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Vermandere H, Martínez-Silva G, Aguilera-Mijares S, Martínez-Dávalos A, Bautista-Arredondo S. Evaluating the Screening and Enrollment of People at Risk of HIV in Mexico's Preexposure Prophylaxis Demonstration Project, 2018-2020. Public Health Rep 2024; 139:606-614. [PMID: 38491784 PMCID: PMC11344982 DOI: 10.1177/00333549241230479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024] Open
Abstract
OBJECTIVES Screening tools in which participants self-report sexual behaviors can identify people at risk of HIV acquisition for enrollment in preexposure prophylaxis (PrEP). We compared enrollment outcomes (ie, receiving PrEP vs being excluded by a counselor or declining PrEP) in Mexico's PrEP demonstration project and evaluated the validity of a 4-criteria PrEP eligibility tool in which participants self-reported risk behavior-having condomless anal sex, transactional sex, a partner living with HIV, or a sexually transmitted infection-as compared with PrEP eligibility assessed by a counselor. METHODS We recruited men who have sex with men and transwomen who were offered PrEP services in Mexico. We characterized participants according to enrollment outcome and identified underlying factors through logistic regression analyses. We calculated the sensitivity and specificity of the self-reported risk criteria, using the counselor's risk assessment as the point of reference. RESULTS Of 2460 participants, 2323 (94%) had risk criteria of HIV acquisition according to the 4-criteria tool; 1701 (73%) received PrEP, 247 (11%) were excluded by a counselor, and 351 (15%) declined PrEP despite being considered eligible by the counselor. Participants who were excluded or who declined PrEP were less likely to report HIV risk behaviors than those who received PrEP, and participants who declined PrEP were more likely to be transwomen (vs men who have sex with men) and aged ≤25 years (vs >25 y). The 4-criteria risk tool had high sensitivity (98.6%) and low specificity (29.8%). CONCLUSION The screening tool identified most participants at risk of HIV acquisition, but counselors' assessment helped refine the decision for enrollment in PrEP by excluding those with low risk. Public health strategies are needed to enhance enrollment in PrEP among some groups.
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Affiliation(s)
- Heleen Vermandere
- Center for Evaluation Research and Surveys, National Institute of Public Health of Mexico, Cuernavaca, México
| | - Gisela Martínez-Silva
- Center for Evaluation Research and Surveys, National Institute of Public Health of Mexico, Cuernavaca, México
| | - Santiago Aguilera-Mijares
- Center for Evaluation Research and Surveys, National Institute of Public Health of Mexico, Cuernavaca, México
| | - Araczy Martínez-Dávalos
- Center for Evaluation Research and Surveys, National Institute of Public Health of Mexico, Cuernavaca, México
| | - Sergio Bautista-Arredondo
- Center for Evaluation Research and Surveys, National Institute of Public Health of Mexico, Cuernavaca, México
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Terada-Hirashima J, Mizushima D, Takano M, Tokita D, Oka S. Efficacy and Safety of Pre-Exposure Prophylaxis to Control HIV and Sexually Transmitted Infection Among Men Who Have Sex With Men: Protocol for a Single-Arm Interventional Study. JMIR Res Protoc 2023; 12:e50919. [PMID: 37966880 PMCID: PMC10687690 DOI: 10.2196/50919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/26/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) against HIV infection is a new approach that involves the prophylactic use of the anti-HIV drug Truvada (tenofovir disoproxil fumarate [TDF] and emtricitabine [FTC]) by people not infected with HIV. OBJECTIVE The objective of this investigator-initiated clinical study of PrEP was to evaluate the incidence of HIV and sexually transmitted infection (STI), safety and efficacy of PrEP in PrEP users, and their compliance with PrEP medication. The social, medical, and economic benefits of PrEP in Japan was assessed. METHODS This single-center feasibility study of PrEP was conducted at the National Center for Global Health and Medicine, Tokyo, Japan, where a cohort of men who have sex with men without HIV was established in January 2017. This single-arm interventional study compared the efficacy and safety of PrEP in a single group of men who have sex with men who participated in PrEP cohort studies. For reference, the cohort study participants who did not participate in the PrEP study were included for comparison. Blood samples were collected for storage at baseline and clinic visits at 1, 3, and 6 months after starting PrEP and every 3 months thereafter. The participants were administered with 1 tablet of Truvada once daily as PrEP. They underwent blood and anal swab tests 1 and 3 months after starting PrEP and then HIV and STI infection assessments at 3-month intervals. Blood samples were centrifuged at the AIDS Clinical Center Laboratory. PrEP safety was evaluated by monitoring serum creatinine levels for symptoms of renal function disorders. The primary end point was the incidence of HIV in PrEP users (100 person-years). The secondary end points were the incidence of STI in PrEP users (100 person-years), incidence of adverse events caused by Truvada, frequency of high-risk sexual activity, and adherence to periodic visits and medication. RESULTS The study protocol was reviewed and approved by the certified review board of the National Center for Global Health and Medicine (NCGM-C-003129-03) on April 20, 2020. Changes to the study plan were submitted for review by the certified review board and approved before implementation. Recruitment was completed on March 28, 2019, and the study was completed (last adult participant and last time point) on March 31, 2021. The data were analyzed, and the main results of the study have been published in a peer-reviewed journal. CONCLUSIONS The findings indicated that PrEP is a highly effective and feasible strategy against HIV infection in terms of prophylactic response, retention, and compliance. TRIAL REGISTRATION UMIN Clinical Trials Registry UMIN000031040; https://tinyurl.com/3msdkeb8 and Japan Registry of Clinical Trials jRCTs031180134; https://tinyurl.com/2p88mhyr. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/50919.
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Affiliation(s)
- Junko Terada-Hirashima
- Department of Clinical Research Promotion, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
- Division of Clinical Research and Education, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Daisuke Mizushima
- Division of Clinical Research and Education, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
- AIDS Clinical Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Misao Takano
- Division of Clinical Research and Education, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
- AIDS Clinical Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Daisuke Tokita
- Department of Clinical Research Promotion, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
- Division of Clinical Research and Education, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinichi Oka
- AIDS Clinical Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
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Vanangamudi M, Palaniappan S, Kathiravan MK, Namasivayam V. Strategies in the Design and Development of Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs). Viruses 2023; 15:1992. [PMID: 37896769 PMCID: PMC10610861 DOI: 10.3390/v15101992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
AIDS (acquired immunodeficiency syndrome) is a potentially life-threatening infectious disease caused by human immunodeficiency virus (HIV). To date, thousands of people have lost their lives annually due to HIV infection, and it continues to be a big public health issue globally. Since the discovery of the first drug, Zidovudine (AZT), a nucleoside reverse transcriptase inhibitor (NRTI), to date, 30 drugs have been approved by the FDA, primarily targeting reverse transcriptase, integrase, and/or protease enzymes. The majority of these drugs target the catalytic and allosteric sites of the HIV enzyme reverse transcriptase. Compared to the NRTI family of drugs, the diverse chemical class of non-nucleoside reverse transcriptase inhibitors (NNRTIs) has special anti-HIV activity with high specificity and low toxicity. However, current clinical usage of NRTI and NNRTI drugs has limited therapeutic value due to their adverse drug reactions and the emergence of multidrug-resistant (MDR) strains. To overcome drug resistance and efficacy issues, combination therapy is widely prescribed for HIV patients. Combination antiretroviral therapy (cART) includes more than one antiretroviral agent targeting two or more enzymes in the life cycle of the virus. Medicinal chemistry researchers apply different optimization strategies including structure- and fragment-based drug design, prodrug approach, scaffold hopping, molecular/fragment hybridization, bioisosterism, high-throughput screening, covalent-binding, targeting highly hydrophobic channel, targeting dual site, and multi-target-directed ligand to identify and develop novel NNRTIs with high antiviral activity against wild-type (WT) and mutant strains. The formulation experts design various delivery systems with single or combination therapies and long-acting regimens of NNRTIs to improve pharmacokinetic profiles and provide sustained therapeutic effects.
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Affiliation(s)
- Murugesan Vanangamudi
- Department of Pharmaceutical Chemistry, Amity Institute of Pharmacy, Amity University Madhya Pradesh, Gwalior 474005, Madhya Pradesh, India;
| | - Senthilkumar Palaniappan
- Faculty of Pharmacy, Karpagam Academy of Higher Education, Coimbatore 641021, Tamilnadu, India;
- Center for Active Pharmaceutical Ingredients, Karpagam Academy of Higher Education, Coimbatore 641021, Tamilnadu, India
| | - Muthu Kumaradoss Kathiravan
- Dr. APJ Abdul Kalam Research Lab, SRM College of Pharmacy, SRMIST, Kattankulathur 603203, Tamilnadu, India;
- Department of Pharmaceutical Chemistry, SRM College of Pharmacy, SRMIST, Kattankulathur 603203, Tamilnadu, India
| | - Vigneshwaran Namasivayam
- Pharmaceutical Chemistry, Pharmaceutical Institute, University of Bonn, 53121 Bonn, Germany
- LIED, University of Lübeck and University Medical Center Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
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4
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Wang CC, Shao CH, Li HJ, Sheng WH. Profiles and persistence of initial antiretroviral therapy among HIV infected patients in taiwan: A nationwide population-based cross-sectional study from 2011 to 2017. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:838-844. [PMID: 35599152 DOI: 10.1016/j.jmii.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/09/2022] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND/PURPOSE Antiretroviral therapy (ART) has been applied for treating patients with human immunodeficiency virus (HIV) for decades. Our study explored initial ART use patterns and ART persistence in patients who begin HIV treatment in Taiwan. METHODS The National Health Insurance Research Database in Taiwan was used in our study. The study cohort included patients who are incident ART users from 2011 to 2017. The patterns of ART-based regimens initiated were documented, mainly including non-nucleoside reverse transcriptase inhibitor (NNRTI)-based, protease inhibitor (PI)-based and integrase inhibitor (INI)-based regimens. Time from HIV diagnosis to ART initiation, ART persistence, and ART treatment patterns were documented. RESULTS There were 19,726 incident ART users. While NNRTI-based regimen was the first choice of initial ART from 2011 to 2017, INI-based regimen accounted for 52.9% of total ART initiation and was the most commonly prescribed regimen in 2017. PI-based regimen decreased from 17.0% to 0.7% during the study period. We found that changes of initial ART between 2011 and 2017 were common, consist with the changes of National Imbursement Guideline for HIV therapy in Taiwan. CONCLUSIONS We found a trend of rapidly increasing INI-based regimen and decreasing PI-based regimen during the study period. Shorten time window for initiating ART was found according to reimbursement regulation of STR as the first-line therapy and government policy of same-day HIV testing and treatment initiation. The persistence of ART was influenced by treatment guideline during the study period.
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Affiliation(s)
- Chi-Chuan Wang
- School of Pharmacy, National Taiwan University, Taipei, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Hao Shao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsing-Jung Li
- School of Pharmacy, National Taiwan University, Taipei, Taiwan
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; School of Medicine, National Taiwan University Medical College, Taipei, Taiwan.
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Socio-Economic and Demographic Factors Associated with Knowledge and Attitude of HIV/AIDS among Women Aged 15–49 Years Old in Indonesia. Healthcare (Basel) 2022; 10:healthcare10081545. [PMID: 36011201 PMCID: PMC9408652 DOI: 10.3390/healthcare10081545] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022] Open
Abstract
Women’s susceptibility to HIV/AIDS infection is related to socio-economic and demographic factors. This study sought to analyze socio-economic and demographic factors related to knowledge and attitude of HIV/AIDS among women aged 15–49 years old in Indonesia. We conducted a secondary data analysis using the 2017 Indonesian Demographic and Health Survey (IDHS). Among 49,627 women, our study analyzed 25,895 women aged 15–49 years familiar with HIV terminology. Multiple logistic regression was utilized to analyze associations between socio-economic and demographic factors with knowledge and attitudes toward HIV/AIDS. Women’s age, education level, wealth quintile, residential area and region, access to information, owning cell phones and autonomy were significantly associated with positive knowledge and attitudes toward HIV/AIDS. These findings revealed that several demographical and social factors contribute to knowledge and attitudes toward HIV/AIDS among women aged 15–49 years in Indonesia.
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Shiraki K, Sato N, Sakai K, Matsumoto S, Kaszynski RH, Takemoto M. Antiviral therapy for COVID-19: Derivation of optimal strategy based on past antiviral and favipiravir experiences. Pharmacol Ther 2022; 235:108121. [PMID: 35121001 PMCID: PMC8806403 DOI: 10.1016/j.pharmthera.2022.108121] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 12/22/2022]
Abstract
Favipiravir, a broad-spectrum RNA-dependent RNA polymerase inhibitor, inhibits the replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at significantly lower concentrations than the plasma trough levels achieved by the dosage adopted for influenza treatment and exhibits efficacy against coronavirus disease 2019 (COVID-19) pneumonia. Although high doses of favipiravir are required due to the molecule being a purine analog, its conversion into the active form in infected cells with active viral RNA synthesis enhances the antiviral specificity and selectivity as a chain terminator with lethal mutagenesis. Another characteristic feature is the lack of generation of favipiravir-resistant virus. COVID-19 pneumonia is caused by strong cell-mediated immunity against virus-infected cells, and the inflammatory response induced by adaptive immunity continues to peak for 3 to 5 days despite antiviral treatment. This has also been observed in herpes zoster (HZ) and cytomegalovirus (CMV) pneumonia. Inflammation due to an immune response may mask the effectiveness of favipiravir against COVID-19 pneumonia. Favipiravir significantly shortened the recovery time in patients with mild COVID-19 pneumonia by 3 days with the start of treatment by the 5th day of symptom onset. Since both CMV and COVID-19 pneumonia are caused by adaptive immunity and prevention of cytomegalovirus pneumonia is the standard treatment due to difficulties in treating refractory CMV pneumonia, COVID-19 pneumonia should be prevented with early treatment as well. In the present study, we have comprehensively reviewed the optimal antiviral therapy for COVID-19 based on clinical trials of favipiravir for the treatment of COVID-19 pneumonia and the concurrently established therapies for other viral infections, particularly HZ and CMV pneumonia. Optimally, antivirals should be administered immediately after COVID-19 diagnosis, similar to that after influenza diagnosis, to prevent COVID-19 pneumonia and complications resulting from microangiopathy.
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Affiliation(s)
| | - Noriaki Sato
- Department of Biomedical Data Intelligence, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kaoru Sakai
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shirou Matsumoto
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Richard H Kaszynski
- Stanford Solutions, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Masaya Takemoto
- Department of Microbiology, Faculty of Pharmaceutical Sciences, Hokuriku University, Kanazawa, Japan
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7
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Mi Y, Zeng Y, Wang P, Zhou M, Cheng F. Cost-Effectiveness of Pre-exposure Prophylaxis Among Men Who Have Sex With Men in China: A Systematic Review. Front Public Health 2022; 10:809268. [PMID: 35801237 PMCID: PMC9253462 DOI: 10.3389/fpubh.2022.809268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/20/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Men who have sex with men in China meet the definition of the population at “substantial risk” of contracting human immunodeficiency virus (HIV) according to the World Health Organization; therefore, initiating pre-exposure prophylaxis (PrEP) is recommended for this population. Lack of convincing evidence on cost-effectiveness has resulted in the lack of large-scale PrEP implementation at a national level. The objective of this review is to assess the cost-effectiveness of pre-exposure prophylaxis implementation among men who have sex with men in China. Methods The following databases were used to search studies of pre-exposure prophylaxis in China in both English and Chinese: PubMed, Embase, the China National Knowledge Infrastructure (CNKI), and the Wanfang Database. Inclusion criteria included pre-exposure intervention, year for publication (2007–2021), setting (China), and cost-effectiveness estimation. Results Seven studies were identified. We found that pre-exposure prophylaxis is only cost-effective among men who have sex with men without prioritization with at least a 5.5% reduction in the market price in the models. Pre-exposure prophylaxis is potentially cost-effective when using the latest market price, combined with other preventive programs or delivered to the population with a high risk of HIV exposure. Conclusion Our study identifies key considerations in cost-effectiveness evaluation: cost assumptions, implementation coverage, and targeted population. The scarce evidence available is not comparable to some extent. However, combined with the latest market and policy reform, the cost-effectiveness of PrEP could be achieved as estimated by the underlying model of the included studies. Consequently, it calls for more standard and transparent modeling studies that include the latest drug types and market prices.
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Affiliation(s)
- Yuanqi Mi
- School of Nursing, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuhong Zeng
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Peicheng Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Mengge Zhou
- Vanke School of Public Health, Tsinghua University, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
- *Correspondence: Mengge Zhou
| | - Feng Cheng
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Feng Cheng
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Tattersall T, Tam C, Moore D, Wesseling T, Grieve S, Wang L, Bacani N, Montaner JSG, Hogg RS, Barrios R, Salters K. Healthcare and treatment experiences among people diagnosed with HIV before and after a province-wide treatment as prevention initiative in British Columbia, Canada. BMC Public Health 2022; 22:1022. [PMID: 35597938 PMCID: PMC9123764 DOI: 10.1186/s12889-022-13415-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/10/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction In 2010, the Canadian province of British Columbia (BC) initiated the Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) program to improve HIV testing, linkage to care, and treatment uptake, thereby operationalizing the HIV Treatment as Prevention (TasP) framework at the population-level. In this analysis, we evaluated self-reported HIV care experiences and therapeutic outcomes among people diagnosed with HIV prior to and after implementation of this provincial program. Methods A cross-sectional analysis was performed on the baseline data of a cohort of people living with HIV (PLWH) (19 years and older) in the province of BC sampled from July 2016 to September 2018. All participants consented to linking their survey data to the provincial HIV treatment registry. Individuals diagnosed with HIV from January 1 2000—December 31 2009 were classified as pre-intervention and those diagnosed January 1 2010—December 31 2018 as post-intervention cohorts. Bivariate analyses were run using Chi-square and Wilcoxon Rank Sum tests. Cox proportional hazards regression model demonstrates time to antiretroviral therapy (ART) initiation (from HIV baseline) and virological suppression (2 consecutive plasma viral load measurements < 200 copies/ml). Results Of the 325 participants included in this analysis, 198 (61%) were diagnosed with HIV in the pre-intervention era and 127 (39%) in the post-intervention era. A higher proportion of participants in post-intervention era were diagnosed at walk-in clinics (45% vs. 39%) and hospitals (21% vs. 11%) (vs pre-intervention) (p = 0.042). Post-intervention participants had initiated ART with less advanced HIV disease (CD4 count 410 vs. 270 cells/ul; p = 0.001) and were less likely to experience treatment interruptions at any point in the 5 years after HIV diagnosis (17% vs. 48%; p < 0.001). The post-intervention cohort had significantly more timely ART initiation (aHR: 5.97, 95%CI 4.47, 7.97) and virologic suppression (aHR: 2.03, 95%CI 1.58, 2.60) following diagnosis, after controlling for confounders. Conclusions We found favourable treatment experiences and more timely ART initiation and virologic suppression after a targeted TasP provincial program. Our results illustrate the importance of accessible low-barrier HIV testing and treatment in tackling the HIV epidemic.
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Affiliation(s)
- Tessa Tattersall
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada
| | - Clara Tam
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada
| | - David Moore
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tim Wesseling
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada
| | - Sean Grieve
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada
| | - Nic Bacani
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kate Salters
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada. .,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
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Mizushima D, Takano M, Ando N, Uemura H, Yanagawa Y, Aoki T, Watanabe K, Ishizuka N, Oka S. A four-year observation of HIV and sexually transmitted infections among men who have sex with men before and during pre-exposure prophylaxis in Tokyo. J Infect Chemother 2022; 28:762-766. [DOI: 10.1016/j.jiac.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/11/2022] [Accepted: 02/16/2022] [Indexed: 10/18/2022]
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Iseselo MK, Tarimo EAM, Sandstrom E, Kulane A. Awareness and willingness to use HIV oral pre-exposure prophylaxis among people who inject drugs in Dar es Salaam, Tanzania: A cross-sectional survey. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000776. [PMID: 36962766 PMCID: PMC10121179 DOI: 10.1371/journal.pgph.0000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/31/2022] [Indexed: 11/23/2022]
Abstract
People who inject drugs (PWID) are at increased risk of HIV infection. Pre-exposure prophylaxis (PrEP) could help in HIV prevention among PWIDs. However, little is known about PrEP use among PWIDs in low and middle-income countries. This study reports the awareness of and willingness to use PrEP and the associated factors among PWID in Tanzania. A cross-sectional survey was conducted using respondent-driven sampling (RDS) to recruit PWIDs in Dar es Salaam, Tanzania. Data were collected using an interviewer-administered questionnaire. Chi-square statistical test was used during data analysis. The P-value of < 0.05 was used to ascertain the statistically significant relationship. IBM SPSS Statistics 25.0 was used to analyze the data. The analysis consisted of 260 PWIDs. The mean age of the respondents was 39.0 years with a standard deviation (SD) of ±7.5. Most of the respondents were male (n = 232, 89.2%) with primary education (n = 176, 67.7%). Despite the low awareness of PrEP (n = 42, 165.28%) in the study sample, the majority (n = 239, 91.9%) were willing to use PrEP. Both awareness of and willingness to use PrEP were associated with gender (p = .002 and p = < .001), awareness of HIV prevention programs(p = < .001 and p = .006), selling sex (p = .010 and p = .021), and frequency of condomless sexual intercourse (p = .029 and p = .025) respectively. In multivariable logistic regression, only gender(p = 0.046) was related to awareness of PrEP while awareness of HIV prevention programs (p = 0.009), the risk level of HIV infection(p = < .001), number of sexual partners(p = 0.046), and frequency of condomless sex(p = 0.032) were associated with willingness to use PrEP. Other factors were not statistically significant. Despite low awareness, PWIDs are highly willing to use PrEP. Future research should assess the acceptability of injectable PrEP for PWID, as their acquaintance with injection may make the formulation more practical.
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Affiliation(s)
- Masunga K Iseselo
- Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden
| | - Edith A M Tarimo
- Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Eric Sandstrom
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Asli Kulane
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden
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Rees H, Chersich MF, Munthali RJ, Brumskine W, Palanee-Phillips T, Nkala B, Ahmed K, Sebe M, Mabude Z, Nchabeleng M, Bekker LG, Kotze P, Mogodiri T, Naidoo I, Panchia R, Myer L, Lombard C, Doncel GF, Gray G, Delany-Moretlwe S. HIV Incidence Among Pregnant and Nonpregnant Women in the FACTS-001 Trial: Implications for HIV Prevention, Especially PrEP Use. J Acquir Immune Defic Syndr 2021; 88:376-383. [PMID: 34710071 DOI: 10.1097/qai.0000000000002785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND During pregnancy and postpartum period, the sexual behaviors of women and their partners change in ways that may either increase or reduce HIV risks. Pregnant women are a priority population for reducing both horizontal and vertical HIV transmission. SETTING Nine sites in 4 South African provinces. METHODS Women aged 18-30 years were randomized to receive pericoital tenofovir 1% gel or placebo gel and required to use reliable modern contraception. We compared HIV incidence in women before, during, and after pregnancy and used multivariate Cox Proportional hazards models to compare HIV incidence by pregnancy status. RESULTS Rates of pregnancy were 7.1 per 100 woman-years (95% confidence interval [CI]: 6.3 to 8.1) and highest in those who reported oral contraceptive use (25.1 per 100 woman-years; adjusted hazard ratio 22.97 higher than other women; 95% CI: 5.0 to 105.4) or had 2 children. Birth outcomes were similar between trial arms, with 59.8% having full-term live births. No difference was detected in incident HIV during pregnancy compared with nonpregnant women (2.1 versus 4.3%; hazard ratio = 0.56, 95% CI: 0.14 to 2.26). Sexual activity was low in pregnancy and the early postpartum period, as was consistent condom use. CONCLUSIONS Pregnancy incidence was high despite trial participation being contingent on contraceptive use. We found no evidence that rates of HIV acquisition were elevated in pregnancy when compared with those in nonpregnant women. Risks from reductions in condom use may be offset by reduced sexual activity. Nevertheless, high HIV incidence in both pregnant and nonpregnant women supports consideration of introducing antiretroviral-containing pre-exposure prophylaxis for pregnant and nonpregnant women in high HIV prevalence settings.
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Affiliation(s)
- Helen Rees
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew Francis Chersich
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard J Munthali
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Busi Nkala
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Zonke Mabude
- MATCH, University of the Witwatersrand, Johannesburg, South Africa
| | - Maphoshane Nchabeleng
- Mecru Clinical Research Unit, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Philip Kotze
- Qhakaza Mbokodo Research Centre, Ladysmith, South Africa
| | - Thembisile Mogodiri
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ishana Naidoo
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ravindre Panchia
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa ; and
- Division of Epidemiology and Biostatistics, Department of Global Health, University of Stellenbosch, Stellenbosch, South Africa
| | | | - Glenda Gray
- Setshaba Research Centre, Soshanguve, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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12
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Workie KL, Birhan TY, Angaw DA. Predictors of mortality rate among adult HIV-positive patients on antiretroviral therapy in Metema Hospital, Northwest Ethiopia: a retrospective follow-up study. AIDS Res Ther 2021; 18:27. [PMID: 33952282 PMCID: PMC8097881 DOI: 10.1186/s12981-021-00353-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/26/2021] [Indexed: 01/16/2023] Open
Abstract
Background Globally Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) is an ongoing public health issue associated with high morbidity and mortality. Efforts have been made to reduce HIV/AIDS-related morbidity and mortality by delivering antiretroviral therapy. However, the incidence and predictors of mortality in border areas like Metema were not investigated. This study aimed to assess predictors of mortality rate among adult HIV-positive patients on antiretroviral therapy at Metema Hospital. Methods Retrospective follow-up study was employed among ART patients from January 1, 2013, to December 30, 2018. Data were entered in Epi-data 3.1 and exported to STATA 14 for analysis. Kaplan–Meier and Log-Rank test was used to compare survival differences among categories of different variables. In bi-variable analysis p-values < 0.20 were entered into a multivariable analysis. Multivariate Weibull model was used to measure the risk of death and identify the significant predictors of death. Variables that were statistically significant at p-value < 0.05 were concluded as predictors of mortality. Result A total of 542 study participants were included. The overall incidence rate was 6.7 (95% CI: 5.4–8.4) deaths per 100 person-years of observation. Being male (HR = 2.4; 95% CI: 1.24–4.62), STAGE IV (HR = 5.64; 95% CI: 2.53–12.56), stage III (HR = 3.31; 95% CI: 1.35–8.10), TB-coinfection (HR = 3.71; 95% CI: 1.59–8.64), low hemoglobin (HR = 4.14; 95% CI: 2.18–7.86), BMI ≤ 15.4 kg/m2 (HR = 2.45; 95% CI: 1.17–5.10) and viral load > 1000 copy/ml (HR = 6.70; 95% CI: 3.4–13.22) were found to be a significant predictor for mortality among HIV patients on ART treatment. Conclusion The incidence of death was high. Being male, viral load, those with advanced STAGE (III & IV), TB co-infected, low BMI, and low hemoglobin were at a higher risk of mortality. Special attention should be given to male patients and high public interventions needed among HIV patients on ART to reduce the mortality rate. Supplementary Information The online version contains supplementary material available at 10.1186/s12981-021-00353-z.
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13
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Felner JK, Mittal ML, Hoenigl M, Amico KR, Grelotti DJ, Eanes A, Hess K, Crawford J, Smith LR. Constructions of HIV Risk Among a Diverse Sample of HIV-Negative Young Men Who Have Sex With Men Who Are Repeat Testers. J Acquir Immune Defic Syndr 2021; 86:e126-e133. [PMID: 33394615 PMCID: PMC7933095 DOI: 10.1097/qai.0000000000002614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To end the HIV epidemic, HIV prevention and pre-exposure prophylaxis (PrEP) promotion efforts must reach young men who have sex with men (YMSM) at greatest risk for HIV. This study qualitatively explored whether common metrics used by clinicians, scientists, and public health officials to objectively assess HIV risk align with how YMSM conceptualize their risk for HIV and the factors that shape YMSM's risk perceptions. METHODS Interviews with a racially/ethnically diverse sample of HIV-negative YMSM (ages 19-24 years, 60% Latinx; n = 20) examined conceptualizations of HIV risk within the context of repeat HIV testing. Iterative, applied thematic analysis examined how participants conceptualized and constructed their HIV risk, and compared participants' descriptions of their risk with a validated quantitative assessment of HIV risk that reliably predicts HIV seroconversion in this group. RESULTS Objective quantitative assessments of HIV risk poorly aligned with participants' perceived HIV risk. Participants described their current risk in relative terms (relative to past risk and relative to friends'/peers' risk) and described age/developmental stage and changes in knowledge about HIV prevention as key factors in risk changes over time. Other factors included substance use and trust/mistrust in sexual partners and scientific advances in HIV prevention (eg, U = U and PrEP). Factors that influenced participants' perceived HIV risk were similar regardless of objective risk assessment. CONCLUSIONS Quantitative assessments of risk may poorly align with risk perception among YMSM. Although objective metrics can effectively target YMSM at greatest risk for HIV transmission, interventions to improve prevention behaviors and PrEP uptake may be more effective when tailored to bridge the disconnection between objective HIV risk assessments and YMSM's constructions of risk.
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Affiliation(s)
- Jennifer K. Felner
- San Diego State University, Institute for Behavioral and Community Health and School of Public Health, 9245 Sky Park Court, Suite 224, San Diego, CA 92123
| | - Maria Luisa Mittal
- University of California San Diego, Department of Medicine, Division of Infectious Diseases and Global Public Health, 9500 Gilman Drive MC 0507, La Jolla, CA 92093
| | - Martin Hoenigl
- University of California San Diego, Department of Medicine, Division of Infectious Diseases and Global Public Health, 9500 Gilman Drive MC 0507, La Jolla, CA 92093
| | - K. Rivet Amico
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
| | - David J. Grelotti
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego School of Medicine, 200 Dickinson St, Suite B, San Diego, CA 92103
| | - Alex Eanes
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
- NASTAD, 444 North Capitol Street NW, Suite 339, Washington, D.C. 20001
| | - Kristen Hess
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
- Clinical Trials Administration, Renown Health, 1155 Mill Street, G14, Reno, NV 89502
| | - Jessica Crawford
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
| | - Laramie R. Smith
- University of California San Diego, Department of Medicine, Division of Infectious Diseases and Global Public Health, 9500 Gilman Drive MC 0507, La Jolla, CA 92093
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Stelzle D, Godfrey-Faussett P, Jia C, Amiesimaka O, Mahy M, Castor D, Hodges-Mameletzis I, Chitembo L, Baggaley R, Dalal S. Estimating HIV pre-exposure prophylaxis need and impact in Malawi, Mozambique and Zambia: A geospatial and risk-based analysis. PLoS Med 2021; 18:e1003482. [PMID: 33428611 PMCID: PMC7799816 DOI: 10.1371/journal.pmed.1003482] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 12/07/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP), a WHO-recommended HIV prevention method for people at high risk for acquiring HIV, is being increasingly implemented in many countries. Setting programmatic targets, particularly in generalised epidemics, could incorporate estimates of the size of the population likely to be eligible for PrEP using incidence-based thresholds. We estimated the proportion of men and women who would be eligible for PrEP and the number of HIV infections that could be averted in Malawi, Mozambique, and Zambia using prioritisation based on age, sex, geography, and markers of risk. METHODS AND FINDINGS We analysed the latest nationally representative Demographic and Health Surveys (DHS) of Malawi, Mozambique, and Zambia to determine the proportion of adults who report behavioural markers of risk for HIV infection. We used prevalence ratios (PRs) to quantify the association of these factors with HIV status. Using a multiplier method, we combined these proportions with the number of new HIV infections by district, derived from district-level modelled HIV estimates. Based on these numbers, different scenarios were analysed for the minimum number of person-years on PrEP needed to prevent 1 HIV infection (NNP). An estimated total of 38,000, 108,000, and 46,000 new infections occurred in Malawi, Mozambique, and Zambia in 2016, corresponding with incidence rates of 0.43, 0.63, and 0.57 per 100 person-years. In these countries, 9%-20% of new infections occurred among people with a sexually transmitted infection (STI) in the past 12 months and 40%-42% among people with either an STI or a non-regular sexual partner (NP) in the past 12 months (STINP). The models estimate that around 50% of new infections occurred in districts with incidence rates ≥1.0% in Mozambique and Zambia and ≥0.5% in Malawi. In Malawi, Mozambique, and Zambia, 35.1%, 21.9%, and 12.5% of the population live in these high-incidence districts. In the most parsimonious scenario, if women aged 15-34 years and men 20-34 years with an STI in the past 12 months living in high-incidence districts were to take PrEP, it would take a minimum of 65.8 person-years on PrEP to avert 1 HIV infection per year in Malawi, 35.2 in Mozambique, and 16.4 in Zambia. Our findings suggest that 3,300, 5,200, and 1,700 new infections could be averted per year in the 3 countries, respectively. Limitations of our study are that these values are based on modelled estimates of HIV incidence and self-reported behavioural risk factors from national surveys. CONCLUSIONS A large proportion of new HIV infections in these 3 African countries were estimated to occur among people who had either an STI or an NP in the past year, providing a straightforward means to set PrEP targets. Greater prioritisation of PrEP by district, sex, age, and behavioural risk factors resulted in lower NNPs thereby increasing PrEP cost-effectiveness, but also diminished the overall impact on reducing new infections.
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Affiliation(s)
- Dominik Stelzle
- Center for Global Health, Department of Neurology, Technical University, Munich, Germany
- Chair of Epidemiology, Faculty of Sport and Health Sciences, Technical University, Munich, Germany
| | - Peter Godfrey-Faussett
- Strategic Information Department, UNAIDS, Geneva, Switzerland
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chuan Jia
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Obreniokibo Amiesimaka
- Center for Global Health, Department of Neurology, Technical University, Munich, Germany
| | - Mary Mahy
- Strategic Information Department, UNAIDS, Geneva, Switzerland
| | - Delivette Castor
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, United States of America
| | | | | | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Shona Dalal
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
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Malinverni S, Bédoret F, Bartiaux M, Gilles C, De Wit S, Libois A. Single-tablet regimen of emtricitabine/tenofovir disoproxil fumarate plus cobicistat-boosted elvitegravir increase adherence for HIV postexposure prophylaxis in sexual assault victims. Sex Transm Infect 2020; 97:329-333. [PMID: 33106437 DOI: 10.1136/sextrans-2020-054714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/17/2020] [Accepted: 09/27/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Postexposure prophylaxis (PEP) is a recommended public health intervention after a sexual assault to prevent HIV infection. METHODS We conducted a retrospective case-control study on how use of a single-tablet regimen (STR) of elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (Stribild) affected adherence to PEP and attendance of a follow-up visit to the STI clinic compared with those who received a multitablet regimen (MTR). Data from sexual assault victims consulting for PEP were prospectively recorded between January 2011 and December 2017. Data were systematically collected on patient demographics, time of medical contact, source risk factors, type of exposure, attendance to follow-up visit, reported completion of PEP and adherence based on pharmacy records. RESULTS A total of 422 patients received PEP following a sexual assault, of whom 52% had documented completion of a 28-day PEP regimen and 71% attended a follow-up clinic visit. Patients who received an elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (EVG/COBI/FTC/TDF)-based STR had a similar likelihood of attending their first follow-up visit (OR: 0.97; 95% CI: 0.64 to 1.48, p=0.90) but were more likely to complete the PEP regimen (OR: 1.70; 95% CI: 1.16 to 2.50, p=0.007). After adjusting for confounders, those who were prescribed an STR regimen were more likely to complete the PEP regimen (OR: 1.66, 95% CI: 1.09 to 2.53, p=0.019) than those who were prescribed an MTR such as stavudine/lamivudine/lopinavir/ritonavir or zidovudine/lamivudine/indinavir/ritonavir. CONCLUSIONS Sexual assault victims who were prescribed an STR based on EVG/COBI/FTC/TDF were more likely to complete PEP than those who were prescribed an MTR.
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Affiliation(s)
| | | | | | | | | | - Agnes Libois
- Infectious Diseases, CHU Saint-Pierre, Bruxelles, Belgium
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16
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Riddler SA, Balkus JE, Parikh UM, Mellors JW, Akello C, Dadabhai S, Mhlanga F, Ramjee G, Mayo AJ, Livant E, Heaps AL, O'Rourke C, Baeten JM. Clinical and Virologic Outcomes Following Initiation of Antiretroviral Therapy Among Seroconverters in the Microbicide Trials Network-020 Phase III Trial of the Dapivirine Vaginal Ring. Clin Infect Dis 2020; 69:523-529. [PMID: 30346511 DOI: 10.1093/cid/ciy909] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 10/18/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND A vaginal ring containing dapivirine, a non-nucleoside human immunodeficiency virus (HIV)-1 reverse transcriptase inhibitor (NNRTI), was safe and effective in preventing HIV-1 infection in African women. We examined the impact of dapivirine ring use at the time of HIV-1 acquisition on subsequent HIV-1 disease progression and responses to NNRTI-containing antiretroviral therapy (ART). METHODS HIV-1 disease progression and virologic failure following initiation of ART were assessed among women who acquired HIV-1 while participating in Microbicide Trials Network-020, a randomized, placebo-controlled trial of a monthly, dapivirine vaginal ring. RESULTS Among the 158 participants who acquired HIV-1 (65 dapivirine, 93 placebo), no differences between dapivirine and placebo participants were observed in CD4+ cell counts or plasma HIV-1 RNA over the first year after infection (prior to ART). During follow-up, 100/158 (63%) participants initiated NNRTI-containing ART (dapivirine: 39/65; placebo: 61/93); the median time to HIV-1 RNA <200 copies/ml was approximately 90 days for both dapivirine and placebo ring recipients (log-rank P = .40). Among the 81 participants with at least 6 months of post-ART follow-up, 19 (24%) experienced virologic failure (dapivirine: 6/32, 19%; placebo: 13/39, 27%; P = .42). CONCLUSIONS The acquisition of HIV-1 infection during dapivirine or placebo treatment in ASPIRE did not lead to differences in HIV-1 disease progression. After the initiation of NNRTI-containing ART, dapivirine and placebo participants had similar times to virologic suppression and risks of virologic failure. These results provide reassurance that NNRTI-based ART regimens are effective among women who acquired HIV-1 while receiving the dapivirine vaginal ring. CLINICAL TRIALS REGISTRATION NCT016170096 and NCT00514098.
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Affiliation(s)
| | | | | | | | - Carolyne Akello
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Sufia Dadabhai
- Johns Hopkins Bloomberg School of Public Health, Blantyre, Malawi
| | | | - Gita Ramjee
- South African Medical Research Council, Durban
| | | | - Edward Livant
- Magee-Womens Research Institute & Foundation, Pittsburgh, Pennsylvania
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Skakoon-Sparling S, Cramer KM. Are We Blinded by Desire? Relationship Motivation and Sexual Risk-Taking Intentions during Condom Negotiation. JOURNAL OF SEX RESEARCH 2020; 57:545-558. [PMID: 30884967 DOI: 10.1080/00224499.2019.1579888] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Effective condom negotiation skills support better sexual health for both men and women. The current study explored relationship motivation (motivation to establish and maintain long-term romantic relationships), gender, and sexual orientation as factors influencing the condom negotiation process. Participants (177 heterosexual women, 157 heterosexual men, and 106 men who have sex with men) read a vignette describing an encounter with a hypothetical new sexual/romantic partner and responded to embedded items and scales. Stronger relationship motivation predicted increased willingness to have condomless sex among women who perceived greater familiarity with the hypothetical partner. Gender and sexual orientation predicted different preferences for condom insistence strategies. The findings suggest that there are a number of conditions that make it more difficult to recognize risk during a sexual encounter and demonstrate how the process of condom negotiation can be impacted by gender, sexual orientation, and relationship motivation.
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Tan CJ, Li SF, Huang N, Zhang Y, Di YT, Zheng YT, Hao XJ. Daphnane Diterpenoids from Trigonostemon lii and Inhibition Activities Against HIV-1. NATURAL PRODUCTS AND BIOPROSPECTING 2020; 10:37-44. [PMID: 32048186 PMCID: PMC7046902 DOI: 10.1007/s13659-020-00231-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
Natural products are the important source for the discovery of more potent anti-HIV agents. In this study, six daphnane diterpenoids including three unreported structures were isolated from Trigonostemon lii, which showed significant activities against HIV-1 strains replication in the nanomolar/picomolar range. Meanwhile, these diterpenoids significantly inhibited the fusion of H9/HIV-1 IIIB cells with uninfected C8166 cells, with the EC50s from 1.06 to 8.73 ng/mL, and did not show any inhibition activities against HIV-1 reverse transcriptase. Moreover, all of the diterpenoids shows significant inhibitions against T20-resistan HIV-1 strains, PNL4-3gp41(36G)V38E, N42S and pNL4-3gp41(36G)V38A, N42T. The results revealed that the six diterpenoids could be a new type of potential lead candidate as an HIV entry inhibitor, particularly for those infected by T20-resistant variants.
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Affiliation(s)
- Cheng-Jian Tan
- State Key Laboratory of Phytochemistry and Plant Resources in West China, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, 650204, Yunnan, People's Republic of China
- School of Ethnic Medicine, Guizhou Minzu University, Guiyang, 550025, Guizhou, People's Republic of China
| | - Shi-Fei Li
- State Key Laboratory of Phytochemistry and Plant Resources in West China, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, 650204, Yunnan, People's Republic of China
- Institute of Molecular Science, Shanxi University, Taiyuan, 030006, Shanxi, People's Republic of China
| | - Ning Huang
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, 650223, Yunnan, People's Republic of China
- School of Basic Medical, Kunming Medical University, Kunming, 650500, Yunnan, People's Republic of China
| | - Yu Zhang
- State Key Laboratory of Phytochemistry and Plant Resources in West China, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, 650204, Yunnan, People's Republic of China
| | - Ying-Tong Di
- State Key Laboratory of Phytochemistry and Plant Resources in West China, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, 650204, Yunnan, People's Republic of China
| | - Yong-Tang Zheng
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, Center for Biosafety Mega-Science, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, 650223, Yunnan, People's Republic of China.
| | - Xiao-Jiang Hao
- State Key Laboratory of Phytochemistry and Plant Resources in West China, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, 650204, Yunnan, People's Republic of China.
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Horvath KJ, Lammert S, Martinka A, Erickson D. Defining Sexual Risk in the Era of Biomedical HIV Prevention: Implications for HIV Research and Practice. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:91-102. [PMID: 31630287 PMCID: PMC7018580 DOI: 10.1007/s10508-019-01499-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 06/05/2019] [Accepted: 06/17/2019] [Indexed: 06/10/2023]
Abstract
Advancing HIV behavioral science and its integration with recent biomedical prevention strategies-treatment as prevention and pre-exposure prophylaxis (PrEP)-is complicated because traditional definitions of sexual risk (condomless anal sex [CAS] or CAS with a serodiscordant partner) may not suffice given the success of biomedical prevention in the absence of condoms. To better understand how to define and understand risk in the era of biomedical HIV prevention, we assessed correlates of four different definitions of high-risk sexual behavior among a sample of 401 adult HIV-positive MSM (57% African American) residing in the New York City area: (1) a traditional model of risk defined as CAS with an HIV-negative or unknown serostatus partner; (2) a definition that considered participant viral load (VL); (3) a definition that considered partner PrEP use; and (4) a definition that considered participant HIV VL and partner PrEP use. Among participants reporting anal sex (n = 281) with a man in the past 3 months, 42% were considered high risk under Definition 1, 6% under Definition 2, 25% under Definition 3, and 2% under Definition 4. Correlates of risk varied across definitions. For example, while education was the strongest predictor of high-risk sexual behavior in Definitions 1 and 2, alcohol use and enacted stigma were the strongest predictors in the model that only accounted for partner PrEP use (Definition 3). These findings have implications for whom to reach for intervention efforts, the difficulty in meeting recruitment goals, and the types of interventions that should be used.
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Affiliation(s)
- Keith J Horvath
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
- Department of Psychology, San Diego State University, 6363 Alvarado Court, San Diego, CA, 92120, USA.
| | - Sara Lammert
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Aldona Martinka
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Darin Erickson
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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Beltrami J, Gans A, Wozniak M, Murphy J, Puesta B, Kennebrew D, Angie Allen M, OʼConnor K. The Usefulness of Individual-Level HIV Surveillance Data to Initiate Statewide HIV Partner Services: Experiences From Hawaii and New Mexico. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 24:519-525. [PMID: 28763430 DOI: 10.1097/phh.0000000000000643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Partner services are a broad array of services that should be offered to persons with human immunodeficiency virus (HIV) and that are based on a process through which HIV-infected persons are interviewed to elicit information about their sex and needle-sharing partners. Human immunodeficiency virus testing of partners can result in a high yield of newly diagnosed HIV positivity, but despite this yield and the benefits of partners knowing their exposures and HIV status, partner services are often not conducted. OBJECTIVE We sought to determine the newly diagnosed HIV positivity and benefits to 2 health departments that conducted demonstration projects that focused on statewide HIV partner services. DESIGN The main sources of information used for this case study analysis included the health department funding applications, progress reports and final reports submitted to the Centers for Disease Control and Prevention, and records of communications between Centers for Disease Control and Prevention and the health departments. Required quantitative reporting included the number of partners tested and the number of partners with newly diagnosed confirmed HIV infection. Required qualitative reporting included how health departments benefited from their demonstration project activities. SETTING Hawaii and New Mexico. PARTICIPANTS Sex and needle-sharing partners of persons who were newly diagnosed with HIV infection. INTERVENTION The use of HIV surveillance data to initiate statewide HIV partner services. MAIN OUTCOME MEASURE Newly diagnosed HIV positivity. RESULTS During 2012-2015, the newly diagnosed HIV positivity among partners was 18% (78/427): 16% (17/108) in Hawaii and 19% (61/319) in New Mexico. The health departments benefited from improved collaborations among HIV prevention program and surveillance staff and among the health departments, providers, and AIDS service organizations. CONCLUSIONS Hawaii and New Mexico each achieved a high newly diagnosed HIV positivity and benefited from improved local collaborations. As a result of the success of these projects, both health departments have continued the activities since the end of category C funding by securing alternative funding sources.
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Affiliation(s)
- John Beltrami
- US Public Health Service, Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia (Dr Beltrami); New Mexico Department of Health, Santa Fe, New Mexico (Messrs Gans and Murphy); Hawaii Department of Health, Honolulu, Hawaii (Ms Wozniak); Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia (Mr Puesta and Mss Kennebrew and Allen); and Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia (Mr O'Connor)
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21
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Pan Y, Metsch LR, Gooden LK, Philbin MM, Daar ES, Douaihy A, Jacobs P, Del Rio C, Rodriguez AE, Feaster DJ. Viral suppression and HIV transmission behaviors among hospitalized patients living with HIV. Int J STD AIDS 2019; 30:891-901. [PMID: 31159715 DOI: 10.1177/0956462419846726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
From July 2012 to January 2014, the CTN0049 study, Project HOPE (Hospital Visit as Opportunity for Prevention and Engagement for HIV-infected Drug Users) interviewed 1227 people with HIV infection from 11 hospitals in the US to determine eligibility for participation in a randomized trial. Using these screening interviews, we conducted a cross-sectional study with multivariable analysis to examine groups that are at highest risk for having a detectable viral load (VL) and engaging in HIV transmission behaviors. Viral suppression was 42.8%. Persons with a detectable VL were more likely to have sex partners who were HIV-negative or of unknown status (OR = 1.72, 95% CI = 1.22–2.38), report not cleaning needles after injecting drugs (OR = 3.13, 95% CI = 1.33–7.14), and to engage in sex acts while high on drugs or alcohol (OR = 1.85, 95% CI = 1.28–2.7) compared to their counterparts. Many hospitalized people with HIV infection are unsuppressed and more likely to engage in HIV transmission behaviors than those with viral suppression. Developing behavioral interventions targeting HIV transmission behaviors toward patients with unsuppressed HIV VLs in the hospital setting has the potential to prevent HIV transmission.
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Affiliation(s)
- Yue Pan
- 1 Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lisa R Metsch
- 2 Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lauren K Gooden
- 2 Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Morgan M Philbin
- 2 Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Eric S Daar
- 3 Los Angeles Biomedical Research Institute at Harbor, University of California Los Angeles Medical Center, Torrance, CA, USA
| | - Antoine Douaihy
- 4 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Petra Jacobs
- 5 Center for the Clinical Trials Network, National Institute on Drug Abuse, North Bethesda, MD, USA
| | - Carlos Del Rio
- 6 Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Allan E Rodriguez
- 7 Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel J Feaster
- 1 Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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22
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Abstract
PURPOSE OF REVIEW This study aims to review the epidemiology of sexually transmitted infections (STIs) among men who have sex with men (MSM) and suggest control measures. RECENT FINDINGS Despite declines in new HIV diagnosis, bacterial STIs among MSM have dramatically risen since the late 1990s. This increase occurred concurrent with introduction of effective antiretroviral therapy, the advent of electronic mechanisms for meeting sex partners and population-level changes in sexual behavior, including decreased condom use. HIV pre-exposure prophylaxis (PrEP) is now further diminishing condom use, though its impact on STIs is uncertain. A plan to confront the MSM STI epidemic should include increased HIV/STI testing promoted through expanded public health clinical infrastructure, health care system reform to improve the care of gender and sexual minorities and promote low-barrier care, re-invigorated condom promotion, and scientific innovation. There is an urgent need to implement new STI control measures while continuing to expand PrEP use.
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Affiliation(s)
- Meena S Ramchandani
- Department of Medicine, Harborview Medical Center, University of Washington, Mailstop: 359777, 325 Ninth Avenue, Seattle, WA, 98104, USA.
- Public Health-Seattle and King County HIV/STD Program, Seattle, WA, USA.
| | - Matthew R Golden
- Department of Medicine, Harborview Medical Center, University of Washington, Mailstop: 359777, 325 Ninth Avenue, Seattle, WA, 98104, USA
- Public Health-Seattle and King County HIV/STD Program, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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23
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Moorman JP, Krolikowski MR, Mathis SM, Pack RP. HIV/HCV Co-infection: Burden of Disease and Care Strategies in Appalachia. Curr HIV/AIDS Rep 2019; 15:308-314. [PMID: 29931466 DOI: 10.1007/s11904-018-0404-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to address infection with HIV and hepatitis C in the Appalachian region of the USA and the driving forces underlying this epidemic. We seek to discuss epidemiology of disease and the possible interventions to reduce incidence and burden of disease in this resource-limited area. RECENT FINDINGS The rise of the opioid crisis has fueled a rise in new hepatitis C infection, and a rise in new HIV infection is expected to follow. Injection drug use has directly contributed to the epidemic and continues to remain a risk factor. Men who have sex with men remains a significant risk factor for HIV acquisition as well. Progress has been made in the battle against HIV and, to a lesser extent, hepatitis C, but much more can be done. Limited data on co-infection with HIV/HCV are currently available for this at-risk region, but it is clear that Appalachia is highly vulnerable to co-infection outbreaks. A multipronged approach that includes advances in assessment of co-infection and education for both patients and clinicians can help to recognize, manage, and ideally prevent these illnesses.
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Affiliation(s)
- Jonathan P Moorman
- Center of Excellence in Inflammation, Infectious Diseases and Immunity, College of Medicine, East Tennessee State University, Johnson City, TN, USA. .,Department of Medicine, Division of Infectious Diseases, College of Medicine, East Tennessee State University, Johnson City, TN, USA.
| | - Matthew R Krolikowski
- Department of Medicine, Division of Infectious Diseases, College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Stephanie M Mathis
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN, USA.,Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, TN, USA
| | - Robert P Pack
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN, USA.,Center for Prescription Drug Abuse Prevention and Treatment, East Tennessee State University, Johnson City, TN, USA
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24
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Rao DW, Carr J, Naismith K, Hood JE, Hughes JP, Morris M, Goodreau SM, Rosenberg ES, Golden MR. Monitoring HIV Preexposure Prophylaxis Use Among Men Who Have Sex With Men in Washington State: Findings From an Internet-Based Survey. Sex Transm Dis 2019; 46:221-228. [PMID: 30870322 PMCID: PMC7687921 DOI: 10.1097/olq.0000000000000965] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Many state and local health departments now promote and support the use of HIV preexposure prophylaxis (PrEP), yet monitoring use of the intervention at the population level remains challenging. METHODS We report the results of an online survey designed to measure PrEP use among men who have sex with men (MSM) in Washington State. Data on the proportion of men with indications for PrEP based on state guidelines and levels of awareness, interest, and use of PrEP are presented for 1080 cisgender male respondents who completed the survey between January 1 and February 28, 2017. We conducted bivariate and multivariable logistic regression to identify factors associated with current PrEP use. To examine patterns of discontinuation, we conducted Cox proportional hazards regression and fit a Kaplan-Meier curve to reported data on time on PrEP. RESULTS Eighty percent of respondents had heard of PrEP, 19% reported current use, and 36% of men who had never used PrEP wanted to start taking it. Among MSM for whom state guidelines recommend PrEP, 31% were taking it. In multivariable analysis, current PrEP use was associated with older age, higher education, and meeting indications for PrEP use. Our data suggest that 20% of PrEP users discontinue within 12 months, and men with lower educational attainment were more likely to discontinue. CONCLUSIONS Despite high levels of use, there is significant unmet need for PrEP in Washington. Our experience indicates that Internet surveys are feasible and informative for monitoring PrEP use in MSM.
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Affiliation(s)
- Darcy White Rao
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Jason Carr
- Infectious Disease Assessment Unit, Disease Control and Health Statistics, Washington State Department of Health, Olympia, Washington, USA
| | - Kelly Naismith
- Infectious Disease Assessment Unit, Disease Control and Health Statistics, Washington State Department of Health, Olympia, Washington, USA
| | - Julia E. Hood
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - James P. Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Martina Morris
- Department of Statistics, University of Washington, Seattle, Washington, USA
- Department of Sociology, University of Washington, Seattle, Washington, USA
| | - Steven M. Goodreau
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Anthropology, University of Washington, Seattle, Washington, USA
| | - Eli S. Rosenberg
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY
| | - Matthew R. Golden
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
- School of Medicine, University of Washington, Seattle, Washington, USA
- Center for AIDS and STD, University of Washington, Seattle, Washington, USA
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25
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Wenzel SL, Rhoades H, La Motte-Kerr W, Duan L, Harris T, Rice E, Henwood BF. Do HIV risk and prevention behaviors change over time among adults in permanent supportive housing? AIDS Care 2019; 31:1172-1177. [PMID: 30724581 DOI: 10.1080/09540121.2019.1576849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Persons experiencing homelessness have a disproportionate burden of HIV infection and high rates of HIV risk behavior. Permanent supportive housing (PSH) has been identified as a primary solution to homelessness, but little is known about HIV sexual risk behavior among persons in PSH, nor about how HIV risk and prevention behavior may change as persons move from homelessness into PSH. Utilizing longitudinal data from 421 persons prior to moving in and over their first year living in PSH, this study assesses change over time in HIV risk and prevention behavior utilizing generalized linear mixed models. Results reveal changes in sexual risk behavior over time, including an overall increase in the rate of sexual activity, but a decrease in rates of some sexual risk behaviors, including condomless sex and multiple partners. While decreasing overall, the prevalence of condomless sex remains high (63%) at 12-months. Combined with a precipitous drop in HIV prevention programming exposure (from 56% at baseline to 23% at 12-months), only two-thirds of those sexually active reporting a past year HIV test at 12-months post-housing, and rare use of PrEP, these findings suggest a need for additional attention to promotion of sexual health behaviors and HIV prevention within PSH.
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Affiliation(s)
- Suzanne L Wenzel
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
| | - Harmony Rhoades
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
| | - Wichada La Motte-Kerr
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
| | - Lei Duan
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
| | - Taylor Harris
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
| | - Eric Rice
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
| | - Benjamin F Henwood
- a Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , US
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26
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Patel RR, Luke DA, Proctor EK, Powderly WG, Chan PA, Mayer KH, Harrison LC, Dhand A. Sex Venue-Based Network Analysis to Identify HIV Prevention Dissemination Targets for Men Who Have Sex with Men. LGBT Health 2018; 5:78-85. [PMID: 29324178 DOI: 10.1089/lgbt.2017.0018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The aim of this study was to identify sex venue-based networks among men who have sex with men (MSM) to inform HIV preexposure prophylaxis (PrEP) dissemination efforts. METHODS Using a cross-sectional design, we interviewed MSM about the venues where their recent sexual partners were found. Venues were organized into network matrices grouped by condom use and race. We examined network structure, central venues, and network subgroups. RESULTS Among 49 participants, the median age was 27 years, 49% were Black and 86% reported condomless anal sex (ncAS). Analysis revealed a map of 54 virtual and physical venues with an overlap in the ncAS and with condom anal sex (cAS) venues. In the ncAS network, virtual and physical locations were more interconnected. The ncAS venues reported by Blacks were more diffusely organized than those reported by Whites. CONCLUSION The network structures of sex venues for at-risk MSM differed by race. Network information can enhance HIV prevention dissemination efforts among subpopulations, including PrEP implementation.
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Affiliation(s)
- Rupa R Patel
- 1 Division of Infectious Diseases, Washington University in St. Louis , St. Louis, Missouri
| | - Douglas A Luke
- 2 Center for Public Health Systems Science, Washington University in St. Louis , St. Louis, Missouri
| | - Enola K Proctor
- 3 Brown School, Washington University in St. Louis , St. Louis, Missouri
| | - William G Powderly
- 1 Division of Infectious Diseases, Washington University in St. Louis , St. Louis, Missouri
| | - Philip A Chan
- 4 Division of Infectious Diseases, Brown University , Providence, Rhode Island
| | - Kenneth H Mayer
- 5 Division of Infectious Diseases, Beth Israel Deaconess Medical Center , Boston, Massachusetts
- 6 Division of Infectious Diseases, Harvard Medical School , Boston, Massachusetts
- 7 The Fenway Institute , Fenway Health, Boston, Massachusetts
| | - Laura C Harrison
- 1 Division of Infectious Diseases, Washington University in St. Louis , St. Louis, Missouri
| | - Amar Dhand
- 8 Department of Neurology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
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27
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Leal L, Guardo AC, Morón-López S, Salgado M, Mothe B, Heirman C, Pannus P, Vanham G, van den Ham HJ, Gruters R, Andeweg A, Van Meirvenne S, Pich J, Arnaiz JA, Gatell JM, Brander C, Thielemans K, Martínez-Picado J, Plana M, García F. Phase I clinical trial of an intranodally administered mRNA-based therapeutic vaccine against HIV-1 infection. AIDS 2018; 32:2533-2545. [PMID: 30289805 PMCID: PMC6221380 DOI: 10.1097/qad.0000000000002026] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective: The efficacy of therapeutic vaccines against HIV-1 infection has been modest. New inerts to redirect responses to vulnerable sites are urgently needed to improve these results. Design: We performed the first-in-human clinical trial with naked mRNA (iHIVARNA) combining a dendritic cell activation strategy (TriMix:CD40L+CD70+caTLR4 RNA) with a novel HIV immunogen sequences (HTI immunogen). Methods: A dose escalation, phase I clinical trial was performed in 21 chronic HIV-1-infected patients under ART who received three intranodal doses of mRNA (weeks 0, 2 and 4) as follow: TriMix-100 g, TriMix-300 g, TriMix-300 g with HTI-300 g, TriMix-300 g with HTI-600 g, TriMix-300 g with HTI-900 g. Primary end-point was safety and secondary-exploratory end-points were immunogenicity, changes in viral reservoir and transcriptome. Results: Overall, the vaccine was secure and well tolerated. There were 31 grade 1/2 and 1 grade 3 adverse events, mostly unrelated to the vaccination. Patients who received the highest dose showed a moderate increase in T-cell responses spanning HTI sequence at week 8. In addition, the proportion of responders receiving any dose of HTI increased from 31% at w0 to 80% postvaccination. The intervention had no impact on caHIV-DNA levels, however, caHIV-RNA expression and usVL were transiently increased at weeks 5 and 6 in the highest dose of iHIVARNA, and these changes were positively correlated with HIV-1-specific-induced immune responses. Conclusion: This phase I dose-escalating trial showed that iHIVARNA administration was safe and well tolerated, induced moderate HIV-specific T-cell responses and transiently increased different viral replication readouts. These data support further exploration of iHIVARNA in a phase II study. ClinicalTrials.gov Identifier: NCT02413645
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28
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McKay VR, Hoffer LD, Combs TB, Margaret Dolcini M. The dynamic influence of human resources on evidence-based intervention sustainability and population outcomes: an agent-based modeling approach. Implement Sci 2018; 13:77. [PMID: 29866135 PMCID: PMC5987464 DOI: 10.1186/s13012-018-0767-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 05/21/2018] [Indexed: 11/27/2022] Open
Abstract
Background Sustaining evidence-based interventions (EBIs) is an ongoing challenge for dissemination and implementation science in public health and social services. Characterizing the relationship among human resource capacity within an agency and subsequent population outcomes is an important step to improving our understanding of how EBIs are sustained. Although human resource capacity and population outcomes are theoretically related, examining them over time within real-world experiments is difficult. Simulation approaches, especially agent-based models, offer advantages that complement existing methods. Methods We used an agent-based model to examine the relationships among human resources, EBI delivery, and population outcomes by simulating provision of an EBI through a hypothetical agency and its staff. We used data from existing studies examining a widely implemented HIV prevention intervention to inform simulation design, calibration, and validity. Once we developed a baseline model, we used the model as a simulated laboratory by systematically varying three human resource variables: the number of staff positions, the staff turnover rate, and timing in training. We tracked the subsequent influence on EBI delivery and the level of population risk over time to describe the overall and dynamic relationships among these variables. Results Higher overall levels of human resource capacity at an agency (more positions) led to more extensive EBI delivery over time and lowered population risk earlier in time. In simulations representing the typical human resource investments, substantial influences on population risk were visible after approximately 2 years and peaked around 4 years. Conclusions Human resources, especially staff positions, have an important impact on EBI sustainability and ultimately population health. A minimum level of human resources based on the context (e.g., size of the initial population and characteristics of the EBI) is likely needed for an EBI to have a meaningful impact on population outcomes. Furthermore, this model demonstrates how ABMs may be leveraged to inform research design and assess the impact of EBI sustainability in practice. Electronic supplementary material The online version of this article (10.1186/s13012-018-0767-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Virginia R McKay
- Center for Public Health Systems Research in the Warren G. Brown School of Social Work, Washington University in St. Louis, Campus Box1196, One Brookings Drive, St. Louis, MO, 63130, USA.
| | - Lee D Hoffer
- Department of Anthropology, Case Western Reserve University, Mather Memorial Room 238 11220, Bellflower Road, Cleveland, OH, 44106-7125, USA
| | - Todd B Combs
- Center for Public Health Systems Research in the Warren G. Brown School of Social Work, Washington University in St. Louis, Campus Box1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - M Margaret Dolcini
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Hallie E. Ford Center for Health Children and Families, 2631 SW Campus Way, Corvallis, OR, 97331, USA
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29
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Patel RR, Chan PA, Harrison LC, Mayer KH, Nunn A, Mena LA, Powderly WG. Missed Opportunities to Prescribe HIV Pre-Exposure Prophylaxis by Primary Care Providers in Saint Louis, Missouri. LGBT Health 2018; 5:250-256. [PMID: 29688800 DOI: 10.1089/lgbt.2017.0101] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Optimal HIV pre-exposure prophylaxis (PrEP) scale-up in the United States requires prescribing by primary care providers (PCPs). We assessed barriers to patients obtaining PrEP from their PCPs. METHODS Patients seeking PrEP at an Infectious Diseases (ID) Clinic in St. Louis, Missouri from 2014 to 2016 were asked about demographics, sexual behaviors, whether PrEP was initially sought from their PCP, and barriers to obtaining PrEP from their PCP. Multivariable logistic regression was performed to identify predictors for having asked a PCP for PrEP. RESULTS Among 102 patients, the median age was 29 years, 58% were white, and 88% were men who have sex with men. Most (65%) had a PCP and, of these, 48% had asked their PCP for PrEP, but were not prescribed it. About half (52%) reported that their PCPs perceived prescribing PrEP as specialty care. Many (39%) indicated that they felt uncomfortable discussing their sexual behaviors with their PCP. Patients with an HIV-positive sex partner in the last 3 months were less likely to ask for PrEP from their PCPs than others (Adjusted Odds Ratio: 0.07; 95% CI: 0.01-0.53). Eighty-three percent of patients were referred to a new PCP with whom they could feel more comfortable discussing PrEP. CONCLUSIONS During initial PrEP implementation, ID specialists can play an important role in providing education and linking PrEP patients to PCPs. However, PCPs may need additional training about PrEP and how to provide culturally sensitive sexual healthcare, if widespread scale-up is to be effective in decreasing HIV incidence.
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Affiliation(s)
- Rupa R Patel
- 1 Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine , St. Louis, Missouri
| | - Philip A Chan
- 2 Division of Infectious Diseases, Department of Medicine, Brown University , Providence, Rhode Island
| | - Laura C Harrison
- 1 Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine , St. Louis, Missouri
| | - Kenneth H Mayer
- 3 Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center , Boston, Massachusetts.,4 Department of Medicine, Harvard Medical School , Boston, Massachusetts.,5 The Fenway Institute , Fenway Health, Boston, Massachusetts
| | - Amy Nunn
- 6 Department of Behavioral and Social Sciences, Brown University School of Public Health , Providence, Rhode Island.,7 The Rhode Island Public Health Institute , Providence, Rhode Island
| | - Leandro A Mena
- 8 Division of Infectious Diseases, Department of Medicine, University of Mississippi , Jackson, Mississippi
| | - William G Powderly
- 1 Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine , St. Louis, Missouri
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30
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Kowalska JD, Pietraszkiewicz E, Firląg-Burkacka E, Horban A. Suspected unexpected and other adverse reactions to antiretroviral drugs used as post-exposure prophylaxis of HIV infection - five-year experience from clinical practice. Arch Med Sci 2018; 14:547-553. [PMID: 29765441 PMCID: PMC5949906 DOI: 10.5114/aoms.2016.59701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 04/01/2016] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION With increased use of antiretroviral drugs (ARVs) in HIV uninfected persons, proper reporting on suspected unexpected serious adverse reactions (SUSARs) and continued insight into adverse drug reactions (ADRs) are needed for adequate information on safety of ARVs in such populations. MATERIAL AND METHODS Medical documentation of persons receiving ARVs after non-occupational HIV exposure (non-occupational post-exposure prophylaxis - nPEP) during 5 successive years (2009-2013) was evaluated by two HIV physicians. Adverse drug reactions s and SUSARs were defined according to international standards. In statistical analyses Cox proportional hazard models were used to identify independent predictors of developing a first ADR. RESULTS In total 375 persons received nPEP with the following indications: needle stick (43%), unprotected sexual intercourse (17%), rape (10%) and first aid (10%). In 84 (22%) cases the source patient was HIV positive or an active injecting drug user. In total 170 ADRs were reported. One hundred thirty-nine persons had only 1 ADR. The most frequent first ADRs were gastrointestinal disorders (22%), followed by general symptoms (9%), hypersensitivity reactions (1.6%) and CNS symptoms (1.3%). The remaining events represented less than 1% of all patients. Eight (2.1%) patients developed a SUSAR. In multivariate analyses only age at first visit to the clinic was an independent predictor of developing an ADR (HR = 1.17, 95% CI: 1.03-1.34; p = 0.02). CONCLUSIONS In our observations ADRs in reaction to nPEP were frequent yet usually mild events, mostly occurring in the first 2 weeks and rarely causing discontinuation. The only significant factor increasing the risk of ADR was age. SUSARs were rare, transient and clinically insignificant.
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Affiliation(s)
- Justyna D. Kowalska
- Department for Adults’ Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
- HIV Out-Patient Clinic, Hospital for Infectious Diseases, Warsaw, Poland
| | | | | | - Andrzej Horban
- Department for Adults’ Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
- HIV Out-Patient Clinic, Hospital for Infectious Diseases, Warsaw, Poland
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31
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Mah ND, Birmingham AR, Treu CN, Bodkin RP, Awad NI, Acquisto NM. Sexually Transmitted Infection Review for the Acute Care Pharmacist. J Pharm Pract 2018; 33:63-73. [PMID: 29558852 DOI: 10.1177/0897190018764567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Review selected sexually transmitted infections (STIs) and treatment recommendations for pharmacists and providers practicing in the acute care setting. SUMMARY In 2015, the Centers for Disease Control and Prevention (CDC) published an updated guideline on the treatment of STIs with an emphasis on prevention and new diagnostic strategies to combat the growing problem of STIs in the United States. Despite this guidance, the incidence of infection has continued to grow. In October 2016, an in-depth analysis reported that 20 million new infections occur annually in the United States. With this growing burden of disease, it is pertinent that health-care providers optimize their treatment strategies to improve upon the management of STIs. Focusing on identification of asymptomatic- and symptomatic-infected persons, treatment, education, effective follow-up, and counseling for patients and sexual partners, emergency medicine pharmacists and providers can help minimize the negative long-term health consequences of STIs. CONCLUSION In the emergency department setting, clinical pharmacists and providers can play a crucial role in preventing and treating STIs and should continue to expand and keep current their knowledge of this topic.
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Affiliation(s)
- Nathan D Mah
- Department of Pharmacy, Oregon Health and Science University, Portland, OR, USA
| | - Asha R Birmingham
- Department of Pharmacy, Oregon Health and Science University, Portland, OR, USA
| | - Cierra N Treu
- Emergency Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Ryan P Bodkin
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Nadia I Awad
- Department of Pharmacy, Emergency Medicine Pharmacist, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Nicole M Acquisto
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA.,Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA
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Nghiem VT, Bui TC, Nadol PP, Phan SH, Kieu BT, Kling R, Hammett TM. Prevalence and correlates of HIV infection among men who inject drugs in a remote area of Vietnam. Harm Reduct J 2018; 15:8. [PMID: 29444685 PMCID: PMC5813411 DOI: 10.1186/s12954-018-0210-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/19/2018] [Indexed: 11/13/2022] Open
Abstract
Background Lack of information on the HIV epidemic among men who inject drugs (MWID) in northwestern Vietnam, a remote area, may hamper national efforts to control the disease. We examined HIV prevalence, needle–syringe sharing behaviors, and associated factors among MWID in three areas of northwestern Vietnam. Methods We used descriptive analysis to report the characteristics, frequency of risk behaviors, and of access to healthcare services among the MWID. Univariable logistic regression was used to assess the associations between the HIV infection, needle–syringe sharing behaviors, and their independent variables. We further explored these associations in multivariable analyses where we included independent variables based on a priori knowledge and their associations with the dependent variables determined in univariable analyses (p < 0.25). Results The HIV prevalence was 37.9, 16.9, and 18.5% for Tuan Giao, Bat Xat, and Lao Cai City, respectively, and 25.4% overall. MWID of Thai minority ethnicity were more likely to be HIV-positive (adjusted odds ratio (AOR) 3.55; 95% confidence interval (CI) 1.84–6.87). The rate of needle–syringe sharing in the previous 6 months was approximately 9% among the MWID in Tuan Giao and Lao Cai City, and 27.8% in Bat Xat. Two thirds of the participants never underwent HIV testing before this study. Ever having been tested for HIV before this study was not associated with any needle–syringe sharing behaviors. Among the HIV-positive MWID, those who received free clean needles and syringes were less likely to give used needles and syringes to peers (AOR 0.21; 95% CI 0.06–0.79). Going to a “hotspot” in the previous week was associated with increased odds of needle–syringe sharing in multiple subgroups. Conclusion Our findings on HIV prevalence and testing participation among a subset of MWID in the northwestern Vietnam were corroborated with trend analysis results from the most recent HIV/STI Integrated Biological and Behavioral Surveillance report (data last collected in 2013.) We provided important insights into these MWID’s risky injection behaviors. We suggest heightened emphasis on HIV testing and needle and syringe provision for this population. Also, policymakers and program implementers should target hotspots as a main venue to tackle HIV epidemics.
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Affiliation(s)
- Van T Nghiem
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, 77030, USA. .,Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA.
| | - Thanh C Bui
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Patrick P Nadol
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Hanoi, Vietnam
| | - Son H Phan
- International Health Division, Abt Associates, Bethesda, MD, 20814, USA
| | | | - Ryan Kling
- U.S. Health Division, Abt Associates, Cambridge, MA, 02138, USA
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Siguier M, Molina JM. HIV preexposure prophylaxis: An essential, safe and effective prevention tool for sexual health. Med Mal Infect 2018; 48:318-326. [PMID: 29433965 DOI: 10.1016/j.medmal.2018.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/17/2018] [Indexed: 01/26/2023]
Abstract
Preexposure prophylaxis of HIV with antiretroviral drugs is a prevention tool available in France since 2016, combined with the prevention methods already used (condoms, post-exposure treatment, rapid treatment of diagnosed HIV infections, etc.). It is targeted at populations at high risk of HIV infection, especially men who have sex with men, for whom traditional prevention methods are insufficient. We collected clinical research data, which resulted in the launch of preexposure prophylaxis in the United States and then elsewhere in the world, safety, tolerability and cost data, as well as ongoing research data (new molecules/methods of administration). We also provided an update of its use in France.
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Affiliation(s)
- M Siguier
- Service de maladies infectieuses et tropicales, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot, 5, rue Thomas-Mann, 75013 Paris, France.
| | - J-M Molina
- Service de maladies infectieuses et tropicales, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France; Université Paris-Diderot, 5, rue Thomas-Mann, 75013 Paris, France
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Cruess DG, Burnham KE, Finitsis DJ, Goshe BM, Strainge L, Kalichman M, Grebler T, Cherry C, Kalichman SC. A Randomized Clinical Trial of a Brief Internet-based Group Intervention to Reduce Sexual Transmission Risk Behavior Among HIV-Positive Gay and Bisexual Men. Ann Behav Med 2018; 52:116-129. [PMID: 29538626 PMCID: PMC6361295 DOI: 10.1093/abm/kax031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background HIV disproportionately affects sexual minority men, and developing strategies to reduce transmission risk is a public health priority. Purpose The goal was to empirically test a newly developed, Information, Motivation, Behavioral skills (IMB) theoretically derived, online HIV sexual risk reduction intervention (called HINTS) among a sample of sexual minority men living with HIV. Methods Participants were 167 men randomized to either the four-session online HINTS intervention or to a time-matched, online control condition. Participants were assessed at baseline and at 6-month follow-up for demographic, medical and psychosocial factors, and sexual risk behavior. Analyses examined group differences in incidence rates of condomless anal sex (CAS) at follow-up with all male sex partners and by partner serostatus, either seroconcordant or serodiscordant for HIV infection. Results Men assigned to the HINTS intervention reported decreased CAS with serodiscordant partners, a behavior that confers high risk of HIV transmission, compared to the control group. Men assigned to the HINTS intervention also reported increased CAS with seroconcordant partners, a behavior indicative of serosorting. Although the IMB model did not appear to mediate these intervention effects, some IMB components were associated with behavioral outcomes at 6-month follow-up. Conclusions A new group-based sexual risk reduction intervention conducted exclusively online was successful in reducing HIV transmission risk behavior in a sample of gay and bisexual men living with HIV. Future work should consider utilizing this intervention with other groups living with HIV, perhaps in combination with biomedical HIV prevention strategies.
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Affiliation(s)
- Dean G Cruess
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - Kaylee E Burnham
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - David J Finitsis
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - Brett M Goshe
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - Lauren Strainge
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Moira Kalichman
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - Tamar Grebler
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - Chauncey Cherry
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, CT
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Abstract
Fungi must meet four criteria to infect humans: growth at human body temperatures, circumvention or penetration of surface barriers, lysis and absorption of tissue, and resistance to immune defenses, including elevated body temperatures. Morphogenesis between small round, detachable cells and long, connected cells is the mechanism by which fungi solve problems of locomotion around or through host barriers. Secretion of lytic enzymes, and uptake systems for the released nutrients, are necessary if a fungus is to nutritionally utilize human tissue. Last, the potent human immune system evolved in the interaction with potential fungal pathogens, so few fungi meet all four conditions for a healthy human host. Paradoxically, the advances of modern medicine have made millions of people newly susceptible to fungal infections by disrupting immune defenses. This article explores how different members of four fungal phyla use different strategies to fulfill the four criteria to infect humans: the Entomophthorales, the Mucorales, the Ascomycota, and the Basidiomycota. Unique traits confer human pathogenic potential on various important members of these phyla: pathogenic Onygenales comprising thermal dimorphs such as Histoplasma and Coccidioides; the Cryptococcus spp. that infect immunocompromised as well as healthy humans; and important pathogens of immunocompromised patients-Candida, Pneumocystis, and Aspergillus spp. Also discussed are agents of neglected tropical diseases important in global health such as mycetoma and paracoccidiomycosis and common pathogens rarely implicated in serious illness such as dermatophytes. Commensalism is considered, as well as parasitism, in shaping genomes and physiological systems of hosts and fungi during evolution.
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Mullins TLK, Zimet G, Lally M, Xu J, Thornton S, Kahn JA. HIV Care Providers' Intentions to Prescribe and Actual Prescription of Pre-Exposure Prophylaxis to At-Risk Adolescents and Adults. AIDS Patient Care STDS 2017; 31:504-516. [PMID: 29211514 DOI: 10.1089/apc.2017.0147] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) is indicated for use in US adults, and little is known about clinician intentions to prescribe and actual prescription of PrEP to adolescents younger than 18. Fifty-six clinicians who care for HIV-infected and at-risk youth completed an anonymous online survey in 2014. Primary outcomes were (1) intentions to prescribe PrEP to adolescents and adults in four risk categories [men who have sex with men (MSM), transgender women, heterosexuals with multiple partners of unknown HIV status, heterosexuals with HIV-infected partners]; and (2) actual prescription of PrEP to adolescents and adults in these risk groups. Independent variables included clinician characteristics, experience prescribing nonoccupational postexposure prophylaxis, familiarity with and knowledge of PrEP and PrEP guidance, attitudes toward PrEP, and facilitating factors for prescribing PrEP and incorporation of PrEP guidance into practice. Variables associated with intention to prescribe ("very likely to prescribe" vs. other responses) and actual prescription of PrEP stratified by age and risk category were identified in logistic regression models. Mean age was 45.9 years (standard deviation 10.7); 64% were physicians. More clinicians reported high intention to prescribe PrEP to adult versus adolescent MSM (p = 0.02) and transgender women (p = 0.001). Variables associated with intention to prescribe and prescription of PrEP differed by age and risk category. In adolescents, those variables included positive beliefs, higher number of facilitating factors, and fewer barriers to PrEP prescription. Designing strategies based on these findings that address both facilitating factors and barriers to PrEP prescription may improve PrEP uptake by at-risk youth.
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Affiliation(s)
- Tanya L. Kowalczyk Mullins
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gregory Zimet
- Section of Adolescent Medicine, Indiana University, Indianapolis, Indiana
| | - Michelle Lally
- Division of Infectious Diseases, Department of Medicine, Lifespan Hospital System/Alpert Medical School of Brown University, Providence, Rhode Island
| | | | | | - Jessica A. Kahn
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
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Ganczak M, Korzeń M, Olszewski M. Attitudes, Beliefs and Predictors of Male Circumcision Promotion among Medical University Students in a Traditionally Non-Circumcising Region. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1097. [PMID: 28934174 PMCID: PMC5664598 DOI: 10.3390/ijerph14101097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/12/2017] [Accepted: 09/18/2017] [Indexed: 12/24/2022]
Abstract
Objective: To evaluate the beliefs of medical university students regarding male circumcision (MC), as well as attitudes and the predictors of its promotion in the case of adults at risk of HIV. Methods: A cross-sectional survey was conducted between 2013-2016 at the Medical University in Szczecin, Poland, among final year Polish/foreign students from Northern Europe, using a standardized questionnaire. Results: There were 539 participants, median age 25 years, 40.8% males, and 66.8% were Polish nationals. The MC rate was 16.7%. Regarding HIV/AIDS knowledge, 66.6% of the students scored more than 75%; and, 34.2% knew that MC reduces the risk of HIV infection. One in eleven respondents (9.1%) believed that circumcised men felt more intense sexual pleasure. More than half of the respondents (54.8%) declared that they would recommend MC to adult patients at risk for HIV. The belief that circumcised men felt more intense sexual pleasure, and knowledge on MC regarding HIV risk reduction was associated with greater odds of recommending adult MC (OR = 3.35 and OR = 2.13, respectively). Conclusions: Poor knowledge of its benefits and a low willingness to promote the procedure-strongly dependent on personal beliefs-suggest that medical students may need additional training to help them to discuss MC more openly with adult men at risk for HIV infection. Knowledge may be an effective tool when making decisions regarding MC promotion.
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Affiliation(s)
- Maria Ganczak
- Department of Epidemiology and Management, Faculty of Medical Sciences, Pomeranian Medical University, 71-210 Szczecin, Poland.
| | - Marcin Korzeń
- Department of Methods of Artificial Intelligence and Applied Mathematics, Faculty of Computer Science and Information Technology, West Pomeranian University of Technology, 71-210 Szczecin, Poland.
| | - Maciej Olszewski
- Students' Scientific Association, Pomeranian Medical University, 70-204 Szczecin, Poland.
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Kuchenbecker R. What is the benefit of the biomedical and behavioral interventions in preventing HIV transmission? REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 18 Suppl 1:26-42. [PMID: 26630297 DOI: 10.1590/1809-4503201500050004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 08/25/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Scientific evidence supports the synergy between biomedical and behavioral interventions aimed at preventing the transmission of HIV as a strategy to eradicate AIDS. OBJECTIVE To characterize comparatively the benefits from biomedical and behavioral interventions to prevent HIV transmission. METHODS Narrative review. We performed a comparative analysis of the benefits of studied interventions by means of estimating the number needed to treat (NNT). Evaluated interventions: counseling activities for behavior change to prevent exposure to HIV; antiretroviral pre-exposure prophylaxis (PrEP) and antiretroviral post-exposure prophylasis (PEP) for HIV and treatment of serodiscordant couples as a strategy for prevention of HIV transmission (TasP). RESULTS counseling interventions and TasP have smaller NNTs, equal to, respectively, 11 (95%CI 9 - 18) at 12 months and 34 (95%CI 23 - 54) in 42 months comparatively to PrEP interventions, that resulted in 41 (95%CI 28 - 67) individuals receiving antiretrovirals in order to prevent one case of HIV infection at 36 months for men and serodiscordant couples. PEP interventions are associated with protective effects estimated at 81%. Lack of trials evaluating PEP prevents estimate of NNT. CONCLUSION The estimate of the NNT can be a helpful parameter in the comparison between the effectiveness of different behavioral and biomedical HIV prevention strategies. Studies evaluating the benefit and safety of combined behavioral and biomedical interventions are needed, especially considering the attributable fraction of each component. Integration of behavioral and biomedical interventions is required to achieve complete suppression of the virus, and thus reducing viral replication, infectivity and the number of cases.
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Affiliation(s)
- Ricardo Kuchenbecker
- School of Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Andreatos N, Grigoras C, Shehadeh F, Pliakos EE, Stoukides G, Port J, Flokas ME, Mylonakis E. The impact of HIV infection and socioeconomic factors on the incidence of gonorrhea: A county-level, US-wide analysis. PLoS One 2017; 12:e0183938. [PMID: 28863154 PMCID: PMC5580927 DOI: 10.1371/journal.pone.0183938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 08/14/2017] [Indexed: 11/24/2022] Open
Abstract
Background Gonorrhea is the second most commonly reported identifiable disease in the United States (U.S.). Importantly, more than 25% of gonorrheal infections demonstrate antibiotic resistance, leading the Centers for Disease Control and Prevention (CDC) to classify gonorrhea as an “urgent threat”. Methods We examined the association of gonorrhea infection rates with the incidence of HIV and socioeconomic factors. A county-level multivariable model was then constructed. Results Multivariable analysis demonstrated that HIV incidence [Coefficient (Coeff): 1.26, 95% Confidence Interval (CI): 0.86, 1.66, P<0.001] exhibited the most powerful independent association with the incidence of gonorrhea and predicted 40% of the observed variation in gonorrhea infection rates. Sociodemographic factors like county urban ranking (Coeff: 0.12, 95% CI: 0.03, 0.20, P = 0.005), percentage of women (Coeff: 0.41, 95% CI: 0.28, 0.53, P<0.001) and percentage of individuals under the poverty line (Coeff: 0.45, 95% CI: 0.32, 0.57, P<0.001) exerted a secondary impact. A regression model that incorporated these variables predicted 56% of the observed variation in gonorrhea incidence (Pmodel<0.001, R2 model = 0.56). Conclusions Gonorrhea and HIV infection exhibited a powerful correlation thus emphasizing the benefits of comprehensive screening for sexually transmitted infections (STIs) and the value of pre-exposure prophylaxis for HIV among patients visiting an STI clinic. Furthermore, sociodemographic factors also impacted gonorrhea incidence, thus suggesting another possible focus for public health initiatives.
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Affiliation(s)
- Nikolaos Andreatos
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Christos Grigoras
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Fadi Shehadeh
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Elina Eleftheria Pliakos
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Georgianna Stoukides
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Jenna Port
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Myrto Eleni Flokas
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
- * E-mail:
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Abstract
Supplemental Digital Content is Available in the Text. Objective: To develop and validate an HIV risk assessment tool to predict HIV acquisition among African women. Design: Data were analyzed from 3 randomized trials of biomedical HIV prevention interventions among African women (VOICE, HPTN 035, and FEM-PrEP). Methods: We implemented standard methods for the development of clinical prediction rules to generate a risk-scoring tool to predict HIV acquisition over the course of 1 year. Performance of the score was assessed through internal and external validations. Results: The final risk score resulting from multivariable modeling included age, married/living with a partner, partner provides financial or material support, partner has other partners, alcohol use, detection of a curable sexually transmitted infection, and herpes simplex virus 2 serostatus. Point values for each factor ranged from 0 to 2, with a maximum possible total score of 11. Scores ≥5 were associated with HIV incidence >5 per 100 person-years and identified 91% of incident HIV infections from among only 64% of women. The area under the curve (AUC) for predictive ability of the score was 0.71 (95% confidence interval [CI]: 0.68 to 0.74), indicating good predictive ability. Risk score performance was generally similar with internal cross-validation (AUC = 0.69; 95% CI: 0.66 to 0.73) and external validation in HPTN 035 (AUC = 0.70; 95% CI: 0.65 to 0.75) and FEM-PrEP (AUC = 0.58; 95% CI: 0.51 to 0.65). Conclusions: A discrete set of characteristics that can be easily assessed in clinical and research settings was predictive of HIV acquisition over 1 year. The use of a validated risk score could improve efficiency of recruitment into HIV prevention research and inform scale-up of HIV prevention strategies in women at highest risk.
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Craw JA, Bradley H, Gremel G, West BT, Duke CC, Beer L, Weiser J. Retention in Care Services Reported by HIV Care Providers in the United States, 2013 to 2014. J Int Assoc Provid AIDS Care 2017; 16:460-466. [PMID: 28791914 DOI: 10.1177/2325957417724204] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Evidence-based guidelines recommend that HIV care providers offer retention-in-care services, but data are needed to assess service provision. METHODS We surveyed a probability sample of 1234 HIV care providers to estimate the percentage of providers whose practices offered 5 recommended retention services and describe providers' perceptions of barriers to care among patients. RESULTS An estimated 21% of providers' practices offered all 5 retention services. Providers at smaller (<50 versus >400 patients), private, and non-Ryan White HIV/AIDS Program (RWHAP)-funded practices, and practices without on-site case management were significantly less likely to provide patient navigation services or do systematic monitoring of retention. Providers' most commonly perceived barriers to care among patients were mental health (40%), substance abuse (36%), and transportation (34%) issues. CONCLUSION Deficiencies in the provision of key retention services are substantial. New strategies may be needed to increase the delivery of recommended retention services, especially among private, non-RWHAP-funded, and smaller facilities.
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Affiliation(s)
- Jason A Craw
- 1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Heather Bradley
- 1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Brady T West
- 3 Survey Research Center, University of Michigan, Ann Arbor, MI, USA
| | | | - Linda Beer
- 1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Weiser
- 1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Nosyk B, Zang X, Min JE, Krebs E, Lima VD, Milloy MJ, Shoveller J, Barrios R, Harrigan PR, Kerr T, Wood E, Montaner JSG. Relative effects of antiretroviral therapy and harm reduction initiatives on HIV incidence in British Columbia, Canada, 1996-2013: a modelling study. Lancet HIV 2017; 4:e303-e310. [PMID: 28366707 PMCID: PMC5494273 DOI: 10.1016/s2352-3018(17)30045-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 01/16/2017] [Accepted: 01/20/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Antiretroviral therapy (ART) and harm reduction services have been cited as key contributors to control of HIV epidemics; however, the specific contribution of ART has been questioned due to uncertainty of its true efficacy on HIV transmission through needle sharing. We aimed to isolate the independent effects of harm reduction services (opioid agonist treatment uptake and needle distribution volumes) and ART on HIV transmission via needle sharing in British Columbia, Canada, from 1996 to 2013. METHODS We used comprehensive linked individual health administrative and registry data for the population of diagnosed people living with HIV in British Columbia to populate a dynamic, compartmental transmission model to simulate the HIV/AIDS epidemic in British Columbia from 1996 to 2013. We estimated HIV incidence, mortality, and quality-adjusted life-years (QALYs). We also estimated scenarios designed to isolate the independent effects of harm reduction services and ART, assuming 50% (10-90%) efficacy, in reducing HIV incidence through needle sharing, and we investigated structural and parameter uncertainty. FINDINGS We estimate that 3204 (upper bound-lower bound 2402-4589) incident HIV cases were averted between 1996 and 2013 as a result of the combined effect of the expansion of harm reduction services and ART coverage on HIV transmission via needle sharing. In a hypothetical scenario assuming ART had zero effect on transmission through needle sharing, we estimated harm reduction services alone would have accounted for 77% (upper bound-lower bound 62-95%) of averted HIV incidence. In a separate hypothetical scenario where harm reduction services remained at 1996 levels, we estimated ART alone would have accounted for 44% (10-67%) of averted HIV incidence. As a result of high distribution volumes, needle distribution predominantly accounted for incidence reductions attributable to harm reduction but opioid agonist treatment provided substantially greater QALY gains. INTERPRETATION If the true efficacy of ART in preventing HIV transmission through needle sharing is closer to its efficacy in sexual transmission, ART's effect on incident cases averted could be greater than that of harm reduction. Nonetheless, harm reduction services had a vital role in reducing HIV incidence in British Columbia, and should be viewed as essential and cost-effective tools in combination implementation strategies to reduce the public health and economic burden of HIV/AIDS. FUNDING BC Ministry of Health; National Institutes of Health (R01DA041747); Genome Canada (142HIV).
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Affiliation(s)
- Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Xiao Zang
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Jeong E Min
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada
| | - Emanuel Krebs
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada
| | - Viviane D Lima
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - M-J Milloy
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jean Shoveller
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Rolando Barrios
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - P Richard Harrigan
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Kerr
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Evan Wood
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julio S G Montaner
- BC Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Riddler SA, Husnik M, Ramjee G, Premrajh A, Tutshana BO, Pather A, Siva S, Jeenarain N, Nair G, Selepe P, Kabwigu S, Palanee-Phillips T, Panchia R, Mhlanga F, Levy L, Livant E, Patterson K, Elharrar V, Balkus J. HIV disease progression among women following seroconversion during a tenofovir-based HIV prevention trial. PLoS One 2017; 12:e0178594. [PMID: 28658251 PMCID: PMC5489164 DOI: 10.1371/journal.pone.0178594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/15/2017] [Indexed: 11/18/2022] Open
Abstract
Background Little is known regarding HIV disease outcomes among individuals who become infected with HIV while receiving antiretroviral medications for prevention. We compared HIV disease parameters among women who seroconverted while receiving tenofovir-containing oral or vaginal pre-exposure prophylaxis (PrEP) to placebo. Methods Participants with HIV seroconversion in a randomized placebo-controlled trial of oral tenofovir, oral tenofovir/emtricitabine, and vaginal tenofovir gel (MTN-003) were followed in a longitudinal cohort study (MTN-015). The effect of oral and vaginal tenofovir-containing PrEP on HIV disease progression was compared to placebo using linear mixed effects and Cox proportional hazard models, as appropriate. Additional analyses were performed to compare the outcomes among participants with detectable tenofovir or emtricitabine in plasma at the first quarterly visit in MTN-003. Results A total of 224 participants were included in the analysis; 93% from South Africa and 94% clade C virus. No differences in HIV RNA at steady state or the trajectory over 12 months were observed for each active arm compared to placebo; tenofovir gel recipients had higher CD4+ T cell counts (722 vs 596 cells/mm3; p = 0.02) at 90 days after estimated HIV seroconversion and higher average rates of change over 12 months compared to placebo (-181 vs -92 cells/mm3 per year; p = 0.08). With a median follow-up of 31 months, no significant differences were observed for time to CD4+ T cell count ≤350 cells/mm3, or the composite endpoint of CD4+ T cells ≤350 cells/mm3, initiation of antiretroviral therapy or death for each active arm compared to placebo. Additionally, there were no significant differences in the HIV RNA or CD4+ T cell counts at baseline, the change to month 12, or any disease progression outcomes among participants with oral drug detected and no oral drug detected compared to placebo. Conclusions No clinically significant differences in HIV seroconversion outcomes were observed among women randomized to tenofovir-containing oral or vaginal PrEP regimens, however low overall adherence limits the generalizability of these findings.
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Affiliation(s)
- Sharon A. Riddler
- University of Pittsburgh, Pittsburgh, PA, United States of America
- * E-mail:
| | - Marla Husnik
- Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Seattle, WA, United States of America
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Westville, Kwa Zulu Natal, South Africa
| | - Anamika Premrajh
- HIV Prevention Research Unit, South African Medical Research Council, Westville, Kwa Zulu Natal, South Africa
| | - Bomkazi Onini Tutshana
- HIV Prevention Research Unit, South African Medical Research Council, Westville, Kwa Zulu Natal, South Africa
| | - Arendevi Pather
- HIV Prevention Research Unit, South African Medical Research Council, Westville, Kwa Zulu Natal, South Africa
| | - Samantha Siva
- HIV Prevention Research Unit, South African Medical Research Council, Westville, Kwa Zulu Natal, South Africa
| | - Nitesha Jeenarain
- HIV Prevention Research Unit, South African Medical Research Council, Westville, Kwa Zulu Natal, South Africa
| | | | | | - Samuel Kabwigu
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Ravindre Panchia
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Felix Mhlanga
- University of Zimbabwe, UZ-UCSF Collaborative Research Programme, Harare, Zimbabwe
| | - Lisa Levy
- FHI 360, Durham, NC, United States of America
| | - Edward Livant
- Magee-Womens Research Institute, Pittsburgh, PA, United States of America
| | - Karen Patterson
- Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Seattle, WA, United States of America
| | | | - Jennifer Balkus
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
- University of Washington, Seattle, WA, United States of America
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Brantley M, Schumacher C, Fields EL, Perin J, Safi AG, Ellen JM, Muvva R, Chaulk P, Jennings JM. The network structure of sex partner meeting places reported by HIV-infected MSM: Opportunities for HIV targeted control. Soc Sci Med 2017; 182:20-29. [PMID: 28411524 PMCID: PMC6598677 DOI: 10.1016/j.socscimed.2017.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 03/24/2017] [Accepted: 04/05/2017] [Indexed: 01/08/2023]
Abstract
Baltimore, Maryland ranks among U.S. cities with the highest incidence of HIV infection among men who have sex with men (MSM). HIV screening at sex partner meeting places or venues frequented by MSM with new diagnoses and/or high HIV viral load may reduce transmission by identifying and linking infected individuals to care. We investigated venue-based clustering of newly diagnosed MSM to identify high HIV transmission venues. HIV surveillance data from MSM diagnosed between October 2012-June 2014 and reporting ≥1 sex partner meeting place were examined. Venue viral load was defined according to the geometric mean viral load of the cluster of cases that reported the venue and classified as high (>50,000 copies/mL), moderate (1500-50,000 copies/mL), and low (<1500 copies/mL). 143 MSM provided information on ≥1 sex partner meeting place, accounting for 132 unique venues. Twenty-six venues were reported by > 1 MSM; of these, a tightly connected cluster of six moderate viral load sex partner meeting places emerged, representing 66% of reports. Small, dense networks of moderate to high viral load venues may be important for targeted HIV control among MSM.
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Affiliation(s)
- Meredith Brantley
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Center for Child and Community Health Research, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Christina Schumacher
- Center for Child and Community Health Research, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Baltimore City Health Department, Baltimore, MD, USA
| | - Errol L Fields
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Center for Child and Community Health Research, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jamie Perin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Center for Child and Community Health Research, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Amelia Greiner Safi
- Center for Child and Community Health Research, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jonathan M Ellen
- Center for Child and Community Health Research, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL, USA
| | - Ravikiran Muvva
- Center for Child and Community Health Research, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Baltimore City Health Department, Baltimore, MD, USA
| | - Patrick Chaulk
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Baltimore City Health Department, Baltimore, MD, USA; Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jacky M Jennings
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Center for Child and Community Health Research, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Leal L, Lucero C, Gatell JM, Gallart T, Plana M, García F. New challenges in therapeutic vaccines against HIV infection. Expert Rev Vaccines 2017; 16:587-600. [PMID: 28431490 DOI: 10.1080/14760584.2017.1322513] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION There is a growing interest in developing curative strategies for HIV infection. Therapeutic vaccines are one of the most promising approaches. We will review the current knowledge and the new challenges in this research field. Areas covered: PubMed and ClinicalTrial.gov databases were searched to review the progress and prospects for clinical development of immunotherapies aimed to cure HIV infection. Dendritic cells (DC)-based vaccines have yielded the best results in the field. However, major immune-virologic barriers may hamper current vaccine strategies. We will focus on some new challenges as the antigen presentation by DCs, CTL escape mutations, B cell follicle sanctuary, host immune environment (inflammation, immune activation, tolerance), latent reservoir and the lack of surrogate markers of response. Finally, we will review the rationale for designing new therapeutic vaccine candidates to be used alone or in combination with other strategies to improve their effectiveness. Expert commentary: In the next future, the combination of DCs targeting candidates, inserts to redirect responses to unmutated parts of the virus, adjuvants to redirect responses to sanctuaries or improve the balance between activation/tolerance (IL-15, anti-PD1 antibodies) and latency reversing agents could be necessary to finally achieve the remission of HIV-1 infection.
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Affiliation(s)
- Lorna Leal
- a Infectious Diseases Unit, HIVACAT, Hospital Clínic, IDIBAPS , University of Barcelona , Barcelona , Spain
| | - Constanza Lucero
- a Infectious Diseases Unit, HIVACAT, Hospital Clínic, IDIBAPS , University of Barcelona , Barcelona , Spain
| | - Josep M Gatell
- a Infectious Diseases Unit, HIVACAT, Hospital Clínic, IDIBAPS , University of Barcelona , Barcelona , Spain
| | - Teresa Gallart
- b Retrovirology and Viral Immunopathology Laboratories, HIVACAT, Hospital Clínic, IDIBAPS , University of Barcelona , Barcelona , Spain
| | - Montserrat Plana
- b Retrovirology and Viral Immunopathology Laboratories, HIVACAT, Hospital Clínic, IDIBAPS , University of Barcelona , Barcelona , Spain
| | - Felipe García
- a Infectious Diseases Unit, HIVACAT, Hospital Clínic, IDIBAPS , University of Barcelona , Barcelona , Spain
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Ross I, Mejia C, Melendez J, Chan PA, Nunn AC, Powderly W, Goodenberger K, Liu J, Mayer KH, Patel RR. Awareness and attitudes of pre-exposure prophylaxis for HIV prevention among physicians in Guatemala: Implications for country-wide implementation. PLoS One 2017; 12:e0173057. [PMID: 28257475 PMCID: PMC5336255 DOI: 10.1371/journal.pone.0173057] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 02/14/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION HIV continues to be a major health concern with approximately 2.1 million new infections occurring worldwide in 2015. In Central America, Guatemala had the highest incident number of HIV infections (3,700) in 2015. Antiretroviral pre-exposure prophylaxis (PrEP) was recently recommended by the World Health Organization (WHO) as an efficacious intervention to prevent HIV transmission. PrEP implementation efforts are underway in Guatemala and success will require providers that are knowledgeable and willing to prescribe PrEP. We sought to explore current PrEP awareness and prescribing attitudes among Guatemalan physicians in order to inform future PrEP implementation efforts. METHODS We conducted a cross-sectional survey of adult internal medicine physicians at the main teaching hospital in Guatemala City in March 2015. The survey included demographics, medical specialty, years of HIV patient care, PrEP awareness, willingness to prescribe PrEP, previous experience with post-exposure prophylaxis, and concerns about PrEP. The primary outcome was willingness to prescribe PrEP, which was assessed using a 5-point Likert scale for different at-risk population scenarios. Univariate and multivariate logistic regression was performed to identify predictors for willingness to prescribe PrEP. RESULTS Eighty-seven physicians completed the survey; 66% were male, 64% were internal medicine residency trainees, and 10% were infectious disease (ID) specialists. Sixty-nine percent of physicians were PrEP aware, of which 9% had previously prescribed PrEP. Most (87%) of respondents were willing to prescribe PrEP to men who have sex with men (MSM), sex workers, injection drug users, or HIV-uninfected persons having known HIV-positive sexual partners. Concerns regarding PrEP included development of resistance (92%), risk compensation (90%), and cost (64%). Univariate logistic regression showed that younger age, being a resident trainee, and being a non-ID specialist were significant predictors for willingness to prescribe PrEP. In multivariate logistic regression, being a non-ID specialist was a significant predictor. CONCLUSIONS Guatemalan physicians at an urban public hospital were PrEP aware and willing to prescribe, but few have actually done so yet. Future education programs should address the concerns identified, including the low potential for the development of antiretroviral resistance. These findings can aid PrEP implementation efforts in Guatemala.
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Affiliation(s)
- Ian Ross
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Carlos Mejia
- Division of Infectious Diseases, Roosevelt Hospital, Guatemala City, Guatemala
| | - Johanna Melendez
- Division of Infectious Diseases, Roosevelt Hospital, Guatemala City, Guatemala
| | - Philip A. Chan
- Division of Infectious Diseases, Brown University, Providence, Rhode Island, United States of America
| | - Amy C. Nunn
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
| | - William Powderly
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Katherine Goodenberger
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Jingxia Liu
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Kenneth H. Mayer
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Harvard Medical School, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Rupa R. Patel
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States of America
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Moreno S, Antela A, García F, Del Amo J, Boix V, Coll P, Fortuny C, Sirvent JLG, Gutiérrez F, Iribarren JA, Llibre JM, Quirós JCLBD, Losa JE, Lozano A, Meulbroek M, Olalla J, Pujol F, Pulido F, Crespo Casal M, García JG, Aldeguer JL, Molina JAP, Podzamczer Palter D, Román AR. Executive summary: Pre-exposure prophylaxis for prevention of HIV infection in adults in Spain: July 2016. Enferm Infecc Microbiol Clin 2017; 35:377-383. [PMID: 28236498 DOI: 10.1016/j.eimc.2016.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 11/09/2016] [Accepted: 11/25/2016] [Indexed: 11/30/2022]
Abstract
Administration of antiretroviral drugs to individuals exposed to, but not infected by, HIV has been shown to reduce the risk of transmission. The efficacy of pre-exposure prophylaxis (PrEP) makes it obligatory to include it in an integral program of prevention of HIV transmission, together with other measures, such as use of the condom, training, counseling, and appropriate treatment of infected individuals. In this document, the AIDS Study Group (GeSIDA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica [SEIMC]) provides its views on this important subject. The available evidence on the usefulness of PrEP in the prevention of transmission of HIV is presented, and the components that should make up a PrEP program and whose development and implementation are feasible in Spain are set out.
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Affiliation(s)
| | - Antonio Antela
- Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Felipe García
- Hospital Clínic, Hospital Universitario Ramón y Cajal, IRYCIS , Barcelona, Spain
| | | | | | - Pep Coll
- IrsiCaixa, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | | | | | | | - Josep M Llibre
- Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | | | - Ana Lozano
- Hospital de Poniente, El Ejido, Almería, Spain
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Marrazzo JM. HIV Prevention: Opportunities and Challenges. TOPICS IN ANTIVIRAL MEDICINE 2017; 24:123-126. [PMID: 28208119 PMCID: PMC5677047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Preexposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF)-based regimens has been shown to be effective in preventing acquisition of HIV infection, with protective efficacy being dependent on adherence to treatment. Data from the PROUD (Preexposure Option for Reducing HIV in the UK) and IPERGAY (Action to Prevent Risk Exposure By and For Gay Men) studies, the later of which employed event-driven PrEP, showed a high rate of protective efficacy of PrEP with TDF and emtricitabine among men who have sex with men. Data from the ASPIRE (A Study to Prevent Infection With a Ring for Extended Use) study of a dapivirine vaginal ring showed a moderate rate of protective efficacy among women older than 21 years. Ongoing investigations are examining long-acting PrEP modalities and combination PrEP and contraception products. This article summarizes a presentation by Jeanne M. Marrazzo, MD, MPH, at the IAS-USA continuing education program, Improving the Management of HIV Disease, held in Washington, DC, in April 2016.
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Abstract
The advent of combination antiretroviral therapy (ART) has significantly decreased AIDS-related morbidity and mortality. Nevertheless, the benefits of ART are only realized through adherence to lifelong treatment. Though contemporary antiretroviral (ARV) drugs have fewer adverse effects in comparison to older ARV drugs, many agents are associated with negative or unknown long-term effects. There is increasing evidence that two-drug (dual-therapy) regimens may be an effective alternative to the currently recommended three-drug (triple-therapy) regimens. In this review, we provide a comprehensive and critical review of recently completed and ongoing trials of dual-therapy regimens in treatment-naïve and treatment-experienced HIV-1-infected patients. We also review current HIV/AIDS society recommendations regarding dual therapy as well as future therapeutic possibilities.
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Affiliation(s)
- Sean G Kelly
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 645 N Michigan Ave, Suite 900, Chicago, IL, 60611, USA
| | - Amesika N Nyaku
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 645 N Michigan Ave, Suite 900, Chicago, IL, 60611, USA
| | - Babafemi O Taiwo
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 645 N Michigan Ave, Suite 900, Chicago, IL, 60611, USA. .,Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Public Health-Seattle & King County and Washington State Department of Health Preexposure Prophylaxis Implementation Guidelines, 2015. Sex Transm Dis 2016; 43:264-5. [PMID: 26967306 DOI: 10.1097/olq.0000000000000427] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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