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Guiraud V, Beaulieu Q, Fauchois A, Jean-Charles P, Costes MC, Labousse BL, Gautheret-Dejean PA. Rapid tests should be used with caution for HIV-1 primary infection screening. Med Microbiol Immunol 2024; 213:10. [PMID: 38907945 DOI: 10.1007/s00430-024-00792-1] [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: 12/04/2023] [Accepted: 06/05/2024] [Indexed: 06/24/2024]
Abstract
Rapid tests allow outpatient, low cost, reliable, screening for chronic HIV infection. However, data regarding their sensitivity on primary infection remain scarce. The objective of this study was to assess sensitivity of nine HIV rapid tests for primary HIV-1 infection screening. Seventy-five serum samples from patients during HIV-1 primary infection were included. Primary infection was diagnosed by a positive 4th generation ELISA and HIV-1 RNA positivity confirmed by Western blot patterns associated with HIV-1 primary infection. Early seroconversion was defined as the absence of antibodies on HIV-1 Western blot associated with HIV-1 RNA and p24-antigen positivity. An identical sensitivity (95% CI) of 76.7% (65.2-84.2%) was observed for HIV 1/2 STAT-PAK® Assay (STAT-PAK), INSTI™ HIV-1/HIV-2 antibody Test (INSTI), SURE CHECK® HIV 1/2 (SURE CHECK) and MULTISURE HIV rapid test (MULTISURE) with visual reading. Sensitivity was 74.7% (63.8-83.1%) for MULTISURE (automatic reading), 77.0% (66.3-85.1%) for FIRST RESPONSE® Test VIH 1-2.O CARTE (FIRST RESPONSE), 83.8% (73.8-90.5%) for VIKIA HIV1/2® (VIKIA), 88.0% (78.7-93.6%) for Genie™ Fast HIV 1/2 (Genie Fast), 88.6% (79.0-94.1%) for Hexagon HIV (Hexagon), and 92.8% (83.6-96.3%) for Exacto® TEST HIV Pro (Exacto). However, rapid tests performed poorly for the early seroconversion subgroup (n = 14), with sensitivities ranging from 7% (1.3-31.5%) for STAT-PAK, INSTI, SURE CHECK, MULTISURE (automatic reading), to 29% (12-55%) for FIRST RESPONSE, 31% (13-58%) for VIKIA, 43% (21-67%) for Hexagon and 57.1% (32.6-78.6%) for Exacto and Genie Fast. Overall, despite significant discrepancies in sensitivity, HIV rapid tests should be used with caution in the context of a suspected primary infection.
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Affiliation(s)
- Vincent Guiraud
- Service de Virologie, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Paris, F- 75013, France
| | - Quentin Beaulieu
- Service de Virologie, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Paris, F- 75013, France
| | - Antoine Fauchois
- Service de Virologie, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Paris, F- 75013, France
| | - Pascale Jean-Charles
- Service de Virologie, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Paris, F- 75013, France
| | - Marie-Capucine Costes
- Service de Virologie, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Paris, F- 75013, France
| | - Bruno Le Labousse
- Service de Virologie, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Paris, F- 75013, France
| | - Pr Agnès Gautheret-Dejean
- Service de Virologie, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Paris, F- 75013, France.
- Université Paris cité, INSERM UMR-S 1139 Physiopathologie et pharmacotoxicologie placentaire humaine : microbiote pré & post-natal, Paris, F-75006, France.
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2
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Allen LI, Fraser H, Stone J, McAuley A, Trayner KMA, Metcalfe R, Peters SE, Hutchinson SJ, Vickerman P, Hickman M. Testing and Treatment Interventions in Community Settings Key to Controlling a Recent Human Immunodeficiency Virus Outbreak Among People Who Inject Drugs in Glasgow: A Modeling Study. J Infect Dis 2024; 230:jiae206. [PMID: 38775628 PMCID: PMC11272080 DOI: 10.1093/infdis/jiae206] [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: 01/10/2024] [Accepted: 04/18/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND A human immunodeficiency virus (HIV) outbreak was identified among people who inject drugs (PWID) in Glasgow in 2015, with >150 diagnoses by the end of 2019. The outbreak response involved scaling up HIV testing and improving HIV treatment initiation and retention. METHODS We parameterized and calibrated a dynamic, deterministic model of HIV transmission among PWID in Glasgow to epidemiological data. We use this model to evaluate HIV testing and treatment interventions. We present results in terms of relative changes in HIV prevalence, incidence, and cases averted. RESULTS If the improvements in both testing and treatment had not occurred, we predict that HIV prevalence would have reached 17.8% (95% credible interval [CrI], 14.1%-22.6%) by the beginning of 2020, compared to 5.9% (95% CrI, 4.7%-7.4%) with the improvements. If the improvements had been made on detection of the outbreak in 2015, we predict that peak incidence would have been 26.2% (95% CrI, 8.8%-49.3%) lower and 62.7% (95% CrI, 43.6%-76.6%) of the outbreak cases could have been averted. The outbreak could have been avoided if the improvements had already been in place. CONCLUSIONS Our modeling suggests that the HIV testing and treatment interventions successfully brought the HIV outbreak in Glasgow under control by the beginning of 2020.
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Affiliation(s)
- Lara I Allen
- Population Health Sciences, Bristol Medical School, University of Bristol
- Clinical and Protecting Health Directorate, Public Health Scotland
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol
| | - Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol
| | - Andrew McAuley
- Clinical and Protecting Health Directorate, Public Health Scotland
- School of Health and Life Sciences, Glasgow Caledonian University
| | - Kirsten M A Trayner
- Clinical and Protecting Health Directorate, Public Health Scotland
- School of Health and Life Sciences, Glasgow Caledonian University
| | - Rebecca Metcalfe
- School of Health and Life Sciences, Glasgow Caledonian University
- Sandyford Sexual Health Service, National Health Service Greater Glasgow and Clyde
| | - S Erica Peters
- Brownlee Centre for Infectious Diseases, National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Sharon J Hutchinson
- Clinical and Protecting Health Directorate, Public Health Scotland
- School of Health and Life Sciences, Glasgow Caledonian University
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol
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Buzanelo Machado M, Oliveira VDC, Amadio Domingues PC, Maciel Monteiro R, Pereira Dos Santos A, Lazarini Bim L, de Andrade D, Watanabe E. Unveiling the efficacy of latex gloves in preventing viral infections during needlestick injuries: An in vitro mixed-methods study. Infect Dis Health 2024; 29:65-72. [PMID: 38368141 DOI: 10.1016/j.idh.2023.10.001] [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: 07/08/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 02/19/2024]
Abstract
BACKGROUND Gloves are personal protective equipment designed to prevent contamination and reduce the spread of microorganisms. This study aimed to assess in vitro the physical integrity of latex gloves and the retention of biological contamination in healthcare simulation. METHOD Three different batches of latex procedure gloves from five different brands and specific batches were evaluated before use for physical integrity by the standard protocols of the Society for Testing and Materials (ASTM) and of the American Food and Drug Administration (FDA). Moreover, the retention of biological contamination by latex procedure gloves in needlestick injury simulation with crystal violet and bacteriophages were applied in order to mimic human blood and virus presence. RESULTS Brands D and C showed the best and worst results in the immediate inspections and after 2 min, respectively. For Brand C, damage occurred in one finger/region in a total of 12 gloves, while seven gloves were damaged/unable to be worn. Brand D presented only two gloves with tears and/or holes in one finger/region. Regarding the viral contamination, in a simulated needlestick injury, data showed no significant difference among the groups. CONCLUSION All glove brands presented physical damage that might affect the spread of microorganisms. The gloves did not exert an additional protective effect during a needlestick injury simulation in accordance with the two techniques used in this study.
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Affiliation(s)
- Marinila Buzanelo Machado
- Human Exposome and Infectious Diseases Network (HEID), Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Viviane de Cássia Oliveira
- Human Exposome and Infectious Diseases Network (HEID), Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, SP, Brazil; Department of Dental Materials and Prosthodontics, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Pedro Castania Amadio Domingues
- Human Exposome and Infectious Diseases Network (HEID), Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Rachel Maciel Monteiro
- Human Exposome and Infectious Diseases Network (HEID), Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, SP, Brazil; Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - André Pereira Dos Santos
- Human Exposome and Infectious Diseases Network (HEID), Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Lucas Lazarini Bim
- Human Exposome and Infectious Diseases Network (HEID), Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Denise de Andrade
- Human Exposome and Infectious Diseases Network (HEID), Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Evandro Watanabe
- Human Exposome and Infectious Diseases Network (HEID), School of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil; Department of Restorative Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, SP, Brazil.
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4
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Rock KS, Chapman LAC, Dobson AP, Adams ER, Hollingsworth TD. The Hidden Hand of Asymptomatic Infection Hinders Control of Neglected Tropical Diseases: A Modeling Analysis. Clin Infect Dis 2024; 78:S175-S182. [PMID: 38662705 PMCID: PMC11045017 DOI: 10.1093/cid/ciae096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Neglected tropical diseases are responsible for considerable morbidity and mortality in low-income populations. International efforts have reduced their global burden, but transmission is persistent and case-finding-based interventions rarely target asymptomatic individuals. METHODS We develop a generic mathematical modeling framework for analyzing the dynamics of visceral leishmaniasis in the Indian sub-continent (VL), gambiense sleeping sickness (gHAT), and Chagas disease and use it to assess the possible contribution of asymptomatics who later develop disease (pre-symptomatics) and those who do not (non-symptomatics) to the maintenance of infection. Plausible interventions, including active screening, vector control, and reduced time to detection, are simulated for the three diseases. RESULTS We found that the high asymptomatic contribution to transmission for Chagas and gHAT and the apparently high basic reproductive number of VL may undermine long-term control. However, the ability to treat some asymptomatics for Chagas and gHAT should make them more controllable, albeit over relatively long time periods due to the slow dynamics of these diseases. For VL, the toxicity of available therapeutics means the asymptomatic population cannot currently be treated, but combining treatment of symptomatics and vector control could yield a quick reduction in transmission. CONCLUSIONS Despite the uncertainty in natural history, it appears there is already a relatively good toolbox of interventions to eliminate gHAT, and it is likely that Chagas will need improvements to diagnostics and their use to better target pre-symptomatics. The situation for VL is less clear, and model predictions could be improved by additional empirical data. However, interventions may have to improve to successfully eliminate this disease.
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Affiliation(s)
- Kat S Rock
- Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research (SBIDER), University of Warwick, Coventry, United Kingdom
- Mathematics Institute, University of Warwick, Coventry, United Kingdom
| | - Lloyd A C Chapman
- Department of Mathematics and Statistics, Lancaster University, Lancaster, United Kingdom
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andrew P Dobson
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, USA
- Santa Fe Institute, Santa Fe, New Mexico, USA
| | - Emily R Adams
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - T Déirdre Hollingsworth
- Nuffield Department of Medicine, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
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5
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Obeng BM, Kelleher AD, Di Giallonardo F. Molecular epidemiology to aid virtual elimination of HIV transmission in Australia. Virus Res 2024; 341:199310. [PMID: 38185332 PMCID: PMC10825322 DOI: 10.1016/j.virusres.2024.199310] [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: 11/03/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/09/2024]
Abstract
The Global UNAIDS 95/95/95 targets aim to increase the percentage of persons who know their HIV status, receive antiretroviral therapy, and have achieved viral suppression. Achieving these targets requires efforts to improve the public health response to increase access to care for those living with HIV, identify those yet undiagnosed with HIV early, and increase access to prevention for those most at risk of HIV acquisition. HIV infections in Australia are among the lowest globally having recorded significant declines in new diagnoses in the last decade. However, the HIV epidemic has changed with an increasing proportion of newly diagnosed infections among those born outside Australia observed in the last five years. Thus, the current prevention efforts are not enough to achieve the UNAIDS targets and virtual elimination across all population groups. We believe both are possible by including molecular epidemiology in the public health response. Molecular epidemiology methods have been crucial in the field of HIV prevention, particularly in demonstrating the efficacy of treatment as prevention. Cluster detection using molecular epidemiology can provide opportunities for the real-time detection of new outbreaks before they grow, and cluster detection programs are now part of the public health response in the USA and Canada. Here, we review what molecular epidemiology has taught us about HIV evolution and spread. We summarize how we can use this knowledge to improve public health measures by presenting case studies from the USA and Canada. We discuss the successes and challenges of current public health programs in Australia, and how we could use cluster detection as an add-on to identify gaps in current prevention measures easier and respond quicker to growing clusters. Lastly, we raise important ethical and legal challenges that need to be addressed when HIV genotypic data is used in combination with personal data.
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Affiliation(s)
- Billal M Obeng
- The Kirby Institute, University of New South Wales, Sydney, Australia
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6
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González Del Castillo J, Mirò E, Miguens I, Trenc P, Espinosa B, Piedrafita L, Pérez Elías MJ, Moreno S, García F, Villamor A, Carbó M, Gené E, Mirò Ò. Feasibility of a selective targeted strategy of HIV testing in emergency departments: a before-after study. Eur J Emerg Med 2024; 31:29-38. [PMID: 37729041 DOI: 10.1097/mej.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
BACKGROUND AND IMPORTANCE The rates of hidden infection and late diagnosis of HIV still remain high in Western countries. Missed diagnostic opportunities represent the key point in changing the course of the epidemic. OBJECTIVE To evaluate the feasibility and results of implementation of a selective strategy to test for HIV in the emergency department (ED) in patients with six pre-defined medical situations: sexually transmitted infections, herpes zoster, community-acquired pneumonia, mononucleosis syndrome, practice of chemsex (CS) or request of post-exposure prophylaxis. DESIGN This quasi-experimental longitudinal study evaluated the pre- and post-implementation results of HIV testing in the six aforementioned clinical scenarios. SETTINGS AND PARTICIPANTS Patients attended 34 Spanish EDs. INTERVENTION OR EXPOSURE The intervention was an intensive educational program and pathways to facilitate and track orders and results were designed. We collected and compared pre- and post-implementation ED census and diagnoses, and HIV tests requested and results. OUTCOME MEASURES AND ANALYSIS The main outcome was adherence to the recommendations. Secondary outcomes were to evaluate the effectiveness of the program by the rate of positive test and the new HIV diagnoses. Differences between first and second periods were assessed. The magnitude of changes (absolute and relative) was expressed with the 95% confidence interval (CI). MAIN RESULTS HIV tests increasing from 7080 (0.42% of ED visits) to 13 436 (relative increase of 75%, 95% CI from 70 to 80%). The six conditions were diagnosed in 15 879 and 16 618 patients, and HIV testing was ordered in 3393 (21%) and 7002 (42%) patients (increase: 97%; 95% CI: 90-104%). HIV testing significantly increased for all conditions except for CS. The positive HIV test rates increased from 0.92 to 1.67%. Detection of persons with undiagnosed HIV increased from 65 to 224, which implied a 220% (95% CI: 143-322%) increase of HIV diagnosis among all ED comers and a 71% (95% CI: 30-125%) increase of positive HIV tests. CONCLUSION Implementation of a strategy to test for HIV in selective clinical situations in the ED is feasible and may lead to a substantial increase in HIV testing and diagnoses.
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Affiliation(s)
- Juan González Del Castillo
- Emergency Department, Instituto de Investigación Sanitaria (IdISSC), Hospital Clínico San Carlos, Madrid
| | | | - Iria Miguens
- Emergency Department, Hospital Universitario Gregorio Marañon, Madrid
| | - Patricia Trenc
- Emergency Department, Hospital Universitario Miguel Servet, Zaragoza
| | - Begoña Espinosa
- Emergency Department, Hospital General Universitario de Alicante Dr. Blamis. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante
| | | | - María Jesús Pérez Elías
- Servicio de Enfermedades Infecciosas. Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, CIBERINFECC, Madrid
| | - Santiago Moreno
- Servicio de Enfermedades Infecciosas. Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, CIBERINFECC, Madrid
| | - Federico García
- Servicio de Microbiología Clínica. Hospital Universitario Clínico San Cecilio, Granada
| | | | - Míriam Carbó
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona
| | - Emili Gené
- Servicio de Urgencias, Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - Òscar Mirò
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona
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Cafaro A, Schietroma I, Sernicola L, Belli R, Campagna M, Mancini F, Farcomeni S, Pavone-Cossut MR, Borsetti A, Monini P, Ensoli B. Role of HIV-1 Tat Protein Interactions with Host Receptors in HIV Infection and Pathogenesis. Int J Mol Sci 2024; 25:1704. [PMID: 38338977 PMCID: PMC10855115 DOI: 10.3390/ijms25031704] [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: 12/30/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Each time the virus starts a new round of expression/replication, even under effective antiretroviral therapy (ART), the transactivator of viral transcription Tat is one of the first HIV-1 protein to be produced, as it is strictly required for HIV replication and spreading. At this stage, most of the Tat protein exits infected cells, accumulates in the extracellular matrix and exerts profound effects on both the virus and neighbor cells, mostly of the innate and adaptive immune systems. Through these effects, extracellular Tat contributes to the acquisition of infection, spreading and progression to AIDS in untreated patients, or to non-AIDS co-morbidities in ART-treated individuals, who experience inflammation and immune activation despite virus suppression. Here, we review the role of extracellular Tat in both the virus life cycle and on cells of the innate and adaptive immune system, and we provide epidemiological and experimental evidence of the importance of targeting Tat to block residual HIV expression and replication. Finally, we briefly review vaccine studies showing that a therapeutic Tat vaccine intensifies ART, while its inclusion in a preventative vaccine may blunt escape from neutralizing antibodies and block early events in HIV acquisition.
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Affiliation(s)
- Aurelio Cafaro
- National HIV/AIDS Research Center, Istituto Superiore di Sanità, 00161 Rome, Italy; (I.S.); (L.S.); (R.B.); (M.C.); (F.M.); (S.F.); (M.R.P.-C.); (A.B.); (P.M.)
| | | | | | | | | | | | | | | | | | | | - Barbara Ensoli
- National HIV/AIDS Research Center, Istituto Superiore di Sanità, 00161 Rome, Italy; (I.S.); (L.S.); (R.B.); (M.C.); (F.M.); (S.F.); (M.R.P.-C.); (A.B.); (P.M.)
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8
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Parsons TL, Bolker BM, Dushoff J, Earn DJD. The probability of epidemic burnout in the stochastic SIR model with vital dynamics. Proc Natl Acad Sci U S A 2024; 121:e2313708120. [PMID: 38277438 PMCID: PMC10835029 DOI: 10.1073/pnas.2313708120] [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: 08/09/2023] [Accepted: 11/17/2023] [Indexed: 01/28/2024] Open
Abstract
We present an approach to computing the probability of epidemic "burnout," i.e., the probability that a newly emergent pathogen will go extinct after a major epidemic. Our analysis is based on the standard stochastic formulation of the Susceptible-Infectious-Removed (SIR) epidemic model including host demography (births and deaths) and corresponds to the standard SIR ordinary differential equations (ODEs) in the infinite population limit. Exploiting a boundary layer approximation to the ODEs and a birth-death process approximation to the stochastic dynamics within the boundary layer, we derive convenient, fully analytical approximations for the burnout probability. We demonstrate-by comparing with computationally demanding individual-based stochastic simulations and with semi-analytical approximations derived previously-that our fully analytical approximations are highly accurate for biologically plausible parameters. We show that the probability of burnout always decreases with increased mean infectious period. However, for typical biological parameters, there is a relevant local minimum in the probability of persistence as a function of the basic reproduction number [Formula: see text]. For the shortest infectious periods, persistence is least likely if [Formula: see text]; for longer infectious periods, the minimum point decreases to [Formula: see text]. For typical acute immunizing infections in human populations of realistic size, our analysis of the SIR model shows that burnout is almost certain in a well-mixed population, implying that susceptible recruitment through births is insufficient on its own to explain disease persistence.
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Affiliation(s)
- Todd L. Parsons
- Laboratoire de Probabilités, Statistique et Modélisation, Sorbonne Université, CNRS UMR 8001, Paris75005, France
| | - Benjamin M. Bolker
- Department of Biology, McMaster University, Hamilton, OntarioL8S 4K1, Canada
- Department of Mathematics & Statistics, McMaster University, Hamilton, OntarioL8S 4K1, Canada
| | - Jonathan Dushoff
- Department of Biology, McMaster University, Hamilton, OntarioL8S 4K1, Canada
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, OntarioL8S 4K1, Canada
| | - David J. D. Earn
- Department of Mathematics & Statistics, McMaster University, Hamilton, OntarioL8S 4K1, Canada
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, OntarioL8S 4K1, Canada
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9
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Alonso D, Vallès X. A potential transition from a concentrated to a generalized HIV epidemic: the case of Madagascar. Infect Dis Poverty 2023; 12:112. [PMID: 38057918 DOI: 10.1186/s40249-023-01164-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND HIV expansion is controlled by a range of interrelated factors, including the natural history of HIV infection and socio-economical and structural factors. However, how they dynamically interact in particular contexts to drive a transition from concentrated HIV epidemics in vulnerable groups to generalized epidemics is poorly understood. We aim to explore these mechanisms, using Madagascar as a case-study. METHODS We developed a compartmental dynamic model using available data from Madagascar, a country with a contrasting concentrated epidemic, to explore the interaction between these factors with special consideration of commercial and transactional sex as HIV-infection drivers. RESULTS The model predicts sigmoidal-like prevalence curves with turning points within years 2020-2022, and prevalence reaching stabilization by 2033 within 9 to 24% in the studied (10 out of 11) cities, similar to high-prevalence regions in Southern Africa. The late/slow introduction of HIV and circumcision, a widespread traditional practice in Madagascar, could have slowed down HIV propagation, but, given the key interplay between risky behaviors associated to young women and acute infections prevalence, mediated by transactional sex, the protective effect of circumcision is currently insufficient to contain the expansion of the disease in Madagascar. CONCLUSIONS These results suggest that Madagascar may be experiencing a silent transition from a concentrated to a generalized HIV epidemic. This case-study model could help to understand how this HIV epidemic transition occurs.
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Affiliation(s)
- David Alonso
- Computational and Theoretical Ecology, Spanish Council for Scientific Research (CEAB-CSI)C, C/Access Cala Francesc, 14, 17300, Blanes, Spain
| | - Xavier Vallès
- International Health Program (PROSICS), North Metropolitan Health Area From Barcelona, Hospital Universitari Germans Trias i Pujol, Passatge dels Encants, s/n, 08914, Badalona, Catalonia, Spain.
- Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, C/Canyet s/n, 08916, Badalona, Spain.
- Fundació Lluita contra les Infeccions, C/Canyet s/n, 08916, Badalona, Spain.
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10
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Bruzzesi E, Gabrieli A, Bernasconi D, Marchetti G, Calcagno A, Ripamonti D, Antinori A, Squillace N, Cingolani A, Muscatello A, Bandera A, Gori A, Rusconi S, Nozza S. HIV-DNA decrease during treatment in primary HIV-1 infection with three different drug regimens: Italian Network of Acute HIV Infection (INACTION) clinical trial. J Med Virol 2023; 95:e29114. [PMID: 37752816 DOI: 10.1002/jmv.29114] [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: 04/17/2023] [Revised: 09/06/2023] [Accepted: 09/10/2023] [Indexed: 09/28/2023]
Abstract
As the introduction of antiretroviral therapy (ART) during primary HIV-1 infection (PHI) could restrict the establishment of HIV reservoirs, we aimed to assess the effect of three different ART regimens on HIV-DNA load in people living with HIV (PLWH), who started ART in PHI. Randomized, open-label, multicentric study, including subjects in PHI (defined as an incomplete HIV-1 Western blot and detectable plasma HIV-RNA) in the Italian Network of Acute HIV Infection cohort. Participants were randomly assigned (10:10:8) to a fixed-dose combination of tenofovir alafenamide fumarate (TAF) 10 mg plus emtricitabine (FTC) 200 mg, darunavir 800 mg, and cobicistat 150 mg once daily (group A), or TAF 25 mg plus FTC 200 mg, dolutegravir 50 mg once daily (group B), or an intensified four-drug regimen (TAF 10 mg plus FTC 200 mg, dolutegravir 50 mg, darunavir 800 mg, and cobicistat 150 mg once daily) (group C). The primary endpoint was the decrease of HIV-DNA copies/106 peripheral blood mononuclear cells (PBMCs) at weeks (W) 12 and 48. Secondary endpoints were increased in CD4+ cells and in CD4+/CD8+ ratio and percentage of PLWH reaching undetectable HIV-RNA. HIV-DNA was quantified by Droplet Digital PCR (Biorad QX100) and normalized to RPP30 reference gene. This study was registered in ClinicalTrials.gov (number NCT04225325). Among 78 participants enrolled, 30 were randomized to group 1, 28 to group 2, and 20 to group 3. At baseline, median CD4+ count was 658/µL (476-790), HIV-RNA 5.37 (4.38, 6.12) log10 copies/mL, without statistical difference in their change among groups at weeks 12 and 48 (p = 0.432 and 0.234, respectively). The trial was prematurely discontinued for slow accrual and for COVID-19 pandemic-associated restrictions. In the per-protocol analysis, PLWH (n = 72) with undetectable viral load was 54.3% at W12 and 86.4% at W48. Interestingly, the CD4/CD8 ratio progressively increased over time, up to normalization in almost half of the cohort by week 48, despite a deflection in group 3; no difference was observed by the Fiebig stage (I-III vs. IV-VI). HIV-DNA decreased from 4.46 (4.08, 4.81) log10 copies/106 PBMCs to 4.22 (3.79, 4.49) at week 12, and 3.87 (3.46, 4.34) at week 48, without difference among groups. At multivariable analysis, HIV-DNA delta at W48 was associated only with the increase of CD4+ count by 100 cells/mm3 but not with the Fiebig stage, the CD4+/CD8+ ratio, and treatment arm, despite a higher decrease in group 3. Six adverse events were recorded during our study, which did not cause any withdrawal from the study. We observed a decrease in HIV-DNA from baseline to W48 in PLWH treated during PHI, associated with an increase in CD4+ count, unrelated to the treatment arm.
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Affiliation(s)
| | - Arianna Gabrieli
- Dipartimento di Scienze Biomediche e Cliniche (DIBIC), Milan, Italy
| | - Davide Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4 School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giulia Marchetti
- Clinic of Infectious Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
- School of Medicine and Surgery, University of Milan, Milan, Italy
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Diego Ripamonti
- Infectious Disease Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Nicola Squillace
- Infectious Disease Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Antonella Cingolani
- Istituto Clinica di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Muscatello
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Alessandra Bandera
- School of Medicine and Surgery, University of Milan, Milan, Italy
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Andrea Gori
- School of Medicine and Surgery, University of Milan, Milan, Italy
| | - Stefano Rusconi
- School of Medicine and Surgery, University of Milan, Milan, Italy
- SC Malattie Infettive, Ospedale di Legnano, ASST Ovest Milanese, Legnano, Italy
| | - Silvia Nozza
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases Unit, IRCCS Ospedale San Raffaele, Milan, Italy
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11
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Guzauskas GF, Hallett TB. The long-term impact and value of curative therapy for HIV: a modelling analysis. J Int AIDS Soc 2023; 26:e26170. [PMID: 37749063 PMCID: PMC10519941 DOI: 10.1002/jia2.26170] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 08/28/2023] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION Curative therapies (CTx) to achieve durable remission of HIV disease without the need for antiretroviral therapy (ART) are currently being explored. Our objective was to model the long-term health and cost outcomes of HIV in various countries, the impact of future CTx on those outcomes and the country-specific value-based prices (VBPs) of CTx. METHODS We developed a decision-analytic model to estimate the future health economic impacts of a hypothetical CTx for HIV in countries with pre-existing access to ART (CTx+ART), compared to ART alone. We modelled populations in seven low-and-middle-income countries and five high-income countries, accounting for localized ART and other HIV-related costs, and calibrating variables for HIV epidemiology and ART uptake to reproduce historical HIV outcomes before projecting future outcomes to year 2100. Health was quantified using disability-adjusted life-years (DALYs). Base case, pessimistic and optimistic scenarios were modelled for CTx+ART and ART alone. Based on long-term outcomes and each country's estimated health opportunity cost, we calculated the country-specific VBP of CTx. RESULTS The introduction of a hypothetical CTx lowered HIV prevalence and prevented future infections over time, which increased life-years, reduced the number of individuals on ART, reduced AIDS-related deaths, and ultimately led to fewer DALYs versus ART-alone. Our base case estimates for the VBP of CTx ranged from $5400 (Kenya) up to $812,300 (United States). Within each country, the VBP was driven to be greater primarily by lower ART coverage, lower HIV incidence and prevalence, and higher CTx cure probability. The VBP estimates were found to be greater in countries where HIV prevalence was higher, ART coverage was lower and the health opportunity cost was greater. CONCLUSIONS Our results quantify the VBP for future curative CTx that may apply in different countries and under different circumstances. With greater CTx cure probability, durability and scale up, CTx commands a higher VBP, while improvements in ART coverage may mitigate its value. Our framework can be utilized for estimating this cost given a wide range of scenarios related to the attributes of a given CTx as well as various parameters of the HIV epidemic within a given country.
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Affiliation(s)
- Gregory F Guzauskas
- The Comparative Health Outcomes, Policy, and Economics Institute, Department of Pharmacy, University of Washington, Seattle, Washington, USA
- HCD Economics, Daresbury, UK
| | - Timothy B Hallett
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
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12
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Shaikh N, Swali P, Houben RMGJ. Asymptomatic but infectious - The silent driver of pathogen transmission. A pragmatic review. Epidemics 2023; 44:100704. [PMID: 37413887 PMCID: PMC10260263 DOI: 10.1016/j.epidem.2023.100704] [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: 05/22/2022] [Revised: 05/29/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023] Open
Abstract
Throughout 2020, COVID-19 interventions prioritised symptomatic individuals despite growing evidence of pre-symptomatic and asymptomatic transmission. From the pandemic we have learned that global health is slow to quantify asymptomatic disease transmission and slow to implement relevant interventions. While asymptomatic infectious periods exist for nearly all pathogens, it is frequently ignored during case finding, and there are limited research efforts to understand its potential to drive small scale outbreaks, epidemics and pandemics. We conducted a pragmatic review on 15 key pathogens including SARS-CoV-2 and Ebola to demonstrate substantial variation in terminology around asymptomatic infectious individuals, and varying proportions of asymptomatic amongst prevalent infectious cases (0-99 %) and their contribution to transmission (0-96 %). While no pattern was discernible by pathogen type (virus, bacteria, parasite) or mode of transmission (direct, indirect or mixed), there are multiple lessons to learn from previous and current control programmes. As found during the COVID-19 pandemic, overlooking asymptomatic infectious individuals can impede disease control. Improving our understanding of how asymptomatic individuals can drive epidemics can strengthen our efforts to control current pathogens, and improve our preparedness for when the next new pathogen emerges..
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Affiliation(s)
- Nabila Shaikh
- TB Modelling Group, TB Centre, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom; Sanofi Pasteur, 410 Thames Valley Park Drive, Reading RG6 1PT, United Kingdom.
| | - Pooja Swali
- Ancient Genomics Laboratory, The Francis Crick Institute, 1 Midland Road, London NW11AT, United Kingdom
| | - Rein M G J Houben
- TB Modelling Group, TB Centre, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
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13
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Su X, Xia D, Sun Y, Hao Y, Liu G, Huang C, Lu H. A novel internet sampling for HIV surveillance: feasibility of self-sampling and preparation of DBS for delivery detection of HIV total nucleic acid and complementarity to sentinel surveillance. BMC Infect Dis 2023; 23:509. [PMID: 37542229 PMCID: PMC10401770 DOI: 10.1186/s12879-023-08456-w] [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: 03/30/2023] [Accepted: 07/10/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND To propose a new mode of HIV test and surveillance among population of men who have sex with men (MSM): Internet-based Self-sampling at home plus Laboratory testing of HIV total nucleic acid (TNA) in dried blood spot (DBS) (ISL of DBS TNA). Feasibility of ISL of DBS TNA was studied. Characteristics of the new mode and that of conventional surveillance mode at HIV voluntary counseling and testing clinic (VCT) were compared. METHODS A non-governmental organization (NGO) published the recruitment information on the WeChat public account. MSM filled in the questionnaire online, applied for self-sampling service package, and mailed the self made DBS to professional laboratory. The laboratory performed HIV TNA test and submitted the test results to online platform. Participants queried test results online with their unique ID. Center for Disease Control and Prevention (CDC) followed up participants with positive nucleic acid results using IDs and contact information. Rates were compared by using the Chi-Square test or Fisher's exact test. RESULTS Four hundred twenty-three questionnaires were completed. 423 self-sampling service packages were sent out and 340 DBSs were returned to professional laboratory within one month with qualified rate of sampling as high as 95.0% (323/340). Seven samples were found to be TNA positive. Comparing ISL of DBS TNA with sentinel surveillance, it was found that there was a significant difference in the composition ratio of the two modes of surveillance population (P < 0.05). HIV prevalence of ISL of DBS as 2.17% was significantly lower than sentinel site as 8.96% (χ2 = 14.953, P = 0.000 < 0.05). CONCLUSIONS ISL of DBS TNA proposed is feasible and has a high self-sampling qualification rate, good confidentiality. It is an effective supplement to routine sentinel surveillance and has important promotion value.
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Affiliation(s)
- Xueli Su
- Department of AIDS/STDs Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing, China.
| | - Dongyan Xia
- Department of AIDS/STDs Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing, China
| | - Yanming Sun
- Department of AIDS/STDs Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing, China
| | - Yinxiao Hao
- Department of AIDS/STDs Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing, China
| | - Guowu Liu
- Department of AIDS/STDs Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing, China
| | - Chun Huang
- Department of AIDS/STDs Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing, China.
| | - Hongyan Lu
- Department of AIDS/STDs Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing, China
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14
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Moso MA, Williams E, Singh KP, Lewin SR, Williamson DA. Reducing time to new HIV diagnosis: time for change in the HIV diagnostic algorithm? Pathology 2023; 55:740-742. [PMID: 36842873 DOI: 10.1016/j.pathol.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Michael A Moso
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of Microbiology, Royal Melbourne Hospital, Melbourne, Vic, Australia; Victorian Infectious Diseases Reference Laboratory (VIDRL) at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia.
| | - Eloise Williams
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Victorian Infectious Diseases Reference Laboratory (VIDRL) at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - Kasha P Singh
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - Sharon R Lewin
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic, Australia
| | - Deborah A Williamson
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Victorian Infectious Diseases Reference Laboratory (VIDRL) at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
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15
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Wang Z, Chan PSF, Xin M, Fang Y, Chidgey A, Yu FY, Ip M, Chen S, Mo PKH. An Online Intervention Promoting HIV Testing Service Utilization Among Chinese men who have sex with men During the COVID-19 Pandemic: A quasi-experimental Study. AIDS Behav 2023:10.1007/s10461-023-04100-5. [PMID: 37284925 DOI: 10.1007/s10461-023-04100-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/08/2023]
Abstract
The COVID-19 pandemic created disruptions in HIV testing service utilization among men who have sex with men (MSM). The present study was to evaluate the effectiveness of an online health promotion program implemented by a community-based organization (CBO) in increasing the uptake of any type of HIV testing and home-based HIV self-testing (HIVST) over a six-month follow-up period. Participants of an observational prospective cohort study conducted during the same period served as the comparison group. This study was conducted between September 2020 and December 2021. Participants were Chinese-speaking adult MSM who were HIV-negative/unknown sero-status recruited through multiple sources in Hong Kong, China. Participants in the intervention group were exposed to the following health promotion components: (1) viewing an online video promoting HIVST, (2) visiting the project webpage, and (3) having access to a chargeable HIVST service implemented by the CBO. Among 400 and 412 participants in the intervention group and the comparison group, 349 (87.3%) and 298 (72.3%) completed follow-up evaluation at Month 6. Multiple imputation was used to replace missing values. At Month 6, participants in the intervention group reported significantly higher uptake of any type of HIV testing (57.0% versus 49.0%, adjusted odds ratios [AOR]: 1.43, p = .03) and HIVST (25.8% versus 14.8%, AOR: 2.04, p = .001), as compared to those in the comparison group. Process evaluation of the health promotion components for the intervention group was positive. Promoting HIVST is a potentially useful strategy to increase HIV testing service utilization among Chinese MSM during the pandemic.
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Affiliation(s)
- Zixin Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China.
| | - Paul Shing-Fong Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China
| | - Meiqi Xin
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, the Hong Kong Polytechnic University, Hong Kong, China
| | - Yuan Fang
- Department of Health and Physical Education, the Education University of Hong Kong, Hong Kong, China
| | | | - Fuk-Yuen Yu
- JC School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China
| | - Mary Ip
- JC School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China
| | - Siyu Chen
- JC School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China
| | - Phoenix K H Mo
- JC School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China.
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16
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Bouman JA, Venner CM, Walker C, Arts EJ, Regoes RR. Per-pathogen virulence of HIV-1 subtypes A, C and D. Proc Biol Sci 2023; 290:20222572. [PMID: 37161335 PMCID: PMC10170192 DOI: 10.1098/rspb.2022.2572] [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: 05/11/2023] Open
Abstract
HIV-1 subtypes differ in their clinical manifestations and the speed in which they spread. In particular, the frequency of subtype C is increasing relative to subtypes A and D. We investigate whether HIV-1 subtypes A, C and D differ in their per-pathogen virulence and to what extend this explains the difference in spread between these subtypes. We use data from the hormonal contraception and HIV-1 genital shedding and disease progression among women with primary HIV infection study. For each study participant, we determine the set-point viral load value, CD4+ T cell level after primary infection and CD4+ T cell decline. Based on both the CD4+ T cell count after primary infection and CD4+ T cell decline, we estimate the time until AIDS. We then obtain our newly introduced measure of virulence as the inverse of the estimated time until AIDS. After fitting a model to the measured virulence and set-point viral load values, we tested if this relation varies per subtype. We found that subtype C has a significantly higher per-pathogen virulence than subtype A. Based on an evolutionary model, we then hypothesize that differences in the primary length of infection period cause the observed variation in the speed of spread of the subtypes.
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Affiliation(s)
- Judith A Bouman
- Institute of Integrative Biology, ETH Zurich, 8092 Zurich, Switzerland
| | - Colin M Venner
- Department of Microbiology and Immunology, Western University, London, Ontario N6A 3K7, Canada
| | - Courtney Walker
- Department of Microbiology and Immunology, Western University, London, Ontario N6A 3K7, Canada
| | - Eric J Arts
- Department of Microbiology and Immunology, Western University, London, Ontario N6A 3K7, Canada
| | - Roland R Regoes
- Institute of Integrative Biology, ETH Zurich, 8092 Zurich, Switzerland
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17
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Gurski K, Hoffman K. Staged HIV transmission and treatment in a dynamic model with long-term partnerships. J Math Biol 2023; 86:74. [PMID: 37052718 PMCID: PMC10100640 DOI: 10.1007/s00285-023-01885-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 01/02/2023] [Accepted: 01/29/2023] [Indexed: 04/14/2023]
Abstract
The transmission dynamics of HIV are closely tied to the duration and overlap of sexual partnerships. We develop an autonomous population model that can account for the possibilities of an infection from either a casual sexual partner or a long-term partner who was either infected at the start of the partnership or has been newly infected since the onset of the partnership. The impact of the long-term partnerships on the rate of infection is captured by calculating the expected values of the rate of infection from these extended contacts. The model includes three stages of infectiousness: acute, chronic, and virally suppressed. We calculate HIV incidence and the fraction of new infections attributed to casual contacts and long-term partnerships allowing for variability in condom usage, the effect of achieving and maintaining viral suppression, and early intervention by beginning HAART during the acute phase of infection. We present our results using data on MSM HIV transmission from the CDC in the U.S. While the acute stage is the most infectious, the majority of the new infections will be transmitted by long-term partners in the chronic stage when condom use is infrequent as is common in long-term relationships. Time series analysis of the solution, as well as parameter sensitivity analysis, are used to determine effective intervention strategies.
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Affiliation(s)
- Katharine Gurski
- Department of Mathematics, Howard University, Washington, DC, 20059, USA.
| | - Kathleen Hoffman
- Department of Mathematics and Statistics, University of Maryland Baltimore County, Baltimore, MD, 21250, USA.
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18
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Madham S, Visshishta J, Dasagari Vinod H, S OK, Cherukuri VP. A Review of Basic Knowledge of HIV Infection for Orthodontic Management of HIV Patients. Cureus 2023; 15:e37770. [PMID: 37214076 PMCID: PMC10194426 DOI: 10.7759/cureus.37770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
Human immunodeficiency virus (HIV) is a retrovirus that causes an infection affecting immunity-providing white blood cells. The HIV pandemic is far from over and is a major socio-economical burden. As there is no cure yet, prevention of new infections is the major path to control the infection. There is a low chance of orthodontic procedures carrying a risk of HIV infection transmission. It is important to have knowledge about the disease to effectively and safely treat known or unknown patients with HIV.
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Affiliation(s)
- Saritha Madham
- Orthodontics and Dentofacial Orthopaedics, Malla Reddy Institute of Dental Sciences, Hyderabad, IND
| | - J Visshishta
- Orthodontics and Dentofacial Orthopaedics, Malla Reddy Institute of Dental Sciences, Hyderabad, IND
| | - Haritha Dasagari Vinod
- Orthodontics and Dentofacial Orthopaedics, AH Dental and Orthodontic Centre, Hyderabad, IND
| | - Ojass Kumar S
- Orthodontics and Dentofacial Orthopaedics, Malla Reddy Dental College for Women, Hyderabad, IND
| | - Vishnu Priya Cherukuri
- Orthodontics and Dentofacial Orthopaedics, MNR Dental College & Hospital, Hyderabad, IND
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19
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Stone J, Trickey A, Walker JG, Bivegete S, Semchuk N, Sazonova Y, Varetska O, Altice FL, Saliuk T, Vickerman P. Modelling the impact and cost-effectiveness of non-governmental organizations on HIV and HCV transmission among people who inject drugs in Ukraine. J Int AIDS Soc 2023; 26:e26073. [PMID: 37012669 PMCID: PMC10070931 DOI: 10.1002/jia2.26073] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 02/23/2023] [Indexed: 04/05/2023] Open
Abstract
INTRODUCTION People who inject drugs (PWID) in Ukraine have high prevalences of HIV and hepatitis C virus (HCV). Non-governmental organizations (NGOs) provide PWID with needles/syringes, condoms, HIV/HCV testing and linkage to opioid agonist treatment (OAT) and antiretroviral therapy (ART). We estimated their impact and cost-effectiveness among PWID. METHODS A dynamic HIV and HCV transmission model among PWID was calibrated using data from four national PWID surveys (2011-2017). The model assumed 37-49% coverage of NGOs among community PWID, with NGO contact reducing injecting risk and increasing condom use and recruitment onto OAT and ART. We estimated the historic (1997-2021) and future (2022-2030, compared to no NGO activities from 2022) impact of NGOs in terms of the proportion of HIV/HCV infections averted and changes in HIV/HCV incidence. We estimated the future impact of scaling-up NGOs to 80% coverage with/without scale-up in OAT (5-20%) and ART (64-81%). We estimated the cost per disability-adjusted life-year (DALY) averted of current NGO provision over 2022-2041 compared to NGO activities stopping over 2022-2026, but restarting after that till 2041. We assumed average unit costs of US$80-90 per person-year of NGO contact for PWID. RESULTS With existing coverage levels of NGOs, the model projects that NGOs have averted 20.0% (95% credibility interval: 13.3-26.1) and 9.6% (5.1-14.1) of new HIV and HCV infections among PWID over 1997-2021, respectively, and will avert 31.8% (19.6-39.9) and 13.7% (7.5-18.1) of HIV and HCV infections over 2022-2030. With NGO scale-up, HIV and HCV incidence will decrease by 54.2% (43.3-63.8) and 30.2% (20.5-36.2) over 2022-2030, or 86.7% (82.9-89.3) and 39.8% (31.4-44.8) if OAT and ART are also scaled-up. Without NGOs, HIV and HCV incidence will increase by 51.6% (23.6-76.3) and 13.4% (4.8-21.9) over 2022-2030. Current NGO provision over 2022-2026 will avert 102,736 (77,611-137,512) DALYs when tracked until 2041 (discounted 3% annually), and cost US$912 (702-1222) per DALY averted; cost-effective at a willingness-to-pay threshold of US$1548/DALY averted (0.5xGDP). CONCLUSIONS NGO activities have a crucial preventative impact among PWID in Ukraine which should be scaled-up to help achieve HIV and HCV elimination. Disruptions could have a substantial detrimental impact.
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Affiliation(s)
- Jack Stone
- Population Health SciencesUniversity of BristolBristolUK
| | - Adam Trickey
- Population Health SciencesUniversity of BristolBristolUK
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20
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Alshorman A, Al-Hosainat N, Jackson T. Analysis of HIV latent infection model with multiple infection stages and different drug classes. JOURNAL OF BIOLOGICAL DYNAMICS 2022; 16:713-732. [PMID: 36264087 DOI: 10.1080/17513758.2022.2113828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 08/09/2022] [Indexed: 06/16/2023]
Abstract
Latently infected CD4+ T cells represent one of the major obstacles to HIV eradication even after receiving prolonged highly active anti-retroviral therapy (HAART). Long-term use of HAART causes the emergence of drug-resistant virus which is then involved in HIV transmission. In this paper, we develop mathematical HIV models with staged disease progression by incorporating entry inhibitor and latently infected cells. We find that entry inhibitor has the same effect as protease inhibitor on the model dynamics and therefore would benefit HIV patients who developed resistance to many of current anti-HIV medications. Numerical simulations illustrate the theoretical results and show that the virus and latently infected cells reach an infected steady state in the absence of treatment and are eliminated under treatment whereas the model including homeostatic proliferation of latently infected cells maintains the virus at low level during suppressive treatment. Therefore, complete cure of HIV needs complete eradication of latent reservoirs.
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Affiliation(s)
- Areej Alshorman
- Department of Mathematics, University of Michigan, Ann Arbor, MI, USA
| | | | - Trachette Jackson
- Department of Mathematics, University of Michigan, Ann Arbor, MI, USA
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21
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Stone J, Fraser H, Walker JG, Mafirakureva N, Mundia B, Cleland C, Bartilol K, Musyoki H, Waruiru W, Ragi A, Bhattacharjee P, Chhun N, Lizcano J, Akiyama MJ, Cherutich P, Wisse E, Kurth A, Luhmann N, Vickerman P. Modelling the impact of HIV and hepatitis C virus prevention and treatment interventions among people who inject drugs in Kenya. AIDS 2022; 36:2191-2201. [PMID: 36111533 PMCID: PMC9671825 DOI: 10.1097/qad.0000000000003382] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES People who inject drugs (PWID) in Kenya have high HIV (range across settings: 14-26%) and hepatitis C virus (HCV; 11-36%) prevalence. We evaluated the impact of existing and scaled-up interventions on HIV and HCV incidence among PWID in Kenya. DESIGN HIV and HCV transmission model among PWID, calibrated to Nairobi and Kenya's Coastal region. METHODS For each setting, we projected the impact (percent of HIV/HCV infections averted in 2020) of existing coverages of antiretroviral therapy (ART; 63-79%), opioid agonist therapy (OAT; 8-13%) and needle and syringe programmes (NSP; 45-61%). We then projected the impact (reduction in HIV/HCV incidence over 2021-2030), of scaling-up harm reduction [Full harm reduction ('Full HR'): 50% OAT, 75% NSP] and/or HIV (UNAIDS 90-90-90) and HCV treatment (1000 PWID over 2021-2025) and reducing sexual risk (by 25/50/75%). We estimated HCV treatment levels needed to reduce HCV incidence by 90% by 2030. RESULTS In 2020, OAT and NSP averted 46.0-50.8% (range of medians) of HIV infections and 50.0-66.1% of HCV infections, mostly because of NSP. ART only averted 12.9-39.8% of HIV infections because of suboptimal viral suppression (28-48%). Full HR and ART could reduce HIV incidence by 51.5-64% and HCV incidence by 84.6-86.6% by 2030. Also halving sexual risk could reduce HIV incidence by 68.0-74.1%. Alongside full HR, treating 2244 PWID over 2021-2025 could reduce HCV incidence by 90% by 2030. CONCLUSION Existing interventions are having substantial impact on HIV and HCV transmission in Kenya. However, to eliminate HIV and HCV, further scale-up is needed with reductions in sexual risk and HCV treatment.
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Affiliation(s)
- Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
| | - Josephine G. Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
| | | | | | | | | | | | - Wanjiru Waruiru
- Global Programs for Research and Training, Surveillance Department, University of California San Francisco, San Francisco, California, USA
| | | | | | - Nok Chhun
- Yale University School of Nursing, New Haven, Connecticut
| | - John Lizcano
- Yale University School of Nursing, New Haven, Connecticut
| | - Matthew J. Akiyama
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | - Ann Kurth
- Yale University School of Nursing, New Haven, Connecticut
| | - Niklas Luhmann
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, Bristol, UK
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22
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Trickey A, Walker JG, Bivegete S, Semchuk N, Saliuk T, Varetska O, Stone J, Vickerman P. Impact and cost-effectiveness of non-governmental organizations on the HIV epidemic in Ukraine among MSM. AIDS 2022; 36:2025-2034. [PMID: 36305181 PMCID: PMC7613764 DOI: 10.1097/qad.0000000000003347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Non-governmental organizations (NGOs) in Ukraine have provided HIV testing, treatment, and condom distribution for MSM. HIV prevalence among MSM in Ukraine is 5.6%. We estimated the impact and cost-effectiveness of MSM-targeted NGO activities in Ukraine. DESIGN A mathematical model of HIV transmission among MSM was calibrated to data from Ukraine (2011-2018). METHODS The model, designed before the 2022 Russian invasion of Ukraine, evaluated the impact of 2018 status quo coverage levels of 28% of MSM being NGO clients over 2016-2020 and 2021-2030 compared with no NGO activities over these time periods. Impact was measured in HIV incidence and infections averted. We compared the costs and disability adjusted life years (DALYs) for the status quo and a counterfactual scenario (no NGOs 2016-2020, but with NGOs thereafter) until 2030 to estimate the mean incremental cost-effectiveness ratio (cost per DALY averted). RESULTS Without NGO activity over 2016-2020, the HIV incidence in 2021 would have been 44% (95% credibility interval: 36-59%) higher than with status quo levels of NGO activity, with 25% (21-30%) more incident infections occurring over 2016-2020. Continuing with status quo NGO coverage levels will decrease HIV incidence by 41% over 2021-2030, whereas it will increase by 79% (60-120%) with no NGOs over this period and 37% (30-51%) more HIV infections will occur. Compared with if NGO activities had ceased over 2016-2020 (but continued thereafter), the status quo scenario averts 14 918 DALYs over 2016-2030 with a mean incremental cost-effectiveness ratio of US$600.15 per DALY averted. CONCLUSION MSM-targeted NGOs in Ukraine have prevented considerable HIV infections and are highly cost-effective compared with a willingness-to-pay threshold of 50% of Ukraine's 2018 GDP (US$1548).
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Affiliation(s)
- Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Sandra Bivegete
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, Bristol, UK
| | | | | | | | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, Bristol, UK
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23
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A deep learning approach to real-time HIV outbreak detection using genetic data. PLoS Comput Biol 2022; 18:e1010598. [PMID: 36240224 PMCID: PMC9604978 DOI: 10.1371/journal.pcbi.1010598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 10/26/2022] [Accepted: 09/23/2022] [Indexed: 12/15/2022] Open
Abstract
Pathogen genomic sequence data are increasingly made available for epidemiological monitoring. A main interest is to identify and assess the potential of infectious disease outbreaks. While popular methods to analyze sequence data often involve phylogenetic tree inference, they are vulnerable to errors from recombination and impose a high computational cost, making it difficult to obtain real-time results when the number of sequences is in or above the thousands. Here, we propose an alternative strategy to outbreak detection using genomic data based on deep learning methods developed for image classification. The key idea is to use a pairwise genetic distance matrix calculated from viral sequences as an image, and develop convolutional neutral network (CNN) models to classify areas of the images that show signatures of active outbreak, leading to identification of subsets of sequences taken from an active outbreak. We showed that our method is efficient in finding HIV-1 outbreaks with R0 ≥ 2.5, and overall a specificity exceeding 98% and sensitivity better than 92%. We validated our approach using data from HIV-1 CRF01 in Europe, containing both endemic sequences and a well-known dual outbreak in intravenous drug users. Our model accurately identified known outbreak sequences in the background of slower spreading HIV. Importantly, we detected both outbreaks early on, before they were over, implying that had this method been applied in real-time as data became available, one would have been able to intervene and possibly prevent the extent of these outbreaks. This approach is scalable to processing hundreds of thousands of sequences, making it useful for current and future real-time epidemiological investigations, including public health monitoring using large databases and especially for rapid outbreak identification.
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24
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Knight J, Kaul R, Mishra S. Risk heterogeneity in compartmental HIV transmission models of ART as prevention in Sub-Saharan Africa: A scoping review. Epidemics 2022; 40:100608. [PMID: 35843152 DOI: 10.1016/j.epidem.2022.100608] [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: 05/25/2021] [Revised: 06/11/2022] [Accepted: 07/05/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Transmission models provide complementary evidence to clinical trials about the potential population-level incidence reduction attributable to ART (ART prevention impact). Different modelling assumptions about risk heterogeneity may influence projected ART prevention impacts. We sought to review representations of risk heterogeneity in compartmental HIV transmission models applied to project ART prevention impacts in Sub-Saharan Africa. METHODS We systematically reviewed studies published before January 2020 that used non-linear compartmental models of sexual HIV transmission to simulate ART prevention impacts in Sub-Saharan Africa. We summarized data on model structure/assumptions (factors) related to risk and intervention heterogeneity, and explored multivariate ecological associations of ART prevention impacts with modelled factors. RESULTS Of 1384 search hits, 94 studies were included. 64 studies considered sexual activity stratification and 39 modelled at least one key population. 21 studies modelled faster/slower ART cascade transitions (HIV diagnosis, ART initiation, or cessation) by risk group, including 8 with faster and 4 with slower cascade transitions among key populations versus the wider population. In ecological analysis of 125 scenarios from 40 studies (subset without combination intervention), scenarios with risk heterogeneity that included turnover of higher risk groups were associated with smaller ART prevention benefits. Modelled differences in ART cascade across risk groups also influenced the projected ART benefits, including: ART prioritized to key populations was associated with larger ART prevention benefits. Of note, zero of these 125 scenarios considered lower ART coverage among key populations. CONCLUSION Among compartmental transmission models applied to project ART prevention impacts in Sub-Saharan Africa, representations of risk heterogeneity and projected impacts varied considerably. Inclusion/exclusion of risk heterogeneity with turnover, and intervention heterogeneity across risk groups could influence the projected impacts of ART scale-up. These findings highlight a need to capture risk heterogeneity with turnover and cascade heterogeneity when projecting ART prevention impacts.
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Affiliation(s)
- Jesse Knight
- Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Sharmistha Mishra
- Institute of Medical Science, University of Toronto, Toronto, Canada; MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada; Division of Infectious Disease, Department of Medicine, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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25
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Safina KR, Sidorina Y, Efendieva N, Belonosova E, Saleeva D, Kirichenko A, Kireev D, Pokrovsky V, Bazykin GA. Molecular Epidemiology of HIV-1 in Oryol Oblast, Russia. Virus Evol 2022; 8:veac044. [PMID: 35775027 PMCID: PMC9239399 DOI: 10.1093/ve/veac044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 05/15/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022] Open
Abstract
The HIV/AIDS epidemic in Russia is growing, with approximately 100,000 people infected annually. Molecular epidemiology can provide insight into the structure and dynamics of the epidemic. However, its applicability in Russia is limited by the weakness of genetic surveillance, as viral genetic data are only available for <1 per cent of cases. Here, we provide a detailed description of the HIV-1 epidemic for one geographic region of Russia, Oryol Oblast, by collecting and sequencing viral samples from about a third of its known HIV-positive population (768 out of 2,157 patients). We identify multiple introductions of HIV-1 into Oryol Oblast, resulting in eighty-two transmission lineages that together comprise 66 per cent of the samples. Most introductions are of subtype A (315/332), the predominant HIV-1 subtype in Russia, followed by CRF63 and subtype B. Bayesian analysis estimates the effective reproduction number Re for subtype A at 2.8 [1.7–4.4], in line with a growing epidemic. The frequency of CRF63 has been growing more rapidly, with the median Re of 11.8 [4.6–28.7], in agreement with recent reports of this variant rising in frequency in some regions of Russia. In contrast to the patterns described previously in European and North American countries, we see no overrepresentation of males in transmission lineages; meanwhile, injecting drug users are overrepresented in transmission lineages. This likely reflects the structure of the HIV-1 epidemic in Russia dominated by heterosexual and, to a smaller extent, people who inject drugs transmission. Samples attributed to men who have sex with men (MSM) transmission are associated with subtype B and are less prevalent than expected from the male-to-female ratio for this subtype, suggesting underreporting of the MSM transmission route. Together, our results provide a high-resolution description of the HIV-1 epidemic in Oryol Oblast, Russia, characterized by frequent interregional transmission, rapid growth of the epidemic, and rapid displacement of subtype A with the recombinant CRF63 variant.
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Affiliation(s)
- Ksenia R Safina
- The Institute for Information Transmission Problems of Russian Academy of Sciences , Moscow, Russian Federation
- Skolkovo Institute of Science and Technology , Moscow, Russian Federation
| | - Yulia Sidorina
- Oryol Regional Center for AIDS and Infectious Diseases Control and Prevention , Oryol, Russian Federation
| | - Natalya Efendieva
- Oryol Regional Center for AIDS and Infectious Diseases Control and Prevention , Oryol, Russian Federation
| | - Elena Belonosova
- Oryol Regional Center for AIDS and Infectious Diseases Control and Prevention , Oryol, Russian Federation
| | - Darya Saleeva
- Central Research Institute of Epidemiology , Moscow, Russian Federation
| | - Alina Kirichenko
- Central Research Institute of Epidemiology , Moscow, Russian Federation
| | - Dmitry Kireev
- Central Research Institute of Epidemiology , Moscow, Russian Federation
| | - Vadim Pokrovsky
- Central Research Institute of Epidemiology , Moscow, Russian Federation
| | - Georgii A Bazykin
- The Institute for Information Transmission Problems of Russian Academy of Sciences , Moscow, Russian Federation
- Skolkovo Institute of Science and Technology , Moscow, Russian Federation
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26
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Ringa N, Diagne ML, Rwezaura H, Omame A, Tchoumi SY, Tchuenche JM. HIV and COVID-19 co-infection: A mathematical model and optimal control. INFORMATICS IN MEDICINE UNLOCKED 2022; 31:100978. [PMID: 35663416 PMCID: PMC9148865 DOI: 10.1016/j.imu.2022.100978] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/22/2022] [Accepted: 05/22/2022] [Indexed: 01/08/2023] Open
Abstract
A new mathematical model for COVID-19 and HIV/AIDS is considered to assess the impact of COVID-19 on HIV dynamics and vice-versa. Investigating the epidemiologic synergy between COVID-19 and HIV is important. The dynamics of the full model is driven by that of its sub-models; therefore, basic analysis of the two sub-models; HIV-only and COVID-19 only is carried out. The basic reproduction number is computed and used to prove local and global asymptotic stability of the sub-models' disease-free and endemic equilibria. Using the fmincon function in the Optimization Toolbox of MATLAB, the model is fitted to real COVID-19 data set from South Africa. The impact of intervention measures, namely, COVID-19 and HIV prevention interventions and COVID-19 treatment are incorporated into the model using time-dependent controls. It is observed that HIV prevention measures can significantly reduce the burden of co-infections with COVID-19, while effective treatment of COVID-19 could reduce co-infections with opportunistic infections such as HIV/AIDS. In particular, the COVID-19 only prevention strategy averted about 10,500 new co-infection cases, with similar number also averted by the HIV-only prevention control.
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Affiliation(s)
- N Ringa
- Data and Analytic Services, British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, Canada V5Z 4R4
- School of Population and Public Health, University of British Columbia, 2329 West Mall Vancouver, BC, Canada V6T 1Z4
| | - M L Diagne
- Département de Mathématiques, UFR des Sciences et Technologies, Université de Thiès, BP 967 Thiès, Senegal
| | - H Rwezaura
- Mathematics Department, University of Dar es Salaam, P.O. Box 35062, Dar es Salaam, Tanzania
| | - A Omame
- Department of Mathematics, Federal University of Technology, Owerri, Nigeria
- Abdus Salam School of Mathematical Sciences, Government College University Lahore, Pakistan
| | - S Y Tchoumi
- Department of Mathematics and Computer Sciences ENSAI, University of Ngaoundéré, P.O. Box 455 Ngaoundéré, Cameroon
| | - J M Tchuenche
- School of Computer Science and Applied Mathematics, University of the Witwatersrand, Private Bag 3, Wits 2050, Johannesburg, South Africa
- School of Computational and Communication Sciences and Engineering, Nelson Mandela African Institution of Science and Technology, P.O. Box 447, Arusha, Tanzania
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27
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Flountzi E, Lim AG, Vickerman P, Paraskevis D, Psichogiou M, Hatzakis A, Sypsa V. Modeling the impact of interventions during an outbreak of HIV infection among people who inject drugs in 2012-2013 in Athens, Greece. Drug Alcohol Depend 2022; 234:109396. [PMID: 35349919 DOI: 10.1016/j.drugalcdep.2022.109396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND A large HIV outbreak in People Who Inject Drugs (PWID) occurred in Athens, Greece in 2011-2013. In response, opioid substitution treatment (OST) and needle and syringe programs (NSP) were scaled-up and a seek-test-treat program was introduced in mid-2012. We aim to assess the impact of these interventions. METHODS A mathematical model of HIV transmission among PWID was calibrated to data available over time (2009-2013) on HIV prevalence, NSP/antiretroviral treatment (ART) coverage and high-risk injection. A combined interventions scenario, including decrease in high-risk injection through linkage to OST and modification of risk behaviours and access to NSP and ART, was compared to a counterfactual scenario (no improvement at the levels of these interventions), with HIV incidence being the main outcome. RESULTS HIV incidence increased from <0.1 new cases/100 person-years (in 2009) to 11.0 new cases/100 person-years (in 2012). Under both models, a subsequent decline was projected following early 2012, with incidence at the end of 2013 in the combined interventions scenario being lower by 77% compared to the counterfactual. The projected reduction in incidence under the intervention scenario was in agreement with empirical data. HIV prevalence would have escalated to 20.4% (95% CrI: 16.9%, 23.6%) in 2013 under the counterfactual scenario (vs. 16.8% (95% CrI: 11.2%, 23.0%) under the combined interventions scenario). In total, 31.4% of HIV cases (392) were averted over 2012-2013. CONCLUSION These results underline the importance of high-coverage harm reduction programs and of community-based interventions to rapidly reach PWID most in need.
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Affiliation(s)
- Eleni Flountzi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mina Psichogiou
- First Department of Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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28
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Milwid RM, Xia Y, Doyle CM, Cox J, Lambert G, Thomas R, Mishra S, Grace D, Lachowsky NJ, Hart TA, Boily MC, Maheu-Giroux M. Past dynamics of HIV transmission among men who have sex with men in Montréal, Canada: a mathematical modeling study. BMC Infect Dis 2022; 22:233. [PMID: 35255860 PMCID: PMC8902714 DOI: 10.1186/s12879-022-07207-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/24/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (gbMSM) experience disproportionate risks of HIV acquisition and transmission. In 2017, Montréal became the first Canadian Fast-Track City, setting the 2030 goal of zero new HIV infections. To inform local elimination efforts, we estimate the evolving role of prevention and sexual behaviours on HIV transmission dynamics among gbMSM in Montréal between 1975 and 2019. METHODS Data from local bio-behavioural surveys were analyzed to develop, parameterize, and calibrate an agent-based model of sexual HIV transmission. Partnership dynamics, HIV's natural history, and treatment and prevention strategies were considered. The model simulations were analyzed to estimate the fraction of HIV acquisitions and transmissions attributable to specific groups, with a focus on age, sexual partnering level, and gaps in the HIV care-continuum. RESULTS The model-estimated HIV incidence peaked in 1985 (2.3 per 100 person years (PY); 90% CrI: 1.4-2.9 per 100 PY) and decreased to 0.1 per 100 PY (90% CrI: 0.04-0.3 per 100 PY) in 2019. Between 2000-2017, the majority of HIV acquisitions and transmissions occurred among men aged 25-44 years, and men aged 35-44 thereafter. The unmet prevention needs of men with > 10 annual anal sex partners contributed 90-93% of transmissions and 67-73% of acquisitions annually. The primary stage of HIV played an increasing role over time, contributing to 11-22% of annual transmissions over 2000-2019. In 2019, approximately 70% of transmission events occurred from men who had discontinued, or never initiated antiretroviral therapy. CONCLUSIONS The evolving HIV landscape has contributed to the declining HIV incidence among gbMSM in Montréal. The shifting dynamics identified in this study highlight the need for continued population-level surveillance to identify gaps in the HIV care continuum and core groups on which to prioritize elimination efforts.
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Affiliation(s)
- Rachael M. Milwid
- grid.14709.3b0000 0004 1936 8649Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC Canada
| | - Yiqing Xia
- grid.14709.3b0000 0004 1936 8649Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC Canada
| | - Carla M. Doyle
- grid.14709.3b0000 0004 1936 8649Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC Canada
| | - Joseph Cox
- grid.14709.3b0000 0004 1936 8649Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC Canada ,grid.459278.50000 0004 4910 4652Direction Régionale de Santé Publique de Montréal, Montréal, QC Canada
| | - Gilles Lambert
- grid.459278.50000 0004 4910 4652Direction Régionale de Santé Publique de Montréal, Montréal, QC Canada
| | | | - Sharmistha Mishra
- grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada
| | - Daniel Grace
- grid.17063.330000 0001 2157 2938Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Nathan J. Lachowsky
- grid.143640.40000 0004 1936 9465School of Public Health and Social Policy, University of Victoria, Victoria, BC Canada
| | - Trevor A. Hart
- grid.68312.3e0000 0004 1936 9422Department of Psychology, Ryerson University, Toronto, ON Canada
| | - Marie-Claude Boily
- grid.7445.20000 0001 2113 8111Department of Infectious Diseases, Imperial College London, London, UK
| | - Mathieu Maheu-Giroux
- grid.14709.3b0000 0004 1936 8649Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montréal, QC Canada
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29
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Mariaggi AA, Bauer R, Charre C, Gardiennet E, Meiffredy V, Ajana F, Lacombe K, Pialoux G, Cua E, Rouzioux C, Meyer L, Cheret A, Avettand-Fenoel V. HIV-1-RNA and total HIV-1-DNA loads in the genital compartment in men receiving dolutegravir- versus darunavir-based combined ART (cART) regimens during primary HIV infection. J Antimicrob Chemother 2022; 77:735-739. [PMID: 35195692 DOI: 10.1093/jac/dkab427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/21/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Dolutegravir is a widespread integrase strand-transfer inhibitor (INSTI) recommended for treatment of primary HIV infection (PHI). PHI is a high-risk stage for sexual transmission because of the high viral load in semen. Yet dolutegravir concentrations in semen are lower than in blood during chronic treatment. OBJECTIVES To compare the kinetics of HIV-RNA and total HIV-DNA in the genital compartment in subjects receiving either tenofovir/emtricitabine/dolutegravir or tenofovir/emtricitabine/darunavir/cobicistat as a first-line combined ART (cART) at the time of PHI. PATIENTS AND METHODS Eighteen subjects receiving tenofovir/emtricitabine/dolutegravir and 19 receiving tenofovir/emtricitabine/darunavir/cobicistat enrolled in the ANRS169 OPTIPRIM-2 trial participated in the genital substudy. RESULTS Between week (W) 0 and W2 HIV-RNA in seminal plasma (SP) decreased by 1 log10 copies/mL. Undetectable SP HIV-RNA was achieved in similar proportions between the two regimens at each timepoint. Overall, eight patients still presented detectable HIV-RNA or HIV-DNA in semen at W48; 15.4% and 28.6% presented detectable HIV-RNA and 9.1% and 14.3% presented detectable HIV-DNA in dolutegravir- and darunavir-based cART groups, respectively, with no significant difference. CONCLUSIONS For the first time, to the best of our knowledge, we showed that a dolutegravir-based regimen initiated as soon as PHI reduces HIV-RNA and HIV-DNA with no difference compared with a control group receiving a darunavir-based regimen. Although the viral purge in semen seems longer after treatment in PHI than CHI, due to high viral loads, early dolutegravir-based treatment initiation permits a major decay of both viral particles and infected cells in semen, efficiently reducing the high risk of transmission during PHI.
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Affiliation(s)
- Alice-Andrée Mariaggi
- Université de Paris, Faculté de Médecine, Paris, France.,INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France.,AP-HP, Laboratoire de Virologie, CHU Cochin, Paris, France
| | | | - Caroline Charre
- Université de Paris, Faculté de Médecine, Paris, France.,INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France.,AP-HP, Laboratoire de Virologie, CHU Cochin, Paris, France
| | - Elise Gardiennet
- Université de Paris, Faculté de Médecine, Paris, France.,INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France
| | | | - Faiza Ajana
- CH Tourcoing, Service de Maladies Infectieuses, Tourcoing, France
| | - Karine Lacombe
- AP-HP, Hôpital Saint Antoine, Service de Maladies Infectieuses et Tropicales, Paris, France.,Sorbonne Université, Faculté de Médecine, Paris, France
| | - Gilles Pialoux
- Sorbonne Université, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Tenon, Service de Maladies Infectieuses et Tropicales, Paris, France
| | - Eric Cua
- CHU de Nice l'Archet, Service de Maladies Infectieuses et Tropicales, Nice, France
| | | | - Laurence Meyer
- INSERM SC10, Villejuif, France.,INSERM CESP U1018, Université Paris Saclay, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, France
| | - Antoine Cheret
- INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France.,AP-HP, Service de Médecine Interne et d'Immunologie Clinique, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Véronique Avettand-Fenoel
- Université de Paris, Faculté de Médecine, Paris, France.,INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France.,AP-HP, Laboratoire de Microbiologie clinique, Hôpital Necker-Enfants Malades, Paris, France
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Zayats R, Murooka TT, McKinnon LR. HPV and the Risk of HIV Acquisition in Women. Front Cell Infect Microbiol 2022; 12:814948. [PMID: 35223546 PMCID: PMC8867608 DOI: 10.3389/fcimb.2022.814948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/03/2022] [Indexed: 01/08/2023] Open
Abstract
The risk of HIV acquisition is low on a per-contact basis but increased by transmission co-factors such as other sexually transmitted infections (STIs). Human papillomavirus (HPV) is a prevalent STI that most individuals will acquire HPV in their lifetime. Current HPV vaccines can prevent newly acquired infections, but are largely ineffective against established HPV, complicating worldwide eradication efforts. In addition to being the causative agent of cervical cancer, accumulating evidence suggests that HPV infection and/or accompanying cervical inflammation increase the risk of HIV infection in men and women. The fact that immunological features observed during HPV infection overlap with cellular and molecular pathways known to enhance HIV susceptibility underscore the potential interplay between these two viral infections that fuel their mutual spread. Here we review current insights into how HPV infection and the generation of anti-HPV immunity contribute to higher HIV transmission rates, and the impact of HPV on mucosal inflammation, immune cell trafficking, and epithelial barrier function.
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Affiliation(s)
- Romaniya Zayats
- Department of Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Thomas T. Murooka
- Department of Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- *Correspondence: Thomas T. Murooka, ; Lyle R. McKinnon,
| | - Lyle R. McKinnon
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- *Correspondence: Thomas T. Murooka, ; Lyle R. McKinnon,
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31
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Zang X, Mah C, Linh Quan AM, Min JE, Armstrong WS, Behrends CN, Del Rio C, Dombrowski JC, Feaster DJ, Kirk GD, Marshall BDL, Mehta SH, Metsch LR, Pandya A, Schackman BR, Shoptaw S, Strathdee SA, Krebs E, Nosyk B. Human Immunodeficiency Virus transmission by HIV Risk Group and Along the HIV Care Continuum: A Contrast of 6 US Cities. J Acquir Immune Defic Syndr 2022; 89:143-150. [PMID: 34723929 PMCID: PMC8752472 DOI: 10.1097/qai.0000000000002844] [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] [Received: 07/14/2021] [Accepted: 10/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Understanding the sources of HIV transmission provides a basis for prioritizing HIV prevention resources in specific geographic regions and populations. This study estimated the number, proportion, and rate of HIV transmissions attributable to individuals along the HIV care continuum within different HIV transmission risk groups in 6 US cities. METHODS We used a dynamic, compartmental HIV transmission model that draws on racial behavior-specific or ethnic behavior-specific and risk behavior-specific linkage to HIV care and use of HIV prevention services from local, state, and national surveillance sources. We estimated the rate and number of HIV transmissions attributable to individuals in the stage of acute undiagnosed HIV, nonacute undiagnosed HIV, HIV diagnosed but antiretroviral therapy (ART) naïve, off ART, and on ART, stratified by HIV transmission group for the 2019 calendar year. RESULTS Individuals with undiagnosed nonacute HIV infection accounted for the highest proportion of total transmissions in every city, ranging from 36.8% (26.7%-44.9%) in New York City to 64.9% (47.0%-71.6%) in Baltimore. Individuals who had discontinued ART contributed to the second highest percentage of total infections in 4 of 6 cities. Individuals with acute HIV had the highest transmission rate per 100 person-years, ranging from 76.4 (58.9-135.9) in Miami to 160.2 (85.7-302.8) in Baltimore. CONCLUSION These findings underline the importance of both early diagnosis and improved ART retention for ending the HIV epidemic in the United States. Differences in the sources of transmission across cities indicate that localized priority setting to effectively address diverse microepidemics at different stages of epidemic control is necessary.
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Affiliation(s)
- Xiao Zang
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Cassandra Mah
- Faculty of Health Sciences, Simon Fraser University; Burnaby, British Columbia, Canada
| | - Amanda My Linh Quan
- Faculty of Health Sciences, Simon Fraser University; Burnaby, British Columbia, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jeong Eun Min
- Center for Health Evaluation and Outcome Sciences; Vancouver, British Columbia, Canada
| | - Wendy S Armstrong
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Czarina N Behrends
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York, United States
| | - Carlos Del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Julia C Dombrowski
- Department of Medicine, Division of Allergy and Infectious Disease, University of Washington, Seattle, Washington, United States
| | - Daniel J Feaster
- Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States
| | - Gregory D. Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Brandon DL Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Shruti H Mehta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City, New York, United States
| | - Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Bruce R Schackman
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York City, New York, United States
| | - Steven Shoptaw
- School of Medicine, University of California Los Angeles, Los Angeles, California, United States
| | - Steffanie A Strathdee
- School of Medicine, University of California San Diego, La Jolla, California, United States
| | - Emanuel Krebs
- Faculty of Health Sciences, Simon Fraser University; Burnaby, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences; Vancouver, British Columbia, Canada
| | - Bohdan Nosyk
- Faculty of Health Sciences, Simon Fraser University; Burnaby, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences; Vancouver, British Columbia, Canada
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Fojo A, Wallengren E, Schnure M, Dowdy DW, Shah M, Kasaie P. Potential Effects of the Coronavirus Disease 2019 (COVID-19) Pandemic on Human Immunodeficiency Virus (HIV) Transmission: A Modeling Study in 32 US Cities. Clin Infect Dis 2022; 75:e1145-e1153. [PMID: 35016216 PMCID: PMC8755375 DOI: 10.1093/cid/ciab1029] [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] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The degree to which the 2019 novel coronavirus disease (COVID-19) pandemic will affect the US human immunodeficiency virus (HIV) epidemic is unclear. METHODS We used the Johns Hopkins Epidemiologic and Economic Model to project HIV infections from 2020 to 2025 in 32 US metropolitan statistical areas (MSAs). We sampled a range of effects of the pandemic on sexual transmission (0-50% reduction), viral suppression among people with HIV (0-40% reduction), HIV testing (0-50% reduction), and pre-exposure prophylaxis use (0-30% reduction), and indexed reductions over time to Google Community Mobility Reports. RESULTS Simulations projected reported diagnoses would drop in 2020 and rebound in 2021 or 2022, regardless of underlying incidence. If sexual transmission normalized by July 2021 and HIV care normalized by January 2022, we projected 1161 (1%) more infections from 2020 to 2025 across all 32 cities than if COVID-19 had not occurred. Among "optimistic" simulations in which sexual transmission was sharply reduced and viral suppression was maintained we projected 8% lower incidence (95% credible interval: 14% lower to no change). Among "pessimistic" simulations where sexual transmission was largely unchanged but viral suppression fell, we projected 11% higher incidence (1-21% higher). MSA-specific projections are available at www.jheem.org?covid. CONCLUSIONS The effects of COVID-19 on HIV transmission remain uncertain and differ between cities. Reported diagnoses of HIV in 2020-2021 are likely to correlate poorly with underlying incidence. Minimizing disruptions to HIV care is critical to mitigating negative effects of the COVID-19 pandemic on HIV transmission.
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Affiliation(s)
- Anthony Fojo
- Correspondence: A. T. Fojo, 1830 East Monument Street, Room 8060, Baltimore, MD 21205 ()
| | - Emma Wallengren
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Melissa Schnure
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Maunank Shah
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Parastu Kasaie
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Xia X, Zhang X, Zhou J, Zhang M. An Analysis of Predictive Sample-to-Cutoff Index for HIV Infection Confirmation Using Elecsys® HIV Combi PT Assay. Int J Clin Pract 2022; 2022:5097189. [PMID: 36016828 PMCID: PMC9385312 DOI: 10.1155/2022/5097189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early and rapid diagnosis is crucial in HIV preventing and treatment. However, the false-positive rate (FPR) by 4-th generation detection assays was high in low-HIV-prevalence regions. OBJECTIVES To analyze the relation between sample-to-cutoff index (COI) and HIV confirmatory results, and to explore a new COI threshold in our own laboratory to predict HIV infection. METHODS We retrospectively analyzed primarily reactive results by Elecsys® HIV combi PT assays and their confirmatory results by western blot (WB) at Nanjing Center for Disease Control and Prevention (CDC). The mean COI values of true positive (TP), false positive (FP), and indeterminate groups were compared, and receiver operating characteristic curve (ROC) analysis was performed to determine the optimal COI value for predicting HIV infection. RESULTS Totally 150,980 HIV serological results were reviewed, and 305 (0.2%) were primarily reactive. There are 82 (26.89%) true positives, 210 (71.92%) false positives, and 11 indeterminate samples confirmed by WB tests, and another 2 patients rejected WB tests. Mean COI values of TP (643.5) were greatly higher than that of FP (3.174) (P < 0.0001), but there is no significant difference between FP and indeterminate groups. Combining the requirement of HIV diagnosis and ROC analysis, 9.87 was established as the optimal threshold to predict the infection, with 100% sensitivity and 99.99% specificity. CONCLUSIONS By adjusting the COI threshold, the FP samples can be reduced and the efficiency of screening assays can be increased, which can save much additional reagent and staff costs and much time for delivery of HIV test results.
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Affiliation(s)
- Xiaohong Xia
- Department of Laboratory Medicine, Branch of National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing 210029, China
| | - Xiang Zhang
- Department of Infection Management, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jun Zhou
- Department of Laboratory Medicine, Branch of National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing 210029, China
| | - Mengying Zhang
- Department of Laboratory Medicine, Branch of National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing 210029, China
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Yufenyuy EL, Detorio M, Dobbs T, Patel HK, Jackson K, Vedapuri S, Parekh BS. Performance evaluation of the Asante Rapid Recency Assay for verification of HIV diagnosis and detection of recent HIV-1 infections: Implications for epidemic control. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000316. [PMID: 36962217 PMCID: PMC10021762 DOI: 10.1371/journal.pgph.0000316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/09/2022] [Indexed: 11/18/2022]
Abstract
We previously described development of a rapid test for recent infection (RTRI) that can diagnose HIV infection and detect HIV-1 recent infections in a single device. This technology was transferred to a commercial partner as Asante Rapid Recency Assay (ARRA). We evaluated performance of the ARRA kits in the laboratory using a well-characterized panel of specimens. The plasma specimen panel (N = 1500) included HIV-1 (N = 570), HIV-2 (N = 10), and HIV-negatives (N = 920) representing multiple subtypes and geographic locations. Reference diagnostic data were generated using the Bio-Rad HIV-1-2-O EIA/Western blot algorithm with further serotyping performed using the Multispot HIV-1/2 assay. The LAg-Avidity EIA was used to generate reference data on recent and long-term infection for HIV-1 positive specimens at a normalized optical density (ODn) cutoff of 2.0 corresponding to a mean duration of about 6 months. All specimens were tested with ARRA according to the manufacturer's recommendations. Test strips were also read for line intensities using a reader and results were correlated with visual interpretation. ARRA's positive verification line (PVL) correctly classified 575 of 580 HIV-positive and 910 of 920 negative specimens resulting in a sensitivity of 99.1% (95% CI: 98.0-99.6) and specificity of 98.9% (95% CI: 98.1-99.4), respectively. The reader-based classification was similar for PVL with sensitivity of 99.3% (576/580) and specificity of 98.8% (909/920). ARRA's long-term line (LTL) classified 109 of 565 HIV-1 specimens as recent and 456 as long-term compared to 98 as recent and 467 as long-term (LT) by LAg-Avidity EIA (cutoff ODn = 2.0), suggesting a mean duration of recent infection (MDRI) close to 6 months. Agreement of ARRA with LAg recent cases was 81.6% (80/98) and LT cases was 93.8% (438/467), with an overall agreement of 91.7% (kappa = 0.72). The reader (cutoff 2.9) classified 109/566 specimens as recent infections compared to 99 by the LAg-Avidity EIA for recency agreement of 81.8% (81/99), LT agreement of 9% (439/467) with overall agreement of 91.9% (kappa = 0.72). The agreement between visual interpretation and strip reader was 99.9% (95% CI: 99.6-99.9) for the PVL and 98.1% (95% CI: 96.6-98.9) for the LTL. ARRA performed well with HIV diagnostic sensitivity >99% and specificity >98%. Its ability to identify recent infections is comparable to the LA-Avidity EIA corresponding to an MDRI of about 6 months. This point-of-care assay has implications for real-time surveillance of new infections among newly diagnosed individuals for targeted prevention and interrupting ongoing transmission thus accelerating epidemic control.
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Affiliation(s)
- Ernest L Yufenyuy
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mervi Detorio
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Trudy Dobbs
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hetal K Patel
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Keisha Jackson
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shanmugam Vedapuri
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Bharat S Parekh
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Haas AD, Radin E, Birhanu S, Low AJ, Saito S, Sachathep K, Balachandra S, Manjengwa J, Duong YT, Jonnalagadda S, Payne D, Bello G, Hakim AJ, Smart T, Ahmed N, Cuervo-Rojas J, Auld A, Patel H, Parekh B, Williams DB, Barradas DT, Mugurungi O, Mulenga LB, Voetsch AC, Justman JE. Prevalence of and factors associated with late diagnosis of HIV in Malawi, Zambia, and Zimbabwe: Results from population-based nationally representative surveys. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000080. [PMID: 36962254 PMCID: PMC10021857 DOI: 10.1371/journal.pgph.0000080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Late diagnosis of HIV (LD) increases the risk of morbidity, mortality, and HIV transmission. We used nationally representative data from population-based HIV impact assessment (PHIA) surveys in Malawi, Zambia, and Zimbabwe (2015-2016) to characterize adults at risk of LD and to examine associations between LD and presumed HIV transmission to cohabiting sexual partners. METHODS We estimated the prevalence of LD, defined as CD4 count <350 cells/μL, among adults newly diagnosed with HIV during the surveys and odds ratios for associated factors. We linked newly diagnosed adults (index cases) to their household sexual partners and calculated adjusted odds ratios for associations between LD of the index case, viral load of the index case, and duration of HIV exposure in the relationship, and the HIV status of the household sexual partner. RESULTS Of 1,804 adults who were newly diagnosed with HIV in the surveys, 49% (882) were diagnosed late. LD was associated with male sex, older age, and almost five times the odds of having an HIV-positive household sexual partner (adjusted odds ratio [aOR], 4.65 [95% confidence interval: 2.56-8.45]). Longer duration of HIV exposure in a relationship and higher viral load of the index case were both independently associated with higher odds of having HIV-positive household sexual partners. Individuals with HIV exposure of more than 5 years had more than three times (aOR 3.42 [95% CI: 1.63-7.18]) higher odds of being HIV positive than those with less than 2 years HIV exposure. The odds of being HIV positive were increased in individuals who were in a relationship with an index case with a viral load of 400-3499 copies/mL (aOR 4.06 [95% CI 0.45-36.46]), 3,500-9,999 copies/mL (aOR 11.32 [95% CI: 4.08-31.39]), 10,000-49,999 copies/mL (aOR 17.07 [95% CI: 9.18-31.72]), and ≥50,000 copies/mL (aOR 28.41 [95% CI: 12.18-66.28]) compared to individuals who were in a relationship with an index case with a viral load of <400 copies/mL. CONCLUSIONS LD remains a challenge in Southern Africa and is strongly associated with presumed HIV transmission to household sexual partners. Our study underscores the need for earlier HIV diagnosis, particularly among men and older adults, and the importance of index testing.
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Affiliation(s)
- Andreas D Haas
- ICAP, Columbia University, New York, New York, United States of America
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Elizabeth Radin
- ICAP, Columbia University, New York, New York, United States of America
| | - Sehin Birhanu
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Andrea J Low
- ICAP, Columbia University, New York, New York, United States of America
| | - Suzue Saito
- ICAP, Columbia University, New York, New York, United States of America
| | | | | | - Julius Manjengwa
- ICAP, Columbia University, New York, New York, United States of America
| | - Yen T Duong
- ICAP, Columbia University, New York, New York, United States of America
| | - Sasi Jonnalagadda
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Danielle Payne
- Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - George Bello
- Government of Malawi, Ministry of Health, Lilongwe, Malawi
| | - Avi J Hakim
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Theo Smart
- ICAP, Columbia University, New York, New York, United States of America
| | - Nahima Ahmed
- ICAP, Columbia University, New York, New York, United States of America
| | - Juliana Cuervo-Rojas
- ICAP, Columbia University, New York, New York, United States of America
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Andrew Auld
- Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Hetal Patel
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Bharat Parekh
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Daniel B Williams
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Owen Mugurungi
- Government of Zimbabwe, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Andrew C Voetsch
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jessica E Justman
- ICAP, Columbia University, New York, New York, United States of America
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Hioe CE, Li G, Liu X, Tsahouridis O, He X, Funaki M, Klingler J, Tang AF, Feyznezhad R, Heindel DW, Wang XH, Spencer DA, Hu G, Satija N, Prévost J, Finzi A, Hessell AJ, Wang S, Lu S, Chen BK, Zolla-Pazner S, Upadhyay C, Alvarez R, Su L. Non-neutralizing antibodies targeting the immunogenic regions of HIV-1 envelope reduce mucosal infection and virus burden in humanized mice. PLoS Pathog 2022; 18:e1010183. [PMID: 34986207 PMCID: PMC8765624 DOI: 10.1371/journal.ppat.1010183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/18/2022] [Accepted: 12/09/2021] [Indexed: 02/07/2023] Open
Abstract
Antibodies are principal immune components elicited by vaccines to induce protection from microbial pathogens. In the Thai RV144 HIV-1 vaccine trial, vaccine efficacy was 31% and the sole primary correlate of reduced risk was shown to be vigorous antibody response targeting the V1V2 region of HIV-1 envelope. Antibodies against V3 also were inversely correlated with infection risk in subsets of vaccinees. Antibodies recognizing these regions, however, do not exhibit potent neutralizing activity. Therefore, we examined the antiviral potential of poorly neutralizing monoclonal antibodies (mAbs) against immunodominant V1V2 and V3 sites by passive administration of human mAbs to humanized mice engrafted with CD34+ hematopoietic stem cells, followed by mucosal challenge with an HIV-1 infectious molecular clone expressing the envelope of a tier 2 resistant HIV-1 strain. Treatment with anti-V1V2 mAb 2158 or anti-V3 mAb 2219 did not prevent infection, but V3 mAb 2219 displayed a superior potency compared to V1V2 mAb 2158 in reducing virus burden. While these mAbs had no or weak neutralizing activity and elicited undetectable levels of antibody-dependent cellular cytotoxicity (ADCC), V3 mAb 2219 displayed a greater capacity to bind virus- and cell-associated HIV-1 envelope and to mediate antibody-dependent cellular phagocytosis (ADCP) and C1q complement binding as compared to V1V2 mAb 2158. Mutations in the Fc region of 2219 diminished these effector activities in vitro and lessened virus control in humanized mice. These results demonstrate the importance of Fc functions other than ADCC for antibodies without potent neutralizing activity.
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Affiliation(s)
- Catarina E. Hioe
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- James J. Peters VA Medical Center, Bronx, New York, New York, United States of America
| | - Guangming Li
- Laboratory of Viral Pathogenesis and Immunotherapy, Division of Virology, Pathogenesis, and Cancer, Institute of Human Virology, Department of Pharmacology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Lineberger Comprehensive Cancer Center, Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Xiaomei Liu
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Ourania Tsahouridis
- Lineberger Comprehensive Cancer Center, Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Xiuting He
- Laboratory of Viral Pathogenesis and Immunotherapy, Division of Virology, Pathogenesis, and Cancer, Institute of Human Virology, Department of Pharmacology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Masaya Funaki
- Laboratory of Viral Pathogenesis and Immunotherapy, Division of Virology, Pathogenesis, and Cancer, Institute of Human Virology, Department of Pharmacology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Jéromine Klingler
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- James J. Peters VA Medical Center, Bronx, New York, New York, United States of America
| | - Alex F. Tang
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- School of Medicine, University of California, San Francisco, California, United States of America
| | - Roya Feyznezhad
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Daniel W. Heindel
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Xiao-Hong Wang
- VA New York Harbor Healthcare System–Manhattan, New York, New York, United States of America
| | - David A. Spencer
- Division of Pathobiology & Immunology, Oregon Health & Science University, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
| | - Guangnan Hu
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Namita Satija
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Jérémie Prévost
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Quebec, Canada
| | - Andrés Finzi
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Quebec, Canada
| | - Ann J. Hessell
- Division of Pathobiology & Immunology, Oregon Health & Science University, Oregon National Primate Research Center, Beaverton, Oregon, United States of America
| | - Shixia Wang
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Shan Lu
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Benjamin K. Chen
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Susan Zolla-Pazner
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Chitra Upadhyay
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Raymond Alvarez
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Lishan Su
- Laboratory of Viral Pathogenesis and Immunotherapy, Division of Virology, Pathogenesis, and Cancer, Institute of Human Virology, Department of Pharmacology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Lineberger Comprehensive Cancer Center, Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Laboratory of Viral Pathogenesis and Immunotherapy, Division of Virology, Pathogenesis and Cancer, Institute of Human Virology, Departments of Pharmacology and Microbiology & Immunology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
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Reeves I, Cromarty B, Deayton J, Dhairyawan R, Kidd M, Taylor C, Thornhill J, Tickell-Painter M, van Halsema C. British HIV Association guidelines for the management of HIV-2 2021. HIV Med 2021; 22 Suppl 4:1-29. [PMID: 34927347 DOI: 10.1111/hiv.13204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Iain Reeves
- Consultant in HIV Medicine, Homerton University Hospital NHS Trust, London, UK
| | | | - Jane Deayton
- Clinical Senior Lecturer in HIV, Barts and the London, Queen Mary University of London, London, UK
| | - Rageshri Dhairyawan
- Consultant in Sexual Health and HIV Medicine, Barts Health NHS Trust, London, UK
| | - Mike Kidd
- Consultant Virologist, National Infection Service, Public Health England, UK
| | - Chris Taylor
- Consultant Physician Sexual Health and HIV, Kings College Hospital, London, UK
| | - John Thornhill
- Consultant in Sexual Health and HIV Medicine, Barts Health NHS Trust, London, UK
| | - Maya Tickell-Painter
- Specialist Registrar in Infectious Diseases and Microbiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Clare van Halsema
- Consultant in Infectious Diseases, North Manchester General Hospital, Manchester, UK
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Ahmed S, Rahman S, Kamrujjaman M. Optimal treatment strategies to control acute HIV infection. Infect Dis Model 2021; 6:1202-1219. [PMID: 34786525 PMCID: PMC8569721 DOI: 10.1016/j.idm.2021.09.004] [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: 06/24/2020] [Accepted: 09/16/2021] [Indexed: 11/27/2022] Open
Abstract
Various antiretroviral therapies (ART) are administered to symptomatic human immunodeficiency virus (HIV) infected individuals to improve their health. The treatment effectiveness may depend on suppressing development of drug resistance, reduce evolution of new viral strains, minimize serious side effects and the costs of drugs. This paper deals with some results concerning optimal drug administration scheme successful in improving patients' health especially in poorly resourced settings. The model under consideration describes the interaction between the uninfected cells, the latently infected cells, the productively infected cells, and the free viruses. Generally, in viral infection, the drug strategy aspects either the virus infectivity or reduce the virion production. The mathematical model proposed here, deals with both situations with the objective function based on a combination of maximizing benefit relied on T cells count (the white cells that coordinate activities of the immune system) and minimizing the systemic cost. The existence of the optimal control pair is established and the Pontryagin's minimum principle is used to characterize these two optimal controls. The optimality system is derived and solved numerically using the forward and backward sweep method (FBSM). Our results indicate that early initiation of treatment makes a profound impact in both improving the quality of life and reducing the economic costs of therapy.
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Affiliation(s)
- Shohel Ahmed
- Department of Mathematics, Bangladesh University of Engineering and Technology, Dhaka, 1000, Bangladesh
| | - Sumaiya Rahman
- Department of Statistics, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Md Kamrujjaman
- Department of Mathematics, University of Dhaka, Dhaka, 1000, Bangladesh
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Optimization of Case Definitions for Sensitivity as a Preventive Strategy-A Modelling Exemplified with Rapid Diagnostic Test-Based Prevention of Sexual HIV Transmission. Diagnostics (Basel) 2021; 11:diagnostics11112079. [PMID: 34829425 PMCID: PMC8620421 DOI: 10.3390/diagnostics11112079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 12/14/2022] Open
Abstract
In clinical studies, case definitions are usually designed to optimally match the desired clinical state, because lacking specificity is associated with a risk of bias regarding the study outcome. In preventive medicine, however, high sensitivity is sometimes considered as more critical in order not to overlook infectious individuals, because the latter may be associated with ongoing spread of a transmittable disease. Accordingly, this work was focused on a theoretical model on how the sensitivity of case definitions can be optimized by adding clinical symptoms to diagnostic results for preventive purposes, if the associated reduction in specificity is considered as acceptable. The model was exemplified with an analysis on whether and in how far exposure risk can be reduced by the inclusion of observable symptoms during seroconversion syndrome in case of rapid diagnostic test-based prevention of sexual HIV transmission. The approach provided a high level of safety (negative predictive values close to 1) for the price of a considerably number of false positives (positive predictive values < 0.01 for some subpopulations). When applying such a sensitivity-optimized screening as a "diagnostics as prevention" strategy, the advantages of excellent negative predictive values need to be cautiously balanced against potential undesirable consequences of low positive predictive values.
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40
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Fraser H, Borquez A, Stone J, Abramovitz D, Brouwer KC, Goodman-Meza D, Hickman M, Patterson TL, Silverman J, Smith L, Strathdee SA, Martin NK, Vickerman P. Overlapping Key Populations and HIV Transmission in Tijuana, Mexico: A Modelling Analysis of Epidemic Drivers. AIDS Behav 2021; 25:3814-3827. [PMID: 34216285 PMCID: PMC8560668 DOI: 10.1007/s10461-021-03361-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 12/18/2022]
Abstract
Tijuana, Mexico, has a concentrated HIV epidemic among overlapping key populations (KPs) including people who inject drugs (PWID), female sex workers (FSW), their male clients, and men who have sex with men (MSM). We developed a dynamic HIV transmission model among these KPs to determine the extent to which their unmet prevention and treatment needs is driving HIV transmission. Over 2020-2029 we estimated the proportion of new infections acquired in each KP, and the proportion due to their unprotected risk behaviours. We estimate that 43.7% and 55.3% of new infections are among MSM and PWID, respectively, with FSW and their clients making-up < 10% of new infections. Projections suggest 93.8% of new infections over 2020-2029 will be due to unprotected sex between MSM or unsafe injecting drug use. Prioritizing interventions addressing sexual and injecting risks among MSM and PWID are critical to controlling HIV in Tijuana.
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Affiliation(s)
- Hannah Fraser
- Oakfield House, Population Health Sciences - Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK.
| | - Annick Borquez
- School of Medicine, University of California San Diego, San Diego, USA
| | - Jack Stone
- Oakfield House, Population Health Sciences - Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | | | | | - David Goodman-Meza
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Matthew Hickman
- Oakfield House, Population Health Sciences - Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | | | - Jay Silverman
- School of Medicine, University of California San Diego, San Diego, USA
| | - Laramie Smith
- School of Medicine, University of California San Diego, San Diego, USA
| | | | - Natasha K Martin
- Oakfield House, Population Health Sciences - Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
- School of Medicine, University of California San Diego, San Diego, USA
| | - Peter Vickerman
- Oakfield House, Population Health Sciences - Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK.
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41
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Fojo AT, Schnure M, Kasaie P, Dowdy DW, Shah M. What Will It Take to End HIV in the United States? : A Comprehensive, Local-Level Modeling Study. Ann Intern Med 2021; 174:1542-1553. [PMID: 34543589 PMCID: PMC8595759 DOI: 10.7326/m21-1501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Ending the HIV Epidemic (EHE) initiative aims to reduce incident HIV infections by 90% over a span of 10 years. The intensity of interventions needed to achieve this for local epidemics is unclear. OBJECTIVE To estimate the effect of HIV interventions at the city level. DESIGN A compartmental model of city-level HIV transmission stratified by age, race, sex, and HIV risk factor was developed and calibrated. SETTING 32 priority metropolitan statistical areas (MSAs). PATIENTS Simulated populations in each MSA. INTERVENTION Combinations of HIV testing and preexposure prophylaxis (PrEP) coverage among those at risk for HIV, plus viral suppression in persons with diagnosed HIV infection. MEASUREMENTS The primary outcome was the projected reduction in incident cases from 2020 to 2030. RESULTS Absent intervention, HIV incidence was projected to decrease by 19% across all 32 MSAs. Modest increases in testing (1.25-fold per year), PrEP coverage (5 percentage points), and viral suppression (10 percentage points) across the population could achieve reductions of 34% to 67% by 2030. Twenty-five percent PrEP coverage, testing twice a year on average, and 90% viral suppression among young Black and Hispanic men who have sex with men (MSM) achieved similar reductions (13% to 68%). Including all MSM and persons who inject drugs could reduce incidence by 48% to 90%. Thirteen of 32 MSAs could achieve greater than 90% reductions in HIV incidence with large-scale interventions that include heterosexuals. A web application with location-specific results is publicly available (www.jheem.org). LIMITATION The COVID-19 pandemic was not represented. CONCLUSION Large reductions in HIV incidence are achievable with substantial investment, but the EHE goals will be difficult to achieve in most locations. An interactive model that can help policymakers maximize the effect in their local environments is presented. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Anthony Todd Fojo
- Johns Hopkins University School of Medicine, Baltimore, Maryland (A.T.F., M.S.)
| | - Melissa Schnure
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.S., P.K., D.W.D.)
| | - Parastu Kasaie
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.S., P.K., D.W.D.)
| | - David W Dowdy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (M.S., P.K., D.W.D.)
| | - Maunank Shah
- Johns Hopkins University School of Medicine, Baltimore, Maryland (A.T.F., M.S.)
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42
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Qiu X, Sokoll L, Duong Ly T, Coignard C, Eshleman SH, Mohr P, Huizenga C, Swanson P, Cloherty G, Hackett J. An improved HIV antigen/antibody prototype assay for earlier detection of acute HIV infection. J Clin Virol 2021; 145:105022. [PMID: 34739837 DOI: 10.1016/j.jcv.2021.105022] [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: 07/13/2021] [Revised: 09/21/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Early detection of acute HIV infection by HIV antigen/antibody assays depends on antigen sensitivity. Maintaining consistently high sensitivity across diverse HIV strains is critical to ensure equal detection. OBJECTIVES The performance of an improved HIV antigen/antibody prototype, HIV Combo Next, was evaluated for detection of genetically-diverse HIV strains and seroconversion samples. STUDY DESIGN Antigen sensitivity of the prototype was evaluated and compared to five FDA-approved HIV antigen/antibody assays using World Health Organization (WHO) HIV p24 antigen standard and reference panels, 17 virus isolates and 9 seroconversion panels. Antibody sensitivity and assay specificity of the prototype were also assessed with 1062 disease-staged and genotyped samples, and samples from 3000 blood donors and 955 individuals with low-risk for HIV infection. RESULTS Compared with other assays evaluated, the prototype demonstrated the best analytical sensitivity for WHO antigen standard, reference panels including 12 HIV-1 variants (0.04 - 0.25 IU/ml) and one HIV-2 variant, and 17 HIV virus isolates including HIV-1 group M, N, P and O and HIV-2 (0.3 -16 pg/ml). The enhanced sensitivity was also observed for seroconversion samples, detecting more PCR-positive samples with detection up to 7 days earlier than the other assays. Improvement in antigen sensitivity did not compromise antibody sensitivity or assay specificity, detecting all HIV disease-staged and genotyped samples, with assay specificity of 99.97% for blood donors and 99.68% for the low-risk population. CONCLUSIONS These data indicate that the new prototype HIV Combo Next assay will be of diagnostic value, providing improved early detection for acute HIV infection from divergent HIV strains.
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Affiliation(s)
- Xiaoxing Qiu
- Infectious Disease Research, Abbott, Core Diagnostics, Abbott Park, IL, United States.
| | - Lori Sokoll
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | | | - Susan H Eshleman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Phaedre Mohr
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Clinton Huizenga
- Infectious Disease Research, Abbott, Core Diagnostics, Abbott Park, IL, United States
| | - Priscilla Swanson
- Infectious Disease Research, Abbott, Core Diagnostics, Abbott Park, IL, United States
| | - Gavin Cloherty
- Infectious Disease Research, Abbott, Core Diagnostics, Abbott Park, IL, United States
| | - John Hackett
- Infectious Disease Research, Abbott, Core Diagnostics, Abbott Park, IL, United States
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43
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Fraser H, Stone J, Wisse E, Sambu V, Mfisi P, Duran IJ, Soriano MA, Walker JG, Makere N, Luhmann N, Kafura W, Nouvellet M, Ragi A, Mundia B, Vickerman P. Modelling the impact of HIV and HCV prevention and treatment interventions for people who inject drugs in Dar es Salaam, Tanzania. J Int AIDS Soc 2021; 24:e25817. [PMID: 34661964 PMCID: PMC8522890 DOI: 10.1002/jia2.25817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction People who inject drugs (PWID) in Dar es Salaam, Tanzania, have a high prevalence of HIV and hepatitis C virus (HCV). While needle and syringe programmes (NSP), opioid agonist therapy (OAT) and anti‐retroviral therapy (ART) are available in Tanzania, their coverage is sub‐optimal. We assess the impact of existing and scaled up harm reduction (HR) interventions on HIV and HCV transmission among PWID in Dar es Salaam. Methods An HIV and HCV transmission model among PWID in Tanzania was calibrated to data over 2006–2018 on HIV (∼30% and ∼67% prevalence in males and females in 2011) and HCV prevalence (∼16% in 2017), numbers on HR interventions (5254 ever on OAT in 2018, 766–1479 accessing NSP in 2017) and ART coverage (63.1% in 2015). We evaluated the impact of existing interventions in 2019 and impact by 2030 of scaling‐up the coverage of OAT (to 50% of PWID), NSP (75%, both combined termed “full HR”) and ART (81% with 90% virally suppressed) from 2019, reducing sexual HIV transmission by 50%, and/or HCV‐treating 10% of PWID infected with HCV annually. Results The model projects HIV and HCV prevalence of 19.0% (95% credibility interval: 16.4–21.2%) and 41.0% (24.4–49.0%) in 2019, respectively. For HIV, 24.6% (13.6–32.6%) and 70.3% (59.3–77.1%) of incident infections among male and female PWID are sexually transmitted, respectively. Due to their low coverage (22.8% for OAT, 16.3% for NSP in 2019), OAT and NSP averted 20.4% (12.9–24.7%) of HIV infections and 21.7% (17.0–25.2%) of HCV infections in 2019. Existing ART (68.5% coverage by 2019) averted 48.1% (29.7–64.3%) of HIV infections in 2019. Scaling up to full HR will reduce HIV and HCV incidence by 62.6% (52.5–74.0%) and 81.4% (56.7–81.4%), respectively, over 2019–2030; scaled up ART alongside full HR will decrease HIV incidence by 66.8% (55.6–77.5%), increasing to 81.5% (73.7–87.5%) when sexual risk is also reduced. HCV‐treatment alongside full HR will decrease HCV incidence by 92.4% (80.7–95.8%) by 2030. Conclusions Combination interventions, including sexual risk reduction and HCV treatment, are needed to eliminate HCV and HIV among PWID in Tanzania.
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Affiliation(s)
- Hannah Fraser
- Population HealthSciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jack Stone
- Population HealthSciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Veryeh Sambu
- National AIDS Control Programmes, Dar es Salaam, Tanzania
| | - Peter Mfisi
- The Drug Control and Enforcement Authority, Prime Ministers Office, Dar es Salaam, Tanzania
| | | | | | - Josephine G Walker
- Population HealthSciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nobelrich Makere
- Tanzania Council for Social Development (TACOSODE), Dar es Salaam, Tanzania
| | | | - William Kafura
- Tanzania Commission for AIDS (TACAIDS), Dar es Salaam, Tanzania
| | | | - Allan Ragi
- Kenya AIDS NGO Consortium, Nairobi, Kenya
| | | | - Peter Vickerman
- Population HealthSciences, Bristol Medical School, University of Bristol, Bristol, UK
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44
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Matsuda EM, Ahagon CM, Coelho LPO, Campos IB, Colpas DR, Campos NC, López-Lopes GIS, Silva VO, de Oliveira IP, Brígido LFDM. A simple algorithm for selecting cases to investigate acute and early HIV infections in low- and middle-income countries. J Med Virol 2021; 94:791-794. [PMID: 34647636 DOI: 10.1002/jmv.27398] [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: 06/02/2021] [Accepted: 10/08/2021] [Indexed: 11/08/2022]
Abstract
We documented the outcome of an over 10-year (2011-2021) effort to diagnose acute and early HIV infections (AEHI) in an Infectious Diseases Outpatient Clinic with limited resources. Of a total of 132, 119 HIV-RNA tests were performed from 2017 to 2020, 12 cases were identified, using a simple algorithm: risk exposure of 6 weeks or less before the visit and/or symptoms compatible with acute retroviral syndrome 7-30 days after exposure and/or undetermined 3rd generation rapid diagnostic test or serology. AEHI diagnoses varied from 2.4% among asymptomatic to 25% for undetermined serology cases using this simple screening applicable to different settings.
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Affiliation(s)
- Elaine Monteiro Matsuda
- Infectious Diseases Outpatient Clinic, Santo André Health Secretary, Santo André, São Paulo, Brazil
| | | | | | - Ivana Barros Campos
- Santo André Regional Center, Adolfo Lutz Institute, Santo André, São Paulo, Brazil
| | | | | | | | | | - Isabela Penteriche de Oliveira
- Bioprocess and Biotecnology Engeneering, São Paulo State University-UNESP, Avenida Universitária, Botucatu, São Paulo, Brazil
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45
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van Empel E, de Vlieg RA, Montana L, Gómez-Olivé FX, Kahn K, Tollman S, Berkman L, Bärnighausen TW, Manne-Goehler J. Older Adults Vastly Overestimate Both HIV Acquisition Risk and HIV Prevalence in Rural South Africa. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3257-3276. [PMID: 34599468 PMCID: PMC8563552 DOI: 10.1007/s10508-021-01982-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/02/2021] [Accepted: 03/08/2021] [Indexed: 06/13/2023]
Abstract
Perceptions of HIV acquisition risk and prevalence shape sexual behavior in sub-Saharan Africa (SSA). We used data from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa baseline survey. Data were collected through home-based interviews of 5059 people ≥ 40 years old. We elicited information on perceived risk of HIV acquisition and HIV prevalence among adults ≥ 15 and ≥ 50 years old. We first describe these perceptions in key subgroups and then compared them to actual estimates for this cohort. We then evaluated the relationship between sociodemographic characteristics and accurate perceptions of prevalence in regression models. Finally, we explored differences in behavioral characteristics among those who overestimated risk compared to those who underestimated or accurately estimated risk. Compared to the actual HIV acquisition risk of < 1%, respondents vastly overestimated this risk: 35% (95% CI: 32-37) and 34% (95% CI: 32-36) for men and women, respectively. Respondents overestimated HIV prevalence at 53% (95% CI: 52-53) for those ≥ 15 years old and 48% (95% CI: 48-49) for those ≥ 50 years old. True values were less than half of these estimates. There were few significant associations between demographic characteristics and accuracy. Finally, high overestimators of HIV prevalence tested themselves less for HIV compared to mild overestimators and accurate reporters. More than 30 years into the HIV epidemic, older people in a community with hyperendemic HIV in SSA vastly overestimate both HIV acquisition risk and prevalence. These misperceptions may lead to fatalism and reduced motivation for prevention efforts, possibly explaining the continued high HIV incidence in this community.
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Affiliation(s)
- Eva van Empel
- Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA.
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Rebecca A de Vlieg
- Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Livia Montana
- Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA
| | - F Xavier Gómez-Olivé
- Medical Research Council/Wits Rural, Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, South Africa
| | - Kathleen Kahn
- Medical Research Council/Wits Rural, Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, South Africa
| | - Stephen Tollman
- Medical Research Council/Wits Rural, Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, South Africa
| | - Lisa Berkman
- Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA
- Medical Research Council/Wits Rural, Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, South Africa
| | - Till W Bärnighausen
- Medical Research Council/Wits Rural, Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, Parktown, South Africa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Africa Health Research Institute, Mtubatuba, South Africa
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Jennifer Manne-Goehler
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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46
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Lim AG, Trickey A, Thompson LH, Emmanuel F, Reza TE, Reynolds R, Cholette F, Melesse DY, Archibald C, Sandstrom P, Blanchard JF, Vickerman P. Elucidating Drivers for Variations in the Explosive Human Immunodeficiency Virus Epidemic Among People Who Inject Drugs in Pakistan. Open Forum Infect Dis 2021; 8:ofab457. [PMID: 34584901 PMCID: PMC8465332 DOI: 10.1093/ofid/ofab457] [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: 06/25/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background Pakistan’s explosive human immunodeficiency virus (HIV) epidemic among people who inject drugs (PWID) varies widely across cities. We evaluated possible drivers for these variations. Methods Multivariable regression analyses were undertaken using data from 5 national surveys among PWID (n = 18 467; 2005–2017) to determine risk factors associated with variations in city-level HIV prevalence. A dynamic HIV model was used to estimate the population-attributable fraction (PAF; proportion of HIV infections prevented over 10 years when that risk factor is removed) of these risk factors to HIV transmission and impact on HIV incidence of reducing their prevalence. Results Regression analyses suggested that city-level HIV prevalence is strongly associated with the prevalence of using professional injectors at last injection, heroin use in last month, and injecting ≥4 times per day. Through calibrating a model to these associations, we estimate that the 10-year PAFs of using professional injectors, heroin use, and frequent injecting are 45.3% (95% uncertainty interval [UI], 4.3%–79.7%), 45.9% (95% UI, 8.1%–78.4%), and 22.2% (95% UI, 2.0%–58.4%), respectively. Reducing to lowest city-level prevalences of using professional injectors (2.8%; median 89.9% reduction), heroin use (0.9%; median 91.2% reduction), and frequent injecting (0.1%; median 91.8% reduction) in 2020 reduces overall HIV incidence by 52.7% (95% UI, 6.1%–82.0%), 53.0% (95% UI, 11.3%–80.2%), and 28.1% (95% UI, 2.7%–66.6%), respectively, over 10 years. Conclusions Interventions should focus on these risk factors to control Pakistan’s explosive HIV epidemic among PWID, including a concomitant expansion of high-coverage needle/syringe provision, opioid substitution therapy, and antiretroviral therapy.
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Affiliation(s)
- Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Adam Trickey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Laura H Thompson
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Faran Emmanuel
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada.,Canada-Pakistan HIV/AIDS Surveillance Project, Islamabad, Pakistan
| | - Tahira E Reza
- Canada-Pakistan HIV/AIDS Surveillance Project, Islamabad, Pakistan
| | - Rosy Reynolds
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - François Cholette
- National HIV and Retrovirology Laboratories, JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | | | - Chris Archibald
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Canada
| | - Paul Sandstrom
- National HIV and Retrovirology Laboratories, JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - James F Blanchard
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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47
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Malloy GSP, Goldhaber-Fiebert JD, Enns EA, Brandeau ML. Predicting the Effectiveness of Endemic Infectious Disease Control Interventions: The Impact of Mass Action versus Network Model Structure. Med Decis Making 2021; 41:623-640. [PMID: 33899563 PMCID: PMC8295189 DOI: 10.1177/0272989x211006025] [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: 11/16/2022]
Abstract
BACKGROUND Analyses of the effectiveness of infectious disease control interventions often rely on dynamic transmission models to simulate intervention effects. We aim to understand how the choice of network or compartmental model can influence estimates of intervention effectiveness in the short and long term for an endemic disease with susceptible and infected states in which infection, once contracted, is lifelong. METHODS We consider 4 disease models with different permutations of socially connected network versus unstructured contact (mass-action mixing) model and heterogeneous versus homogeneous disease risk. The models have susceptible and infected populations calibrated to the same long-term equilibrium disease prevalence. We consider a simple intervention with varying levels of coverage and efficacy that reduces transmission probabilities. We measure the rate of prevalence decline over the first 365 d after the intervention, long-term equilibrium prevalence, and long-term effective reproduction ratio at equilibrium. RESULTS Prevalence declined up to 10% faster in homogeneous risk models than heterogeneous risk models. When the disease was not eradicated, the long-term equilibrium disease prevalence was higher in mass-action mixing models than in network models by 40% or more. This difference in long-term equilibrium prevalence between network versus mass-action mixing models was greater than that of heterogeneous versus homogeneous risk models (less than 30%); network models tended to have higher effective reproduction ratios than mass-action mixing models for given combinations of intervention coverage and efficacy. CONCLUSIONS For interventions with high efficacy and coverage, mass-action mixing models could provide a sufficient estimate of effectiveness, whereas for interventions with low efficacy and coverage, or interventions in which outcomes are measured over short time horizons, predictions from network and mass-action models diverge, highlighting the importance of sensitivity analyses on model structure. HIGHLIGHTS • We calibrate 4 models-socially connected network versus unstructured contact (mass-action mixing) model and heterogeneous versus homogeneous disease risk-to 10% preintervention disease prevalence.• We measure the short- and long-term intervention effectiveness of all models using the rate of prevalence decline, long-term equilibrium disease prevalence, and effective reproduction ratio.• Generally, in the short term, prevalence declined faster in the homogeneous risk models than in the heterogeneous risk models.• Generally, in the long term, equilibrium disease prevalence was higher in the mass-action mixing models than in the network models, and the effective reproduction ratio was higher in network models than in the mass-action mixing models.
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Affiliation(s)
- Giovanni S P Malloy
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Jeremy D Goldhaber-Fiebert
- Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Eva A Enns
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Margaret L Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
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Saz J, Dalmau-Bueno A, Meulbroek M, Pujol F, Coll J, Herraiz-Tomey Á, Pérez F, Marazzi G, Taboada H, Culqui DR, Caylà JA. Use of fourth-generation rapid combined antigen and antibody diagnostic tests for the detection of acute HIV infection in a community centre for men who have sex with men, between 2016 and 2019. PLoS One 2021; 16:e0255065. [PMID: 34314468 PMCID: PMC8315512 DOI: 10.1371/journal.pone.0255065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/08/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To assess the use of fourth-generation rapid diagnostic tests in identifying acute infection of Human Immunodeficiency Virus (HIV). Methods BCN Checkpoint promotes sexual health among men who have sex with men (MSM), with a focus on diagnosing HIV early, initiating combined antiretroviral treatment (cART) promptly, and recommending regular repeat testing for those who have tested negative. This cross-sectional study included all test results obtained at the centre between 25 March 2016 and 24 March 2019. The Alere™ HIV Combo (now rebranded to Determine™ HIV Ultra, from Abbott) was used to detect p24 antigen (p24 Ag) and/or immunoglobulin M (IgM) and G (IgG) antibodies to HIV-1/HIV-2 (HIV Ab). Rapid polymerase chain reaction (PCR) confirmatory testing and Western blot (WB) were performed for clients with a positive rapid test result. Confirmed HIV cases were promptly referred to the HIV unit for care and cART prescription. Results A total of 12,961 clients attended BCN Checkpoint during the study and 27,298 rapid tests were performed. 450 tests were found to be reactive, of which 430 confirmed as HIV-positive, representing a prevalence of 3.32%. Four confirmed cases (0.93%) were detected as “p24 Ag only”, nine (2.09%) as “both p24 and HIV Ab” and 417 (96.98%) as “HIV Ab only”. The “p24 Ag only” group had a 1-log higher viral load than the other groups and initiated treatment on the following working day. Overall, there were 20 false-positive results (0.07% and 4.44% of total and reactive tests, respectively), of which 10 positive for “p24 Ag only” and 10 for “HIV Ab only”. Conclusions Four Acute HIV Infections (AHI), with very high viral loads, have been detected with the “p24 Ag only” while the HIV Ab were still absent. Referral to the HIV unit and initiation of cART on the following working day contributed to improving persons’ health and to reduce HIV transmission chain.
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Affiliation(s)
- Jorge Saz
- Projecte dels NOMS-Hispanosida, Barcelona, Spain
- * E-mail:
| | | | | | - Ferran Pujol
- Projecte dels NOMS-Hispanosida, Barcelona, Spain
| | - Josep Coll
- IrsiCaixa AIDS Research Institute, Fight AIDS and Infectious Diseases Foundation, Badalona, Spain
| | | | - Félix Pérez
- Projecte dels NOMS-Hispanosida, Barcelona, Spain
| | | | | | - Dante R. Culqui
- Grupo Pulso (a company of Evidenze Group), Sant Cugat del Vallés, Spain
- Isabel Roig-Blauclinic Socio-Sanitary Centre, Barcelona, Spain
| | - Joan A. Caylà
- Tuberculosis Research Unit of Barcelona (UITB) Foundation, Barcelona, Spain
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Martin TCS, Abrams M, Anderson C, Little SJ. Rapid Antiretroviral Therapy Among Individuals With Acute and Early HIV. Clin Infect Dis 2021; 73:130-133. [PMID: 32777035 PMCID: PMC8246801 DOI: 10.1093/cid/ciaa1174] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/06/2020] [Indexed: 11/14/2022] Open
Abstract
HIV transmission is increased during acute and early HIV (AEH). Rapid antiretroviral therapy may shorten the duration of infectivity. We show rapid antiretroviral therapy in AEH is acceptable and effective, with 69.0% of participants starting ART within 7 days of HIV diagnosis disclosure, and 88.1% achieving suppression by 48 weeks.
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Affiliation(s)
- Thomas C S Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Matthew Abrams
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Christy Anderson
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Susan J Little
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
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Masuda N, Miller JC, Holme P. Concurrency measures in the era of temporal network epidemiology: a review. J R Soc Interface 2021; 18:20210019. [PMID: 34062106 PMCID: PMC8169215 DOI: 10.1098/rsif.2021.0019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/11/2021] [Indexed: 01/19/2023] Open
Abstract
Diseases spread over temporal networks of interaction events between individuals. Structures of these temporal networks hold the keys to understanding epidemic propagation. One early concept of the literature to aid in discussing these structures is concurrency-quantifying individuals' tendency to form time-overlapping 'partnerships'. Although conflicting evaluations and an overabundance of operational definitions have marred the history of concurrency, it remains important, especially in the area of sexually transmitted infections. Today, much of theoretical epidemiology uses more direct models of contact patterns, and there is an emerging body of literature trying to connect methods to the concurrency literature. In this review, we will cover the development of the concept of concurrency and these new approaches.
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Affiliation(s)
- Naoki Masuda
- Department of Mathematics, State University of New York at Buffalo, New York, NY, USA
- Computational and Data-Enabled Science and Engineering Program, State University of New York at Buffalo, New York, NY, USA
| | - Joel C. Miller
- School of Engineering and Mathematical Sciences, La Trobe University, Bundoora, Australia
| | - Petter Holme
- Tokyo Tech World Research Hub Initiative (WRHI), Institute of Innovative Research, Tokyo Institute of Technology, Yokohama 226-8503, Japan
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