Transmission Of Immunodeficiency Virus Research Articles

Community pharmacists, injecting drug misusers and the reduction of HIV transmission

Abstract The role of 268 community pharmacists in reducing human immunodeficiency virus (HIV) transmission by providing advice and injecting equipment to drug addicts was investigated. Postal questionnaires were issued to proprietors or managers of all (362) community pharmacies in two family health services authorities within the North West Thames regional health authority to determine their current activities concerning the reduction of HIV transmission between injecting drug misusers (IDMs). More than half of the pharmacists supplied injecting equipment to IDMs, most frequently as 1ml disposable insulin syringes. Eleven per cent of those pharmacies from which equipment was sold provided disposal facilities. More than half of those without disposal facilities failed to provide information regarding safe disposal when supplying injecting equipment. Virtually all the pharmacists surveyed did not supply accompanying health education literature when they sold injecting equipment

Program and Policy Interventions for Preventing Mother-to-Child Transmission of HIV in New York State

Mother-to-child transmission (MTCT) of human immunodeficiency virus has been virtually eliminated in New York State (NYS) in a relatively short time. The dramatic reduction in MTCT was achieved through a comprehensive public health program that maximized the benefits of advances in both diagnosis and treatment of HIV infection. The multifaceted program encompassed interventions at multiple levels. It mobilized and engaged medical providers, and it changed clinical practice and the health care delivery system in NYS. Specific approaches were developed and modified over time by using data from multiple sources and in response to medical and scientific advances. This article describes factors associated with MTCT in NYS, the framework for program development, the evolution of NYS's public health program to prevent MTCT, remaining issues, and recommendations.

Population Risk of Syringe Reuse: Estimating the Probability of Transmitting Bloodborne Disease

In 2008, the Medical Officer of Health at Alberta Health Services (Edmonton, Canada) was notified that, in some practice settings, a syringe was used to administer medication through the side port of an intravenous circuit and then the syringe, with residual drug, was used to administer medication to other patients in the same manner. This practice has been implicated in several outbreaks of bloodborne infection in hospital and clinic settings. A risk assessment model was developed to predict the risk of a patient contracting a bloodborne viral infection from the practice. The risk of transmission was defined as the product of 5 factors: (1) the population prevalence of a specific bloodborne pathogen, (2) the probability of finding a viral bloodborne pathogen in an intravenous circuit, (3) the rate of syringe reuse, (4) the probability of causing disease given a bloodborne pathogen exposure, and (5) the susceptibility of the exposed person. The risk was modeled first with consistent use of the proximal port of the intravenous circuit. The risk of transmission of hepatitis B virus was approximately 12-53 transmission events per 1,000,000 exposure events for a range of practice probabilities (ie, frequency of the risk practice) from 20% to 80%, respectively. The risk of transmission of hepatitis C virus was approximately 1.0-4.3 transmission events per 1,000,000 exposure events for the same practice probability range, and the risk of transmission of human immunodeficiency virus was approximately 0.03-0.15 transmission events per 1,000,000 exposure events for the same practice probability range. The use of the distal port was associated with a 10-fold decrease in the risk. Practitioners must practice safe, aseptic injection techniques. The model presented here can be used to estimate the risk of disease transmission in situations where reuse has occurred and can serve as a framework for informing public health action.

Mining the Proteome of Haemophilus ducreyi for Identification of Potential Drug Targets

Chancroid is an extremely infectious sexually transmitted disease (STD) caused by the bacterium Haemophilus ducreyi, prevalent in Africa, United States and in some parts of South Asia. Chancroid has been recognized as a cofactor for human immunodeficiency virus (HIV) transmission. So, there is a requirement to develop an efficient drug to combat chancroid, which can also diminish the HIV prevalence in those populations where chancroid is a prime source for HIV infection. The availability of the complete proteome information of H. ducreyi help enabled in silico analysis for identification of potential vaccine candidates and drug targets. Our study revealed 1226 proteins in H. ducreyi to be nonhomologous with human proteome. Screening these proteins using the Database of Essential Genes (DEG) resulted in the identification of 451 essential proteins. Analysis of the identified essential proteins, using the KEGG Automated Annotation Server (KAAS), revealed 40 proteins of H. ducreyi as potential drug targets as they are involved in pathogen specific metabolic pathways. Subcellular localization prediction of these 451 essential proteins revealed that 11 proteins lie on the outer membrane of the pathogen which could be potential vaccine candidates. Functional family prediction for the 50 putative uncharacterized essential proteins of H. ducreyi by SVM-Prot web server revealed that out of 50, 3 proteins as transmembrane proteins, which may be potential drug targets. Identification of potential inhibitors against these targets through virtual screening may consequence in detection of novel lead compounds effective against H. ducreyi to combat chancroid.

Human immunodeficiency virus serodiscordant couples on highly active antiretroviral therapies with undetectable viral load: conception by unprotected sexual intercourse or by assisted reproduction techniques?

Until recently, only assisted reproduction was proposed to serodiscordant couples wishing to conceive. Nevertheless, recent publications have proposed unprotected sexual intercourse, targeting fertile days, for couples where antiretroviral treatment has lowered blood viral load to an undetectable level. Available data and the arguments for and against conception by safe sex versus the use of a strategy of unprotected sexual intercourse targeting fertile days are reviewed and analyzed. Although the rate of transmission of human immunodeficiency virus in serodiscordant couples in precise conditions (such as an undetectable viral load on treatment by highly active antiretroviral therapies and sexual intercourse limited to the fertile days) is very low, not zero, here we stress the various factors which can increase the risk of seroconversion in this particular population. In this context, it seems less cautious to abandon the recommendations of safe sex in serodiscordant couples desiring a child. The recourse to medically assisted procreation is advised, as long as evidence from further studies does not show that unprotected sexual intercourse, targeted to fertile days, does not have unexpected harmful consequences.

Preventing human immunodeficiency virus (HIV) and other sexually transmitted infections and reducing HIV-stigmatizing attitudes in high-risk youth: Evaluation of a comprehensive community-based and peer-facilitated curriculum

Comprehensive prevention programs for youth are needed to reduce transmission of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) and address HIV-stigmatizing attitudes effectively. We evaluated a behavioral risk-reduction curriculum with high-risk youth in the United States. Participants in the five-session course were recruited through a community-based agency in San Diego, California. Participants completed a demographic survey and pre-/post-test. Descriptive statistics and paired t-tests are provided for the 286 youth with complete pre-/post-tests. Participants were 37% Latino, 21% non-Latino white, 17% African American, 25% > one ethnicity/other and mean age 16 years. Pre-/post-self-reports indicated significantly (p≤0.05) increased HIV/STI knowledge; ability to refuse sex without a condom; intention to use a condom with new partner; and decreased stigmatization of HIV-positive people. Significant improvements in knowledge and intention to practice safer sex were noted and HIV-related stigma was significantly decreased, indicating the curriculum's potential with ethnically diverse youth in other regions and global contexts.

Prevalence of Human Immunodeficiency Virus (HIV-1) P24 Antigen Among HIV Antibody - Negative Blood Donors in Kano, Nigeria

We investigated the possible risk of human immunodeficiency virus (HIV) transmission through transfusion of screened HIV-I and II antibody negative blood by evaluating the prevalence of HIV-I P24 antigen in screened bloodunits. A total of 330 consecutive HIV-I antibody negative blood units were tested for HIV-I P24 antigen by direct ELISA. Eleven of 330 (3.3%) tested positive to HIV-1 P24 antigens. Highest prevalence of 2.1% was observed among the 113 donors within the age group of 31 – 40 years. Blood units of all female donors tested negative to HIV-1 P24 antigens. This calls for the need to supplement the HIV antibody testing with antigen test to reduce the risk of viral transmission through blood donated at the window period of HIV infection.

Effect of a Point‐of‐Use Water Treatment and Safe Water Storage Intervention on Diarrhea in Infants of HIV‐Infected Mothers

To reduce mother-to-child transmission of human immunodeficiency virus (HIV) in resource-poor settings, the World Health Organization recommends exclusive breast-feeding for 6 months, followed by rapid weaning if replacement feeding is affordable, feasible, available, safe, and sustainable. In the Kisumu Breastfeeding Study (trial registration: Clinicaltrials.gov identifier NCT00146380), infants of HIV-infected mothers who received antiretroviral therapy experienced high rates of diarrhea at weaning. To address this problem, mothers in the Kisumu Breastfeeding Study were given safe water storage vessels, hygiene education, and bleach for household water treatment. We compared the incidence of diarrhea in infants enrolled before (cohort A) and after (cohort B) implementation of the intervention. Cohort B infants experienced less diarrhea than cohort A infants, before and after weaning (P < .001 and P = .047, respectively); however, during the weaning period, there were no differences in the frequency of diarrhea between cohorts (P = 0.89). Testing of stored water in cohort B homes indicated high adherence (monthly range, 80%-95%) to recommended chlorination practices. Among infants who were weaned early, provision of safe water may be insufficient to prevent weaning-associated diarrhea.

The infant-feeding practices of mothers enrolled in the prevention of mother-to-child transmission of HIV programme at a primary health care clinic in the Mpumalanga province, South Africa

Purpose: To determine whether mothers attending a primary health care (PHC) clinic in the Mpumalanga province, South Africa for post-delivery prevention of mother-to-child transmission (PMTCT) of the Human Immunodeficiency Virus (HIV) follow-up care were adhering to the recommendation of exclusive infant-feeding practices, and to identify possible areas for improvement of the PMTCT of HIV services at the clinic. Setting: A municipal PHC clinic in White River, a semi-urban town in Mpumalanga, South Africa. Design: A cross-sectional descriptive study using a structured infant-feeding questionnaire. Subjects: All mothers attending the clinic for post-delivery PMTCT of HIV follow-up care during a four-month period from 1 November 2007 to Results: A total of 33 mothers with infants attended the clinic during the period. All 33 mothers took part in the questionnaire study. Thirty questionnaires were subsequently found suitable for analysis. The mothers were predominantly rural, with low levels of education and no formal employment. Their ages ranged from 22 to 42 years, with a mean of 30.7 years. Fifteen (50%) of the 30 mothers practised exclusive replacement feeding (ERF), 8 (27%) practised exclusive breast-feeding (EBF), and 7 (23%) practised mixed feeding. Conclusion: More than three-quarters of the mothers practised the recommended exclusive infant-feeding methods for PMTCT of HIV, with ERF as the most popular choice. However, the infant-feeding practices could not be generalised as the attendance of mothers for post-delivery follow-up care at the clinic was very poor during the study period. This poor attendance was attributed to frequent non-availability of free formula milk for the programme. Better quality counselling is needed to further increase the adherence to exclusive infant-feeding practices, and to improve the uptake of post-delivery follow-up care.

The prevalence of the use of ‘dry sex’ traditional medicines, among Zambian women, and the profile of the users

Concern has been voiced about the ‘dry sex’ practice in Southern and Central Africa, and its possible role in the transmission of the Human Immuno-deficiency Virus (HIV). Despite this concern, there has been little information about the practice. Most of the available information has been anecdotal, speculative or inadequate mainly because of cultural reluctance to discuss or investigate personal sexual issues. This article provides information about the prevalence of the practice in Zambia and the profile of its practitioners. A cross-sectional study involving 812 Zambian women was undertaken in Lusaka, the capital city of Zambia. Quantitative and qualitative data was obtained through self-administered questionnaires, interviews, in-depth interviews and focus group discussions. The quantitative data was analysed using SPSS, and the qualitative data was used to complement and clarify the quantitative data. Awareness of the ‘dry sex’ practice was almost universal among Zambian women. About two-thirds had used ‘dry sex’ traditional medicines (DSTM) at some point in their lives, and about half were using them. Those who were most likely to have been using, or to have used DSTM, were those who were older, married, with little or no formal education, mainstream Christians, from the lower socio-economic levels, homemakers, manual workers (p < 0.001), originally from the Eastern province of Zambia (p < 0.002) and those who had spent most of their formative years in rural areas (p < 0.006).The study showed that the knowledge and use of DSTM is widespread among Zambian women, especially among those who were most likely to adhere to traditional views and beliefs about womanhood and marriage, and perhaps those likely to have a poor sense of self-worth or less confidence. In view of the concern about the possible role of ‘dry sex’ in HIV transmission, these findings would be useful in Health education strategies.

Characterization of vaginal transmission of a simian human immunodeficiency virus (SHIV) encoding the reverse transcriptase gene from HIV-1 in Chinese rhesus macaques

Replication competent recombinant simian-human immunodeficiency virus encoding the reverse transcriptase gene (RT SHIV) from HIV-1 was characterized for vaginal transmission in rhesus macaques. RT SHIV was shown to transmit efficiently via the vaginal route in macaques with detectable plasma viremia persisting for a year in some animals. Analyses of virus load in tissues of infected animals revealed accumulation of viral RNA in lymph nodes and spleen with levels correlating with plasma viremia. RT-SHIV was inhibited by dapivirine, nevirapine, efavirenz and tenofovir in vitro, although the effect was less pronounced with tenofovir. Virus isolated from infected animals at early and later time points had limited changes in RT sequences and exhibited similar sensitivity to RT inhibitors as the challenge virus. The vaginal transmission of RT SHIV demonstrated here suggests this virus may possibly be used in the nonhuman primate model for limited evaluation of RT inhibitors applied vaginally.

Reduced rate of adverse reactions to the BCG vaccine in children exposed to the vertical transmission of HIV infection and in HIV-infected children from an endemic setting in Brazil

We report on the adverse reactions to the Bacillus Calmette-Guérin (BCG) vaccine in BCG-vaccinated children. We examined children exposed to the vertical transmission of human immunodeficiency virus (HIV) (n = 141), who participated in a prevention program of vertical transmission, and HIV-infected children (n = 66) in a setting endemic for HIV and tuberculosis (TB) in Brazil from August 2000 to February 2008. No cases of disseminated BCG disease occurred in either group of children. While no cases of regional BCG disease were noted in exposed/uninfected children, the rate of regional BCG disease in HIV-infected children was 4.5% (3/66); the three events occurred in <1-year-old children (3/17; 17.6%). One case was associated with severe immunodepression before highly active antiretroviral therapy (HAART). Two cases were manifestations of immune reconstitution inflammatory syndrome (IRIS). Among the HIV-infected children, the accrued benefits of potentially preventing severe TB outweighed the risks associated with the use of the BCG vaccine.

Backpack Needle Exchange: Background, Design, and Pilot Testing of a Program in Rhode Island

ABSTRACT Many individuals who inject drugs do not access existing needle and syringe exchange programs. The ability to obtain clean needles from needle exchanges is limited by operational difficulties, the hours of operation, the location of the programs, and a lack of transportation. Providing multiple points of access to clean needles, including mobile exchange sites, may be necessary to prevent the transmission of the human immunodeficiency virus and other blood-borne viruses. A novel backpack needle exchange outreach model was implemented in Providence, Rhode Island. Backpack exchange participants completed surveys similar to those done by clients of Providence's storefront needle exchange. Backpack exchangers were significantly more likely to be Hispanic and inject more frequently than those who utilized the fixed site. Backpack exchange is a feasible method for providing needle exchange services and referrals to hard-to-reach injectors.

Low seroprevalence of herpes simplex virus type 2 among pregnant women in Senegal

Herpes simplex virus type 2 (HSV-2) is considered as a major co-factor of both sexual transmission and acquisition of the human immunodeficiency virus (HIV). The HIV epidemic in Senegal is characterized by a remarkable and stable low prevalence. Whether HSV-2 may also constitute a possible co-factor favouring the spreading of HIV epidemic in Senegal is yet unknown. This prompted us to evaluate the HSV-2 seroprevalence in the sentinel population of pregnant women in Senegal. Two hundred and sixty pregnant women attending Roi Baudouin maternity in the capital city Dakar (n = 14; 135) and the antenatal clinic in Kaolack (n = 125), the third city of Senegal, were prospectively recruited between March and August 2003. Fifty-six women (22%) were positive for HSV-2 serology. The prevalence of HSV-2 seropositivity was higher in women living in Dakar (26%) than in those living in Kaolack (16%) (P < 0.01). Only two women from Dakar and two other from Kaolack were found to be HIV-1-infected. Our observations suggest a seemingly low seroprevalence of HSV-2 infection in adult women Senegal, comparable with those usually reported in Western countries. Further, epidemiological surveys are needed to confirm these results in the general population.

Body Image, Body Satisfaction, and Unsafe Anal Intercourse Among Men Who Have Sex With Men

Using survey results from the 1998 Twin Cities Lesbian, Gay, Bisexual, and Transgender (LGBT) Pride Festival (N = 535), we explored associations between body image and unsafe anal intercourse (UAI) among men who have sex with men (MSM), and evaluated whether body satisfaction mediated this association. MSM who reported underweight body image had lower odds than those who reported average weight of UAI (AOR = 0.33; 95% CI = 0.13, 0.85); body satisfaction was not found to mediate this association. 13.3% of men who reported overweight/obese body image had engaged in UAI compared with 21.6% of those who reported average weight and 8.2% of those who reported underweight (p < .05). Compared with MSM in exclusive relationships, MSM in non exclusive relationships had increased odds of UAI (AOR = 5.78; 95% CI = 2.96, 11.29) as did men who were not partnered (AOR = 3.20; 95% CI = 1.72, 5.93). These findings highlight the importance of including body image in sexual behavior models of MSM to better understand body image's role in influencing sexual risk and sexually transmitted infections (STI)/human immunodeficiency virus (HIV) transmission.

212. Specific targeting of uterine proprotein convertase 6 (PC6) facilitates the development of dual function contraception

Proprotein convertase 6 (PC6), is a key player during embryo implantation in humans and mice. We have previously shown that PC6 is essential for decidualisation in the mouse and knockdown of endometrial PC6 leads to implantation failure. The PC family of proteases, including PC6, are necessary for transmission of human immunodeficiency virus (HIV). It has been postulated that inhibition of PC activity could prevent HIV infection. We hypothesise that PC6 is a prospective target for the development of a dual role contraceptive for women to avoid pregnancy and protect from HIV infection. The aim of this study is to evaluate if a PC6 inhibitor that is capable of preventing HIV transmission can block implantation in mice. We used a generic PC peptide substrate to assess the potency of the inhibitor to block PC6 activity in vitro. The substrate releases a fluorochrome when cleaved by PC6; no fluorescent signals were observed in samples when inhibitor concentrations were 10μM or higher. We then gauged inhibitor uptake by the uterus over 24 h in mice by two delivery routes; intrauterine injection (IU) and vaginal delivery (VD) with a neutral gel. Uptake was tracked with a FITC-conjugated inhibitor at 50μM (IU) and 500μM (VD). Strong fluorescent signals were seen at 2, 4, 6 and 24 h at sites of endometrial PC6 activity in the IU and VD groups. Administration of a 50μM dosage (20μl) to the uterine lumen (IU) caused a significant reduction (P = 0.002) in the number of implantation sites compared with controls (saline only) when treated between 2000–2100 on E3.75. The inhibitor's ability to block uterine PC6 activity and implantation via VD was assessed and to date outcomes have suggested that correct timing is crucial to prevent implantation and decidualisation. These outcomes show the potential of the inhibitor to block implantation in mice.

Isolation of a new HIV-2 group in the US

Human immunodeficiency virus type 2 (HIV-2) emerged following cross-species transmission of simian immunodeficiency virus (SIV) from sooty mangabeys to humans several decades ago. The epidemic groups of HIV-2 have been established in the human population for at least 50 years. However, it is likely that new divergent SIVs can infect humans and lead to new outbreaks. We report the isolation of a new strain of HIV-2, HIV2-NWK08F, from an immunodeficient Sierra Leone immigrant. Health care providers in Sierra Leone and elsewhere need to be alerted that a subtype of HIV-2, which is not detected by PCR for epidemic HIV-2 strains, exists and can lead to immunosuppression.

Efforts to Prevent HIV Infection That Target People Living with HIV/AIDS: What Works?

Proven prevention strategies aimed at reducing the frequency of behaviors that increase the risk of human immunodeficiency virus (HIV) transmission and acquisition must be made available to greater numbers of persons with or at high risk for HIV infection. This article outlines programs that have effectively reduced rates of high-risk behavior and HIV transmission and suggests that it may be possible to improve the efficacy of such programs by concurrent implementation of multiple effective interventions.

Developing a neonatal HIV vaccine: insights from macaque models of pediatric HIV/AIDS

This review analyzes recent findings from nonhuman primate models of HIV/AIDS that are most relevant to developing active neonatal vaccine strategies against HIV breast milk transmission. We focus on studies published from 2005 to early 2007 that have characterized simian immunodeficiency virus or simian/human immunodeficiency virus transmission and the efficacy of HIV vaccine strategies in neonatal macaques. Nonhuman primate models of natural HIV breast milk transmission recapitulate many features of infection in human infants; however, the variation in timing and overall low rate of infection in these models precludes their use in conducting vaccine studies. Oral inoculation of infant macaques with defined viral inocula results in reliable transmission and is an efficient model for evaluating neonatal HIV vaccine strategies. All HIV vaccine strategies tested in neonatal macaques are immunogenic, but only a subset of these vaccines confer significant protection against virus acquisition or simian AIDS after oral challenge. Candidate HIV vaccine strategies can elicit virus-specific humoral and cell-mediated immune responses in newborn primates; however, vaccine immunogenicity in infant macaques is not a reliable criterion for predicting a vaccine's efficacy against oral virus challenge exposure.

Regarding “Male and Female Circumcision Associated with Prevalent HIV Infection in Virgins and Adolescents in Kenya, Lesotho, and Tanzania”

Brewer Potterat Roberts and Brody (BPRB) provide the latest in a series of papers encouraging researchers to explore nonsexual routes of human immunodeficiency virus (HIV) transmission in sub-Saharan Africa (SSA). Whereas recent findings demonstrate that circumcision provides a substantial protective effect against contracting HIV BPRB suggest tempering the enthusiasm for any interventions based on these findings until hygienic means to obtaining circumcisions can be guaranteed. They highlight levels of HIV prevalence among self-reported virgins in several SSA countries and assess variation in these countries in light of male and female circumcision practices - which they suggest add to the mounting evidence supporting iatrogenic transmission routes. We agree that medical practitioners should take care in implementing any new strategies (i.e. hygienic circumcision should be the goal not just circumcision). Furthermore we recognize that identifying routes of HIV transmission in SSA is an empiric question demanding rigorous exploration - that transmission routes should not be a foregone conclusion. But in light of our experience collecting data in this context and assessing data quality we contend that the evidence in BPRB calls for an alternate interpretation. (excerpt)