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Kalichman SC, Kalichman MO, Cherry C, Grebler T. HIV Disclosure and Transmission Risks to Sex Partners Among HIV-Positive Men. AIDS Patient Care STDS 2017; 30:221-8. [PMID: 27158850 DOI: 10.1089/apc.2015.0333] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Disclosure of HIV-positive status to sex partners is critical to protecting uninfected partners. In addition, people living with HIV often risk criminal prosecution when they do not inform sex partners of their HIV status. The current study examined factors associated with nondisclosure of HIV status by men living with HIV in Atlanta, GA (92% African African, mean age = 43.8), who engage in condomless sex with uninfected sex partners. Sexually active HIV-positive men (N = 538) completed daily electronic sexual behavior assessments over the course of 28 days and completed computerized interviews, drug testing, medication adherence assessments, and HIV viral load retrieved from medical records. Results showed that 166 (30%) men had engaged in condomless vaginal or anal intercourse with an HIV-uninfected or unknown HIV status sex partner to whom they had not disclosed their HIV status. Men who engaged in nondisclosed condomless sex were less adherent to their HIV treatment, more likely to have unsuppressed HIV, demonstrated poorer disclosure self-efficacy, enacted fewer risk reduction communication skills, and held more beliefs that people with HIV are less infectious when treated with antiretroviral therapy. We conclude that undisclosed HIV status is common and related to condomless sex with uninfected partners. Men who engage in nondisclosed condomless sex may also be more infectious given their nonadherence and viral load. Interventions are needed in HIV treatment as prevention contexts that attend to disclosure laws and enhance disclosure self-efficacy, improve risk reduction communication skills, and increase understanding of HIV infectiousness.
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Affiliation(s)
- Seth C. Kalichman
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Moira O. Kalichman
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Chauncey Cherry
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Tamar Grebler
- Department of Psychology, University of Connecticut, Storrs, Connecticut
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102
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Ginindza TG, Stefan CD, Tsoka-Gwegweni JM, Dlamini X, Jolly PE, Weiderpass E, Broutet N, Sartorius B. Prevalence and risk factors associated with sexually transmitted infections (STIs) among women of reproductive age in Swaziland. Infect Agent Cancer 2017; 12:29. [PMID: 28559923 PMCID: PMC5445272 DOI: 10.1186/s13027-017-0140-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/16/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) remain an important public health problem with approximately half a billion new cases annually among persons aged 15-49 years. Epidemiological data on STIs among women of reproductive age in Swaziland are limited. The availability of epidemiological data on STIs and associated risk factors in this population is essential for the development of successful prevention, diagnosis and management strategies in the country. The study aimed to determine the prevalence and risk factors associated with STIs. METHODS A total of 655 women aged 15-49 years were systematically enrolled from five health facilities using a cross-sectional study design. Cervical specimen were tested using GeneXpert CT/NG Assays for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), GeneXpertTV Assay for Trichomonas vaginalis (TV), and GeneXpert HPV Assays for hr-HPV. Blood samples were tested using Alere Determine HIV-1/2Ag/Ab Combo and Trinity Biotech Uni-Gold Recombigen HIV test for confirmation for HIV, and Rapid Plasma Reagin and TPHA test for confirmation for Treponema pallidum (syphilis). Genital warts were assessed prior to specimen collection. Survey weighted analyses were done to estimate the population burden of STIs. RESULTS The four most common curable STIs: CT, NG, TV, Treponema pallidum (syphilis), as well as genital warts were considered in this study. The overall weighted prevalence of any of these five STIs was 19.4% (95% CI: 14.9-24.8), corresponding to 72 990 women with STIs in Swaziland. The estimated prevalences were 7.0% (95% CI: 4.1-11.2) for CT, 6.0% (95% CI: 3.8-8.8) for NG, 8.4% (95% CI: 5.4-12.8) for TV, 1.4% (95% CI: 1.1-10.2) for syphilis and 2.0% (95% CI: 1.0-11.4) for genital warts. The overall weighted HIV prevalence was 42.7% (95%CI: 35.7-46.2). Among hr-HPV positive women, 18.8% (95% CI: 13.1-26.3) had one STI, while 6.3% (95% CI: 3.3-11.7) had multiple STIs. Risk factors associated with STIs were being employed (OR = 2.2, 95% CI: 1.0-4.7), self-employed (OR = 2.8, 95% CI: 1.5-5.5) and being hr-HPV positive (OR = 2.0, 95% CI: 1.3-3.1). Age (0.9, 95% CI: 0.8-0.9), being married (OR = 0.4, 95% CI: 0.3-0.7) and not using condoms with regular partners (OR = 0.5, 95% CI: 0.3-0.9) were inversely associated with STIs. CONCLUSION STIs are highly prevalent among women of reproductive age in Swaziland. Thus, a comprehensive STIs screening, surveillance and treatment programme would be justified and could potentially lower the burden of STIs in the country.
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Affiliation(s)
- Themba G. Ginindza
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Mazisi Kunene Road, 4041 Durban, South Africa
| | | | - Joyce M. Tsoka-Gwegweni
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Mazisi Kunene Road, 4041 Durban, South Africa
| | - Xolisile Dlamini
- Epidemiology Unit, Ministry of Health and Social Welfare, Mbabane, Swaziland
| | - Pauline E. Jolly
- Department of Epidemiology, University of Alabama, Birmingham, USA
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Nathalie Broutet
- World Health Organization; Department of Reproductive Health and Research, Geneva, Switzerland
| | - Benn Sartorius
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Mazisi Kunene Road, 4041 Durban, South Africa
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103
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Awungafac G, Delvaux T, Vuylsteke B. Systematic review of sex work interventions in sub-Saharan Africa: examining combination prevention approaches. Trop Med Int Health 2017; 22:971-993. [PMID: 28449198 DOI: 10.1111/tmi.12890] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The incidence of HIV and sexually transmitted infections is disproportionately high among sex workers (SW). We aimed to update the evidence on the effectiveness of SW interventions in sub-Saharan Africa and to provide more insights into combination prevention. METHODS The Systematic review followed PRISMA guidelines in a search of PUBMED and POPLINE for peer-reviewed literature published between 1 January 2000 and 22 July 2016 (registration number on PROSPERO: CRD42016042529). We considered cohort interventions, randomised controlled trials and cross-sectional surveys of SW programmes. A framework was used in the description and mapping of intervention to desired outcomes. RESULTS Twenty-six papers(reporting on 25 studies) were included. A strategy that empowered peer educator leaders to steer community activities showed a twofold increase in coverage of behaviour change communication and utilisation of health facility among SW. Brief alcohol harm reduction effort demonstrated a significant effect on sexual violence and engagement in sex trading. A risk reduction counselling intervention among drug-injecting SW showed an effect on alcohol, substance use and engagement in sex work. No study on a promising intervention like PrEP among SWs was found. We observed that interventions that combined some structural components, biomedical and behavioural strategies tend to accumulate more desired outcomes. CONCLUSION The evidence base that can be considered in intervention designs to prevent HIV in SW in SSA is vast. The health sector should consider interventions to reduce binge alcohol intake and intravenous drug use among sex workers. Programmes should staunchly consider multicomponent approaches that explore community-based structural approaches.
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Affiliation(s)
- George Awungafac
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia.,Ministry of Health, Yaoundé, Cameroon
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104
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Menezes LJ, Pokharel U, Sudenga SL, Botha MH, Zeier M, Abrahamsen ME, Glashoff RH, Engelbrecht S, Schim van der Loeff MF, van der Laan LE, Kipping S, Taylor D, Giuliano AR. Patterns of prevalent HPV and STI co-infections and associated factors among HIV-negative young Western Cape, South African women: the EVRI trial. Sex Transm Infect 2017; 94:55-61. [PMID: 28490581 DOI: 10.1136/sextrans-2016-053046] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/30/2017] [Accepted: 04/18/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To estimate the prevalence and describe the patterns of concurrent human papillomavirus (HPV) and STIs and associated factors among HIV-negative young Western Cape, South African women participating in the Efficacy of HPV Vaccine to Reduce HIV Infection (EVRI) trial. METHODS HIV-negative women aged 16-24 years old were enrolled in the EVRI trial (NCT01489527) and randomised to receive the licensed four-valent HPV vaccine or placebo. At study entry, participants were clinically evaluated for five STIs: herpes simplex virus type 2 (HSV-2), chlamydia, gonorrhoea, syphilis and disease-causing HPV genotypes (6/11/16/18/31/33/35/39/45/51/52/56/58/59/68). Demographic and sexual history characteristics were compared among women with STI co-infections, single infection and no infection using Pearson χ2 and Mann-Whitney tests. ORs were calculated to evaluate factors associated with STI co-infection prevalence. RESULTS Among 388 young women, STI co-infection prevalence was high: 47% had ≥2 concurrent STIs, 36% had a single STI and 17% had none of the five evaluated STIs. HPV/HSV-2 (26%) was the most prevalent co-infection detected followed by HPV/HSV-2/Chlamydia trachomatis (CT) (17%) and HPV/CT (15%). Co-infection prevalence was independently associated with alcohol use (adjusted OR=2.01, 95% CI 1.00 to 4.06) and having a sexual partner with an STI (adjusted OR=6.96, 95% CI 1.53 to 30.08). CONCLUSIONS Among high-risk young women from underserved communities such as in Southern Africa, a multicomponent prevention strategy that integrates medical and behavioural interventions targeting both men and women is essential to prevent acquisition of concurrent STI infections and consequent disease. TRIAL REGISTRATION NUMBER NCT01489527; Post-results.
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Affiliation(s)
- Lynette J Menezes
- Division of Infectious Disease and International Medicine, University of South Florida, Tampa, Florida, USA
| | - Ubin Pokharel
- Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
| | - Staci L Sudenga
- Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
| | - Matthys H Botha
- Department of Obstetrics and Gynaecology and Unit for Gynaecological Oncology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Michele Zeier
- Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa
| | - Martha E Abrahamsen
- Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
| | - Richard H Glashoff
- Division of Medical Virology, Stellenbosch University and NHLS Tygerberg, Cape Town, South Africa
| | - Susan Engelbrecht
- Division of Medical Virology, Stellenbosch University and NHLS Tygerberg, Cape Town, South Africa
| | | | - Louvina E van der Laan
- Department of Obstetrics and Gynaecology and Unit for Gynaecological Oncology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Siegfried Kipping
- Department of Obstetrics and Gynaecology and Unit for Gynaecological Oncology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | | | - Anna R Giuliano
- Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
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105
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Jaumdally SZ, Jones HE, Hoover DR, Gamieldien H, Kriek JM, Langwenya N, Myer L, Passmore JAS, Todd CS. Comparison of sampling methods to measure HIV RNA viral load in female genital tract secretions. Am J Reprod Immunol 2017; 77:10.1111/aji.12619. [PMID: 28111861 PMCID: PMC6457130 DOI: 10.1111/aji.12619] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/19/2016] [Indexed: 01/07/2023] Open
Abstract
PROBLEM How does menstrual cup (MC) compare to other genital sampling methods for HIV RNA recovery? METHOD OF STUDY We compared HIV RNA levels between MC, endocervical swab (ECS), and ECS-enriched cervicovaginal lavage (eCVL) specimens in 51 HIV-positive, antiretroviral therapy-naive women at enrollment, 3 and 6 months, with order rotated by visit. Paired comparisons were analyzed with McNemar's exact tests, signed-rank tests, and an extension of Somer's D for pooled analyses across visits. RESULTS MC specimens had the highest proportion of quantifiable HIV VL at enrollment and month 3, but more MC specimens (n=12.8%) were insufficient for testing, compared with ECS (2%, P=0.006) and eCVL (0%, P<0.001). Among sufficient specimens, median VL was significantly higher for MC (2.62 log10 copies/mL) compared to ECS (1.30 log10 copies/mL, P<0.001) and eCVL (1.60 log10 copies/mL, P<0.001) across visits. CONCLUSION MC may be more sensitive than eCVL and CVS, provided insufficient specimens are reduced.
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Affiliation(s)
- Shameem Z. Jaumdally
- Division of Medical Virology, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Heidi E. Jones
- Department of Epidemiology and Biostatistics, City University of New York Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Donald R. Hoover
- Department of Statistics & Biostatistics, Rutgers The State University, Piscataway, NJ, USA
| | - Hoyam Gamieldien
- Division of Medical Virology, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Jean-Mari Kriek
- Division of Medical Virology, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Nontokozo Langwenya
- Division of Epidemiology & Biostatistics and Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics and Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jo-Ann S. Passmore
- Division of Medical Virology, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- National Health Laboratory Services, Cape Town, South Africa
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106
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Affiliation(s)
- Harold C Wiesenfeld
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, and the Sexually Transmitted Diseases Program, Allegheny County Health Department - both in Pittsburgh
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107
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Kohler PK, Marumo E, Jed SL, Mema G, Galagan S, Tapia K, Pillay E, DeKadt J, Naidoo E, Dombrowski JC, Holmes KK. A national evaluation using standardised patient actors to assess STI services in public sector clinical sentinel surveillance facilities in South Africa. Sex Transm Infect 2017; 93:247-252. [PMID: 28130505 DOI: 10.1136/sextrans-2016-052930] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/19/2016] [Accepted: 01/04/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Quality concerns in STI service delivery and missed opportunities for integration with HIV testing and prevention services in South Africa have been well documented. This national evaluation aimed to evaluate current utilisation and adherence to national STI guidelines, including partner notification and integration with HIV services, for diagnosis and management of STIs. METHODS Facility surveys assessed infrastructure and resource availability, and standardised patient (SP) assessments evaluated quality of STI care in 50 public clinics in nine provinces in South Africa. The primary outcome was the proportion of SPs receiving essential STI care, defined as: offered an HIV test, condoms, partner notification counselling and correct syndromic treatment. Weighted proportions were generated, and SP findings were compared by gender using χ2 tests with Rao-Scott correction. RESULTS More than 80% of facilities reported medications in stock, with the exceptions of oral cefixime (48.3%), oral erythromycin (75.1%) and paediatric syrups. Among 195 SP encounters, 18.7% (95% CI 10.7% to 30.5%) received all hypothesised essential STI services: offered HIV test (67.1%), offered condoms (31.4%), partner notification counselling (70.2%) and recommended syndromic treatment (60.7%). Men were more likely than women to be offered all services (25.1% vs 12.3%, p=0.023), recommended treatment (70.7% vs 50.9%, p=0.013) and partner notification counselling (79.9% vs 60.6%, p=0.020). Only 6.3% of providers discussed male circumcision with male SPs, and 26.3% discussed family planning with female SPs. CONCLUSIONS This evaluation of STI services across South Africa found gaps in the availability of medications, adherence to STI guidelines, condom provision and prevention messaging. Limited integration with HIV services for this high-risk population was a missed opportunity. Quality of STI care should continue to be monitored, and interventions to improve quality should be prioritised as part of national strategic HIV and primary healthcare agendas.
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Affiliation(s)
- Pamela K Kohler
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Psychosocial and Community Health, University of Washington, Seattle, Washington, USA.,International Training and Education Center for Health, University of Washington, Pretoria South Africa
| | - Eva Marumo
- National Department of Health, Pretoria South Africa Civitas Building, Pretoria, South Africa
| | - Suzanne L Jed
- Department of Global Health, University of Washington, Seattle, Washington, USA.,International Training and Education Center for Health, University of Washington, Pretoria South Africa
| | - Gladys Mema
- International Training and Education Center for Health, University of Washington, Pretoria South Africa
| | - Sean Galagan
- Department of Global Health, University of Washington, Seattle, Washington, USA.,International Training and Education Center for Health, University of Washington, Pretoria South Africa
| | - Kenneth Tapia
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Erushka Pillay
- International Training and Education Center for Health, University of Washington, Pretoria South Africa
| | - Julia DeKadt
- International Training and Education Center for Health, University of Washington, Pretoria South Africa
| | - Evasen Naidoo
- International Training and Education Center for Health, University of Washington, Pretoria South Africa
| | - Julia C Dombrowski
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - King K Holmes
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA
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108
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Travassos AG, Xavier-Souza E, Netto E, Dantas EV, Timbó M, Nóbrega I, Haguihara T, Neumeyer J, Lisboa N, Soidan MA, Ferreira F, Brites C. Anogenital infection by Chlamydia trachomatis and Neisseria gonorrhoeae in HIV-infected men and women in Salvador, Brazil. Braz J Infect Dis 2016; 20:569-575. [PMID: 27765581 PMCID: PMC9427556 DOI: 10.1016/j.bjid.2016.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/12/2016] [Accepted: 09/04/2016] [Indexed: 11/27/2022] Open
Abstract
Background Infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae are the most common bacterial sexually transmitted infections throughout the world. These sexually transmitted infections are a growing problem in people living with HIV/AIDS. However, the presence of these agents in extra genital sites, remains poorly studied in our country. The objective of this study was to estimate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae anal and genital infection in people living with HIV/AIDS followed in a reference center in Salvador, Brazil. Methods Cross-sectional study, from June 2013 to June 2015. Proven HIV-infected people attending this reference center were invited. Clinical and epidemiological data were obtained through interview with standardized form. Chlamydia trachomatis and Neisseria gonorrhoeae screening was performed using qPCR (COBAS 4800® Roche). Results The frequency of positive cases of Chlamydia trachomatis and Neisseria gonorrhoeae was 12.3% in total, 9.2% cases amongst women and 17.1% amongst men. We found 14.0% of positive cases in anus and 3.1% in genital region in men, while 5.6% and 3.6%, in women, respectively. Among men, anal infection was associated with age <29 years (p = 0.033), report of anal intercourse (p = 0.029), pain during anal intercourse (p = 0.028). On the other hand, no association between genital infection and other variables were detected in bivariate analysis. Among women, we detected an association between Chlamydia trachomatis genital infection and age <29 years (p < 0.001), younger age at first sexual intercourse (p = 0.048), pregnancy (p < 0.001), viral load >50 copies/mL (p = 0.020), and no antiretroviral use (p = 0.008). Anal infection in women was associated with age <29 years old (p < 0.001) and pregnancy (p = 0.023), and was not associated with report of anal intercourse (p = 0.485). Conclusion Missed opportunities for diagnosis in extra genital sites could impact on HIV transmission. The extra genital sites need to be considered to break the HIV and bacterial sexually transmitted infections chain-of-transmission.
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Affiliation(s)
- Ana Gabriela Travassos
- Universidade Estadual da Bahia (UNEB), Salvador, BA, Brazil; Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Salvador, BA, Brazil.
| | | | - Eduardo Netto
- Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Eda Vinhaes Dantas
- Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Salvador, BA, Brazil
| | - Maiara Timbó
- Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Isabella Nóbrega
- Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Salvador, BA, Brazil
| | - Tatiana Haguihara
- Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Salvador, BA, Brazil
| | - Júlia Neumeyer
- Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | | | - Maria Angela Soidan
- Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Salvador, BA, Brazil
| | - Fábio Ferreira
- Laboratório Central de Saúde Pública Professor Gonçalo Moniz (LACEN-BA), Salvador, BA, Brazil
| | - Carlos Brites
- Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
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109
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Efosa OB, Uwadiegwu AP. Cytopathological Examination and Epidemiological Study of Cervicitis in Commercial Sex Workers (CSWs) in Coal City (Enugu), Nigeria. Ethiop J Health Sci 2016; 25:225-30. [PMID: 26633925 PMCID: PMC4650877 DOI: 10.4314/ejhs.v25i3.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background llicit sexual behavior by commercial sex workers (CSW) may have a disproportionate impact on the reproductive health of a woman that often leads to cervicitis. This study aimed at examining the cytopathology, patterns, prevalence and burden of cervicitis in CSW in Enugu metropolis, Nigeria. Methods Cervical smear was collected from the endocervix of about one hundred and eighteen (n=118) CSWs between November, 2014 and February, 2015 using the liquid-based cytology (LBC) method. Smears were processed and stained by the modified Papanicolaou method. Leftover samples were tested for sexually transmitted diseases, especially N. gonorrhea, and C. trachomatis using ligase chain reaction and nucleic acid amplification test. A randomized sampling design was used for data collection. Results Cytopathological examination of cervicitis in CSWs showed a moderate infection, and moderately severe to chronic inflammatory cells. The epidemiological study revealed that acute cervicitis are predominant 7(5.9%) and 2(1.7%) are chronic cervicitis. The prevalence of CSWs living with cervicitis in Enugu, Nigeria (7.6%), is significantly affected by age and working duration as CSWs. Also, Chlamydia trachomatis is the solely associated pathogen implicated in cervicitis group (n=9). Candidiasis infection (n=12) and T. vaginalis (n=3) are observed in non-cervicitis group (n=109) while the association between C. trachomatis and cervicitis infection is statistically significant (P= 0.0221). Conclusions Acute cervicitis was prevalent with a preponderance of 4:1 in CSWs in Enugu, Nigeria. C. trachomatis infection was the most prevalent etiologic agent of cervicitis in this study. Further molecular study of LBC smears from CSWs using PCR is strongly recommended.
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Affiliation(s)
- Odigie Bolaji Efosa
- Department of Medical Laboratory Science, School of Basic Medical Science, College of Medical Science, University of Benin, Nigeria ; Department of Medical Laboratory Science, Faculty of Health Science and Technology, College of Medicine, University of Nigeria, Nigeria
| | - Achukwu Peter Uwadiegwu
- Department of Medical Laboratory Science, Faculty of Health Science and Technology, College of Medicine, University of Nigeria, Nigeria
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Kalichman SC, Cherry C, Kalichman MO, Washington C, Grebler T, Hoyt G, Merely C, Welles B. Sexual Behaviors and Transmission Risks Among People Living with HIV: Beliefs, Perceptions, and Challenges to Using Treatments as Prevention. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1421-30. [PMID: 26292837 PMCID: PMC4761529 DOI: 10.1007/s10508-015-0559-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 04/29/2015] [Accepted: 04/29/2015] [Indexed: 05/15/2023]
Abstract
Antiretroviral therapy (ART) improves the health of people living with HIV and can reduce infectiousness, preventing HIV transmission. The potential preventive benefits of ART are undermined by beliefs that it is safe to have condomless sex when viral load is below levels of detection (infectiousness beliefs and risk perceptions). In this study, we hypothesized that infectiousness beliefs and HIV transmission risk perceptions would prospectively predict people living with HIV engaging in more condomless sex with HIV-negative and unknown HIV status sex partners. Sexually active HIV-positive men (n = 538, 76 %) and women (n = 166, 24 %) completed computerized interviews of sexually transmitted infection (STI) symptoms and diagnoses, unannounced pill counts for medication adherence, medical chart-abstracted HIV viral load, and 28 daily cell-phone-delivered prospective sexual behavior assessments. Results showed that a total of 313 (44 %) participants had engaged in condomless sex with HIV-negative/unknown status sex partners, and these individuals demonstrated higher rates of STI symptoms and diagnoses. Two-thirds of participants who had condomless sex with HIV-negative/unknown status partners had not disclosed their HIV status. Multivariable logistic regression models showed that beliefs regarding viral load and HIV infectiousness and perceptions of lower risk of HIV transmission resulting from HIV viral suppression predicted condomless sex with potentially uninfected partners over and above sex behaviors with HIV-positive partners and STI symptoms/diagnoses. Interventions that address HIV status disclosure and aggressively treat STI in sexually active people living with HIV should routinely accompany the use of HIV treatments as prevention.
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Affiliation(s)
- Seth C Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA.
| | - Chauncey Cherry
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Moira O Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Christopher Washington
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Tamar Grebler
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Ginger Hoyt
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Cindy Merely
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
| | - Brandi Welles
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
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111
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Abstract
Despite the availability of inexpensive antimicrobial treatment, syphilis remains prevalent worldwide, affecting millions of individuals. Furthermore, syphilis infection is suspected of increasing both susceptibility to, and tendency to transmit, HIV. Development of a syphilis vaccine would be a potentially promising step towards control, but the value of dedicating resources to vaccine development should be evaluated in the context of the anticipated benefits. Here, we use a detailed mathematical model to explore the potential impact of rolling out a hypothetical syphilis vaccine on morbidity from both syphilis and HIV and compare it to the impact of expanded ‘screen and treat’ programmes using existing treatments. Our results suggest that an efficacious vaccine has the potential to sharply reduce syphilis prevalence under a wide range of scenarios, while expanded treatment interventions are likely to be substantially less effective. Our modelled interventions in our simulated study populations are expected to have little effect on HIV, and in some scenarios lead to small increases in HIV incidence, suggesting that interventions against syphilis should be accompanied with interventions against other sexually transmitted infections to prevent the possibility that lower morbidity or lower perceived risk from syphilis could lead to increases in other sexually transmitted diseases.
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HIV-1 is undetectable in preejaculatory secretions from HIV-1-infected men on suppressive HAART. AIDS 2016; 30:1899-903. [PMID: 27124897 DOI: 10.1097/qad.0000000000001130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Preejaculatory fluid, a viscous, lubricating secretion expressed by penile urethral glands during sexual excitement, may play a role in the sexual transmission of HIV-1. The urethra has been shown to be an important site of HIV infection in men and male macaques, and preejaculatory fluid and urethral swabs from HIV-1-infected men often contain HIV. Recent studies have shown that HAART reduces but does not eliminate seminal HIV shedding in infected men, and that the penile urethra remains a site of persistent simian immunodeficiency virus infection in HAART-treated macaques. The objective of this study was to determine whether HIV-infected men on stable HAART continue to shed HIV into preejaculatory secretions. DESIGN Single-center prospective study. METHODS Sixty HIV-infected men on HAART were recruited to provide preejaculatory fluid, semen, and blood for HIV RNA quantification by reverse transcription-PCR. RESULTS Eight men had detectable HIV in blood; of these four had HIV in semen (range: 40-96 000 copies/ml), and one had HIV in preejaculate (2400 copies/sample). Fifty-two men had undetectable HIV RNA in blood; of these 10 (19.2%) had HIV RNA in semen (range: 59-800 copies/ml) whereas none (0%) had HIV RNA in preejaculate (P = 0.004). CONCLUSIONS This study documents for the first time high levels of HIV RNA in preejaculate fluid. However, none of the men on stable HAART with undetectable blood viral load had HIV RNA in preejaculate, even though many had detectable HIV in semen. The urethral glands do not appear to be a principal source of HIV in men on suppressive HAART.
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113
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Abstract
BACKGROUND Sexually transmitted infections (STIs) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) can lead to adverse pregnancy and neonatal outcomes. The prevalence of STIs and its association with HIV mother-to-child transmission (MTCT) were evaluated in a substudy analysis from a randomized, multicenter clinical trial. METHODOLOGY Urine samples from HIV-infected pregnant women collected at the time of labor and delivery were tested using polymerase chain reaction testing for the detection of CT and NG (Xpert CT/NG; Cepheid, Sunnyvale, CA). Infant HIV infection was determined by HIV DNA polymerase chain reaction at 3 months. RESULTS Of the 1373 urine specimens, 249 (18.1%) were positive for CT and 63 (4.6%) for NG; 35 (2.5%) had both CT and NG detected. Among 117 cases of HIV MTCT (8.5% transmission), the lowest transmission rate occurred among infants born to CT- and NG-uninfected mothers (8.1%) as compared with those infected with only CT (10.7%) and both CT and NG (14.3%; P = 0.04). Infants born to CT-infected mothers had almost a 1.5-fold increased risk for HIV acquisition (odds ratio, 1.47; 95% confidence interval, 0.9-2.3; P = 0.09). CONCLUSIONS This cohort of HIV-infected pregnant women is at high risk for infection with CT and NG. Analysis suggests that STIs may predispose to an increased HIV MTCT risk in this high-risk cohort of HIV-infected women.
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114
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Hashemi-Shahri SM, Sharifi-Mood B, Kouhpayeh HR, Moazen J, Farrokhian M, Salehi M. Sexually Transmitted Infections Among Hospitalized Patients With Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS) in Zahedan, Southeastern Iran. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2016; 5:e28028. [PMID: 27818966 PMCID: PMC5086419 DOI: 10.5812/ijhrba.28028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 06/16/2015] [Accepted: 06/30/2015] [Indexed: 02/06/2023]
Abstract
Background Studies show that nearly 40 million people are living with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) around the world and since the beginning of the epidemic, about 35 million have died from AIDS. Heterosexual intercourse is the most common route for transmission of HIV infection (85%). People with a sexually transmitted infection (STI), such as syphilis, genital herpes, chancroid, or bacterial vaginosis, are more likely to obtain HIV infection during sex. On the other hand, a patient with HIV can acquire other infections such as hepatitis C virus (HCV) and hepatitis B virus (HBV) and also STIs. Co-infections and co-morbidities can affect the treatment route of patients with HIV/AIDs. Sometimes, physicians should treat these infections before treating the HIV infection. Therefore, it is important to identify co-infection or comorbidity in patients with HIV/AIDS. Objectives This study was conducted in order to understand the prevalence of HIV/AIDS/STI co-infection. Patients and Methods In this cross-sectional study, we evaluated all HIV/AIDS patients who were admitted to the infectious wards of Boo-Ali hospital (Southeastern Iran) between March 2000 and January 2015. All HIV/AIDS patients were studied for sexually transmitted infections (STI) such as syphilis, gonorrhea, hepatitis B virus (HBV) and genital herpes. A questionnaire including data on age, sex, job, history of vaccination against HBV, hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), hepatitis B surface antigen (anti-HBs), HCV-Ab, venereal disease research laboratory (VDRL) test, fluorescent treponemal antibody absorption (FTA-Abs) test, and urine culture was designed. Data was analyzed by the Chi square test and P values of < 0.05 were considered significant. Results Among the 41 patients with HIV/AIDS (11 females and 30 males; with age range of 18 to 69 years) five cases (12.1%) had a positive test (1:8 or more) for VDRL. The FTA-Abs was positive for all patients who were positive for VDRL. Gonorrhea was found in seven patients (17%) and three cases had genital herpes in clinical examinations. All patients who had positive test results for these STIs were male. Eleven patients (26.8%) had HBV infection (three females and eight males). hepatitis C virus (HCV) was found in 13 cases (31%). Eighty percent of patients were unemployed. Seventy-eight percent of patients with HIV/STI were aged between 18 and 38 years. There was a significant difference between sex and becoming infected with HIV and also STI (P < 0.05). Conclusions Patients with HIV/AIDS are more likely to acquire other STIs, because the same behaviors that increase the risk of becoming HIV infected can also increase the risk of acquiring STIs. Having a sore on the skin due to an STI can make the transmission of HIV to the sex partner more likely than people who don’t have such sore in their genital area.
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Affiliation(s)
| | - Batool Sharifi-Mood
- Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Hamid-Reza Kouhpayeh
- Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Javad Moazen
- Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Mohsen Farrokhian
- Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Masoud Salehi
- Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
- Corresponding author: Masoud Salehi, Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran. Tel: +98-54132281012, Fax: +98-5413236722, E-mail:
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115
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Mauck C, Chen PL, Morrison CS, Fichorova RN, Kwok C, Chipato T, Salata RA, Doncel GF. Biomarkers of Cervical Inflammation and Immunity Associated with Cervical Shedding of HIV-1. AIDS Res Hum Retroviruses 2016; 32:443-51. [PMID: 26650885 DOI: 10.1089/aid.2015.0088] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Cervicovaginal HIV shedding is associated with increased female-to-male and mother-to-child transmission. Genital inflammation may increase shedding through cytokines/chemokines which recruit and activate HIV target cells. We evaluated whether cervical immune mediators present before seroconversion affected HIV shedding and whether mediators differed between shedders and nonshedders. METHODS We used cervical samples from 187 African women with documented HIV seroconversion in the Hormonal Contraception and HIV study. Samples were from the two visits before seroconversion (T-2 and/or T-1), and/or at seroconversion (T0), and/or the two visits (T + 1 and/or T + 2) after seroconversion. We measured interleukin (IL)-1β, IL-1 Receptor Antagonist (IL-1RA), IL-6, IL-8, RANTES (Regulated on Activation, Normal T-Cell Expressed and Secreted), MIP-3α, vascular endothelial growth factor (VEGF), Intercellular Adhesion Molecule-1 (ICAM-1), secretory leukocyte protease inhibitor (SLPI), and BD-2 and used the Wilcoxon test and generalized linear models to evaluate the association between mediators and shedding. RESULTS The only immune mediator that differed at T-1 was RANTES, which was higher among shedders (p ≤ .05). HIV seroconversion was followed by significant decreases in many mediators, but a significant increase in RANTES. The magnitude of the change was significantly different for shedders versus nonshedders with regard to RANTES (increased in both groups, significantly more so in shedders), SLPI (decreased in both groups, significantly more so in shedders), and MIP-3α (decreased in shedders and increased in nonshedders). At T0, shedders had lower levels of SLPI and MIP-3α than nonshedders. CONCLUSIONS In this study, a specific immune mediator profile was associated with risk of cervical HIV shedding. Higher and increasing levels of RANTES and lower and decreasing levels of SLPI and MIP-3α were associated with increased risk of HIV shedding.
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Affiliation(s)
- Christine Mauck
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, CONRAD, Arlington, Virginia
| | - Pai-Lien Chen
- Department of Biostatistics, FHI 360, Durham, North Carolina
| | | | - Raina N. Fichorova
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cynthia Kwok
- Department of Biostatistics, FHI 360, Durham, North Carolina
| | - Tsungai Chipato
- Department of Obstetrics and Gynecology, University of Zimbabwe, Harare, Zimbabwe
| | - Robert A. Salata
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Gustavo F. Doncel
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, CONRAD, Arlington, Virginia
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Kriek JM, Jaumdally SZ, Masson L, Little F, Mbulawa Z, Gumbi PP, Barnabas SL, Moodley J, Denny L, Coetzee D, Williamson AL, Passmore JAS. Female genital tract inflammation, HIV co-infection and persistent mucosal Human Papillomavirus (HPV) infections. Virology 2016; 493:247-54. [PMID: 27065342 DOI: 10.1016/j.virol.2016.03.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/24/2016] [Accepted: 03/28/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Persistent genital infections with high-risk HPV types increase risk of cervical disease and cancer. Since genital inflammation increases HIV acquisition risk and cancer progression, we evaluated whether HPV infection induces cytokine expression in the reproductive tract. METHODS Genital cytokines concentrations were measured in 93 HIV-infected and 72 uninfected women. HPV typing was done by Roche Linear array. Persistence and clearance of HPV were evaluated using longitudinal data. RESULTS Infection with HPV did not influence genital cytokine concentrations. In contrast, HIV-infected women had higher IL-1α, IL-6, IL-8, IP-10, MCP-1 and G-CSF concentrations compared to HIV-uninfected women, and HPV-infections that were more prevalent, persistent and multi-type. CONCLUSION HPV did not influence inflammatory cytokine levels in the genital tract, although immune suppression may favor persistence.
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Affiliation(s)
- Jean-Mari Kriek
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Shameem Z Jaumdally
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Lindi Masson
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Francesca Little
- Department of Statistical Science, University of Cape Town, Cape Town, South Africa
| | - Zizipho Mbulawa
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Center for HIV and STIs National Institute for Communicable Disease, National Health Laboratory Service, South Africa
| | - Pamela P Gumbi
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Shaun L Barnabas
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | - Jennifer Moodley
- UCT/MRC Clinical Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa; Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Women׳s Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Lynette Denny
- UCT/MRC Clinical Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa; Department of Obstetrics and Gynaecology, University of Cape Town/Groote Schuur Hospital, Cape Town, South Africa
| | - David Coetzee
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Anna-Lise Williamson
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; UCT/MRC Clinical Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa; National Health Laboratory Service, South Africa
| | - Jo-Ann S Passmore
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; UCT/MRC Clinical Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa; National Health Laboratory Service, South Africa.
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117
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Acceptability and Feasibility of Sexually Transmitted Infection Testing and Treatment among Pregnant Women in Gaborone, Botswana, 2015. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1251238. [PMID: 27119076 PMCID: PMC4826911 DOI: 10.1155/2016/1251238] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/18/2016] [Indexed: 11/26/2022]
Abstract
Introduction. Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) are curable sexually transmitted infections (STIs) that can cause adverse maternal and birth outcomes. Most countries do not conduct routine testing during antenatal care. We present data on the acceptability and feasibility of testing and treating pregnant women for STIs in an antenatal clinic in Gaborone, Botswana. Materials and Methods. We offered CT, NG, and TV testing using self-collected vaginal swabs to eligible pregnant women. Participants received same-day test results. Those who tested positive were given treatment. Results. Among the 225 women who were eligible and recruited, 200 (89%) agreed to participate. The median age of our study sample was 30 years; most were unmarried (77%), with a median gestational age of 27 weeks and a 23% HIV prevalence. All participants received their results with at least 72% (n = 143) on the same day. Thirty participants (15%) tested positive for an STI, all were treated, and 24 (80%) were treated on the same day. Conclusion. The acceptability of STI testing was high, and the intervention was feasible. This study provides support for continued research into STI prevalence, cost-effectiveness, and the association of STIs with adverse maternal and infant outcomes.
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118
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Mulhall BP, Wright ST, De La Mata N, Allen D, Brown K, Dickson B, Grotowski M, Jackson E, Petoumenos K, Foster R, Read T, Russell D, Smith DJ, Templeton DJ, Fairley CK, Law MG. Risk factors associated with incident sexually transmitted infections in HIV-positive patients in the Australian HIV Observational Database: a prospective cohort study. HIV Med 2016; 17:623-30. [PMID: 27019207 DOI: 10.1111/hiv.12371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We established a subcohort of HIV-positive individuals from 10 sexual health clinics within the Australian HIV Observational Database (AHOD). The aim of this study was to assess demographic and other factors that might be associated with an incident sexually transmitted infection (STI). METHODS The cohort follow-up was from March 2010 to March 2013, and included patients screened at least once for an STI. We used survival methods to determine time to first new and confirmed incident STI infection (chlamydia, gonorrhoea, syphilis or genital warts). Factors evaluated included sex, age, mode of HIV exposure, year of AHOD enrolment, hepatitis B or C coinfection, time-updated CD4 cell count, time-updated HIV RNA viral load, and prior STI diagnosis. RESULTS There were 110 first incident STI diagnoses observed over 1015 person-years of follow-up, a crude rate of 10.8 [95% confidence interval (CI) 9.0-13.0] per 100 person-years. Factors independently associated with increased risk of incident STI included younger age [≥ 50 vs. 30-39 years old, adjusted hazards ratio (aHR) 0.4; 95% CI 0.2-0.8; P < 0.0001]; prior STI infection (aHR 2.5; 95% CI 1.6-3.8; P < 0.001), and heterosexual vs. men who have sex with men (MSM) as the likely route of exposure (aHR 0.2; 95% CI 0.1-0.6; P < 0.001). CONCLUSIONS In this cohort of individualsbeing treated with antiretroviral drugs, those who were MSM, who were 30-39 years old, and who had a prior history of STI, were at highest risk of a further STI diagnosis.
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Affiliation(s)
- B P Mulhall
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,University of Sydney, Camperdown, NSW, Australia
| | - S T Wright
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - N De La Mata
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - D Allen
- Holden Street Sexual Health Clinic, Gosford, NSW, Australia
| | - K Brown
- University of Sydney, Camperdown, NSW, Australia.,Illawarra Sexual Health Services, Warrawong, NSW, Australia.,University of Wollongong, Wollongong, NSW, Australia
| | - B Dickson
- Caradata, Arundel DC, Qld, Australia
| | - M Grotowski
- Tamworth Sexual Health, Clinic 468, HNEAHS, NSW, Australia
| | - E Jackson
- Nepean/Blue Mountains Sexual Health, Nepean Hospital, Kingswood, NSW, Australia
| | - K Petoumenos
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - R Foster
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,Sydney Sexual Health Centre, Sydney, NSW, Australia
| | - T Read
- Melbourne Sexual Health Centre, Alfred Hospital, Prahran, Vic., Australia
| | - D Russell
- Cairns Sexual Health Service, Cairns, Qld, Australia.,Central Clinical School Monash University, Alfred Hospital, Melbourne, Vic., NSW, Australia
| | - D J Smith
- Lismore Sexual Health Services, Lismore, NSW, Australia
| | - D J Templeton
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.,RPA Sexual Health, Camperdown, NSW, Australia
| | - C K Fairley
- Melbourne Sexual Health Centre, Alfred Hospital, Prahran, Vic., Australia.,Central Clinical School Monash University, Alfred Hospital, Melbourne, Vic., NSW, Australia
| | - M G Law
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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119
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Strong Country Level Correlation between Syphilis and HSV-2 Prevalence. JOURNAL OF SEXUALLY TRANSMITTED DISEASES 2016; 2016:5959032. [PMID: 27069710 PMCID: PMC4812442 DOI: 10.1155/2016/5959032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/07/2016] [Indexed: 02/01/2023]
Abstract
Background. Syphilis is curable but Herpes Simplex Virus-2 (HSV-2) is not. As a result, the prevalence of syphilis but not HSV-2 may be influenced by the efficacy of national STI screening and treatment capacity. If the prevalence of syphilis and HSV-2 is found to be correlated, then this makes it more likely that something other than differential STI treatment is responsible for variations in the prevalence of both HSV-2 and syphilis. Methods. Simple linear regression was used to evaluate the relationship between national antenatal syphilis prevalence and HSV-2 prevalence in women in two time periods: 1990–1999 and 2008. Adjustments were performed for the laboratory syphilis testing algorithm used and the prevalence of circumcision. Results. The prevalence of syphilis was positively correlated with that of HSV-2 for both time periods (adjusted correlations, 20–24-year-olds: 1990–99: R2 = 0.54, P < 0.001; 2008: R2 = 0.41, P < 0.001 and 40–44-year-olds: 1990–99: R2 = 0.42, P < 0.001; 2008: R2 = 0.49, P < 0.001). Conclusion. The prevalence of syphilis and HSV-2 is positively correlated. This could be due to a common set of risk factors underpinning both STIs.
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120
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Barbee LA, Golden MR. Editorial Commentary: When to Perform a Test of Cure for Gonorrhea: Controversies and Evolving Data: Table 1. Clin Infect Dis 2016; 62:1356-9. [DOI: 10.1093/cid/ciw142] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 02/26/2016] [Indexed: 11/14/2022] Open
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Pilapil M, Morris L, Saito K, Kouya F, Maku V, Kwalar R, Palmer N, Tih PM, Jao J. Retrospective analysis of the prevalence of and factors associated with condom use among young HIV-infected women in Cameroon. SAGE Open Med 2016; 4:2050312115626432. [PMID: 26835019 PMCID: PMC4724765 DOI: 10.1177/2050312115626432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 12/15/2015] [Indexed: 12/02/2022] Open
Abstract
Objectives: Young women are more likely to be infected with HIV globally, in sub-Saharan Africa, and in Cameroon. Despite its clear clinical and public health benefits, condom use among HIV-infected women continues to be low. The objective of this study was to describe the prevalence of inconsistent condom use among HIV-infected women in Cameroon and the factors associated with it. Methods: We conducted a cross-sectional study of HIV-infected young women aged 17–26 years from three semi-urban HIV clinics in the Northwest Region of Cameroon. This study was a subgroup analysis of a previously reported study on inconsistent condom use in HIV-infected and -uninfected youth. Inconsistent condom use was defined as reporting “sometimes” or “never” to questions regarding frequency of condom use. Logistic regression modeling was used to determine factors associated with inconsistent condom use. Results: A total of 84 participants were recruited and submitted completed questionnaires for analysis. Median age was 24 years (interquartile range = 22–25) and the median age at HIV diagnosis was 21 years (interquartile range = 20–23). Fifty percent of the participants reported no prior schooling or only primary school education. Overall, 61/84 (73%) reported inconsistent condom use. After adjusting for potential confounders, education to the secondary school level was protective against inconsistent condom use (odds ratio = 0.19; confidence interval: 0.04–0.95), and having ≥2 pregnancies was associated with inconsistent condom use (odds ratio = 7.52; confidence interval: 1.67–34.00). Conclusion: There is a high prevalence of inconsistent condom use among young HIV-infected women in Cameroon, which appears to be associated with lower levels of educational attainment and higher parity. Further larger studies assessing the factors associated with poor condom use in this population are warranted and may inform public health policy in resource-limited settings with high HIV prevalence.
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Affiliation(s)
- Mariecel Pilapil
- Division of General Internal Medicine, Department of Medicine and Division of General Pediatrics, Department of Pediatrics, Hofstra Northwell School of Medicine, Lake Success, NY, USA
| | - Lee Morris
- Division of Pediatric Infectious Disease and Immunology, Department of Pediatrics, Levine Children's Hospital, Carolinas Healthcare System, Charlotte, NC, USA
| | - Kohta Saito
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Francine Kouya
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Vivian Maku
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Rene Kwalar
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Nancy Palmer
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Pius Muffih Tih
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Jennifer Jao
- Division of Infectious Diseases, Department of Medicine and Division of General Internal Medicine, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Slade J, Hall JV, Kintner J, Schoborg RV. Chlamydial Pre-Infection Protects from Subsequent Herpes Simplex Virus-2 Challenge in a Murine Vaginal Super-Infection Model. PLoS One 2016; 11:e0146186. [PMID: 26726882 PMCID: PMC4699815 DOI: 10.1371/journal.pone.0146186] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 12/14/2015] [Indexed: 11/18/2022] Open
Abstract
Chlamydia trachomatis and Herpes Simplex Virus-2 (HSV-2) genital tract co-infections have been reported in humans and studied in vitro but the clinical consequences are unknown. Limited epidemiologic evidence suggests that these co-infections could be more severe than single infections of either pathogen, but the host-pathogen interactions during co-infection remain uncharacterized. To determine whether disease progression and/or pathogen shedding differs between singly-infected and super-infected animals, we developed an in vivo super-infection model in which female BALB/c mice were vaginally infected with Chlamydia muridarum (Cm) followed later by HSV-2. Pre-infection with Chlamydia 3 or 9 days prior to HSV-2 super-infection conferred significant protection from HSV-2-induced neurologic disease and significantly reduced viral recovery compared to HSV-2 singly-infected controls. Neither protection from mortality nor reduced viral recovery were observed when mice were i) super-infected with HSV-2 on day 27 post Cm; ii) infected with UV-irradiated Cm and super-infected with HSV-2; or iii) azithromycin-treated prior to HSV-2 super-infection. Therefore, protection from HSV-2-induced disease requires active infection with viable chlamydiae and is not observed after chlamydial shedding ceases, either naturally or due to antibiotic treatment. Thus, Chlamydia-induced protection is transient and requires the continued presence of chlamydiae or their components. These data demonstrate that chlamydial pre-infection can alter progression of subsequent HSV-2 infection, with implications for HSV-2 transmission from co-infected humans.
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Affiliation(s)
- Jessica Slade
- Department of Biomedical Sciences, Center for Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, United States of America
| | - Jennifer V. Hall
- Department of Biomedical Sciences, Center for Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, United States of America
| | - Jennifer Kintner
- Department of Biomedical Sciences, Center for Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, United States of America
| | - Robert V. Schoborg
- Department of Biomedical Sciences, Center for Inflammation, Infectious Disease and Immunity, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, United States of America
- * E-mail:
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Munawwar A, Singh S. Human Herpesviruses as Copathogens of HIV Infection, Their Role in HIV Transmission, and Disease Progression. J Lab Physicians 2016; 8:5-18. [PMID: 27013807 PMCID: PMC4785766 DOI: 10.4103/0974-2727.176228] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Of eight human herpesviruses (HHVs), often, only herpes simplex virus types 1 (HSV-1) and 2 (HSV-2) find mention in medical literature as both of these viruses are commonly associated with genital lesions and oral ulcers, commonly known as cold sores. However, role of human herpesviruses as copathogens and in aggravation and in the transmission of other human diseases, especially the Acquired immunodeficiency syndrome (HIV/AIDS) has only very recently been recognized. Therefore, screening and treating subclinical HHV infections may offer slowing of HIV infection, disease progression, and its transmission. Beside HSV-1 and HSV-2, HHV-3 a causative agent of herpes zoster remained one of the first manifestations of HIV disease before the era of highly active antiretroviral therapy (HAART). HHV-5 also known as human Cytomegalovirus infection remains a significant risk factor for HIV-associated mortality and morbidity even in HAART era. It is proposed that Cytomegalovirus viremia could be a better predictor of HIV disease progression than CD4+ T-lymphocyte count. The role of HHV-4 or Epstein-Burr virus and HHV-6, HHV-7, and HHV-8 is still being investigated in HIV disease progression. This review provides insight into the current understanding about these 8 HHVs, their co-pathogenesis, and role in HIV/AIDS disease progression. The review also covers recent literature in favor and against administering anti-HHV treatment along with HAART for slower AIDS progression and interrupted sexual transmission.
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Affiliation(s)
- Arshi Munawwar
- Department of Laboratory Medicine, Division of Clinical Microbiology and Molecular Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sarman Singh
- Department of Laboratory Medicine, Division of Clinical Microbiology and Molecular Medicine, All India Institute of Medical Sciences, New Delhi, India
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The contribution of Mycoplasma genitalium to the aetiology of sexually acquired infectious proctitis in men who have sex with men. Clin Microbiol Infect 2015; 22:260-5. [PMID: 26686807 DOI: 10.1016/j.cmi.2015.11.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/05/2015] [Accepted: 11/28/2015] [Indexed: 11/20/2022]
Abstract
This study examined the contribution of Mycoplasma genitalium to sexually acquired infectious proctitis in men who have sex with men (MSM). MSM with symptomatic proctitis between May 2012 and August 2013 were tested for rectal sexually transmitted infections including chlamydia, gonorrhoea, herpes simplex virus (HSV) and M. genitalium. The load of rectal M. genitalium in men with symptomatic proctitis was compared with a separate group of men who had rectal M. genitalium but no symptoms of proctitis. Among 154 MSM with proctitis, rectal M. genitalium was detected in 18 men (12%, 95% CI 6.9-17.1) and was significantly more common among human immunodeficiency virus (HIV) -positive men (21%, 95% CI 9.5-32.6) than HIV-negative men (8%, 95% CI 2.9-13.1; prevalence ratio 3.2, 95% CI 1.2-8.8). Among HIV-positive men the detection of M. genitalium was comparable to that for chlamydia (21%, 95% CI 9.5-32.5), gonorrhoea (25%, 95% CI 16.2-41.8) and HSV (19%, 95% CI 7.9-30.1). Rectal M. genitalium load was significantly higher among the 18 men with symptomatic M. genitalium-associated proctitis than among a separate group of 18 men with asymptomatic rectal M. genitalium infection (60 000 copies of organism/swab versus 10 744 copies of organism/swab, p 0.023). Comprehensive testing for rectal pathogens in MSM with proctitis should include testing for M. genitalium.
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Magaisa K, Taylor M, Kjetland EF, Naidoo PJ. A review of the control of schistosomiasis in South Africa. S AFR J SCI 2015. [DOI: 10.17159/sajs.2015/20140427] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract Schistosomiasis is the second most important tropical disease in the world in terms of public health impact. In South Africa, more than 4 million people are estimated to be infected with schistosomiasis. School-age children usually have the highest prevalence and intensity of infection. Schistosoma haematobium may result in female genital schistosomiasis which presents as inflammation and ulceration of the genital mucosa and pathological blood vessels. These effects may increase the susceptibility of women with female genital schistosomiasis to HIV. Praziquantel is the drug used to treat schistosomiasis and it is best to treat people during the early stages of infection, before female genital schistosomiasis presents as lesions and sandy patches, as there currently is no treatment for these symptoms. Schistosomiasis is not regarded as a serious public health issue in South Africa despite evidence revealing the seriousness of the disease. In areas endemic for schistosomiasis, the World Health Organization recommends regular mass treatment of all school-age children. In 2001, South Africa became a signatory to the World Health Assembly resolution 54.19 which urged all member states to achieve the minimum goal of 75% treatment coverage in school-age children at risk by 2010. This goal was not achieved in South Africa, despite efforts made by the Department of Health, such as the first statutory school-based geohelminth control programme in the province of KwaZulu-Natal. However, this programme has not been continued. Therefore, there is still much work to be done in order to control and decrease the prevalence of schistosomiasis in endemic areas.
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Berry SA, Ghanem KG, Mathews WC, Korthuis PT, Yehia BR, Agwu AL, Lehmann CU, Moore RD, Allen SL, Gebo KA. Brief Report: Gonorrhea and Chlamydia Testing Increasing but Still Lagging in HIV Clinics in the United States. J Acquir Immune Defic Syndr 2015; 70:275-9. [PMID: 26068721 PMCID: PMC4607588 DOI: 10.1097/qai.0000000000000711] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Screening persons living with HIV for gonorrhea and chlamydia has been recommended since 2003. We compared annual gonorrhea/chlamydia testing to syphilis and lipid testing among 19,368 adults (41% men who have sex with men, 30% heterosexual men, and 29% women) engaged in HIV care. In 2004, 22%, 62%, and 70% of all patients were tested for gonorrhea/chlamydia, syphilis, and lipid levels, respectively. Despite increasing steadily [odds ratio per year (95% confidence interval): 1.14 (1.13 to 1.15)], gonorrhea/chlamydia testing in 2010 remained lower than syphilis and lipid testing (39%, 77%, 76%, respectively). Interventions to improve gonorrhea/chlamydia screening are needed. A more targeted screening approach may be warranted.
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Affiliation(s)
| | | | | | | | - Baligh R. Yehia
- University of Pennsylvania School of Medicine, Philadelphia PA
| | | | | | | | - Sara L. Allen
- Drexel University School of Medicine, Philadelphia PA
| | - Kelly A. Gebo
- Johns Hopkins University School of Medicine, Baltimore MD
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Redelinghuys MJ, Ehlers MM, Dreyer AW, Lombaard H, Olorunju SAS, Kock MM. A cross-sectional study on the relationship of age, gestational age and HIV infection to bacterial vaginosis and genital mycoplasma infection. BMJ Open 2015; 5:e008530. [PMID: 26482771 PMCID: PMC4611850 DOI: 10.1136/bmjopen-2015-008530] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Pregnant women are especially at risk of developing complications when infected with reproductive tract infections (RTIs). The objective of this study was to determine the prevalence of bacterial vaginosis (BV) and genital mycoplasmas in pregnant women and investigate the associations between BV, genital mycoplasmas, HIV infection, age and gestational age. DESIGN Cross-sectional study with descriptive and analytical components. SETTING Antenatal clinic of a tertiary academic hospital in South Africa. PARTICIPANTS 220 pregnant women older than 18 were included in the study and provided self-collected vaginal swabs. PRIMARY AND SECONDARY OUTCOMES BV and genital mycoplasma colonisation and/or infection in women of differing age, gestational period and HIV status. RESULTS The prevalence of BV was 17.7% (39/220) (95% CI 12.9 to 23.4), intermediate vaginal flora (IVF) 15% (33/220) (95% CI 10.56 to 20.42), and the overall prevalence of genital mycoplasmas was 84% (185/220) (95% CI 78.47 to 88.58). BV was significantly associated with HIV infection with an OR of 2.84 (95% CI 1.08 to 7.46 and p value=0.034). However, BV was inversely associated with gestational age with an OR of 0.08 (95% CI 0.01 to 0.42 and p value=0.003) for second trimester pregnancies and an OR of 0.03 (95% CI 0.01 to 0.17 and p value<0.001) for third trimester pregnancies using the first trimester as reference. IVF was significantly associated with HIV infection with an OR of 2.7 (95% CI 1.07 to 6.79 and p value=0.035) but not with age or gestational age. Genital mycoplasmas were not significantly associated with age, gestational age, HIV status, BV flora or IVF. CONCLUSIONS The high infection rate of genital mycoplasmas and the association of BV with HIV found in this study reiterate the importance of screening for these RTIs in high-risk groups such as pregnant women.
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Affiliation(s)
| | - Marthie M Ehlers
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa Department of Medical Microbiology, Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa
| | - Andries W Dreyer
- Centre for Tuberculosis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Hennie Lombaard
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Steve A S Olorunju
- Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa
| | - Marleen M Kock
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa Department of Medical Microbiology, Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa
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Bacterial sexually transmitted infections among HIV-infected patients in the United States: estimates from the Medical Monitoring Project. Sex Transm Dis 2015; 42:171-9. [PMID: 25763669 DOI: 10.1097/olq.0000000000000260] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Bacterial sexually transmitted infections may facilitate HIV transmission. Bacterial sexually transmitted infection testing is recommended for sexually active HIV-infected patients annually and more frequently for those at elevated sexual risk. We estimated percentages of HIV-infected patients in the United States receiving at least one syphilis, gonorrhea, or chlamydia test, and repeat (≥2 tests, ≥3 months apart) tests for any of these sexually transmitted infections from mid-2008 through mid-2010. DESIGN The Medical Monitoring Project collects behavioral and clinical characteristics of HIV-infected adults receiving medical care in the United States using nationally representative sampling. METHODS Sexual activity included self-reported oral, vaginal, or anal sex in the past 12 months. Participants reporting more than 1 sexual partner or illicit drug use before/during sex in the past year were classified as having elevated sexual risk. Among participants with only 1 sex partner and no drug use before/during sex, those reporting consistent condom use were classified as low risk; those reporting sex without a condom (or for whom this was unknown) were classified as at elevated sexual risk only if they considered their sex partner to be a casual partner, or if their partner was HIV-negative or partner HIV status was unknown. Bacterial sexually transmitted infection testing was ascertained through medical record abstraction. RESULTS Among sexually active patients, 55% were tested at least once in 12 months for syphilis, whereas 23% and 24% received at least one gonorrhea and chlamydia test, respectively. Syphilis testing did not vary by sex/sexual orientation. Receipt of at least 3 CD4+ T-lymphocyte cell counts and/or HIV viral load tests in 12 months was associated with syphilis testing in men who have sex with men (MSM), men who have sex with women only, and women. Chlamydia testing was significantly higher in sexually active women (30%) compared with men who have sex with women only (19%), but not compared with MSM (22%). Forty-six percent of MSM were at elevated sexual risk; 26% of these MSM received repeat syphilis testing, whereas repeat testing for gonorrhea and chlamydia was only 7% for each infection. CONCLUSIONS Bacterial sexually transmitted infection testing among sexually active HIV-infected patients was low, particularly for those at elevated sexual risk. Patient encounters in which CD4+ T-lymphocyte cell counts and/or HIV viral load testing occurs present opportunities for increased bacterial sexually transmitted infection testing.
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Etiology and antimicrobial susceptibility of pathogens responsible for urethral discharge among men in Harare, Zimbabwe. Sex Transm Dis 2015; 41:713-7. [PMID: 25581806 DOI: 10.1097/olq.0000000000000204] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Periodic etiological surveillance of sexually transmitted infection (STI) syndromes is required to validate treatment algorithms used to control STIs. However, such surveys have not been performed in Zimbabwe over the past decade. METHODS A cross-sectional study design was used to determine the prevalence of the key STI etiological agents causing male urethral discharge (MUD). Urethral swab specimens were collected for molecular analysis and Neisseria gonorrhoeae isolation from consenting men 18 years and older who presented with MUD to the 12 clinics in Harare, Zimbabwe, between November 2010 and May 2011. A validated in-house multiplex polymerase chain reaction assay was used to detect the presence of N. gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium. Gonococci were cultured on selective media, and antimicrobial susceptibilities were determined locally for ciprofloxacin, kanamycin, ceftriaxone, and cefixime using Etest strips, and minimum inhibitory concentrations were reported using defined breakpoints. RESULTS Among 130 participants, N. gonorrhoeae was the most frequent pathogen detected (106; 82.8%), followed by C. trachomatis (15; 11.7%), M. genitalium (6; 4.7%), and T. vaginalis (2; 1.6%). Four (6.1%) of the 66 gonococci isolated were resistant to fluoroquinolones, whereas all viable isolates were susceptible to kanamycin, cefixime, and ceftriaxone. CONCLUSIONS Gonorrhea is the most important cause of MUD in men in Harare, and our study highlights the emergence of fluoroquinolone-resistant N. gonorrhoeae. Further STI surveys are required in other regions of Zimbabwe to obtain a nationally representative picture of gonococcal burden and antimicrobial resistance among MUD patients.
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HIV sexual transmission risks in the context of clinical care: a prospective study of behavioural correlates of HIV suppression in a community sample, Atlanta, GA, USA. J Int AIDS Soc 2015; 18:19930. [PMID: 26249127 PMCID: PMC4528077 DOI: 10.7448/ias.18.1.19930] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 04/27/2015] [Accepted: 06/09/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction Antiretroviral therapy (ART) improves the health of people living with HIV and has the potential to reduce HIV infectiousness, thereby preventing HIV transmission. However, the success of ART for HIV prevention hinges on sustained ART adherence and avoiding sexually transmitted infections (STI). Objectives To determine the sexual behaviours and HIV transmission risks of individuals with suppressed and unsuppressed HIV replication (i.e., viral load). Methods Assessed HIV sexual transmission risks among individuals with clinically determined suppressed and unsuppressed HIV. Participants were 760 men and 280 women living with HIV in Atlanta, GA, USA, who completed behavioural assessments, 28-daily prospective sexual behaviour diaries, one-month prospective unannounced pill counts for ART adherence, urine screening for illicit drug use and medical record chart abstraction for HIV viral load. Results Individuals with unsuppressed HIV demonstrated a constellation of behavioural risks for transmitting HIV to uninfected sex partners that included symptoms of STI and substance use. In addition, 15% of participants with suppressed HIV had recent STI symptoms/diagnoses, indicating significant risks for sexual infectiousness despite their HIV suppression in blood plasma. Overall, 38% of participants were at risk for elevated sexual infectiousness and just as many engaged in unprotected sexual intercourse with non-HIV-infected partners. Conclusions Implementation strategies for using HIV treatments as HIV prevention requires enhanced behavioural interventions that extend beyond ART to address substance use and sexual health that will otherwise undermine the potential preventive impact of early ART.
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Cingolani A, Zona S, Girardi E, Cozzi-Lepri A, Monno L, Quiros Roldan E, Guaraldi G, Antinori A, D’Arminio Monforte A, Marcotullio S. Incidence and factors associated with the risk of sexually transmitted diseases in HIV-infected people seen for care in Italy: data from the Icona Foundation cohort. HIV Med 2015; 16:412-20. [PMID: 25959419 PMCID: PMC4682467 DOI: 10.1111/hiv.12226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aims of this study were to identify temporal trends in the incidence of sexually transmitted diseases (STDs) in a cohort of HIV-infected people and to evaluate factors associated with the risk of a new STD diagnosis. METHODS All HIV-infected patients in the Icona Foundation Study cohort enrolled after 1998 were included in this study. STD incidence rates (IRs) were calculated and stratified by calendar period. Predictors of STDs were identified using a Poisson regression model with sandwich estimates for standard errors. RESULTS Data for 9168 participants were analysed [median age 37.3 (range 18-81) years; 74% male; 30% men who have sex with men (MSM)]. Over 46 736 person-years of follow-up (PYFU), 996 episodes of STDs were observed [crude IR 21.3/1000 PYFU; 95% confidence interval (CI) 20.0-22.6/1000 PYFU]. In multivariable Poisson regression analysis, MSM [rate ratio (RR) 3.03; 95% CI 2.52-3.64 versus heterosexuals], calendar period (RR 1.67; 95% CI 1.42-1.97 for 2008-2012 versus 1998-2002), HIV RNA > 50 HIV-1 RNA copies/mL (RR 1.44; 95% CI 1.19-1.74 versus HIV RNA ≤ 50 copies/mL) and a current CD4 count < 100 cells/μL (RR 4.66; 95% CI 3.69-5.89; P < 0.001 versus CD4 count > 500 cells/μL) were associated with an increased risk of STDs. In contrast, older age (RR 0.82 per 10 years older; 95% CI 0.77-0.89) and being currently on ART (RR 0.38; 95% CI 0.33-0.45) compared with being ART-naïve or on a treatment interruption were associated with a lower risk of developing STDs. CONCLUSIONS An increase in the incidence of STDs was observed in more recent years. Interventions to prevent STDs and potential spread of HIV should target the younger population, MSM and people currently not receiving ART.
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Affiliation(s)
- A Cingolani
- Department of Public Health, Infectious Diseases, Catholic UniversityRome, Italy
| | - S Zona
- Clinic of Infectious Diseases, Univeristy of Modena and Reggio EmiliaModena, Italy
| | - E Girardi
- Department of Epidemiology, National Institute for Infectious Diseases ‘L. Spallanzani’Rome, Italy
| | - A Cozzi-Lepri
- Department of Infection and Population Health, Division of Population Health, University College London Medical School, Royal Free CampusLondon, UK
| | - L Monno
- Institute of Infectious Diseases, University of BariBari, Italy
| | - E Quiros Roldan
- Institute of Infectious Diseases, University of BresciaBrescia, Italy
| | - G Guaraldi
- Clinic of Infectious Diseases, Univeristy of Modena and Reggio EmiliaModena, Italy
| | - A Antinori
- Clinical Department, National Institute for Infectious Diseases ‘L. Spallanzani’Rome, Italy
| | - A D’Arminio Monforte
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, San Paolo University HospitalMilan, Italy
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The effect of sexually transmitted co-infections on HIV viral load amongst individuals on antiretroviral therapy: a systematic review and meta-analysis. BMC Infect Dis 2015; 15:249. [PMID: 26123030 PMCID: PMC4486691 DOI: 10.1186/s12879-015-0961-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 05/21/2015] [Indexed: 12/04/2022] Open
Abstract
Background Antiretroviral therapy (ART) markedly reduces HIV transmission, and testing and treatment programs have been advocated as a method for decreasing transmission at the population level. Little is known, however, about the extent to which sexually transmitted infections (STIs), which increase the HIV infectiousness of untreated individuals, may decrease the effectiveness of treatment as prevention. Methods We searched major bibliographic databases to August 12th, 2014 and identified studies reporting differences in HIV transmission rate or in viral load between individuals on ART who either were or were not co-infected with another STI. We used hierarchical Bayesian models to estimate viral load differences between individuals with and without STI co-infections. Results The search strategy retrieved 1630 unique citations of which 14 studies (reporting on 4607 HIV viral load measurements from 2835 unique individuals) met the inclusion criteria. We did not find any suitable studies that estimated transmission rates directly in both groups. Our meta-analysis of HIV viral load measurements among treated individuals did not find a statistically significant effect of STI co-infection; viral loads were, on average, 0.11 log10 (95 % CI −0.62 to 0.83) higher among co-infected versus non-co-infected individuals. Conclusions Direct evidence about the effects of STI co-infection on transmission from individuals on ART is very limited. Available data suggests that the average effect of STI co-infection on HIV viral load in individuals on ART is less than 1 log10 difference, and thus unlikely to decrease the effectiveness of treatment as prevention. However, there is not enough data to rule out the possibility that particular STIs pose a larger threat. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-0961-5) contains supplementary material, which is available to authorized users.
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Ondoa P, Gautam R, Rusine J, Lutter R, Jurriaans S, Kootstra N, Karita E, van de Wijgert J. Twelve-Month Antiretroviral Therapy Suppresses Plasma and Genital Viral Loads but Fails to Alter Genital Levels of Cytokines, in a Cohort of HIV-Infected Rwandan Women. PLoS One 2015; 10:e0127201. [PMID: 26010956 PMCID: PMC4444210 DOI: 10.1371/journal.pone.0127201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 04/12/2015] [Indexed: 11/19/2022] Open
Abstract
Background Genital viral load (GVL) is the main determinant of sexual transmission of human immune-deficiency virus (HIV). The effect of antiretroviral therapy (ART) on local cervico-vaginal immunological factors associated with GVL is poorly described. We aimed to identify the risk factors of detectable GVL, and the impact of ART on HIV genital shedding and its correlates in a cohort of HIV-infected women, attending HIV care in Kigali, Rwanda. Materials and Methods All participants were evaluated for GVL, plasma viral load (PVL), CD4 count, various sexually-transmitted infections (STIs) at baseline and at month 12. Genital concentration of 19 cytokines and mRNA expression of APOBEC3G and BST2, two host HIV restriction factors, were evaluated at baseline in all participants. Cytokine levels were re-assessed at month 12 only in participants eligible for ART at baseline. Risk factors of GVL ≥40copies/mL at baseline and month 12 were assessed using logistic regression. Effect of 12-month ART on various local and systemic immunological parameters was examined using a paired t-test and McNemar as appropriate. Results 96 of the 247 women enrolled in the study were eligible for ART. After 12 months of ART, PVL and GVL decreased to undetectable level in respectively 74 and 88% of treated participants. ART did not affect cytokine levels. HIV genital shedding occurred only when PVL was detectable. At baseline, GVL was independently associated with IL-1β after controlling for PVL, age and N. gonorrhea infection (95% CI 1.32-2.15) and at month 12 with MIP-1β (95% CI 0.96-21.32) after controlling for baseline GVL, PVL and month 12 IL-8. Conclusion Suppressive ART does not necessarily reduce genital level of immune activation. Minimizing all conditions favoring genital inflammation, including active detection and treatment of STIs, might reduce the risk of HIV transmission as supplement to the provision of potent ART.
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Affiliation(s)
- Pascale Ondoa
- Amsterdam Institute of Global Health and Development (AIGHD), Department of Global Health of the Academic Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Raju Gautam
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - John Rusine
- INTERACT Program, Kigali, Rwanda
- National Reference Laboratory, Kigali, Rwanda
| | - Rene Lutter
- Department of Respiratory Medicine of the Academic Medical Center, Amsterdam, The Netherlands
- Department of Experimental Immunology of the Academic Medical Center, Amsterdam, The Netherlands
| | - Suzanne Jurriaans
- Department of Medical Microbiology of the Academic Medical Center, Amsterdam, The Netherlands
| | - Neeltje Kootstra
- Department of Experimental Immunology of the Academic Medical Center, Amsterdam, The Netherlands
| | | | - Janneke van de Wijgert
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
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The association of uncontrolled HIV infection and other sexually transmitted infections in metropolitan Atlanta youth. Pediatr Infect Dis J 2015; 34:e119-24. [PMID: 25461474 DOI: 10.1097/inf.0000000000000632] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Half of the 19 million sexually transmitted infections (STIs) and 26% of HIV infections annually in the United States occur in youth aged 13-24 years. STIs are a risk factor for HIV acquisition and transmission, but data are lacking on HIV treatment as an intervention to reduce STIs. METHODS A single-centered, retrospective analysis of HIV-infected sexually active adolescents and young adults from January 2009 to December 2011 was performed to compare STI incidence among patients with controlled and uncontrolled HIV and to identify associated risk factors. RESULTS Of 205 enrolled subjects, 59% were male and 92% African American with mean age of 21 years (2.1 SD). Sixty-six percent were horizontally infected, and 19% met the definition of controlled HIV. Forty-seven percent were men who have sex with men, 76% reported condom use, 27% prior sexual abuse, 58% drug use and 50% claimed >5 lifetime sexual partners. Sixty-seven percent contracted a co-STI for a cumulative incidence rate of 35 STIs per 100 person-years. Subjects with uncontrolled HIV had a significantly higher STI incidence than did subjects with controlled infection (42.7 vs. 19.7 per 100 person-years, P < 0.001). Uncontrolled individuals had more STIs (P = 0.01), sexual partners (P = 0.008) and horizontal acquisition (P = 0.001). In an adjusted logistic model, having ≥1 STI was associated with older age (P = 0.033), >5 sexual partners (6-10 partners, P = 0.001; >10, P < 0.001) and no condom use (P = 0.025). Subjects with uncontrolled infection had 2.8 times [95% confidence interval (CI): 1.16-6.94] the odds of ≥1 STI relative to controlled HIV. CONCLUSIONS Uncontrolled HIV increases the incidence of co-STIs among adolescents and young adults. Interventions to improve antiretroviral compliance and reduce risk behaviors are urgently needed.
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Ferreira VH, Nazli A, Dizzell SE, Mueller K, Kaushic C. The anti-inflammatory activity of curcumin protects the genital mucosal epithelial barrier from disruption and blocks replication of HIV-1 and HSV-2. PLoS One 2015; 10:e0124903. [PMID: 25856395 PMCID: PMC4391950 DOI: 10.1371/journal.pone.0124903] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 03/16/2015] [Indexed: 12/04/2022] Open
Abstract
Inflammation is a known mechanism that facilitates HIV acquisition and the spread of infection. In this study, we evaluated whether curcumin, a potent and safe anti-inflammatory compound, could be used to abrogate inflammatory processes that facilitate HIV-1 acquisition in the female genital tract (FGT) and contribute to HIV amplification. Primary, human genital epithelial cells (GECs) were pretreated with curcumin and exposed to HIV-1 or HIV glycoprotein 120 (gp120), both of which have been shown to disrupt epithelial tight junction proteins, including ZO-1 and occludin. Pre-treatment with curcumin prevented disruption of the mucosal barrier by maintaining ZO-1 and occludin expression and maintained trans-epithelial electric resistance across the genital epithelium. Curcumin pre-treatment also abrogated the gp120-mediated upregulation of the proinflammatory cytokines tumor necrosis factor-α and interleukin (IL)-6, which mediate barrier disruption, as well as the chemokines IL-8, RANTES and interferon gamma-induced protein-10 (IP-10), which are capable of recruiting HIV target cells to the FGT. GECs treated with curcumin and exposed to the sexually transmitted co-infecting microbes HSV-1, HSV-2 and Neisseria gonorrhoeae were unable to elicit innate inflammatory responses that indirectly induced activation of the HIV promoter and curcumin blocked Toll-like receptor (TLR)-mediated induction of HIV replication in chronically infected T-cells. Finally, curcumin treatment resulted in significantly decreased HIV-1 and HSV-2 replication in chronically infected T-cells and primary GECs, respectively. All together, our results suggest that the use of anti-inflammatory compounds such as curcumin may offer a viable alternative for the prevention and/or control of HIV replication in the FGT.
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Affiliation(s)
- Victor H. Ferreira
- Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster Immunology Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Aisha Nazli
- Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster Immunology Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Sara E. Dizzell
- Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster Immunology Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Kristen Mueller
- Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster Immunology Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Charu Kaushic
- Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster Immunology Research Centre, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
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136
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Redelinghuys MJ, Ehlers MM, Dreyer AW, Kock MM. Normal flora and bacterial vaginosis in pregnancy: an overview. Crit Rev Microbiol 2015; 42:352-63. [DOI: 10.3109/1040841x.2014.954522] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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137
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Epidemiology of Mycoplasma acquisition in male HIV-1 infected patients: a multistage cross-sectional survey in Jiangsu, China. Epidemiol Infect 2015; 143:3327-34. [PMID: 25792346 DOI: 10.1017/s0950268815000461] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Mycoplasma infections are most frequently associated with disease in the urogenital or respiratory tracts and, in most cases, mycoplasmas infect the host persistently. In HIV-infected individuals the prevalence and role of genital mycoplasmas has not been well studied. To investigate the six species of Mycoplasma and the risk factors for infection in Jiangsu province, first-void urine and venous blood samples were collected and epidemiological questionnaires were administered after informed consent. A total of 1541 HIV/AIDS patients were recruited in this study. The overall infection rates of six Mycoplasma species were: Ureaplasma urealyticum (26·7%), Mycoplasma hominis (25·3%), M. fermentans (5·1%), M. genitalium (20·1%), M. penetrans (1·6%) and M. pirum (15·4%). The Mycoplasma infection rate in the unmarried group was lower than that of the married, divorced and widowed groups [adjusted odds ratio (aOR) 1·432, 95% confidence interval (CI) 1·077-1·904, P < 0·05]. The patients who refused highly active antiretroviral therapy (HAART) had a much higher risk of Mucoplasma infection (aOR 1·357, 95% CI 1·097-1·679, P < 0·05). Otherwise, a high CD4+ T cell count was a protective factor against Mycoplasma infection (aOR 0·576, 95% CI 0·460-0·719, P < 0·05). Further research will be required to confirm a causal relationship and to identify risk factors for Mycoplasma infection in HIV/AIDS populations.
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138
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Haddad LB, Polis CB, Sheth AN, Brown J, Kourtis AP, King C, Chakraborty R, Ofotokun I. Contraceptive methods and risk of HIV acquisition or female-to-male transmission. Curr HIV/AIDS Rep 2014; 11:447-58. [PMID: 25297973 PMCID: PMC4310558 DOI: 10.1007/s11904-014-0236-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Effective family planning with modern contraception is an important intervention to prevent unintended pregnancies which also provides personal, familial, and societal benefits. Contraception is also the most cost-effective strategy to reduce the burden of mother-to-child HIV transmission for women living with HIV who wish to prevent pregnancy. There are concerns, however, that certain contraceptive methods, in particular the injectable contraceptive depot medroxyprogesterone acetate (DMPA), may increase a woman's risk of acquiring HIV or transmitting it to uninfected males. These concerns, if confirmed, could potentially have large public health implications. This paper briefly reviews the literature on use of contraception among women living with HIV or at high risk of HIV infection. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommendations place no restrictions on the use of hormonal contraceptive methods by women with or at high risk of HIV infection, although a clarification recommends that, given uncertainty in the current literature, women at high risk of HIV who choose progestogen-only injectable contraceptives should be informed that it may or may not increase their risk of HIV acquisition and should also be informed about and have access to HIV preventive measures, including male or female condoms.
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Affiliation(s)
- Lisa B Haddad
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, GA, 30303, USA,
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Co-occurrence of Trichomonas vaginalis and bacterial vaginosis and vaginal shedding of HIV-1 RNA. Sex Transm Dis 2014; 41:173-9. [PMID: 24521723 DOI: 10.1097/olq.0000000000000089] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trichomonas vaginalis (TV) and bacterial vaginosis (BV) are independently associated with increased risk of vaginal shedding in HIV-positive women. Because these 2 conditions commonly co-occur, this study was undertaken to examine the association between TV/BV co-occurrence and vaginal shedding of HIV-1 RNA. METHODS HIV-positive women attending outpatient HIV clinics in 3 urban US cities underwent a clinical examination; were screened for TV, BV, Neisseria gonorrhoeae, Chlamydia trachomatis, and vulvovaginal candidiasis; and completed a behavioral survey. Women shedding HIV-1 RNA vaginally (≥50 copies/mL) were compared with women who had an undetectable (<50 copies/mL) vaginal viral load to determine if women who were TV positive and BV positive or had co-occurrence of TV/BV had higher odds of shedding vaginally when compared with women who did not have these conditions. RESULTS In this sample of 373 HIV-positive women, 43.1% (n = 161) had co-occurrence of TV/BV and 33.2% (n = 124) were shedding HIV-1 RNA vaginally. The odds of shedding HIV vaginally in the presence of TV alone or BV alone and when TV/BV co-occurred were 4.07 (95% confidence interval [CI], 1.78-9.37), 5.65 (95% CI, 2.64-12.01), and 18.63 (95% CI, 6.71-51.72), respectively, when compared with women with no diagnosis of TV or BV, and after adjusting for age, antiretroviral therapy status, and plasma viral load. CONCLUSIONS T. vaginalis and BV were independently and synergistically related to vaginal shedding of HIV-1 RNA. Screening and prompt treatment of these 2 conditions among HIV-positive women are important not only clinically but for HIV prevention, as well.
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140
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Hoffman JC, Anton PA, Baldwin GC, Elliott J, Anisman-Posner D, Tanner K, Grogan T, Elashoff D, Sugar C, Yang OO, Hoffman RM. Seminal plasma HIV-1 RNA concentration is strongly associated with altered levels of seminal plasma interferon-γ, interleukin-17, and interleukin-5. AIDS Res Hum Retroviruses 2014; 30:1082-8. [PMID: 25209674 DOI: 10.1089/aid.2013.0217] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Seminal plasma HIV-1 RNA level is an important determinant of the risk of HIV-1 sexual transmission. We investigated potential associations between seminal plasma cytokine levels and viral concentration in the seminal plasma of HIV-1-infected men. This was a prospective, observational study of paired blood and semen samples from 18 HIV-1 chronically infected men off antiretroviral therapy. HIV-1 RNA levels and cytokine levels in seminal plasma and blood plasma were measured and analyzed using simple linear regressions to screen for associations between cytokines and seminal plasma HIV-1 levels. Forward stepwise regression was performed to construct the final multivariate model. The median HIV-1 RNA concentrations were 4.42 log10 copies/ml (IQR 2.98, 4.70) and 2.96 log10 copies/ml (IQR 2, 4.18) in blood and seminal plasma, respectively. In stepwise multivariate linear regression analysis, blood HIV-1 RNA level (p<0.0001) was most strongly associated with seminal plasma HIV-1 RNA level. After controlling for blood HIV-1 RNA level, seminal plasma HIV-1 RNA level was positively associated with interferon (IFN)-γ (p=0.03) and interleukin (IL)-17 (p=0.03) and negatively associated with IL-5 (p=0.0007) in seminal plasma. In addition to blood HIV-1 RNA level, cytokine profiles in the male genital tract are associated with HIV-1 RNA levels in semen. The Th1 and Th17 cytokines IFN-γ and IL-17 are associated with increased seminal plasma HIV-1 RNA, while the Th2 cytokine IL-5 is associated with decreased seminal plasma HIV-1 RNA. These results support the importance of genital tract immunomodulation in HIV-1 transmission.
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Affiliation(s)
- Jennifer C. Hoffman
- Department of Medicine and UCLA AIDS Institute, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Peter A. Anton
- Department of Medicine and UCLA AIDS Institute, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Gayle Cocita Baldwin
- Department of Medicine and UCLA AIDS Institute, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Julie Elliott
- Department of Medicine and UCLA AIDS Institute, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Deborah Anisman-Posner
- Department of Medicine and UCLA AIDS Institute, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Karen Tanner
- Department of Medicine and UCLA AIDS Institute, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Tristan Grogan
- Medicine Statistics Core, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - David Elashoff
- Medicine Statistics Core, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Catherine Sugar
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Otto O. Yang
- Department of Medicine and UCLA AIDS Institute, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
- Department of Microbiology, Immunology, and Molecular Genetics, University of California Los Angeles, Los Angeles, California
- AIDS Healthcare Foundation, Los Angeles, California
| | - Risa M. Hoffman
- Department of Medicine and UCLA AIDS Institute, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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141
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Wangnapi RA, Soso S, Unger HW, Sawera C, Ome M, Umbers AJ, Ndrewei N, Siba P, Li Wai Suen CSN, Vallely A, Wapling J, Ryan C, Mueller I, Rogerson SJ. Prevalence and risk factors for Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis infection in pregnant women in Papua New Guinea. Sex Transm Infect 2014; 91:194-200. [PMID: 25313204 DOI: 10.1136/sextrans-2014-051670] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 09/21/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the prevalence of, and risk factors associated with, Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis infection in pregnant women in Madang, Papua New Guinea (PNG). METHODS A cross-sectional survey was conducted among 400 pregnant women presenting to antenatal clinics. Sociodemographic and behavioural data were collected and real-time PCR diagnostic methods were used to detect the presence of chlamydia, gonorrhoea and trichomonas in self-collected vaginal swabs. The relationships between symptoms, sociodemographic and behavioural factors and infection were assessed. RESULTS The prevalence of C. trachomatis was 11.1%, N. gonorrhoeae was 9.7% and T. vaginalis was 21.3%. One-third of women (33.7%) had at least one infection. The most common symptom was abdominal pain (48.0%), but only abnormal vaginal discharge was consistently associated with infection (p<0.001). Women diagnosed with vaginal discharge syndrome were more likely to have at least one treatable infection (50.0% (47/94) vs 26.8% (68/254), p<0.001), yet 59.1% of women with infection would have been missed by the current clinically-based syndromic diagnosis. Risk factors included having a partner at perceived risk of infection, maternal extramarital intercourse, early sexual debut, lack of formal education, urban residence and smoking. 78.8% of women reported never using condoms. CONCLUSIONS The prevalences of T. vaginalis, C. trachomatis and N. gonorrhoeae were high among pregnant women in coastal PNG. The poor performance of clinically based syndromic diagnosis suggests that alternative strategies are urgently required to improve detection and reduce the burden of sexually transmitted infections and their associated adverse pregnancy outcomes in this population.
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Affiliation(s)
- R A Wangnapi
- Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea
| | - S Soso
- Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea
| | - H W Unger
- Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, Victoria, Australia
| | - C Sawera
- Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea
| | - M Ome
- Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea
| | - A J Umbers
- Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, Victoria, Australia
| | - N Ndrewei
- Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea
| | - P Siba
- Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea
| | - C S N Li Wai Suen
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - A Vallely
- Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea The Kirby Institute, University of New South Wales, Sydney, Australia
| | - J Wapling
- Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea The Burnet Institute, Melbourne, Victoria, Australia
| | - C Ryan
- Papua New Guinea Institute of Medical Research (PNGIMR), Goroka, Papua New Guinea The Burnet Institute, Melbourne, Victoria, Australia
| | - I Mueller
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - S J Rogerson
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, Victoria, Australia
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142
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Prevalence and associated factors for HIV-1 transmitted drug resistance in voluntary clients for counseling and testing in Southern Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 49:487-93. [PMID: 25315212 DOI: 10.1016/j.jmii.2014.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 07/15/2014] [Accepted: 08/07/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND According to the World Health Organization, HIV-transmitted drug resistance (TDR) is increasing. We analyzed voluntary counseling test data from a hospital in Southern Taiwan to investigate the TDR pattern in Southern Taiwan, the potential relationship between sexual behavior and HIV transmission, and HIV drug-resistant strain transmission. METHODS Genotypic resistance assays were performed on treatment-naïve HIV patients recruited from voluntary counseling testing (VCT) in Southern Taiwan from 2007 to 2011. Drug resistance-associated mutations were interpreted with Stanford University HIV Drug Resistance Database HIVdb program. Socio-demographics and sexual activity were recorded from the VCT questionnaire. Logistic regression analysis was used to analyze the risk factors for TDR, and a phylogenetic tree was constructed to elucidate the pattern of HIV drug-resistant strains. RESULTS Among the 161 treatment-naïve HIV-infected patients, most were men who reported having sex with men. The overall TDR rate was 10.6%. Patients with a history of sexually transmitted diseases had a 7.8-fold higher risk of becoming infected with genotypic resistant strains. CONCLUSION In Southern Taiwan, the HIV TDR rate was 10.6% among those receiving VCT. Our findings suggest that sexual behavior may play an important role in HIV drug-resistant strain transmission.
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143
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Sheth AN, Evans-Strickfaden T, Haaland R, Martin A, Gatcliffe C, Adesoye A, Omondi MW, Lupo LD, Danavall D, Easley K, Chen CY, Pau CP, Hart C, Ofotokun I. HIV-1 genital shedding is suppressed in the setting of high genital antiretroviral drug concentrations throughout the menstrual cycle. J Infect Dis 2014; 210:736-44. [PMID: 24643223 PMCID: PMC4202306 DOI: 10.1093/infdis/jiu166] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/03/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It is not known if fluctuations in genital tract antiretroviral drug concentrations correlate with genital virus shedding in human immunodeficiency virus (HIV)-infected women on antiretroviral therapy (ART). METHODS Among 20 HIV-infected women on ART (tenofovir [TFV], emtricitabine [FTC], and ritonavir-boosted atazanavir [ATV]) with suppressed plasma virus loads, blood and cervicovaginal samples collected twice weekly for 3 weeks were tested for antiretroviral concentrations, HIV-1 RNA, and proviral DNA. RESULTS Cervicovaginal:plasma antiretroviral concentration ratios were highest for FTC (11.9, 95% confidence interval [CI], 8.66-16.3), then TFV (3.52, 95% CI, 2.27-5.48), and ATV (2.39, 95% CI, 1.69-3.38). Within- and between-person variations in plasma and genital antiretroviral concentrations were observed. Low amounts of genital HIV-1 RNA (<50 copies/mL) were detected in 45% of women at 16% of visits. Genital HIV-1 DNA was detected in 70% of women at 35% of visits. Genital virus detection was associated with higher concentrations of mucosal leukocytes but not with genital antiretroviral concentrations, menstrual cycle phase, bacterial vaginosis, genital bleeding, or plasma virus detection. CONCLUSIONS Standard doses of ART achieved higher genital than plasma concentrations across the menstrual cycle. Therapeutic ART suppresses genital virus shedding throughout the menstrual cycle, even in the presence of factors reported to increase virus shedding.
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Affiliation(s)
- Anandi N. Sheth
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine
| | | | - Richard Haaland
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
| | - Amy Martin
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
| | - Chelsea Gatcliffe
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine
| | - Adebola Adesoye
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
| | - Michael W. Omondi
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
| | - L. Davis Lupo
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
| | - Damien Danavall
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kirk Easley
- Department Biostatistics and Bioinformatics, Emory University School of Public Health
| | - Cheng-Yen Chen
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chou-Pong Pau
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
| | - Clyde Hart
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine
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Dehon PM, McGowin CL. Mycoplasma genitalium infection is associated with microscopic signs of cervical inflammation in liquid cytology specimens. J Clin Microbiol 2014; 52:2398-405. [PMID: 24759719 PMCID: PMC4097708 DOI: 10.1128/jcm.00159-14] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 04/16/2014] [Indexed: 11/20/2022] Open
Abstract
Cervicitis is a common clinical finding often attributed to sexually transmitted infections (STIs), but no etiologic agent is identified in the majority of cases. In this study, we comparatively assessed inflammation among the common infectious etiologies of cervicitis and assessed the potential value of liquid cytology specimens for predicting STIs. Among 473 Louisiana women at low risk for acquiring STIs, the prevalences of Mycoplasma genitalium, Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis in liquid-based cytology specimens were 1.5, 2.1, 0.6, and 4.4%, respectively. N. gonorrhoeae and human papillomavirus 18 (HPV18) infections were significantly more common among subjects infected with M. genitalium. Using direct microscopy, we observed significant increases in leukocyte infiltrates among subjects with monoinfections with M. genitalium or C. trachomatis compared to women with no detectable STIs. Inflammation was highest among subjects with M. genitalium. Using a threshold of ≥ 2 leukocytes per epithelial cell per high-powered field, the positive predictive values for M. genitalium, C. trachomatis, N. gonorrhoeae, and T. vaginalis were 100, 70, 67, and 20%, respectively. Several novel M. genitalium genotypes were identified, all of which were predicted to be susceptible to macrolide antibiotics, suggesting that different strains may circulate among low-risk women and that macrolide resistance is substantially lower than in high-risk populations. This study highlights the capacity of M. genitalium to elicit cervical inflammation and, considering the strong epidemiologic associations between M. genitalium and human immunodeficiency virus (HIV), provides a potential mechanism for acquisition and shedding of HIV via chronic leukocyte recruitment to the cervical mucosa.
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Affiliation(s)
- Patricia M Dehon
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Chris L McGowin
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA Department of Internal Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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Wilson KS, Odem-Davis K, Shafi J, Kashonga F, Wanje G, Masese L, Mandaliya K, Jaoko W, McClelland RS. Association between alcohol use and sexually transmitted infection incidence among kenyan women engaged in transactional sex. AIDS Behav 2014; 18:1324-9. [PMID: 24179037 DOI: 10.1007/s10461-013-0648-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Few prospective studies have evaluated the association between alcohol use and STI acquisition among African women. We examined the association between baseline drinking frequency and STIs in a cohort of Kenyan women reporting transactional sex. The association between alcohol use and STI differed significantly by HIV status. Among 139 HIV-positive women, STI acquisition was significantly associated with consuming 1-7 drinks/week and marginally associated with ≥8 drinks/week in unadjusted analyses. However, no association between alcohol use and STIs was observed among 335 HIV-negative women. Addressing alcohol use within comprehensive HIV care may also reduce the burden of STIs among high-risk women.
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Affiliation(s)
- Kate S Wilson
- Department of Epidemiology, University of Washington, 325 Ninth Ave, Box 359909, Seattle, WA, 98104, USA,
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146
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Kalichman SC, Washington C, Grebler T, Kalichman MO, Cherry C, Eaton L. Elevated urinary leukocyte esterase as a potential surrogate marker for HIV sexual transmission risks in men receiving antiretroviral therapy. Int J STD AIDS 2014; 26:313-21. [PMID: 24867820 DOI: 10.1177/0956462414536147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Local genital tract inflammation stimulates leukocyte activity and causes HIV shedding, potentially increasing HIV sexual infectiousness. Although there are available clinical markers for genital tract inflammation, such as urinary leukocyte esterase, none have yet been examined in relation to HIV sexual risk behaviours. We sought to examine the association between urinary leukocyte esterase and sexual practices. Sexually active men living with HIV and receiving antiretroviral therapy (ART, N = 290) provided urine specimens and completed behavioural health assessments. HIV RNA tests and CD4 cell counts were abstracted from medical records. Urine specimens were analysed for leukocyte esterase using a standard point-of-care dipstick test. Thirty-one (10.6%) participants tested positive for leukocyte esterase. Logistic regression models did not indicate differences between men with elevated and un-elevated leukocyte activity on demographic, health, recent sexually transmitted infection symptoms and diagnoses or substance use. However, men with elevated leukocyte activity indicated significantly greater sexual behaviour in the previous three months, including more recent unprotected sexual intercourse. A simple over-the-counter urine test may serve as an indicator of sexual HIV infectiousness to inform further evaluation and treatment of genital tract inflammation, as well as condom use decisions during times of increased genital tract inflammation.
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Affiliation(s)
- Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | | | - Tamar Grebler
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Moira O Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Chauncey Cherry
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Lisa Eaton
- Department of Psychology, University of Connecticut, Storrs, CT, USA
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147
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Lurie MN, Kirwa K, Daniels J, Berteler M, Kalichman SC, Mathews C. High burden of STIs among HIV-infected adults prior to initiation of ART in South Africa: a retrospective cohort study. Sex Transm Infect 2014; 90:615-9. [PMID: 24837992 DOI: 10.1136/sextrans-2013-051446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess the burden of sexually transmitted infections (STIs) among HIV-positive South Africans in the period prior to antiretroviral therapy (ART) initiation compared with the period once on ART. METHODS We linked the clinic records of 1465 patients currently on ART to the electronic database which records all visits to city clinics. We used a mixed effects Poisson model to assess the relative rates of occurrence of treatment seeking for an STI in the periods prior to initiation of ART and while on ART. RESULTS We accumulated 4214 person-years of follow-up, divided nearly equally between the pre-ART and on-ART periods. The rate of treatment seeking for new STIs was 5.50 (95% CI 5.43 to 5.78) per 100 person-years, and individuals had on average a sevenfold higher rate of seeking treatment for STIs in the period prior to initiating ART (9.57 per 100 person-years) compared with the period once on ART (5.5 per 100 person-years) (adjusted rate ratio (RR) 7.01, 95% CI 4.64 to 10.59). Being male (RR 1.73, 95% CI 1.18 to 2.55) or younger (age <25) (RR 2.67, 95% CI 1.53 to 4.65) was associated with higher incidence of clinic visits for STI treatment, while advanced stage of HIV disease (WHO stage 4) (RR 0.33, 95% CI 0.15 to 0.69) was associated with lower incidence. CONCLUSIONS The period prior to the initiation of ART is a critical period where increased attention should be focused on the detection and treatment of STIs. A successful effort to treat STIs in this period will likely reduce further HIV transmission and fits within a test-and-treat approach.
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Affiliation(s)
- Mark N Lurie
- Brown University School of Public Health, Providence, Rhode Island, USA
| | - Kipruto Kirwa
- Brown University School of Public Health, Providence, Rhode Island, USA Department of Epidemiology and Nutrition, Moi University School of Public Health, Eldoret, Kenya
| | - Johann Daniels
- Health Information and Technology, City Health, Cape Town, South Africa
| | - Marcel Berteler
- Health Information and Technology, City Health, Cape Town, South Africa
| | - Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, Connecticut, USA
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council; and the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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148
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A new mouse model for female genital schistosomiasis. PLoS Negl Trop Dis 2014; 8:e2825. [PMID: 24786606 PMCID: PMC4006711 DOI: 10.1371/journal.pntd.0002825] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 03/12/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Over 112 million people worldwide are infected with Schistosoma haematobium, one of the most prevalent schistosome species affecting humans. Female genital schistosomiasis (FGS) occurs when S. haematobium eggs are deposited into the female reproductive tract by adult worms, which can lead to pelvic pain, vaginal bleeding, genital disfigurement and infertility. Recent evidence suggests co-infection with S. haematobium increases the risks of contracting sexually transmitted diseases such as HIV. The associated mechanisms remain unclear due to the lack of a tractable animal model. We sought to create a mouse model conducive to the study of immune modulation and genitourinary changes that occur with FGS. METHODS To model FGS in mice, we injected S. haematobium eggs into the posterior vaginal walls of 30 female BALB/c mice. A control group of 20 female BALB/c mice were injected with uninfected LVG hamster tissue extract. Histology, flow cytometry and serum cytokine levels were assessed at 2, 4, 6, and 8 weeks post egg injection. Voiding studies were performed at 1 week post egg injection. RESULTS Vaginal wall injection with S. haematobium eggs resulted in synchronous vaginal granuloma development within 2 weeks post-egg injection that persisted for at least 6 additional weeks. Flow cytometric analysis of vaginal granulomata revealed infiltration by CD4+ T cells with variable expression of the HIV co-receptors CXCR4 and CCR5. Granulomata also contained CD11b+F4/80+ cells (macrophages and eosinophils) as well as CXCR4+MerTK+ macrophages. Strikingly, vaginal wall-injected mice featured significant urinary frequency despite the posterior vagina being anatomically distant from the bladder. This may represent a previously unrecognized overactive bladder response to deposition of schistosome eggs in the vagina. CONCLUSION We have established a new mouse model that could potentially enable novel studies of genital schistosomiasis in females. Ongoing studies will further explore the mechanisms by which HIV target cells may be drawn into FGS-associated vaginal granulomata.
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149
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Gottlieb SL, Low N, Newman LM, Bolan G, Kamb M, Broutet N. Toward global prevention of sexually transmitted infections (STIs): the need for STI vaccines. Vaccine 2014; 32:1527-35. [PMID: 24581979 PMCID: PMC6794147 DOI: 10.1016/j.vaccine.2013.07.087] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 07/23/2013] [Indexed: 02/06/2023]
Abstract
An estimated 499 million curable sexually transmitted infections (STIs; gonorrhea, chlamydia, syphilis, and trichomoniasis) occurred globally in 2008. In addition, well over 500 million people are estimated to have a viral STI such as herpes simplex virus type 2 (HSV-2) or human papillomavirus (HPV) at any point in time. STIs result in a large global burden of sexual, reproductive, and maternal-child health consequences, including genital symptoms, pregnancy complications, cancer, infertility, and enhanced HIV transmission, as well as important psychosocial consequences and financial costs. STI control strategies based primarily on behavioral primary prevention and STI case management have had clear successes, but gains have not been universal. Current STI control is hampered or threatened by several behavioral, biological, and implementation challenges, including a large proportion of asymptomatic infections, lack of feasible diagnostic tests globally, antimicrobial resistance, repeat infections, and barriers to intervention access, availability, and scale-up. Vaccines against HPV and hepatitis B virus offer a new paradigm for STI control. Challenges to existing STI prevention efforts provide important reasons for working toward additional STI vaccines. We summarize the global epidemiology of STIs and STI-associated complications, examine challenges to existing STI prevention efforts, and discuss the need for new STI vaccines for future prevention efforts.
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Affiliation(s)
- Sami L Gottlieb
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Nicola Low
- Department of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Lori M Newman
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Gail Bolan
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary Kamb
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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150
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Cervicovaginal HIV-1 shedding in women taking antiretroviral therapy in Burkina Faso: a longitudinal study. J Acquir Immune Defic Syndr 2014; 65:237-45. [PMID: 24226060 PMCID: PMC3979829 DOI: 10.1097/qai.0000000000000049] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antiretroviral therapy (ART) reduces transmission of HIV-1. However, genital HIV-1 can be detected in patients on ART. We analyzed factors associated with genital HIV-1 shedding among high-risk women on ART in Burkina Faso. METHODS Plasma viral load (PVL) and enriched cervicovaginal lavage HIV-1 RNA were measured every 3-6 months for up to 8 years. Random-effects logistic and linear regression models were used to analyze associations of frequency and quantity of genital HIV-1 RNA with behavioral and biological factors, adjusting for within-woman correlation. The lower limit of detection of HIV-1 RNA in plasma and eCVL samples was 300 copies per milliliter. RESULTS One hundred and eighty-eight participants initiated ART from 2004 to 2011. PVL was detectable in 16% (171/1050) of visits, in 52% (90/174) of women. Cervicovaginal HIV-1 RNA was detectable in 16% (128/798) of visits with undetectable plasma HIV-1 RNA in 45% (77/170) of women. After adjusting for PVL, detectable cervicovaginal HIV-1 RNA was independently associated with abnormal vaginal discharge and use of nevirapine or zidovudine vs. efavirenz and stavudine, respectively; longer time on ART and hormonal contraception were not associated with increased shedding. The presence of bacterial vaginosis, herpes simplex virus-2 DNA, and the use of nevirapine vs efavirenz were independently associated with an increased quantity of cervicovaginal HIV-1 RNA. CONCLUSIONS Certain ART regimens, abnormal vaginal discharge, bacterial vaginosis, and genital herpes simplex virus-2 are associated with HIV-1 cervicovaginal shedding or quantity in women on ART after adjusting for PVL. This may reduce the effectiveness of ART as prevention in high-risk populations.
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