Trends In HIV Infection Research Articles

HIV infection status and characteristics of non-remunerated blood donors in Hangzhou, 2008-2017

Objective: To understand HIV infection status and characteristics of non-remunerated blood donors in Hangzhou. Methods: HIV antibody test were conducted for non-remunerated blood donors in Hangzhou and their demographic and epidemiological information were collected from 2008-2017. χ(2) test for trend (liner by liner association chi square test) was used for the comparison of the HIV infection trends in each year. Results: A total of 1 461 129 non-remunerated blood donors were surveyed in Hangzhou during 2008-2017, and 260 blood donors were HIV positive. Most HIV infected blood donors were males (96.5%, 251/260) and aged 18-34 years (72.7%, 189/260). Among 260 HIV positive blood donors, those reporting repeated non-remunerated blood donation accounted for 36.9% (96/260), those reporting homosexual transmission accounted for 53.5% (139/260) and those reporting heterosexual transmission accounted for 44.6% (116/260). The HIV infected persons reporting homosexual behaviors were mainly aged 18-34 years (82.0%, 114/139) and unmarried (71.2%, 99/139). Most HIV infected students reported homosexual transmission (88.4%, 23/26). The crude HIV positive rate was 0.8/10 000-2.5/10 000, the differences in annual HIV positive rate had no significance (trend χ(2)=2.355, P=0.125). The crude HIV positive rate in male blood donors aged 18-24 years increased from 1.1/10 000 in 2008 to 3.7/10 000 in 2017, the difference was significant (trend χ(2)=5.175, P=0.023). Standardized HIV positive rate was 0.9/10 000-2.4/10 000. Conclusions: HIV infection rate was low in non-remunerated blood donors in Hangzhou during 2008-2017. Most HIV infected persons were males and aged 18-34 years. Heterosexual and homosexual contacts were the major transmission routes. The HIV positive rate in males aged 18-24 years showed an increase trend.

Tracking HIV infection and networks of drugs users in China: a national series, cross-sectional study

BackgroundWHO reported that HIV infection transmitted through injection drug use has declined; however, some studies have indicated that HIV infection is still high in this population in many countries and these changes are uncertain. We therefore aimed to evaluate the prevalence and trend of HIV infection in opioid and synthetic users in China. MethodsWe analysed the Drug User Surveillance Database of 3·3 million drug users reported nationwide in China between Jan 1, 2008, and Aug 1, 2016. We included 368 354 individuals who tested for HIV infection for the first time and persistently used opioid or synthetic drugs in our analysis of prevalence and trend of HIV infection. We grouped all participants into three groups according to their HIV status and positions in social networks: individual users (2·6 million users), HIV clustered network (8175 users), and non-HIV network (0·6 million users). The networks were tied by peer relationships, which was defined as both drug users who were reported at the same time, same location, and one of them nominated another user. Relationship of information was extracted from users' text document record, using breadth first search algorithm and the keywords matching method. The study was approved by Peking University Institutional Review Board. FindingsThe prevalence of HIV infection was estimated at 3·1% (7236 of 232 415) in opioid users, which was about six times more than in synthetic users (598 [0·4%] of 135 939; adjusted odds ratio [ORadj] 5·90, 95% CI 5·37–6·47), but reduced to 2·5 times in injection drug users (2·49, 1·28–4·85). From 2008 to 2015, the prevalence in opioid users presented a U-shaped trend, declining from 3·8% (691 of 18 336) in 2008 to 2·3% (745 of 31 980) in 2010 (ORadj 0·59, 95% CI 0·53–0·65) and increasing by 4·2% (1074 of 25 622) in 2015 (1·47, 1·33–1·62), while it maintained a stable increase in synthetic users from 0·2% (12 of 5047) in 2009 to 0·6% (234 of 40 336) in 2015 (ORadj 3·27, 95% CI 1·72–6·21). A total of 226 357 networks were mapped and 1401 networks were identified as HIV clustered networks, which covered 1962 HIV infections. The prevalence of HIV infection in HIV clustered network was 53·4% (1962 of 3675), which was about 25 times (ORadj 25·69, 95% CI 24·75–26·66) more than 2·1% (7990 of 384 430) in individual users. 75·8% (4324 of 5708) of users in the HIV clustered network were exposed to injection drug use compared with 15·2% (39 158 of 257 126) in the non-HIV cluster network and 26·9% (271 241 of 1 008 561) in individual users. InterpretationHIV infection in opioid users decreased from 2008–10 but subsequently increased from 2010–15, whereas HIV infection keeps increasing stably in synthetic users. Injection drug use in the HIV cluster network is still a high-risk factor and the effect of current strategies on HIV control in drug users, such as the needle and syringe programmes, need to be further estimated. FundingThis study was supported by the National Natural Science Foundation of China (grant number 91546203) and the Chinese Ministry of Public Security (0716-1541GA590508).

Modelling the Trend of HIV Transmission and Treatment in Kenya

HIV infection remains a major contributor to disease burden and a global leading cause of death. Although progress is being made to control HIV infections, Kenya still remains one of the high HIV burden countries in Sub-Sahara Africa. A deterministic model was proposed to describe the trend of HIV infection in Kenya and suggest some control strategies. The basic reproduction number, $$\mathcal {R}_0$$ , is derived and global asymptotic stability analysis of the disease-free equilibrium carried out. We proved that HIV infections will be contained if the reproduction number is kept below one. Routine data from national survey is used to assess the variation of the new HIV infections in Kenya. Based on this data, least squares method was used to estimate the unknown parameters. The HIV incidence shows of an infection at an endemic state implying of ceaseless problem. Furthermore, improvement in immunological status of the HIV patients on ART due to attrition, may lead to decline in HIV infection and be beneficial to the disease control. The findings suggested that treatment with ART greatly aids the decline in HIV infections hence strengthening its intensity will effectively contribute to the disease control.

Trends in HIV prevalence among people injecting drugs, men having sex with men, and female sex workers in Ukraine.

Once recognized as the most severe in Europe, the HIV epidemic in Ukraine is concentrated among people who inject drugs, men who have sex with men, and female sex workers. Integrated biobehavioral surveys, as a part of the second generation surveillance, are used to monitor HIV infection trends in key populations since 2002. The present paper is focused on the analysis of HIV prevalence trends in four nationally representative rounds of integrated biobehavioral surveys from 2008/9, 2011, 2013, and 2015 in people who inject drugs, men who have sex with men, and female sex workers. Between 2008/9 and 2015, the HIV prevalence has decreased significantly in people who inject drugs (24.2 to 22.0%) and female sex workers (13.6 to 6.3%), while the change in men who have sex with men was not significant (8.5 to 7.8%). There was a significant increase in people who inject drugs and men who have sex with men between 2013 and 2015. In subgroups younger than 25 years, prevalence increased more than twofold in men who have sex with men (1.9 to 4.3%), with no changes in people who inject drugs and female sex workers. The observed decline in prevalence, especially in young subgroups, may result from the effect of extensive prevention efforts on drug injection-related transmission. Recent increase in young men who have sex with men may be a sign of a new wave of the epidemic in this group.

Trend of HIV/AIDS for the last 26\xa0years and predicting achievement of the 90\u201390-90 HIV prevention targets by 2020 in Ethiopia: a time series analysis

BackgroundHIV infection continues to be epidemic of public health importance with a prevalence of 1.1% and incidence of 0.33/1000 population having low-intensity mixed epidemic. Ethiopia has adopted the 90–90-90 by 2020 target but its progress was not yet assessed. Therefore, this study aimed to assess the trend of HIV infection for the last 26 years and to predict the achievements of the 90–90-90 target.MethodsWe used aggregates of HIV/AIDS indicator data from 1990 to 2016 of UNAIDS data bases. The data were analyzed with excel and STATA. The trend line that best fits the regression was drawn, annual change was estimated and future values of HIV detection rate, coverage of antiretroviral therapy and viral suppression indicators were predicted and compared with the 90–90-90 targets.ResultSince 1995, new infection has declined by 81% and since 2002; number of HIV cases has declined by 35.5%. However, after remarkable decline for decades, since 2008 HIV incidence rate began to rise by 10% and number of new infection diagnosed each year increased by 36% among all ages and doubled among adults. ART coverage has increased by 90% among all age and tripled among pregnant women within 6 years. Nationally, 67% of people living with HIV know their status, 88% of them are on treatment and 86% of people on treatment have viral suppression. As a result, AIDS-related death declined by 77 and 79% among all age and children respectively. By 2020, 79% of people living with HIV will know their HIV status, of which 96–99% of HIV infected people will be on ART and more than 86% will have viral suppression.ConclusionAfter remarkable decline, HIV infection started to increase in the last few years among adults. With the current trend, Ethiopia will achieve the second and third 90% HIV targets, while the first target is not achievable and without achieving this overarching goal control of the epidemic will not be achieved. Therefore due attention is needed to avert the current epidemics and diagnosis of cases.

Trends in, and factors associated with, HIV infection amongst tuberculosis patients in the era of anti-retroviral therapy: a retrospective study in England, Wales and Northern Ireland

BackgroundHIV increases the progression of latent tuberculosis (TB) infection to active disease and contributed to increased TB in the UK until 2004. We describe temporal trends in HIV infection amongst patients with TB and identify factors associated with HIV infection.MethodsWe used national surveillance data of all TB cases reported in England, Wales and Northern Ireland from 2000 to 2014 and determined HIV status through record linkage to national HIV surveillance. We used logistic regression to identify associations between HIV and demographic, clinical and social factors.ResultsThere were 106,829 cases of TB in adults (≥ 15 years) reported from 2000 to 2014. The number and proportion of TB patients infected with HIV decreased from 543/6782 (8.0%) in 2004 to 205/6461 (3.2%) in 2014. The proportion of patients diagnosed with HIV > 91 days prior to their TB diagnosis increased from 33.5% in 2000 to 60.2% in 2013. HIV infection was highest in people of black African ethnicity from countries with high HIV prevalence (32.3%), patients who misused drugs (8.1%) and patients with miliary or meningeal TB (17.2%).ConclusionsThere has been an overall decrease in TB-HIV co-infection and a decline in the proportion of patients diagnosed simultaneously with both infections. However, high rates of HIV remain in some sub-populations of patients with TB, particularly black Africans born in countries with high HIV prevalence and people with a history of drug misuse. Whilst the current policy of testing all patients diagnosed with TB for HIV infection is important in ensuring appropriate management of TB patients, many of these TB cases would be preventable if HIV could be diagnosed before TB develops. Improving screening for both latent TB and HIV and ensuring early treatment of HIV in these populations could help prevent these TB cases. British HIV Association guidelines on latent TB testing for people with HIV from sub-Saharan Africa remain relevant, and latent TB screening for people with HIV with a history of drug misuse, homelessness or imprisonment should also be considered.

Emerging HIV Epidemic in the North-Eastern State of Assam, India: An Exploratory Study Using Mixed-Methods Approach

Background: The national HIV scenario in India has improved impressively during past two decades. Contrastingly, the State-level HIV sentinel surveil-lance and routine programme data from various testing facilities indicated an increasing HIV prevalence among antenatal clinic attendees and female sex workers (FSWs) in three districts of Assam. Objectives: 1) To explore the reasons behind increasing adult HIV prevalence and 2) To understand the role of FSW and Migrants/long distance truckers as drivers of the HIV epi-demic in these districts. Methodology: Three sources of data were utilized in this concurrent mixed methods study—1) existing programme data for past three years; 2) questionnaire-based data for a case-control study, where dur-ing past six months at designated testing facilities HIV(+) married women were “cases” and age-matched HIV(?) women from the same district were “controls”. Spouses of these women were also interviewed separately; and 3) a qualitative study, where focus group discussions were conducted among FSWs, outgoing male migrant labourers and long-distance truckers. Results: The study revealed high levels of unsafe sexual practices among the FSWs. Sometimes in poverty-struck areas, women, not identifying themselves as sex workers, sold sex on a part-time basis to earn extra money for financial sup-port and often remained invisible to the programme. The clients of the sex workers, male migrants and truckers also revealed various risk behaviours for contracting and transmitting HIV infection. Conclusion: Population and context specific programme strategies are required to halt the rising trend of HIV infection in the general population in Assam.

HIV-Sero-prevalence trend among blood donors in North East Ethiopia.

Although blood transfusion is one of the known therapeutic interventions that cuts across a number of clinical disciplines. It is necessary to test all intending blood donors for HIV infection before donation. The aim of this study was to determine the prevalence of HIV among blood donors at Dessie Blood Bank, Northeast Ethiopia. A retrospective study was conducted in Dessie Blood Bank through the year 2008-2012. Sera from blood donors were tested for the detection of Anti HIV by using 4th generation ELISA. Data were abstracted from records and analyzed using Microsoft Excel sheet. From the total of 9384 screened blood samples collected, the prevalence of HIV in blood donors in the blood bank was 5.1% in the five consecutive years but the trend of HIV infection has decreased from 2008(5.2%) to 2012 (2.3%). The age groups 15-24 and 35-44 were the highest prevalence and the age group 45-54 was the lowest prevalence of HIV infection. The prevalence of HIV among female (7.9%) was higher than in male donors (4.4%). The trend of HIV infection was decreasing for both male and female blood donors. The prevalence of HIV infections among blood donors is still high in this study setting, and needs constant monitoring to evaluate prevention and control strategies to reduce the burden of transfusion-transmissible HIV infections.

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OBJECTIVES/SPECIFIC AIMS: Approximately 50% of people who have been diagnosed with HIV are either not linked to a care provider or not retained in medical care. This has substantial implications for both individual and public health outcomes. On an individual level, being retained in care is necessary for continuous receipt of antiretroviral therapy and sustained viral suppression. The public health implications of poor retention in HIV care are also serious, as it is estimated that people with HIV who are not retained in medical care are responsible for a majority of HIV transmissions, even more than the number of transmissions attributable to those who are HIV infected but undiagnosed. State departments of health routinely collect surveillance data including positive HIV test results, CD4 counts and viral load measures for monitoring trends in HIV infection. A shift in the use of these surveillance measures, guided by the CDC, has brought forth the opportunity to use these data for direct patient services and, more specifically, to direct re-engagement and retention in care efforts. Although the risk factors for poor retention in HIV care have been characterized using information from individual or multiple clinics, this study seeks to incorporate state surveillance data into the retention measures. METHODS/STUDY POPULATION: This retrospective cohort study was performed at the University of Alabama at Birmingham 1917 HIV/AIDS Clinic among patients with at least one attended HIV primary care visit during the calendar year of 2015. Retention during the calendar year of 2016 was then measured as whether or not a patient had 2 or more completed clinic visits which were separated by more than 90 days (in accordance with the Health Resources and Services Administration or HRSA guidelines, a National HIV Quality Indicator). For patients who did not have any primary care visit in 2016, the Alabama Department of Public Health will provide a status of care (out of care, in care elsewhere, died, moved out of state, and cannot locate) based on HIV laboratory results reported from all clinics and labs across the state and/or mortality information. A multinominal regression model of the status of care will be fitted to demographic, clinical, laboratory, and behavioral patient reported outcomes captured during an index visit in 2015. RESULTS/ANTICIPATED RESULTS: Data were recently obtained and is currently being analyzed on 3107 patients included in this study. We anticipate that there will be differences in the factors significantly associated with patients classified as out of care, poorly retained (patients who have only one completed clinic visit), and retained in care by the HRSA measure during calendar year 2016. DISCUSSION/SIGNIFICANCE OF IMPACT: By incorporating state surveillance data into our analysis, we expect to obtain a more precise picture of the risk factors for poor retention among HIV patients. For the first time, we will be able to determine if patients lost to our HIV clinic (~10% annually) are entirely lost to medical care or are seeking care elsewhere as indicated by HIV lab data reported to public health via surveillance. Identified risk factors will then be able to better inform the efforts to proactively improve the efficiency for HIV patient retention and re-engagement, and therefore lead to better individual outcomes for HIV patients and reduce the incidence of new HIV cases.

Infection status of HIV in men who have sex with men in Nanjing, 2011-2015

Objective: To understand the current status of HIV infection in men who have sex with men (MSM) in Nanjing, explore the associated factors with HIV infection, and provide information for the intervention in MSM. Methods: Data collected in the consecutive sentinel surveillances among MSM during 2011-2015 includes MSM's social-demographic information, sexual behavior histories, access to HIV prevention services and HIV testing in the past year. The infection trend was analyzed with χ2 test and the factors associated with HIV infection were identified through multivariate logistic regression analysis. Results: From 2011 to 2015, 712, 670, 656, 681 and 601 MSM were surveyed respectively. The HIV infection rates were 7.4%, 13.7%, 9.8%, 12.0% and 12.0% respectively, with an increasing trend (P=0.044). Syphilis prevalence rates were 9.1%, 11.5%, 6.0%, 10.6% and 5.8% respectively, with a decreasing trend (P=0.042). From 2011 to 2015, the percentage of MSM who failed to consistently use condoms for anal sex in the past 6 months increased significantly from 46.4%(260/560) to 55.7%(257/461) the percentage of those having commercial sex with males increased significantly from 1.2%(8/692) to 3.0%(18/593) in 2015, while the percentage of those receiving HIV test in the past year decreased significantly from 67.7%(482/712) to 57.6%(346/601). Those who were aged >25 years, lived in Nanjing for less than 2 years, had a high school or below educational level, failed to consistently use condoms at anal sex in the past 6 months, failed to have HIV test in the past year and were infected with syphilis had higher risk for HIV infection. Conclusion: Given the increasing trend of HIV infection and high risk sexual behavior in MSM in Nanjing, it is necessary to strengthen the comprehensive HIV prevention and intervention through expanding HIV test coverage and promoting condom use to curb HIV epidemic in MSM.

Trends in HIV Infection Among Persons Who Inject Drugs: United States and Puerto Rico, 2008-2013.

To describe trends in HIV diagnoses and prevalence among persons who inject drugs (PWID), and trend variations by jurisdiction. We used National HIV Surveillance System data to estimate the number of HIV diagnoses made during 2008 through 2013, and measured trends by estimated annual percent change; and persons living with diagnosed HIV infection at year-end 2008 to 2012, and measured trends in prevalence by the 2012-2008 arithmetic difference. During 2008 through 2013, the number of HIV diagnoses was stable among all persons (< 2% per year), and decreased among PWID (> 10% per year) overall and in 10 jurisdictions. The Black-to-White PWID diagnosis ratio was 2 to 1. During 2008 through 2012, the number of persons living with diagnosed HIV infection increased overall, was stable among PWID, and decreased in 14 jurisdictions. Had the rate of decrease in diagnoses of HIV infection among PWID equaled that of all persons, an additional 1500 diagnoses would have occurred between 2008 and 2013. Prevalence was stable among PWID, and increased overall among all persons living with HIV infection. Pronounced racial inequities persist, particularly for Blacks, and appear to be diminishing.

Flash Diagnostic Tool for MDR TB in HIV Era

Tuberculosis (TB) is one of the commonest opportunistic infection and the leading cause of death in HIV patients in developing countries. HIV infection is a well recognised risk factor for both activation of initial infection and reactivation of latent infection. This study was done to find out the co-prevalence and the trend of HIV infection among tuberculosis patients and to determine the prevalence of MDR Tuberculosis in HIV positive patients using Xpert MTB/RIF assay (Cepheid, Sunnyvale, CA, United States).The sputum samples are received from patients attending ICTC clinic at Osmania General Hospital, Hyderabad. Sputum specimen was processed for TB detection by Cartridge Based Nucleic Acid Amplification testing (CB-NAAT) using Xpert MTB/RiF assay technology. A total of 125 HIV patients were in the study. Out of these patients 20 MTB cases were detected. Of these 20 cases 18(90%) cases were sensitive to Rifampicin (RIF) and 2(10%) cases were showing resistance to Rifampicin (RIF) drug. Co-existence of HIV and tuberculosis is high and there is high Prevalence of MDR tuberculosis in HIV patients. The Gene Xpert MTB/RIF assay is a novel integrated diagnostic device that performs sample processing and real-time PCR analysis in a single hands-free step for the diagnosis of tuberculosis and rapid detection of RIF resistance in clinical specimens.

Research protocol for an epidemiological study on estimating disease burden of pediatric HIV in Belgaum district, India.

BackgroundPediatric HIV is poised to become a major public health problem in India with the rising trend of HIV infection in pregnant women (Department of AIDS Control, Ministry of Health and Family Welfare, http://www.naco.gov.in). There is lack of information on the epidemiology of pediatric HIV infection in India. Existing surveillance systems tend to underestimate the Pediatric burden. The overall aim of the present study is to estimate the disease burden of pediatric HIV among children in Belgaum district in the state of Karnataka in Southern India. An innovative multipronged epidemiological approach to comb the district is proposed.MethodsThe primary objectives of the study would be attained under three strategies. A prospective cohort design for objective (i) to determine the incidence rate of HIV by early case detection in infants and toddlers (0–18 months) born to HIV infected pregnant women; and cross sectional design for objectives (ii) to determine the prevalence of HIV infection in children (0–14 years) of HIV infected parents and (iii) to determine the prevalence of HIV in sick children (0–14 years) presenting with suspected signs and symptoms using age specific criteria for screening. Burden of pediatric HIV will be calculated as a product of cases detected in each strategy multiplied by a net inflation factor for each strategy.Study participants (i) (ii) (iii): HIV infected pregnant women and their live born children (ii) Any HIV-infected man/woman, of age 18–49 years, having a biological child of age 0–14 years (iii) Sick children of age 0–14 years presenting with suspected signs and symptoms and satisfying age-specific criteria for screening. Setting and conduct: Belgaum district which is a Category ‘A’ district (with more than 1 % antenatal prevalence in the district over the last 3 years before the study). Age-appropriate testing is used to detect HIV infection.DiscussionThere is a need to strengthen existing pediatric HIV estimation methods in India and other developing countries. We hope that the novel methodology emanating from this study would be applicable for estimating the burden of HIV in other settings and it would be adaptable for estimating the burden of other infectious/chronic diseases. Findings from this study will give future direction to the national program for prevention and control of HIV in India and other developing countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3132-8) contains supplementary material, which is available to authorized users.

HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities.

Global trends in HIV infection demonstrate an overall increase in HIV prevalence and substantial declines in AIDS related deaths largely attributable to the survival benefits of antiretroviral treatment. Sub-Saharan Africa carries a disproportionate burden of HIV, accounting for more than 70% of the global burden of infection. Success in HIV prevention in sub-Saharan Africa has the potential to impact on the global burden of HIV. Notwithstanding substantial progress in scaling up antiretroviral therapy (ART), sub-Saharan Africa accounted for 74% of the 1.5 million AIDS related deaths in 2013.Of the estimated 6000 new infections that occur globally each day, two out of three are in sub-Saharan Africa with young women continuing to bear a disproportionate burden. Adolescent girls and young women aged 15-24 years have up to eight fold higher rates of HIV infection compared to their male peers. There remains a gap in women initiated HIV prevention technologies especially for women who are unable to negotiate the current HIV prevention options of abstinence, behavior change, condoms and medical male circumcision or early treatment initiation in their relationships.The possibility of an AIDS free generation cannot be realized unless we are able to prevent HIV infection in young women. This review will focus on the epidemiology of HIV infection in sub-Saharan Africa, key drivers of the continued high incidence, mortality rates and priorities for altering current epidemic trajectory in the region. Strategies for optimizing the use of existing and increasingly limited resources are included.

Non-AIDS-associated cancer disorders. A novel scenario after over thirty years from HIV discovery? Clinical experience and literature appraisal

Both natural history and epidemiological trend of HIV infection have been deeply modified by the introduction of highly active antiretroviral therapy (HAART), around twenty years ago. However, despite a rapid drop of the incidence of the large majority of opportunistic infections, a slow, but continued increase of malignancies occurred, with particular evidence focused on cancers which are not strictly related to the definition of full blown AIDS (the so called non-AIDS-defining malignancies). The unique clinical occurrence of HIV infection complicated by even four non-AIDS-defining cancers prompted us to re-discuss the epidemiology and the possible pathogenesis, the clinical presentation, and the differential diagnosis of this pathologic presentation. On the ground of our experience in this field, and the available literature evidences, we discuss how this clinical occurrence is acting on HIV infection presentation during the HAART era of the third millennium. These changes need broad scale studies, and promise relevant consequences on etiopathogenetic, prevention, therapeutic, and management aspects of HIV disease in the next future.

"Any Condomless Anal Intercourse" is No Longer an Accurate Measure of HIV Sexual risk Behavior in Gay and Other Men Who have Sex with Men.

Background: Condomless anal intercourse (CLAI) has long been recognized as the primary mode of sexual transmission of HIV in gay and other men who have sex with men (MSM). A variety of measures of CLAI have been commonly used in behavioral surveillance for HIV risk and to forecast trends in HIV infection. However, gay and other MSM’s sexual practices changed as the understanding of disease and treatment options advance. In the present paper, we argue that summary measures such as “any CLAI” do not accurately measure HIV sexual risk behavior.Methods: Participants were 1,427 HIV-negative men from the Health in Men cohort study run from 2001 to 2007 in Sydney, Australia, with six-monthly interviews. At each interview, detailed quantitative data on the number of episodes of insertive and receptive CLAI in the last 6 months were collected, separated by partner type (regular vs. casual) and partners’ HIV status (negative, positive, and HIV status unknown).Results: A total of 228,064 episodes of CLAI were reported during the study period with a mean of 44 episodes per year per participant (median: 14). The great majority of CLAI episodes were with a regular partner (92.6%), most of them with HIV-negative regular partners (84.8%). Participants were more likely to engage in insertive CLAI with casual than with regular partners (66.7 vs. 55.3% of all acts of CLAI with each partner type, p < 0.001). Men were more likely to report CLAI in the receptive position with HIV-negative and HIV status unknown partners than with HIV-positive partners (p < 0.001 for both regular and casual partners).Conclusion: Gay and other MSM engaging in CLAI demonstrate clear patterns of HIV risk reduction behavior. As HIV prevention enters the era of antiretroviral-based biomedical approach, using all forms of CLAI indiscriminately as a measure of HIV behavioral risk is not helpful in understanding the current drivers of HIV transmission in the community.

Monitoring HIV Epidemic in Pregnant Women: Are the Current Measures Enough?

Introduction. Burden of HIV in pregnant women follows overall epidemic in India. Hence, it is imperative that prevalence calculations in this group be accurate. The present study was carried out to determine prevalence of HIV in pregnant women attending our hospital, to determine trend of HIV infection and to compare our results with reported prevalence. Methods. All pregnant women are routinely counselled for HIV testing using opt-out strategy. Year-wise positivity and trend were determined in these patients over a period of five years. The positivity in different age groups was determined. Results. 31,609 women were tested of which 279 (0.88%) were positive. Positivity showed a declining trend over study period and significant quadratic trend (biphasic, P < 0.05) was observed. The positivity in older age group ≥35 years (1.64%) was significantly more than younger age groups (0.76% in 15–24-year and 0.94% in 25–34-year age group) (P = 0.0052). Conclusion. A significant decline in HIV positivity was seen over the study period. Taking into account heterogeneous nature of HIV epidemic even within the same district, analysis at local levels especially using the prevention of parent to child transmission of HIV program data is critical for HIV programming and resource allocation.

HIV Prevalence and HIV-Related Sexual Practices among Men Who Have Sex with Men in Portuguese Bathhouses

Background: To determine the perceived prevalence (the response of known HIV diagnosis) and trends of HIV infection among mem who have sex with men (MSM) frequenting gay bathhouses; and (2) to identify the risk factors associated sexual practices. Methods: A total of 424 MSM (Mean age 35.64, SD=10.05) recruited through informal social networks and the Internet participated in this study. Most participants were single and self-identified as gay (66.7%). Participants were asked to recall their sexual experiences while visiting a bathhouse for sexual purposes. Results: 9.4% (n=40) of participants reported being HIV positive and approximately 14.5% (n=62) reported not knowing their status. MSM visited the bathhouses 1.76 times per month (SD=2.12) and involved themselves with 3 men (on average) per each visit. Statistically significant differences between having sex with or without a condom were found (p<0.001) reflect that risky behavior occurs (95% CI). Risk practices involving fluid exchange (condomless practices) were also reported. Ejaculation in the mouth was reported by 29.3% to 48.9% of all participants, and ejaculation in the anus was reported by 15.8% to 17.4% of all participants. Linear regression indicated that sex role, substance use, sexual orientation and number of monthly visits were predictors of sexual practices involving fluid exchange. Conclusion: Results from this study show that HIV prevalence and HIV-related practices is high among MSM who use bathhouses to engage in sexual activity, and this can serve as a reference for researchers interested in these behavioral patterns and for local authorities aiming to promote health education among MSM.

The Trend of HIV Infection among Tuberculosis Patients and the Relation with CD 4 Counts

The Trend of HIV Infection among Tuberculosis Patients and the Relation with CD 4 Counts

Rapid Detection of Mycobacterium tuberculosis in Sputum Samples by Cepheid Xpert Assay: A Clinical Study.

Tuberculosis (TB) is one of the commonest opportunistic infection and the leading cause of death in HIV patients in developing countries. HIV infection is a well recognised risk factor for both activation of initial infection and reactivation of latent infection. This study was done to find out the co-prevalence and the trend of HIV infection among tuberculosis patients and to determine the prevalence of MDR Tuberculosis in HIV positive patients using Xpert MTB/RIF assay (Cepheid, Sunnyvale, CA, United States). The sputum samples are received from five districts of Punjab. Sputum samples of the patients with symptoms suggestive of pulmonary tuberculosis including both new cases and on treatment are received from the various district and civil hospitals of five districts. Sputum specimen was processed for TB detection by Cartridge Based Nucleic Acid Amplification testing (CB-NAAT) using Xpert MTB/RiF assay technology. The study period is from October 2013 to September 2014. A total of 907 patients with symptoms suggestive of pulmonary tuberculosis including both new cases and on treatment. Out of these patients 733 were reported MTB detected. Out of these 907 patients 29 were reported HIV positive and out of 733 patients 19(2.5%) were reported positive for (HIV +TUBERCULOSIS). Of these 19 cases 16(84.21%) cases were sensitive to rifampicin (RIF) and 3(15.78%) cases were showing resistance to rifampicin (RIF) Drug. Co-existence of HIV and tuberculosis is high and there is high Prevalence of MDR tuberculosis in HIV patients.