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Non-alcoholic fatty liver disease is not associated with impairment in health-related quality of life in virally suppressed persons with human immune deficiency virus.

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in persons with HIV (PWH) (HIV-NAFLD). It is unknown if HIV-NAFLD is associated with impairment in health-related quality of life (HRQOL). We examined HRQOL in PWH with and without NAFLD, compared HRQOL in HIV- versus primary NAFLD, and determined factors associated with HRQOL in these groups. Prospectively enrolled 200 PWH and 474 participants with primary NAFLD completed the Rand SF-36 assessment which measures 8 domains of HRQOL. Individual domain scores were used to create composite physical and mental component summary scores. Univariate and multivariate analyses determined variables associated with HRQOL in PWH and in HIV- and primary NAFLD. In PWH, 48% had HIV-NAFLD, 10.2% had clinically significant fibrosis, 99.5% were on antiretroviral therapy, and 96.5% had HIV RNA <200 copiesml. There was no difference in HRQOL in PWH with or without NAFLD. Diabetes, non-Hispanic ethnicity, and nadir CD4 counts were independently associated with impaired HRQOL in PWH. In HIV-NAFLD, HRQOL did not differ between participants with or without clinically significant fibrosis. Participants with HIV-NAFLD compared to those with primary NAFLD were less frequently cisgender females, White, more frequently Hispanic, had lower BMI and lower frequency of obesity and diabetes. HRQOL of individuals with HIV-NAFLD was not significantly different from those with primary NAFLD. In conclusion, in virally suppressed PWH, HRQOL is not different between participants with or without HIV-NAFLD. HRQOL is not different between HIV-NAFLD and primary NAFLD.

CD4 binding site immunogens elicit heterologous anti-HIV-1 neutralizing antibodies in transgenic and wild-type animals.

Passive transfer of broadly neutralizing anti-HIV-1 antibodies (bNAbs) protects against infection, and therefore, eliciting bNAbs by vaccination is a major goal of HIV-1 vaccine efforts. bNAbs that target the CD4 binding site (CD4bs) on HIV-1 Env are among the most broadly active, but to date, responses elicited against this epitope in vaccinated animals have lacked potency and breadth. We hypothesized that CD4bs bNAbs resembling the antibody IOMA might be easier to elicit than other CD4bs antibodies that exhibit higher somatic mutation rates, a difficult-to-achieve mechanism to accommodate Envs N276

Community myths and misconceptions about sexual health in Tanzania Stakeholders views from a qualitative study in Dar es Salaam Tanzania.

Sexual and reproductive health problems are one of the top five risk factors for disability in the developing world. The rates of sexual health problems in most African countries are overwhelming, which is why HIV and other STIs are still such a challenge in sub-Saharan Africa. Talking about sex in most African countries is a taboo, leading to common myths and misconceptions that ultimately impact community sexual health. In this study, we conducted 11 key stakeholder individual interviews with community, religious, political, and health leaders (sexual health stakeholders) in Tanzania. Qualitative content analysis was used to analyze all the materials. Two main categories merged from the analysis. The first category, Ambiguities about sexual health focused on societal and political misconceptions and identified ten myths or misconceptions common in Tanzania. Stakeholders highlighted the confusion that happens when different information about sexual health is presented from two different sources (e.g., community leaderspeers and political leaders), which leaves the community and community leaders unsure which one is reliable. The second category, Practical dilemmas in serving clients, addressed a range of professional and religious dilemmas in addressing sexual health concerns. This included the inability of religious leaders and health care providers to provide appropriate sexual health care because of internal or external influences. Myths and misconceptions surrounding sexual health can prevent communities from adequately addressing sexual health concerns, and make it more difficult for healthcare providers to comfortably provide sexual health care to patients and communities. Stakeholders affirmed a need to develop a sexual health curriculum for medical, nursing and midwifery students because of the lack of education in this area. Such a curriculum needs to address nine common myths which were identified through the interviews.

Use and effectiveness of remdesivir for the treatment of patients with covid-19 using data from the Lean European Open Survey on SARS-CoV-2 infected patients (LEOSS) a multicentre cohort study.

The use of remdesivir (RDV) as the first drug approved for coronavirus disease 2019 (COVID-19) remains controversial. Based on the Lean European Open Survey on severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infected patients (LEOSS), we aim to contribute timing-focused complementary real-world insights to its evaluation. SARS-CoV-2 infected patients between January 2020 and December 2021 treated with RDV were matched 11 to controls considering sociodemographics, comorbidities and clinical status. Multiple imputations were used to account for missing data. Effects on fatal outcome were estimated using uni- and multivariable Cox regression models. We included 9,687 patients. For those starting RDV administration in the complicated phase, Cox regression for fatal outcome showed an adjusted hazard ratio (aHR) of 0.59 (95%CI 0.41-0.83). Positive trends could be obtained for further scenarios an aHR of 0.51 (95%CI 0.16-1.68) when RDV was initiated in uncomplicated and of 0.76 (95% CI 0.55-1.04) in a critical phase of disease. Patients receiving RDV with concomitant steroids exhibited a further reduction in aHR in both, the complicated (aHR 0.50, 95%CI 0.29-0.88) and critical phase (aHR 0.63, 95%CI 0.39-1.02). Our study results elucidate that RDV use, in particular when initiated in the complicated phase and accompanied by steroids is associated with improved mortality. However, given the limitations of non-randomized trials in estimating the magnitude of the benefit of an intervention, further randomized trials focusing on the timing of therapy initiation seem warranted.

Clinical and histopathology characteristics of Castleman disease a multicenter study of 51 Brazilian patients.

Castlemans disease (CD) is a rare and heterogeneous lymphoproliferative disorder, with limited available clinical information in Brazil. A retrospective study was carried out through information contained in the medical records of 51 patients, between July 1999 and June 2020. Seven patients were excluded, and 44 were analyzed in total. The average age of unicentric CD (UCD) patients was 35 years old and of multicentric CD (MCD) patients was 49 years old (p 0.013). Regarding gender, there was a predominance of females among patients with UCD (68.4%) and males in patients with MCD (57.9%) (p 0.103). The most common site of involvement in UCD was the cervical region (36.8%). A total of 73.7% of patients with UCD and 68.4% of patients with MCD presented the histological form hialyne-vascular (HV) (p 0.499). Most patients with laboratory abnormalities had MCD. A total of 78% of the patients were asymptomatic, with the majority of symptomatic patients with MCD (p 0.042). Only two of the 27 patients evaluated for the presence of human immunodeficiency virus (HIV) had positive serology. HHV-8 was evaluated in 14 cases, being positive in two. Of the patients with UCD, 94.7% underwent excisional biopsy, against only 41.2% of patients with MCD (p 0.01). The mean follow-up was 61 months. We observed similarities in the clinical profile between patients in our study and patients described in the literature, such as gender, mean age, B symptoms, visceromegaly, fluid accumulation, and treatment. Unlike the literature, the cervical region was the most affected site, besides the greater association of the HV histological subtype among patients with MCD.

Varied Patterns of Decay of Intact HIV-1 Proviruses Over two Decades of Art.

Fourteen people with HIV-1 on two decades of antiretroviral therapy had longitudinal measurements of intact, defective, and total proviral DNA. Three patterns of intact proviral DNA decay were revealed 1) biphasic decline with markedly slower second phase decline 2) initial decline that transitions to a zero-slope plateau and 3) initial decline followed by later increases in intact proviral DNA. Defective proviral DNA levels were essentially stable. Mechanisms of slowing or reversal of second phase decay of intact proviral DNA may include the inability to clear cells with intact but transcriptionally silent proviruses and clonal expansion of cells with intact proviruses.

Responses to Monkeypox Learning from Previous Public Health Emergencies.

Since the 1970s, the zoonotic disease monkeypox was reported as appearing in humans, principally in central and west Africa. However, from May 2022, escalating numbers of persons worldwide contracted it. On 23 July 2022, the World Health Organization declared this outbreak to be a public health emergency of international concern (PHEIC) and initially observed that it was concentrated among men who have sex with men, especially those with multiple sexual partners. The international public health response to monkeypox provides a litmus test to evaluate whether lessons have been learned from experiences of other infectious diseases in recent decades. This editorial identifies evidence of progress in the following areas the declaration of a PHEIC in relation to monkeypox some high-income countries responses to monkeypox naming of the virus, its variants and the disease it causes protection of LGBTIQ communities and engagement of them to curb transmission of monkeypox and efforts to ensure access to equitable vaccines.

Differential regulation of tachykinin and opioid system gene expression in brain and immune cells of chronic binge alcohol-treated, simian immunodeficiency virus (SIV)-infected macaques.

People living with HIV (PLWH) have a high likelihood of at-risk alcohol use and are at increased risk for neurocognitive decline. The underlying mechanisms involved in HIV-associated neurocognitive disorder (HAND) are not completely understood. Previously, we showed that chronic binge alcohol (CBA) administration produced behavioral deficits in non-antiretroviral therapy (ART)-treated simian immunodeficiency virus (SIV)-infected macaques. Moreover, we observed that CBASIV enhanced neuroinflammatory gene expression and attenuated growth factor signaling in the frontal cortex (FC) and basal ganglia, effects that were partially ameliorated by ART. We hypothesized that the neuroinflammatory and growth factor changes observed could be associated with alterations in opioid, tachykinin, and endocannabinoid gene expression. Furthermore, that gene expression patterns in peripheral blood mononuclear cells (PBMCs) could serve as an indicators of expression changes in the brain (FC). We examined gene expression patterns of opioid, tachykinin, and endocannabinoid systems in FC and PBMCs isolated from CBASIV macaques. Expression of targeted genes as determined by RT-qPCR was analyzed in relation to CBA, ART, plasma, and brain viral loads (PVL and BVL, respectively) and compared to baseline (PBMC) or FC from SIV- controls. Results did not reveal parallel changes (in magnitude or direction) in PBMC and FC gene expression. FC expression of ORM1, POMC, and TACR1 were negatively associated with PVL (p0.03, 0.002, 0.05 respectively). FC expression of TAC1 was positively associated with CBA exposure (p0.05). PBMC expression of DAGLA was positively associated with CBA exposure but negatively associated with combined CBAART exposure (p0.03). Our findings reflect the complex interactions of SIV, CBA, and ART in modulating opioid and tachykinin system gene expression. Further studies are warranted to determine the relevance of these transcriptional changes in modulating HAND-related behaviors resulting from at-risk alcohol use and HIVSIV exposure.

Mixed Origins HIV gp120-specific memory develops from pre-existing memory and naïve B cells following vaccination in humans.

The most potent and broad HIV envelope (Env)-specific antibodies often when reverted to their inferred germline versions representing the naïve B cell receptor, fail to bind Env suggesting that the initial responding B cell population is not exclusively comprised of a naïve population, but also a pre-existing cross-reactive antigen-experienced B cell pool that expands following Env exposure. Previously we isolated gp120-reactive monoclonal antibodies (mAbs) from participants in HVTN 105, an HIV vaccine trial. Using deep sequencing, focused on IgG, IgA and IgM, VH-lineage tracking we identified 4 of these mAb lineages in pre-immune peripheral blood. We also looked through the 7 month post-vaccination bone marrow and interestingly, several of these lineages that were found in pre-vaccination blood were still persistent in the post-vaccination bone marrow, including CD138 long-lived plasma cell compartment. The majority of the pre-immune lineage members included IgM, however IgG and IgA members were also prevalent and exhibited somatic hypermutation. These results suggest that vaccine-induced gp120-specific antibody lineages originate from both naïve and cross-reactive memory B cells.

Advances in Genetic Editing of the Human Embryo.

Genetic engineering has allowed a major development of research in this field, with specialists attempting to edit the human genome, after the successful editing of the genomes of plants and animals. However, human gene editing technologies are at the center of ethical debates around the world. Ethical concerns about genetic editing of the human embryo raise several issues that can be viewed through the prism of optimism and reluctance leading to a number of recommendations regarding the acceptance of what may soon become a reality. A literature search was conducted through PubMed, MEDLINE, Plus, Scopus, and Web of Science (2015-2022) using combinations of keywords, including human genome or gene editing plus ethics. Gene therapy is seen by researchers as a way to solve congenital diseases, multifactorial diseases in general or specific diseases such as cystic fibrosis, muscular dystrophy, or can increase resistance to HIV infection. Genome editing technologies, germline gene editing, clustered regularly interspaced short palindromic repeats gene editing technology, technologies such as zinc finger nucleases are not only advanced gene therapies that require solving technical problems, but also techniques that require complex and complete analysis of ethical problems. Genetic engineering raises many ethical concerns such as safety concerns especially the risk of off-target effects autonomy of the individual-with the limitation of the future generations to consent for an intervention over their genome social justice-keeping in mind the costs of the procedures and their availability to the general population. Discussions can go further from questions such as How can we do this to questions such as Should we do this or Is society ready to accept this technology and is it able to manage it rationally The ethics of biomedical research should be based on global dialogue, on the involvement of experts and the public, to achieve a broad social consensus. The fundamental review of the ethics of genetics is a desire and an opportunity of the current period.

Field investigation of high reported non-neonatal tetanus burden in Uganda, 2016-2017.

Despite providing tetanus-toxoid-containing vaccine (TTCV) to infants and reproductive-age women, Uganda reports one of the highest incidences of non-neonatal tetanus (non-NT). Prompted by unusual epidemiologic trends among reported non-NT cases, we conducted a retrospective record review to see whether these data reflected true disease burden. We analysed nationally reported non-NT cases during 2012-2017. We visited 26 facilities (14 hospitals, 12 health centres) reporting high numbers of non-NT cases (n 20) or zero cases (n 6). We identified non-NT cases in facility registers during 1 January 2016-30 June 2017 the identified case records were abstracted. During 2012-2017, a total of 24 518 non-NT cases were reported and 74% were ≥5 years old. The average annual incidence was 3.43 per 100 000 population based on inpatient admissions. Among 482 non-NT inpatient cases reported during 1 January 2016-30 June 2017 from hospitals visited, 342 (71%) were identified in facility registers, despite missing register data (21%). Males comprised 283 (83%) of identified cases and 60% were ≥15 years old. Of 145 cases with detailed records, 134 (92%) were clinically confirmed tetanus among these, the case-fatality ratio (CFR) was 54%. Fourteen cases were identified at two hospitals reporting zero cases. Among >4000 outpatient cases reported from health centres visited, only 3 cases were identified the remainder were data errors. A substantial number of non-NT cases and deaths occur in Uganda. The high CFR and high non-NT burden among men and older children indicate the need for TTCV booster doses across the life course to all individuals as well as improved coverage with the TTCV primary series. The observed data errors indicate the need for data quality improvement activities.

Bioinspired CRISPR-Mediated Cascade Reaction Biosensor for Molecular Detection of HIV Using a Glucose Meter.

HIV molecular detection plays a significant role in early diagnosis and antiretroviral therapy for HIV patients. CRISPR technology has recently emerged as a powerful tool for highly sensitive and specific nucleic acid based molecular detection when used in combination with isothermal amplification. However, it remains a challenge to improve the compatibility of such a multienzyme reaction system for simple and sensitive molecular detection. Inspired by the multicompartment structures in a living cell, we present a nanoporous membrane-separated (compartmentalized), artificial, cascade reaction system to improve the compatibility of a CRISPR-mediated multienzyme reaction. We further integrated the multienzyme cascade reaction system with a microfluidic platform and glucose biosensing technology to develop a bioinspired, CRISPR-mediated cascade reaction (CRISPR-MCR) biosensor, enabling HIV molecular detection by a simple glucose meter, analogous to diabetes home testing. We applied the bioinspired CRISPR-MCR biosensor to detect HIV DNA and HIV RNA, achieving a detection sensitivity of 43 copies and 200 copies per test, respectively. Further, we successfully validated the bioinspired biosensor by testing clinical plasma samples of HIV, demonstrating its great application potential for point-of-care testing of HIV virus and other pathogens at home or in resource-limited settings.

Low rates of antibiotics prescribed during telehealth primary-care visits persisted during the coronavirus disease 2019 (COVID-19) pandemic.

For primary care clinics at a Veterans Affairs (VA) medical center, the shift from in-person to telehealth visits during the coronavirus disease 2019 (COVID-19) pandemic was associated with low rates of antibiotic prescription. Understanding contextual factors associated with antibiotic prescription practices during telehealth visits may help promote antibiotic stewardship in primary care settings.

HIV-1 transmission modelling and direct visualization in the 3rd dimension.

Identifying initial events of mucosal entry of HIV-1 in laboratory-based, physiologically-relevant and high-throughput contexts may aid in designing effective strategies to block local transmission and spread of HIV-1. Several paradigms have been posited for how HIV-1 crosses mucosal barriers to establish infection based on 2D culture or animal-based models. Nevertheless, despite these models stemming from 2D culture and animal studies, monolayers of cells poorly replicate the complex niche that influences viral entry at mucosal surfaces, whereas animal models often inadequately reproduce human disease pathophysiology and are prohibitively expensive. Organoids, having never been directly utilised in HIV-1 transmission investigations, may offer a compromise between 2D culture and animal models as they provide a platform which mimics the biophysical and biochemical niche of mucosal tissues. Importantly, observation of events downstream of viral inoculation is potentially accessible to researchers via an array of microscopy techniques. Because of the potential insights organoids may provide in this context, we offer this review to highlight key physiological factors of HIV-1 transmission at common mucosal sites and a discussion highlighting how many of these factors can be recapitulated in organoids, their current limitations and what questions can initially be addressed, particularly by a selective inclusion of quantitative light microscopy techniques. Harnessing organoids for direct observation of HIV-1 entry at mucosal sites may uncover potential therapeutic targets which prevent the establishment of HIV-1 infection.

Diagnostic accuracy of screening algorithms to identify persons with active pulmonary tuberculosis at prison entry protocol of a systematic review and network meta-analysis.

Prison inmates are a high-risk group for tuberculosis (TB) infection and disease due to the increasing number of vulnerable fringe groups, risk factors (

Prevalence and associated factors of intestinal parasitic infections among HIV clients attending Masaka Regional Referral Hospital, Uganda.

infection with Human Immune deficiency Virus (HIV) increases the risk of opportunistic infections, which aggravates life-long complications. We report the prevalence and the associated factors of intestinal parasites among HIV infected clients attending anti-retroviral therapy (ART) clinic at Masaka Regional Referral Hospital, in Uganda. this was a cross-sectional study that purposefully enrolled 410 HIV infected clients. Stool samples were macroscopically assessed, and analyzed using wet preparations, Formol ether concentration and Modified Ziehl Neelsen (ZN) techniques to identify cysts and ova of intestinal parasites. Further, a questionnaire was used to obtain data on socio-demographic, hygiene and immunologic markers. Logistic regression analysis was used to determine the associated factors of intestinal parasitic infection. of the 410 adult HIV sero-positive clients enrolled, 58.0% (238410) were females. Participants mean age was 26.8 years, (range of 18-59 years). The prevalence of intestinal parasites was 49410 (11.95% 95% confidence interval 10.3 - 14.7). Intestinal parasites isolated were Giardia lamblia (N10, 20.4%), strongloides stercolaris (N4, 8.2%), and modified ZN showed Cryptosporidium species (N35, 71.4%). Hand washing, history of not deworming in the previous 1 year, deteriorating HIV clinical stage and unprotected open water sources were the associated factors. this study reports a high prevalence of opportunistic intestinal parasites. As these are neglected tropical infections, early detection and exploration of the associated factors is key to their proper management.

Trends of stillbirths in Harare City, Zimbabwe, 2015-2019 a secondary data analysis.

in Zimbabwe, perinatal mortality is a major public health problem. Harare City data showed increase in stillbirth rate trend from 41000 live births in 2014 to 61000 live births in 2018, failing to meet the countrys target of reducing stillbirth rate by 40%. We analysed the characteristics of stillbirths from 2015 to 2019 in Harare City. we conducted a retrospective analytical cross-sectional study using secondary data from Harare City Health Departments 12 baby-delivery polyclinics. Fourteen key informants were interviewed to verify information obtained. Using Epi-info, descriptive summaries and graphs were generated and bivariate and multivariate logistic regression was conducted. Statistical significance was considered at a p-value <0.05. a total of 700(74.9%) perinatal death notification records were reviewed. The majority were macerated stillbirths 418(59.7%) followed by fresh stillbirths 189(27.0%). The median age for women who had fresh stillbirths was 26 years (Q stillbirths in Harare City were increasing and were due to preventable causes. The younger maternal age group was most affected hence preventive activities should focus on them. Improving the quality of antenatal care, delivery, and new-born care can help reduce stillbirths and early neonatal death.

Implementation and contribution of temperature screening and handwashing practice at points of entry for COVID-19 pandemic response in a humanitarian crisis setting.

over the last decade, insecurity in the Lake Chad Basin has triggered an unprecedented humanitarian crisis in the Niger´s Diffa Region with a significant population movement. In this humanitarian setting, we reviewed the implementation process and the contribution of temperature screening and handwashing practice at points of entry as part of non-pharmaceutical interventions against COVID-19. in Diffa, border officers were trained on the fundamentals of infection prevention and control in relation to COVID-19 readiness and response and a 14-day district response team was constituted. To examine the significance of the implementation process of temperature screening and handwashing practices at points of entry, we conducted a secondary analysis of data submitted by the six health districts of the Diffa Region between March and July 2020. travellers screened for fever ranged from 10,499 (in March 2020) to 62,441 (in April 2020) with the health districts of Diffa (mean standard error of the mean 25,999 9,220) and of Bosso (mean standard error of the mean 30.4 19.1) accounting for the most and the least of activities during the entire period, respectively. Overall, 125169,475 travellers presented fever and were effectively quarantined. Only the Ngourti Health District reported travellers who declined handwashing (54169,475) this was during the first three months of the first wave of the COVID-19 pandemic. we have documented a successful implementation of measures related to temperature screening with some unsubstantial denial of handwashing. Given the importance of border traffic due to insecurity in the Diffa Region, maintaining temperature screening and handwashing in this humanitarian setting is necessary but requires coordinated actions of all stakeholders involved in the region.

Frosted branch angiitis as an immune recovery response in newly diagnosed acquired immunodeficiency syndrome and systemic cytomegalovirus infection.

Frosted branch angiitis (FBA) is an uncommon form of severe retinal perivasculitis associated with systemic inflammatoryinfectious diseases. In this report, we describe a case of FBA and macular edema as a result of immune recovery response in a patient newly diagnosed with HIV infection and cytomegalovirus viremia.

Scaling Biosafety Up During and Down After the COVID-19 Pandemic.

The aim of this work was to review and analyze changes to the practice of biosafety imposed by pandemics. A narrative review of the COVID-19 pandemic that began in 2020 and prior pandemics from the perspective of a working virologist. By definition, pandemics, outbreaks, and other emergencies are transient phenomena. They manifest as waves of events that induce unforeseen needs and present unknown challenges. After a pandemic, the return to normality is as crucial as the scale-up during the exponential growth phase. The COVID-19 pandemic presents an example to study operational biosafety and biocontainment issues during community transmission of infectious agents with established pandemic potential, the propensity to induce severe disease, and the ability to disrupt aspects of human society. Scaling down heightened biocontainment measures after a pandemic is as important as scaling up during a pandemic. The availability of preventive vaccines, and therapeutic drug regimens, should be considered in risk assessments for laboratory studies. There exists the need to preserve situational memory at the personal and institutional levels that can be served by professional societies.

Similarities and differences of chemical compositions and physical and functional properties of adjuvant system 01 and army liposome formulation with QS21.

A vaccine adjuvant known as Adjuvant System 01 (AS01) consists of liposomes containing a mixture of natural congeners of monophosphoryl lipid A (MPL

Vulnerability of the HIV cascade of care in an Amazonian town A qualitative study.

The HIV care cascade spans from diagnosis to patient linkage and retention in health services for treatment. Brazil has made substantial efforts to optimize the cascade of care. However, despite these advances, there are striking regional differences and difficulties from testing to treatment, particularly in the north and northeast regions, often reflecting social inequalities. Oiapoque, a highly affected city in the state of Amapá, shares its borders with an overseas European territory-French Guiana. The objective of this study was to get a clearer picture of the different components of the HIV care cascade in the municipality of Oiapoque. The study was exploratory and qualitative, involving the mapping of health structures in the research area and interviews with the responsible healthcare professionals working in the municipality. Patients are vulnerable at several levels, including mobility limitations, mismatched information that affects the linkage and retention of treatment, an absence of infectious disease doctors, an absence of user autonomy, missed appointments, dropouts, and abandonment of care. We found that the five recommended steps in the continuum of care for people living with HIV all had weak points or were non-existent or unavailable. These results will be fundamental to rethink the municipalitys actions and the strategies of the Unified Health System SUS for the HIV epidemic in these border regions of the Amazon.

Sexually transmitted infections on the border between Brazil and French Guiana.

The border between the State of Amapa, Brazil, and French Guiana is mostly primary forest. In the Oyapock basin, socioeconomic circumstances have fueled sex work, gold mining and the circulation of sexually transmitted infections. Given the lack of comprehensive data on this border area, we describe the different sexually transmitted infections along the BrazilFrench Guiana border and the testing and care activity. We conducted a review of the available scientific and technical literature on sexually transmitted infections in this complex border area. Temporal trends were graphed and for Human Immunodeficiency Virus (HIV) we estimated incidence using the European Center for prevention and Disease Control modeling tool. Until 2019, 26 of the 46 HIV-infected patients followed and treated in Saint Georges de lOyapock were residing on the Brazilian side in Oiapoque. Virological suppression was only achieved for 75% of treated patients but dropped to 62% during the COVID-19 epidemic. In 2019, cooperation efforts allowed HIV care in Oiapoque, resulting in the transfer of Brazilian patients previously followed on the French side and a substantial increase in the number of patients followed in Oiapoque. The average yearly HIV serological testing activity at the health center in Saint Georges was 16 tests per 100 inhabitants per year in Camopi it was 12.2 per 100 inhabitants. Modeling estimated the number of persons living with HIV around 170 persons, corresponding to a prevalence of 0.54% and about 40 undiagnosed infections. The model also suggested that there were about 12 new infections per year in Saint Georges and Oiapoque, representing an HIV incidence rate of 3.8 cases per 10,000 per year. HPV prevalence in Saint Georges ranges between 25 and 30% and between 35 and 40% in Camopi. Testing activity for other sexually transmitted infections markedly increased in the past 5 years the introduction of PCR for chlamydiasis and gonorrhea also had a substantial impact on the number of diagnoses. The ongoing cooperation between multiple partners on both sides of the border has led to remarkable progress in primary prevention, in testing efforts, in treatment and retention on both sides of the border. In a region with intense health professional turnover, nurturing cooperation and providing accurate assessments of the burden of sexually transmitted infections is essential to tackle a problem that is shared on both sides of the border.

Monkeypox outbreaks in the context of the COVID-19 pandemic Network and clustering analyses of global risks and modified SEIR prediction of epidemic trends.

Ninety-eight percent of documented cases of the zoonotic disease human monkeypox (MPX) were reported after 2001, with especially dramatic global spread in 2022. This longitudinal study aimed to assess spatiotemporal risk factors of MPX infection and predict global epidemiological trends. Twenty-one potential risk factors were evaluated by correlation-based network analysis and multivariate regression. Country-level risk was assessed using a modified Susceptible-Exposed-Infectious-Removed (SEIR) model and a risk-factor-driven k-means clustering analysis. Between historical cases and the 2022 outbreak, MPX infection risk factors changed from relatively simple human immunodeficiency virus (HIV) infection and population density to multiple human mobility, population of men who have sex with men, coronavirus disease 2019 (COVID-19) infection, and socioeconomic factors, with human mobility in the context of COVID-19 being especially key. The 141 included countries classified into three risk clusters 24 high-risk countries mainly in West Europe and Northern America, 70 medium-risk countries mainly in Latin America and Asia, and 47 low-risk countries mainly in Africa and South Asia. The modified SEIR model predicted declining transmission rates, with basic reproduction numbers ranging 1.61-7.84 in the early stage and 0.70-4.13 in the current stage. The estimated cumulative cases in Northern and Latin America may overtake the number in Europe in autumn 2022. In the current outbreak, risk factors for MPX infection have changed and expanded. Forecasts of epidemiological trends from our modified SEIR models suggest that Northern America and Latin America are at greater risk of MPX infection in the future.

Video selection and assessment for an app-based HIV prevention messaging intervention formative research.

Gay, bisexual, and other men who have sex with men (GBMSM) continue to be overrepresented in human immunodeficiency virus (HIV) infection in the United States. HIV prevention and care interventions that are tailored to an individuals serostatus have the potential to lower the rate of new infections among GBMSM. Mobile technology is a critical tool for disseminating targeted messaging and increasing uptake of basic prevention services including HIV testing, sexually transmitted infection (STI) testing, and pre-exposure prophylaxis (PrEP). Mobile Messaging for Men (M-Cubed) is a mobile health HIV prevention intervention designed to deliver video- and text-based prevention messages, provide STI and HIV information, and link GBMSM to prevention and healthcare resources. The current report describes an iterative process of identifying and selecting publicly available videos to be used as part of the M-Cubed intervention. We also conducted interviews with GBMSM to assess the acceptability, comprehension, and potential audience reach of the selected video messages. The selection of videos included balancing of specific criteria e.g., accuracy of scientific information, video length, prevention domains HIVSTI testing, antiretroviral therapy (ART), PrEP, engagement in care, and condom use to ensure that they were intended for our GBMSM audiences HIV-negative men who engage in condomless anal sex, HIV-negative men who do not engage in condomless anal sex, and men living with HIV. This formative study included in-person interviews with 26 GBMSM from three U.S. cities heavily impacted by the HIV epidemic-New York City, Detroit, and Atlanta. Following a qualitative content analysis, the study team identified five themes across the interviews participant reactions to the video messages, message comprehension, PrEP concerns, targeting of video messaging, and prompted action. Study results informed a final selection of 12 video messages for inclusion in a randomized controlled trial of M-Cubed. Findings may serve as a guide for researchers who plan to develop HIV prevention interventions that utilize publicly available videos to promote behavioral change. Further, the findings presented here suggest the importance of developing videos with broad age and gender diversity for use in interventions such as M-Cubed, and in other health promotion settings.

Development and Validation of a Diagnostic Nomogram for

This study was a retrospective, cross-sectional research. The development group included 434 patients who were admitted with pneumonia from 6 hospitals. Demographics, symptomatic features, laboratory and computed tomography data were analyzed using the least absolute shrinkage and selection operator (LASSO) to select potential diagnostic indicators. Binary logistic regression was used to develop a diagnostic nomogram. Another 119 patients with pneumonia admitted at Sichuan Provincial Peoples Hospital was used as the validation group. The diagnostic performance of the nomogram was measured by area under the receiver-operating-characteristics curve (AUC), calibration curves, and the net benefit by decision curve. PJP prevalence was 25.3% in the development group. LASSO regression revealed that age, lymphocyte count, fever, dry cough, respiratory failure, ground-glass opacity in lungs, glucocorticoid therapy duration, and immunosuppressive therapy were indicators of PJP. The nomogram showed robust discrimination, with an AUC of 0.82 (95% CI 0.77-0.86) in the development group and an AUC of 0.87 (95% CI 0.80-0.94) in the validation group, both showing acceptable calibration. In the decision curve analysis, our model consistently achieved a greater net benefit across almost all ranges of clinical thresholds. We developed a nomogram with good diagnostic power for PJP diagnosis in pneumonia patients receiving oral glucocorticoids. This nomogram may help promote timely treatment of PJP and thus reduce the mortality rate in these patients.

Demographic Factors Among HIV Confirmed Blood Donors from 2013 to 2021 in Shenzhen.

New HIV (Human immune deficiency virus) infections are continuously increasing in China and it remains a huge challenge to blood donation. As access to health services has affected by COVID-19 (Corona virus disease 2019) pandemic, a drop in new diagnoses (especially HIV) was observed worldwide. During 2013-2021, 735,247 specimens from unpaid blood donors collected by Shenzhen Blood Center underwent ELISA (Enzyme -linked immunosorbent assay) and NAT (Nucleic acid test). Samples with reactivity results were sent to the Shenzhen Center for Disease Control and Prevention for WB (Western blot). All data were statistically analyzed by the Chi-Square test. From 2013 to 2021, the prevalence of HIV among male blood donors was higher than in females (P < 0.01). During the COVID-19 pandemic, the prevalence of HIV among repeat blood donors decreased significantly compared to 2019 (P < 0.05), and the characteristics of blood donors changed in 2020 compared to 2019 and 2021. The high proportion of female blood donors would help prevent HIV from getting into the blood supply. The COVID-19 pandemic affected the demographics of blood donors as well as the prevalence of HIV among repeat blood donors. An increased number of repeat blood donors can help decrease the risk of HIV transfusion transmission during the epidemic.

Artificial Intelligence and Machine Learning Based Prediction of Viral Load and CD4 Status of People Living with HIV (PLWH) on Anti-Retroviral Treatment in Gedeo Zone Public Hospitals.

Despite the success made in scaling up HIV treatment activities, there remains a tremendous unmet demand for the monitoring of the disease progression and treatment success, which threatens HIVAIDS treatment and control. This research presented the assessments of viral load and CD4 classification of adults enrolled in ART care using machine learning algorithms. We trained, validated, and tested eight machine learning (ML) classifier algorithms with historical data, including demographics, clinical, and laboratory data. Data were extracted from the ART registry database of Yirgacheffe Primary Hospital and Dilla University Referral Hospital. ML classifiers were trained to predict virological failure (viral load >1000 copiesmL) and poor CD4 (CD4 cell count <200 cellsmL). The model predictive performances were evaluated using accuracy, sensitivity, specificity, precision, f1-score, F-beta scores, and AUC. The mean age of the sample participants was 41.6 years (SD 10.9). The experimental results showed that XGB classifier ranked as the best algorithm for viral load prediction in terms of sensitivity (97%), f1-score (96%), AUC (0.99), accuracy (96%), followed by RF. The GB classifier exhibited a better predictive capability in predicting participants with a CD4 cell count <200 cellsmL. In this study, the XGB and RF models had the highest accuracy and outperformed on various evaluation metrics among the models examined for viral load classification. In the prediction of participants CD4, GB model had the highest accuracy.

Non-hepatitis-associated mixed cryoglobulinemia with polyclonal plasma cells disease and alcoholic cirrhosis A rare case report.

Mixed cryoglobulinemia refers to the serum presence of a variety of cryoglobulins, which are defined as immunoglobulins that precipitate at temperatures of < 37°C. The most common cause of mixed cryoglobulinemia is hepatitis C virus (HCV), while other infections, including hepatitis B virus (HBV) and HIV infections, and lymphoproliferative and autoimmune disorders have also been associated with the disease. We reported a rare case of type II-III mixed cryoglobulinemia caused by alcoholic cirrhosis. We need to increase the awareness of and facilitate the early identification of mixed cryoglobulinemia in our clinical study when encountering a patient with liver cirrhosis combined with renal impairment so that treatment can begin early to improve the success rate of therapy and reduce the fatality rate in a potentially life-saving therapy.

Utilizing the codon adaptation index to evaluate the susceptibility to HIV-1 and SARS-CoV-2 related coronaviruses in possible target cells in humans.

Comprehensive identification of possible target cells for viruses is crucial for understanding the pathological mechanism of virosis. The susceptibility of cells to viruses depends on many factors. Besides the existence of receptors at the cell surface, effective expression of viral genes is also pivotal for viral infection. The regulation of viral gene expression is a multilevel process including transcription, translational initiation and translational elongation. At the translational elongation level, the translational efficiency of viral mRNAs mainly depends on the match between their codon composition and cellular translational machinery (usually referred to as codon adaptation). Thus, codon adaptation for viral ORFs in different cell types may be related to their susceptibility to viruses. In this study, we selected the codon adaptation index (CAI) which is a common codon adaptation-based indicator for assessing the translational efficiency at the translational elongation level to evaluate the susceptibility to two-pandemic viruses (HIV-1 and SARS-CoV-2) of different human cell types. Compared with previous studies that evaluated the infectivity of viruses based on codon adaptation, the main advantage of our study is that our analysis is refined to the cell-type level. At first, we verified the positive correlation between CAI and translational efficiency and strengthened the rationality of our research method. Then we calculated CAI for ORFs of two viruses in various human cell types. We found that compared to high-expression endogenous genes, the CAIs of viral ORFs are relatively low. This phenomenon implied that two kinds of viruses have not been well adapted to translational regulatory machinery in human cells. Also, we indicated that presumptive susceptibility to viruses according to CAI is usually consistent with the results of experimental research. However, there are still some exceptions. Finally, we found that two viruses have different effects on cellular translational mechanisms. HIV-1 decouples CAI and translational efficiency of endogenous genes in host cells and SARS-CoV-2 exhibits increased CAI for its ORFs in infected cells. Our results implied that at least in cases of HIV-1 and SARS-CoV-2, CAI can be regarded as an auxiliary index to assess cells susceptibility to viruses but cannot be used as the only evidence to identify viral target cells.

There Are Just Too Many Rooms Here Perception of Clients and Health Care Workers on the Implementation of Test and Treat Strategy at Area 25 Health Center in Lilongwe, Malawi.

Stable HIV decoy receptor expression after in vivo HSC transduction in mice and NHPs Safety and efficacy in protection from SHIV.

We aim to develop an in vivo hematopoietic stem cell (HSC) gene therapy approach for persistent controlprotection of HIV-1 infection based on the stable expression of a secreted decoy protein for HIV receptors CD4 and CCR5 (eCD4-Ig) from blood cells. HSCs in mice and a rhesus macaque were mobilized from the bone marrow and transduced by an intravenous injection of HSC-tropic, integrating HDAd535 vectors expressing rhesus eCD4-Ig. In vivo HSC transductionselection resulted in stable serum eCD4-Ig levels of ∼100 μgmL (mice) and >20 μgmL (rhesus) with half maximal inhibitory concentrations (IC

Aleukemic Acute Promyelocytic Leukemia How Concomitant HIV, Hepatitis C, and Chronic Alcohol Use Disorder May Have Hidden an Underlying Malignancy.

BACKGROUND Acute promyelocytic leukemia (APL) is a rare subtype of acute myeloid leukemia (AML) and is characterized by a genetic translocation affecting the retinoic acid receptor-alpha gene, leading to blockage in the differentiation of granulocytic cells. The accumulation of promyelocytes in bone marrow leads to cytopenias and life-threatening coagulopathies. Definitive diagnosis is made with bone marrow biopsy. Differentiation of APL from other leukemias is important to appropriately treat with all-trans retinoic acid (ATRA) and arsenic trioxide. Patients with HIV are at a higher risk to develop AML. This article identifies how multiple comorbidities and social factors can contribute to difficulties in diagnosing AML. CASE REPORT We present a 67-year-old man with a past medical history of hypertension and substance use disorder who presented with progressive exertional dyspnea and was found to have HIV, chronic hepatitis C, and APL with pancytopenia. His bone marrow biopsy confirmed AML. This was a case of co-existing HIV and aleukemic leukemia. CONCLUSIONS APL can present with pancytopenia, weakness, failure to thrive, or bleeding complications, which can be similar to presentations of those diagnosed with HIV. Diagnosis of APL can be differentiated between hypergranular and hypogranular our patient demonstrated APL with only 52% blasts, which can make for a challenging diagnosis. Given increased mortality of APL, immediate ATRA therapy is warranted. Aleukemic leukemia is a rare presentation typically accompanied by skin manifestations. Our case highlights the importance of having high clinical suspicion for malignancy in patients with comorbidities that can interfere with the classic presentation of leukemia.

Co-administration of alcohol and combination antiretroviral therapy (cART) in male Sprague Dawley rats A study on testicular morphology, oxidative and cytokines perturbations.

Alcohol consumption alongside combination antiretroviral therapy (cART) has attracted research interest, especially because of increasing male infertility. This study investigated the combined effects of alcohol and cART on testicular morphology, biomarkers of oxidative stress, inflammation, and apoptosis. Rats, weighing 330-370 g, were divided into four groups of six animals each control, alcohol treated (A), cART, and alcohol plus cART treated (AcART). Following 90 days treatment period, animals were euthanized, testis extracted, and routinely processed for histology and immunohistochemical analysis. Significantly decreased epithelial area fraction, increased luminal and connective tissue area fractions, and reduction of epithelial height and spermatocyte number, were recorded in the treated groups compared to control. Extensive seminiferous epithelial lesions including widened intercellular space, karyolysis, and sloughing of germinal epithelium were recorded in all the treated groups. Furthermore, upregulation of inducible nitric oxide synthase and 8-hydroxydeoxyguanosine, interleukin-6, and caspase 3 recorded in treated animals, was more significant in AcART group. Also, the levels of interleukin-1β and tumor necrosis factor-α were more elevated in A and cART treated groups than in AcART, while MDA was significantly elevated in cART and AcART treated groups compared to control group. Altogether, the results indicate testicular toxicity of the treatments. It is concluded that consuming alcohol or cART induces oxidative stress, inflammation, and apoptosis in testis of rats, which lead to testicular structural and functional derangements, which are exacerbated when alcohol and cART are consumed concurrently. The result will invaluably assist clinicians in management of reproductive dysfunctions in male HIVAIDS-alcoholic patients on cART.

Need for integration of hepatitis C (HCV) services in community-based settings for people who inject drugs results from a global values and preferences survey.

To inform the development of updated World Health Organization (WHO) guidelines on simplified service delivery for HCV infection, a global survey was undertaken among people affected or infected by HCV. The objective of this analysis is to identify specific needs and preferences among people who inject drugs. A multi-country, anonymous, self-administered online survey conducted in 2021 was developed by Coalition PLUS and the World Hepatitis Alliance in partnership with the WHO. Preferences for test and treat locations and simplifying HCV care were collected among people affected or infected by HCV. Chi-square tests were used to compare respondents who identified with current or former injection drug users through identification with key population to other respondents who did not identify with this key population. Among 202 respondents, 62 (30.7%) identified with currentformer injection drug users. Compared to other respondents, they were older median (IQR) 48 (36-57) vs. 39 (31-51) years, p 0.003 more likely to have been tested for HCV (90.2% vs. 64.3%, p 0.001) more likely to prefer testing in a community-based centre (CBC) (55.4% vs. 33.3%, p 0.005) or in a support centres for people who use drugs (SCPUD)(50.0% vs. 9.8%, p < 0.001). The most important considerations regarding testing locations among people identified with currentformer injection drug users (compared to the other respondents) were non-judgemental atmosphere (p < 0.001), anonymity (p 0.018) and community worker (CW) presence (p < 0.001). People identified with currentformer injection drug users were more likely to prefer to receive HCV treatment in a CBC (63.0% vs. 44.8%, p 0.028) or in a SCPUD (46.3% vs. 9.5%, p < 0.001), compared to the other respondents. The most important considerations regarding treatment locations among people identified with currentformer injection drug users were the non-stigmatisingnon-judgemental approach at the site (p < 0.001) and the presence of community-friendly medical personnel or CW (p 0.016 and 0.002), compared to the other respondents. The preferences of people identified with currentformer injection drug users indicated specific needs concerning HCV services. Integration of HCV services in community-based risk reduction centres may be an important element in the development of adapted services to increase uptake and retention in HCV care among this population.

Affordable drug resistance genotyping of HIV-1 reverse transcriptase, protease and integrase genes, for resource limited settings.

As use of dolutegravir (DTG) becomes more common in resource limited settings (RLS), the demand for integrase resistance testing is increasing. Affordable methods for genotyping all relevant HIV-1 pol genes (i.e., protease (PR), reverse transcriptase (RT) and integrase (IN)) are required to guide choice of future antiretroviral therapy (ART). We designed an in-house HIV-1 drug resistance (HIVDR) genotyping method that is affordable and suitable for use in RLS. We obtained remnant plasma samples from CAPRISA 103 study and amplified HIV-1 PR, RT and IN genes, using an innovative PCR assay. We validated the assay using remnant plasma samples from an external quality assessment (EQA) programme. We genotyped samples by Sanger sequencing and assessed HIVDR mutations using the Stanford HIV drug resistance database. We compared drug resistance mutations with previous genotypes and calculated method cost-estimates. From 96 samples processed, we obtained sequence data for 78 (81%), of which 75 (96%) had a least one HIVDR mutation, with no major-IN mutations observed. Only one sample had an E157Q INSTI-accessory mutation. When compared to previous genotypes, 1878 (23%) had at least one discordant mutation, but only 278 (3%) resulted in different phenotypic predictions that could affect choice of subsequent regimen. All CAPRISA 103 study sequences were HIV-1C as confirmed by phylogenetic analysis. Of the 7 EQA samples, 4 were HIV-1C, 2 were HIV-1D, and 1 was HIV-1A. Genotypic resistance data generated using the IDR method were 100% concordant with EQA panel results. Overall genotyping cost per sample was estimated at US$43-$US49, with a processing time of 2 working days. We successfully designed an in-house HIVDR method that is suitable for genotyping HIV-1 PR, RT and IN genes, at an affordable cost and shorter turnaround time. This HIVDR genotyping method accommodates changes in ART regimens and will help to guide HIV-1 treatment decisions in RLS.

Ultra-long-acting in-situ forming implants with cabotegravir protect female macaques against rectal SHIV infection.

Ultra-long-acting delivery platforms for HIV pre-exposure prophylaxis (PrEP) may increase adherence and maximize public health benefit. We report on an injectable, biodegradable, and removable in-situ forming implant (ISFI) that is administered subcutaneously and can release the integrase inhibitor cabotegravir (CAB) above protective benchmarks for more than 6 months. CAB ISFIs are well-tolerated in female mice and female macaques showing no signs of toxicity or chronic inflammation. In macaques, median plasma CAB concentrations exceed established PrEP protection benchmarks within 3 weeks and confer complete protection against repeated rectal SHIV challenges. Implant removal via a small incision in 2 macaques at week 12 results in a 7- to 48-fold decrease in plasma CAB levels within 72 hours. Modeling to translate CAB ISFI dosing suggests that a 3 mL injection would exceed protective benchmarks in humans for over 5 months post administration. Our results support the clinical advancement of CAB ISFIs for ultra-long-acting PrEP in humans.

Visualizing RNA conformational and architectural heterogeneity in solution.

RNA flexibility is reflected in its heterogeneous conformation. Through direct visualization using atomic force microscopy (AFM) and the adenosylcobalamin riboswitch aptamer domain as an example, we show that a single RNA sequence folds into conformationally and architecturally heterogeneous structures under near-physiological solution conditions. Recapitulated 3D topological structures from AFM molecular surfaces reveal that all conformers share the same secondary structural elements. Only a population-weighted cohort, not any single conformer, including the crystal structure, can account for the ensemble behaviors observed by small-angle X-ray scattering (SAXS). All conformers except one are functionally active in terms of ligand binding. Our findings provide direct visual evidence that the sequence-structure relationship of RNA under physiologically relevant solution conditions is more complex than the one-to-one relationship for well-structured proteins. The direct visualization of conformational and architectural ensembles at the single-molecule level in solution may suggest new approaches to RNA structural analyses.

A molecular switch modulates assembly and host factor binding of the HIV-1 capsid.

The HIV-1 capsid is a fullerene cone made of quasi-equivalent hexamers and pentamers of the viral CA protein. Typically, quasi-equivalent assembly of viral capsid subunits is controlled by a molecular switch. Here, we identify a Thr-Val-Gly-Gly motif that modulates CA hexamerpentamer switching by folding into a 3

Fertility Desire and Associations with Condomless Sex, Antiretroviral Adherence, and Transmission Potential in a Cohort of Kenyan Women Living with HIV in Sero-discordant Relationships A Mixed Methods Study.

For women living with HIV (WLH) in serodiscordant partnerships, decisions about childbearing can challenge condom use and antiretroviral adherence. In a prospective cohort of 148 WLH in serodiscordant partnerships, 58 (39%) wanted more children in the future but were not currently trying to conceive (fertility desire), and 32 (22%) were currently trying to become pregnant (fertility intent). Detection of prostate specific antigen (PSA) in vaginal secretions, a marker for recent condomless sex, was lowest in women with fertility desire and highest in women with fertility intent. Detectable viral load followed a similar pattern. Risk of HIV transmission, when condomless sex and PSA detection occurred concurrently, was three to fourfold higher at visits with fertility intent compared to visits with fertility desire. Qualitative interviews underscored the importance women place on childbearing and suggested that they had limited information about the role of antiretroviral therapy in reducing sexual HIV transmission.

Usefulness of artery femoral ultrasound complementary to carotid exploration for the detection of subclinical atheromatosis in patients with human immunodeficiency virus infection.

Detection of subclinical atheromatosis disease (SAD) in patients with human immunodeficiency virus (HIV) infection is usually based on carotid ultrasound. However, studies in other pathologies have shown a probable underestimation of SAD when its detection is exclusively based on carotid exploration. This study evaluates the impact on detection of SAD in patients with HIV through combined carotid and femoral exploration. Cross-sectional and prospective study of patients with HIV, diagnosed between 2008-2017. Carotid and femoral ultrasound examination was performed in all patients. EAS was defined according to Mannheim criteria. One hundred two patients were included (mean age 40 years, 73.5% being male). The prevalence of carotid SAD in the total sample was 15.7% (n16), and the prevalence of femoral SAD was 18.6% (n19). The proportion of patients with global SAD criteria (carotid or femoral) was 23.5% (n24), which implies an absolute increase in SAD detection of 7.84% (95% CI 2.63-13.06%) at the total sample. Detection of SAD is significantly increased by the combined use of carotid and femoral arterial ultrasound in the population affected by HIV infection.

Prevalence of

To summarise the prevalence of We searched MEDLINE, Embase, Web of Science and Global Index Medicus up to 30 September 2022. We included studies reporting the prevalence of MG andor antibiotic-resistant MG infection among PrEP users. Two reviewers independently searched for studies and extracted data. A systematic review with random-effects meta-analysis was performed to quantitatively summarise the results of included studies. The critical appraisal of included studies was conducted with the Joanna Briggs Institute checklist for prevalence studies and the quality of evidence was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE). A total of 15 studies were included in the systematic review, with 2341 individuals taking PrEP. Studies were conducted in high-income level countries between 2014 and 2019. Median age of participants varied from 23.5 to 40 years. The majority were men (85%) and among them, 93% were men who have sex with men. To identify MG, urine samples were analysed in 14 studies, rectal or anal swabs in 12 studies, oral or pharyngeal swabs in 9 studies, and urethral or vaginal in 3 studies. The pooled point prevalence of MG among PrEP users was 16.7% (95% CI 13.6% to 20.3% 95% prediction interval (95% PI) 8.2% to 31.1%). The pooled point prevalence of macrolide-resistant infections was 82.6% (95% CI 70.1% to 90.6% 95% PI 4.7% to 99.8%) and the prevalence of fluoroquinolone-resistant infections was 14.3% (95% CI 1.8% to 42.8%). Individuals taking PrEP have a higher chance of being infected with MG compared with those not taking PrEP (OR 2.30 95% CI 1.6 to 3.4). The quality of evidence was very low to moderate. We observed a high prevalence of MG and its macrolide resistance among PrEP users, highlighting the need to reinforce prevention strategies against sexually transmitted infections in this population. CRD42022310597.

Insufficient PrEParation an assessment of primary care prescribing habits and use of pre-exposure prophylaxis in patients at risk of HIV acquisition at a single medical centre.

To assess HIV pre-exposure prophylaxis (PrEP) prescribing habits by primary care providers and the number of patients at risk of HIV acquisition at a single medical centre in the Northwestern USA from 1 July 2018 to 31 June 2020. An electronic cross-sectional survey was administered in April and May 2021 to providers in family medicine, internal medicine, adolescent and young adult health, student health and womens health clinics affiliated with the medical centre with questions pertaining to PrEP prescribing practices. Electronic medical record abstraction was used to quantify the number of eligible patients who sought care in primary care departments and the adherence to PrEP initiation guidelines from 1 July 2018 to 31 June 2020. 74% (6182) of providers reported familiarity with national clinical practice guidelines for the prevention of HIV infection. 50% (4182) of respondents were located in family medicine clinics. 57% (4782) of providers counseled less than one-quarter of those who they identified as at risk of HIV infection. The major barriers to prescribing PrEP were insufficient time and lack of familiarity with guidelines. Of the 4330 eligible patients for PrEP, 8% (3374330) received at least one PrEP prescription during the study period. For patients newly prescribed PrEP, only 23% (39170) had appropriate counseling and labs at initiation. The top three qualifying indications for PrEP were identifying as transgender (36%, n1562), high-risk sexual behaviour (32%, n1405) and injection drug use (30%, n1289). This study highlights intervention points in the HIV prevention cascade warranting attention in order to achieve the 2025 Ending the HIV Epidemic in the U.S. target for PrEP coverage. These include increasing provider adherence to prescribing guidelines and reducing the logistical barriers to prescribing.

Accuracy of Sexual and Reproductive Health information among adolescent girls a cross-sectional study.

The leading cause of death for girls aged 15-19 years globally is complications from pregnancy and childbirth. Girls have poor access to Sexual and Reproductive Health (SRH) services including information. We describe accuracy of SRH information (SRHI) and its associated factors among adolescent girls in Uganda. We conducted a cross-sectional study among girls aged 13-19 years in an urban and rural district. Accuracy of SRHI was assessed using a set of 13 questions covering Sex and reproduction, condom use and HIV and other sexually transmitted diseases. Accuracy was categorized as low (≤7 items correct), moderate (8-11 items correct) and high accuracy (≥12 items) according to the number of correct answers. Poisson regression analysis was used to determine factors associated with accurate SRHI using STATA version 14. Of the 600 girls, mean age 16.9 years (SD 3.84), 75.3% were in-school. The mean score of SRHI knowledge was 9.9. SRHI accuracy score was low among 6.3% of adolescents, moderate among 80.7% and high among 13%. Parents with permissive parenting styles had adolescents with low accuracy of SRHI compared to the disciplinarianauthoritarian parents IRR 0.93(0.885-0.987) P0.004, while parents talking about sex with their adolescents was associated with accurate SRHI IRR 1.1 (1.051-1.153) P<0.001. Adolescents who had ever been pregnant had low accuracy of SRHI 0.98 (0.911-0.989) P0.019. There was no difference in accuracy of SRHI between the urban or rural districts (P0.45). The low accuracy of SRH information calls for interventions aimed at engaging and training parents who are considered to be the first in line to provide accurate information to adolescents irrespective of their location. The interventions and training should be culturally appropriate and parents need to be supported with skills aimed at demystifying sexual and reproductive health information.

Chronic medical conditions associated with invasive pneumococcal diseases in inpatients in teaching hospitals in São Paulo city Estimating antimicrobial susceptibility and serotype-coverage of pneumococcal vaccines.

Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI) PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities healthy, without comorbidities at-risk, included immunocompetent persons with specific medical conditions high-risk, with immunocompromising conditions and others RESULTS 406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n 211), cancer (28%), HIVAIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each) 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was PCV10, 19.1%, PCV13, 43.8% PCV15, 47.8% PCV20, 62.9% PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly.

Predictors of hepatitis C cure among people who inject drugs treated with directly observed therapy supported by peer case managers in Kenya.

Directly observed therapy (DOT) maximizes adherence and minimizes treatment gaps. Peer case managers (PCM) have also shown promise as a component of integrated HCV treatment strategies. DOT and PCM-support have been underexplored, particularly in low- and middle-income countries (LMICs). The objective of this study was to evaluate predictors of sustained virologic response (SVR) among people who inject drugs (PWID) attending medication-assisted treatment (MAT) and needle and syringe programs (NSP) sites in Kenya. We recruited PWID accessing MAT and NSP in Nairobi and Coastal Kenya. PWID were treated with ledipasvirsofosbuvir using DOT supported by PCMs. We used bivariate and multivariate logistic regression to examine the impact of sociodemographic, behavioral, and clinical factors on SVR. Among 92 PWID who initiated HCV treatment, 79 (86%) were male with mean age of 36.3 years (SD±6.5) 38 (41%) were HIV-positive, and 87 (95%) reported injecting drugs in the last 30 days. Just over half of participants were genotype 1a (55%), followed by genotype 4a (41%) and mixed 1a4a (3%). Most participants, 85 (92%) completed treatment and 79 (86%) achieved SVR. While sociodemographic and behavioral factors including recent injection drug use were not significantly associated with achieving SVR, being fully adherent (p0.042), number of doses taken (p0.008) and treatment completion (p 0.001) were associated with higher odds of achieving SVR. DOT with PCM-support was an effective model for HCV treatment among PWID in this LMIC setting. Adherence was the most important driver of SVR suggesting DOT and PCM support can overcome other factors that might limit adherence. Further research is necessary to ascertain the effectiveness of other models of HCV care for PWID in LMICs given NSP and MAT access is variable, and DOT may not be sustainable with limited resources.

Prevalence of and risk factors for Human Immunodeficiency Virus (HIV) infection in entrants and residents of an Ethiopian prison.

Prisoners generally have a higher prevalence of HIV infection compared to the general population from which they come. Whether this higher prevalence reflects a higher HIV prevalence in those entering prisons or intramural transmission of HIV within prisons or both is unclear. Any of these possibilities would increase the prevalence found in resident prisoners above that in the general population. Moreover, comparisons of HIV prevalence in entrants and residents and in men and women in African prisons are not well documented. The purpose of this study was to estimate and compare the prevalence and risk factors for HIV infection amongst both male as well as female and entrant and resident prisoners in a large Ethiopian Federal Prison. We studied consenting prisoners cross-sectionally from August 2014 through November 2016. Prison entrants were screened continuously for HIV infection and its associated risk factors and residents were screened in two waves one year apart. HIV was diagnosed at the prison hospital laboratory based on the Ethiopian national HIV rapid antibody testing protocol. An external, internationally-accredited reference laboratory confirmed results. Agreement of results between the laboratories were assessed. A total of 10,778 participants were screened for HIV. Most participants were young (median age of 26 years, IQR 21-33), male (84%), single (61%), literate (89%), and urban residents (91%) without prior incarceration (96%). Prevalence of HIV was 3.4% overall. Rates of HIV (p 0.80) were similar in residents and entrants in wave 1 and in entrants in both waves, but were 1.9-fold higher (5.4% vs 2.8%) in residents than entrants in wave 2 (both p<0.001). At entrance to the prison women were more likely to be HIV than men (5.5% in women vs 2.5% in men, p< 0.001). In contrast resident women were less likely to be HIV, but this difference was not statistically significant (3.2% in women vs 4.3% in men, p 0.125). Other risk factors associated with HIV infection were increasing age (p<0.001), female gender (p<0.001), marital status (never vs other categories, p 0.016), smaller number of rooms in their houses pre-imprisonment (p 0.031), TB diagnosis ever (p<0.001), number of lifetime sex partners (especially having 2-10, p<0.001), and genital ulcer (p 0.037). Prevalence of HIV in the residents at this large, central Ethiopian prison was higher than that estimated for the general population and lower than in many other studies from other smaller Ethiopian prisons. A higher prevalence in residents than in entrants were found only in our second wave of screening after one year of continuous screening and treatment, possibly representing increased willingness of residents at increased risk of HIV to participate in the second wave. Thus, this findings did not clearly support intramural transmission of HIV or the effectiveness of screening to reduce prevalence. Finally, the higher HIV prevalence in women than men requires that they be similarly screened and treated for HIV infection.

The forgotten people Hepatitis B virus (HBV) infection as a priority for the inclusion health agenda.

Hepatitis B virus (HBV) infection represents a significant global health threat, accounting for 300 million chronic infections and up to 1 million deaths each year. HBV disproportionately affects people who are under-served by health systems due to social exclusion, and can further amplify inequities through its impact on physical and mental health, relationship with stigma and discrimination, and economic costs. The inclusion health agenda focuses on excluded and vulnerable populations, who often experience barriers to accessing healthcare, and are under-represented by research, resources, interventions, advocacy, and policy. In this article, we assimilate evidence to establish HBV on the inclusion health agenda, and consider how this view can inform provision of better approaches to diagnosis, treatment, and prevention. We suggest approaches to redress the unmet need for HBV interventions among excluded populations as an imperative to progress the global goal for the elimination of viral hepatitis as a public health threat.

Acceptability and retention of the key population-led HIV treatment service for men who have sex with men and transgender women living with HIV in Thailand.

In Thailand, where the HIV epidemic is concentrated among key populations (KPs), particularly men who have sex with men (MSM) and transgender women (TGW), an HIV service delivery model tailored to KPs was piloted. This study evaluated the acceptability and retention of clients who accepted and declined the KP-led HIV treatment service. A retrospective cohort study was conducted using secondary data from three community-based organizations (CBOs) and three hospitals in Thailand. KP lay providers were trained to lead HIV treatment service in which MSM and TGW living with HIV received counselling and a 3-month antiretroviral therapy (ART) supply at CBOs. Thai MSM and TGW who were at least 18 years, on ART for at least 6-12 months, without co-morbiditiesco-infections, and virally suppressed were eligible and offered the service. Those who declined received ART via other service models offered by the hospitals and served as a comparison group. Of 220 clients screened between February 2019 and February 2020, 72% (159220) were eligible of which 146 were MSM and 13 were TGW. Overall, 45% (72159) accepted the KP-led service. Of those who declined, 98% (8587) preferred to see the physician at the hospital. After 12 months of follow-up, among those accepted, 57% were in care at the CBO, 32% were referred back to and in care in other service models offered by the hospital, 10% were successfully transferred out to other hospital and 1% were lost to follow-up (LTFU) among those declined, 92% were in care in any service models offered by the hospital, 5% were successfully transferred out to other hospital, 2% were LTFU and 1% died (p-value<0.001). Despite moderate acceptability and retention in care at the CBO among the clients accepting the KP-led service, almost all clients were engaged in care overall. Multiple service models that meet the preferences and needs of KPs living with HIV should be available to optimize engagement in care.

Necrotizing Blepharoconjunctivitis and Keratitis in Human Monkeypox.

Ophthalmic manifestations occur in less than 5% of patients with human mpox (monkeypox), most commonly presenting with self-limiting conjunctivitis and keratitis. Cases with severe ophthalmic complication are uncommon. To present a case of human mpox with sight-threatening necrotizing blepharoconjunctivitis. This is a report of a patient who developed necrotizing conjunctivitis due to the monkepox virus at a large university hospital. Data were collected from July to October 2022. Description of the progression and clinical evaluation of the ocular condition and the management. A 63-year-old HIV-positive man presented initially with conjunctivitis and eyelid swelling and developed skin lesions from monkeypox virus 2 days later. Despite remaining stable systemically, after 4 days, his ophthalmic condition evolved to necrotizing blepharoconjunctivitis for which systemic antiviral treatment with tecovirimat was given along with topical trifluoridine, 1%, eye drops. In addition, he required repeated tissue debridement with amniotic membrane grafting to preserve the eye integrity. The severity of this observation was associated with a coexisting immunocompromised state and appeared similar to findings associated with other orthopoxviruses. Ophthalmic manifestations could be the initial presentation of human mpox and could also be severe. Early recognition and intervention may limit the likelihood of substantial ocular morbidity.

Patterns of Infectious Disease Associated with Injection Drug Use in Massachusetts.

Since 2014, multiple outbreaks of HIV among people who inject drugs (PWID) have occurred across the United States along with hepatitis C (HCV), skin and soft tissue infections (SSTI) and infective endocarditis (IE), creating a converging public health crisis. We analyzed the temporal patterns of infectious disease and overdose (OD) using a hierarchical Bayesian distributed lag logistic regression model examining the probability that a given geographic area experienced at least one HIV case in a given month as a function of the countsrates of OD, HCV, SSTI, IE and associated medical procedures at different lagged time periods. Current-month HIV is associated with increasing HCV cases abscess incision and drainage, and SSTI cases, in distinct temporal patterns. For example, one additional HCV case occurring 5 and 7 months previously is associated with a 4% increase in the odds of observing at least one current-month HIV case in a given locale (odds ratios 1.04, 1.04 90% credible intervals 1.01-1.10, 1.00-1.09). No such associations were observed for echocardiograms, IE, or OD. Lagged associations in other infections preceding rises in current-month HIV counts cannot be described as predictive of HIV outbreaks but may point towards newly discovered epidemics of injection drug use and associated clinical sequalae, prompting clinicians to screen patients more carefully for substance use disorder and associated infections.

Cancer in Transgender and Gender-Diverse Persons A Review.

Transgender and gender-diverse individuals face unique challenges, including barriers to health care access and inequities in treatment, that may influence cancer risk and outcomes. In this narrative review, a scoping review was conducted focusing on primary and secondary prevention and epidemiology of cancer, barriers to health care services, and health care practitioners knowledge about specific issues pertaining to transgender and gender-diverse individuals. PubMed, the Cochrane Library, and Embase, were reviewed for citations from their inception to December 31, 2021. This review revealed that transgender and gender-diverse people had a high prevalence of tobacco consumption and alcohol use and high rates of infection with human papillomavirus (HPV) and HIV. Transgender and gender-diverse individuals were less likely to adhere to cancer screening programs and had a higher incidence of HIV- and HPV-associated cancers. Social and economic determinants seemed to drive these disparities in risk factors and outcomes. A lack of knowledge about gender minorities health needs among health care practitioners was evidenced, and it represented a major hurdle to cancer prevention, care, and survivorship for transgender and gender-diverse individuals. Discrimination, discomfort caused by gender-labeled oncological services, stigma, and lack of cultural sensitivity of health care practitioners were other barriers met by transgender and gender-diverse persons in the oncology setting. The findings suggest that transgender and gender-diverse peoples needs in the cancer care continuum are not optimally addressed. Effective solutions are needed to offer the best care to every patient in a person-centric and gender diversity-sensitive environment.

Tools for Screening and Measuring Anxiety Among Women Living with HIV of Reproductive Age A Scoping Review.

Emerging evidence suggests that women living with HIV (WLWH) may experience higher rates of anxiety than men living with HIV and women living without HIV. To date, relatively little knowledge exists on valid anxiety screening and diagnostic tools and how they are used among WLWH, specifically WLWH of reproductive age. Thus, the purpose of this scoping review was to describe what is known in the published literature about anxiety among WLWH and the tools used to measure and screen for anxiety in clinical and research contexts. The Arksey and OMalley methodological framework was used to guide a scoping review of published articles in PsycINFO, Scopus, Sociological Abstracts, and PubMed databases. Twenty-one measures of anxiety were used across the 52 articles identified in the search. Most measures used were self-report. Inconsistencies in standardized screening tools and cutoff scores were observed across studies. Further, measures to assess anxiety varied among studies focused on WLWH. Based on the results from this review, there is a need for consistent, valid measures of anxiety to advance research and clinical practice to support the well-being of WLWH.

Quantitative analysis of Epstein-Barr virus DNA in plasma and stomach biopsies of patients with gastric cancer.

Epstein-Barr virus (EBV) associated gastric carcinoma (EBVaGC) is a subtype of gastric cancer with distinct histological and molecular features. The study aimed to assess the EBV DNA copy number and the prevalence of EBVaGC in gastric cancer samples taken from Iranian patients. The next aim was to assess whether the DNA and microRNAs EBV are present in plasma. EBV load was analyzed in 68 gastric cancer biopsies and compared with the results of EBV-encoded small RNA in situ hybridization (EBER-ISH) test in these patients. After the detection of 6 EBV miRNAs in gastric tissue by stem-loop RT-PCR, plasma samples were evaluated for the viral load and EBV miRNAs. Four gastric cancer cases were EBER -ISH positive (5.8%), with a significantly higher viral load than the remaining cases, 47,781 vs. 1909 copiesμg of tissue DNA. Here, was also found a significant difference in plasma EBV load between EBER-positive and EBER-negative cases. Although EBV miRNAs were detectable in all the EBER-positive tumors, the test did not detect any of these miRNAs among the plasma samples tested. Our data indicate that the prevalence of EBVaGC among Iranian patients with gastric cancer is lower than the global prevalence and although none of the EBV miRNAs were detected in plasma, evaluation of EBV microRNAs in tumor tissue, especially miR-BART7-3p, may constitute useful biomarkers for diagnosis of EBVaGC.

Evaluation of a statewide online at-home STI and HIV screening program.

Innovative approaches such as online, at-home programs may address important barriers to sexually transmitted infection (STI) and HIV screening in the United States. This study evaluates the first year of a online, at-home program offering HIV and triple-site (urogenital, rectal, and pharyngeal) gonorrhea (GC) and chlamydia (CT) testing in Colorado. Test Yourself Colorado (TYC) is an online, at-home program that provides free mailed HIV tests andor GCCT tests to Colorado adults. Program use and outcomes between June 1, 2021 and May 31, 2022 were analyzed. A total of 1790 unique clients utilized TYC. Of 1709 clients who ordered HIV tests, 508 (29.7%) were men who have sex with men (MSM), and 41.3% (210508) of these clients reported having never been tested for HIV before or were not tested in the year prior. Hispanic clients had lower STI test return rates (37.1% 134361) compared to non-Hispanic clients (45.9% 5181128 P 0.003). Positive STI tests were identified in 9.6% (68708) of clients. Positive STI tests were more common in MSM clients (15.7% 34216) compared to all other sexual orientations (6.9% 34492 p < 0.001). STI treatment was confirmed in 80.9% (5568) of clients. The TYC online, home testing portal is a scalable tool that reaches clients at risk of STIs and HIV and navigates those with positive STI tests to treatment. HIVSTI home testing programs such as TYC need to further assess and address utilization and outcomes for disparities by race and ethnicity to assure programs equitably benefit all at-risk communities.

The effectiveness of digital sexual health interventions for young adults a systematic literature review (2010-2020).

There has been a proliferation of digital sexual health interventions targeting adolescents however, limited evaluative reviews have compared the effectiveness of multiple digital tools for sexual health literacy and behaviour change. This study conducted a systematic literature review, screened 9881 records and analysed 61 studies. Findings suggest that websites and mobile phones dominate digital sexual health interventions, with a majority effectively delivering cognitive (e.g. awareness and attitudes about sexual and reproductive health) and behavioural outcomes (e.g. abstinence and use of contraception). The most popular sexual health promotion mechanisms were interactive websites, text messaging and phone calls, and online education programmes, followed by mobile applications-fewer studies in this review utilized social media, games and multimedia. Previous reviews focused on single outcome measures (e.g. sexually transmitted infection testing) to assess interventions effectiveness. The current review moves beyond single outcome measures to cover a wider range of behavioural and non-behavioural sexual health issues and contexts covered in the literature. Four main categories were analysed as outcomes cognitive perceptions, promoting sexual health-related behaviours, promoting sexual health-related products and services, and impact (viral load). Seventy-nine per cent of interventions focused on preventive sexual health behaviours and products (e.g. condoms) and services (e.g. HIV testing). Overall, 75% of studies effectively changed sexual health behaviour and cognitive perceptions. However, the digital-only tools did not vary from the blended formats, in influence outcomes, even after categorizing them into behavioural or non-behavioural outcomes. Compared to previous systematic reviews, more studies from the last decade used rigorous research design in the form of randomized controlled trials, non-randomized control trials, and quasi-experiments and lasted longer. Sexual health literacy among adolescents is essential to avert unwanted pregnancies or abortions and sexually transmitted diseases. Culturally sensitive and age-appropriate interventions are required to educate youth about safe-sex practices and increase their self-efficacy and accessibility to health products and services. Meta-analytical and systematic literature reviews have identified limitations in traditional interventions that rely heavily on classroom-based activities and lectures to educate adolescents about safe sex. In recent years, digital tools have proved productive however, limited evaluative reviews have compared the effectiveness of multiple digital technologies (such as smartphones, web-based programs, social media, games and multimedia) used within sexual health interventions. This systematic review assessed 9881 articles and synthesized 61 experimental studies on adolescent sexual behaviour conducted in the last decade to identify tools that positively influence cognitive and safe-sex behaviour among youth. Interactive websites, mobile technology and online education programmes were popular promotional tools, but very few studies utilized multimedia alongside games and social media. Findings from this review could facilitate future research and practice in adolescent sexual health.

Relationships between Patient Race and Residential Race Context with Missed HIV Care Visits in the United States, 2010-2015.

Racial inequities exist in retention in HIV care and multi-level analyses are needed to contextualize and address these differences. Leveraging data from a multi-site clinical cohort of people with HIV (PWH), we assessed the relationships between patient race and residential characteristics with missed HIV care visits. Medical record and patient reported outcome (PRO, including mental health and substance use measures) data were drawn from seven participating Center for AIDS Research Network of Integrated Clinical Systems (CNICS) sites including N 20,807 PWH from January 2010 through December 2015. Generalized estimating equations were used to account for nesting within individuals and within census tracts in multivariable models assessing the relationship between race and missed HIV care visits controlling for individual demographic and health characteristics and census tract characteristics. Black PWH resided in more disadvantaged census tracts on average. Black PWH residing in census tracts with higher proportion of Black residents were more likely to miss an HIV care visit. Non-Black PWH were less likely to miss a visit regardless of where they lived. These relationships were attenuated when PRO data were included. Residential racial segregation and disadvantage may create inequities between Black PWH and non-Black PWH in retention in HIV care. Multi-level approaches are needed to retain PWH in HIV care accounting for community, healthcare setting, and individual needs and resources.

Prevalence of and risk factors for HCV among incarcerated people at Great Tehran Prison a cross-sectional study.

Hepatitis C is one of the major health issues in both developed and developing countries. Hepatitis C virus (HCV) infection is more common in prisoners than in the general population. The purpose of this study was to determine the prevalence of HCV and its associated risk factors in Iranian male prisoners in Tehran. In this cross-sectional study, the authors investigated the frequency and risk factors of hepatitis C infection among male prisoners in the Great Tehran Prison. Information on risk factors including the length of imprisonment, previous history of imprisonment, history of drug injection, history of tattooing, history of piercing, history of high-risk sex and family history of hepatitis C were extracted from patients records. To evaluate HCV status, blood samples were collected and tested. In this study, 179 participants were included. Nine participants (5.0%, 95% CI, 2.3-9.3) were positive for hepatitis C. HCV infection was not significantly associated with age, marital status, education, previous history of imprisonment, length of imprisonment, piercing and high-risk sex however, there was a significant association between a history of tattooing and a history of injecting drug use and Hepatitis C. The prevalence of hepatitis C among male prisoners in Great Tehran Prison was 5% in this study, similar to recent studies on prisoners in Tehran. A history of drug injections as well as tattooing were the most important risk factors for hepatitis C in male prisoners.

Monkeypox outbreak in Genoa, Italy clinical, laboratory, histopathologic features, management and outcome of the infected patients.

Since May 2022, multiple human Monkeypox cases were identified in non-endemic countries, mainly among men who have sex with men. We aimed to report the features, clinical course, management, and outcome of the Monkeypox cases diagnosed in the Dermatology and Infectious Disease Units of the San Martino Hospital, Genoa, Italy. We performed an observational study of the Monkeypox cases diagnosed from 1st July until 31st August 2022, collecting clinical, laboratory, and histological data. We studied 16 Monkeypox-infected men (14 homosexual, 2 bisexual) with a median age of 37 years. Three were HIV-infected. All patients reported multiple sexual partners andor unprotected sex in the two weeks before the diagnosis. Most patients had prodromal signssymptoms before the appearance of the skinmucosal eruption, consisting of erythematous papulesvesiclespustules in the anogenital area which tended to erode evolving into crusts and ulcers. Lesions were often associated with local andor systemic symptoms. Histopathology showed overlapping features in all cases epidermal ulceration and dermal inflammatory infiltrate consisting of lymphocytes and neutrophils with an interstitial and perivascularperi-adnexal pattern and endothelial swelling. Concomitant STIs (gonococcalnon-gonococcal proctitis and anal high-risk human papillomavirus HR-HPV infection) were frequent. Four patients were hospitalized, and one received specific treatment. The overall outcome was good. At the follow-up visit, three patients presented skin scars. Our series confirms the features of the current Monkeypox outbreak however, different from other studies, we found a considerable rate of concomitant STIs, such as anal HR-HPV infection, that should be kept in mind because this persistent infection is the main cause of anal cancers. This article is protected by copyright. All rights reserved.

Factors associated with partner notification intentions among symptomatic sexually transmitted infection service attendees in South Africa.

In South Africa (SA), a client-initiated partner notification (PN) approach is implemented for the management of sexual partners of patients presenting with sexually transmitted infections (STIs) or STI syndromes. To explore the demographic, sexual behavioural and clinical characteristics associated with PN intentions among symptomatic STI service attendees at sentinel primary healthcare facilities in three SA provinces. We analysed cross-sectional data obtained from 1 293 adults enrolled into STI aetiological surveillance during 2019 - 2020 in Gauteng, KwaZulu-Natal and Western Cape provinces. Self-reported sexual practices, PN intentions and clinical data were collected using nurse-administrated questionnaires. We assessed gender-stratified factors associated with the index cases willingness to notify their sexual partners of their STI syndrome diagnosis. Univariable and multivariable Poisson regression models with robust error variance were used to determine factors associated with gender-stratified PN intentions. The enrolled participants comprised 887 male (68.6%) and 406 female (31.4%) STI clients. Self-reported PN intentions were higher among women than men (83.5% v. 64.4% p<0.001). Multivariable analyses revealed that casual sex partnerships during the preceding 3-month period and enrolment at the KwaZulu-Natal site were independent barriers to PN intent among male participants. For females, enrolment at the Gauteng site was independently associated with lower PN intentions, while presenting with genital ulcer syndrome was a motivator towards PN intent. The primary reasons cited for non-disclosure across both genders were casual sexual encounters, followed by geographically distant partnerships and fear of disclosure. We show that demographic and behavioural characteristics, as well as relationship dynamics, may influence the PN intentions of STI service attendees in SA. Alternative PN strategies should be considered, based on the reported barriers, to increase overall STI notification, strengthen partner management and ultimately reduce STI incidence.

Peritoneal dialysis outcomes in a tertiary-level state hospital in Johannesburg, South Africa Ethnicity and HIV co-infection do not increase risk of peritonitis or discontinuation.

Peritoneal dialysis (PD) is a valuable means to increase access to kidney replacement therapy in South Africa (SA). An increased rate of modality discontinuation related to an increased risk of peritonitis in patients of black African ethnicity, in those with diabetes and in those living with HIV has previously been suggested, which may lead to hesitancy in adoption of PD first programmes. To analyse the safety of a PD-first programme in terms of 5-year peritonitis risk and patient and modality survival at the outpatient PD unit at Helen Joseph Hospital, Johannesburg. After exclusions, clinical data from 120 patients were extracted for analysis. The effects of patient age at PD initiation, ethnicity, gender, diabetes mellitus and HIV infection on patient and modality survival and peritonitis risk were analysed using Cox proportional hazards modelling and logistic regression analysis. Five-year technique and patient Kaplan-Meier survival curves for peritonitis and comorbidity groups were compared using the Cox-Mantel test. The Mann-Whitney U-test and Fishers exact test were used to compare continuous and categorical variables where appropriate. Five-year patient survival was 49.9%. Black African ethnicity was associated with reduced mortality hazard (hazard ratio (HR) 0.33 95% confidence interval (CI) 0.15 - 0.71 p0.004), and patients with diabetes had poorer 5-year survival (19.1% p0.097). Modality survival at 5 years was 48.1%. Neither Black African ethnicity nor HIV infection increased the risk of PD discontinuation. Peritonitis was associated with increased modality failure (HR 2.99 95% CI 1.31 - 6.87 p0.009). Black African ethnicity did not increase the risk of peritonitis. HIV was not independently associated with an increased risk of peritonitis. Patient and PD survival were generally similar to other contemporaneous cohorts, and the peritonitis rate in this study was within the International Society for Peritoneal Dialysis acceptable range. PD is a safe and appropriate therapy in a low socioeconomic setting with a high prevalence of HIV infection. Consideration of home circumstances and training in sterile technique reduce peritonitis risk and improve PD modality survival. Patients with diabetes may be at risk of poorer outcomes on PD.

Healthcare Delivery.

We report here on the process and findings of a research prioritisation exercise for universal health coverage (UHC) in South Africa, conducted during the course of 2019. As plans to roll out National Health Insurance (NHI) gather momentum and we transition into a pandemic recovery phase, we believe that it is now time to revisit these priorities, while recognising that experiences with the COVID-19 pandemic have revealed new system challenges and strengths and introduced new priorities. The UHC research priority-setting methodology followed a stepwise process of collation of evidence, expert brainstorming and the development of a survey completed by 68 members of the Public Health Association of South Africa. Themes related to leadership and governance were ranked most highly, and with other priorities generated, provide an initial road map of knowledge needs that could guide individual institutions and commissioning by funding bodies. We further reflect on the importance of researcher-decision-maker dialogue and strengthening the contribution of health policy and systems research to policy and practice, especially as new reforms are implemented.

Risk stratification of hospital admissions for COVID-19 pneumonia by chest radiographic scoring in a Johannesburg tertiary hospital.

Chest radiographic scoring systems for COVID-19 pneumonia have been developed. However, little is published on the utilityof these scoring systems in low- and middle-income countries. To perform risk stratification of COVID-19 pneumonia in Johannesburg, South Africa (SA), by comparing the Brixia score withclinical parameters, disease course and clinical outcomes. To assess inter-rater reliability and developing predictive models of the clinicaloutcome using the Brixia score and clinical parameters. Retrospective investigation was conducted of adult participants with established COVID-19 pneumonia admitted at a tertiaryinstitution from 1 May to 30 June 2020. Two radiologists, blinded to clinical data, assigned Brixia scores. Brixia scores were compared withclinical parameters, length of stay and clinical outcomes (dischargedeath). Inter-rater agreement was determined. Multivariable logisticregression extracted variables predictive of in-hospital demise. The cohort consisted of 263 patients, 51% male, with a median age of 47 years (interquartile range (IQR) 20 95% confidenceinterval (CI) 46.5 - 49.9). Hypertension (38.4%), diabetes (25.1%), obesity (19.4%) and HIV (15.6%) were the most common comorbidities.The median length of stay for 258 patients was 7.5 days (IQR 7 95% CI 8.2 - 9.7) and 6.5 days (IQR 8 95% CI 6.5 - 12.5) for intensivecare unit stay. Fifty (19%) patients died, with a median age of 55 years (IQR 23 95% CI 50.5 - 58.7) compared with survivors, of medianage 46 years (IQR 20 95% CI 45 - 48.6) (p0.01). The presence of one or more comorbidities resulted in a higher death rate (23% v. 9.2%p0.01) than without comorbidities. The median Brixia score for the deceased was higher (14.5) than for the discharged patients (9.0)(p<0.001). Inter-rater agreement for Brixia scores was good (intraclass correlation coefficient 0.77 95% CI 0.6 - 0.85 p<0.001). A modelcombining Brixia score, age, male gender and obesity (sensitivity 84% specificity 63%) as well as a model with Brixia score and C-reactiveprotein (CRP) count (sensitivity 81% specificity 63%) conferred the highest risk for in-hospital mortality. We have demonstrated the utility of the Brixia scoring system in a middle-income country setting and developed the first SArisk stratification models incorporating comorbidities and a serological marker. When used in conjunction with age, male gender, obesityand CRP, the Brixia scoring system is a promising and reliable risk stratification tool. This may help inform the clinical decision pathway inresource-limited settings like ours during future waves of COVID-19.

Self-reported beta-lactam allergy in government and private hospitals in Cape Town, South Africa.

Up to a quarter of inpatients in high-income countries (HICs) self-report beta-lactam allergy (BLA), which if incorrect,increases the use of alternative antibiotics, worsening individual health outcomes and driving bacterial resistance. In HICs, up to 95% ofself-reported BLAs are incorrect. The epidemiology of BLA in low- and middle-income African countries is unknown. To describe the epidemiology and de-labelling outcomes of self-reported BLA in hospitalised South African (SA) patients. Point-prevalence surveys were conducted at seven hospitals (adult, paediatric, government and privately funded, district andtertiary level) in Cape Town, SA, between April 2019 and June 2021. Ward prescription records and in-person interviews were conductedto identify and risk-stratify BLA patients using the validated PEN-FAST tool. De-labelling was attempted at the tertiary allergy clinic atGroote Schuur Hospital. A total of 1 486 hospital inpatients were surveyed (1 166 adults and 320 children). Only 48 patients (3.2%) self-reported a BLA,with a higher rate in private than in government-funded hospitals (6.3% v. 2.8% p0.014). Using the PEN-FAST tool, only 10.4% (n548)of self-reported BLA patients were classified as high risk for true penicillin hypersensitivity. Antibiotics were prescribed to 70.8% (n3448)of self-reported BLA patients, with 64.7% (n2234) receiving a beta-lactam. Despite three attempts to contact patients for de-labelling atthe allergy clinic, only 336 underwent in vivo testing, with no positive results, and 1 patient proceeded to a negative oral challenge. Unlike HICs, self-reported BLA is low among inpatients in SA. The majority of those who self-reported BLA were low risk fortype 1 hypersensitivity, but outpatient de-labelling efforts were largely unsuccessful.

Establishing an Academic-Community Partnership to Explore the Potential of Barbers and Barbershops in the Southern United States to Address Racial Disparities in HIV Care Outcomes for Black Men Living With HIV.

Black men comprise most new HIV infections in the Southern United States and have worse HIV outcomes than their non-Black counterparts. We developed an academic-community partnership in Nashville, Tennessee, to explore opportunities to improve HIV outcomes for Black men. We recruited barbers to an HIV training and focus group discussion about prevention and potential barberbarbershop-based strategies to address HIV-related needs for Black men. We assessed HIV knowledge and stigma with validated scales and conducted thematic analysis on discussion transcripts. HIV-related stigma was low (1.8 of 15 points

Prevalence of HIV Transmitted Drug Resistance in Nanjing from 2018 to 2021.

Transmitted drug resistance (TDR) is a major challenge in the clinical management of acquired immunodeficiency syndrome (AIDS). Therefore, this study aimed to investigate the epidemic characteristics of and risk factors for human immunodeficiency virus (HIV)-1 TDR in Nanjing from 2018 to 2021 to provide support for clinical management. The HIV-1 Pol gene was amplified by nested reverse transcription polymerase chain reaction from venous blood of 1190 HIV-infected patients who did not receive antiviral therapy, and the amplified product was sequenced using an in-house sequencing method. The sequencing result was compared with the HIV drug resistance database from Stanford University to elucidate the rates of antiviral drug resistance and distribution of drug-resistant mutation sites. Factors associated with TDR were evaluated using a logistic regression model. Detection of drug resistance at the gene level was successful in 1138 of 1190 HIV-1-infected patients (95.6%), and the overall 4-year drug resistance rate was 8.2% (931138). The drug resistance rate was higher for non-nucleoside reverse transcriptase inhibitors (NNRTIs 6.7%) than for nucleoside reverse transcriptase inhibitors (NRTIs 2.5%) or protease inhibitors (PIs 0.1%) ( The prevalence of TDR in the city of Nanjing from 2018 to 2021 was at a moderate epidemic risk according to World Health Organization standards. Continuous monitoring of TDR can inform clinical diagnosis and treatment. Patients with advanced disease and a low CD4

Contemporary progress in the green synthesis of spiro-thiazolidines and their medicinal significance a review.

The development of new strategies for the production of nitrogen and sulfur-containing heterocycles remains an extremely alluring but challenging proposition. Among these heterocyclic compounds, spiro-thiazolidines are a distinct class of heterocyclic motifs with an all-encompassing range of pharmaceutical activities such as anti-histaminic, anti-proliferative, anesthetic, hypnotic, anti-fungal, anti-inflammatory, anti-HIV, anthelmintic, CNS stimulant, and anti-viral potentials. Consequently, investigators have produced these heterocycles through diversified intricate pathways as object structures for medicinal studies. Notwithstanding their innumerable manmade solicitations, there is yet no special periodical on MCRs concerning spiro-thiazolidine

HIV prevalence and access to HIV testing and care in patients with psychosis in South Africa.

Human immunodeficiency virus (HIV) and psychosis share a complex bidirectional relationship, with people living with HIV being at increased risk of psychosis and those with psychosis at increased risk of HIV. However, people living with severe mental illness often have limited or reduced access to HIV testing and care. This study aimed to determine the prevalence of HIV and describe the access to HIV testing and care among adult patients with recent-onset psychosis who were admitted to a psychiatric hospital in KwaZulu-Natal (KZN) province, South Africa. A psychiatric hospital in Pietermaritzburg, KZN province, South Africa. A retrospective chart review of 294 patients with recent-onset psychosis admitted between May 2018 and November 2020. A total of 291 (99%) patients had access to HIV testing during the study period, with the HIV seroprevalence rate being 21.5% among the 294 patients HIV seropositivity was associated with the 25-49 age category (adjusted odds ratio aOR 3.09, 95% confidence interval CI 1.27-7.50), female gender (aOR 9.55, 95% CI 4.40-20.74), current alcohol and cannabis use (aOR 3.43, 95% CI 1.01-11.62), family history of psychosis (aOR 3.22, 95% CI 1.03-10.02) and no tertiary education (aOR 3.7, 95% CI 0.14-0.99). All those living with HIV were on antiretroviral treatment. This study showed that HIV testing and care was accessible at a psychiatric hospital but the prevalence of HIV in people living with recent onset psychosis remains high. The study findings suggest the importance of integrating mental health and HIV management.

Electroconvulsive therapy (ECT) with ketamine induction for catatonia in an HIV positive patient.

The successful use of ECT as treatment for catatonia, in the context of HIV (human immunodeficiency virus) infection, has been described previously. Ketamine has been used as an anaesthetic induction agent for ECT, although not considered the induction agent of choice. There are also case reports suggesting that ketamine may be an alternative treatment specifically for catatonia. This case report describes the management of a female patient who presented with catatonia, evidenced by stupor, waxy flexibility, mutism, negativism, and stereotypy, as well as stage four HIV infection, with poor response to previous psychotherapeutic interventions. We describe the course of management of this patient with ECT, following poor initial clinical response to ECT with propofol induction, the subsequent use of ketamine as an anaesthetic induction agent for ECT, with associated improvement in seizure quality, and good overall clinical response to ECT demonstrated thereafter. This case report suggests that ketamine may be a viable induction agent for ECT in this clinical setting.

Dual ankyrinG and subpial autoantibodies in a man with well-controlled HIV infection with steroid-responsive meningoencephalitis A case report.

Neuroinvasive infection is the most common cause of meningoencephalitis in people living with human immunodeficiency virus (HIV), but autoimmune etiologies have been reported. We present the case of a 51-year-old man living with HIV infection with steroid-responsive meningoencephalitis whose comprehensive pathogen testing was non-diagnostic. Subsequent tissue-based immunofluorescence with acute-phase cerebrospinal fluid revealed anti-neural antibodies localizing to the axon initial segment (AIS), the node of Ranvier (NoR), and the subpial space. Phage display immunoprecipitation sequencing identified ankyrinG (AnkG) as the leading candidate autoantigen. A synthetic blocking peptide encoding the PhIP-Seq-identified AnkG epitope neutralized CSF IgG binding to the AIS and NoR, thereby confirming a monoepitopic AnkG antibody response. However, subpial immunostaining persisted, indicating the presence of additional autoantibodies. Review of archival tissue-based staining identified candidate AnkG autoantibodies in a 60-year-old woman with metastatic ovarian cancer and seizures that were subsequently validated by cell-based assay. AnkG antibodies were not detected by tissue-based assay andor PhIP-Seq in control CSF (

Demographic profile of HIV and helminth-coinfected adults in KwaZulu-Natal, South Africa.

Helminth and HIV infections are endemic among poor populations. Studies investigating the socio-demographic and economic risk factors associated with dual HIV and helminth coinfection are scarce. This study aimed to describe risk factors associated with HIV and helminth coinfections among peri-urban South African adults residing in poorly developed areas with high poverty levels, lack of sanitation and a clean water supply. Adult participants ( Overall coinfection was 15%, and single helminth and HIV prevalence were 33% and 52%, respectively. Findings suggest that the dual infection with HIV and helminth infections among adults residing in under-resourced areas with poor sanitary conditions is frequent. Older age, poor toilet use and low income are associated with coinfection. More attention is required to break the cycle of coinfections and possible disease interactions. The study highlights the importance of determining and treating helminth infections among adult population during HIV and helminth coinfection and the influence of poor sanitation and socioeconomic status on disease transmission.

Challenges faced by the HIV testing system in low- and middle-income countries.

Determining the HIV status of some individuals remains challenging due to multidimensional factors such as flaws in diagnostic systems, technological challenges, and viral diversity. This report pinpoints challenges faced by the HIV testing system in Cameroon. A 53-year-old male received a positive HIV result by a rapid testing algorithm in July 2016. Not convinced of his HIV status, he requested additional tests. In February 2017, he received a positive result using ImmunoComb Given that the patient remained asymptomatic with no evidence of viral replication, no antiretroviral therapy was initiated. This case highlights the struggles faced by some individuals in confirming their HIV status and the need to update existing technologies and develop an algorithm for managing exceptional cases.

The microbiota as a modulator of mucosal inflammation and HIVHPV pathogenesis From association to causation.

Although the microbiota has largely been associated with the pathogenesis of viral infections, most studies using omics techniques are correlational and hypothesis-generating. The mechanisms affecting the immune responses to viral infections are still being fully understood. Here we focus on the two most important sexually transmitted persistent viruses, HPV and HIV. Sophisticated omics techniques are boosting our ability to understand microbiota-pathogen-host interactions from a functional perspective by surveying the host and bacterial protein and metabolite production using systems biology approaches. However, while these strategies have allowed describing interaction networks to identify potential novel microbiota-associated biomarkers or therapeutic targets to prevent or treat infectious diseases, the analyses are typically based on highly dimensional datasets -thousands of features in small cohorts of patients-. As a result, we are far from getting to their clinical use. Here we provide a broad overview of how the microbiota influences the immune responses to HIV and HPV disease. Furthermore, we highlight experimental approaches to understand better the microbiota-host-virus interactions that might increase our potential to identify biomarkers and therapeutic agents with clinical applications.

Primary Esophageal Lymphoma A Histopathological Experience from Two Tertiary Hospitals, Western Saudi Arabia.

Primary esophageal lymphoma (PEL) is a rare disorder. The objective of this study was to document the clinicopathological features of PEL at two tertiary hospitals in the western region of the Kingdom of Saudi Arabia. All PELs diagnosed between May 2002 and June 2022 were retrieved. Histopathological and immunohistochemical slides were reviewed. Additional immunohistochemistry stains were performed in selected cases. Follow-up data were collected. There were only eight cases of PEL in the records of the two hospitals. The age of the patients ranged between 50 and 74 years (median 62 years and mean 62.5 years). There were six males (80%) and two females (20%). None of the patients were immunocompromised or had human immunodeficiency virus (HIV) infection. The clinical manifestation included dysphagia and loss of weight. Six cases were diffuse large B-cell lymphoma (DLBCL), and two were low-grade mucosa-associated lymphoid tissue lymphoma. PEL is an extremely rare disease with male predominance. DLBCL is the most common pathological type in our community. There was no relation to immune status or HIV infection in this series. Clinical presentations were typically dysphagia with weight loss. Further reporting of PEL cases might help explain this disease and improve its diagnosis and management.

Cryptococcal Neoformans and Varicella Zoster Meningitis in a Patient With Selective Innate Immunodeficiency A Case Report.

Cryptococcal neoformans (C. neoformans) and varicella-zoster (VZV) meningitis are opportunistic infections that are primarily seen in immunocompromised patients, including those with HIV, cancer, or receiving transplants. Despite treatment, infection in immunocompromised patients can be lethal, including those with T-cell dysfunction or deficiency. Whether innate immunodeficiencies also predispose to these infections remains less clear. Here, we report a case of disseminated C. neoformans and VZV meningitis in a young male with idiopathic hypereosinophilic syndrome and hypocomplementemia and no history of HIV infection, malignancy, or transplant. The patient presented with a pulsating headache, myalgia, joint pain, insomnia, night sweats, and subjective fever, along with clusters of vesicular lesions on his neck and back. A lumbar puncture and an MRI of the brain confirmed C. neoformans and VZV meningitis. Vesicular skin lesions proved to be VZV, and blood culture confirmed fungemia, suggesting disseminated disease. We investigated his medical history further to determine the underlying cause of his prior hypereosinophilia and current meningitis. The patient had idiopathic hypereosinophilia with high IgE levels, low complement levels, high rheumatoid factor levels, and an intermittent rash dating back two years, which had been treated intermittently with prednisone and hydroxyurea, with the most recent admission three weeks prior to this admission. Prior to admission, the patient had a peak absolute eosinophil count of 18.6 x10

Promoting health equity in HIV prevention and treatment research a practical guide to establishing, implementing, and sustaining community advisory boards.

Over the last 25 years, community-based participatory research (CBPR) has emerged as an innovative methodological approach to break down the barriers toward health equity in biopsychosocial research. Although there are several methods one can use to conduct CBPR research, one widely used established tool that has shown to be effective for engaging community meaningfully in research is community advisory boards (CABs). CABs are formalized collaborative bodies consisting of community and research stakeholders and have been integral in engaging underserved groups experiencing HIV-related health inequities at the early stages of the AIDS crisis. Even though evidence suggests that CABs are an effective tool for conducting high-quality, rigorous, and community-centered HIV-related research, there are minimal guidelines summarizing the steps needed for developing and maintaining a CAB. Therefore, to fill this gap in the literature, this article offers a practical guide to help researchers with minimal experience, particularly graduate students and early-stage investigators, feel more comfortable with establishing a CAB for equity-focused HIV-related research. This article synthesizes already established guidelines and frameworks for CAB development while specifically outlining unique steps related to the three main stages of CAB formation - establishment, implementation, and sustainment. Throughout this article, the authors offer tension points, generated from the literature and with consultation from a CAB working alongside the authors, that researchers and community partners may need to navigate during each of these three stages. In addition, best practices from the literature are identified for each step in the guidelines so that readers can see firsthand how research groups have carried out these steps in their own practice.

Association between childhood sexual abuse and early sexual debut among Chinese adolescents The role of sexual and reproductive health education.

Despite accumulating evidence of the long-term impacts of childhood sexual abuse (CSA), few studies have investigated the association between CSA and early sexual debut among adolescents. In this study, we examine the relationship between CSA and early initiation of sexual intercourse among Chinese youth, and the role of school-based sex education in this association, based on a nationally representative survey. Data were collected from the Survey of Youth Access to Reproductive Health in China (YARHC) conducted in 2009. Multivariable logistic regression models were used to investigate the association between CSA experience and early sexual debut, and the interaction terms between sexual and reproductive health education and CSA were included to examine the role of education in the association between CSA and early sexual debut. Among 4,907 sexually experienced youth, 1,062 (21.6%) made their early sexual debut. After adjusting for sociodemographic characteristics, it was found that CSA experience was significantly associated with early sexual debut, with an adjusted odds ratio of 3.13 (95% CI 1.67-5.87). Receiving any type of sexuality education (reproductive health, sexually transmitted disease (STD) and HIV prevention, or contraception use) was not associated with a decreased risk of early sexual debut. Our results indicate a greater risk of early sexual debut among Chinese adolescents with a history of CSA, and only 46.7% sexually experienced youth had received prior sex education, which suggested an inadequacy of school-based sexuality education. To reduce this risk, targeted intervention with timely and adequate sexuality education for both early starters of sexual intercourse and CSA victims is warranted in China.

Assessing the association of stigma and HIV service and prevention uptake among men who have sex with men and transgender women in South Africa.

HIV prevention for gay, bisexual, and other men who have sex with men (GBMSM) and transgender women (TGW) is critical to reducing health disparities and population HIV prevalence. To understand if different types of stigma impact engagement with HIV prevention services, we assessed associations between stigmas and use of HIV prevention services offered through an HIV prevention intervention. This analysis included 201 GBMSM and TGW enrolled in a prospective cohort offering a package of HIV prevention interventions. Participants completed a baseline survey that included four domains of sexual identitybehavior stigma, HIV-related stigma, and healthcare stigma. Impact of stigma on PrEP uptake and the number of drop-in visits was assessed. No domain of stigma was associated with PrEP uptake. In bivariate analysis, increased enacted sexual identity stigma increased number of drop-in visits. In a logistic regression analysis constrained to sexual identity stigma, enacted stigma was associated with increased drop-in visits (aIRR 1.30, 95% CI 1.02, 1.65). Participants reporting higher enacted stigma were modestly more likely to attend additional services and have contact with the study clinics and staff. GBMSM and TGW with higher levels of enacted stigma may seek out sensitized care after negative experiences in their communities or other healthcare settings.

The impact of COVID-19 on cardiovascular health behaviors in people living with HIV.

The COVID-19 pandemics impact on cardiovascular health behaviors including diet, physical activity, medication adherence, and self-care among people living with HIV (PLWH) remains unknown. Using qualitative analyses, we examined the impact of the COVID-19 pandemic on cardiovascular health behaviors among PLWH. Twenty-four PLWH were enrolled in this multisite study from September to October 2020. Individuals participated in semi-structured telephone interviews that were recorded, transcribed, and coded by 4 independent coders. Codes were adjudicated and analyzed for common themes. Participants were, on average, 59.2 years old (-9.4), 75% African American (

Dysregulation of memory B cells and circulating T follicular helper cells is a predictor of poor immune recovery in HIV-infected patients on antiretroviral therapy.

T follicular helper (Tfh) cells and their interactions with B cells within the germinal center play extensive roles in human immunodeficiency virus (HIV) pathology. However, their association with immune reconstitution during antiretroviral therapy (ART) is still unclear. The aim of this study was to determine the impact of Tfh and memory B-cell function on T helper cell recovery in patients with acute or chronic HIV infection. A total of 100 HIV-infected individuals were enrolled in our study, classified into acute and chronic HIV infection groups (60 and 40, respectively) and subsequently classified into immunological responder (IR) and immunological nonresponder (INR) subgroups according to immune recovery outcomes after 96 weeks of ART. Liquid chromatography-mass spectrometry was used to quantify the temporal regulation patterns of B and CD4 The prevalence of Tfh cells in the T helper cell population correlated negatively with CD4 Our results suggest that the functions of memory B cells in INRs are dysregulated at the early stage of ART, possibly through disruption of Tfh cell function. The frequency and function of Tfh cells and their subsets are potential predictors of poor immune recovery. This article is protected by copyright. All rights reserved.

Spontaneous nosocomial Proteus mirabilis meningitis in a Human Immunodeficiency Virus (HIV)-infected adult patient a case report.

Gram-negative bacillary meningitis remains a rare occurrence, even in patients with human immunodeficiency virus. Current literature only describes anecdotal cases of spontaneous nosocomial Proteus mirabilis meningitis. This report describes the clinical manifestations and management of a patient with healthcare-associated spontaneous Gram-negative bacillary meningitis in a patient with advanced human immunodeficiency virus disease. A 23-year-old Congolese female was hospitalized in a human immunodeficiency virus specialized center for ongoing weight loss, chronic abdominal pain, and vomiting 9 months after initiation of treatment for tuberculosis meningitis. Hospitalization was complicated by healthcare-associated Gram-negative bacillary meningitis on day 18. Blood and cerebrospinal fluid cultures confirmed Proteus mirabilis. Antibiotic susceptibility testing showed extended spectrum beta-lactamase resistant to common antibiotics, and sensitive to meropenem. Despite initiation of high-dose meropenem by intravenous infusion (2 g every 8 hours), the patient did not improve, and died after 4 days of meropenem treatment. Gram-negative bacillary meningitis remains rare and is associated with an unfavorable prognosis. This case report highlights the importance of microbiological identification of pathogens in resource-limited settings. As Gram-negative bacillary meningitis does not present with pleocytosis in patients with advanced human immunodeficiency virus, a negative lumbar puncture cannot exclude this diagnosis. Access to clinical bacteriology in resource-limited settings is essential to enable correct antibiotic treatment and avoid overuse of antibiotics to which there is already resistance. It further plays an essential role in public health by identifying antibiotic susceptibilities. Infection prevention and control measures must be reinforced in order to protect patients from such avoidable healthcare-associated infections.

Explaining sexual self-care status and its predictor factors in women referring to healthcare centers of Sari, Iran, 2021.

With the increase in the prevalence of non-communicable diseases and chronic health problems along with population growth, one of the definitions that is expanding is the ability to adapt and self-manage against diseases and self-care. Although there are several studies to examine self-care in medical conditions, there are not enough concepts and data related to sexual self-care. Therefore, the present study was conducted with the aim of explaining the status of sexual self-care and its predictor factors in women of reproductive age referring to healthcare centers. This research was a cross-sectional study that was conducted on 400 women of reproductive age that referring to healthcare centers affiliated to Mazandaran University of Medical Sciences, Sari in 2021. Data were collected using personal-obstetric characteristics and sexual self-care questionnaires in women of reproductive age. Pearson correlation coefficients, independent t-test, one-way analysis of variance and multiple linear regression model were used to analyze the data. The average total score of sexual self-care in reproductive age women participating in the research was 70.66% ± 12.52%. In addition, the prevention of womens cancers and the prevention of unintended pregnancies obtained the lowest and highest scores, respectively. Factors such as age, education, education related to medical sciences, history of HIV testing, history of HPV vaccination, source of sexual information, method of contraception and infection-related action in a person can affect the level of sexual self-care in women. Based on the final regression model, education related to medical sciences (B 5.46, P 0.035), family income (B 5.58, P 0.025), prevention method (B 10.127, P 0.000) and action related to infection in the person (B 12.27, P 0.047) were the final predictors of sexual self-care score in reproductive age women. Based on the findings of the study, development of self-care promotion programs for reproductive aged women are necessary in all areas of reproductive health, with a priority for womens cancer prevention, and focusing on promoting education and related economic assistance. The results of this study can be available to experts and policy makers to design programs to promote sexual self-care in women.

Modern contraception utilization and associated factors among all women aged 15-49 in Ethiopia evidence from the 2019 Ethiopian Mini Demographic and Health Survey.

The use of contraceptive is key in reducing unsafe abortion from unintended pregnancies, infant mortality, adolescent pregnancies, slowing population growth and helps to prevent HIVAIDS. However, less than one-third of women within reproductive age in Ethiopia uses modern contraceptive methods. Hence, this study aimed to determine the prevalence of modern contraceptive utilization and to identify potential factors on use of modern contraceptive method. Data from 2019 Ethiopian Mini Demographic and Health Survey were used in this analysis. A total of 8885 women within the ages of 15-49 years across 305 enumeration areas in nine regions and two city administrations were included in the analysis. Multivariable logistic regression model were applied to examine the association between womens background characteristics and modern contraceptives utilization. Only 28.1% of all women used modern contraceptives. About 40% of the modern contraceptive users were between age of 25-29 and 30-34 years. There was significant association between womens age, level of education, region, religion, parity, wealth quintile and marital status on use of modern contraceptives. Women who were married and living with partners were about 20 (AOR 19.91, 95% CI 14.27, 27.78) and 24 (AOR 23.51, 95% CI 14.66, 37.72) times more likely to use modern contraceptives compared to sexually active unmarried women. The study showed that the use of modern contraceptive method is not adequate and it is also influenced by socio-demographic and economic characteristics of women in Ethiopia. Therefore, increasing the awareness of women to use modern contraceptive methods is vital. We suggest that there is a need to improve the service in women age above 39 years, women in Afar, Somali, Harari and Diredawa regions and protestant, Muslim and traditional religion followers.

Lymphocyte Membrane- and 12p1-Dual-Functionalized Nanoparticles for Free HIV-1 Trapping and Precise siRNA Delivery into HIV-1-Infected Cells.

Despite the success of small interfering RNA (siRNA) in clinical settings and its potential value in human immunodeficiency virus (HIV) therapy, the rapid clearance and absence of precise delivery to target cells still hinder the therapeutic effect of siRNA. Herein, a new system, which can escape immune recognition, has HIV-1 neutralizing capacity, and the ability to deliver siRNA specifically into HIV-1-infected cells, is constructed by functionalizing siRNA delivery lipid nanoparticles with the lymphocyte membrane and 12p1. The constructed system is shown to escape uptake by the mononuclear phagocyte system. The constructed system exhibits strong binding ability with gp120, thus displaying distinguished neutralizing breadth and potency. The constructed system neutralizes all tested HIV-1 pseudotyped viruses with a geometric mean 80% inhibitory concentration (IC80) of 29.75 µg mL

Critical Pronociceptive Role of Family 2 Voltage-Gated Calcium Channels in a Novel Mouse Model of HIV-Associated Sensory Neuropathy.

Some people living with HIV present painful sensory neuropathy (HIV-SN) that is pharmacoresistant, sex-associated, and a major source of morbidity. Since the specific mechanisms underlying HIV-SN are not well understood, the aim of our study was to characterize a novel model of painful HIV-SN by combining the HIV-1 gp120 protein and the antiretroviral stavudine (d4T) in mice and to investigate the pronociceptive role of the family 2 voltage-gated calcium channel (VGCC) α1 subunit (Cav2.X channels) in such a model. HIV-SN was induced in male and female C57BL6 mice by administration of gp120 andor d4T and detected by a battery of behavior tests and by immunohistochemistry. The role of Cav2.X channels was assessed by the treatment with selective blockers and agonists as well as by mRNA detection. Repeated administration with gp120 andor d4T produced long-lasting touch-evoked painful-like behaviors (starting at 6 days, reaching a maximum on day 13, and lasting up to 28 days after treatment started), with a greater intensity in female mice treated with the combination of gp120 d4T. Moreover, gp120 d4T treatment reduced the intraepidermal nerve fibers and well-being of female mice, without altering other behaviors. Mechanistically, gp120 d4T treatment induced Cav2.1, 2.2, and 2.3 transcriptional increases in the dorsal root ganglion and the Cav2.X agonist-induced nociception. Accordingly, intrathecal selective Cav2.2 blockade presented longer and better efficacy in reversing the hyperalgesia induced by gp120 d4T treatment compared with Cav2.1 or Cav2.3, but also presented the worst safety (inducing side effects at effective doses). We conclude that the family 2 calcium channels (Cav2.X) exert a critical pronociceptive role in a novel mouse model of HIV-SN.

Ethnicity, Language, and HIV Screening in Older Adult Safety-Net Patients.

HIV screening should occur for all adults at least once by age 65 years. Older adults have low screening rates. Latinos, with historically low screening rates, have worse HIV outcomes than non-Hispanic White patients. Electronic health record data from a multistate network of community health centers were used to examine whether there are differences in HIV screening for Latino (English and Spanish preferring) and non-Hispanic White older adults. Data were from the Accelerating Data Value Across a National Community Health Center Network Clinical Research Network of PCORnet from 21 states in 2012-2021 among an open cohort of patients aged 50-65 years. Relative odds of ever having received HIV screening comparing Latinos with non-Hispanic Whites using generalized estimating equation logistic regression modeling were calculated, adjusting for relevant patient-level covariates. Analyses were conducted in 2022. Among 251,645 patients, the covariate-adjusted odds of ever receiving HIV screening were 18% higher for English-preferring Latino patients (OR1.18, 95% CI1.11, 1.25) and 32% higher for Spanish-preferring Latinos than for non-Hispanic Whites (OR1.32, 95% CI1.24, 1.42). Latinos seen in community health centers, regardless of language spoken, are more likely to be screened at least once for HIV than non-Hispanic Whites. This increased screening may be due at least in part to the community health center setting, a setting known to mitigate disparities, as well as due to participation efforts by community health centers in public health campaigns. Future research can prioritize understanding the cause of this relative advantage.

Association between integrase strand transfer inhibitor use with insulin resistance and incident diabetes mellitus in persons living with HIV a systematic review and meta-analysis.

Whether integrase strand transfer inhibitors (INSTIs) are associated with a higher risk of incident type 2 diabetes mellitus (DM) than other antiretroviral therapies (ART) needs to be established.MEDLINE, Embase, Web of Science, and ClinicalTrials.gov registries were searched for studies published between 1 January 2000 and 15 June 2022. Eligible studies reported incident DM or mean changes in insulin resistance measured by Homeostatic Model for Insulin Resistance (HOMA-IR) in patients on INSTIs compared with other ARTs. We performed random-effects meta-analyses to obtain pooled relative risks (RRs) with 95% CIs.A total of 16 studies were pooled 13 studies meta-analyzed for incident diabetes with a patient population of 72 404 and 3 for changes in HOMA-IR. INSTI therapy was associated with a lower risk of incident diabetes in 13 studies (RR 0.80, 95% CI 0.67 to 0.96, I

Antimicrobial efficacy and inactivation kinetics of a novel LED based UV-irradiation technology.

UV light emitting diodes (UV-LEDs) are energy efficient and of special interest for the inactivation of microorganisms. In context of the current pandemic, novel UV technologies can offer a powerful alternative of effective infection prevention and control (IPC). We here assessed the antimicrobial efficacy of UV-C LEDs on Escherichia coli, Pseudomonas fluorescens and Listeria innocua as well as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), human immunodeficiency virus 1 (HIV-1) and murine norovirus (MNV) dried on inanimate surfaces based on the European standard EN 17272. We found an inactivation rate of 90% for the tested bacteria at a mean UV-C dose, averaged over all three investigated UV-C wavelengths, of 1.7 mJ cm Overall, our data recommend the use of LEDs emitting at shorter wavelengths of the UV-C spectrum to inactivate bacteria as well as enveloped and non-enveloped viruses by exposure to the appropriate UV-dose. However, low availability and excessive production costs of shortwave UV-C LEDs restricts the implementation currently and supports the use of longwave UV-C LEDs in combination with higher irradiation doses.

The structural basis for HIV-1 Vif antagonism of human APOBEC3G.

The APOBEC3 (A3) proteins are host antiviral cellular proteins that hypermutate the viral genome of diverse viral families. In retroviruses, this process requires A3 packaging into viral particles

Prevalence of suicidal ideations and suicide attempts in patients with tuberculosis A systematic review and meta-analysis.

Suicide and suicidal behaviors are reported to be common in patients with Tuberculosis (TB). This systematic review and meta-analysis aimed to quantitively assess the prevalence of suicidality and identify the factors associated with suicidality in patients with TB. We searched databases PubMed, SCOPUS, Web of Science, PsycINFO, and Google Scholar for studies that reported the prevalence of suicide, suicidal ideations, or suicide attempts in patients with TB. We assessed the quality of studies with the Newcastle Ottawa scale. Random-effects models were used to calculate the pooled prevalence with 95% confidence intervals (CI). Nine studies (8770 participants) were included. Pooled prevalence for current suicidal ideations within the last year was 8.5% 95% CI 5.8%12.3%. Pooled prevalence for current suicidal attempts within the last year was 3.1% 2.2%- 4.5%. Suicide was reported in 0.92% of TB patients at the end of 2 years, whereas 2.2% to 8.4% of all TB deaths were reported due to suicide. Factors associated with suicidality were female gender, TB retreatment, comorbid HIV, presence of another chronic medical illness, psychological distress, and comorbid psychiatric illnesses. The prevalence rates of suicidal ideation and attempts were higher in patients with TB than in the general population. Integrating mental health services with TB programs will help develop interventions for high-risk individuals. Prospero registration number CRD42021281849.

Shifting the power scale-up of access to point-of-care and self-testing for sexually transmitted infections in low-income and middle-income settings.

Point-of-care (POC) testing for sexually transmitted infections (STIs) can provide complementary coverage to existing HIV testing services in LMICs. This review summarizes current and emerging technologies for detecting STIs in LMICs, with an emphasis on women, discharge-causing infections (chlamydia, gonorrhoea, trichomoniasis, and syphilis), true POC, self-testing, ethics, and economic considerations related to equitable access. The WHO have recently adapted guidelines for treatment of STIs in women that advise the use of true-POC or near-POC tests to improve case finding. The number of rapid, sensitive, and specific POC diagnostics for STIs has increased significantly over the past 10 years, although adoption of these in low-income and middle-income countries (LMICs) remains limited. Barriers to POC adoption by patients include the cost of tests, the inconvenience of lengthy clinic visits, low perceived risk, stigma, lack of partner notification, and lack of trust in healthcare providers. Lowering the cost of true POC lateral flow devices, interfacing these with digital or eHealth technologies, and enabling self-testingself-sampling will overcome some of these barriers in LMICs. Ensuring linkage of diagnostic tests to subsequent care remains one of the major concerns about self-testing, irrespective of geography, although available evidence from HIV self-testing suggests that linkage to care is similar to that for facility-based testing. Increasing access to sensitive STI true POC tests will strengthen reproductive healthcare in LMICs. Although HIV self-testing is demonstrably useful in LMICs, there is an urgent need for randomized trials evaluating the utility and cost-effectiveness of similar tests for other sexually transmitted infections.

Lenacapavir and the novel HIV-1 capsid inhibitors an emerging therapy in the management of multidrug-resistant HIV-1 virus.

The aim of this study was to summarize current evidence regarding lenacapavir, a first in class HIV-1 capsid inhibitor, and its role as an emergent therapy for the treatment of HIV-1 infection. HIV-1 capsid inhibitors (of which lenacapavir is the first in class) has been postulated to have activity against multidrug resistant HIV-1 viral isolates. Initial results from the phase 3 trial CAPELLA (combining oral and subcutaneous lenacapavir alongside failing drug therapies) suggest that there may be a role for these novel agents in a cohort of patients living with HIV-1 infection (PLWH) for whom multidrug resistance has previously been a barrier to effective therapy. Despite emergent lenacapavir resistance mutations detected in some study participants, virological suppression was still potentially attainable, offering some hope to PLWH with limited antiviral regimens available. Initial results from the CALIBRATE trial show promise for the role of lenacapavir-containing regimens in a treatment-naive cohort as well. Lenacapavir may prove to be an adjunctive agent in the management of PLWH with significant HIV-1 drug resistance.

COVID-19 in people living with HIV a single-center descriptive study.

People living with human immunodeficiency virus (PLHIV) may suffer more severe symptoms of coronavirus disease 2019 (COVID-19) due to their immunocompromised status, even if they are undetectable. Human immunodeficiency virus (HIV) infection has been reported as an independent factor associated with higher mortality in patients with COVID-19. The present study aims to describe the clinical characteristics of PLHIV and COVID-19 in one center in Mexico. We conducted an observational retrospective monocentric cohort study of PLHIV diagnosed with COVID-19 between 1 March 2020 and 30 April 2021. SARS-CoV-2 was detected by polymerase chain reaction (PCR) of a nasopharyngeal swab sample, clinical features, and epidemiological characteristics. We identified 55 PLHIV with COVID-19. The median age was 36 years (IQR 25-41.5 years), and 54 patients were men. The median duration of HIV-1 infection was 4.3 years (Interquartile range, IQR 2.6-7.2 years), and 100% were on antiretroviral therapy (ART). The last HIV-1 RNA viral load analysis of the patients was 5255 (94.5%) indicating that they were in virological suppression. The median CD4 T-cell count was 734mm3 (IQR 541.5-921mm3). The most frequent pre-existing comorbidities found were obesity (21.8%), hypertension (7.2%), and diabetes (5.4%). Only one death was reported (1.8%). It has been reported that COVID-19HIVAIDS co-infection has a higher risk of mortality, admission to intensive care, and complications. However, our study found that people living with HIV-1 with adequate virological control did not present a severe course of COVID -19.

Implementation process and challenges of index testing in Côte dIvoire from healthcare workers perspectives.

A major limiting factor in combatting the HIV epidemic has been the identification of people living with HIV. Index testing programs were developed to face that challenge. Index testing is a focused HIV testing service approach in which family members and partners of people living with HIV are offered testing. Despite the implementation of index testing, there is still a gap between the estimated number of people living with HIV and those who know their status in Côte dIvoire. This study aimed to understand the implementation process of index testing in Côte dIvoire and to identify implementation challenges from healthcare workers perspectives. In January and February 2020, we conducted a qualitative study through 105 individual semi-structured interviews regarding index testing with clinical providers (physicians, nurses, and midwives) and non-clinical providers (community counselors and their supervisors) at 16 rural health facilities across four regions of Côte dIvoire. We asked questions regarding the index testing process, index client intake, contact tracing and testing, the challenges of implementation, and solicited recommendations on improving index testing in Côte dIvoire. The interviews revealed that index testing is implemented by non-clinical providers. Passive referral, by which the index client brought their contact to be tested, and providers referral, by which a healthcare worker reached out to the index clients contact, were the preferred contact tracing and testing strategies. There was not statistically significant difference between immediate and delayed notification. Reported challenges of index testing implementation included index cases refusing to give their partners information or a partner refusing to be tested, fear of divorce, societal stigma, long distances, lack of appropriate training in index testing strategies, and lack of a private room for counseling. The recommendations given by providers to combat these was to reinforce HIV education among the population, to train healthcare workers on index testing strategies, and to improve infrastructure, transportation, and communication resources. The study showed that the elements that influenced the process of index testing in Côte dIvoire were multifactorial, including individual, interpersonal, health systems, and societal factors. Thus, a multi-faceted approach to overcoming challenges of index testing in Côte dIvoire is needed to improve the yield of index testing.

STI testing and subsequent clinic attendance amongst test negative asymptomatic users of an internet STI testing service one-year retrospective study.

To explore the characteristics of online STI test users, and assess the frequency and factors associated with subsequent service use following a negative online STI test screen in individuals without symptoms. One-year retrospective study of online and clinic STI testing within a large integrated sexual health service (Umbrella in Birmingham and Solihull, England) between January and December 2017. A multivariable analysis of sociodemographic and behavioural characteristics of patients was conducted. Sexual health clinic appointments occurring within 90 days of a negative STI test, in asymptomatic individuals who tested either online or in clinic were determined. Factors associated with online STI testing and subsequent clinic use were determined using generalized estimating equations and reported as odds ratios (OR) with corresponding 95% confidence intervals (CI). 31 847 online STI test requests and 40 059 clinic attendances incorporating STI testing were included. 79% (2502031846) of online STI test users and 49% (1967240059) of clinic STI test takers were asymptomatic. Online STI testing was less utilised (p<0.05) by men who have sex with men (MSM), non-Caucasians and those living in neighborhoods of greater deprivation. Subsequent clinic appointments within 90 days of an asymptomatic negative STI test occurred in 6.2% (4847769) of the online testing group and 33% (496015238) for the clinic tested group. Re-attendance following online testing was associated with being MSM (aOR 2.551.58 to 4.09-MSM vs Female) and a recent prior history of STI testing (aOR 5.654.30 to 7.43 clinic tested vs No recent testing history). Subsequent clinic attendance amongst online STI test service users with negative test results was infrequent, suggesting that their needs were being met without placing an additional burden on clinic based services. However, unequal use of online services by different patient groups suggests that optimised messaging and the development of online services in partnership with users are required to improve uptake.

Characteristics and short- and long-term direct medical costs among adults with timely and delayed presentation for HIV care in the Netherlands.

In Europe, half of people living with HIV (PLWH) present late to care, with associated higher morbidity and mortality. This study aims to assess short- and long-term costs of HIV-care based on time of presentation and identify other factors contributing to higher costs in the first and fifth year after antiretroviral therapy (ART) initiation. We included ATHENA cohort data which prospectively includes 98% of PLWH in the Netherlands. PLWH who initiated ART in 2013 were included and followed over five years. PLWH were divided in three categories based on CD4 cell-count at time of ART initiation timely presentation (CD4>350cellsμL), late presentation (CD4 200-350cellsμL or >350cellsμL with AIDS-defining illness) and very late presentation (CD4<200cellsμL). The total HIV-care cost was calculated distinguishing ART medication and non-ART medication costs (hospitalization, outpatient clinic visits, co-medications, and HIV-laboratory tests). From 1,296 PLWH, 273 (21%) presented late and 179 (14%) very late. Nearly half of those who entered HIV-care in a very late stage were of non-Dutch origin, with 21% originating from sub-Saharan Africa. The mean cost per patient in the first year was €12,902 (SD€11,098), of which about two-thirds due to ART (€8,250 (SD€3,142)). ART costs in the first and fifth year were comparable regardless of time of presentation. During the first year on treatment, non-ART medication costs were substantially higher among those with late presentation (€4,749 (SD€8,009)) and very late presentation (€15,886 (SD€ 21,834)), compared with timely presentation (€2,407(SD€4,511)). Higher non-ART costs were attributable to hospitalization and co-medication. The total non-ART costs incurred across five years on treatment were 56% and 246% higher for late and very late presentation respectively as compared to timely presentation. Very late presentation is associated with substantial costs, with non-ART costs nearly seven times higher than for those presenting timely. Hospitalization and co-medication costs are likely to continue to drive higher costs for individuals with late presentation into the future. Programs that identify individuals earlier will therefore likely provide significant short- and long-term health cost savings.

Effectiveness of structural interventions to promote condom use in adolescents and young people Systematic Review.

Evaluate the effectiveness of structural or multicomponent interventions aimed at increasing the use of condoms in adolescents and young adults, identifying the strategies that form the interventions evaluated, and recognizing the theoretical models that support these interventions. Design Systematic review of literature. Data source MEDLINE databases were consulted via OVID, Embase, and CENTRAL in order to search for studies on interventions aimed at increasing the use of condoms in adolescents and young adults. Selection of studies A total of 7 primary investigations were selected, in which the effect of a structured or multicomponent intervention to increase the use of condoms in adolescents and young adults was evaluated. The quality of the studies was evaluated using the Cochrane bias risk assessment. Five investigations show changes in the percentages of condom use with values between 53% and 68%. The interventions targeted guided their actions more at individual level with strategies such as sexual health education, reproductive health counseling, knowledge about the condom, knowledge about STIs HIV, than at organizational and environ-mental levels, which were aimed at the provision of condoms. The theoretical models proposed in the studies are focused on human behavior, individual behavior, and social learning. Structural interventions that aim to increase the use of condoms in adolescents and young adults seem to show significant changes at individual level, but possible changes generated at both organization and environment levels are unknown. Evaluar la efectividad de las intervenciones de tipo estructural o multicomponente dirigidas al incremento del uso del preservativo en adolescentes y jóvenes, identificar las estrategias que conforman las intervenciones evaluadas y reconocer los modelos teóricos que sustentan dichas intervenciones. Diseño revisión sistemática de la literatura. Fuente de datos se consultaron las bases de datos MEDLINE vía OVID, Embase y CENTRAL para buscar estudios sobre intervenciones dirigidas al incremento del uso del preservativo en adolescentes y jóvenes. Selección de estudios se seleccionaron un total de 7 investigaciones primarias donde se evaluaba el efecto de una intervención estructural o multicomponente para incrementar el uso del preservativo en adolescentes y jóvenes. La calidad de los estudios fue evaluada usando la herramienta para valoración de riesgo de sesgos de Cochrane. Cinco investigaciones mostraron cambios en los porcentajes del uso del preservativo con valores entre 53 % y el 68 %. Las intervenciones planteadas orientaban sus acciones más a nivel individual con estrategias como educación sobre salud sexual, consejería en salud reproductiva, conocimientos acerca del preservativo, conocimientos acerca de las ITSVIH. A nivel organizacional y del entorno iban dirigidas a la provisión de preservativos. Los modelos teóricos planteados en los estudios están centrados en la conducta humana, comportamiento del individuo y el aprendizaje social. Las intervenciones de tipo estructural que tienen como fin el incremento del uso del preservativo en adolescentes y jóvenes parecen mostrar cambios significativos a nivel individual, pero se desconocen los posibles cambios generados a nivel de la organización y del entorno.

Trends in the incidence of the human immunodeficiency (HIV) virus in Chile, by age and gender 2010-2017.

To determine the trends in the incidence of contagion by the HIV in Chile, according to age and gender, for the period 2010-2017. Analysis from the database of confirmed HIV positive diagnosis cases. HIV incidence rates were made from HIV-confirmed cases adjusted for year, age, and sex, with population denominators from the INE. A general and specific trend analysis was performed using regression equations. There is a trend to increase in HIV incidence rates in the study period. 36.48% of the reported cases correspond to the male sex between 20-29 years, group with the highest incidence in the period. The estimated regression equations effectively increase more steadily in the male and young population. There are deficit informative and educational factors in HIV prevention in the Chilean population. Despite the strong progression of new cases, the diagnostic gap of people living with HIV who are unaware of their health remains to be consolidated. Gaps were identified between recommendations, public policies and the Chilean results obtained. Determinar las tendencias de la incidencia del contagio por VIH en Chile, según edad y género, para el período 2010-2017. Análisis desde la base de datos de casos confirmados de diagnóstico de VIH positivos. Las tasas de incidencia de VIH se confeccionaron a partir de los casos confirmados por VIH ajustados por año, edad y sexo, con denominadores poblacionales del INE. Se realizó un análisis de tendencia general y específica mediante ecuaciones de regresión. Existe tendencia al aumento en tasas de incidencia del VIH en el periodo de estudio. El 36,48% de los casos reportados corresponde al sexo masculino entre 20 y 29 años, grupo con más alta incidencia en el período. Las ecuaciones de regresión estimadas efectivamente aumentan más sostenidamente en población masculina y joven. Existen factores informativos y educacionales deficitarios en la prevención del VIH en la población chilena. A pesar de la fuerte progresión de los casos nuevos, aún resta consolidar la brecha diagnóstica de personas que viven con VIH que desconocen su estado de salud. Se identificaron brechas entre recomendaciones, políticas públicas y resultados chilenos obtenidos.

Active syphilis infection in homeless people and associated factors.

To identify the personal and sociodemographic factors associated with the syphilis infection in homeless people in Medellin city, 2016. Quantitative, observational and cross-sectional study. it surveyed 145 homeless people between 18 and 59 years of age. The study included univariate and bivariate analysis, it used the chi square test, the prevalence ratio, confidence intervals of the 95% with level of significance less than 5%. For the development of the study a survey and a serological test of syphilis were applied to 145 homeless people. The 64,1% were men, the average age was 42 years (de 9,5), the predominant social stratum was low (71%), the syphilis infection in homeless people was 27.6%. the people with greater risk to acquire syphilis infection were women (IC1,57-4,57), single people (0,71-2,80), bazuco consumers (IC0,86-3,06) and people with previous diagnosis of syphilis (IC1,81-4,68). In the homeless people there is a higher than expected presence of syphilis. The women, single people, bazuco consumers and people with previous diagnosis of syphilis are the most predisposed individuals to acquire the infection. This situation suggests the need to increase and focus the health promotion actions. It suggests fomenting the induced demand to sexual and reproductive health services with a differential approach of the population, too. Identificar los factores personales y sociodemográficos asociados a la infección por sífilis en habitantes de calle de la ciudad de Medellín, 2016. Se realizó un estudio cuantitativo, observacional, transversal, se encuestaron 145 habitantes de calle entre 18 y 59 años. Se incluyó el análisis univariado y bivariado se utilizó la prueba chi-cuadrado (x2) razón de prevalencia, intervalos de confianza del 95% con nivel de significancia menor del 5%. Para el desarrollo de estudio, se aplicó una encuesta y una prueba serológica para sífilis (VDRL) a 145 habitantes de calle, de los cuales 64,1% eran hombres, la edad promedio fue de 42 años (DE 9,5), el estrato social predominante fue bajo (71%). La infección de sífilis en los habitantes fue de 27,6%. Quienes presentaron mayor riesgo de adquirir la infección fueron las mujeres (IC1,57-4,57), los de estado civil soltero (0,71-2,80), quienes consumían basuco (IC0,86-3,06) y quienes anteriormente habían sido diagnosticado con sífilis (IC1,81-4,68). En la población de habitantes de calle, la sífilis tiene una presencia mayor a la esperada y quienes tienen mayor disposición para adquirir la infección son las mujeres, las personas consumidoras, de estado civil soltero y que hayan adquirido la infección anteriormente, situación que sugiere un aumento y focalización de la promoción de salud y el fomento de la demanda inducida a los servicios de salud sexual y reproductiva de la población, con un alto enfoque diferencial.

Expression of TIGIT, PD-1 and HLA-DRCD38 markers on CD8-T cells of children and adolescents infected with HIV and uninfected controls.

Immune exhaustion and senescence are scarcely studied in HIV-pediatric patients. We studied the circulatory CD8 T cells activationexhaustion and senescent phenotype of children and adolescents vertically infected with HIV or uninfected controls based on the expression of human leukocyte antigen (HLA-DR), CD38, T cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif (ITIM) domain (TIGIT), programmed death 1 (PD-1) and CD57 by flow cytometry, during approximately one year. Eleven HIV-infected (HI) and nine HIV-uninfected (HU) childrenadolescents who received two doses or one dose of meningococcal C conjugate vaccine (MenC), respectively, were involved in this study. Blood samples were collected before the immunization (T0), 1-2 months after the first dose (T1), and 1-2 months after the second dose (T2), which was administered approximately one year after the first one. HI patients not receiving combined antiretroviral therapy (cART) showed a higher frequency of CD8 T cells TIGIT, PD-1 or CD57, as well as a higher frequency of CD8 T cells co-expressing CD38HLA-DRTIGIT or CD38HLA-DRPD-1 when compared to HI treated or HU individuals, at all times that they were assessed. CD8 T cells co-expressing CD38DRTIGIT were inversely correlated with the CD4CD8 ratio but positively associated with viral load. The co-expression of CD38DRTIGIT or CD38DRPD-1 on CD8 T cells was also inversely associated with the CD4 T cells expressing co-stimulatory molecules CD127CD28. The results showed a higher expression of exhaustionsenescence markers on CD8 T cells of untreated HI childrenadolescents and its correlations with viral load.