Serological Tests For HIV Research Articles

HPV infections among MSM in Shenzhen, China.

BackgroundAn increasing incidence of anal cancer among men, especially men who have sex with men (MSM) suggests a need to better understand anal human papillomavirus (HPV) infection among this group.MethodsA cross-sectional study was conducted among MSM in Shenzhen, China. Blood was collected for HIV serological testing and syphilis serological screening, and anal swabs were collected for HPV genotyping. Difference of HPV prevalence between HIV seropositive and HIV seronegative MSM was assessed by chi-square test. Factors associated with anal canal HPV infection were assessed by univariate and multivariate logistic regression.ResultsA total of 408 MSM were recruited. HIV and HPV prevalence were 6.9% and 36.4%, respectively. HPV was detected in the anal canal in 71.4% of the HIV-positive MSM and in 33.8% of the HIV-negative MSM (P<0.001). Oncogenic types were seen more often in anal specimens of HIV-positive MSM than in specimens of HIV-negative MSM (P = 0.001). The HPV genotypes detected most frequently were HPV06 (8.2%), HPV16 (7.2%), HPV11 (6.4%), HPV18 (4.7%), HPV58 (4.7%), and HPV52 (4.2%).ConclusionsIn this study, HIV positive MSM had a higher burden of HPV infection, especially oncogenic HPV infection. HPV types 52 and 58 were as popular as those types designed for the currently available vaccine (HPV6, 11, 16, 18).

The Kenya AIDS Indicator Survey 2012: rationale, methods, description of participants, and response rates.

Cross-sectional population-based surveys are essential surveillance tools for tracking changes in HIV epidemics. In 2007, Kenya implemented the first AIDS Indicator Survey [Kenya AIDS Indicator Survey (KAIS) 2007)], a nationally representative, population-based survey that collected demographic and behavioral data and blood specimens from individuals aged 15-64 years. Kenya's second AIDS Indicator Survey (KAIS 2012) was conducted to monitor changes in the epidemic, evaluate HIV prevention, care, and treatment initiatives, and plan for an efficient and effective response to the HIV epidemic. KAIS 2012 was a cross-sectional 2-stage cluster sampling design, household-based HIV serologic survey that collected information on households as well as demographic and behavioral data from Kenyans aged 18 months to 64 years. Participants also provided blood samples for HIV serology and other related tests at the National HIV Reference Laboratory. Among 9300 households sampled, 9189 (98.8%) were eligible for the survey. Of the eligible households, 8035 (87.4%) completed household-level questionnaires. Of 16,383 eligible individuals aged 15-64 years and emancipated minors aged less than 15 years in these households, 13,720 (83.7%) completed interviews; 11,626 (84.7%) of the interviewees provided a blood specimen. Of 6302 eligible children aged 18 months to 14 years, 4340 (68.9%) provided a blood specimen. Of the 2094 eligible children aged 10-14 years, 1661 (79.3%) completed interviews. KAIS 2012 provided representative data to inform a strategic response to the HIV epidemic in the country.

Executive Summary of the Consensus Statement on monitoring HIV: Pregnancy, birth, and prevention of mother-to-child transmission

The main objective in the management of HIV-infected pregnant women is prevention of mother-to-child transmission; therefore, it is essential to provide universal antiretroviral treatment, regardless of CD4 count.All pregnant women must receive adequate information and undergo HIV serology testing at the first visit. If the serological status is unknown at the time of delivery, or in the immediate postpartum, HIV serology testing has to be performed as soon as possible.In this document, recommendations are made regarding the health of the mother and from the perspective of minimizing mother-to-child transmission.

Documento de consenso para el seguimiento de la infección por el virus de la inmunodeficiencia humana en relación con la reproducción, el embarazo, el parto y la profilaxis de la transmisión vertical del niño expuesto

ObjectiveThe main objective in the management of HIV-infected pregnant women is prevention of mother-to-child transmission; therefore, it is essential to provide universal antiretroviral treatment, regardless of CD4 count. All pregnant women must receive adequate information and undergo HIV serology testing at the first visit. MethodsWe assembled a panel of experts appointed by the Secretariat of the National AIDS Plan (SPNS) and the other participating Scientific Societies, which included internal medicine physicians with expertise in the field of HIV infection, gynecologists, pediatricians and psychologists. Four panel members acted as coordinators. Scientific information was reviewed in publications and conference reports up to November 2012. In keeping with the criteria of the Infectious Diseases Society of America, 2levels of evidence were applied to support the proposed recommendations: the strength of the recommendation according to expert opinion (A, B, C), and the level of empirical evidence (I, II, III). This approach has already been used in previous documents from SPNS. Results and conclusionsThe aim of this paper was to review current scientific knowledge, and, accordingly, develop a set of recommendations regarding antiretroviral therapy (ART), regarding the health of the mother, and from the perspective of minimizing mother-to-child transmission (MTCT), also taking into account the rest of the health care of pregnant women with HIV infection. We also discuss and evaluate other strategies to reduce the MTCT (elective Cesarean, child's treatment…), and different aspects of the topic (ARV regimens, their toxicity, monitoring during pregnancy and postpartum, etc.).

HIV-negative, HHV-8-unrelated primary effusion lymphoma-like lymphoma with genotypic infidelity and c-MYC expression

Dear Editor, HIVor HHV-8-related primary effusion lymphoma (PEL) is a rare and poor prognostic disease which presents as serous effusion without detectable tumor masses. PEL occasionally has both immunoglobulin (Ig) and T cell receptor (TCR) gene rearrangements, so-called genotypic infidelity [1, 2]. Recently, HIV-negative HHV-8-unrelated primary effusion lymphomalike lymphoma (PEL-LL) has been reported, and some cases are associated with c-MYC amplification. Although HHV-8 virus antigen can increase c-MYC stability in PEL [3], c-MYC expression in PEL-LL has not been confirmed so far. A 76-year-old male had suffered from esophageal cancer, which responded to chemoradiotherapy. Three years after treatment, however, he had experienced cough, general fatigue, and night sweats. Physical examination revealed no breath sounds on the right hemithorax. Chest X-ray showed severe pleural effusion in the right lung (Fig. 1a). However, no tumor mass or lymphadenopathy was detected. Gastrointestinal fiberscope showed no sign of esophageal cancer recurrence. Complete blood count and serum biochemistry studies were as follows: WBC 7,170/μl, hemoglobin 10.6 g/dL, platelet 402,000/μl, AST 20 IU/L, ALT 12 IU/L, LDH 377 IU/L, total bilirubin 0.4 mg/dL, and sIL-2R 525 U/ml. Serological tests for HIV, HTLV-1, and HCV were negative. Bone marrow was intact. In analysis of pleural effusion, there were many large atypical lymphocytes which were positive for CD19, CD20, CD30, CD79a, and Ig lambda light chain but negative for CD10 and CD56 (Fig. 1b). HHV-8 and EBVencoded RNA by immunochemistry were negative. There was a small fraction of normal T cells. Eighty percent of lymphocytes were Ki-67 positive. Southern blot analysis of tumor cells demonstrated Ig heavy chain (IgH) as well as TCR rearrangement (Fig. 1c). Karyotype analysis showed complex karyotype, including add(8)(q24) and c-MYC amplification, and these cells strongly expressed c-MYC protein by immunostaining (Fig.1d). He was diagnosed with PEL-LL and was treated with six courses of R-CHOP. He remains alive and well with slight pleural effusion without additional therapy for more than 18 months. There are only two cases of PEL-LL with both IgH and TCR rearrangements. The first case is a pleural cavity-based T cell-rich B cell lymphoma [4]. Actually, it was reported for this lymphoma to show the dual gene rearrangement [5]. It could be bi-clonal lymphoma, of which the T cell clone was derived from abundant background Tcells. The second case is post-liver transplant effusion lymphoma [6]. It demonstrated incomplete TCR-β rearrangements by PCR; wherein, these rearrangements can be found in some B cell lymphomas [7]. In our case, most cells in the effusion were B cells. In addition, we confirmed both rearrangements by southern blot analysis (Fig. 1c). Therefore, we believe that this is the first definitive case of genotypic infidelity in PEL-LL. In addition, we confirmed strong c-MYC expression on tumor cells along with T. Kashiwagi :K. Minagawa :H. Kawano : T. Hirata : S. Kashiwagi :Y. Nakagawa : S. Kusaka : T. Suzuki : T. Inagaki : M.Kishi :N.Miwa : S. Kimura :M. Takechi :M. Koide :M. Iwai : T. Matsui Department of Internal Medicine, Nishiwaki Municipal Hospital, Nishiwaki, Hyogo 677-0043, Japan

Acquired human immunodeficiency virus/ HIV in the neonatal period

Blocking mother-to-child transmission was one of the greatest victories against HIV infection. A reduction in infection rates down to below 2% was achieved by applying strategies such as the recognition of maternal infection (HIV serological testing or rapid test) during the prenatal period or at delivery, use of antiretrovirals, elective route of delivery according to the patient’s viral load, and replacement of breastfeeding by formula. In Brazil, the recommended regimen includes the use of an anti-retroviral scheme composed of three anti-retroviral drugs from two different class es, from the 14th week of pregnancy (after the first trimester), in all pregnant women infected with HIV regardless of their virological or immunological parameters, use of intravenous zidovudine at the time of delivery, and of zidovudine in all children born to HIV infected mothers during the first four weeks of life. In special situations, adding other antiretrovirals, such as lamivudine and nevirapine, has been suggested. The benefits of maternal use of anti-retroviral drugs to prevent HIV transmission to children are unanimous. The safety of these short-term schemes has already been demonstrated, however, the association between maternal use of antiretrovirals drugs and congenital anomalies, prematurity, mitochondrial toxicity, anemia, neutropenia, and increased liver enzymes have been described. Serious effects rarely occur. Long-term follow-up of all children exposed to antiretroviral drugs is still necessary to answer many existing questions.

Stability of anti-HIV antibodies in serum samples stored for two to eighteen years periods

Introduction: The antibodies have an important role in the serodiagnosis, constituting the most widely used biomarkers to detect and confirm various diseases. Objective: To investigate the reproducibility of anti-human immunodeficiency virus (HIV) antibodies reactivity, to assess the stability of the sera samples stored at -20oC for two to eighteen years. Method: Sera were collected in the period 1988-2004 for routine anti-HIV antibodies diagnostic testing. The remaining samples stored at -20oC, were analyzed in this study. Serum sample stability was assessed by enzyme-linked immunosorbent assay/enzyme immunoassay (ELISA/EIA), indirect immunofluorescence assay (IFA), and Western blot (WB) for detecting anti-HIV antibodies. The previously found results (1988-2004) and those obtained in 2006 were subjected to Kappa index analysis. Result: In the period 1988-to 2004, the degree of concordance of the ELISA/EIA, IFA and WB results were considered, good (k = 0.80), regular (k = 0.35), and good (k = 0.63), respectively. Conclusion: Regarding HIV serologic test, the serum samples were stable for 18 years in ELISA/EIA and for 4 years in IFA technique, however, for the WB methodology it was not possible to determine the time of stability of the anti-HIV antibodies.

Interobserver reproducibility of ThinPrep anal cytology in men who have sex with men

Background Anal cytology is a sensitive and beneficial screening method for detecting anal intraepithelial lesions in high risk populations such as men who have sex with men (MSM) and HIV infected individuals. Methods Two hundred MSM were enrolled between July 2012 and January 2013. Anal specimens were collected for ThinPrep cytology test and HPV DNA test. Consented HIV serology tests were performed. The cytology slides were separately evaluated using the Bethesda 2001 system by two cytopathologists who were blinded to HPV results. Interobserver reproducibility of cytology diagnoses was evaluated by weighted kappa statistics. Consensus diagnoses were given on any disagreement cases. Results The patients’ ages ranged from 18 to 54 years (mean 27.21+SD 7.92). At total of 122 were HIV positive (61.00%), and 49 were HIV negative (24.50%). High risk HPV was detected in 132 out of 197 patients (67.01%). The final cytology diagnoses were as follows: 114 negative (57.00%), 28 ASC-US (14.00%), 56 LSIL (28.00%), 1 ASC-H (0.50%), and 1 HSIL (0.50%). Cytology diagnostic agreement was 95% with weighted kappa value of 0.899 (95%CI=0.862-0.931). Conclusion The interobserver reproducibility of ThinPrep anal cytology was almost perfect in the setting of MSM population. Acknowledgments National Research University Funds, Japan Society for the Promotion of Science Grants, Faculty of Medicine and Research Institute for Health Science-Chiang Mai University

Why people delay seeking care after a positive HIV test: a qualitative study in Burkina

Delayed care-seeking occurs when a person who received a positive HIV serology test result does not immediately seek medical treatment for this HIV infection. It has serious consequences for patient survival. This study aims to analyze the factors leading to delayed care-seeking in this circumstance. Applying a qualitative approach, we conducted individual interviews and focus groups in 9 community-based organizations of people living with HIV and AIDS in Burkina Faso. In total, 112 people including 70 HIV-positive patients, 30 healthcare providers, and 12 people leaving the laboratory after an HIV test, were interviewed. A thematic content analysis identified the factors that delayed care-seeking. Several factors explain the delay in seeking care. The weight of the negative representations of HIV and AIDS, its impact on those diagnosed with them, and fear of stigmatization (especially by family members) are major factors in delayed care. The poor quality of pre- and post-test counseling is another factor. This study also shows that financial barriers remain important in this delay. These findings suggest that earlier HIV care may be possible through efforts to reduce stigma, removal of financial barriers, and improvement of the quality of pre- and post-test counseling in mobile-device strategies and during large-scale testing campaigns.

Seroprevalence of HIV, Hepatitis B Virus, and HCV Among Injection Drug Users in Connecticut: Understanding Infection and Coinfection Risks in a Nonurban Population

We examined HIV, hepatitis B virus (HBV), and HCV seroprevalence in an interim analysis and the potential risk factors associated with these infections among injection drug users (IDUs) residing in nonurban communities of southwestern Connecticut. We recruited and interviewed active adult IDUs about their injection-associated risk and conducted serological tests for HIV, HBV, and HCV. Regression analyses were performed to identify risk factors for infection and coinfection. Among 446 participants, 51.6% carried at least 1 infection, and 16.3% were coinfected. Infection risk was associated with longer duration of injection use, overdose, substance abuse treatment, depression, and involvement with the criminal justice system. Coinfection was associated with longer injection drug use, lower education, overdose, and criminal justice involvement. Multivariate models identified injection drug use duration, substance abuse treatment, and criminal justice involvement as the most significant predictors of infection; injection drug use duration and education were the most significant predictors of coinfection. Suburban IDUs are at significant risk for acquiring single and multiple viral infections. Effective harm reduction strategies are needed to reach users early. There might be roles for interventions in the treatment and justice systems in which IDUs interact.

Automatic oral fluid‐based HIV testing in HIV screening programmes: automatic for the people

UK guidelines recommend routine HIV testing in general clinical settings when the local HIV prevalence is > 0.2%. During pilot programmes evaluating the guidelines, we used laboratory-based testing of oral fluid from patients accepting tests. Samples (n = 3721) were tested manually using the Bio-Rad Genscreen Ultra HIV Ag-Ab test (Bio-Rad Laboratories Ltd, Hemel Hempstead, UK). This was a methodologically robust method, but handling of samples was labour intensive. We performed a validation study to ascertain whether automation of oral fluid HIV testing using the fourth-generation HIV test on the Abbott Architect (Abbott Diagnostics, Maidenhead, UK) platform was possible. Oral fluid was collected from 143 patients (56 known HIV-positive volunteers and 87 others having contemporaneous HIV serological tests) using the Oracol+ device (Malvern Medicals, Worcester, UK). Samples were tested concurrently: manually using the Genscreen Ultra test and automatically on the Abbott Architect. For oral fluid, the level of agreement of results between the platforms was 100%. All results agreed with HIV serology. The use of the Oracol+ device produced high-quality samples. Subsequent field use of the test has shown a specificity of 99.97% after nearly 3000 tests. Laboratory-based HIV testing of oral fluid requires less training of local staff, with fewer demands on clinical time and space than near-patient testing. It is acceptable to patients. The validation exercise and subsequent clinical experience support automation, with test performance preserved. Automation reduces laboratory workload and speeds up the release of results. Automated oral fluid testing is thus a viable option for large-scale HIV screening programmes.

Donor-Derived Infections With Central Nervous System Pathogens After Solid Organ Transplantation

During the past decade, numerous instances have been reportedofdonor-derived infectionamongrecipientsof solidorgan transplants with pathogens associated with central nervous system (CNS) infections.1-7 Many cases have received significant attention both among the transplant community and the laymedia.Notablepathogenshave includedWestNile virus (WNV), Balamuthia mandrillaris, lymphocytic choriomeningitis virus, and rabies virus. In most cases, donorderived infection was suspected only after symptoms developed in recipients and further testing of archived specimens identified a donor source. In some cases, lack of recipient exposure to the pathogenprompted investigation for donor origin of the infection. Recipient outcomes were often poor; in part because even after identification of infection, effective treatment was not available. In this issueof JAMA, Vora andcolleagues8describe a case of donor-derived rabies in a recipient of a kidney transplant. The investigationwas prompted by the death from rabies of a recipient 18 months after transplant in the absence of exposures.Adetailed inquiry ledbyCenters forDiseaseControl and Prevention investigators confirmeddonor origin of the recipient’s infectionwith a raccoon rabies virus. The report contains a number of unexpected clinical features. Despite the immunosuppressed state of all 4 organ recipients, the affected patient remained asymptomatic for 18months after transplantation, and the 3 other patients did not develop rabies. The authors speculate that either a low dose of rabies virus or differential behavioral of the raccoon rabies variant explains these clinical features. Although the epidemiology and pathogenesis considerations are interesting, the most notable aspect of this report surrounds the implications for improving the safety of solid organ transplantation. Combined with previous cases,1-7 this report highlights a pattern of donor-derived infection caused by unidentified (at the time of procurement) donor infection with pathogens associated with CNS infection. Reducing the riskofdonor-derived infection requiresunderstanding thecurrent system of screening potential donors. Policy governing solid organ transplantation is established by the Organ Procurement and Transplantation Network (OPTN). Assessment of deceased donors for the risk of transmissible disease relies on amultipronged approach. The organ procurement organization (OPO)managing the process obtains amedical and social history from individuals familiar with the donor. Information that might reasonably be expected to affect potential recipients (eg, a history of recent intravenous drug usewould increase risk of acute viral hepatitis or human immunodeficiencyvirus [HIV] infection thatmightnotbedetectedon routine serologic donor screening tests) must be communicated to transplant programs.9 Limitations include the availability of friends and family and their familiaritywith thedonor’s exposures and behaviors. In addition, specific laboratory testingmust beperformedonall deceaseddonors. Required tests include serological testing forHIV, hepatitis C virus, hepatitis B virus, syphilis, cytomegalovirus, and Epstein-Barr virus as well as blood and urine cultures. At the time of a potential recipient being offered an organ for transplantation, the accepting transplant center must, in a time-pressured environment, integrate all this information, including the medical urgency of the potential recipient, andmake a decision regarding whether to accept the organs. Accepting centers necessarily rely on the clinical impression of treating physicians. For situations in which an increased riskof transmissible infection is present, specific informed consent must be obtained from the potential recipient.10 As an added safeguard, OPOs are required to report additional information that becomesavailable after transplant (eg, autopsy results) that might affect recipients. Furthermore, transplant centers must report any recipient events suggestive of donor-derived infection, thereby allowing notification of other centers that received organs from the same donor.For example, if a recipientwithnootherknownexposures is newly diagnosedwith hepatitis C after transplantation, the event should be reported to the OPTN. In the case described by Vora and colleagues,8 suspected donor-derived rabieswas reported to theOPTN, allowing rapidnotificationof the transplant centers caring for other recipients andadministrationof postexposure rabiesprophylaxis.AnOPTNcommittee, theDisease Transmission Advisory Committee (DTAC), reviews all such reports anddecideswhether theevent resulted indonorderived disease. Data are aggregated andused to guide policy development and educational efforts within the transplant community. Under the current system, episodes of unexpected donor-derived infection are rare. During 2008-2011, 113 622 patients received solid organ transplants from 57 488 donors.Donor-deriveddisease (infectionandmalignancy)developed in139 recipients (0.1%) resulting in29deaths (0.03%).11 A relevant comparison to make is that, during the same period, 26 852peoplediedwaiting for anorgan transplantation.12 Despite these safeguards, reports of CNS infection transmissionmandate consideration ofwhatmight be done to furRelated article page 398 Opinion

P3.179 Prevalence of HIV and Syphilis and Social Behaviour Characteristics of Native Populations in Three Geographical Areas of Paraguay - 2011

BackgroundThe indigenous population presents cultural, socioeconomic characteristics that increases its vulnerability to sexually transmitted infections, like syphilis and HIV.MethodsCross-sectional descriptive study, with confidential linked serological tests for HIV and Syphilis,...

Individual-level, network-level and city-level factors associated with HIV prevalence among people who inject drugs in eight Russian cities: a cross-sectional study

ObjectivesTo ascertain HIV prevalence among people who inject drug (injection drug users (IDUs)) in the Russian Federation and identify explanations for the disparity in different cities.DesignCross-sectional survey with serological testing...

Case series of syphilis and HIV co-infections

Syphilis and HIV co-infection are indeed dangerous combinations. The present communication describes three different cases of syphilis and HIV co-infection in young men. The first case is a 25-year-old medical graduate with a primary and secondary syphilis lesions at time of presentation. The second case is a 24-year-old government officer with right eye posterior uveitis where the serology tests for syphilis were reactive. His HIV tests were also positive. The final case is a 25-year-old homosexual who was admitted to the medical ward because of Mycobacterium tuberculosis infection. The HIV and syphilis serology tests were noted to be positive.

Impact of HIV/sexually transmitted infection testing on risky sexual behaviors among men who have sex with men in Langfang, China

Background Men who have sex with men (MSM) in China remain at high risk for HIV infection, the proportion of reported HIV/AIDS cases that occurred among MSM rose greatly from 2005 to 2011. HIV testing and counseling is a critical HIV prevention strategy among HIV related high-risk population, including MSM in China. This article aimed to assess the association between receiving HIV testing and high-risk sexual behaviors among MSM in Langfang, Hebei Province, China. Methods Between September and November 2007, 233 MSM were recruited to receive an HIV testing intervention. Face-to-face interviews were conducted before HIV testing and 3 months later HIV-related risk behaviors were assessed. Serological testing for HIV and other sexually transmitted infections (STIs) was performed. Results Of the recruited 233 MSM, 200 completed follow-up. Baseline prevalence was 7.8% for HIV, 21.0% for syphilis, 15.8% for gonorrhea, and 5.0% for chlamydia. Multivariate analysis indicated that inconsistent condom use (OR=7.9, 95% CI: 0.9-66.7, P=0.059) and bleeding during anal sex (OR=5.9, 95% CI: 1.3-26.2, P=0.019) were risk factors for HIV infection, and group sex (OR=6.6, 95% CI: 2.2-19.7, P=0.001) was a risk factor for syphilis infection at baseline. At 3 months follow-up, among STI-positive MSM, self-reported anal sex fell from 73.1% to 38.5% (P&lt;0.001); group sex fell from 19.2% to 5.8% (P&lt;0.001); and bleeding during anal sex fell from 23.1% to 5.8% (P&lt;0.001). Among STI-negative MSM, the frequency of one-night stands fell from 32.5% to 17.2% (P &lt;0.001), and oral sex rose from 57% to 78.5% (P &lt;0.001). STI-positive MSM were less likely to engage in anal sex compared to STI-negative MSM (χ2=5.189, P=0.023). Conclusions HIV testing is an important intervention strategy among MSM. HIV testing services among MSM need to be scaled up, along with comprehensive, tailored interventions including condom promotion and STI treatment.

Burden of Infectious Diseases, Substance Use Disorders, and Mental Illness among Ukrainian Prisoners Transitioning to the Community

BackgroundThe epidemics of incarceration, substance use disorders (SUDs), and infectious diseases are inextricably intertwined, especially in the Former Soviet Union (FSU). Few objective data documenting this relationship regionally are available. We therefore conducted a comprehensive, representative country-wide prison health survey in Ukraine, where one of the world’s most volatile HIV epidemics persists, in order to address HIV prevention and treatment needs.MethodsA nation-wide, multi-site randomly sampled biobehavioral health survey was conducted in four Ukrainian regions in 13 prisons among individuals being released within six months. After consent, participants underwent standardized health assessment surveys and serological testing for HIV, viral hepatitis, and syphilis.ResultsOf the 402 participants (mean age = 31.9 years), 20.1% were female. Prevalence of HIV, HCV, HBV, and syphilis was 19.4% (95% CI = 15.5%–23.3%), 60.2% (95% CI = 55.1%–65.4%), 5.2% (95% CI = 3.3%–7.2%), and 10% (95% CI = 7.4%–13.2%), respectively, with regional differences observed; HIV prevalence in the south was 28.6%. Among the 78 HIV-infected inmates, 50.7% were unaware of their HIV status and 44 (56.4%) had CD4<350 cells/mL, of which only five (11%) antiretroviral-eligible inmates were receiving it. Nearly half of the participants (48.7%) reported pre-incarcertion drug injection, primarily of opioids, yet multiple substance use (31.6%) and alcohol use disorders (56.6%) were common and 40.3% met screening criteria for depression.ConclusionsThis is the only such representative health study of prisoners in the FSU. This study has important implications for regional prevention and treatment because, unlike elsewhere, there is no recent evidence for reduction in HIV incidence and mortality in the region. The prevalence of infectious diseases and SUDs is high among this sample of prisoners transitioning to the community. It is critical to address pre- and post-release prevention and treatment needs with the development of linkage programs for the continuity of care in the community after release.

Water, water, everywhere

In July, 2010, a previously healthy 34-year-old woman presented to us with fatigue and progressive generalised oedema. 3 weeks earlier, she had had faint exanthema on her arms and legs followed by transient swelling of the ankles, knees, and hands. Bilateral oedema of the legs with progression to the trunk and the arms, periorbital oedema, shortness of breath, and weight gain of 10 kg within 1 week led to hospital admission. On examination, her vital signs were normal. Pronounced pitting oedema and pulmonary eff usions without evi dence of congestive heart failure were present. Laboratory analyses showed mild anaemia, raised liver enzymes and hypoproteinaemia with normal albumin. CRP, car diac markers, and urine analysis were also normal. CT of the chest and abdomen showed subcutaneous oedema, bilateral pleural eff usions, ascites, hepatosplenomegaly, and multiple slightly enlarged lymph nodes (fi gure A). Pleural eff usion was a transudate. Echocardiography was normal (LVEF 60–70%, with normal wall motility). Serological tests for HIV, hepatitis viruses, Epstein-Barr virus, and cyto megalovirus were all negative. Hypo thyroidism, Addison’s disease, Still’s disease, and C1-esterase-mediated angio-oedema were excluded by investigations. A bone-marrow biopsy sample showed increased erythropoiesis without giant pronormoblasts. A therapeutic trial with torasemide was not benefi cial. Because of the course of the disease, acute parvovirus B19 infection was suspected and confi rmed by the detection of specifi c IgM antibodies, and a viraemia of 5000 copies per mL (PCR). Our patient recovered slowly without specifi c treatment and was discharged 1 week later. At last follow-up 3 weeks later she was asymptomatic. Parvovirus B19 is a small single-stranded DNA virus. It spreads through respiratory droplets. Infection occurs worldwide throughout the year with high rates of secondary cases among household contacts. Such infection is common in childhood: up to 50% of 15-year-old adolescents have specifi c antibodies and infection continues at a low rate throughout adult life. In children, parvovirus B19 classically causes the so called Lancet 2013; 381: 776

Étiologies des pleurésies purulentes non tuberculeuses chez les patients adultes infectés par le VIH dans un service de pneumologie à Abidjan (Côte d’Ivoire)

To identify the main bacteria that cause thoracic empyema of HIV-infected patients.Retrospective study analyzing the etiology of thoracic empyema in patients admitted to the pneumology clinic of the university hospital center in Abidjan from January 1998 to December 2010. We included all patients with bacteriologically confirmed thoracic empyema and had serological test for HIV. We compared the different pathogens based on HIV status.There were 42 patients of thoracic empyema composed of 24 (63.3%) HIV-infected patients [15 (62.5%) males and nine (37.5%) women] and 18 (36.7%) HIV-negative patients [13 (72.22%) men and five (27.78%) women]. The average age of HIV-infected patients was 41.2 years and 44.8 years for HIV-negative patients. HIV status was known only for 4.76% patients at admission, and most of them had a severe stage of immune suppression, (the average T CD4 cell count was 96/mm(3)). Pleurisy was monomicrobial in 83.33% HIV-infected patients and 94.4% HIV-negative patients. It was polymicrobial in 16.67% immunocompromised patients and 5.56% HIV-negative patient. Gram-negative bacteria were isolated from 58.33% HIV-infected patients. Streptococcus Pneumoniae was observed in 61.11% HIV-negative patients.Gram-negative bacteria are the main causes of thoracic empyema in patients HIV-infected.

HIV prevalence measurement in household surveys

Since the introduction of HIV serological testing in Demographic and Health Surveys (DHS) in 2001, national serosurveys have become the gold standard of HIV prevalence estimation in countries with generalized epidemics [1]. By June 2012, 48 DHS or AIDS Indicator Surveys (AIS) in 33 countries (of which 28 are in Africa, 26 with generalized HIV epidemics) have included HIV serotesting of adult men and women, which is anonymous, informed and voluntary [2,3]. These nationally representative surveys use standardized sampling, questionnaires and testing protocols to produce data that are comparable over time and among countries.