1
|
Nieuwenburg SA, van Bijnen A, Vermey K, Stam A, Zuilhof W, Hoornenborg E, Schim van der Loeff MF, de Vries HJC. Do men who have sex with men recognise syphilis symptoms? A syphilis awareness campaign in Amsterdam, the Netherlands. Sex Transm Infect 2024:sextrans-2023-055925. [PMID: 39059813 DOI: 10.1136/sextrans-2023-055925] [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: 07/10/2023] [Accepted: 06/29/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Syphilis incidence is rising among gay, bisexual and other men who have sex with men (GBMSM). To improve early health-seeking behaviour, we developed an online syphilis symptom score tool for GBMSM to self-identify a higher likelihood of infectious syphilis and promoted its use via an online and offline awareness campaign. METHODS From October 2018 through September 2019, a dedicated website on syphilis including the online symptom score tool was promoted. The reach of the campaign was measured by website metrics and the completion of the self-assessment tool. The impact of the campaign was assessed by comparing the monthly number of syphilis serology tests and the percentages of infectious syphilis diagnoses at the Centre for Sexual Health (CSH) in Amsterdam between three periods: 12 months preceding, 12 months during and 6 months after the campaign. RESULTS During the campaign, 20 341 visitors viewed the website. A total of 13 499 (66.4%) visitors started the self-assessment algorithm, and 11 626 (86.1%) completed it. Prior to the campaign, the mean number of syphilis tests per month was 1650 compared with 1806 per month during the campaign (p=0.02). In the 6 months after the campaign, the mean number of tests per month was 1798 (compared with the period of the campaign, p=0.94). Prior to the campaign, the percentage of infectious syphilis diagnoses was 2.5% compared with 3.0% during the campaign (p=0.009). The percentage of infectious syphilis diagnoses in the 6 months after the campaign was 2.2% (p<0.0001 compared with the period of the campaign, and p=0.045, compared with the period prior to the campaign). CONCLUSIONS Although we did not find definite proof of a (sustained) effect, syphilis symptoms awareness campaigns deserve further evaluation and improvements to help those suspected of syphilis to get tested.
Collapse
Affiliation(s)
- Silvia Achia Nieuwenburg
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | | | | | - Arjen Stam
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, Netherlands
- Department of Medical Microbiology and Infection and Prevention, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | | | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Maarten Franciscus Schim van der Loeff
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Department of Internal Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Henry John Christiaan de Vries
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Department of Dermatology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| |
Collapse
|
2
|
Ge Q, Lu X, Jiang R, Zhang Y, Zhuang X. Data mining and machine learning in HIV infection risk research: An overview and recommendations. Artif Intell Med 2024; 153:102887. [PMID: 38735156 DOI: 10.1016/j.artmed.2024.102887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 03/07/2024] [Accepted: 04/27/2024] [Indexed: 05/14/2024]
Abstract
In the contemporary era, the applications of data mining and machine learning have permeated extensively into medical research, significantly contributing to areas such as HIV studies. By reviewing 38 articles published in the past 15 years, the study presents a roadmap based on seven different aspects, utilizing various machine learning techniques for both novice researchers and experienced researchers seeking to comprehend the current state of the art in this area. While traditional regression modeling techniques have been commonly used, researchers are increasingly adopting more advanced fully supervised machine learning and deep learning techniques, which often outperform the traditional methods in predictive performance. Additionally, the study identifies nine new open research issues and outlines possible future research plans to enhance the outcomes of HIV infection risk research. This review is expected to be an insightful guide for researchers, illuminating current practices and suggesting advancements in the field.
Collapse
Affiliation(s)
- Qiwei Ge
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, China
| | - Xinyu Lu
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, China
| | - Run Jiang
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, China
| | - Yuyu Zhang
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, China
| | - Xun Zhuang
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, China.
| |
Collapse
|
3
|
McNulty MC, Stanford KA, Eller D, Sha BE, Purim-Shem-Tov Y, Kishen E, Glick N, Hunt B, Lin JY, Maheswaran A, Galvin S, Turelli R, Schmitt J, Pitrak D. Concurrent Testing for COVID-19 and HIV Infection at 6 High-Volume Emergency Departments in a Priority Jurisdiction for Ending the HIV Epidemic in the United States. J Acquir Immune Defic Syndr 2023; 94:364-370. [PMID: 37884056 PMCID: PMC10609715 DOI: 10.1097/qai.0000000000003287] [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: 11/22/2022] [Accepted: 08/01/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The COVID-19 pandemic caused disruptions in access to routine HIV screening. SETTING We assess HIV and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing across 6 emergency departments (EDs) in Cook County, Illinois. METHODS We retrospectively analyzed the number of SARS-CoV-2 tests, HIV screens, and the proportion of concurrent tests (encounters with both SARS-CoV-2 and HIV testing), correlating with diagnoses of new and acute HIV infection. RESULTS Five sites reported data from March 1, 2020, to February 28, 2021, and 1 site from September 1, 2020, to February 28, 2021. A total of 1,13,645 SARS-CoV-2 and 36,094 HIV tests were performed; 17,469 of these were concurrent tests. There were 102 new HIV diagnoses, including 25 acute infections. Concurrent testing proportions ranged from 6.7% to 37% across sites (P < 0.001). HIV testing volume correlated with the number of new diagnoses (r = 0.66, P < 0.01). HIV testing with symptomatic SARS-CoV-2 testing was strongly correlated with diagnosis of acute infections (r = 0.87, P < 0.001); this was not statistically significant when controlling for HIV testing volumes (r = 0.59, P = 0.056). Acute patients were more likely to undergo concurrent testing (21/25) versus other new diagnoses (29/77; odds ratio = 8.69, 95% CI: 2.7 to 27.8, P < 0.001). CONCLUSIONS Incorporating HIV screening into SARS-CoV-2 testing in the ED can help maintain HIV screening volumes. Although all patients presenting to the ED should be offered opt-out HIV screening, testing individuals with symptoms of COVID-19 or other viral illness affords the opportunity to diagnose symptomatic acute and early HIV infection, rapidly link to care, and initiate treatment.
Collapse
Affiliation(s)
- Moira C. McNulty
- Section of Infectious Diseases and Global Health, The University of Chicago Medicine, Chicago, IL
| | | | - Dylan Eller
- Section of Infectious Diseases and Global Health, The University of Chicago Medicine, Chicago, IL
| | - Beverly E. Sha
- Division of Infectious Diseases, Rush University Medical Center, Chicago, IL
| | | | - Ekta Kishen
- Clinical Data Analytics, Research Core, Rush University Medical Center, Chicago, IL
| | - Nancy Glick
- Sinai Infectious Disease Center, Chicago, IL
| | - Bijou Hunt
- Sinai Infectious Disease Center, Chicago, IL
| | - Janet Y. Lin
- Department of Emergency Medicine, The University of Illinois Chicago, Chicago, IL
| | - Anjana Maheswaran
- Department of Emergency Medicine, The University of Illinois Chicago, Chicago, IL
| | - Shannon Galvin
- Division of Infectious Disease, Northwestern University, Chicago, IL; and
| | - Robert Turelli
- Department of Emergency Medicine, Northwestern University, Chicago, IL
| | - Jessica Schmitt
- Section of Infectious Diseases and Global Health, The University of Chicago Medicine, Chicago, IL
| | - David Pitrak
- Section of Infectious Diseases and Global Health, The University of Chicago Medicine, Chicago, IL
| |
Collapse
|
4
|
Luo Q, Luo Y, Cui T, Li T. Performance of HIV Infection Prediction Models in Men Who Have Sex with Men: A Systematic Review and Meta-Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2023:10.1007/s10508-023-02574-x. [PMID: 36884160 DOI: 10.1007/s10508-023-02574-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/29/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Effective ways to identify and predict men who have sex with men (MSM) at substantial risk for HIV is a global priority. HIV risk assessment tools can improve individual risk awareness and subsequent health-seeking actions. We sought to identify and characterize the performance of HIV infection risk prediction models in MSM through systematic review and meta-analysis. PubMed, Embase, and The Cochrane Library were searched. Eighteen HIV infection risk assessment models with a total of 151,422 participants and 3643 HIV cases were identified, eight of which have been externally validated by at least one study (HIRI-MSM, Menza Score, SDET Score, Li Model, DHRS, Amsterdam Score, SexPro model, and UMRSS). The number of predictor variables in each model ranged from three to 12, age, the number of male sexual partners, unprotected receptive anal intercourse, recreational drug usage (amphetamines, poppers), and sexually transmitted infections were critical scoring variables. All eight externally validated models performed well in terms of discrimination, with the pooled area under the receiver operating characteristic curve (AUC) ranging from 0.62 (95%CI: 0.51 to 0.73, SDET Score) to 0.83 (95%CI: 0.48 to 0.99, Amsterdam Score). Calibration performance was only reported in 10 studies (35.7%, 10/28). The HIV infection risk prediction models showed moderate-to-good discrimination performance. Validation of prediction models across different geographic and ethnic environments is needed to ensure their real-world application.
Collapse
Affiliation(s)
- Qianqian Luo
- School of Nursing, Binzhou Medical University, 346 Guanhai Road, Laishan District, Yantai, 264003, China.
| | - Yongchuan Luo
- Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Tianyu Cui
- School of Nursing, Binzhou Medical University, 346 Guanhai Road, Laishan District, Yantai, 264003, China
| | - Tianying Li
- School of Nursing, Binzhou Medical University, 346 Guanhai Road, Laishan District, Yantai, 264003, China
| |
Collapse
|
5
|
Utility of the Signal-to-Cutoff Ratio and Antigen Index from Fourth- and Fifth-Generation HIV-1/HIV-2 Antigen/Antibody Assays for the Diagnosis of Acute HIV Infection: Applicability for Real-Time Use for Immediate Initiation of Antiretroviral Therapy. J Clin Microbiol 2022; 60:e0120422. [PMID: 36448814 PMCID: PMC9769902 DOI: 10.1128/jcm.01204-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Identification of individuals with acute HIV infection (AHI) and rapid initiation of antiretroviral therapy (ART) are priorities for HIV elimination efforts. Fourth- and fifth-generation HIV-1/HIV-2 antigen (Ag)/antibody (Ab) combination assays can quickly identify patients with AHI, but false-positive results can occur. Confirmatory nucleic acid amplification testing (NAAT) may not be rapidly available. We reviewed the data for 127 patients with positive fourth-generation ARCHITECT and fifth-generation Bio-Plex immunoassay results who had negative or indeterminate confirmatory Ab testing results, which yielded 38 patients with confirmed AHI and 89 patients with false-positive results. The receiver operating characteristic (ROC) curves showed excellent discriminatory power, with an area under the curve (AUC) for the signal-to-cutoff (S/CO) ratio of 0.970 (95% confidence interval [CI], 0.935 to 1.00) and an AUC for the Ag index (AI) of 0.968 (95% CI, 0.904 to 1.00). A threshold of 3.78 for the S/CO ratio would maximize the sensitivity (96.3%) and specificity (93.4%). The threshold for AI was 2.83 (sensitivity of 100% and specificity of 96.4%). The S/CO ratio was significantly correlated with the viral load (Spearman correlation coefficient, 0.486 [P = 0.014]), but the AI was not. The viral loads were all high, with a median of >2.8 million copies/mL. Two false-positive results with AI and S/CO ratio values markedly higher than the medians were observed, indicating that biological false-positive results can occur. Review of the S/CO ratio or AI may be used to improve the accuracy of AHI diagnosis prior to confirmatory NAAT results being available.
Collapse
|
6
|
Nieuwenburg SA, Hoornenborg E, Davidovich U, de Vries HJC, Schim van der Loeff M. Developing a symptoms-based risk score for infectious syphilis among men who have sex with men. Sex Transm Infect 2022:sextrans-2022-055550. [PMID: 36400527 DOI: 10.1136/sextrans-2022-055550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/21/2022] [Indexed: 11/19/2022] Open
Abstract
BackgroundSyphilis incidence is rising among men who have sex with men (MSM). An online tool based on a risk score identifying men with higher risk of infectious syphilis could motivate MSM to seek care. We aimed therefore to develop a symptoms-based risk score for infectious syphilis.MethodsWe included data from all consultations by MSM attending the Amsterdam Centre for Sexual Health in 2018–2019. Infectious syphilis (ie, primary, secondary or early latent syphilis) was diagnosed according to the centre’s routine protocol. Associations between symptoms and infectious syphilis were expressed as odds ratios (OR), with 95% confidence intervals (CI). Based on multivariable logistic regression models, we created risk scores, combining various symptoms. We assessed the area under the curve (AUC) and cut-off based on the Youden Index. We estimated which percentage of MSM should be tested based on a positive risk score and which percentage of infectious syphilis cases would then be missed.ResultsWe included 21,646 consultations with 11,594 unique persons. The median age was 34 years (IQR 27–45), and 14% were HIV positive (93% on antiretroviral treatment). We diagnosed 538 cases of infectious syphilis. Associations with syphilis symptoms/signs were strong and highly significant, for example, OR for a painless penile ulcer was 35.0 (CI 24.9 to 49.2) and OR for non-itching rash 57.8 (CI 36.8 to 90.9). Yet, none of the individual symptoms or signs had an AUC >0.55. The AUC of risk scores combining various symptoms varied from 0.68 to 0.69. For all risk scores using cut-offs based on Youden Index, syphilis screening would be recommended in 6% of MSM, and 59% of infectious syphilis cases would be missed.ConclusionSymptoms-based risk scores for infectious syphilis perform poorly and cannot be recommended to select MSM for syphilis screening. All MSM with relevant sexual exposure should be regularly tested for syphilis.
Collapse
Affiliation(s)
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Henry John Christiaan de Vries
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten Schim van der Loeff
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
7
|
Risk-Based Screening Tools to Optimise HIV Testing Services: a Systematic Review. Curr HIV/AIDS Rep 2022; 19:154-165. [PMID: 35147855 PMCID: PMC8832417 DOI: 10.1007/s11904-022-00601-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 12/31/2022]
Abstract
Purpose of review Effective ways to diagnose the remaining people living with HIV who do not know their status are a global priority. We reviewed the use of risk-based tools, a set of criteria to identify individuals who would not otherwise be tested (screen in) or excluded people from testing (screen out). Recent findings Recent studies suggest that there may be value in risk-based tools to improve testing efficiency (i.e. identifying those who need to be tested). However, there has not been any systematic reviews to synthesize these studies. Summary We identified 18,238 citations, and 71 were included. The risk-based tools identified were most commonly from high-income (51%) and low HIV (<5%) prevalence countries (73%). The majority were for “screening in” (70%), with the highest performance tools related to identifying MSM with acute HIV. Screening in tools may be helpful in settings where it is not feasible or recommended to offer testing routinely. Caution is needed for screening out tools, where there is a trade-off between reducing costs of testing with missing cases of people living with HIV. Supplementary Information The online version contains supplementary material available at 10.1007/s11904-022-00601-5.
Collapse
|
8
|
Letizia AG, Eller LA, Bryant C, Dawson P, Nitayaphan S, Kosgei J, Kibuuka H, Maganga L, Kroon E, Sriplienchan S, Michael NL, O’Connell RJ, Kim JH, Robb ML. Clinical signs and symptoms associated with acute HIV infection from an intensely monitored cohort on 2 continents. Medicine (Baltimore) 2022; 101:e28686. [PMID: 35119011 PMCID: PMC8812633 DOI: 10.1097/md.0000000000028686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/04/2022] [Indexed: 01/04/2023] Open
Abstract
Define the clinical presentation of acute human immunodeficiency virus infection (AHI) among men and women from 2 continents to create a clinical scoring algorithm.Comparison of incident sign and symptom between those with and without AHI.At-risk human immunodeficiency virus (HIV) negative men and women in Thailand, Kenya, Tanzania, and Uganda underwent twice-weekly testing for HIV. Newly diagnosed participants were evaluated twice weekly for 21 days after infection.Of the 3345 participants enrolled, 56 African females and 36 biological males from Thailand were diagnosed with AHI. Four hundred fifty-two of their encounters were compared to 18,281 HIV negative encounters. Due to a high degree of heterogeneity among incident symptoms, 2 unique subgroups based upon geography and sex were created. Among Thai males, the signs and symptoms with the greatest odds ratio (OR) between AHI and uninfected participants were nausea (OR 16.0, 95% confidence interval [CI] 3.9-60.2, P < .001) and lymphatic abnormalities (OR 11.8, 95% CI 4.2-49.0, P < .001); and among African females were pain behind the eyes (OR 44.4, 95% CI 12.0-158.0, P < .0001) and fatigue (OR 22.7, 95% CI 11.3-44.3, P < .001). The Thai male scoring algorithm had a 66% sensitivity and 84% specificity while the African female algorithm had a sensitivity of 27% and specificity of 98%.The different incident symptoms during AHI necessitated creating 2 different scoring algorithms that can guide diagnostic testing among a particular sex in the appropriate geographic setting. Further research on risk exposure, sex, and demographic specific models is warranted.
Collapse
Affiliation(s)
| | - Leigh Anne Eller
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | | | | | - Sorachai Nitayaphan
- Department of Retrovirology, United States Army Medical Directorate, Armed Forces Research Institute of Medical Sciences (USAMD-AFRIMS), Bangkok, Thailand
| | - Josphat Kosgei
- Kenya Medical Research Institute (KEMRI), United States Army Medical Research Directorate-Kenya (USAMRD-K), Henry Jackson Foundation Medical Research International (HJFMRI), Kericho, Kenya
| | - Hannah Kibuuka
- Makerere University Walter Reed Project, Kampala, Uganda
| | | | - Eugène Kroon
- The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Somchai Sriplienchan
- Department of Retrovirology, United States Army Medical Directorate, Armed Forces Research Institute of Medical Sciences (USAMD-AFRIMS), Bangkok, Thailand
| | - Nelson L. Michael
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD
| | | | - Jerome H. Kim
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD
- International Vaccine Institute, Seoul, South Korea
| | - Merlin L. Robb
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| |
Collapse
|
9
|
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.
Collapse
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
| | | |
Collapse
|
10
|
Wahdini S, Putra VP, Sungkar S. The Prevalence of Intestinal Protozoan Infections among Children in Southwest Sumba Based on the Type of Water Sources. Infect Chemother 2021; 53:519-527. [PMID: 34623780 PMCID: PMC8511361 DOI: 10.3947/ic.2021.0067] [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: 06/13/2021] [Accepted: 08/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background Intestinal protozoan infection is a public health problem in Indonesia, particularly in regions lacking clean water sources such as Perokonda and Perobatang villages, Southwest Sumba Regency, East Nusa Tenggara Province. The residents of Perokonda and Perobatang villages use wells and unprotected open springs respectively. Therefore, this study aims to determine the prevalence of intestinal protozoan infections in these two villages. Materials and Methods This was a cross-sectional study, carried out in Perokonda and Perobatang from August 2016 to August 2017. A total of 291 children aged 6 months to 18 years were used as subjects. Furthermore, fecal examinations were carried out by preparing smears, which were stained with lugol solution and examined under the microscopes by four experienced technicians. The data were processed using SPSS version 20 and analyzed by chi-square test. Results Among the 291 samples, the prevalence of intestinal protozoan infections was 20%, with 23.4% in Perokonda and 17.2% in Perobatang. The predominant species found were Blastocystis hominis (34.5%), Giardia lamblia (19.0%), and Entamoeba coli (15.5%). Moreover, approximately 69.0% of single infections were found while 31.0% were mixed and associated with 2 to 3 protozoan species. There were no significant differences between the prevalence of intestinal protozoan infections and the children in Perokonda and Perobatang villages (confidence interval 0.83 - 2.62, P = 0.19). Conclusion The type of water sources has no relationship with the species of intestinal protozoan infecting children in Perokonda and Perobatang.
Collapse
Affiliation(s)
- Sri Wahdini
- Department of Parasitology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
| | | | - Saleha Sungkar
- Department of Parasitology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| |
Collapse
|
11
|
Crowell TA, Ritz J, Coombs RW, Zheng L, Eron JJ, Mellors JW, Dragavon J, van Zyl GU, Lama JR, Ruxrungtham K, Grinsztejn B, Arduino RC, Fox L, Ananworanich J, Daar ES. Novel Criteria for Diagnosing Acute and Early Human Immunodeficiency Virus Infection in a Multinational Study of Early Antiretroviral Therapy Initiation. Clin Infect Dis 2021; 73:e643-e651. [PMID: 33382405 DOI: 10.1093/cid/ciaa1893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) initiation during acute and early human immunodeficiency virus infection (AEHI) limits HIV reservoir formation and may facilitate post-ART control but is logistically challenging. We evaluated the performance of AEHI diagnostic criteria from a prospective study of early ART initiation. METHODS AIDS Clinical Trials Group A 5354 enrolled adults at 30 sites in the Americas, Africa, and Asia who met any 1 of 6 criteria based on combinations of results of HIV RNA, HIV antibody, Western blot or Geenius assay, and/or the signal-to-cutoff (S/CO) ratio of the ARCHITECT HIV Ag/Ab Combo or GS HIV Combo Ag/Ab EIA. HIV status and Fiebig stage were confirmed by centralized testing. RESULTS From 2017 through 2019, 195 participants were enrolled with median age of 27 years (interquartile range, 23-39). Thirty (15.4%) were female. ART was started by 171 (87.7%) on the day of enrollment and 24 (12.3%) the next day. AEHI was confirmed in 188 (96.4%) participants after centralized testing, 4 (2.0%) participants were found to have chronic infection, and 3 (1.5%) found not to have HIV discontinued ART and were withdrawn. Retrospectively, a nonreactive or indeterminate HIV antibody on the Geenius assay combined with ARCHITECT S/CO ≥10 correctly identified 99 of 122 (81.2%) Fiebig II-IV AEHI cases with no false-positive results. CONCLUSIONS Novel AEHI criteria that incorporate ARCHITECT S/CO facilitated rapid and efficient ART initiation without waiting for an HIV RNA result. These criteria may facilitate AEHI diagnosis, staging, and immediate ART initiation in future research studies and clinical practice. CLINICAL TRIALS REGISTRATION NCT02859558.
Collapse
Affiliation(s)
- Trevor A Crowell
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Justin Ritz
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Robert W Coombs
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Lu Zheng
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Joseph J Eron
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John W Mellors
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joan Dragavon
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Gert U van Zyl
- Department of Pathology, Stellenbosch University, Cape Town, South Africa
| | - Javier R Lama
- Asociación Civil Impacta Salud y Educación, Lima, Peru
| | - Kiat Ruxrungtham
- Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Roberto C Arduino
- Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Lawrence Fox
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Jintanat Ananworanich
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.,Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric S Daar
- Lundquist Institute at Harbor-University of California-Los Angeles Medical Center, Torrance, California, USA
| | | |
Collapse
|
12
|
McNulty M, Schmitt J, Friedman E, Hunt B, Tobin A, Maheswaran AB, Lin J, Novak R, Sha B, Rolfsen N, Moswin A, Rose B, Pitrak D, Glick N. Implementing Rapid Initiation of Antiretroviral Therapy for Acute HIV Infection Within a Routine Testing and Linkage to Care Program in Chicago. J Int Assoc Provid AIDS Care 2021; 19:2325958220939754. [PMID: 32734805 PMCID: PMC7401059 DOI: 10.1177/2325958220939754] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Growing evidence suggests that rapid initiation of antiretroviral therapy for HIV improves care continuum outcomes. We evaluated process and clinical outcomes for rapid initiation in acute HIV infection within a multisite health care–based HIV testing and linkage to care program in Chicago. Through retrospective analysis of HIV testing data (2016-2017), we assessed linkage to care, initiation of antiretroviral therapy, and viral suppression. Of 334 new HIV diagnoses, 33 (9.9%) individuals had acute HIV infection. Median time to linkage was 11 (interquartile range [IQR]: 5-19.5) days, with 15 days (IQR 5-27) to initiation of antiretroviral therapy. Clients achieved viral suppression at a median of 131 (IQR: 54-188) days. Of all, 69.7% were retained in care, all of whom were virally suppressed. Sites required few additional resources to incorporate rapid initiation into existing processes. Integration of rapid initiation of antiretroviral therapy into existing HIV screening programs is a promising strategy for scaling up this important intervention.
Collapse
Affiliation(s)
- Moira McNulty
- Section of Infectious Diseases and Global Health, University of Chicago, IL, USA
| | - Jessica Schmitt
- Section of Infectious Diseases and Global Health, University of Chicago, IL, USA
| | - Eleanor Friedman
- Section of Infectious Diseases and Global Health, University of Chicago, IL, USA
| | - Bijou Hunt
- Sinai Infectious Disease Center, Sinai Health System, Chicago, IL, USA
| | - Audra Tobin
- Sinai Infectious Disease Center, Sinai Health System, Chicago, IL, USA
| | | | - Janet Lin
- University of Illinois Hospital and Health Sciences and Systems, Chicago, IL, USA
| | - Richard Novak
- University of Illinois Hospital and Health Sciences and Systems, Chicago, IL, USA
| | - Beverly Sha
- Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
| | | | - Arthur Moswin
- Mercy Hospital and Medical Center, Chicago, IL, USA.,Michael Reese Research and Education Foundation, Chicago, IL, USA
| | | | - David Pitrak
- Section of Infectious Diseases and Global Health, University of Chicago, IL, USA
| | - Nancy Glick
- Sinai Infectious Disease Center, Sinai Health System, Chicago, IL, USA
| |
Collapse
|
13
|
Dijkstra M, Mohamed K, Kigoro A, Mumba T, Mahmoud S, Wesonga A, Mukuria N, Oduor T, Gichuru E, Schim van der Loeff MF, Palmer S, Graham SM, van der Elst EM, Sanders EJ. Peer Mobilization and Human Immunodeficiency Virus (HIV) Partner Notification Services Among Gay, Bisexual, and Other Men Who Have Sex With Men and Transgender Women in Coastal Kenya Identified a High Number of Undiagnosed HIV Infections. Open Forum Infect Dis 2021; 8:ofab219. [PMID: 34113688 PMCID: PMC8186249 DOI: 10.1093/ofid/ofab219] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/24/2021] [Indexed: 11/12/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) partner notification services (HPN), peer mobilization with HIV self-testing, and acute and early HIV infection (AEHI) screening among gay, bisexual, and other men who have sex with men (GBMSM) and transgender women (TGW) were assessed for acceptability, feasibility, and linkage to antiretroviral therapy (ART) and preexposure prophylaxis (PrEP) services. Methods Between April and August 2019, peer mobilizers mobilized clients by offering HIV oral self-tests and immediate clinic referral for clients with AEHI symptoms. Mobilized participants received clinic-based rapid antibody testing and point-of-care HIV RNA testing. Newly diagnosed participants including those derived from HIV testing services were offered immediate ART and HPN. Partners were recruited through HPN. Results Of 772 mobilized clients, 452 (58.5%) enrolled in the study as mobilized participants. Of these, 16 (3.5%) were HIV newly diagnosed, including 2 (0.4%) with AEHI. All but 2 (14/16 [87.5%]) initiated ART. Thirty-five GBMSM and TGW were offered HPN and 27 (77.1%) accepted it. Provider referral identified a higher proportion of partners tested (39/64 [60.9%] vs 5/14 [35.7%]) and partners with HIV (27/39 [69.2%] vs 2/5 [40.0%]) than index referral. Of 44 enrolled partners, 10 (22.7%) were newly diagnosed, including 3 (6.8%) with AEHI. All 10 (100%) initiated ART. PrEP was initiated among 24.0% (103/429) mobilized participants and 28.6% (4/14) partners without HIV. Conclusions HPN, combined with a peer mobilization-led self-testing strategy and AEHI screening for GBMSM and TGW, appears to be acceptable and feasible. These strategies, especially HPN provider referral, effectively identified undiagnosed HIV infections and linked individuals to ART and PrEP services.
Collapse
Affiliation(s)
- Maartje Dijkstra
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.,Division of Infectious Diseases, Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Khamisi Mohamed
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | - Alex Kigoro
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | - Teresia Mumba
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | - Shally Mahmoud
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | - Abdalla Wesonga
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | - Nana Mukuria
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | - Tony Oduor
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | - Evans Gichuru
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.,Division of Infectious Diseases, Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Shaun Palmer
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | - Susan M Graham
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya.,University of Washington, Seattle, Washington, USA
| | | | - Eduard J Sanders
- Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Department of Global Health, Amsterdam University Medical Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
14
|
Felner JK, Mittal ML, Hoenigl M, Amico KR, Grelotti DJ, Eanes A, Hess K, Crawford J, Smith LR. Constructions of HIV Risk Among a Diverse Sample of HIV-Negative Young Men Who Have Sex With Men Who Are Repeat Testers. J Acquir Immune Defic Syndr 2021; 86:e126-e133. [PMID: 33394615 PMCID: PMC7933095 DOI: 10.1097/qai.0000000000002614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To end the HIV epidemic, HIV prevention and pre-exposure prophylaxis (PrEP) promotion efforts must reach young men who have sex with men (YMSM) at greatest risk for HIV. This study qualitatively explored whether common metrics used by clinicians, scientists, and public health officials to objectively assess HIV risk align with how YMSM conceptualize their risk for HIV and the factors that shape YMSM's risk perceptions. METHODS Interviews with a racially/ethnically diverse sample of HIV-negative YMSM (ages 19-24 years, 60% Latinx; n = 20) examined conceptualizations of HIV risk within the context of repeat HIV testing. Iterative, applied thematic analysis examined how participants conceptualized and constructed their HIV risk, and compared participants' descriptions of their risk with a validated quantitative assessment of HIV risk that reliably predicts HIV seroconversion in this group. RESULTS Objective quantitative assessments of HIV risk poorly aligned with participants' perceived HIV risk. Participants described their current risk in relative terms (relative to past risk and relative to friends'/peers' risk) and described age/developmental stage and changes in knowledge about HIV prevention as key factors in risk changes over time. Other factors included substance use and trust/mistrust in sexual partners and scientific advances in HIV prevention (eg, U = U and PrEP). Factors that influenced participants' perceived HIV risk were similar regardless of objective risk assessment. CONCLUSIONS Quantitative assessments of risk may poorly align with risk perception among YMSM. Although objective metrics can effectively target YMSM at greatest risk for HIV transmission, interventions to improve prevention behaviors and PrEP uptake may be more effective when tailored to bridge the disconnection between objective HIV risk assessments and YMSM's constructions of risk.
Collapse
Affiliation(s)
- Jennifer K. Felner
- San Diego State University, Institute for Behavioral and Community Health and School of Public Health, 9245 Sky Park Court, Suite 224, San Diego, CA 92123
| | - Maria Luisa Mittal
- University of California San Diego, Department of Medicine, Division of Infectious Diseases and Global Public Health, 9500 Gilman Drive MC 0507, La Jolla, CA 92093
| | - Martin Hoenigl
- University of California San Diego, Department of Medicine, Division of Infectious Diseases and Global Public Health, 9500 Gilman Drive MC 0507, La Jolla, CA 92093
| | - K. Rivet Amico
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
| | - David J. Grelotti
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego School of Medicine, 200 Dickinson St, Suite B, San Diego, CA 92103
| | - Alex Eanes
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
- NASTAD, 444 North Capitol Street NW, Suite 339, Washington, D.C. 20001
| | - Kristen Hess
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
- Clinical Trials Administration, Renown Health, 1155 Mill Street, G14, Reno, NV 89502
| | - Jessica Crawford
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
| | - Laramie R. Smith
- University of California San Diego, Department of Medicine, Division of Infectious Diseases and Global Public Health, 9500 Gilman Drive MC 0507, La Jolla, CA 92093
| |
Collapse
|
15
|
Tordoff DM, Barbee LA, Khosropour CM, Hughes JP, Golden MR. Derivation and Validation of an HIV Risk Prediction Score Among Gay, Bisexual, and Other Men Who Have Sex With Men to Inform PrEP Initiation in an STD Clinic Setting. J Acquir Immune Defic Syndr 2021; 85:263-271. [PMID: 32658131 DOI: 10.1097/qai.0000000000002438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clinicians and health departments would ideally undertake targeted efforts to promote HIV pre-exposure prophylaxis (PrEP) and frequent HIV testing using data-based criteria to identify populations at elevated risk for HIV. We developed an HIV risk prediction score for men who have sex with men (MSM) to identify individuals at substantial risk for HIV acquisition. METHODS We created a retrospective cohort of MSM who tested HIV-negative at the sexually transmitted disease clinic in Seattle, WA, from 2001 to 2015, and identified seroconversions using HIV surveillance data. We split the cohort randomly 2:1 into derivation and validation data sets, and used Cox proportional hazards to estimate the hazard of acquiring HIV associated with behavioral and clinical predictors, and the Akaike information criterion to determine which variables to retain in our model. RESULTS Among 16,448 MSM, 640 seroconverted over a 14.3-year follow-up period. The best prediction model included 13 variables and had an area under the receiver operating characteristic curve of 0.73 (95% confidence interval: 0.71 to 0.76), 76% sensitivity, and 63% specificity at a score cutoff ≥11. A simplified model restricted to 2011-2015 included 4 predictors [methamphetamine use, condomless receptive anal intercourse (CRAI), ≥10 partners, and current diagnosis or self-reported gonorrhea/syphilis in the past year]. This model, the Seattle PrEP Score, had an area under the receiver operating characteristic curve of 0.69 (95% confidence interval: 0.64 to 0.73), 62% sensitivity, and 70% specificity. One-year incidence was 0.5% for a score of 0, 0.7% for a score of 1, and 2.1% for scores ≥2. CONCLUSIONS The Seattle PrEP Score was predictive of HIV acquisition and could help clinicians and public health agencies identify MSM who could benefit from PrEP and frequent HIV testing.
Collapse
Affiliation(s)
| | - Lindley A Barbee
- Medicine, University of Washington, Seattle, WA.,Public Health-Seattle & King County HIV/STD Program, Seattle, WA; and
| | - Christine M Khosropour
- Departments of Epidemiology.,Public Health-Seattle & King County HIV/STD Program, Seattle, WA; and
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Matthew R Golden
- Departments of Epidemiology.,Medicine, University of Washington, Seattle, WA.,Public Health-Seattle & King County HIV/STD Program, Seattle, WA; and
| |
Collapse
|
16
|
Palmer S, Dijkstra M, Ket JCF, Wahome EW, Walimbwa J, Gichuru E, van der Elst EM, Schim van der Loeff MF, de Bree GJ, Sanders EJ. Acute and early HIV infection screening among men who have sex with men, a systematic review and meta-analysis. J Int AIDS Soc 2020; 23 Suppl 6:e25590. [PMID: 33000916 PMCID: PMC7527764 DOI: 10.1002/jia2.25590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Screening for acute and early HIV infections (AEHI) among men who have sex with men (MSM) remains uncommon in sub-Saharan Africa (SSA). Yet, undiagnosed AEHI among MSM and subsequent failure to link to care are important drivers of the HIV epidemic. We conducted a systematic review and meta-analysis of AEHI yield among MSM mobilized for AEHI testing; and assessed which risk factors and/or symptoms could increase AEHI yield in MSM. METHODS We systematically searched four databases from their inception through May 2020 for studies reporting strategies of mobilizing MSM for testing and their AEHI yield, or risk and/or symptom scores targeting AEHI screening. AEHI yield was defined as the proportion of AEHI cases among the total number of visits. Study estimates for AEHI yield were pooled using random effects models. Predictive ability of risk and/or symptom scores was expressed as the area under the receiver operator curve (AUC). RESULTS Twenty-two studies were identified and included a variety of mobilization strategies (eight studies) and risk and/or symptom scores (fourteen studies). The overall pooled AEHI yield was 6.3% (95% CI, 2.1 to 12.4; I2 = 94.9%; five studies); yield varied between studies using targeted strategies (11.1%; 95% CI, 5.9 to 17.6; I2 = 83.8%; three studies) versus universal testing (1.6%; 95% CI, 0.8 to 2.4; two studies). The AUC of risk and/or symptom scores ranged from 0.69 to 0.89 in development study samples, and from 0.51 to 0.88 in validation study samples. AUC was the highest for scores including symptoms, such as diarrhoea, fever and fatigue. Key risk score variables were age, number of sexual partners, condomless receptive anal intercourse, sexual intercourse with a person living with HIV, a sexually transmitted infection, and illicit drug use. No studies were identified that assessed AEHI yield among MSM in SSA and risk and/or symptom scores developed among MSM in SSA lacked validation. CONCLUSIONS Strategies mobilizing MSM for targeted AEHI testing resulted in substantially higher AEHI yields than universal AEHI testing. Targeted AEHI testing may be optimized using risk and/or symptom scores, especially if scores include symptoms. Studies assessing AEHI yield and validation of risk and/or symptom scores among MSM in SSA are urgently needed.
Collapse
Affiliation(s)
- Shaun Palmer
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
- International AIDS Vaccine InitiativeAmsterdamthe Netherlands
| | - Maartje Dijkstra
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamthe Netherlands
- Department of Internal MedicineDivision of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II)Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Johannes CF Ket
- Medical LibraryVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Elizabeth W Wahome
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
| | | | - Evanson Gichuru
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
| | - Elise M van der Elst
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
| | - Maarten F Schim van der Loeff
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamthe Netherlands
- Department of Internal MedicineDivision of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II)Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Godelieve J de Bree
- Department of Internal MedicineDivision of Infectious Diseases, and Amsterdam Institute for Infection and Immunity (AI&II)Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Eduard J Sanders
- Centre for Geographic Medicine Research – CoastKenya Medical Research InstituteKilifiKenya
- Department of Global Health, and Amsterdam Institute for Global Health and DevelopmentAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
- Nuffield Department of MedicineUniversity of OxfordHeadingtonUnited Kingdom
| |
Collapse
|
17
|
Jangra M, Dutta U, Shah J, Thapa BR, Nada R, Gupta N, Sehgal R, Sharma V, Khurana S. Role of Polymerase Chain Reaction in Stool and Duodenal Biopsy for Diagnosis of Giardiasis in Patients with Persistent/Chronic Diarrhea. Dig Dis Sci 2020; 65:2345-2353. [PMID: 31955285 DOI: 10.1007/s10620-019-06042-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/31/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND Giardia duodenalis is a common cause of chronic diarrhea especially in tropical countries. Diagnosis is based on microscopy (three stool samples) for trophozoites/cysts. Role of stool or duodenal biopsy PCR as a diagnostic method needs to be defined. We conducted a prospective study to determine the diagnostic characteristics of G. duodenalis stool and duodenal biopsy PCR in comparison to stool microscopy (reference standard). Later, we compared other techniques with stool PCR, considering it as new reference standard and characterized the type of Giardia assemblage. METHODS G. duodenalis stool nested PCR was first evaluated using 40 positive controls and 50 negative controls considering stool microscopy as reference standard. Patients with chronic diarrhea (n = 100) were evaluated by stool microscopy and nested PCR. In 30 patients in whom upper gastrointestinal endoscopy was performed, duodenal biopsy samples were obtained and evaluated by histopathology, imprint cytology, and nested PCR. The type of Giardia assemblage was detected by assemblage-specific PCR. RESULTS Stool nested PCR was found to have sensitivity and specificity of 100% and 94%, respectively, compared to stool microscopy. In patients with chronic diarrhea, 48% had evidence of Giardia infection. Stool microscopy detected 65%, stool PCR detected an additional 27%, and duodenal biopsy PCR detected an additional 8% of cases. The commonest assemblage found was assemblage B. Clinical and demographic characteristics were similar in patients harboring either assemblage A or B. CONCLUSION Stool PCR is more sensitive than stool microscopy. By utilizing stool microscopy, stool nested PCR, and duodenal biopsy PCR in sequential manner, diagnostic yield can be increased.
Collapse
Affiliation(s)
- Monika Jangra
- Department of Medical Parasitology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, India
| | - Usha Dutta
- Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jimil Shah
- Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - B R Thapa
- Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritambhra Nada
- Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nalini Gupta
- Cytological and Gynaecological Pathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rakesh Sehgal
- Department of Medical Parasitology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, India
| | - Vishal Sharma
- Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sumeeta Khurana
- Department of Medical Parasitology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, India.
| |
Collapse
|
18
|
Sanders EJ, Kigoro A, Thiong'o A, Nduati E, Graham SM. Symptom-based Scoring for Acute Human Immunodeficiency Virus. Clin Infect Dis 2020; 69:736-737. [PMID: 30689775 PMCID: PMC6669286 DOI: 10.1093/cid/ciz059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/16/2019] [Indexed: 01/08/2023] Open
Affiliation(s)
- Eduard J Sanders
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.,Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Alex Kigoro
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
| | - Alexander Thiong'o
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
| | - Eunice Nduati
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
| | - Susan M Graham
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.,University of Washington, Seattle
| |
Collapse
|
19
|
HIV-associated gut dysbiosis is independent of sexual practice and correlates with noncommunicable diseases. Nat Commun 2020; 11:2448. [PMID: 32415070 PMCID: PMC7228978 DOI: 10.1038/s41467-020-16222-8] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/15/2020] [Indexed: 02/08/2023] Open
Abstract
Loss of gut mucosal integrity and an aberrant gut microbiota are proposed mechanisms contributing to chronic inflammation and increased morbidity and mortality during antiretroviral-treated HIV disease. Sexual practice has recently been uncovered as a major source of microbiota variation, potentially confounding prior observations of gut microbiota alterations among persons with HIV (PWH). To overcome this and other confounding factors, we examine a well-powered subset of AGEhIV Cohort participants comprising antiretroviral-treated PWH and seronegative controls matched for age, body-mass index, sex, and sexual practice. We report significant gut microbiota differences in PWH regardless of sex and sexual practice including Gammaproteobacteria enrichment, Lachnospiraceae and Ruminococcaceae depletion, and decreased alpha diversity. Men who have sex with men (MSM) exhibit a distinct microbiota signature characterized by Prevotella enrichment and increased alpha diversity, which is linked with receptive anal intercourse in both males and females. Finally, the HIV-associated microbiota signature correlates with inflammatory markers including suPAR, nadir CD4 count, and prevalence of age-associated noncommunicable comorbidities.
Collapse
|
20
|
Dijkstra M, Lin TC, de Bree GJ, Hoenigl M, Schim van der Loeff MF. Validation of the San Diego Early Test Score for Early Human Immunodeficiency Virus Infection Among Amsterdam Men Who Have Sex With Men. Clin Infect Dis 2020; 70:2228-2230. [PMID: 31499523 PMCID: PMC7931835 DOI: 10.1093/cid/ciz895] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 09/06/2019] [Indexed: 11/13/2022] Open
Abstract
The San Diego Early Test score is a simple risk-assessment tool for acute, and early human immunodeficiency virus (HIV) infection. Validation in a prospective cohort of Amsterdam men who have sex with men showed fair prediction of HIV seroconversion (AUC, 0.701). This score can help prioritize and target HIV-prevention strategies.
Collapse
Affiliation(s)
- Maartje Dijkstra
- Department of Infectious Diseases, Public Health Services of Amsterdam, Amsterdam, The Netherlands
- Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Timothy C Lin
- University of California (UC) San Diego School of Medicine, La Jolla, California, United States of America
| | - Godelieve J de Bree
- Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Global Health and Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
- Division of Pulmonology, Medical University of Graz, Graz, Austria
- Division of Infectious Diseases and Global Public Health, Department of Medicine, UC San Diego School of Medicine, San Diego, California, United States of America
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Services of Amsterdam, Amsterdam, The Netherlands
- Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
21
|
Martin TCS, Chaillon A, Graves SK, Lin T, Gianella S, Smith DM, Little SJ, Hoenigl M. Genetic Network Analysis to Assess the Risk of Human Immunodeficiency Virus Transmission Among Men Who Have Sex With Men Seeking Partners on the Internet. Clin Infect Dis 2020; 70:925-932. [PMID: 30953067 PMCID: PMC7319271 DOI: 10.1093/cid/ciz278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/01/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Online partner seeking (OPS) among men who have sex with men (MSM) is associated with increased risk behavior including frequency of unprotected anal intercourse, number of partners, and incidence of sexually transmitted infections (STIs). However, the impact on transmission of human immunodeficiency virus (HIV) is uncertain. METHODS MSM diagnosed with acute and early HIV infection were recruited from the Primary Infection Resource Consortium. HIV transmission events in the year following infection were inferred using estimated date of infection combined with genetic network analysis with linked sequences defined as ≤0.015 sequences/site difference in the HIV type 1 (HIV-1) pol coding region. Participants completed a detailed baseline questionnaire including reported methods of meeting sexual partners, including OPS, in the prior 3 months, and regression was performed with inferred transmission as the outcome. RESULTS From 147 MSM who completed the questionnaire, there were an associated 20 inferred HIV transmissions. No association with OPS was found (odds ratio, 0.64 [95% confidence interval, .24-1.69]; P = .37), though individuals who reported OPS were more likely to have reported a greater number of partners (P = .003) and prior STIs (P = .002). Geospatial analysis did not indicate that OPS was associated with increased geographical reach of the user (P = .68). CONCLUSIONS Individuals reporting OPS did not have increased odds of inferred HIV-1 transmission in the year following infection using genetic linkage analysis despite apparently increased risk behavior. OPS also did not increase the geographic distance between genetically clustered HIV infections, suggesting that individuals mainly use the internet to meet partners in their local region.
Collapse
Affiliation(s)
- Thomas C S Martin
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, California
| | - Antoine Chaillon
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, California
| | - Susannah K Graves
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, California
| | - Timothy Lin
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, California
| | - Sara Gianella
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, California
| | - Davey M Smith
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, California
- San Diego Veterans Affairs Health System, California
| | - Susan J Little
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, California
| | - Martin Hoenigl
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, California
| |
Collapse
|
22
|
Aw JYH, Clarke NE, McCarthy JS, Traub RJ, Amaral S, Huque MH, Andrews RM, Gray DJ, Clements ACA, Vaz Nery S. Giardia duodenalis infection in the context of a community-based deworming and water, sanitation and hygiene trial in Timor-Leste. Parasit Vectors 2019; 12:491. [PMID: 31627736 PMCID: PMC6798381 DOI: 10.1186/s13071-019-3752-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/14/2019] [Indexed: 12/26/2022] Open
Abstract
Background Giardiasis is a common diarrhoeal disease caused by the protozoan Giardia duodenalis. It is prevalent in low-income countries in the context of inadequate access to water, sanitation and hygiene (WASH), and is frequently co-endemic with neglected tropical diseases such as soil-transmitted helminth (STH) infections. Large-scale periodic deworming programmes are often implemented in these settings; however, there is limited evidence for the impact of regular anthelminthic treatment on G. duodenalis infection. Additionally, few studies have examined the impact of WASH interventions on G. duodenalis. Methods The WASH for WORMS cluster randomised controlled trial was conducted in remote communities in Manufahi municipality, Timor-Leste, between 2012 and 2016. All study communities received four rounds of deworming with albendazole at six-monthly intervals. Half were randomised to additionally receive a community-level WASH intervention following study baseline. We measured G. duodenalis infection in study participants every six months for two years, immediately prior to deworming, as a pre-specified secondary outcome of the trial. WASH access and behaviours were measured using questionnaires. Results There was no significant change in G. duodenalis prevalence in either study arm between baseline and the final study follow-up. We found no additional benefit of the community-level WASH intervention on G. duodenalis infection (relative risk: 1.05, 95% CI: 0.72–1.54). Risk factors for G. duodenalis infection included living in a household with a child under five years of age (adjusted odds ratio, aOR: 1.35, 95% CI: 1.04–1.75), living in a household with more than six people (aOR: 1.32, 95% CI: 1.02–1.72), and sampling during the rainy season (aOR: 1.23, 95% CI: 1.04–1.45). Individuals infected with the hookworm Necator americanus were less likely to have G. duodenalis infection (aOR: 0.71, 95% CI: 0.57–0.88). Conclusions Prevalence of G. duodenalis was not affected by a community WASH intervention or by two years of regular deworming with albendazole. Direct household contacts appear to play a dominant role in driving transmission. We found evidence of antagonistic effects between G. duodenalis and hookworm infection, which warrants further investigation in the context of global deworming efforts. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12614000680662. Registered 27 June 2014, retrospectively registered. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366540.![]()
Collapse
Affiliation(s)
- Jessica Y H Aw
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Naomi E Clarke
- Research School of Population Health, Australian National University, Canberra, ACT, Australia. .,The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia.
| | - James S McCarthy
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Rebecca J Traub
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Salvador Amaral
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Md Hamidul Huque
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia
| | - Ross M Andrews
- Research School of Population Health, Australian National University, Canberra, ACT, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Darren J Gray
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Archie C A Clements
- Research School of Population Health, Australian National University, Canberra, ACT, Australia.,Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Susana Vaz Nery
- Research School of Population Health, Australian National University, Canberra, ACT, Australia.,The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
23
|
Hoenigl M, Mathur K, Blumenthal J, Brennan J, Zuazo M, McCauley M, Horton LE, Wagner GA, Reed SL, Vilke GM, Coyne CJ, Little SJ. Universal HIV and Birth Cohort HCV Screening in San Diego Emergency Departments. Sci Rep 2019; 9:14479. [PMID: 31597939 PMCID: PMC6785532 DOI: 10.1038/s41598-019-51128-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/25/2019] [Indexed: 12/11/2022] Open
Abstract
Universal HIV and HCV screening in emergency departments (ED) can reach populations who are less likely to get tested otherwise. The objective of this analysis was to evaluate universal opt-out HIV and HCV screening in two EDs in San Diego. HIV screening for persons aged 13-64 years (excluding persons known to be HIV+ or reporting HIV testing within last 12 months) was implemented using a 4th generation HIV antigen/antibody assay; HCV screening was offered to persons born between 1945 and 1965. Over a period of 16 months, 12,575 individuals were tested for HIV, resulting in 33 (0.26%) new HIV diagnoses, of whom 30 (90%) were successfully linked to care. Universal screening also identified 74 out-of-care for >12-months HIV+ individuals of whom 50 (68%) were successfully relinked to care. Over a one-month period, HCV antibody tests were conducted in 905 individuals with a seropositivity rate of 9.9% (90/905); 61 seropositives who were newly identified or never treated for HCV had HCV RNA testing, of which 31 (51%) resulted positive (3.4% of all participants, including 18 newly identified RNA positives representing 2% of all participants), and 13/31 individuals (42%) were linked to care. The rate of newly diagnosed HCV infections exceeded the rate of newly diagnosed HIV infections by >7-fold, underlining the importance of HCV screening in EDs.
Collapse
Affiliation(s)
- Martin Hoenigl
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States.
| | - Kushagra Mathur
- University of San Diego School of Medicine, San Diego, California, United States
| | - Jill Blumenthal
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States
| | - Jesse Brennan
- Department of Emergency Medicine, University of California San Diego, San Diego, California, United States
| | - Miriam Zuazo
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States
| | - Melanie McCauley
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States
| | - Lucy E Horton
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States
| | - Gabriel A Wagner
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States
| | - Sharon L Reed
- Department of Pathology, University of California San Diego, San Diego, California, United States
| | - Gary M Vilke
- Department of Emergency Medicine, University of California San Diego, San Diego, California, United States
| | - Christopher J Coyne
- Department of Emergency Medicine, University of California San Diego, San Diego, California, United States
| | - Susan J Little
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States
| |
Collapse
|
24
|
Brief Report: The Amsterdam Symptom and Risk-Based Score Predicts for Acute HIV Infection in Men Who Have Sex With Men in San Diego. J Acquir Immune Defic Syndr 2019; 79:e52-e55. [PMID: 30015794 DOI: 10.1097/qai.0000000000001800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Dijkstra et al recently described a risk- and symptom-based score moderately predictive for HIV seroconversion in the preceding 6-12 months in men who have sex with men (MSM) in Amsterdam. Our objective was to determine whether this "Amsterdam Score" could also predict for acute HIV infection (AHI) in MSM. DESIGN AND SETTING This study is a case-control analysis of a prospectively enrolled cohort of MSM who voluntarily presented for HIV testing in San Diego. The study sample was composed of MSM who screened HIV antibody-negative and then either tested positive with AHI [HIV nucleic acid test (NAT)-positive] or tested HIV NAT-negative. METHODS The Amsterdam Score was calculated for each participant in the study sample. Score performance was assessed using receiver operating characteristic curves and their area under the curve (AUC). An optimal cutoff was determined using the Youden index. RESULTS Seven hundred fifty-seven MSM (110 AHI and 647 HIV NAT-negative) were included in the analysis. AHI and HIV-negative cases were similar in age [median 32 years (interquartile range 26-42) vs 33 (27-45), respectively, P = 0.082]. The Amsterdam Score yielded a receiver operating characteristic curve with an AUC of 0.88 (95% confidence interval: 0.84 to 0.91). An optimal cutoff of ≥1.6 was 78.2% sensitive and 81.0% specific. CONCLUSIONS The risk- and symptom-based Amsterdam Score was highly predictive (AUC of 0.88) of AHI in MSM in San Diego. The Amsterdam Score could be used to target NAT utilization in resource-poor settings among MSM who test HIV antibody-negative, although the potential cost-savings must be balanced with the risk of missing AHI diagnoses.
Collapse
|
25
|
Hoenigl M, Hassan A, Moore DJ, Anderson PL, Corado K, Dubé MP, Ellorin EE, Blumenthal J, Morris SR. Predictors of Long-Term HIV Pre-exposure Prophylaxis Adherence After Study Participation in Men Who Have Sex With Men. J Acquir Immune Defic Syndr 2019; 81:166-174. [PMID: 30865175 PMCID: PMC6522282 DOI: 10.1097/qai.0000000000002003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Efficacy of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men is well documented in randomized trials. After trial completion, participants are challenged with acquiring PrEP on their own and remaining adherent. METHODS This was a follow-up study of the TAPIR randomized controlled multicenter PrEP trial. Participants were contacted after their last TAPIR visit (ie, after study-provided PrEP was discontinued) to attend observational posttrial visits 24 and 48 weeks later. Adherence during TAPIR and posttrial visits was estimated by dried blood spot intracellular tenofovir diphosphate levels (adequate adherence defined as tenofovir diphosphate levels >719 fmol/punch). Binary logistic regression analysis assessed predictors of completing posttrial visits and PrEP adherence among participants completing ≥1 visit. RESULTS Of 395 TAPIR participants who were on PrEP as part of the TAPIR trial for a median of 597 days (range 3-757 days), 122 (31%) completed ≥1 posttrial visit (57% of University of California San Diego participants completed posttrial visits, whereas this was 13% or lower for other study sites). Among participants who completed ≥1 posttrial visit, 57% had adequate adherence posttrial. Significant predictors of adequate adherence posttrial were less problematic substance use, higher risk behavior, and adequate adherence in year 1 of TAPIR. CONCLUSION More than half of PrEP users followed after trial completion had successfully acquired PrEP and showed adequate adherence. Additional adherence monitoring and intervention measures may be needed for those with low PrEP adherence and problematic substance use during the first year of trial.
Collapse
Affiliation(s)
- Martin Hoenigl
- University of California San Diego (UCSD), San Diego, California, United States
| | - Adiba Hassan
- University of California San Diego (UCSD), San Diego, California, United States
| | - David J. Moore
- University of California San Diego (UCSD), San Diego, California, United States
| | - Peter L. Anderson
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Katya Corado
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Michael P. Dubé
- Keck School of Medicine at the University of Southern California, Los Angeles, USA
| | - Eric E. Ellorin
- University of California San Diego (UCSD), San Diego, California, United States
| | - Jill Blumenthal
- University of California San Diego (UCSD), San Diego, California, United States
| | - Sheldon R. Morris
- University of California San Diego (UCSD), San Diego, California, United States
| | | |
Collapse
|
26
|
Chen J, Ramendra R, Lu H, Routy JP. The early bird gets the worm: benefits and future directions with early antiretroviral therapy initiation in primary HIV infection. Future Virol 2018. [DOI: 10.2217/fvl-2018-0110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Primary HIV infection is defined as the first few weeks after infection where plasma viremia is rapidly increasing. Early diagnosis of primary HIV infection enhances the tendency of behavioral changes in newly infected individuals to prevent secondary HIV transmission. Early antiretroviral therapy (ART) benefits individuals by reducing plasma viral load, gut damage, microbial translocation and subsequent systemic immune activation. Early ART leads to the establishment of low HIV reservoir size that may contribute to HIV eradication research. However, substantial diagnostic and logistical barriers remain as a burden to rapid diagnosis and early treatment initiation. In this review, we critically evaluate the effects of early ART and summarize hurdles that must be addressed to implement rapid treatment initiation for newly infected individuals.
Collapse
Affiliation(s)
- Jun Chen
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Shanghai 201508, PR China
| | - Rayoun Ramendra
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Microbiology & Immunology, McGill University, Montreal, QC H4A 3J1, Canada
| | - Hongzhou Lu
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Shanghai 201508, PR China
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Division of Hematology, Department of Medicine, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| |
Collapse
|
27
|
Marcus U, Nöstlinger C, Rosińska M, Sherriff N, Gios L, Dias SF, Gama AF, Toskin I, Alexiev I, Naseva E, Schink SB, Mirandola M. Behavioural and demographic correlates of undiagnosed HIV infection in a MSM sample recruited in 13 European cities. BMC Infect Dis 2018; 18:368. [PMID: 30081839 PMCID: PMC6080551 DOI: 10.1186/s12879-018-3249-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 07/10/2018] [Indexed: 12/29/2022] Open
Abstract
Background Reducing the number of people with undiagnosed HIV infection is a major goal of HIV control and prevention efforts in Europe and elsewhere. We analysed data from a large multi-city European bio-behavioural survey conducted among Men who have Sex with Men (MSM) for previously undiagnosed HIV infections, and aimed to characterise undiagnosed MSM who test less frequently than recommended. Methods Data on sexual behaviours and social characteristics of MSM with undiagnosed HIV infection from Sialon II, a bio-behavioural cross-sectional survey conducted in 13 European cities in 2013/2014, were compared with HIV-negative MSM. Based on reported HIV-testing patterns, we distinguished two subgroups: MSM with a negative HIV test result within 12 months prior to the study, i.e. undiagnosed incident infection, and HIV positive MSM with unknown onset of infection. Bivariate and multivariate associations of explanatory variables were analysed. Distinct multivariate multi-level random-intercept models were estimated for the entire group and both subgroups. Results Among 497 participants with HIV-reactive specimens, 234 (47.1%) were classified as previously diagnosed, 106 (21.3%) as incident, and 58 (11.7%) as unknown onset based on self-reported status and testing history. MSM with incident HIV infection were twice as likely (odds ratio (OR) = 2.22, 95% confidence interval (95%CI): 1.17–4.21) to have used recreational substances during their last anal sex encounter and four times more likely (OR = 3.94, 95%CI: 2.14–7.27) not to discuss their HIV status with the last anal sex partner(s). MSM with unknown onset of HIV infection were 3.6 times more likely (OR = 3.61, 95%CI: 1.74–7.50) to report testing for a sexually transmitted infection (STI) during the last 12 months. Conclusions Approximately one third of the study participants who are living with HIV were unaware of their infection. Almost two-third (65%) of those with undiagnosed HIV appeared to have acquired the infection recently, emphasizing a need for more frequent testing. Men with the identified behavioural characteristics could be considered as primary target group for HIV Pre-Exposure Prophylaxis (PrEP) to avoid HIV infection. The increased odds of those with unknown onset of HIV infection to have had an STI test in the past year strongly suggests a lost opportunity to offer HIV testing. Electronic supplementary material The online version of this article (10.1186/s12879-018-3249-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ulrich Marcus
- Department of Infectious Diseases Epidemiology, Robert Koch-Institute, Berlin, Germany.
| | | | - Magdalena Rosińska
- Department of Epidemiology, National Institute of Public Health, Warsaw, Poland
| | | | - Lorenzo Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Sonia F Dias
- Escola Nacional de Saúde Pública Universidade, Centro de Investigação em Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana F Gama
- Instituto de Higiene e Medicina Tropical, Global Health and Tropical Medicine, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ivailo Alexiev
- National Centre of Infectious and Parasitic Diseases, National Reference Laboratory of HIV, Sofia, Bulgaria
| | - Emilia Naseva
- Ministry of Health, Program "Prevention and control of HIV/AIDS", Sofia, Bulgaria
| | | | - Massimo Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | |
Collapse
|
28
|
Salzer HJF, Schäfer G, Hoenigl M, Günther G, Hoffmann C, Kalsdorf B, Alanio A, Lange C. Clinical, Diagnostic, and Treatment Disparities between HIV-Infected and Non-HIV-Infected Immunocompromised Patients with Pneumocystis jirovecii Pneumonia. Respiration 2018; 96:52-65. [PMID: 29635251 DOI: 10.1159/000487713] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/13/2018] [Indexed: 01/15/2023] Open
Abstract
The substantial decline in the Pneumocystis jirovecii pneumonia (PCP) incidence in HIV-infected patients after the introduction of antiretroviral therapy (ART) in resource-rich settings and the growing number of non-HIV-infected immunocompromised patients at risk leads to considerable epidemiologic changes with clinical, diagnostic, and treatment consequences for physicians. HIV-infected patients usually develop a subacute course of disease, while non-HIV-infected immunocompromised patients are characterized by a rapid disease progression with higher risk of respiratory failure and higher mortality. The main symptoms usually include exertional dyspnea, dry cough, and subfebrile temperature or fever. Lactate dehydrogenase may be elevated. Typical findings on computed tomography scans of the chest are bilateral ground-glass opacities with or without cystic lesions, which are usually associated with the presence of AIDS. Empiric treatment should be initiated as soon as PCP is suspected. Bronchoalveolar lavage has a higher diagnostic yield compared to induced sputum. Immunofluorescence is superior to conventional staining. A combination of different diagnostic tests such as microscopy, polymerase chain reaction, and (1,3)-β-D-glucan is recommended. Trimeth-oprim/sulfamethoxazole for 21 days is the treatment of choice in adults and children. Alternative treatment regimens include dapsone with trimethoprim, clindamycin with primaquine, atovaquone, or pentamidine. Patients with moderate to severe disease should receive adjunctive corticosteroids. In newly diagnosed HIV-infected patients with PCP, ART should be initiated as soon as possible. In non-HIV-infected immunocompromised patients, improvement of the immune status should be discussed (e.g., temporary reduction of immunosuppressive agents). PCP prophylaxis is effective and depends on the immune status of the patient and the underlying immunocompromising disease.
Collapse
Affiliation(s)
- Helmut J F Salzer
- Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.,German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany
| | - Guido Schäfer
- Infectious Diseases Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Section of Rheumatology, 3rd Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Hoenigl
- Division of Infectious Diseases, University of California at San Diego, San Diego, California, USA.,Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Gunar Günther
- Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.,Department of Internal Medicine, School of Medicine, University of Namibia, Windhoek, Namibia
| | - Christian Hoffmann
- Infektionsmedizinisches Centrum Hamburg (ICH) Study Center, Hamburg, Germany.,Department of Medicine II, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Barbara Kalsdorf
- Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.,German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany
| | - Alexandre Alanio
- Parasitology-Mycology Laboratory, Lariboisière Saint-Louis Fernand Widal Hospitals, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris-Diderot, Sorbonne Paris Cité University, Paris, France.,Institut Pasteur, Molecular Mycology Unit, CNRS CMR2000, Paris, France
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Leibniz Lung Center, Borstel, Germany.,German Center for Infection Research, Clinical Tuberculosis Center, Borstel, Germany.,International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|