecological model.

Implementation of a Collaborative HIV and Hepatitis C Screening Program in Appalachian Urgent Care Settings.

IntroductionWith the current hepatitis C (HCV) epidemic in the Appalachian region and the risk of human immunodeficiency virus (HIV) co-infection, there is a need for increased secondary prevention efforts. The purpose of this study was to implement routine HIV and HCV screenings in the urgent care setting through the use of an electronic medical record (EMR) to increase a provider’s likelihood of testing eligible patients.MethodsFrom June 2017 through May 2018, EMR-based HIV and HCV screenings were implemented in three emergency department-affiliated urgent care settings: a local urgent care walk-in clinic; a university-based student health services center; and an urgent care setting located within a multi-specialty clinic. EMR best practice alerts (BPA) were developed based on Centers for Disease Control and Prevention (CDC) guidelines and populated on registered patients who qualified to receive HIV and/or HCV testing. Patients were excluded from the study if they chose to opt out from testing or the provider deemed it clinically inappropriate. Upon notification of a positive HIV and/or HCV test result through the EMR, patient navigators (PNs) were responsible for linking patients to their first medical appointment.ResultsFrom June 2017 through May 2018, 48,531 patients presented to the three urgent care clinics. Out of 27,230 eligible patients, 1,972 patients (7.2%) agreed to be screened for HIV; for HCV, out of 6,509 eligible patients, 1,895 (29.1%) agreed to be screened. Thirty-one patients (1.6%) screened antibody-positive for HCV, with three being ribonucleic acid confirmed positives. No patients in either setting were confirmed positive for HIV; however, two initially screened HIV-positive. PNs were able to link 17 HCV antibody-positive patients (55%) to their first appointment, with the remainder having a scheduled future appointment.ConclusionIntroducing an EMR-based screening program is an effective method to identify and screen eligible patients for HIV and HCV in Appalachian urgent care settings where universal screenings are not routinely implemented.

New Human Immunodeficiency Virus Diagnoses Among Men Who Have Sex With Men Attending Sexually Transmitted Disease Clinics, STD Surveillance Network, January 2010 to June 2013.

Retrospective analysis using 2010 to 2013 data from the STD Surveillance Network (SSuN), a sentinel surveillance system comprised of health departments in 12 cities conducting sentinel surveillance in 40 STD clinics. We analyzed data from all MSM repeatedly (≥2 times) tested for HIV, with an initial negative HIV test required for staggered cohort entry. Follow-up time was accrued from the date of the first negative HIV test to the most recent negative test or the first positive HIV test. The STD diagnoses during the follow-up period were reviewed. We estimated HIV diagnoses rates (number of HIV diagnoses/total number of person-years [PY] at risk) by demographic and clinical characteristics with 95% confidence intervals (CI) using an inverse variance weighted random effects model, adjusting for heterogeneity between SSuN jurisdictions. Overall, 640 HIV diagnoses occurred among 14,824 individuals and 20,951.6 PY of observation, for an adjusted incidence of HIV diagnosis of 3.0 per 100 PY (95% CI, 2.6-3.4). Rates varied across race/ethnicity groups with the highest rate among Blacks (4.7/100 PY; 95% CI, 4.1-5.3) followed by Hispanics, whites, and persons of other races/ethnicities. Men who have sex with men having a diagnosis of primary or secondary (P&S) syphilis on or after the first negative HIV test had a higher new HIV diagnosis rate (7.2/100 PY; 95% CI, 5.8-9.0) compared with MSM who did not have a P&S syphilis diagnosis (2.8/100 PY; 95% CI, 2.6-3.1). Men who have sex with men who tested positive for rectal gonorrhea (6.3/100 PY; 95% CI, 5.7-6.9) or rectal chlamydia (5.6/100 PY; 95% CI, 4.6-6.6) had higher rates of new HIV diagnosis when compared to those with negative test results. Men who have sex with men attending SSuN STD clinics have high rates of new HIV diagnoses, particularly those with a previous diagnosis of P&S syphilis, rectal chlamydia, and/or gonorrhea. Sexually transmitted disease clinics continue to be important clinical setting for diagnosing HIV among MSM populations.

Population HIV transmission risk for serodiscordant couples in Guangxi, Southern China: A cohort study.

We evaluated the risk of human immunodeficiency virus (HIV) transmission among serodiscordant couples with low adherence to antiretroviral therapy (ART).Data of heterosexual couples/partners in 2010 were extracted from an Internet-based system. Participants were then followed over the course of a year with 6- and 12-month assessments. Prevalence and density of HIV seroconversion were calculated for spouses/partners who did not have a positive HIV test results at baseline. We calculated the transmission odds ratio (OR) value stratified by personal characteristics and behavioral correlates at 6- and 12-month follow-up, as well as seroconversion in spouses/partners over the year.A total of 5544 HIV/AIDS patients and their spouses/partners were recruited in this cohort. Incidence of HIV seroconversion among HIV-negative spouse/partner was 63.7/100 person years (PYs) (430/674.9) at the 6-month follow-up and 33.2/100PYs (567/1707.1PYs) at 12 months. The OR value of transmission from female to male was 2.1 times higher than from male to females at 6 months and 2.3 times higher at 12 months (P < .001). The 55- to 64-year age group was most likely to transmit HIV to their spouses/partners, 2.2 times greater than the participants who were 65 years and older. Married participants were 2.4 times higher at 6 months and 2.5 times higher at 12 months to transmit HIV than divorced/widowed participants. Lastly, transmission among illiterate participants was 6.7 times higher at 6 months and 2.3 times higher at 12 months than those with an educational attainment of community college or above.High HIV seroconversion was observed in this cohort. Spouses/partners who were male had the highest risk of HIV acquisition; those aged 55 to 64 years, having married status, and are HIV-positive with less education were more likely to transmit HIV.

Semen residual viral load and reproductive outcomes in HIV-infected men undergoing ICSI after extended semen preparation

The aim of this study was to evaluate the residual presence of the human immunodeficiency virus (HIV) following a triple gradient extended semen wash from ejaculates of serodiscordant couples, and analyse their reproductive outcomes after intracytoplasmic sperm injection (ICSI). For this purpose, a retrospective analysis of our database was performed in serodiscordant couples, with HIV-infected men and non-infected women, using fresh or frozen sperm with ICSI in oocytes from either the patients or donors from January 2006 to September 2013. Overall, the rate of positive HIV test after semen washing was 1.86%. The positive beta human chorionic gonadotrophin, clinical and ongoing pregnancy rates in patients with their own oocytes were 47.1%, 37.5% and 30.8%, respectively, and 58.6%, 50.8% and 39.1%, respectively, in oocyte donation cycles. To summarize, the described method of sperm washing based on triple gradient sperm selection coupled with extensive centrifugations is a highly reliable technique for HIV removal, as it provides lower than reported post-wash positive tests while maintaining high pregnancy rates in assisted reproduction cycles. Despite extensive personnel training and effectiveness of the washing protocol, post-wash HIV test on semen is recommended to identify residual positive samples.

Occupational HIV Transmission Among Male Adult Film Performers - Multiple States, 2014.

In 2014, the California Department of Public Health was notified by a local health department of a diagnosis of acute human immunodeficiency virus (HIV) infection* and rectal gonorrhea in a male adult film industry performer, aged 25 years (patient A). Patient A had a 6-day history of rash, fever, and sore throat suggestive of acute retroviral syndrome at the time of examination. He was informed of his positive HIV and gonorrhea test results 6 days after his examination. Patient A had a negative HIV-1 RNA qualitative nucleic acid amplification test (NAAT)(†) 10 days before symptom onset. This investigation found that during the 22 days between the negative NAAT and being informed of his positive HIV test results, two different production companies directed patient A to have condomless sex with a total of 12 male performers. Patient A also provided contact information for five male non-work-related sexual partners during the month before and after his symptom onset. Patient A had additional partners during this time period for which no locating information was provided. Neither patient A nor any of his interviewed sexual partners reported taking HIV preexposure prophylaxis (PrEP). Contact tracing and phylogenetic analysis of HIV sequences amplified from pretreatment plasma revealed that a non-work-related partner likely infected patient A, and that patient A likely subsequently infected both a coworker during the second film production and a non-work-related partner during the interval between his negative test and receipt of his positive HIV results. Adult film performers and production companies, medical providers, and all persons at risk for HIV should be aware that testing alone is not sufficient to prevent HIV transmission. Condom use provides additional protection from HIV and sexually transmitted infections (STIs). Performers and all persons at risk for HIV infection in their professional and personal lives should discuss the use of PrEP with their medical providers.

Twenty Years of Improved Perinatal Outcomes for Pregnancies Affected by HIV Infection

Background: Highly active antiretroviral therapy has emerged as an essential treatment component to prevent vertical transmission of Human Immunodeficiency Virus (HIV). Yet there often remain missed opportunities to prevent vertical HIV transmission. We present a case that illustrates obstetric management and outcome for involving 2 generations of congenital HIV transmission. Presentation of the Case: Patient is a 19-year-old primigravida with congenital HIV presented to Lincoln Medical and Mental Health Center’s for her initial prenatal care at 36 weeks of gestation. Upon documentation of a high viral load, the patient was given intravenous Azidothymidine and scheduled for Caesarean delivery. AZT and lamivudine were recommended and prescribed for the neonate who tested positive HIV test for which AZT and lamivudine were recommended and prescribed, but the mother discontinued AZT after discharge from the hospital. At 1 month of age the infant succumbed to sudden infant death syndrome (SIDS). During the 2nd pregnancy the patient received adequate prenatal care as well as antiretroviral therapy, Truvada, Abacavir, Mepron, and Kaletra throughout the antenatal course. After preoperative intravenous AZT, via a repeat cesarean the patient delivered a neonate whose HIV test was negative. The patient’s 2nd child had an uncomplicated neonatal course and was negative for HIV on 3 subsequent tests and remained HIV negative until this date. Antiretroviral were removed and the child has remained HIV negative. The mother died from pneumonia and respiratory failure secondary to HIV 2 years after the 2nd delivery. Conclusion: This case serves as a reminder of the importance of adhering to current clinical standards for the care of pregnancies affected by HIV infection.