1
|
Nelson SG, Liu CM. Penile microbiome: decoding its impact on HIV risk. Curr Opin HIV AIDS 2024; 19:241-245. [PMID: 38935058 PMCID: PMC11305963 DOI: 10.1097/coh.0000000000000865] [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: 06/28/2024]
Abstract
PURPOSE OF REVIEW The penile microbiome has been linked to local inflammation and increased risk for sexually transmitted infections, including HIV. This review explores recent studies of this emerging area of HIV research. RECENT FINDINGS The male urogenital tract supports multiple distinct niches, where their associated microbiome are shaped by abiotic (e.g., oxygen, moisture) and biotic (e.g., host immunity) environmental factors and host behaviors, particularly sexual activity. In addition, male circumcision is a significant drivers of male genital microbiome in both children and adults. Recent sexual partner studies provide new insight into the exchange of genital bacteria and concurrent local immune changes that may impact HIV risk. SUMMARY The male genital microbiome is shaped by the local microenvironment and host behaviors including sexual activity. Improving our understanding of the connection between the male genital microbiome, local inflammation, and HIV susceptibility, as well as how pro-inflammatory genital bacteria are transmitted between sexual partners may inform new strategies to prevent HIV transmission.
Collapse
Affiliation(s)
- Sydney G Nelson
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | |
Collapse
|
2
|
Payares-Garcia D, Osei F, Mateu J, Stein A. Multivariate Poisson cokriging: A geostatistical model for health count data. Stat Methods Med Res 2024:9622802241268488. [PMID: 39140295 DOI: 10.1177/09622802241268488] [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: 08/15/2024]
Abstract
Multivariate disease mapping is important for public health research, as it provides insights into spatial patterns of health outcomes. Geostatistical methods that are widely used for mapping spatially correlated health data encounter challenges when dealing with spatial count data. These include heterogeneity, zero-inflated distributions and unreliable estimation, and lead to difficulties when estimating spatial dependence and poor predictions. Variability in population sizes further complicates risk estimation from the counts. This study introduces multivariate Poisson cokriging for predicting and filtering out disease risk. Pairwise correlations between the target variable and multiple ancillary variables are included. By means of a simulation experiment and an application to human immunodeficiency virus incidence and sexually transmitted diseases data in Pennsylvania, we demonstrate accurate disease risk estimation that captures fine-scale variation. This method is compared with ordinary Poisson kriging in prediction and smoothing. Results of the simulation study show a reduction in the mean square prediction error when utilizing auxiliary correlated variables, with mean square prediction error values decreasing by up to 50%. This gain is further evident in the real data analysis, where Poisson cokriging yields a 74% drop in mean square prediction error relative to Poisson kriging, underscoring the value of incorporating secondary information. The findings of this work stress on the potential of Poisson cokriging in disease mapping and surveillance, offering richer risk predictions, better representation of spatial interdependencies, and identification of high-risk and low-risk areas.
Collapse
Affiliation(s)
- David Payares-Garcia
- ITC Faculty Geo-Information Science and Earth Observation, University of Twente, Enschede, the Netherlands
| | - Frank Osei
- Department of Mathematics, University Jaume I, Castellón, Spain
| | - Jorge Mateu
- Department of Mathematics, University Jaume I, Castellón, Spain
| | - Alfred Stein
- ITC Faculty Geo-Information Science and Earth Observation, University of Twente, Enschede, the Netherlands
| |
Collapse
|
3
|
Lindman J, Djalo MA, Biai A, Månsson F, Golparian D, Esbjörnsson J, Jansson M, Medstrand P, Unemo M, Norrgren H. Prevalence of sexually transmitted infections and associated risk factors among female sex workers in Guinea-Bissau. Sex Transm Infect 2024:sextrans-2023-056015. [PMID: 39137971 DOI: 10.1136/sextrans-2023-056015] [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: 10/18/2023] [Accepted: 06/29/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE To estimate the prevalence of the curable sexually transmitted infections (STIs) Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis and Treponema pallidum, to identify associated risk factors and to assess ciprofloxacin resistance in N. gonorrhoeae-positive specimens among female sex workers (FSWs) in Guinea-Bissau. METHODS For this cross-sectional study, FSWs were recruited from October 2014 to May 2019. A questionnaire on STI risk factors was completed by the study participants, and the women were asked to provide a vaginal swab for nucleic acid amplification tests for C. trachomatis, N. gonorrhoeae, M. genitalium, T. vaginalis (Aptima, Hologica), as well as a blood sample for T. pallidum serological testing and discriminatory HIV-testing. The prevalence of STIs was determined, and multivariate logistic regression was used to identify STI risk factors. RESULTS The study included 467 women. The prevalence of current infection with any curable STI was 46.7%, and the most common pathogen was T. vaginalis (26.3%), followed by M. genitalium (21.9%), C. trachomatis (11.8%), N. gonorrhoeae (10.1%) and T. pallidum (2.8%). The proportion of asymptomatic infections among the diagnosed STIs was 61.8%, 61.5%, 55.3%, 55.3% and 52.2% for C. trachomatis, T. pallidum, N. gonorrhoeae, T. vaginalis and M. genitalium, respectively. The prevalence of the gyrA S91F mutation conferring ciprofloxacin resistance in N. gonorrhoeae-positive specimens was 84.0%. Significant risk factors for having a curable STI were age and HIV-1 infection, while use of female condoms was a protective factor. CONCLUSION This study demonstrated that the prevalence of curable STIs was high among FSWs in Guinea-Bissau during the study period, indicating an unmet need for STI services. Moreover, the results indicated that symptomatic treatment might be insufficient, highlighting a need for periodic aetiological testing to facilitate detection of asymptomatic as well as symptomatic STIs to stop ongoing transmission.
Collapse
Affiliation(s)
- Jacob Lindman
- The Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Mamadu Aliu Djalo
- Environmental Action in the Third World (ENDA), Bissau, Guinea-Bissau
| | - Ansu Biai
- The National Public Health Laboratory, Bissau, Guinea-Bissau
| | - Fredrik Månsson
- The Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Daniel Golparian
- WHO Collaborating Centre for Gonorrhea and Other STIs, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden
| | - Joakim Esbjörnsson
- The Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Marianne Jansson
- The Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Patrik Medstrand
- The Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhea and Other STIs, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden
- Institute for Global Health, University College London, London, UK
| | - Hans Norrgren
- The Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| |
Collapse
|
4
|
Allan-Blitz LT, Fifer H, Klausner JD. Managing treatment failure in Neisseria gonorrhoeae infection: current guidelines and future directions. THE LANCET. INFECTIOUS DISEASES 2024; 24:e532-e538. [PMID: 38367636 DOI: 10.1016/s1473-3099(24)00001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 02/19/2024]
Abstract
Due to the continued emergence of resistance to extended-spectrum cephalosporin antibiotics, clinicians are increasingly more likely to encounter cases of Neisseria gonorrhoeae treatment failure. The current international treatment guidelines offer few regimens for cases of N gonorrhoeae infection that do not respond to first-line therapy, and there are many complexities that should be considered with such regimens; these include regional variations in resistance to alternative agents, access to different antibiotics, and penetration of those antibiotics within different tissues. Further, such regimens do not account for the challenges of treating pharyngeal infections; many patients who have not responded to treatment with extended-spectrum cephalosporin antibiotics to date have had pharyngeal involvement. In addition, pharyngeal infections play a pivotal role in the emergence and spread of antimicrobial resistance in N gonorrhoeae and are more difficult to treat than urogenital infections because of the unfavourable pharmacokinetics of cephalosporins in pharyngeal tissues. Here, we summarise the current guidelines, provide additional approaches and considerations for clinicians, and highlight knowledge gaps that should be addressed to ensure appropriate therapy in cases of treatment failure.
Collapse
Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Helen Fifer
- Blood Safety, Hepatitis, STI & HIV Division, UK Health Security Agency, London, UK
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
5
|
de Sousa D, Garrido P, Nunes D, Lemos C, Borges-Costa J. Ten Years of HIV Diagnosis in a Dermatology and Venereology Department: A Retrospective Study on Demographic, Clinical, and Laboratory Characteristics. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:592-595. [PMID: 38311223 DOI: 10.1016/j.ad.2023.09.024] [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: 06/13/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 02/10/2024] Open
Abstract
Human immunodeficiency virus (HIV) transmission remains an important health issue, with a high burden that is felt across the world. This work aims to analyze the demographic, clinical, and laboratory characteristics of newly diagnosed patients with HIV in a Department of Dermatology and Venereology. A retrospective observational study was conducted from all health records of newly diagnosed patients with HIV from a Dermatology unit from January 2011 to December 2020. A total of 134 patients with new HIV diagnoses were included in the analysis. Concurrent dermatological or venereal diseases were diagnosed in 91.0% of the patients (n=122), being the most common conditions syphilis (22.4%, n=30) and urethritis (14.9%, n=20). Out of all the patients with diagnoses of concurrent sexually transmitted infection (STI) (41.0%, n=55), syphilis was reported in 81.8% of the patients (n=45), gonorrhea in 9.1% (n=5), and chlamydia in 5.5% (n=3). We present a large patient database on the clinical conditions associated with newly diagnosed HIV, concluding that infectious diseases were the most common conditions associated with newly diagnosed HIV.
Collapse
Affiliation(s)
- D de Sousa
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
| | - P Garrido
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - D Nunes
- Clinical Pathology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - C Lemos
- Clinical Pathology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - J Borges-Costa
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Dermatology Universitary Clinic, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal; Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
6
|
de Sousa D, Garrido P, Nunes D, Lemos C, Borges-Costa J. Ten Years of HIV Diagnosis in a Dermatology and Venereology Department: A Retrospective Study on Demographic, Clinical, and Laboratory Characteristics. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T592-T595. [PMID: 38648929 DOI: 10.1016/j.ad.2024.04.016] [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: 06/13/2023] [Accepted: 09/19/2023] [Indexed: 04/25/2024] Open
Abstract
Human immunodeficiency virus (HIV) transmission remains an important health issue, with a high burden that is felt across the world. This work aims to analyze the demographic, clinical, and laboratory characteristics of newly diagnosed patients with HIV in a Department of Dermatology and Venereology. A retrospective observational study was conducted from all health records of newly diagnosed patients with HIV from a Dermatology unit from January 2011 to December 2020. A total of 134 patients with new HIV diagnoses were included in the analysis. Concurrent dermatological or venereal diseases were diagnosed in 91.0% of the patients (n=122), being the most common conditions syphilis (22.4%, n=30) and urethritis (14.9%, n=20). Out of all the patients with diagnoses of concurrent sexually transmitted infection (STI) (41.0%, n=55), syphilis was reported in 81.8% of the patients (n=45), gonorrhea in 9.1% (n=5), and chlamydia in 5.5% (n=3). We present a large patient database on the clinical conditions associated with newly diagnosed HIV, concluding that infectious diseases were the most common conditions associated with newly diagnosed HIV.
Collapse
Affiliation(s)
- D de Sousa
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
| | - P Garrido
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - D Nunes
- Clinical Pathology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - C Lemos
- Clinical Pathology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - J Borges-Costa
- Dermatology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Dermatology Universitary Clinic, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal; Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
7
|
Ramboarina S, Crucitti T, Gill K, Bekker LG, Harding-Esch EM, van de Wijgert JHHM, Huynh BT, Fortas C, Harimanana A, Mayouya Gamana T, Randremanana RV, Mangahasimbola R, Dziva Chikwari C, Kranzer K, Mackworth-Young CRS, Bernays S, Thomas N, Anderson D, Tanko FR, Manhanzva M, Lurie M, Khumalo F, Sinanovic E, Honda A, Pidwell T, Francis SC, Masson L, Passmore JA. Novel point-of-care cytokine biomarker lateral flow test for the screening for sexually transmitted infections and bacterial vaginosis: study protocol of a multicentre multidisciplinary prospective observational clinical study to evaluate the performance and feasibility of the Genital InFlammation Test (GIFT). BMJ Open 2024; 14:e084918. [PMID: 38692732 PMCID: PMC11086546 DOI: 10.1136/bmjopen-2024-084918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/03/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION A prototype lateral flow device detecting cytokine biomarkers interleukin (IL)-1α and IL-1β has been developed as a point-of-care test-called the Genital InFlammation Test (GIFT)-for detecting genital inflammation associated with sexually transmitted infections (STIs) and/or bacterial vaginosis (BV) in women. In this paper, we describe the rationale and design for studies that will be conducted in South Africa, Zimbabwe and Madagascar to evaluate the performance of GIFT and how it could be integrated into routine care. METHODS AND ANALYSIS We will conduct a prospective, multidisciplinary, multicentre, cross-sectional and observational clinical study comprising two distinct components: a biomedical ('diagnostic study') and a qualitative, modelling and economic ('an integration into care study') part. The diagnostic study aims to evaluate GIFT's performance in identifying asymptomatic women with discharge-causing STIs (Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Mycoplasma genitalium (MG)) and BV. Study participants will be recruited from women attending research sites and family planning services. Several vaginal swabs will be collected for the evaluation of cytokine concentrations (ELISA), STIs (nucleic acid amplification tests), BV (Nugent score) and vaginal microbiome characteristics (16S rRNA gene sequencing). The first collected vaginal swab will be used for the GIFT assay which will be performed in parallel by a healthcare worker in the clinic near the participant, and by a technician in the laboratory. The integration into care study aims to explore how GIFT could be integrated into routine care. Four activities will be conducted: user experiences and/or perceptions of the GIFT device involving qualitative focus group discussions and in-depth interviews with key stakeholders; discrete choice experiments; development of a decision tree classification algorithm; and economic evaluation of defined management algorithms. ETHICS AND DISSEMINATION Findings will be reported to participants, collaborators and local government for the three sites, presented at national and international conferences, and disseminated in peer-reviewed publications.The protocol and all study documents such as informed consent forms were reviewed and approved by the University of Cape Town Human Research Ethics Committee (HREC reference 366/2022), Medical Research Council of Zimbabwe (MRCZ/A/2966), Comité d'Ethique pour la Recherche Biomédicale de Madagascar (N° 143 MNSAP/SG/AMM/CERBM) and the London School of Hygiene and Tropical Medicine ethics committee (LSHTM reference 28046).Before the start, this study was submitted to the Clinicaltrials.gov public registry (NCT05723484). TRIAL REGISTRATION NUMBER NCT05723484.
Collapse
Affiliation(s)
| | | | - Katherine Gill
- Desmond Tutu HIV Centre, University of Cape Town, South Africa
| | | | | | | | - Bich-Tram Huynh
- Institut Pasteur, Université Paris Cité, France
- Université Paris-Saclay, Université Versailles Saint-Quentin, Inserm, France
| | - Camille Fortas
- Institut Pasteur, Université Paris Cité, France
- Université Paris-Saclay, Université Versailles Saint-Quentin, Inserm, France
| | | | | | | | | | - Chido Dziva Chikwari
- London School of Hygiene & Tropical Medicine, England
- Organization for Public Health Interventions and Development, Zimbabwe
- The Biomedical Research and Training Institute, Zimbabwe
| | - Katharina Kranzer
- London School of Hygiene & Tropical Medicine, England
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
| | | | - Sarah Bernays
- London School of Hygiene & Tropical Medicine, England
- School of Public Health, University of Sydney, New South Wales, Australia
| | - Nicola Thomas
- Desmond Tutu HIV Centre, University of Cape Town, South Africa
| | - David Anderson
- Disease Elimination Program, Life Sciences Discipline,Burnet Institute, Melbourne, Australia
| | - Fatime Ramla Tanko
- Division of Medical Virology, Department of Pathology, University of Cape Town, South Africa
- The Medical Research Centre, Institute of Medical Research and Medicinal Plant Studies (IMPM), Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, South Africa
- Centre for the AIDS Programme of Research in South Africa, South Africa
| | - Monalisa Manhanzva
- Division of Medical Virology, Department of Pathology, University of Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, South Africa
- Centre for the AIDS Programme of Research in South Africa, South Africa
| | - Micaela Lurie
- Division of Medical Virology, Department of Pathology, University of Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, South Africa
- Centre for the AIDS Programme of Research in South Africa, South Africa
| | - Fezile Khumalo
- Division of Medical Virology, Department of Pathology, University of Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, South Africa
- Centre for the AIDS Programme of Research in South Africa, South Africa
| | - Edina Sinanovic
- Health Economics Unit, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Ayako Honda
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Japan
| | - Tanya Pidwell
- Division of Medical Virology, Department of Pathology, University of Cape Town, South Africa
| | | | - Lindi Masson
- Disease Elimination Program, Life Sciences Discipline,Burnet Institute, Melbourne, Australia
- Division of Medical Virology, Department of Pathology, University of Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, South Africa
- Central Clinical School, Monash University, Victoria, Australia
- National Health Laboratory Service, Cape Town, South Africa
| | - Jo-Anne Passmore
- Division of Medical Virology, Department of Pathology, University of Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, South Africa
- Centre for the AIDS Programme of Research in South Africa, South Africa
- National Health Laboratory Service, Cape Town, South Africa
| |
Collapse
|
8
|
Kogler A, Sadoghi B, Draschl A, Chromy D, Binder L, Schiefer-Niederkorn A, Hofmann-Wellenhof EL, Wolf P. Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium at pharyngeal and anorectal sites in patients presenting to an STI outpatient ward. J Eur Acad Dermatol Venereol 2024. [PMID: 38606611 DOI: 10.1111/jdv.20029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/28/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND The incidence of sexually transmitted infections (STIs) is unbridled and on the rise. Extragenital STIs (anal and pharyngeal infections) are commonly asymptomatic, resulting in delayed diagnosis and treatment and consequently higher chances of onward transmission. OBJECTIVE The aim of this observational single-centre study was to determine the prevalence of STIs at extragenital sites in symptomatic and asymptomatic patients presenting at an STI outpatient clinic. METHODS We conducted a retrospective analysis of patients who presented between October 2019 and February 2021 at the STI outpatient clinic of a tertiary centre in Central Europe. Patients were included in the study if they received at least one pharyngeal and/or anorectal swab in addition to a genital swab for multiplex-PCR STI diagnostics. Demographic data, symptoms and serological results were collected and analysed. RESULTS Data collected from 440 patients were analysed (mean age: 33.9 years, male: n = 345, 78.4%, female: n = 95, 21.6%). Ninety-seven males reported having sex with men (MSM); 174 patients identified as heterosexual (132 males, 42 females), and 10 females as bisexual. The sexual orientation was not reported in 159 cases. An STI was confirmed in 195 patients (44.3%) and, among those, 109 patients (55.9%) tested positive for an STI at extragenital sites. Seventy-one patients had a pharyngeal STI whereas 61 were infected in the anorectal region. Of those suffering from an extragenital STI, 64.2% (70 out of 109) tested negative for relevant pathogens at genital sites. The most frequently detected extragenital pathogen was Neisseria gonorrhoeae (71.8% of all pharyngeal STIs [51 out of 71], 55.7% of anorectal STIs [34 out of 61]), followed by Chlamydia trachomatis (41.0% of all anal infections [25 out of 61], 5.6% of pharyngeal infections [4 out of 71]). Pharyngeal and anorectal infections were asymptomatic in 88.7% [63 out of 71] and 65.6% [40 out of 61] of the cases, respectively. CONCLUSION These results underline the need to perform multisite testing, regardless of the presence of symptoms.
Collapse
Affiliation(s)
- A Kogler
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - B Sadoghi
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - A Draschl
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - D Chromy
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - L Binder
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - A Schiefer-Niederkorn
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - E L Hofmann-Wellenhof
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - P Wolf
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| |
Collapse
|
9
|
Liang B, Zhang F, Ou Y, Zhang P, Bao L, Mo S, Nong A, Wei D, Wu Z, Xie H, Yang Y, Liu D, Liang H, Ye L. Prevalence, Trends and Correlates of HIV, Syphilis and HCV Infection Among Chinese Local and Cross-border Migrant Female Sex Workers in the Sino-Vietnam Border Area of Guangxi, 2016-2021. AIDS Behav 2024; 28:1257-1269. [PMID: 37566152 DOI: 10.1007/s10461-023-04153-6] [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] [Accepted: 07/26/2023] [Indexed: 08/12/2023]
Abstract
Female sex workers (FSWs) are considered a high-risk group for sexually transmitted infections (STIs). However, limited data exist on the prevalence and trends of HIV, syphilis and HCV among FSWs in the Sino-Vietnam border area. To determine the prevalence, trends and correlates of STIs among Chinese local FSWs (CL-FSWs) and cross-border migrant FSWs (CM-FSWs), we conducted consecutive cross-sectional surveys from 2016 to 2021, recruiting 7747 CL-FSWs and 932 CM-FSWs. The overall HIV, syphilis and HCV prevalence declined from 1.0%, 8.8% and 1.7% to 0.1%, 0.9% and 0.3%, respectively. There was no significant downward trend in the overall HIV and syphilis prevalence. However, HCV prevalence showed a decreasing trend among CL-FSWs. CM-FSWs had higher HIV prevalence (2.5% vs. 0.6%). Similarities and differences in STIs-related factors existed between CM-FSWs and CL-FSWs. For instance, receiving HIV-related services in the last year reduced the risk of HIV infection (for CM-FSWs: aOR = 0.234, 95% CI: 0.055-0.993; for CL-FSWs: aOR = 0.182, 95% CI: 0.058-0.567). Serving male clients at least 50 years old increased the risk of syphilis infection (for CM-FSWs: aOR = 4.277, 95% CI: 1.535-11.917; for CL-FSWs: aOR = 1.404, 95% CI: 1.087-1.815). Moreover, CM-FSWs with past-year STIs history had a higher risk of HIV (aOR = 34.976, 95% CI: 5.338-229.176) and HCV infection (aOR = 17.649, 95% CI: 1.846-168.846), both of which were associated with multiple factors in CL-FSWs. It is therefore necessary to develop effective, accessible, high-quality and targeted interventions for CM-FSWs and CL-FSWs.
Collapse
Affiliation(s)
- Bingyu Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Collaborative Innovation Center of Regenerative Medicine and Medical Bioresource Development and Application Co-constructed by the Province and Ministry, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Fei Zhang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Collaborative Innovation Center of Regenerative Medicine and Medical Bioresource Development and Application Co-constructed by the Province and Ministry, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Yanyun Ou
- Chongzuo Center for Disease Control and Prevention, Chongzuo, Guangxi, 532200, China
| | - Peidong Zhang
- Fangchenggang Center for Disease Control and Prevention, Fangchenggang, Guangxi, 538000, China
| | - Lijuan Bao
- Chongzuo Center for Disease Control and Prevention, Chongzuo, Guangxi, 532200, China
| | - Shide Mo
- Fangchenggang Center for Disease Control and Prevention, Fangchenggang, Guangxi, 538000, China
| | - Aidan Nong
- Chongzuo Center for Disease Control and Prevention, Chongzuo, Guangxi, 532200, China
| | - Dongmei Wei
- Chongzuo Center for Disease Control and Prevention, Chongzuo, Guangxi, 532200, China
| | - Zhenxian Wu
- Chongzuo Center for Disease Control and Prevention, Chongzuo, Guangxi, 532200, China
| | - Hai Xie
- Fangchenggang Center for Disease Control and Prevention, Fangchenggang, Guangxi, 538000, China
| | - Yuan Yang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China
- Collaborative Innovation Center of Regenerative Medicine and Medical Bioresource Development and Application Co-constructed by the Province and Ministry, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Deping Liu
- Chongzuo Center for Disease Control and Prevention, Chongzuo, Guangxi, 532200, China.
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China.
- Collaborative Innovation Center of Regenerative Medicine and Medical Bioresource Development and Application Co-constructed by the Province and Ministry, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, 530021, China.
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, Guangxi, 530021, China.
- Collaborative Innovation Center of Regenerative Medicine and Medical Bioresource Development and Application Co-constructed by the Province and Ministry, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, 530021, China.
| |
Collapse
|
10
|
Tesfai Y, Lucea MB, Chan E, Asuquo T, Zhu H, Gaines TL, Campbell JC, Stockman JK, Tsuyuki K. Cumulative Lifetime Violence and Bacterial Vaginosis Infection in Sexually Transmitted Infections: Findings From a Retrospective Cohort Study Among Black Women at Risk for HIV. AJPM FOCUS 2024; 3:100180. [PMID: 38445027 PMCID: PMC10912451 DOI: 10.1016/j.focus.2023.100180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Introduction Bacterial vaginosis is the most common vaginal condition among women of reproductive age and has been associated with sexually transmitted infections. This study examines the association between cumulative lifetime violence exposure, bacterial vaginosis, and sexually transmitted infections among Black women at risk for HIV. Methods HIV-negative Black women in a retrospective cohort study (N=230) completed survey questions on cumulative violence (exposure to sexual or physical abuse before age 18 years and exposure to intimate partner violence or sexual violence [partner or other] after age 18 years and past year), bacterial vaginosis (lifetime and past year), and sexually transmitted infection diagnosis (lifetime and past year). Logistic regression models estimated the associations between cumulative violence, bacterial vaginosis, and sexually transmitted infections. Bacterial vaginosis was examined as a moderator in the association between cumulative violence and sexually transmitted infections. Results Many women reported cumulative violence exposure (40%), lifetime bacterial vaginosis diagnosis (53%), and lifetime sexually transmitted infection diagnosis (73%). Cumulative violence experience was significantly associated with increased adjusted odds of lifetime bacterial vaginosis diagnosis (AOR=1.98; 95% CI=1.10, 3.54). Lifetime bacterial vaginosis diagnosis (AOR=2.76; 95% CI=1.45, 5.22) and past-year bacterial vaginosis diagnosis (AOR=2.16; 95% CI=1.14, 4.10) were significantly associated with increased odds of lifetime sexually transmitted infection diagnosis. Lifetime bacterial vaginosis diagnosis (AOR=2.10; 95% CI=1.19, 3.70) and past-year bacterial vaginosis diagnosis (AOR=3.00; 95% CI=1.70, 5.31) were significantly associated with past-year sexually transmitted infection diagnosis. Lifetime bacterial vaginosis infection significantly increased the odds of lifetime sexually transmitted infection diagnosis with increasing cumulative violence exposure. Conclusions Our findings support educating and screening Black women who experience cumulative violence for bacterial vaginosis to reduce the risk of untreated bacterial vaginosis and sexually transmitted infections.
Collapse
Affiliation(s)
- Yordanos Tesfai
- Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Marguerite B. Lucea
- Department of Nursing, College of Health Professions, Towson University, Towson, Maryland
| | - Erica Chan
- Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Theresa Asuquo
- Program in Medical Education - Health Equity (PRIME-HEQ), Department of Medicine, University of California, San Diego, La Jolla, California
| | - Helen Zhu
- Division of Infectious Diseases & Global Public Health, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California
| | - Tommi L. Gaines
- Division of Infectious Diseases & Global Public Health, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California
| | | | - Jamila K. Stockman
- Division of Infectious Diseases & Global Public Health, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California
| | - Kiyomi Tsuyuki
- Division of Infectious Diseases & Global Public Health, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California
| |
Collapse
|
11
|
Lamberti O, Bozzani F, Kiyoshi K, Bustinduy AL. Time to bring female genital schistosomiasis out of neglect. Br Med Bull 2024; 149:45-59. [PMID: 38220571 PMCID: PMC10938538 DOI: 10.1093/bmb/ldad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/08/2023] [Accepted: 12/09/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Female genital schistosomiasis (FGS) is a chronic gynaecological disease affecting girls and women in sub-Saharan Africa (SSA), caused by the parasite Schistosoma (S.) haematobium. FGS is associated with sexual dysfunction, reproductive tract morbidity and increased prevalence of HIV and cervical precancer lesions. SOURCE OF DATA Key peer-reviewed published literature. AREAS OF AGREEMENT FGS screening and diagnosis require costly equipment and specialized training, seldom available in resource-limited settings. FGS surveillance is not included in wider schistosomiasis control strategies. The interplay of FGS with other SRH infections is not fully understood. Integration of FGS within sexual and reproductive health (SRH) control programmes needs to be explored. AREAS OF CONTROVERSY There are no standardized methods for individual or population-based FGS screening and diagnosis, hindering accurate disease burden estimates and targeted resource allocation. Treatment recommendations rely on public health guidelines, without rigorous clinical evidence on efficacy. GROWING POINTS Integrating FGS screening with SRH programmes offers an opportunity to reach at-risk women with limited access to healthcare services. Home-based self-sampling coupled with handheld colposcopes operated by primary healthcare workers show promise for FGS diagnosis and surveillance at scale. AREAS TIMELY FOR DEVELOPING RESEARCH There is growing interest in decentralizing strategies for FGS screening and diagnosis. The accurate predictions on the 'cost-effectiveness' of these approaches will determine their affordability and feasibility within the overburdened health systems in SSA. Clinical trials are needed to optimize FGS treatment. Longitudinal studies can expand on the epidemiological knowledge on co-morbidities and integration within other SRH interventions.
Collapse
Affiliation(s)
- Olimpia Lamberti
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Fiammetta Bozzani
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Kita Kiyoshi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
12
|
Allan-Blitz LT, Sanders G, Shah P, Adams G, Jarolimova J, Ard K, Branda JA, Klausner JD, Sabeti PC, Lemieux JE. Clinical Performance of Cas13a-based Point-of-Care Lateral Flow Assay for Detecting Neisseria gonorrhoeae. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.01.24303603. [PMID: 38496586 PMCID: PMC10942539 DOI: 10.1101/2024.03.01.24303603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Background Diagnosis of Neisseria (N.) gonorrhoeae is dependent on nucleic acid amplification testing (NAAT), which is not available in resource-limited settings where the prevalence of infection is highest. Recent advances in molecular diagnostics leveraging the high specificity of CRISPR enzymes can permit field-deployable, point-of-care lateral flow assays. We previously reported on the development and in vitro performance of a lateral flow assay for detecting N. gonorrhoeae. Here we aimed to pair that assay with point-of-care DNA extraction techniques and assess the performance on clinical urine specimens. Methods We collected an additional urine specimen among individuals enrolling in an ongoing clinical trial at the Massachusetts General Hospital Sexual Health Clinic who presented with symptoms of urethritis or cervicitis (urethral or vaginal discharge, dysuria, or dyspareunia). We then assessed thermal, detergent, and combination DNA extraction conditions, varying the duration of heat at 95°C and concentration of Triton X. We assessed the efficacy of the various DNA extraction methods by quantitative polymerase chain reaction (qPCR). Once an extraction method was selected, we incubated samples for 90 minutes to permit isothermal recombinase polymerase amplification. We then assessed the performance of lateral flow Cas13a-based detection using our previously designed porA probe and primer system for N. gonorrhoeae detection, comparing lateral flow results with NAAT results from clinical care. Results We assessed DNA extraction conditions on 3 clinical urine specimens. There was no consistent significant difference in copies per microliter of DNA obtained using more or less heat. On average, we noted that 0.02% triton combined with 5 minutes of heating to 95°C resulted in the highest DNA yield, however, 0.02% triton alone resulted in a quantity of DNA that was above the previously determined analytic sensitivity of the assay. Given that detergent-based extraction is more easily deployable, we selected that as our method for extraction. We treated 23 clinical specimens with 0.02% triton, which we added to the Cas13a detection system. We ran all lateral flow detections in duplicate. The Cas13a-based assay detected 8 of 8 (100%) positive specimens, and 0 of 15 negative specimens. Conclusion Using point-of-care DNA extraction, isothermal amplification, and Cas13a-based detection, our point-of-care lateral flow N. gonorrhoeae assay correctly identified 23 clinical urine specimens as either positive or negative. Further evaluation of this assay among larger samples and more diverse sample types is warranted.
Collapse
Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Global Health Equity: Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Gabriela Sanders
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Palak Shah
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Gordon Adams
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jana Jarolimova
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Kevin Ard
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - John A. Branda
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Jeffrey D. Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Pardis C. Sabeti
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
| | - Jacob E. Lemieux
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
13
|
Scott K, Faryar KA, Patil N, Gripshover B, Hammond C, Purohit M, Schmotzer C, Suleman-Civis L, Niforatos J, Avery A, Yax J. Evaluation of an emergency department opt-out provider-driven HIV and syphilis screening and linkage-to-care program. Am J Emerg Med 2024; 77:187-193. [PMID: 38163414 DOI: 10.1016/j.ajem.2023.12.029] [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: 07/28/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE While the effectiveness of emergency departments (ED) in screening for HIV and syphilis is understood, less is known about dual screening programs. We aim to evaluate the impact of an opt-out provider-initiated HIV and syphilis program on screening, diagnosis, and linkage to care outcomes. METHODS We performed a retrospective review of patients screened pre (2014-2017) and post (2017-2021) program implementation. Primary outcomes include HIV and syphilis screening, incidence of positive tests, and proportion of patients linked to care. Secondary outcomes included pre-exposure prophylaxis (PrEP) referral and successful linkage rates for HIV-negative syphilis-positive patients. RESULTS Pre-implementation, 882 HIV tests were performed, of which 22 (2.49%) were new cases and 18 (81.82%) were linked to care; 754 syphilis tests were performed, of which 33 (4.38%) were active infections and 30 (90.91%) were treated. No eligible patients received PrEP referral. Post-implementation, 12,999 HIV tests were performed, of which 73 (0.56%) were new cases and 55 (75.34%) were linked to care; 10,885 syphilis tests were performed, of which 216 (1.98%) were active infections and 188 (87.04%) were treated. 25 (9.09%) eligible patients were referred for PrEP, and four (16.0%) attended their appointment. CONCLUSIONS Post-implementation, there was a 1373.81% and 1343.63% increase in screening, and a 231.82% and 554.55% increase in positive cases of HIV and syphilis, respectively. Dual screening programs can be successfully implemented within the existing ED framework to increase screening and early detection for HIV and syphilis.
Collapse
Affiliation(s)
- Kristal Scott
- Department of Emergency Medicine, University Hospitals, Cleveland, OH, USA.
| | - Kiran A Faryar
- Department of Emergency Medicine, University Hospitals, Cleveland, OH, USA
| | - Nirav Patil
- Clinical Research Center, University Hospitals, Cleveland, OH, USA
| | - Barbara Gripshover
- Department of Infectious Disease, University Hospitals, Cleveland, OH, USA
| | | | - Maulik Purohit
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Christine Schmotzer
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Joshua Niforatos
- Department of Emergency Medicine, University Hospitals, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ann Avery
- MetroHealth Medical Center, Cleveland, OH, USA
| | - Justin Yax
- Department of Emergency Medicine, University Hospitals, Cleveland, OH, USA
| |
Collapse
|
14
|
Lehnert T, Gijs MAM. Microfluidic systems for infectious disease diagnostics. LAB ON A CHIP 2024; 24:1441-1493. [PMID: 38372324 DOI: 10.1039/d4lc00117f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Microorganisms, encompassing both uni- and multicellular entities, exhibit remarkable diversity as omnipresent life forms in nature. They play a pivotal role by supplying essential components for sustaining biological processes across diverse ecosystems, including higher host organisms. The complex interactions within the human gut microbiota are crucial for metabolic functions, immune responses, and biochemical signalling, particularly through the gut-brain axis. Viruses also play important roles in biological processes, for example by increasing genetic diversity through horizontal gene transfer when replicating inside living cells. On the other hand, infection of the human body by microbiological agents may lead to severe physiological disorders and diseases. Infectious diseases pose a significant burden on global healthcare systems, characterized by substantial variations in the epidemiological landscape. Fast spreading antibiotic resistance or uncontrolled outbreaks of communicable diseases are major challenges at present. Furthermore, delivering field-proven point-of-care diagnostic tools to the most severely affected populations in low-resource settings is particularly important and challenging. New paradigms and technological approaches enabling rapid and informed disease management need to be implemented. In this respect, infectious disease diagnostics taking advantage of microfluidic systems combined with integrated biosensor-based pathogen detection offers a host of innovative and promising solutions. In this review, we aim to outline recent activities and progress in the development of microfluidic diagnostic tools. Our literature research mainly covers the last 5 years. We will follow a classification scheme based on the human body systems primarily involved at the clinical level or on specific pathogen transmission modes. Important diseases, such as tuberculosis and malaria, will be addressed more extensively.
Collapse
Affiliation(s)
- Thomas Lehnert
- Laboratory of Microsystems, École Polytechnique Fédérale de Lausanne, Lausanne, CH-1015, Switzerland.
| | - Martin A M Gijs
- Laboratory of Microsystems, École Polytechnique Fédérale de Lausanne, Lausanne, CH-1015, Switzerland.
| |
Collapse
|
15
|
de Voux A, Nyemba DC, Silliman M, Mashele N, Mvududu R, Myer L, Joseph Davey D. Point-of-care testing for sexually transmitted infections and HIV pre-exposure prophylaxis among pregnant women in South Africa, 2021-2022: randomised controlled trial. Sex Transm Infect 2024; 100:77-83. [PMID: 38124133 PMCID: PMC11106734 DOI: 10.1136/sextrans-2023-055975] [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] [Received: 08/31/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Pregnant and postpartum women (PPW) in Southern Africa are at increased risk of acquiring HIV and curable sexually transmitted infections (STIs). Oral pre-exposure prophylaxis (PrEP) is safe and effective to use during pregnancy to reduce HIV acquisition and vertical transmission. Point-of-care (POC) STI testing can identify PPW at risk of HIV and facilitate risk-differentiated and person-centred counselling to improve PrEP initiation, persistence and adherence. We evaluated the impact of POC STI testing compared with STI syndromic management on PrEP outcomes among PPW in Cape Town, South Africa. METHODS The STI and PrEP in Pregnancy Study enrolled PPW without HIV and ≤34 weeks pregnant at their regular antenatal care visit with follow-up after 1 month. PPW were randomised to receive POC STI testing or STI syndromic management. PPW randomised to POC STI testing self-collected vaginal swabs for Chlamydia trachomatis, Neisseria gonorhoeae and Trichomonas vaginalis (Cepheid GeneXpert) testing and were offered same-day treatment if diagnosed. We compared PrEP initiation at baseline, PrEP prescription refill at 1 month (persistence) and adherence through tenofovir-diphosphate detection in dried blood spots by randomisation arm. In a secondary analysis, we evaluated the association between an STI diagnosis (positive STI test or reporting STI symptoms) with PrEP outcomes. RESULTS We enrolled and randomised 268 pregnant women. Twenty-eight per cent of women were diagnosed with ≥1 STI. Overall, 65% of women initiated and 79% persisted on PrEP with no significant differences by randomisation arm. Secondary analysis demonstrated that an STI diagnosis (positive STI test or reporting STI symptoms) was associated with higher PrEP initiation (adjusted relative risk=1.28; 95% CI 1.08 to 1.52), controlling for arm, maternal and gestational age. CONCLUSIONS POC STI testing was not associated with PrEP initiation or persistence relative to syndromic management. However, improving STI diagnosis by supplementing syndromic management with POC STI testing could improve PrEP initiation among PPW. TRIAL REGISTRATION NUMBER NCT03902418; Clinical Trials.gov; 1 April 2019.
Collapse
Affiliation(s)
- Alex de Voux
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - Dorothy Chiwoniso Nyemba
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Miriam Silliman
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Nyiko Mashele
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - Rufaro Mvududu
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - Dvora Joseph Davey
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| |
Collapse
|
16
|
Fwambah L, Andisi C, Streatfield C, Bromell R, Hare J, Esbjörnsson J, Ndung’u T, Sanders EJ, Hassan A, Nduati E. Exposure to common infections may shape basal immunity and potentially HIV-1 acquisition amongst a high-risk population in Coastal Kenya. Front Immunol 2024; 14:1283559. [PMID: 38274822 PMCID: PMC10808675 DOI: 10.3389/fimmu.2023.1283559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/12/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction The impact of exposure to endemic infections on basal immunity and susceptibility to HIV-1 acquisition remains uncertain. We hypothesized that exposure to infections such as cytomegalovirus (CMV), malaria and sexually transmitted infections (STIs) in high-risk individuals may modulate immunity and subsequently increase susceptibility to HIV-1 acquisition. Methods A case-control study nested in an HIV-1 negative high-risk cohort from Coastal Kenya was used. Cases were defined as volunteers who tested HIV-1 positive during follow-up and had a plasma sample collected 3 ± 2 months prior to the estimated date of HIV-1 infection. Controls were individuals who remained HIV-1 negative during the follow-up and were matched 2:1 to cases by sex, age, risk group and follow-up time. STI screening was performed using microscopic and serologic tests. HIV-1 pre-infection plasma samples were used to determined exposure to CMV and malaria using enzyme-linked immunosorbent assays and to quantify forty-one cytokines and soluble factors using multiplexing assays. Multiplexing data were analyzed using principal component analysis. Associations between cytokines and soluble factors with subsequent HIV-1 acquisition were determined using conditional logistic regression models. Results and discussion Overall, samples from 47 cases and 94 controls were analyzed. While exposure to malaria (p=0.675) and CMV (p=0.470) were not associated with HIV-1 acquisition, exposure to STIs was (48% [95% CI, 33.3 - 63] vs. 26% [95% CI, 17.3 - 35.9]. Ten analytes were significantly altered in cases compared to controls and were clustered into four principal components: PC1 (VEGF, MIP-1β, VEGF-C and IL-4), PC2 (MCP-1, IL-2 and IL-12p70), PC3 (VEGF-D) and PC4 (Eotaxin-3). PC1, which is suggestive of a Th2-modulatory pathway, was significantly associated with HIV-1 acquisition after controlling for STIs (adjusted odds ratio, (95% CI), p-value: 1.51 [1.14 - 2.00], p=0.004). Elevation of Th2-associated pathways may dampen responses involved in viral immunity, leading to enhanced susceptibility to HIV-1 acquisition. Immunomodulatory interventions aimed at inhibiting activation of Th2-associated pathways may be an additional strategy to STI control for HIV-1 prevention and may reduce dampening of immune responses to vaccination.
Collapse
Affiliation(s)
- Lynn Fwambah
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Biological Sciences, Pwani University, Kilifi, Kenya
| | - Cheryl Andisi
- Department of Biological Sciences, Pwani University, Kilifi, Kenya
| | - Claire Streatfield
- International AIDS Vaccine Initiative (IAVI) Human Immunology Laboratory, Imperial College, London, United Kingdom
| | - Rachel Bromell
- International AIDS Vaccine Initiative (IAVI) Human Immunology Laboratory, Imperial College, London, United Kingdom
| | - Jonathan Hare
- International AIDS Vaccine Initiative (IAVI) Human Immunology Laboratory, Imperial College, London, United Kingdom
- International AIDS Vaccine Initiative (IAVI), New York, NY, United States
| | - Joakim Esbjörnsson
- Department of Translational Medicine, Lund University, Lund, Sweden
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Thumbi Ndung’u
- Africa Health Research Institute (AHRI), Durban, KwaZulu-Natal, South Africa
- Human Immunodeficiency Virus (HIV) Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge, MA, United States
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Eduard J. Sanders
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- The Aurum Institute, HIV Division, Johannesburg, South Africa
| | - Amin S. Hassan
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Eunice Nduati
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Biological Sciences, Pwani University, Kilifi, Kenya
| |
Collapse
|
17
|
Budhwani H, Hao J, Maragh-Bass AC, Hill S, Long DM, Simpson T. Viral load and sexually transmitted infection testing among youth with HIV in a southern United States clinic. Int J STD AIDS 2024; 35:11-17. [PMID: 37678958 DOI: 10.1177/09564624231200917] [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: 09/09/2023]
Abstract
Background: As compared to their older peers, youth with HIV (YWH) are less likely to attain viral suppression and have higher rates of sexually transmitted infections (STI). In this exploratory study, we examine the relationship between HIV viral suppression, STI testing, and STI diagnosis among YWH receiving care at a clinic in the southern United States.Methods: Data from 933 clinical visits (2017-2020) were aggregated into singular patient records for YWH aged 10-24 years in Alabama (N = 139). Analyses included univariate generalized linear mixed models performed with the PROC GLIMMIX procedure approximating the marginal likelihood by using Laplace's method.Results: Sample median age was 22 years at the index visit. Most YWH were 20-24 years old (69.1%), male (67.6%), and identified as Black (77%); 58.3% were virally unsuppressed at index visit. YWH who identified as White or of other races had 4.79 times higher odds of being virally suppressed as compared to Black YWH (p < .01); STI testing behavior and STI positive diagnosis were associated with lower odds of being virally suppression.Conclusions: Findings suggest that among YWH, receiving STI testing and having an STI diagnosis is associated with a lack of viral suppression, suggesting that extra efforts may be necessary to support YWH who have an STI to attain suppression. Research is needed to examine individual behaviors, structural forces, and clinic features that could impact STI care engagement, specifically among unsuppressed YWH.
Collapse
Affiliation(s)
- Henna Budhwani
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Jiaying Hao
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Allysha C Maragh-Bass
- Behavioral, Epidemiological, and Clinical Sciences Division, FHI 360, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Samantha Hill
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dustin M Long
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tina Simpson
- Tulane University, School of Medicine, New Orleans, LA, USA
| |
Collapse
|
18
|
Bichara DM. Characterization of differential susceptibility and differential infectivity epidemic models. J Math Biol 2023; 88:3. [PMID: 38010552 DOI: 10.1007/s00285-023-02023-2] [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: 09/23/2022] [Revised: 05/05/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
Heterogeneity in susceptibility and infectivity is a central issue in epidemiology. Although the latter has received some attention recently, the former is often neglected in modeling of epidemic systems. Moreover, very few studies consider both of these heterogeneities. This paper is concerned with the characterization of epidemic models with differential susceptibility and differential infectivity under a general setup. Specifically, we investigate the global asymptotic behavior of equilibria of these systems when the network configuration of the Susceptible-Infectious interactions is strongly connected. These results prove two conjectures by Bonzi et al. (J Math Biol 62:39-64, 2011) and Hyman and Li (Math Biosci Eng 3:89-100, 2006). Moreover, we consider the scenario in which the strong connectivity hypothesis is dropped. In this case, the model exhibits a wider range of dynamical behavior, including the rise of boundary and interior equilibria, all based on the topology of network connectivity. Finally, a model with multidirectional transitions between infectious classes is presented and completely analyzed.
Collapse
Affiliation(s)
- Derdei M Bichara
- Department of Mathematics, California State University, Fullerton, CA, 92831, USA.
| |
Collapse
|
19
|
Balle C, Happel AU, Heffron R, Jaspan HB. Contraceptive effects on the cervicovaginal microbiome: Recent evidence including randomized trials. Am J Reprod Immunol 2023; 90:e13785. [PMID: 37881121 PMCID: PMC10696626 DOI: 10.1111/aji.13785] [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] [Received: 04/03/2023] [Revised: 07/24/2023] [Accepted: 09/28/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Until recently, most data regarding the effects of non-barrier contraceptives on the mucosal microbiome have derived from observational studies, which are potentially biased due to behavioral confounders that may mask their true biological effects. METHOD OF STUDY This narrative review summarises recent evidence of the effect of contraceptives on the cervicovaginal microbiome, emphasising data obtained through randomized trials. RESULTS Good quality data describe that initiation of long-acting progestin-only contraceptives, including levonorgestrel (LNG)-implant and the injectables depot-medroxyprogesterone acetate (DMPA-IM) and norethisterone enanthate (NET-EN) do not alter the mucosal microbial environment. Likewise, no strong evidence exists that the use of oral contraceptive pills (OCPs) is associated with alterations of the vaginal microbiome or increased risk of bacterial sexually transmitted infections (STIs). Limited data on the effect of intravaginal rings (IVRs) on the mucosal environment exist and show conflicting effects on the vaginal microbiota. Copper intrauterine device (Cu-IUD) initiation has been associated with bacterial vaginosis (BV) acquisition, including in a randomized trial. LNG-IUDs may have similar affects but need to be evaluated further. CONCLUSION Different synthetic hormones have divergent effects on the microbiome and therefore novel hormonal methods need to be rigorously evaluated. Furthermore, the addition of antiretrovirals into multipurpose technologies may alter the effects of the hormonal component. There is thus a critical need to improve our understanding of the biological effects of contraceptive hormones and delivery methods with different pharmacokinetic and chemical properties on the mucosal microbiome in rigorous trials, to inform the development of novel contraceptives and improve individual family planning guidance.
Collapse
Affiliation(s)
- Christina Balle
- Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Anna-Ursula Happel
- Division of Immunology, Department of Pathology, University of Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
| | - Renee Heffron
- University of Washington Department of Global Health, Seattle, WA, USA
| | - Heather B. Jaspan
- Division of Immunology, Department of Pathology, University of Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
- University of Washington Department of Global Health, Seattle, WA, USA
- Seattle Children’s Research Institute, Department of Pediatrics, University of Washington, Seattle, WA, USA
| |
Collapse
|
20
|
Allan-Blitz LT, Shah P, Adams G, Branda JA, Klausner JD, Goldstein R, Sabeti PC, Lemieux JE. Development of Cas13a-based assays for Neisseria gonorrhoeae detection and gyrase A determination. mSphere 2023; 8:e0041623. [PMID: 37732792 PMCID: PMC10597441 DOI: 10.1128/msphere.00416-23] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 09/22/2023] Open
Abstract
Neisseria gonorrhoeae is one of the most common bacterial sexually transmitted infections. The emergence of antimicrobial-resistant N. gonorrhoeae is an urgent public health threat. Currently, the diagnosis of N. gonorrhoeae infection requires expensive laboratory infrastructure, while antimicrobial susceptibility determination requires bacterial culture, both of which are infeasible in low-resource areas where the prevalence of infection is highest. Recent advances in molecular diagnostics, such as specific high-sensitivity enzymatic reporter unlocking (SHERLOCK) using CRISPR-Cas13a and isothermal amplification, have the potential to provide low-cost detection of pathogen and antimicrobial resistance. We designed and optimized RNA guides and primer sets for SHERLOCK assays capable of detecting N. gonorrhoeae via the porA gene and of predicting ciprofloxacin susceptibility via a single mutation in the gyrase A (gyrA) gene. We evaluated their performance using both synthetic DNA and purified N. gonorrhoeae isolates. For porA, we created both a fluorescence-based assay and lateral flow assay using a biotinylated fluorescein reporter. Both methods demonstrated sensitive detection of 14 N. gonorrhoeae isolates and no cross-reactivity with 3 non-gonococcal Neisseria isolates. For gyrA, we created a fluorescence-based assay that correctly distinguished between 20 purified N. gonorrhoeae isolates with phenotypic ciprofloxacin resistance and 3 with phenotypic susceptibility. We confirmed the gyrA genotype predictions from the fluorescence-based assay with DNA sequencing, which showed 100% concordance for the isolates studied. We report the development of Cas13a-based SHERLOCK assays that detect N. gonorrhoeae and differentiate ciprofloxacin-resistant isolates from ciprofloxacin-susceptible isolates. IMPORTANCE Neisseria gonorrhoeae, the cause of gonorrhea, disproportionately affects resource-limited settings. Such areas, however, lack the technical capabilities for diagnosing the infection. The consequences of poor or absent diagnostics include increased disease morbidity, which, for gonorrhea, includes an increased risk for HIV infection, infertility, and neonatal blindness, as well as an overuse of antibiotics that contributes to the emergence of antibiotic resistance. We used a novel CRISPR-based technology to develop a rapid test that does not require laboratory infrastructure for both diagnosing gonorrhea and predicting whether ciprofloxacin can be used in its treatment, a one-time oral pill. With further development, that diagnostic test may be of use in low-resource settings.
Collapse
Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Palak Shah
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gordon Adams
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John A. Branda
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeffrey D. Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Robert Goldstein
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pardis C. Sabeti
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA
| | - Jacob E. Lemieux
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
21
|
Rincón DS, Flórez-Álvarez L, Taborda NA, Hernandez JC, Rugeles MT, Zapata-Builes W. NK cells from Men Who Have Sex with Men at high risk for HIV-1 infection exhibit higher effector capacity. Sci Rep 2023; 13:16766. [PMID: 37798386 PMCID: PMC10556081 DOI: 10.1038/s41598-023-44054-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/03/2023] [Indexed: 10/07/2023] Open
Abstract
Despite being under constant exposure to HIV-1, some individuals do not show serological or clinical evidence of infection and are known as HESN (HIV-Exposed Seronegative). Multiple studies in different HESN cohorts have linked the NK cells as a correlate of resistance; however, little is known about the role of these cells in Men Who Have Sex with Men (MSM) with high risk sexual behaviors. We evaluated a general overview of activation and effector features of NK cells of MSM co-cultured with LT CD4+ HIV+ in which MSM at high risk of HIV-1 infection (HR-MSM) exhibit higher capacity to eliminate infected cells, reduced percentages of CD69+ cells when compared to MSM at low risk of infection (LR-MSM). In addition, we found that, despite the lower levels of CD69+ NK cells on HR-MSM group, within this population, higher percentages of CD69+ IFN-γ+ and CD69+ NKG2D+ NK cells were found together with higher levels of RANTES and Granzyme B production with higher antiviral capacity, resulting in a lower concentration of p24 protein and p24+ CD4+ T cells. Altogether, this information suggests that NK cells of MSM could impact the capacity to face the viral infection.
Collapse
Affiliation(s)
- Daniel S Rincón
- Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia UdeA, Medellín, 050010, Colombia
- Grupo Infettare, Facultad de Medicina, Universidad Cooperativa de Colombia, Medellín, 050016, Colombia
| | - Lizdany Flórez-Álvarez
- Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia UdeA, Medellín, 050010, Colombia
- Grupo Infettare, Facultad de Medicina, Universidad Cooperativa de Colombia, Medellín, 050016, Colombia
| | | | - Juan C Hernandez
- Grupo Infettare, Facultad de Medicina, Universidad Cooperativa de Colombia, Medellín, 050016, Colombia
| | - María T Rugeles
- Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia UdeA, Medellín, 050010, Colombia
| | - Wildeman Zapata-Builes
- Grupo Inmunovirología, Facultad de Medicina, Universidad de Antioquia UdeA, Medellín, 050010, Colombia.
- Grupo Infettare, Facultad de Medicina, Universidad Cooperativa de Colombia, Medellín, 050016, Colombia.
| |
Collapse
|
22
|
Recommendations for reducing the risk of viral transmission during fertility treatment with the use of autologous gametes: a committee opinion. Fertil Steril 2023; 120:794-801. [PMID: 37656091 DOI: 10.1016/j.fertnstert.2023.06.037] [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: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 09/02/2023]
Abstract
Sexually transmitted infections are of major concern to reproductive specialists. Heading the list are human immunodeficiency virus types 1 and 2 and hepatitis B and C viruses. These pathogens, which may cause incurable chronic infections, can be transmitted through assisted reproductive technologies and from infected mothers to the fetus or newborn. This document replaces the document of the same name, last published in 2020.
Collapse
|
23
|
Ghasemian E, Harding-Esch E, Mabey D, Holland MJ. When Bacteria and Viruses Collide: A Tale of Chlamydia trachomatis and Sexually Transmitted Viruses. Viruses 2023; 15:1954. [PMID: 37766360 PMCID: PMC10536055 DOI: 10.3390/v15091954] [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] [Received: 07/28/2023] [Revised: 09/02/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
The global incidence of sexually transmitted infections (STIs) remains high, with the World Health Organization (WHO) estimating that over 1 million people acquire STIs daily. STIs can lead to infertility, pregnancy complications, and cancers. Co-infections with multiple pathogens are prevalent among individuals with an STI and can lead to heightened infectivity and more severe clinical manifestations. Chlamydia trachomatis (CT) is the most reported bacterial STI worldwide in both men and women, and several studies have demonstrated co-infection of CT with viral and other bacterial STIs. CT is a gram-negative bacterium with a unique biphasic developmental cycle including infectious extracellular elementary bodies (EBs) and metabolically active intracellular reticulate bodies (RBs). The intracellular form of this organism, RBs, has evolved mechanisms to persist for long periods within host epithelial cells in a viable but non-cultivable state. The co-infections of CT with the most frequently reported sexually transmitted viruses: human immunodeficiency virus (HIV), human papillomavirus (HPV), and herpes simplex virus (HSV) have been investigated through in vitro and in vivo studies. These research studies have made significant strides in unraveling the intricate interactions between CT, these viral STIs, and their eukaryotic host. In this review, we present an overview of the epidemiology of these co-infections, while specifically delineating the underlying mechanisms by which CT influences the transmission and infection dynamics of HIV and HSV. Furthermore, we explore the intricate relationship between CT and HPV infection, with a particular emphasis on the heightened risk of cervical cancer. By consolidating the current body of knowledge, we provide valuable insights into the complex dynamics and implications of co-infection involving CT and sexually transmitted viruses.
Collapse
Affiliation(s)
- Ehsan Ghasemian
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (E.H.-E.); (D.M.); (M.J.H.)
| | | | | | | |
Collapse
|
24
|
Kovarova M, Wessel SE, Johnson CE, Anderson SV, Cottrell ML, Sykes C, Cohen MS, Garcia JV. EFdA efficiently suppresses HIV replication in the male genital tract and prevents penile HIV acquisition. mBio 2023; 14:e0222422. [PMID: 37306625 PMCID: PMC10470584 DOI: 10.1128/mbio.02224-22] [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] [Received: 12/19/2022] [Accepted: 04/12/2023] [Indexed: 06/13/2023] Open
Abstract
Sexually transmitted HIV infections in heterosexual men are acquired through the penis. Low adherence to condom usage and the fact that 40% of circumcised men are not protected indicate the need for additional prevention strategies. Here, we describe a new approach to evaluate the prevention of penile HIV transmission. We demonstrated that the entire male genital tract (MGT) of bone marrow/liver/thymus (BLT) humanized mice is repopulated with human T and myeloid cells. The majority of the human T cells in the MGT express CD4 and CCR5. Direct penile exposure to HIV leads to systemic infection including all tissues of the MGT. HIV replication throughout the MGT was reduced 100-1,000-fold by treatment with 4'-ethynyl-2-fluoro-2'-deoxyadenosine (EFdA), resulting in the restoration of CD4+ T cell levels. Importantly, systemic preexposure prophylaxis with EFdA effectively protects from penile HIV acquisition. IMPORTANCE Over 84.2 million people have been infected by the human immunodeficiency virus type 1 (HIV-1) during the past 40 years, most through sexual transmission. Men comprise approximately half of the HIV-infected population worldwide. Sexually transmitted HIV infections in exclusively heterosexual men are acquired through the penis. However, direct evaluation of HIV infection throughout the human male genital tract (MGT) is not possible. Here, we developed a new in vivo model that permits, for the first time, the detail analysis of HIV infection. Using BLT humanized mice, we showed that productive HIV infection occurs throughout the entire MGT and induces a dramatic reduction in human CD4 T cells compromising immune responses in this organ. Antiretroviral treatment with novel drug EFdA suppresses HIV replication in all tissues of the MGT, restores normal levels of CD4 T cells and is highly efficient at preventing penile transmission.
Collapse
Affiliation(s)
- Martina Kovarova
- International Center for the Advancement of Translational Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah E. Wessel
- International Center for the Advancement of Translational Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Claire E. Johnson
- International Center for the Advancement of Translational Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shelby V. Anderson
- International Center for the Advancement of Translational Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Craig Sykes
- UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA
| | - Myron S. Cohen
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - J. Victor Garcia
- International Center for the Advancement of Translational Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
25
|
Mofolorunsho KC, Dorsamy V, Bagwandeen C, Abbai NS. Prevalence of gonococcal and chlamydial infections among men who have sex with men in sub-Saharan Africa: protocol for a systematic review and meta-analysis. Syst Rev 2023; 12:141. [PMID: 37580787 PMCID: PMC10424383 DOI: 10.1186/s13643-023-02305-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 08/04/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Bacterial sexually transmitted infections (STIs) including Neisseria gonorrhoeae and Chlamydia trachomatis are common in men who have sex with men (MSM). These infections increase the risk of acquiring and transmitting human immunodeficiency virus (HIV) in this key population. Access to MSM in many countries in sub-Saharan Africa remains generally difficult due to discrimination or criminalization of their sexual orientation which could lead to depression and risky sexual practices associated with prevalence. This protocol therefore proposes to undertake a systematic review and meta-analysis of literature on the prevalence of gonococcal and chlamydial infections among MSM in Sub-Saharan Africa. METHODS This review which aims to ascertain the pooled prevalence and risk factors of these infections in sub-Saharan Africa's MSM population will follow the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. The search strategy will review relevant articles from the following databases: PubMed, Scopus, ISI Web of Science and the Directory of Open Access Journals (DOAJ). Articles screening for eligibility and data extraction will be conducted by two independent reviewers. All discrepancies will be resolved by the third and fourth reviewers. Heterogeneity in studies will be evaluated using the I2 statistic and where heterogeneity is high and significant, a random effect model will be used to estimate the pooled prevalence. Publication bias will be assessed using the Doi plot. Extracted data will be analysed using MetaXL add-on for Microsoft excel. Data will be presented in tables and graphically presented in forest plots. DISCUSSION In this study, we anticipate being able to systematically determine the prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis among MSM as well as explore possible risk factors associated with prevalence. The outcomes of the systematic review and meta-analyses will serve to support researchers and public health stakeholders in identifying healthcare priorities and in addressing issues pertaining to the overall wellbeing of the MSM community. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022327095.
Collapse
Affiliation(s)
- Kehinde Charles Mofolorunsho
- School of Clinical Medicine Laboratory, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
| | - Vinogrin Dorsamy
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Chauntelle Bagwandeen
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Nathlee Samantha Abbai
- School of Clinical Medicine Laboratory, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| |
Collapse
|
26
|
Dauda SE, Collins JA, Byl JAW, Lu Y, Yalowich JC, Mitton-Fry MJ, Osheroff N. Actions of a Novel Bacterial Topoisomerase Inhibitor against Neisseria gonorrhoeae Gyrase and Topoisomerase IV: Enhancement of Double-Stranded DNA Breaks. Int J Mol Sci 2023; 24:12107. [PMID: 37569485 PMCID: PMC10419083 DOI: 10.3390/ijms241512107] [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] [Received: 06/28/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Novel bacterial topoisomerase inhibitors (NBTIs) are an emerging class of antibacterials that target gyrase and topoisomerase IV. A hallmark of NBTIs is their ability to induce gyrase/topoisomerase IV-mediated single-stranded DNA breaks and suppress the generation of double-stranded breaks. However, a previous study reported that some dioxane-linked amide NBTIs induced double-stranded DNA breaks mediated by Staphylococcus aureus gyrase. To further explore the ability of this NBTI subclass to increase double-stranded DNA breaks, we examined the effects of OSUAB-185 on DNA cleavage mediated by Neisseria gonorrhoeae gyrase and topoisomerase IV. OSUAB-185 induced single-stranded and suppressed double-stranded DNA breaks mediated by N. gonorrhoeae gyrase. However, the compound stabilized both single- and double-stranded DNA breaks mediated by topoisomerase IV. The induction of double-stranded breaks does not appear to correlate with the binding of a second OSUAB-185 molecule and extends to fluoroquinolone-resistant N. gonorrhoeae topoisomerase IV, as well as type II enzymes from other bacteria and humans. The double-stranded DNA cleavage activity of OSUAB-185 and other dioxane-linked NBTIs represents a paradigm shift in a hallmark characteristic of NBTIs and suggests that some members of this subclass may have alternative binding motifs in the cleavage complex.
Collapse
Affiliation(s)
- Soziema E. Dauda
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Jessica A. Collins
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Jo Ann W. Byl
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Yanran Lu
- Division of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, The Ohio State University, Columbus, OH 43210, USA
| | - Jack C. Yalowich
- Division of Pharmaceutics and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH 42310, USA
| | - Mark J. Mitton-Fry
- Division of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, The Ohio State University, Columbus, OH 43210, USA
| | - Neil Osheroff
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
- Department of Medicine (Hematology/Oncology), Vanderbilt University School of Medicine, Nashville, TN 37232, USA
- VA Tennessee Valley Healthcare System, Nashville, TN 37212, USA
| |
Collapse
|
27
|
Hendrickson SM, Thomas A, Raué HP, Prongay K, Haertel AJ, Rhoades NS, Slifka JF, Gao L, Quintel BK, Amanna IJ, Messaoudi I, Slifka MK. Campylobacter vaccination reduces diarrheal disease and infant growth stunting among rhesus macaques. Nat Commun 2023; 14:3806. [PMID: 37365162 PMCID: PMC10293212 DOI: 10.1038/s41467-023-39433-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/12/2023] [Indexed: 06/28/2023] Open
Abstract
Campylobacter-associated enteric disease is estimated to be responsible for more than 160 million cases of gastroenteritis each year and is linked to growth stunting of infants living under conditions of poor sanitation and hygiene. Here, we examine naturally occurring Campylobacter-associated diarrhea among rhesus macaques as a model to determine if vaccination could reduce severe diarrheal disease and infant growth stunting. Compared to unvaccinated controls, there are no Campylobacter diarrhea-associated deaths observed among vaccinated infant macaques and all-cause diarrhea-associated infant mortality is decreased by 76% (P = 0.03). By 9 months of age, there is a 1.3 cm increase in dorsal length that equaled a significant 1.28 LAZ (Length-for-Age Z score) improvement in linear growth among vaccinated infants compared to their unvaccinated counterparts (P = 0.001). In this work, we show that Campylobacter vaccination not only reduces diarrheal disease but also potentially serves as an effective intervention that improves infant growth trajectories.
Collapse
Affiliation(s)
- Sara M Hendrickson
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, 97006, USA
| | - Archana Thomas
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, 97006, USA
| | - Hans-Peter Raué
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, 97006, USA
| | - Kamm Prongay
- Division of Animal Resources and Research Support, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, 97006, USA
| | - Andrew J Haertel
- Division of Animal Resources and Research Support, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, 97006, USA
| | - Nicholas S Rhoades
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, College of Medicine, Lexington, KY, 40506, USA
| | - Jacob F Slifka
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, 97006, USA
| | - Lina Gao
- Biostatistics and Bioinformatics Core, Oregon National Primate Research Center, Biostatistics Shared Resource, Knight Cancer Institute, Portland, OR, 97239, USA
| | | | - Ian J Amanna
- Najít Technologies, Inc., Beaverton, OR, 97006, USA
| | - Ilhem Messaoudi
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, College of Medicine, Lexington, KY, 40506, USA
| | - Mark K Slifka
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, 97006, USA.
| |
Collapse
|
28
|
Monteiro IP, Azzi CFG, Bilibio JP, Monteiro PS, Braga GC, Nitz N. Prevalence of sexually transmissible infections in adolescents treated in a family planning outpatient clinic for adolescents in the western Amazon. PLoS One 2023; 18:e0287633. [PMID: 37352297 PMCID: PMC10289307 DOI: 10.1371/journal.pone.0287633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/09/2023] [Indexed: 06/25/2023] Open
Abstract
Sexually transmitted infections (STIs) are among the most common public health problems worldwide, especially among adolescents and young adults, who account for almost 50% of all STI patients. Studies on the subject in the western Amazon are limited. This study aimed to evaluate the prevalence of STIs (chlamydia, gonorrhea, trichomoniasis, herpes simplex virus, syphilis, human immunodeficiency virus [HIV], hepatitis B, and hepatitis C) in adolescents treated at a family planning outpatient clinic in the western Amazon: Porto Velho, Rondônia, Brazil. A total of 196 adolescents were enrolled. During the gynecological examination, endocervical samples were collected to test for four STIs (chlamydia, gonorrhea, trichomoniasis, and herpes simplex virus), and blood samples were collected for the detection of HIV, syphilis, and hepatitis B and C. The mean age was 17.3 ± 1.5 years, the age at sexarche was 14.4 ± 1.6 years, and 54.6% of participants had their first sexual intercourse at 14 years or younger. Only 1.0% of the adolescents used condoms in all sexual relations, and 19.9% had casual partner(s) in the last year. In the evaluation of prevalence, we found that 32% of the adolescents had at least one STI, with the most prevalent being chlamydia (23%), followed by trichomoniasis (5.6%), herpes simplex (4.6%), and gonorrhea (3.1%). No positive cases of hepatitis B, hepatitis C, or HIV were detected, but 1% of the adolescents tested positive for syphilis. These indicators will support more effective health care strategies aimed at improving the quality of life of populations in this region of the western Amazon. In conclusion, our findings demonstrated high rates of STIs in the studied patients, reinforcing the need to expand epidemiological studies to implement more appropriate public policies and intervention strategies to prevent STIs in adolescents and other vulnerable populations in the western Amazon.
Collapse
Affiliation(s)
- Ida Peréa Monteiro
- Municipal Health Department, Mãe Esperança Municipal Maternity, Porto Velho, Rondônia, Brazil
| | - Camila Flávia Gomes Azzi
- Molecular Biology Laboratory, Central Laboratory of Public Health of Rondônia, Porto Velho, Rondônia, Brazil
| | - João Paolo Bilibio
- Faculty of Medicine, Centro Universitário de Brusque–UNIFEBE, Brusque, Santa Catarina, Brazil
| | | | - Giordana Campos Braga
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Nadjar Nitz
- Faculty of Medicine, Interdisciplinary Laboratory of Biosciences, University of Brasília, Brasília, Brazil
| |
Collapse
|
29
|
Lanier P, Kennedy S, Snyder A, Smith J, Napierala E, Talbert J, Hammerslag L, Humble L, Myers E, Whittington A, Smith J, Bachhuber M, Austin A, Blount T, Stehlin G, Lopez-De Fede A, Nguyen H, Bruce J, Grijalva CG, Krishnan S, Otter C, Horton K, Seiler N, Pearson WS. STI Testing among Medicaid Enrollees Initiating PrEP for HIV Prevention in Six Southern States. South Med J 2023; 116:455-463. [PMID: 37263607 PMCID: PMC10247181 DOI: 10.14423/smj.0000000000001564] [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: 06/03/2023]
Abstract
OBJECTIVES The purpose of this study was to measure sexually transmitted infection (STI) testing among Medicaid enrollees initiating preexposure prophylaxis (PrEP) to prevent human immunodeficiency virus. Secondary data are in the form of Medicaid enrollment and claims data in six states in the US South. METHODS Research partnerships in six states in the US South developed a distributed research network to accomplish study aims. Each state identified all first-time PrEP users in fiscal year 2017-2018 (combined N = 990) and measured the presence of STI testing for chlamydia, syphilis, and gonorrhea through 2019. Each state calculated the percentage of individuals with at least one STI test during 3-, 6-, and 12-month follow-up periods. RESULTS The proportion of first-time PrEP users that received an STI test varied by state: 37% to 67% of all of the individuals in each state who initiated PrEP received a test within the first 6 months of PrEP treatment and 50% to 77% received a test within the first 12 months. CONCLUSIONS Although the Centers for Disease Control and Prevention recommends STI testing at least every 6 months for PrEP users, our analysis of Medicaid data suggests that STI testing occurs less frequently than recommended in populations at elevated risk of syphilis, gonorrhea, and chlamydia.
Collapse
Affiliation(s)
- Paul Lanier
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | | | | | | | | | | | | | | | | | | | - Anna Austin
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Grace Stehlin
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | - Jean Bruce
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - Katie Horton
- The George Washington University, Washington, DC
| | - Naomi Seiler
- The George Washington University, Washington, DC
| | | |
Collapse
|
30
|
Allan-Blitz LT, Shah P, Adams G, Branda JA, Klausner JD, Goldstein R, Sabeti PC, Lemieux JE. Development of Cas13a-based Assays for Neisseria gonorrhoeae Detection and Gyrase A Determination. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.21.23290304. [PMID: 37293004 PMCID: PMC10246164 DOI: 10.1101/2023.05.21.23290304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Neisseria gonorrhoeae is one of the most common bacterial sexually transmitted infections. The emergence of antimicrobial-resistant N. gonorrhoeae is an urgent public health threat. Currently, diagnosis of N. gonorrhoeae infection requires expensive laboratory infrastructure, while antimicrobial susceptibility determination requires bacterial culture, both of which are infeasible in low-resource areas where prevalence is highest. Recent advances in molecular diagnostics, such as Specific High-sensitivity Enzymatic Reporter unLOCKing (SHERLOCK) using CRISPR-Cas13a and isothermal amplification, have the potential to provide low-cost detection of pathogen and antimicrobial resistance. Methods and Results We designed and optimized RNA guides and primer-sets for SHERLOCK assays capable of detecting N. gonorrhoeae via the por A gene and of predicting ciprofloxacin susceptibility via a single mutation in the gyrase A ( gyr A) gene. We evaluated their performance using both synthetic DNA and purified N. gonorrhoeae isolates. For por A, we created both a fluorescence-based assay and lateral flow assay using a biotinylated FAM reporter. Both methods demonstrated sensitive detection of 14 N. gonorrhoeae isolates and no cross-reactivity with 3 non-gonococcal Neisseria isolates. For gyr A, we created a fluorescence-based assay that correctly distinguished between 20 purified N. gonorrhoeae isolates with phenotypic ciprofloxacin resistance and 3 with phenotypic susceptibility. We confirmed the gyr A genotype predictions from the fluorescence-based assay with DNA sequencing, which showed 100% concordance for the isolates studied. Conclusion We report the development of Cas13a-based SHERLOCK assays that detect N. gonorrhoeae and differentiate ciprofloxacin-resistant isolates from ciprofloxacin-susceptible isolates.
Collapse
Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Global Health Equity: Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Palak Shah
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Gordon Adams
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - John A. Branda
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Jeffrey D. Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Robert Goldstein
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Pardis C. Sabeti
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
| | - Jacob E. Lemieux
- Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, MA
- Division of Infectious Diseases: Department of Medicine, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
31
|
Sharma A, Gandhi M, Sallabank G, Merrill L, Stephenson R. Perceptions and Experiences of Returning Self-collected Specimens for HIV, Bacterial STI and Potential PrEP Adherence Testing among Sexual Minority Men in the United States. AIDS Behav 2023; 27:1091-1105. [PMID: 36094639 PMCID: PMC9466335 DOI: 10.1007/s10461-022-03846-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 11/04/2022]
Abstract
Few studies among gay, bisexual and other men who have sex with men (GBMSM) have examined facilitators and barriers to self-collecting specimens for extragenital STI screening, and none have evaluated attitudes towards self-collecting hair samples that can be utilized for PrEP drug level testing to assess adherence. To address this gap, we interviewed 25 sexually active GBMSM who were offered a choice to self-collect and return finger-stick blood samples (for actual HIV testing), pharyngeal swabs, rectal swabs and urine specimens (for actual gonorrhea and chlamydia testing), and hair samples (to visually determine their adequacy for PrEP drug level testing): 11 who returned all, 4 who returned some, and 10 who did not return any. Participants found self-collecting finger-stick blood samples and rectal swabs more challenging than other specimens. Frequently discussed facilitators of return included an opportunity to confirm one's HIV or STI status, limited access to a healthcare provider and a desire to advance research focusing on home-based testing. Commonly cited barriers to return included low self-efficacy pertaining to self-collection and apprehension around the possibility of delay or loss of specimens during transit. Offering additional support such as real-time video conferencing may prove helpful in future field-based research with GBMSM.
Collapse
Affiliation(s)
- Akshay Sharma
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48109, USA.
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48109, USA.
| | - Monica Gandhi
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA
| | - Gregory Sallabank
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48109, USA
| | - Leland Merrill
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48109, USA
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48109, USA
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48109, USA
| |
Collapse
|
32
|
Provider perspectives on clinical decision support to improve HIV prevention in pediatric primary care: a multiple methods study. Implement Sci Commun 2023; 4:18. [PMID: 36810099 PMCID: PMC9945664 DOI: 10.1186/s43058-023-00394-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/25/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Clinical decision support (CDS) is a promising intervention for improving uptake of HIV testing and pre-exposure prophylaxis (PrEP). However, little is known regarding provider perspectives on acceptability, appropriateness, and feasibility of CDS for HIV prevention in pediatric primary care, a key implementation setting. METHODS This was a cross-sectional multiple methods study utilizing surveys and in-depth interviews with pediatricians to assess acceptability, appropriateness, and feasibility of CDS for HIV prevention, as well as to identify contextual barriers and facilitators to CDS. Qualitative analysis utilized work domain analysis and a deductive coding approach grounded in the Consolidated Framework of Implementation Research. Quantitative and qualitative data were merged to develop an Implementation Research Logic Model to conceptualize implementation determinants, strategies, mechanisms, and outcomes of potential CDS use. RESULTS Participants (n = 26) were primarily white (92%), female (88%), and physicians (73%). Using CDS to improve HIV testing and PrEP delivery was perceived as highly acceptable (median score 5), IQR [4-5]), appropriate (5, IQR [4-5]), and feasible (4, IQR [3.75-4.75]) using a 5-point Likert scale. Providers identified confidentiality and time constraints as two key barriers to HIV prevention care spanning every workflow step. With respect to desired CDS features, providers sought interventions that were integrated into the primary care workflow, standardized to promote universal testing yet adaptable to the level of a patient's HIV risk, and addressed providers' knowledge gaps and bolstered self-efficacy in providing HIV prevention services. CONCLUSIONS This multiple methods study indicates that clinical decision support in the pediatric primary care setting may be an acceptable, feasible, and appropriate intervention for improving the reach and equitable delivery of HIV screening and PrEP services. Design considerations for CDS in this setting should include deploying CDS interventions early in the visit workflow and prioritizing standardized but flexible designs.
Collapse
|
33
|
Tumalán-Gil OD, Ruiz-González V, García-Cisneros S, González-Rodríguez A, Herrera-Ortiz A, Olamendi-Portugal M, Sánchez-Alemán MA. High Incidence, Reinfections, and Active Syphilis in Populations Attending a Specialized HIV Clinic in Mexico, a Dynamic Cohort Study. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:783-791. [PMID: 36175816 PMCID: PMC9886591 DOI: 10.1007/s10508-022-02433-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Syphilis, a sexually transmitted infection, has reemerged in many vulnerable groups around the world. The objective of the current study was to determine the prevalence and incidence of syphilis among people who attended a specialized HIV clinic in Mexico from 2011 to 2015. Databases from the laboratory were analyzed, and the following four groups were formed: people seeking HIV-1 voluntary counseling and testing (VCT), people in prison (PPr), people living with HIV (PLWH), and patients from primary care clinics (others). The diagnosis of syphilis was made using the reverse algorithm; antibody titers were examined to determine the stage of infection. Baseline data were analyzed and, with follow-up information, a retrospective dynamic cohort was formed. Factors associated with the seroprevalence of syphilis and active syphilis were evaluated by the chi-square test. Moreover, risk factors for the incidence of syphilis were described. A total of 81,863 baseline individuals were analyzed. The seroprevalence of syphilis was 9.9% in the VCT group, 8.2% in the PPr group, 37.0% in the PLWH group, and 8.7% in the others group; the prevalence of active syphilis was 1.7-13.1%. A total of 11,124 people were followed up. The incidence (cases per 100 person-years) was 3.5 among the VCT group, 16.0 among the PLWH group, and < 0.1 among both the PPr and others groups, respectively; moreover, the frequency of reinfections was 11.1-24.4%. The high prevalence and incidence of syphilis, active syphilis, and reinfections among men, transgender people, individuals aged 20-39 years, and people with a history of HIV or hepatitis B suggest that it is critical to improve prevention, diagnosis, and treatment measures to stop the reemergence of syphilis. There are also new factors such as methamphetamine use, group sex, or contacting partners over the internet that are associated with syphilis. In addition, HIV preexposure prophylaxis could contribute to the increased incidence of syphilis by providing false security in the prevention of STIs, thereby increasing risky sexual behaviors.
Collapse
Affiliation(s)
- Omar David Tumalán-Gil
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, C.P. 62100, Cuernavaca, Morelos, México
| | | | - Santa García-Cisneros
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, C.P. 62100, Cuernavaca, Morelos, México
| | | | - Antonia Herrera-Ortiz
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, C.P. 62100, Cuernavaca, Morelos, México
| | - Maria Olamendi-Portugal
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, C.P. 62100, Cuernavaca, Morelos, México
| | - Miguel Angel Sánchez-Alemán
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, C.P. 62100, Cuernavaca, Morelos, México.
| |
Collapse
|
34
|
de Voux A, Mvududu R, Happel A, Jaspan HB, Nyemba DC, Mashele N, Myer L, Davey DLJ. Point-of-Care Sexually Transmitted Infection Testing Improves HIV Preexposure Prophylaxis Initiation in Pregnant Women in Antenatal Care in Cape Town, South Africa, 2019 to 2021. Sex Transm Dis 2023; 50:92-97. [PMID: 36630416 PMCID: PMC9906800 DOI: 10.1097/olq.0000000000001729] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Pre-exposure prophylaxis (PrEP) programs present a platform for diagnostic STI testing in low- and middle-income countries, and availability of targeted STI testing has been hypothesized to influence PrEP use. We evaluated the association of STI testing modality and PrEP uptake among pregnant women in antenatal care. Methods We enrolled pregnant, HIV-uninfected women (≥16 years) at their first antenatal visit with follow-up through 12 months postpartum. Women were offered oral PrEP and tested for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) using a point-of-care (Cepheid, August 2019–November 2020) or laboratory-based (Thermofisher, December 2020–October 2021) test. We compared the proportion of women initiating and continuing PrEP by STI test adjusting for confounders. Results We evaluated 1194 women (median age=26 years [IQR:22–31]) with a STI result (46% POC and 54% laboratory-based). The prevalence of any STI was the same in POC-tested (28%) and laboratory-tested (28%) women — 25% versus 23% for CT (p-value=0.35) and 7% versus 9% for NG (p-value=0.11). Mean time from testing to result was 0 for POC and 26 days for laboratory testing and mean time from testing to treatment was 3 for POC and 38 days for laboratory testing. Receiving a POC STI test was associated with higher PrEP initiation compared to women receiving a laboratory-based test (90% versus 78%; adjusted odds ratio=2.1; 95% CI:1.5–2.9), controlling for age, gravidity, STI diagnosis, intimate partner violence, gestational age, employment, HIV risk perception, and cohabiting status. Conclusion POC STI testing, offering same-day results and treatment initiation, may increase PrEP initiation among pregnant women in antenatal care. A study of HIV-uninfected pregnant women in South Africa found that women offered point-of-care STI testing had a higher odds of initiating HIV pre-exposure prophylaxis than women offered laboratory-based testing.
Collapse
Affiliation(s)
- Alex de Voux
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rufaro Mvududu
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Anna Happel
- Division of Immunology, Department of Pathology, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Heather B Jaspan
- Division of Immunology, Department of Pathology, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Seattle Children’s Research Institute, Seattle, Washington, United States of America
- Department of Pediatrics and Global Health, University of Washington, Seattle, Washington, United States of America
| | - Dorothy Chiwoniso Nyemba
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Nyiko Mashele
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Dvora Leah Joseph Davey
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
- Division of Infectious Diseases, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| |
Collapse
|
35
|
Hart TA, Noor SW, Tavangar F, Berlin GW, Skakoon-Sparling S, Tan DHS, Lambert G, Grace D, Jollimore J, Sang JM, Kirschbaum AL, Kanji R, Apelian H, Cox J, Moore DM, Lachowsky N. Crystal methamphetamine use and bacterial sexually transmitted infections (STIs) among gay, bisexual and other sexual minority men in Canada. Drug Alcohol Depend 2023; 242:109718. [PMID: 36516548 DOI: 10.1016/j.drugalcdep.2022.109718] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE While crystal methamphetamine use by gay, bisexual, and other men who have sex with men (GBM) is associated with increased risk for sexually transmitted infection (STI) transmission, less is understood about the causal pathways between crystal methamphetamine use and STIs. We examined whether the association between greater crystal methamphetamine risk and prevalent bacterial STI diagnosis among GBM was mediated by two types of attitudinal variables: attitudes toward condoms, and sexual escape motives, defined as the use of substances to escape self-awareness during sex, and by sexual behaviors. METHODS We used computer-assisted self-interview questionnaires from 2449 sexually active GBM (18% living with HIV; median age = 33, interquartile range, 27-45) recruited via respondent-driven sampling in Vancouver, Toronto, and Montreal, Canada. Using the baseline data from the Engage cohort study, we fit a series of structural mediation models of the associations between greater crystal methamphetamine risk and bacterial STI (syphilis, gonorrhea, and chlamydia) diagnosis. We estimated indirect paths from greater crystal methamphetamine risk, attitudes toward condoms, sexual escape motives, and sexual risk behaviors, adjusting for self-reported demographic variables. RESULTS In the mediated model, the direct association between greater crystal methamphetamine risk and bacterial STI diagnosis was non-significant; however, five indirect paths were significant. Greater crystal methamphetamine risk was associated with bacterial STIs via condom use attitudes and escape motives, which in turn were associated with number of male anal sex partners, condomless anal sex, and oral sex. DISCUSSION Public health and counselling interventions for GBM who use crystal methamphetamine and who are at higher risk for STIs should target evidence-based causal paths that consider sexual attitudes and sexual practices.
Collapse
Affiliation(s)
- Trevor A Hart
- Toronto Metropolitan University, Toronto, Canada; University of Toronto, Toronto, Canada.
| | - Syed W Noor
- Toronto Metropolitan University, Toronto, Canada; Louisiana State University Shreveport, Shreveport, LA, USA
| | - Farideh Tavangar
- Centre for Urban Health Solutions, St. Michael's Hospital, Canada
| | | | | | - Darrell H S Tan
- Centre for Urban Health Solutions, St. Michael's Hospital, Canada; Unity Health, Toronto, Ontario, Canada
| | - Gilles Lambert
- Institut national de santé publique du Québec, Montréal, QC, Canada; Direction régionale de santé publique - Montréal, Montréal, QC, Canada
| | | | - Jody Jollimore
- Community-Based Research Centre for Gay Men's Health, Vancouver, BC, Canada
| | - Jordan M Sang
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - Rahim Kanji
- Toronto Metropolitan University, Toronto, Canada
| | | | - Joseph Cox
- Direction régionale de santé publique - Montréal, Montréal, QC, Canada; McGill University, Montreal, QC, Canada
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Nathan Lachowsky
- University of Victoria, Victoria, BC, Canada; Canadian Institute for Substance Use Research, Victoria, BC, Canada
| |
Collapse
|
36
|
Karim QA, Archary D, Barré-Sinoussi F, Broliden K, Cabrera C, Chiodi F, Fidler SJ, Gengiah TN, Herrera C, Kharsany ABM, Liebenberg LJP, Mahomed S, Menu E, Moog C, Scarlatti G, Seddiki N, Sivro A, Cavarelli M. Women for science and science for women: Gaps, challenges and opportunities towards optimizing pre-exposure prophylaxis for HIV-1 prevention. Front Immunol 2022; 13:1055042. [PMID: 36561760 PMCID: PMC9763292 DOI: 10.3389/fimmu.2022.1055042] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
Preventing new HIV infections remains a global challenge. Young women continue to bear a disproportionate burden of infection. Oral pre-exposure prophylaxis (PrEP), offers a novel women-initiated prevention technology and PrEP trials completed to date underscore the importance of their inclusion early in trials evaluating new HIV PrEP technologies. Data from completed topical and systemic PrEP trials highlight the role of gender specific physiological and social factors that impact PrEP uptake, adherence and efficacy. Here we review the past and current developments of HIV-1 prevention options for women with special focus on PrEP considering the diverse factors that can impact PrEP efficacy. Furthermore, we highlight the importance of inclusion of female scientists, clinicians, and community advocates in scientific efforts to further improve HIV prevention strategies.
Collapse
Affiliation(s)
- Quarraisha Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Derseree Archary
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | | | - Kristina Broliden
- Department of Medicine Solna, Division of Infectious Diseases, Karolinska Institutet, Department of Infectious Diseases, Karolinska University Hospital, Center for Molecular Medicine, Stockholm, Sweden
| | - Cecilia Cabrera
- AIDS Research Institute IrsiCaixa, Institut de Recerca en Ciències de la Salut Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesca Chiodi
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Sarah J. Fidler
- Department of Infectious Disease, Faculty of Medicine, Imperial College London UK and Imperial College NIHR BRC, London, United Kingdom
| | - Tanuja N. Gengiah
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Carolina Herrera
- Department of Infectious Disease, Section of Virology, Faculty of Medicine, Imperial College London, London, United Kingdom,*Correspondence: Carolina Herrera,
| | - Ayesha B. M. Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Lenine J. P. Liebenberg
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Sharana Mahomed
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Elisabeth Menu
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France,MISTIC Group, Department of Virology, Institut Pasteur, Paris, France
| | - Christiane Moog
- Laboratoire d’ImmunoRhumatologie Moléculaire, Institut national de la santé et de la recherche médicale (INSERM) UMR_S 1109, Institut thématique interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Gabriella Scarlatti
- Viral Evolution and Transmission Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nabila Seddiki
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Aida Sivro
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2Floor), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa,Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa,JC Wilt Infectious Disease Research Centre, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Mariangela Cavarelli
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| |
Collapse
|
37
|
Weng R, Ning N, Zhang C, Wen L, Ye J, Wang H, Li J, Chen X, Cai Y. Acceptability of rectal self-sampling in non-clinical venues for chlamydia and gonorrhea testing among men who have sex with men: A cross-sectional study in Shenzhen, China. Front Public Health 2022; 10:992773. [PMID: 36466478 PMCID: PMC9712709 DOI: 10.3389/fpubh.2022.992773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background Rectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among men who have sex with men (MSM) have become an increasingly important concern. The study aimed to explore (1) the acceptability of rectal self-sampling for chlamydia and gonorrhea testing among MSM in non-clinical venues in Shenzhen city, China; (2) factors associated with the acceptability of rectal self-sampling; and (3) factors associated with rectal CT and NG infections, respectively. Methods This cross-sectional study was conducted in two non-clinical settings in Shenzhen, China, from April 2021 to October 2021. Mixed-effects logistic regression analysis was performed to explore the factors associated with acceptance of rectal self-collection for CT and NG testing. Results Of the 306 MSM who were offered to perform rectal self-sampling, 133 (43.46%) accepted, and 96.24% (128/133) of them successfully provided a valid rectal sample. The prevalence of urogenital CT and NG infections among 303 MSM was 4.29 and 0.66%, respectively. The prevalence of rectal CT and NG infections among 128 participants was 31.25 and 9.38%, respectively. Participants having been diagnosed with HIV infection showed a higher acceptance of rectal self-collection for CT and NG testing. Conclusion This study reported that rectal self-sampling in non-clinical venues for CT and NG testing among MSM was barely acceptable and feasible in China. Most CT and NG infections would have been missed if urethral screening was offered alone, which implies that the CT and NG screening should be scaled up in the above setting. Integrating free CT tests into regular STI interventions for MSM could also be considered.
Collapse
Affiliation(s)
- Rongxing Weng
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Ning Ning
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China,Shantou University Medical College, Shantou University, Shantou, China
| | - Chunlai Zhang
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Lizhang Wen
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Jianbin Ye
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Honglin Wang
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Jing Li
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Xiangsheng Chen
- Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, Nanjing, China,National Center for STD Control, China Center for Disease Control and Prevention, Nanjing, China
| | - Yumao Cai
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, China,*Correspondence: Yumao Cai
| |
Collapse
|
38
|
Marconi A, Falk-Hanson E, Gage J. Adherence to chlamydia and gonorrhea follow up testing in a college population. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:2289-2294. [PMID: 33400634 DOI: 10.1080/07448481.2020.1851232] [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: 01/23/2020] [Revised: 09/17/2020] [Accepted: 11/06/2020] [Indexed: 06/12/2023]
Abstract
Objectives: To examine differences in compliance to follow-up for STD based on demographic, clinical and academic characteristics. Methods: Cross-sectional study examining associations between clinical, demographic and academic variables and compliance to follow-up for STDs in a college population. Participants: Chart review data collected at University Health Services (UHS) UW- Madison, where 449 cases were reported in 2017. Results: Final model includes sex, sex of partners and its interaction. It shows no significant difference in follow-up for males compared to females or for students having partners of the same sex nor students having partners of the same and different sex. Finally, when interactions are introduced, males having partners of a different sex were significantly associated with less compliant follow-up (AOR: 10.36; 95% CI= 1.57- 68.35). Conclusions: The effect of the sexual partners in noncompliance differs by sex. Males with partners of a different sex were 10 times more likely to noncompliance to follow up than females with partners of a different sex.
Collapse
Affiliation(s)
- Agustina Marconi
- University Health Services, University of Wisconsin, Madison, Wisconsin, USA
| | - Elizabeth Falk-Hanson
- Women's Health and Sexual Health Clinics, University Health Services, University of Wisconsin, Madison, Wisconsin, USA
| | - Janine Gage
- Sexual Health Clinic University Health Services, University of Wisconsin, Wisconsin, USA
| |
Collapse
|
39
|
Wu Y, Zhu W, Sun C, Yue X, Zheng M, Fu G, Gong X. Prevalence of syphilis among people living with HIV and its implication for enhanced coinfection monitoring and management in China: A meta-analysis. Front Public Health 2022; 10:1002342. [PMID: 36324449 PMCID: PMC9618949 DOI: 10.3389/fpubh.2022.1002342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/29/2022] [Indexed: 01/27/2023] Open
Abstract
Background People living with HIV (PLWH) are at an increased risk of syphilis infection. The objectives of this study were to assess the overall prevalence of syphilis among PLWH in China and identify factors associated with syphilis infection among PLWH. Methods We searched Medline, Embase, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Wan-fang Data, and Chinese Biomedical Literature Database (CBM) to identify studies that reported the prevalence of syphilis among PLWH in China and were published in English or Chinese from January 1, 1990, to May 31, 2022. The reference lists of retrieved articles and relevant reviews were also checked to identify additional studies. A random-effect model was fitted to calculate the pooled syphilis prevalence among PLWH. Subgroup analyses, meta-regression analyses and sensitivity analyses were conducted to determine the potential source of heterogeneity. Results Of the 1,599 articles screened, 29 studies involving 34,740 participants were eligible for inclusion in this meta-analysis. The overall prevalence of syphilis among PLWH in China was 19.9% [95% confidence interval (CI): 15.4-24.8%, I 2 = 98.9%]. Subgroup analysis showed that the pooled prevalence of syphilis among men who have sex with men (MSM) with HIV (21.9%, 95% CI: 17.2-26.9%) was much higher than that among heterosexuals (10.3%, 95% CI: 5.2-16.8%); there was regional diversity in the prevalence of syphilis, the highest in northern China (31.7%, 95% CI: 17.9-47.4%), followed by central-southern China (26.7%, 95% CI: 11.4-45.7%), and the lowest in northwestern China (15.0%, 95% CI: 6.9-25.4%); the syphilis prevalence among PLWH decreased as CD4 + T cell count increased (19.6% in CD4 + T cell < 200 vs. 8.7% in ≥ 500) and was higher among non-antiretroviral therapy (non-ART) HIV-infected patients (21.0%, 95% CI: 9.9-35.0%) than that among ART ones (16.1%, 95% CI: 3.9-34.3%). Conclusions Our study showed a significantly high prevalence of syphilis among PLWH in China, particularly among MSM with HIV. Developing national guidelines for the integrated screening, monitoring, and management of HIV and syphilis as well as syphilis diagnosis and treatment training programs for physicians at designated HIV treatment hospitals is urgent and crucial to combat HIV and syphilis coinfection in China.
Collapse
Affiliation(s)
- Yuelin Wu
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Wenqian Zhu
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Chengqing Sun
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiaoli Yue
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Department of STD Epidemiology, National Center for STD Control, Nanjing, China
| | - Min Zheng
- Department of HIV/STD Control and Prevention, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Gengfeng Fu
- Department of HIV/STD Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Xiangdong Gong
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Department of STD Epidemiology, National Center for STD Control, Nanjing, China
| |
Collapse
|
40
|
Jones J, Le Guillou A, Gift TL, Chesson H, Bernstein K, Delaney K, Lyles C, Berruti A, Sullivan PS, Jenness SM. Effect of Screening and Treatment for Gonorrhea and Chlamydia on HIV Incidence Among Men Who Have Sex With Men in the United States: A Modeling Analysis. Sex Transm Dis 2022; 49:669-676. [PMID: 35921635 PMCID: PMC9481699 DOI: 10.1097/olq.0000000000001685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous models have estimated the total population attributable fraction of Neisseria gonorrhoeae and Chlamydia trachomatis (NG/CT) on HIV incidence among men who have sex with men (MSM), but this does not represent realistic intervention effects. We estimated the potential impact of screening for NG/CT on downstream incidence of HIV among MSM. METHODS Using a network model, we estimated the effects of varying coverage levels for sexually transmitted infection screening among different priority populations: all sexually active MSM regardless of HIV serostatus, MSM with multiple recent (past 6 months) sex partners regardless of serostatus, MSM without HIV, and MSM with HIV. Under the assumption that all screening events included a urethral test, we also examined the effect of increasing the proportion of screening events that include rectal screening for NG/CT on HIV incidence. RESULTS Increasing annual NG/CT screening among sexually active MSM by 60% averted 4.9% of HIV infections over a 10-year period (interquartile range, 2.8%-6.8%). More HIV infections were averted when screening was focused on MSM with multiple recent sex partners: 60% coverage among MSM with multiple recent sex partners averted 9.8% of HIV infections (interquartile range, 8.1%-11.6%). Increased sexually transmitted infection screening among MSM without HIV averted more new HIV infections compared with the transmissions averted because of screening MSM with HIV, but fewer NG/CT tests were needed among MSM with HIV to avert a single new HIV infection. CONCLUSIONS Screening of NG/CT among MSM is expected to lead to modest but clinically relevant reductions in HIV incidence among MSM.
Collapse
Affiliation(s)
- Jeb Jones
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Adrien Le Guillou
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Thomas L. Gift
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Harrell Chesson
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Kyle Bernstein
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Kevin Delaney
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Cynthia Lyles
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Andres Berruti
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Samuel M. Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University
| |
Collapse
|
41
|
Vollmuth N, Schlicker L, Guo Y, Hovhannisyan P, Janaki-Raman S, Kurmasheva N, Schmitz W, Schulze A, Stelzner K, Rajeeve K, Rudel T. c-Myc plays a key role in IFN-γ-induced persistence of Chlamydia trachomatis. eLife 2022; 11:76721. [PMID: 36155135 PMCID: PMC9512400 DOI: 10.7554/elife.76721] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Chlamydia trachomatis (Ctr) can persist over extended times within their host cell and thereby establish chronic infections. One of the major inducers of chlamydial persistence is interferon-gamma (IFN-γ) released by immune cells as a mechanism of immune defence. IFN-γ activates the catabolic depletion of L-tryptophan (Trp) via indoleamine-2,3-dioxygenase (IDO), resulting in persistent Ctr. Here, we show that IFN-γ induces the downregulation of c-Myc, the key regulator of host cell metabolism, in a STAT1-dependent manner. Expression of c-Myc rescued Ctr from IFN-γ-induced persistence in cell lines and human fallopian tube organoids. Trp concentrations control c-Myc levels most likely via the PI3K-GSK3β axis. Unbiased metabolic analysis revealed that Ctr infection reprograms the host cell tricarboxylic acid (TCA) cycle to support pyrimidine biosynthesis. Addition of TCA cycle intermediates or pyrimidine/purine nucleosides to infected cells rescued Ctr from IFN-γ-induced persistence. Thus, our results challenge the longstanding hypothesis of Trp depletion through IDO as the major mechanism of IFN-γ-induced metabolic immune defence and significantly extends the understanding of the role of IFN-γ as a broad modulator of host cell metabolism.
Collapse
Affiliation(s)
- Nadine Vollmuth
- Department of Microbiology, Biocenter, University of Wuerzburg, Wuerzburg, Germany
| | - Lisa Schlicker
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Yongxia Guo
- Department of Microbiology, Biocenter, University of Wuerzburg, Wuerzburg, Germany.,College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Pargev Hovhannisyan
- Department of Microbiology, Biocenter, University of Wuerzburg, Wuerzburg, Germany
| | | | - Naziia Kurmasheva
- Department of Microbiology, Biocenter, University of Wuerzburg, Wuerzburg, Germany
| | - Werner Schmitz
- Department of Biochemistry and Molecular Biology, University of Wuerzburg, Würzburg, Germany
| | - Almut Schulze
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Biochemistry and Molecular Biology, University of Wuerzburg, Würzburg, Germany
| | - Kathrin Stelzner
- Department of Microbiology, Biocenter, University of Wuerzburg, Wuerzburg, Germany
| | - Karthika Rajeeve
- Department of Microbiology, Biocenter, University of Wuerzburg, Wuerzburg, Germany.,Pathogen Biology, Rajiv Gandhi Centre for Biotechnology (RGCB), Thiruvananthapuram, India
| | - Thomas Rudel
- Department of Microbiology, Biocenter, University of Wuerzburg, Wuerzburg, Germany
| |
Collapse
|
42
|
Abdella S, Demissie M, Worku A, Dheresa M, Berhane Y. HIV prevalence and associated factors among female sex workers in Ethiopia, east Africa: A cross-sectional study using a respondent-driven sampling technique. EClinicalMedicine 2022; 51:101540. [PMID: 35813094 PMCID: PMC9256839 DOI: 10.1016/j.eclinm.2022.101540] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND HIV acquisition among Female Sex Workers (FSWs) is 30 times higher than the acquisition rate among females in the respective general population. A higher HIV burden in FSWs challenges the prevention and control of the virus in other population groups. However, there is inadequate evidence on the burden of HIV among FSWs in Ethiopia. This study was conducted to assess the extent of HIV and associated factors among FSWs in the country. METHODS This was a cross-sectional study that involved a total of 6,085 FSWs. The participants were selected using a respondent-driven sampling technique (RDS). FSWs who lived at the study sites for at least a month before the study time were considered eligible for recruitment. The study was conducted from January 01 to June 30, 2020 in 16 cities across Ethiopia. A mixed-effect logistic regression model was applied to determine factors associated with HIV positivity. FINDINGS The pooled HIV prevalence among FSWs in this study was 18·7% (95% CI: 17·8, 19·7) with considerable variation across cities. The highest HIV prevalence was observed in Bahir Dar city, 28·2% (95% CI: 23·9, 33.0) and the lowest was seen in Shashemene city, 14.0% (95% CI: 10·2, 18·9). The odds of HIV positivity in FSWs was associated with being older than 35 years of age (AOR = 8·1; 95% CI: 6·1, 10·3), reactive for Treponema Pallidum (AOR = 2·6; 95% CI: 1·0, 3·4), being widowed (OR = 2·2; 95% CI: 1·6, 2·9), not able to read and write (OR = 2·0; 95% CI: 1·5, 2·4), incidence of condom breakage (OR = 1·5; 95% CI: 1·2, 1·7) and having a history of STIs (OR = 1·3; 95% CI: 1·1, 1·6). INTERPRETATION One in five FSWs was HIV positive. HIV prevalence was higher in the older age groups and in those who were positive for Treponema Pallidum (Syphilis). The findings indicated the importance of strengthening HIV prevention and control in FSWs to achieve the national goal to eliminate HIV by 2030. FUNDING The study was supported by The Ethiopian Ministry of Health through the Federal HIV/AIDS Prevention and Control Office.
Collapse
Affiliation(s)
- Saro Abdella
- HIV and TB Research directorate, Ethiopian Public Health Institute, Addis Ababa, Swaziland Street, Ethiopia
- School of Nursing and Midwifery, College of Health Sciences, Haramaya University, Harar, Ethiopia
- Corresponding author.
| | - Meaza Demissie
- Department of Global Health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Sefere Selam Campus, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health Sciences, Haramaya University, Harar, Ethiopia
| | - Yemane Berhane
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| |
Collapse
|
43
|
Treibich C, Bell E, Lépine A, Blanc E. From a drought to HIV: An analysis of the effect of droughts on transactional sex and sexually transmitted infections in Malawi. SSM Popul Health 2022; 19:101221. [PMID: 36164494 PMCID: PMC9508466 DOI: 10.1016/j.ssmph.2022.101221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 12/03/2022] Open
Abstract
Each year there are over 300 natural disasters globally with millions of victims that cost economic losses near USD$100 billion. In the context of climate change, an emerging literature linking extreme weather events to HIV infections suggests that efforts to control the HIV epidemic could be under threat. We used Demographic and Health Survey (DHS) data collected during the 2015-2016 harsh drought that affected several areas of Malawi to provide new evidence on the effect of an unanticipated economic shock on sexual behaviours of young women and men. We find that amongst women employed in agriculture, a six-months drought doubles their likelihood of engaging in transactional sex compared to women who were not affected by the drought and increases their likelihood of having a sexually transmitted infections (STI) by 48% in the past twelve months. Amongst men employed outside of agriculture, drought increases by 50% the likelihood of having a relationship with a woman engaged in transactional sex. These results suggest that women in agriculture experiencing economic shocks as a result of drought use transactional sex with unaffected men, i.e. men employed outside agriculture, as a coping mechanism, exposing themselves to the risk of contracting HIV. The effect was especially observed among non-educated women. A single drought in the last five years increases HIV prevalence in Malawi by around 15% amongst men and women. Overall, the results confirm that weather shocks are important drivers of risky sexual behaviours of young women relying on agriculture in Africa. Further research is needed to investigate the most adequate formal shock-coping strategies to be implemented in order to limit the negative consequences of natural disasters on HIV acquisition and transmission.
Collapse
Affiliation(s)
- Carole Treibich
- Univ. Grenoble Alpes, CNRS, INRAE, Grenoble INP, GAEL, 38000, Grenoble, France
| | | | - Aurélia Lépine
- Institute for Global Health, University College London, UK
| | - Elodie Blanc
- MIT Joint Program on the Science and Policy of Global Change, Massachusetts Institute of Technology and Motu Economic and Public Policy Research, United States
| |
Collapse
|
44
|
Asare K, Osman F, Ngcapu S, Vandormael A, Naicker N, Khanyile M, Mindel A, Abdool Karim SS, Tomita A, Garrett N. Burden of sexually transmitted infections from acute HIV infection among women in South Africa: Evidence from a prospective cohort study. Ann Epidemiol 2022; 74:132-139. [PMID: 35977656 DOI: 10.1016/j.annepidem.2022.08.038] [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: 05/31/2022] [Revised: 07/26/2022] [Accepted: 08/09/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE HIV and other sexually transmitted infections (STIs) often co-occur. However, less evidence exists on the long-term STI dynamics among persons living with HIV in sub-Saharan Africa to inform interventions. We investigated the incidence, prevalence and factors associated with STIs, starting from acute HIV infection in a cohort of South African women. METHODS The CAPRISA002 study enrolled women with acute HIV infection and performed STI testing and treatment 1-2 times annually from 2004-2020. We estimated STI incidence, re-infection, and prevalence trends before and after antiretroviral treatment (ART). We fitted Cox regression models to identify factors associated with STIs. RESULTS We followed up 235 women (median age = 25 years, IQR 22-29) for 7.5 years (IQR 5.7-10.8). New STI and re-infection cases per 100 person-years (PYs) were 5.1 and 9.5 for Neisseria gonorrhoeae (NG), 7.4 and 14.7 for Chlamydia trachomatis (CT), 8.0 and 26.6 for Trichomonas vaginalis (TV), 7.7 and 16.7 for Mycoplasma genitalium (MG) and 25.2 and 37.3 for any STI. STI incidence, was associated with HIV log10 viral load (AHR = 1.24, 95% CI 1.06-1.44), active syphilis (AHR = 16.55, 95% CI 7.49-36.55), a positive HSV-2 PCR (AHR = 1.54, 95% CI 1.01-2.35), bacterial vaginosis (AHR = 1.48, 95% CI 1.01-2.18), recent regular sexual partners at enrolment (one vs none: AHR = 2.62, 95% CI 1.41-4.87; two plus vs none: AHR = 3.68, 95% CI 1.79-7.59) and age (5-year fold: AHR = 0.80, 95% CI 0.70-0.92). CONCLUSION The persistent STI/HIV co-infection burden among South African women highlights that early HIV diagnosis and ART initiation needs to be combined with better STI care for women and their partners to prevent HIV and STI transmission.
Collapse
Affiliation(s)
- Kwabena Asare
- School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa; Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.
| | - Farzana Osman
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Sinaye Ngcapu
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Alain Vandormael
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Nivashnee Naicker
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Mlungisi Khanyile
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Adrian Mindel
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Salim S Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; Department of Epidemiology, Columbia University, New York, New York, USA
| | - Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Nigel Garrett
- School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa; Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| |
Collapse
|
45
|
George AF, McGregor M, Gingrich D, Neidleman J, Marquez RS, Young KC, Thanigaivelan KL, Greene WC, Tien PC, Deitchman AN, Spitzer TL, Roan NR. Female Genital Fibroblasts Diminish the In Vitro Efficacy of PrEP against HIV. Viruses 2022; 14:v14081723. [PMID: 36016345 PMCID: PMC9413545 DOI: 10.3390/v14081723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 01/09/2023] Open
Abstract
The efficacy of HIV pre-exposure prophylaxis (PrEP) is high in men who have sex with men, but much more variable in women, in a manner largely attributed to low adherence. This reduced efficacy, however, could also reflect biological factors. Transmission to women is typically via the female reproductive tract (FRT), and vaginal dysbiosis, genital inflammation, and other factors specific to the FRT mucosa can all increase transmission risk. We have demonstrated that mucosal fibroblasts from the lower and upper FRT can markedly enhance HIV infection of CD4+ T cells. Given the current testing of tenofovir disoproxil fumarate, cabotegravir, and dapivirine regimens as candidate PrEP agents for women, we set out to determine using in vitro assays whether endometrial stromal fibroblasts (eSF) isolated from the FRT can affect the anti-HIV activity of these PrEP drugs. We found that PrEP drugs exhibit significantly reduced antiviral efficacy in the presence of eSFs, not because of decreased PrEP drug availability, but rather of eSF-mediated enhancement of HIV infection. These findings suggest that drug combinations that target both the virus and infection-promoting factors in the FRT-such as mucosal fibroblasts-may be more effective than PrEP alone at preventing sexual transmission of HIV to women.
Collapse
Affiliation(s)
- Ashley F. George
- Gladstone Institute of Virology, University of California at San Francisco, San Francisco, CA 94158, USA
- Department of Urology, University of California at San Francisco, San Francisco, CA 94143, USA
| | - Matthew McGregor
- Gladstone Institute of Virology, University of California at San Francisco, San Francisco, CA 94158, USA
- Department of Urology, University of California at San Francisco, San Francisco, CA 94143, USA
| | - David Gingrich
- Drug Research Unit, Department of Clinical Pharmacy, School of Pharmacy, University of California at San Francisco, San Francisco, CA 94143, USA
| | - Jason Neidleman
- Gladstone Institute of Virology, University of California at San Francisco, San Francisco, CA 94158, USA
- Department of Urology, University of California at San Francisco, San Francisco, CA 94143, USA
| | | | - Kyrlia C. Young
- Gladstone Institute of Virology, University of California at San Francisco, San Francisco, CA 94158, USA
- Department of Urology, University of California at San Francisco, San Francisco, CA 94143, USA
| | - Kaavya L. Thanigaivelan
- Gladstone Institute of Virology, University of California at San Francisco, San Francisco, CA 94158, USA
- Department of Urology, University of California at San Francisco, San Francisco, CA 94143, USA
| | - Warner C. Greene
- Gladstone Institute of Virology, University of California at San Francisco, San Francisco, CA 94158, USA
- Departments of Medicine and Microbiology and Immunology, University of California at San Francisco, San Francisco, CA 94143, USA
| | - Phyllis C. Tien
- Departments of Medicine and Veterans Affairs, University of California at San Francisco, San Francisco, CA 94143, USA
| | - Amelia N. Deitchman
- Drug Research Unit, Department of Clinical Pharmacy, School of Pharmacy, University of California at San Francisco, San Francisco, CA 94143, USA
| | - Trimble L. Spitzer
- Lieutenant Colonel, United States Air Force, Medical Center, Women’s Health Clinic, Naval Medical Center, Portsmouth, VA 23708, USA
| | - Nadia R. Roan
- Gladstone Institute of Virology, University of California at San Francisco, San Francisco, CA 94158, USA
- Department of Urology, University of California at San Francisco, San Francisco, CA 94143, USA
- Correspondence:
| |
Collapse
|
46
|
Kandula UR, Wake AD. Promising Stem Cell therapy in the Management of HIV and AIDS: A Narrative Review. Biologics 2022; 16:89-105. [PMID: 35836496 PMCID: PMC9275675 DOI: 10.2147/btt.s368152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/02/2022] [Indexed: 11/23/2022]
Abstract
Stem cell therapies are becoming a major topic in biomedical research all over the planet. It may be a viable treatment choice for people suffering from a wide range of illnesses and injuries. It has recently emerged as an extremely intriguing and well-established science and research topic. Expectations have risen due to advancements in therapeutic approaches. Multiple laboratory testing of regulated stem cell culture and derivation is carried out before the formation of stem cells for the use of therapeutic process. Whereas HIV infection is contagious and can last a lifetime. Researchers are still working to develop a comprehensive and effective treatment for HIV and its associated condition, as well as AIDS. HIV propagation is primarily restricted to the immune system, notably T lymphocytes, as well as macrophages. Large numbers of research studies have contributed to a plethora of data about the enigmatic AIDS life cycle. This vast amount of data provides potential targets for AIDS therapies. Currently, stem cell transplantation, along with other procedures, provided novel insights into HIV pathogenesis and offered a glimpse of hope for the development of a viable HIV cure technique. One of its existing focus areas in HIV and AIDS research is to develop a novel therapeutic strategic plan capable of providing life-long complete recovery of HIV and AIDS without regular drug treatment and, inevitably, curative therapy for HIV and AIDS. The current paper tries to address the possibilities for improved stem cell treatments with “bone marrow, Hematopoietic, human umbilical cord mesenchymal, Genetical modifications with CRISPR/Cas9 in combination of stem cells, induced pluripotent stem cells applications” are discussed which are specifically applied in the HIV and AIDS therapeutic management advancement procedures.
Collapse
Affiliation(s)
- Usha Rani Kandula
- Department of Clinical Nursing, College of Health Sciences, Arsi University, Asella, Ethiopia
- Correspondence: Usha Rani Kandula, Department of Clinical Nursing, College of Health Sciences, Arsi University, P.O. Box-396, Asella, Ethiopia, Tel +251-939052408, Email
| | - Addisu Dabi Wake
- Department of Clinical Nursing, College of Health Sciences, Arsi University, Asella, Ethiopia
| |
Collapse
|
47
|
Sharma A, Gandhi M, Sallabank G, Merrill L, Stephenson R. Study Evaluating Self-Collected Specimen Return for HIV, Bacterial STI, and Potential Pre-Exposure Prophylaxis Adherence Testing Among Sexual Minority Men in the United States. Am J Mens Health 2022; 16:15579883221115591. [PMID: 35950608 PMCID: PMC9380227 DOI: 10.1177/15579883221115591] [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] [Indexed: 11/17/2022] Open
Abstract
Web-based HIV and sexually transmitted infection (STI) prevention studies are
increasingly requesting gay, bisexual, and other men who have sex with men
(GBMSM) to return self-collected specimens for laboratory processing. Some
studies have solicited self-collected extragenital swabs for gonorrhea and
chlamydia testing, but to date, none have solicited self-collected hair samples
for pre-exposure prophylaxis (PrEP) adherence testing. Project Caboodle! offered
100 racially/ethnically diverse GBMSM aged 18 to 34 years residing across the
United States a choice to self-collect at home and return by mail any of the
following: a finger-stick blood sample (for HIV testing), a pharyngeal swab, a
rectal swab and a urine specimen (for gonorrhea and chlamydia testing), and a
hair sample (to visually assess its adequacy for PrEP drug level testing).
Despite not incentivizing specimen return, 51% mailed back at least one type of
specimen within 6 weeks (1% returned three specimens, 11% returned four
specimens and 39% returned all five specimens). The majority of returned
specimens were adequate for laboratory processing. Significantly more
participants without a college education (p = .0003) and those
who were working full-time or part-time (p = .0070) did not
return any specimens. In addition, lower levels of HIV-related knowledge
(p = .0390), STI-related knowledge (p =
.0162), concern about contracting HIV (p = .0484), and concern
about contracting STIs (p = .0108) were observed among
participants who did not return any specimens. Self-collection of specimens
holds promise as a remote monitoring strategy that could supplement testing in
clinical settings, but a better understanding of why some GBMSM may choose to
fully, partially, or not engage in this approach is warranted.
Collapse
Affiliation(s)
- Akshay Sharma
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA.,Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Gregory Sallabank
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Leland Merrill
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Rob Stephenson
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA.,Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
48
|
Miranda MNS, Pingarilho M, Pimentel V, Torneri A, Seabra SG, Libin PJK, Abecasis AB. A Tale of Three Recent Pandemics: Influenza, HIV and SARS-CoV-2. Front Microbiol 2022; 13:889643. [PMID: 35722303 PMCID: PMC9201468 DOI: 10.3389/fmicb.2022.889643] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Emerging infectious diseases are one of the main threats to public health, with the potential to cause a pandemic when the infectious agent manages to spread globally. The first major pandemic to appear in the 20th century was the influenza pandemic of 1918, caused by the influenza A H1N1 strain that is characterized by a high fatality rate. Another major pandemic was caused by the human immunodeficiency virus (HIV), that started early in the 20th century and remained undetected until 1981. The ongoing HIV pandemic demonstrated a high mortality and morbidity rate, with discrepant impacts in different regions around the globe. The most recent major pandemic event, is the ongoing pandemic of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has caused over 5.7 million deaths since its emergence, 2 years ago. The aim of this work is to highlight the main determinants of the emergence, epidemic response and available countermeasures of these three pandemics, as we argue that such knowledge is paramount to prepare for the next pandemic. We analyse these pandemics’ historical and epidemiological contexts and the determinants of their emergence. Furthermore, we compare pharmaceutical and non-pharmaceutical interventions that have been used to slow down these three pandemics and zoom in on the technological advances that were made in the progress. Finally, we discuss the evolution of epidemiological modelling, that has become an essential tool to support public health policy making and discuss it in the context of these three pandemics. While these pandemics are caused by distinct viruses, that ignited in different time periods and in different regions of the globe, our work shows that many of the determinants of their emergence and countermeasures used to halt transmission were common. Therefore, it is important to further improve and optimize such approaches and adapt it to future threatening emerging infectious diseases.
Collapse
Affiliation(s)
- Mafalda N S Miranda
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical/Universidade Nova de Lisboa (IHMT/UNL), Lisboa, Portugal
| | - Marta Pingarilho
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical/Universidade Nova de Lisboa (IHMT/UNL), Lisboa, Portugal
| | - Victor Pimentel
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical/Universidade Nova de Lisboa (IHMT/UNL), Lisboa, Portugal
| | - Andrea Torneri
- Artificial Intelligence Lab, Department of Computer Science, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sofia G Seabra
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical/Universidade Nova de Lisboa (IHMT/UNL), Lisboa, Portugal
| | - Pieter J K Libin
- Artificial Intelligence Lab, Department of Computer Science, Vrije Universiteit Brussel, Brussels, Belgium.,Interuniversity Institute of Biostatistics and Statistical Bioinformatics, Data Science Institute, Hasselt University, Hasselt, Belgium.,Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, University of Leuven, Leuven, Belgium
| | - Ana B Abecasis
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical/Universidade Nova de Lisboa (IHMT/UNL), Lisboa, Portugal
| |
Collapse
|
49
|
Crowell TA, Nitayaphan S, Sirisopana N, Wansom T, Kitsiripornchai S, Francisco L, Li Q, Dear N, O'Connell RJ, Pitisuttithum P, Vasan S. Factors associated with testing for HIV and other sexually transmitted infections in men who have sex with men and transgender women in Bangkok, Thailand. AIDS Res Ther 2022; 19:25. [PMID: 35729561 PMCID: PMC9210729 DOI: 10.1186/s12981-022-00449-0] [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: 08/28/2021] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Routine screening for HIV and other sexually transmitted infections (STIs) facilitates early diagnosis and treatment, thereby preventing morbidity and onward transmission. We estimated the prevalence of prior HIV/STI testing among men who have sex with men (MSM) and transgender women (TGW) in Bangkok, Thailand, and identified factors associated with prior testing. Methods Cross-sectional analyses were performed using data collected at enrollment into an HIV incidence cohort. From April to October 2017, MSM and TGW were enrolled if they were aged 18–35 years, reported anal intercourse with a male or TGW partner, and reported behavioral vulnerability to HIV. Participants answered questions about demographics, sexual behaviors, and lifetime HIV/STI testing history. Multivariable robust Poisson regression was used to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for factors potentially associated with prior testing. Results Among 1,014 participants, 348 (34.3%) were TGW and the median age was 21.6 (interquartile range 20.0-24.8) years. Prior testing for HIV was reported by 421 (41.5%) and for other STIs by 268 (26.4%). HIV testing was more common among participants aged ≥ 22 years (RR 1.37 [95% CI 1.13–1.67]), with college education as compared to secondary or less (RR 1.37 [95% CI 1.08–1.72]), and who met male sexual partners online (RR 1.52 [95% CI 1.24–1.85]), but lower among participants attracted to both men and women as compared to men only (RR 0.64 [95% CI 0.51–0.81]) and who met male sexual partners in bars (RR 0.83 [95% CI 0.72–0.97]). Similar associations were observed with prior testing for other STIs, including increased testing among participants with college education (RR 1.52 [95% CI 1.11–2.09]) and who met male sexual partners online (RR 1.73 [95% CI 1.30–2.31]), but lower among participants attracted to both men and women (RR 0.70 [95% CI 0.51–0.96]) and who met male sexual partners in bars (RR 0.67 [95% CI 0.54–0.83]). Conclusions Despite behavioral vulnerability, prior testing for HIV and other STIs was uncommon. Online engagement strategies may be effectively reaching Thai MSM and TGW who meet sexual partners online, but new interventions are needed to encourage testing among younger, less educated, and bisexual MSM and TGW.
Collapse
Affiliation(s)
- Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA. .,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
| | | | | | - Tanyaporn Wansom
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.,Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.,Dreamlopments Social Enterprise and Foundation, Bangkok, Thailand
| | | | - Leilani Francisco
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Qun Li
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Nicole Dear
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Robert J O'Connell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | | | - Sandhya Vasan
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | | |
Collapse
|
50
|
Hu LI, Stohl EA, Seifert HS. The Neisseria gonorrhoeae type IV pilus promotes resistance to hydrogen peroxide- and LL-37-mediated killing by modulating the availability of intracellular, labile iron. PLoS Pathog 2022; 18:e1010561. [PMID: 35714158 PMCID: PMC9246397 DOI: 10.1371/journal.ppat.1010561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 06/30/2022] [Accepted: 04/29/2022] [Indexed: 11/20/2022] Open
Abstract
The Neisseria gonorrhoeae Type IV pilus is a multifunctional, dynamic fiber involved in host cell attachment, DNA transformation, and twitching motility. We previously reported that the N. gonorrhoeae pilus is also required for resistance against hydrogen peroxide-, antimicrobial peptide LL-37-, and non-oxidative, neutrophil-mediated killing. We tested whether the hydrogen peroxide, LL-37, and neutrophil hypersensitivity phenotypes in non-piliated N. gonorrhoeae could be due to elevated iron levels. Iron chelation in the growth medium rescued a nonpiliated pilE mutant from both hydrogen peroxide- and antimicrobial peptide LL-37-mediated killing, suggesting these phenotypes are related to iron availability. We used the antibiotic streptonigrin, which depends on free cytoplasmic iron and oxidation to kill bacteria, to determine whether piliation affected intracellular iron levels. Several non-piliated, loss-of-function mutants were more sensitive to streptonigrin killing than the piliated parental strain. Consistent with the idea that higher available iron levels in the under- and non-piliated strains were responsible for the higher streptonigrin sensitivity, iron limitation by desferal chelation restored resistance to streptonigrin in these strains and the addition of iron restored the sensitivity to streptonigrin killing. The antioxidants tiron and dimethylthiourea rescued the pilE mutant from streptonigrin-mediated killing, suggesting that the elevated labile iron pool in non-piliated bacteria leads to streptonigrin-dependent reactive oxygen species production. These antioxidants did not affect LL-37-mediated killing. We confirmed that the pilE mutant is not more sensitive to other antibiotics showing that the streptonigrin phenotypes are not due to general bacterial envelope disruption. The total iron content of the cell was unaltered by piliation when measured using ICP-MS suggesting that only the labile iron pool is affected by piliation. These results support the hypothesis that piliation state affects N. gonorrhoeae iron homeostasis and influences sensitivity to various host-derived antimicrobial agents. Neisseria gonorrhoeae is a bacterium that causes the sexually transmitted infection, gonorrhea. The bacteria express a fiber on their surface called a pilus that mediates many interactions of the bacterial cell with host cells and tissues. The ability to resist killing by white cells is one important ability that N. gonorrhoeae uses to allow infection of otherwise healthy people. We show here that the pilus help resist white cell killing by modulating the levels of iron within the bacterial cell.
Collapse
Affiliation(s)
- Linda I. Hu
- Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Elizabeth A. Stohl
- Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - H Steven Seifert
- Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- * E-mail:
| |
Collapse
|