Risk Of Sexual Transmission Research Articles

Rectal Douche as HIV Pre-Exposure Prophylaxis for Receptive Anal Intercourse: An End User Tenofovir Powder Sachet Preparation Feasibility Study (DREAM-04).

Unprotected receptive anal intercourse (RAI) carries the highest sexual HIV transmission risk. The need for diverse pre-exposure prophylaxis (PrEP) options has encouraged the development of on-demand, topical PrEP products for those preferring non-systemic or occasional PrEP. We assessed end-users' proficiency in preparing tenofovir douches from sachets containing two different powder types, lyophilized and spray-dried, and evaluated their experience. Cisgender adult men with a history of RAI-related douching were consented, screened, and randomized 1:1 to the order of the powder type prepared. All participants prepared at least three enema bottles of each powder type. Aliquots from each prepared douche bottle were analyzed for TFV concentration, osmolality, and pH. User experience and likelihood of future product use were assessed by questionnaire. Twenty-one eligible participants were enrolled. Most participants reported both products as easy or very easy to prepare and likely or very likely to be used. Participants preferred the lyophilized product. The lyophilized and spray-dried douche bottles prepared met the osmolality specifications 89% and 61% of the time and TFV content specifications 81% and 29% of the time, respectively. Questionnaires indicated the most common challenges were tearing open the sachets and transferring the spray-dried product. The majority of participants reported the douches were easy to prepare and indicated likely future use. While the lyophilized sachets were prepared sufficiently to establish preparation feasibility, the spray-dried sachets often fell outside specifications. Failure analysis provided insights to guide product modifications to improve the proficiency of douche preparation and future product use.

Specialty Pharmacy Services Compared to Community-Based Pharmacy Services on HIV Viral Load

BackgroundPeople with human immunodeficiency virus (PWH) on antiretroviral therapy (ART) with viral load (VL) suppression eliminate the risk of sexual transmission. Many factors including decreased ART adherence and/or medication access barriers decrease the success of treatment as an HIV prevention strategy. ART access may be enhanced with specialty pharmacy services, but the impact compared to community-based practices is variably reported. ObjectivesCompare the impact of specialty vs community pharmacies on medication adherence via VL assessment. MethodsThis retrospective cohort medical record study investigated whether the use of specialty pharmacies compared to community-based practices significantly improves VL suppression. Patients included were enrolled in the Ryan White HIV/AIDS Program (May 31, 2022-May 30, 2023) at an HIV/Infectious Diseases academic medical center clinic. An undetectable VL was defined as the most recent HIV VL being <50 copies/mL or suppressed as <200 copies/mL. Demographic data collected included age range, race, ethnicity and patient reported gender identity. Pharmacy type was determined via review of prescription refill history linked to the medical record. Results1631 PWH were eligible,179 were excluded and 1452 were included in the analysis. 91.3% were virologically suppressed (N=1326) with an undetectable VL in 83.3% (N=1210). When adjusting for age, self-reported gender identity, race, and ethnicity, PWH using specialty pharmacy services were more likely to have a suppressed (AOR 1.469 95% CI 1.007-2.142) and undetectable VL (AOR 1.396, 95% CI 1.051-1.854), respectively, compared to the use of community-based practices. ConclusionsThe use of specialty compared to community-based pharmacies had a significant, yet modest association with VL suppression in PWH enrolled in Ryan White HIV/AIDS services in this single-academic medical center retrospective analysis. Further studies are needed to determine if mail order services, specifically, without specialty service support, are sufficient for high rates of virologic control.

A protocol for a randomized controlled trial of couples motivational interviewing to reduce drug use and HIV transmission risk among male couples in the US: the Couples Health Project.

To reduce substance use and sexual HIV transmission risk among sexual minority men (SMM) requires the development of interventions tailored for those in relationships. In the past 5 years, there have been considerable advances in the development of motivational nterviewing (MI) with couples. The Couples Health Project (CHP) is the first multi-session risk reduction protocol built on this formative research. The purpose of this study is to evaluate the efficacy of CHP relative to a standard of care control - couples HIV testing and counseling (CHTC). Eligibility includes couples where both partners are aged 18 or older, identify as cisgender male (assigned male sex at birth and identify as male gender), live in the US, and can communicate in English. Additionally, at least one partner has to be aged 18-34, HIV-negative, report recent drug use (excluding cannabis) and report condomless anal sex during the past 30 days. Couples are randomized post-baseline assessment to either CHP or CHTC. Follow-up assessments are completed at 3, 6, and 9-months post-randomization. Findings from this trial will inform the practice of MI with couples. If found efficacious, the CHP intervention would be the first multi-session MI with couples' risk reduction protocol designed for use by substance use treatment or HIV prevention service providers who wish to engage SMM and their relationship partners. 1.0; April 1, 2024. ClinicalTrials.gov Protocol Registration; NCT06307977; completed March 6, 2024; https://register. gov/ .

Association between different levels of suppressed viral load and the risk of sexual transmission of HIV among serodiscordant couples on antiretroviral therapy: a protocol for a two-step systematic review and individual participant data meta-analysis

IntroductionHIV is a major global public health issue. The risk of sexual transmission of HIV in serodiscordant couples when the partner living with HIV maintains a suppressed viral load of...

Can Marburg virus be sexually transmitted?

Marburg virus (MARV) is a highly virulent virus of animal origin and the cause of a lethal infection (known as Marburg virus disease [MVD]) with a case-fatality ratio ranging from 24% to 90%. While the potential nonzoonotic routes of virus spread are plausible, the risk is not yet fully determined. Here, we described the ways by which MARV spreads within the human population focusing mainly on the potential of sexual transmission. In addition, we addressed some measures that should be taken to minimize the risk of sexual spread of the virus and proposed a future research agenda on the risk of sexual transmission. For this perspective, we searched four electronic databases (i.e., PubMed, Scopus, Web of Science, and Google Scholar) and included the most relevant studies published since the first identification of the virus in 1967. We used "Marburg virus," "Marburg virus disease," "Seminal fluid," "Sexually-transmitted virus," "Sexual transmission," and "Emerging infectious disease" as keywords. MARV is transmitted to humans via both direct and indirect contact with infected animals (most importantly bats) and individuals who have recently been diagnosed with or died of the disease. The virus transmission through sexual contact has been previously suspected (exclusively from men to their sexual partners). Studies suggest that this virus persists predominantly in testicular Sertoli cells within seminiferous tubules over a relatively long period and is released through seminal fluid (in some reports >200 days post onset of infection) both could potentially threaten sexual health. In addition to men, women could theoretically, although less probably contribute to the sexual transmission of the disease. MVD, however, rarely, could be passed through sex, and men appear to be the main carriers in this regard. Taking preventive countermeasures and practicing safe sex are recommended to reduce the risk of interhuman transmission.

Optimizing Individual HIV Testing and Counseling for Emerging Adult Sexual Minority Men (Aged 18 to 24) in Relationships: A Pilot Randomized Controlled Trial of Adjunct Communication Components.

The majority of new HIV infections in the US occur among sexual minority men (SMM) with older adolescent and emerging adult SMM at the highest risk. Those in relationships face unique HIV prevention challenges. Existing sexual HIV transmission risk interventions for male couples often encounter implementation challenges and engaging younger SMM early in relationships may be particularly difficult. This pilot randomized controlled trial evaluated the acceptibility and feasibility of We Test HIV testing - a behavioral health intervention tailored for younger SMM in realtionships - and generated preliminary estimates of effect size. The intervention comprises two adjunct moduls - video-based communication skills training as well as communication goal setting and planning - delivered in conjunction with routine HIV testing and counseling in individual or dyadic formats. A sample of 69 SMM aged 17 to 24 were recruited online. Following baseline assessment, youth were randomized to receive either the experimental, We Test, intervention or routine HIV testing (the control condition). Follow-up assessments were completed 3 and 6 months post-baseline. Results suggested the study was feasible and the individually delivered format was acceptible. We Test HIV testing was associated with significant improvements in communication skills. In addition, youth who remained in a relationship experienced an increase in communal coping to reduce HIV infection risk and relationship power. While groups did not differ with respect to condomless anal sex with casual partners, these psycho-social constructs (communication, communal coping with HIV prevention, and relationship power) may serve as mediators of intervention effects on sexual risk reduction in a larger study.

Messaging About HIV Transmission Risk When Viral Load Is Undetectable: Reactions and Perceived Accuracy Among US Sexual Minority Men.

Scientific evidence indicates that HIV viral suppression to an undetectable level eliminates sexual transmission risk ("Undetectable=Untransmittable" or "U=U"). However, U=U messaging has been met with skepticism among sexual minority men (SMM) and others. In this survey-based experiment, we manipulated messaging about HIV risk and examined reactions and perceived message accuracy among US SMM. SMM living with HIV (n = 106) and HIV-negative/status-unknown SMM (n = 351) participated in an online survey (2019-2020). Participants were randomly assigned to 1 of 3 messaging conditions, which varied by level of HIV sexual transmission risk associated with an undetectable viral load (No Risk [U=U]/Low Risk/Control). Participants reported reactions, message accuracy, and reasons for perceiving inaccuracy. We coded open-response data (reactions and reasons) into conceptual categories (eg, "Enthusiasm"). We compared reactions, accuracy ratings, and reasons by condition and serostatus. In the No Risk Condition, common reactions were Enthusiasm (40.0%), Skepticism/Disagreement (20.0%), and Agreement (19.4%), reactions common to comparison conditions. A higher percentage of HIV-negative/status-unknown participants (24.1%) expressed Skepticism/Disagreement in the No Risk Condition compared with other conditions (3.2%-9.7%). Participants living with HIV were more likely than HIV-negative/status-unknown participants to perceive the message as accurate in all conditions. In the No Risk Condition, common reasons for perceiving inaccuracy were Risk Misstated (46.1%), Oversimplified/Caveats Needed (17.1%), and Personal Unfamiliarity/Uncertainty (14.5%), reasons common to comparison conditions. Across conditions, 10.3% of participants attributed message inaccuracy to undetectable being misdefined. Most SMM reacted favorably to U=U messaging. However, many-especially HIV-negative/status-unknown SMM-expressed skepticism. Interventions are needed to enhance U=U understanding and acceptance.

Prevotella timonensis bacteria associated with vaginal dysbiosis enhance HIV-1 susceptibility of vaginal CD4+ T cells.

Dysbiosis of the vaginal microbiome poses a serious risk for sexual HIV-1 transmission. Prevotella spp. are abundant during vaginal dysbiosis and associated with enhanced HIV-1 susceptibility; however, underlying mechanisms remain unclear. Here, we investigated the direct effect of vaginal bacteria on HIV-1 susceptibility of vaginal CD4+ T cells. Notably, pre-exposure to Prevotella timonensis enhanced HIV-1 uptake by vaginal T cells, leading to increased viral fusion and enhanced virus production. Pre-exposure to antiretroviral inhibitors abolished Prevotella timonensis-enhanced infection. Hence, our study shows that the vaginal microbiome directly affects mucosal CD4+ T cell susceptibility, emphasising importance of vaginal dysbiosis diagnosis and treatment.

Prevention and infection control of HIV infection and AIDS

Background: Although the global incidence of human immunodeficiency virus (HIV) has decreased significantly since modern antiretroviral therapy (ART), new HIV infections steadily occur, in the Republic of Korea. Based on the understanding of the risk factors for HIV infection, combined strategic behavioral and biomedical interventions should be implemented to reduce HIV infection. This paper reviews the strategies for the prevention of HIV infection.Current Concepts: While the consistent use of latex condoms is effective for the prevention of HIV transmission, consistent use of condoms is low among sexually active individuals. ART can be initiated, after exposure, to prevent HIV infection (post-exposure prophylaxis) after occupational or sexual exposure, injection drug use, and other nonoccupational exposures to HIV. There is a negligible risk of sexual transmission of HIV when the HIV-infected sexual partner has durably suppressed viral replication with ART. Antiretroviral agents have been shown to be highly effective when administered prophylactically to HIV-uninfected but at-risk individuals (preexposure prophylaxis). A high-risk group, such as men who have sex with men, is required to be included in health insurance care benefits for pre-exposure prophylaxis, in addition to the current partners of HIV-infected individuals, to ensure its efficacy.Discussion and Conclusion: HIV-related deaths are rapidly decreasing, but new HIV infections continue to occur. In an environment where a cure or the development of vaccines is unlikely, a multifaceted and proactive approach is required to minimize new HIV infections.

The effect of demographic stochasticity on Zika virus transmission dynamics: Probability of disease extinction, sensitivity analysis, and mean first passage time.

Viral infections spread by mosquitoes are a growing threat to human health and welfare. Zika virus (ZIKV) is one of them and has become a global worry, particularly for women who are pregnant. To study ZIKV dynamics in the presence of demographic stochasticity, we consider an established ZIKV transmission model that takes into consideration the disease transmission from human to mosquito, mosquito to human, and human to human. In this study, we look at the local stability of the disease-free and endemic equilibriums. By conducting the sensitivity analysis both locally and globally, we assess the effect of the model parameters on the model outcomes. In this work, we use the continuous-time Markov chain (CTMC) process to develop and analyze a stochastic model. The main distinction between deterministic and stochastic models is that, in the absence of any preventive measures such as avoiding travel to infected areas, being careful from mosquito bites, taking precautions to reduce the risk of sexual transmission, and seeking medical care for any acute illness with a rash or fever, the stochastic model shows the possibility of disease extinction in a finite amount of time, unlike the deterministic model shows disease persistence. We found that the numerically estimated disease extinction probability agrees well with the analytical probability obtained from the Galton-Watson branching process approximation. We have discovered that the disease extinction probability is high if the disease emerges from infected mosquitoes rather than infected humans. In the context of the stochastic model, we derive the implicit equation of the mean first passage time, which computes the average amount of time needed for a system to undergo its first state transition.

Results of HDV RNA detection in male seminal fluid and female cervical swab samples using RT-PCR

Mongolia has an extremely high prevalence of hepatitis D virus (HDV), which leads to increased morbidity and mortality from hepatocellular carcinoma (HCC). HDV is the most severe form of chronic viral hepatitis (CVH). A recent study estimated that the prevalence of anti-HDV was 67.5% among hepatitis B surface antigen-positive cases in Mongolia. HDV infection is particularly prevalent in sexually active young people. The virus may be transmitted through sexual intercourse, and it is crucial to confirm this by detecting HDV RNA in semen and cervical swabs of patients with chronic hepatitis delta. This pilot study was conducted with 16 participants, including eight males and eight females. Viral RNA was isolated from the blood, male seminal fluid, and female cervical swab samples of all participants in the study. HDV RNA was quantified using RT-PCR in samples from blood, seminal fluid, and cervical swabs. This study found that the detection rate of HDV RNA differed between male and female samples, with 62.5% of seminal fluid samples in the male cohort being positive compared with 87.5% in the female cohort. The data shows a statistically significant difference between genders for the presence of HDVRNA in seminal fluid and cervical swabs (OR 0.238, 95% CI= 0.02-3.01). A significant correlation was found between blood HDV RNA quantity and HDV RNA presence status in seminal fluid and cervical swab samples, indicating a potential risk of sexual HDV transmission. The R2 values for semen and cervical swab samples were 0.1095 and 0.9755, respectively.

Risk of sexual transmission of HIV in the context of viral load suppression.

In 2018, the Public Health Agency of Canada (PHAC) published a systematic review to calculate the risk of sexual transmission of human immunodeficiency virus (HIV) in the context of antiretroviral therapy (ART). In 2022, PHAC commissioned the Canadian Agency for Drugs and Technologies in Health (CADTH) to conduct a rapid review of evidence published since 2017. We undertook a meta-analysis of relevant studies from these two reviews. Studies from the rapid review that adequately assessed exposure (HIV viral load) and outcome (HIV seroconversion) were included and assessed for risk of bias (RoB) and certainty of evidence. Results were pooled to estimate the risk of HIV transmission per 100 person-years. Three studies from the rapid review were eligible for inclusion and one was excluded after RoB assessment. In the remaining studies examining risk among people living with HIV who take ART and maintain a suppressed viral load (fewer than 200 copies/mL, measured every 4-6 months), no sexual transmissions of HIV were observed. The pooled incidence estimate based on these studies, and one from the 2018 PHAC review, was zero transmissions/100 person-years (95% CI: 0.00-0.10). No studies in the rapid review provided data on the risk of sexual transmission of HIV in situations of varying levels of viral load. This update highlights the consistency of evidence since the 2018 PHAC review. There remains no evidence of HIV transmission to sexual partners when a person living with HIV is on ART and maintains a suppressed viral load.

Impact of SARS-CoV-2 and Other Upper Respiratory Tract Viral Infections on Reproductive Parameters in Young Healthy Men with Mild Symptoms of Disease

Data regarding excretion of SARS-CoV-2 in semen are inconclusive and counseling regarding risk of sexual transmission is still challenging. Our knowledge on the effect of upper respiratory tract infections (URTI) on male reproductive system is also scarce. Apart from negative effect of fever on spermatogenesis virtually no study has been able to compare reproductive parameters in men with COVID-19 or other URTI with predisease data. Eleven men who developed symptoms of URTI during the first and second wave of COVID-19 pandemic and who had preexistent fertility and hormonal data, participated in the study leaving sperm and blood samples. Three additional subjects were recruited among proven SARS-CoV-2 positive male hospital workers (without previous data). SARS-CoV-2 RNA was present in the ejaculate from 2 of 5 (40%) young men with mild COVID-19. In one of them viral particles could be detected in the semen sample 2 weeks after the first sampling. Men with any URTI showed higher LH ( p = 0.02 ), lower sperm concentration ( p = 0.047 ), and free testosterone ( p = 0.008 ) when compared to their samples delivered 10 years earlier. When SARS-CoV-2 positive subjects were compared to subjects with other URTIs, no difference in levels of reproductive parameters or inflammatory markers was seen. In conclusion, SARS-CoV-2 RNA can be present in the ejaculate but does not seem to affect reproductive parameters any more than other viruses. However, mild URTI was shown to affect the sperm concentration, LH, and free testosterone negatively.

The risk of sexual transmission of HIV in individuals with low-level HIV viraemia: a systematic review

The risk of sexual transmission of HIV from individuals with low-level HIV viraemia receiving antiretroviral therapy (ART) has important public health implications, especially in resource-limited settings that use alternatives to plasma-based viral load testing. This Article summarises the evidence related to sexual transmission of HIV at varying HIV viral load levels to inform messaging for people living with HIV, their partners, their health-care providers, and the wider public. We conducted a systematic review and searched PubMed, MEDLINE, Cochrane Central Register of Controlled Trials, Embase, Conference Proceedings Citation Index-Science, and WHO Global Index Medicus, for work published from Jan 1, 2010 to Nov 17, 2022. Studies were included if they pertained to sexual transmission between serodiscordant couples at various levels of viraemia, the science behind undetectable=untransmittable, or the public health impact of low-level viraemia. Studies were excluded if they did not specify viral load thresholds or a definition for low-level viraemia or did not provide quantitative viral load information for transmission outcomes. Reviews, non-research letters, commentaries, and editorials were excluded. Risk of bias was evaluated using the ROBINS-I framework. Data were extracted and summarised with a focus on HIV sexual transmission at varying HIV viral loads. 244 studies were identified and eight were included in the analysis, comprising 7762 serodiscordant couples across 25 countries. The certainty of evidence was moderate; the risk of bias was low. Three studies showed no HIV transmission when the partner living with HIV had a viral load less than 200 copies per mL. Across the remaining four prospective studies, there were 323 transmission events; none were in patients considered stably suppressed on ART. Among all studies there were two cases of transmission when the index patient's (ie, patient with previously diagnosed HIV infection) most recent viral load was less than 1000 copies per mL. However, interpretation of both cases was complicated by long intervals (ie, 50 days and 53 days) between the transmission date and the most recent index viral load result. There is almost zero risk of sexual transmission of HIV with viral loads of less than 1000 copies per mL. These data provide a powerful opportunity to destigmatise HIV and promote adherence to ART through dissemination of this positive public health message. These findings can also promote access to viral load testing in resource-limited settings for all people living with HIV by facilitating uptake of alternative sample types and technologies. Bill & Melinda Gates Foundation.

Substance Use, Sexual Agreements, and Sexual Risk Behaviors Among Adolescent Sexual Minority Males (Aged 13–17) in the United States

PurposeDespite the fact that adolescence represents a distinct developmental period wherein dating and sexual relationships are emergent, much of what is known about substance use, sexual agreements, and sexual risk behaviors among adolescent sexual minority males (ASMM) is extrapolated from research on adults. This study tested associations between substance use and sexual risk behaviors among ASMM and examined whether relationship status and sexual agreements moderated these associations. MethodsCross-sectional online survey data were collected from 2,892 HIV negative ASMM aged 13–17 years between November 2017 and March 2020. All were sexually active with male partners and not on pre-exposure prophylaxis. A multigroup hurdle model predicted the occurrence and frequency of condomless anal sex (CAS) with casual partners. ResultsNon-monogamous ASMM were more likely to use illicit drugs and more likely to have CAS with casual partners compared with single ASMM and those in monogamous relationships. Among ASMM who had CAS at least once, those in relationships (both monogamous and nonmonogamous) had CAS more frequently than single ASMM. Binge drinking (odds ratio (OR) = 1.47, p < .001), cannabis (OR = 1.30, p < .001), and illicit drug use (including prescription drug misuse) (OR = 1.77, p < .001) were associated with the occurrence of CAS with casual partners but only binge drinking (rate ratio (RR) = 1.23, p = .027) and illicit drugs (RR = 1.75, p < .001) were associated with its frequency. DiscussionWhile results aligned with adult studies in many respects, unlike adult sexual minority males, these findings suggest partnered ASMM–particularly those in nonmonogamous relationships–were at highest risk of substance use and associated sexual HIV transmission risk.

Substantial impact of the COVID-19 pandemic on the reported number of diagnosed chronic hepatitis C virus infections in the Netherlands, 2019–2021

BackgroundThe COVID-19 pandemic has widespread consequences for health facilities, social contacts, and health-seeking behaviour, affecting the incidence, diagnosis and reporting of other infectious diseases. We examined trends in reported chronic hepatitis C virus (HCV) infections and associated transmission routes in the Netherlands to identify the potential impact of COVID-19 on access to healthcare (testing) services.MethodsWe analysed notification data of patients with chronic HCV reported to the National Notifiable Disease Surveillance System from January 2019 until December 2021 in the Netherlands. Rates of newly reported chronic cases per 100,000 population with 95% confidence intervals (CI) were calculated, and we compared proportional changes in transmission routes for chronic HCV between 2019, 2020 and 2021.ResultsDuring the study period, a total of 1,521 chronic HCV infections were reported, 72% males, median age 52 years, and an overall rate of 8.8 (95%CI 8.4–9.2) per 100,000 population. We observed an overall decline (-41.9%) in the number of reported chronic HCV in 2020 compared to 2019, with the sharpest decline in men who have sex with men (MSM)-related transmission (-57.9% in 2020, p = 0.005).ConclusionsReported cases of chronic HCV strongly declined during the COVID-19 pandemic when healthcare services were scaled down. Between February and June 2021, reported chronic HCV cases increased again, indicating a recovery of healthcare services. MSM showed the largest decline compared to other groups. Further research is needed to fully understand the impact of access to healthcare, health seeking behaviour, and (sexual) transmission risks of HCV during the COVID-19 pandemic.

Meningococcal Purpura Fulminans After Rectal Sexual Intercourse in Men Having Sex With Men

Abstract Over the past few decades, the incidence of meningococcal disease in the United States has been steadily declining and has reached historic lows. Much of this decrease in numbers of cases is attributed to the effectiveness and acceptance of immunization with conjugate meningococcal vaccines. Although the Advisory Committee on Immunization Practices has expanded its recommendation for vaccination to include all persons older than 2 years with HIV infection, uninfected men who have sex with men (MSM) without other underling conditions have never been singled out for vaccination. However, outbreaks of invasive meningococcal infection in MSM have been reported in recent years, including the largest and most recent one in Florida. The increased rate of urogenital and anorectal colonization with Neisseria meningitidis in MSM and risk of sexual transmission suggests that MSM, regardless of HIV status, should also be vaccinated against meningococcal disease.

Risk of Sexual Transmission of HIV with Antiretroviral Therapy and Variable or Suppressed Viral Load

&#x0D; The absolute risk of HIV transmission through sexual activity, reported as incidence rates of observed seroconversions across person-years of follow-up, ranged widely across the included studies of sex partners living with HIV with variable (or unreported) viral loads.&#x0D; Two studies included sex partners living with HIV with suppressed viral loads of fewer than 200 copies/mL, reporting no phylogenetically linked seroconversions in either study.&#x0D; Most studies in this report included data from heterosexual serodiscordant sex partners and did not report follow-up viral loads of sex partners living with HIV.&#x0D; The included studies incorporated variable methods, investigated a broad variety of populations and exposures, and demonstrated a wide range of methodological strengths and limitations.&#x0D;

Immune activation of vaginal human Langerhans cells increases susceptibility to HIV-1 infection

Vaginal inflammation increases the risk for sexual HIV-1 transmission but underlying mechanisms remain unclear. In this study we assessed the impact of immune activation on HIV-1 susceptibility of primary human vaginal Langerhans cells (LCs). Vaginal LCs isolated from human vaginal tissue expressed a broad range of TLRs and became activated after exposure to both viral and bacterial TLR ligands. HIV-1 replication was restricted in immature vaginal LCs as only low levels of infection could be detected. Notably, activation of immature vaginal LCs by bacterial TLR ligands increased HIV-1 infection, whereas viral TLR ligands were unable to induce HIV-1 replication in vaginal LCs. Furthermore, mature vaginal LCs transmitted HIV-1 to CD4 T cells. This study emphasizes the role for vaginal LCs in protection against mucosal HIV-1 infection, which is abrogated upon activation. Moreover, our data suggest that bacterial STIs can increase the risk of HIV-1 acquisition in women.

U=U, PrEP and the unrealised promise of ending HIV-related stigma.

There is now widespread consensus that by reducing HIV viral load to undetectable levels, HIV treatment also eliminates the risk of HIV sexual transmission. Advocates have hoped that eliminating the risk of HIV will be accompanied by a reduction of HIV-related stigma. These hopes have yet to be realised and people living with HIV continue to report stigma and sexual rejection. The burden of challenging HIV-related stigma has largely fallen on people living with HIV. It is time for those who are HIV-negative to also take on some of the burden in challenging HIV stigma.