Recently acquired HIV infections and associated factors among men who have sex with men diagnosed at Dutch sexual health centres

INTRODUCTION

Surveillance for recent HIV infections was implemented at Dutch sexual health centres (SHCs) for planning and evaluation of HIV prevention initiatives. The study objective is twofold: (1) to explore trends in recent HIV infections and associated socio-demographic and behavioural risk factors among men who have sex with men (MSM )attending SHCs, to gain insight into subgroups at risk for acquiring HIV and(2) to illustrate how comparison with different reference groups affect associations with these risk factors.

METHODS

Residual plasma or serum samples from MSM newly HIV diagnosed at SHCs in 2014-2017 were tested with an avidity assay. Multinomial regression was used to analyse risk factors for recent HIV infections among MSM with established HIV infections among MSM and with HIV-negative MSM as reference groups.

RESULTS

Of newly diagnosed MSM, 33% were classified as recent HIV infection with avidity testing. Combining HIV-negative test results with avidity outcomes resulted in 54% recent infections. Recent infection was associated with having an STI in the past, multiple partners and condom use for both reference groups of MSM. Additionally, relative to the HIV-negative MSM, recent infection was associated with education and having a non-Western origin. In contrast, relative to MSM with established HIV infections, recent infection was associated with Western origin.

CONCLUSION

Our results suggest ongoing but declining transmission of HIV and high uptake of HIV testing among MSM visiting SHCs. The identification of risk factors for recent infections can help healthcare professionals to target subgroups eligible for PrEP or condom use promotion. Differentiation by the reference group in explanatory models for recent infections is important as different risk factors were identified. Likely, associations relative to HIV-negative MSM follow those of acquiring HIV infection in general, whereas the comparison with the established HIV infection reference rather reflects the frequent testing behaviour of subgroups of MSM.

Attenuation of the euphoric effects of cocaine by the dopamine D1/D5 antagonist ecopipam (SCH 39166)

BACKGROUND

The subjective and reinforcing effects of cocaine in humans are associated with the enhancement of endogenous dopamine function in the mesolimbic system. This study examined the role of dopamine D1-like receptors in the behavioral and mood effects of cocaine by evaluating the effects of the selective D1/D5 antagonist ecopipam (SCH 39166) on subjective responses to intravenous cocaine in 11 subjects with cocaine dependence as defined by DSM-IV.

METHODS

Subjects were pretreated in a randomized double-blind fashion with either placebo or 10 mg, 25 mg, or 100 mg of ecopipam orally on 4 separate occasions. Two hours later a single intravenous injection of 30 mg of cocaine was administered. Subjective and cardiovascular responses were measured and blood samples for pharmacokinetic evaluation were obtained prior to cocaine dosing and at various times after dosing.

RESULTS

The euphoric (P = .004) and stimulating (P = .03) effects of cocaine were attenuated in a dose-dependent manner by ecopipam, while ratings of desire to take cocaine were diminished (P = .02). Ecopipam in combination with cocaine was safe and well tolerated.

CONCLUSION

These data indicate a potentially important role for D1-like receptors in the acute mood-altering and rewarding effects of cocaine in humans.

Cocaine abstinence symptomatology and treatment attrition

Premature termination from outpatient cocaine treatment predicts a number of poor outcomes, including higher rates of relapse and unemployment. This study attempted to predict dropouts from outpatient cocaine treatment, as well as those unable to achieve initial abstinence from cocaine, using two baseline variables that had previously been shown to predict treatment dropout: a measure of the severity of cocaine abstinence symptomatology using the Cocaine Selective Severity Assessment (CSSA) and the initial urine toxicology. Results of logistic regression analyses indicated that those with more intense abstinence symptoms, as measured by the CSSA, were five times more likely to terminate treatment prematurely. When combined with the CSSA, the initial urine did not significantly predict dropouts. The CSSA and the baseline urine were equal in their ability to predict those who would fail in their initial attempts to achieve abstinence. Implications for treatment are discussed.

A cocaine-positive baseline urine predicts outpatient treatment attrition and failure to attain initial abstinence

The primary study objective was to ascertain whether a prior finding that the baseline cocaine urine toxicology predicted treatment dropout for cocaine dependent outpatients could be extended to three additional cocaine dependent outpatient treatment samples and whether the urine toxicology also predicted attainment of initial abstinence for the four samples. A secondary objective was to ascertain the extent to which other baseline variables accounted for additional outcome variance over and above that afforded by urine toxicology. To evaluate the first objective, the relationships between the baseline cocaine urine and each of two measures of within treatment response--the completion of treatment or the attainment of initial abstinence--were determined for each of the treatment samples. The second objective was evaluated by a stepwise, hierarchical logistic regression analysis, with the urine toxicology entered in the first step, baseline Addiction Severity Index (ASI) variables in the second step, and achievement of initial abstinence as the outcome. In all four samples, patients with a urine indicative of recent cocaine use were less than half as likely to complete treatment or achieve initial abstinence. Individual ASI baseline variables did not contribute statistically significant variance over and above that predicted by the cocaine urine toxicology. The findings confirm the utility of the initial cocaine urine as a predictor of unfavorable outpatient treatment response.

Amantadine in the early treatment of cocaine dependence: a double-blind, placebo-controlled trial

A 4-week, double-blind, placebo-controlled trial of amantadine was conducted in 61 cocaine dependent outpatients. Subjects received 100 mg of amantadine 3 times daily. A follow-up visit was conducted at week 8. There were no significant differences between groups in treatment retention, or in the number of benzoylecgonine positive urine samples. Self-reported drug and alcohol use declined in both groups. At week 8 follow-up, self-reported drug use was significantly lower in the placebo group. Amantadine was not effective, and discontinuation of it may have been associated with an increase in cocaine use.

Bethanechol in the treatment of stuttering

A double-blind trial of bethanechol for the treatment of stuttering that used a crossover experimental design failed to find the drug superior to placebo. However, two of the patients who did respond favorably elected to continue with the medication and have remained more fluent after taking the drug for 6 months. The notion of "bethanechol responders" is advanced.

Myocardial protection from permanent injury during aortic cross-clamping: effectiveness of pharmacological cardiac arrest combined with topical cardiac hypothermia

In two groups of animals (6 and 9 dogs), the aorta was cross-clamped 60 and 90 minutes, respectively, during hypothermic cardiopulmonary bypass. Immediately after cross-clamping, pharmacological cardiac arrest was induced by injecting 100 ml of a cold cardioplegic solution into the aortic root. Topical cardiac hypothermia was added. In hearts undergoing 90 minutes of ischemia, a repeat injection of the cardioplegic solution was done at 45 minutes. In 14 dogs (control group), only topical cardiac hypothermia was instituted for myocardial protection during 60 minutes of ischemia. Seven weeks after operation the surviving animals (6 in each group) were killed. Study of myocardial performance failed to demonstrate significant differences among the groups. Microscopic examination of transmural samples taken from anatomically defined sides of both ventricles, disclosed isolated, punctuate subendocardial scars in only 2 hearts of the control group. All the hearts having 90 minutes of pharmacological cardiac arrest and topical cardiac hypothermia exhibited diffuse fibrosis replacing 10 to 20% of the left ventricular myocardium. Extent and incidence of fibrosis were significantly higher in these hearts in comparison to those of the other groups. We conclude that pharmacological cardiac arrest plus topical cardiac hypothermia makes a safe and efficient method of myocardial protection during aortic cross-clamping only if the ischemic intervals is limited to 60 minutes. It cannot prevent permanent myocardial injury if the ischemic arrest is extended to 90 minutes.

Ventricular fibrillation during cardiopulmonary bypass: long-term effects on myocardial morphology and function

Mongrel dogs were subjected to hypothermic (28 degrees to 30 degrees C) cardiopulmonary bypass with hemodilution by 50%. In two groups of 8 dogs each, ventricular fibrillation was induced for 60 and 90 minutes, respectively, while the dogs were on bypass. A group of 6 dogs with the heart beating but nonworking served as control. Seven weeks after operation, hemodynamic measurements were made in the survivors (6 in each group) and the heart was fixed by perfusion with glutaraldehyde. Multiple transmural samples were taken from both ventricles. Light microscopy revealed solitary left ventricular scars (0.5 to 3 mm wide) in 2 hearts each from Groups 2 and 3. None of the hearts exhibited diffuse subendocardial fibrosis indicative of healed ischemic injury. All animals were hemodynamically normal. We conclude that in the nonhypertrophied heart, ventricular fibrillation up to 90 minutes with continuous bypass-sustained coronary perfusion (perfusion pressure at or above 70 mm Hg) offers protection from permanent myocardial injury.

Does local cardiac hypothermia during cardiopulmonary bypass protect the myocardium from long-term morphological and functional injury?

Twenty-eight dogs were subjected to 90 minutes of hypothermic (30 degrees C) cardiopulmonary bypass with moderate hemodilution. In 6 dogs the heart was vented and beating for 60 minutes. Eight dogs underwent ventricular fibrillation with coronary perfusion (VF + CP). In 14 dogs the aorta was cross-clamped for 60 minutes while the myocardium was protected by local cardiac hypothermia (ICA + LCH). Eighteen animals survived. Hemodynamic studies at seven weeks revealed no major differences among the three groups. At postmortem examination, no gross scarring was noted in any heart. Microscopical examination of 14 hearts was completely-normal. In the VF + CP group, 2 hearts had isolated microscopical scars. Similar linear subendocardial scars (less than or equal to 1.5 X 0.5 mm) were noted in 2 hearts subjected to ICA + LCH. Survival after 60 minutes of VF + CP or ICA + LCH did not result in long-term morphological injury to or functional impairment of the myocardium.