Prevented perinatal HIV infections in the era of antiretroviral prophylaxis and treatment, United States, 1994-2020.

OBJECTIVE: The primary aim of this serial cross-sectional analysis is to estimate the total number of prevented perinatal HIV transmissions from the time of the initial recommendation for perinatal zidovudine (ZDV) prophylaxis in 1994 through 2020 in the US. METHODS: The estimated number of prevented transmissions was calculated as annual differences between expected and observed numbers of perinatal HIV transmissions. Annual expected number of transmissions was estimated by multiplying the annual number of births to women with HIV by 0.2255 (22.55%), i.e., the transmission rate of the control group in the ACTG Protocol 076 trial. We used published point estimates or, if only ranges were given, the midpoints of those ranges as the best estimates of the annual numbers of births to women with HIV and infants with perinatal HIV. When data were not available, we linearly interpolated or extrapolated the available data to obtain estimated numbers for each year. RESULTS: Between 1978 and 2020, the approximate number of live births to women with HIV was 191 267 (95% confidence interval [CI] 190 392-192 110) and for infants with diagnosed perinatal HIV, it was 21 379 (95% CI 21 088-21 695). Since 1994, the annual number of infants born with HIV decreased from 1263 (95% CI 1194-1333) to 33 in 2019 (95% CI 22-45) and 36 in 2020 (95% CI 25-48), corresponding to a 97% reduction. Cumulatively, an estimated total of 22 732 (95% CI 21 340-24 462) perinatal HIV infections were prevented from 1994 through to 2020. CONCLUSION: The elimination of perinatal HIV transmission-accompanied by the cumulative number of prevented cases exceeding that of perinatal HIV infections-is a major public health achievement in the US.

[Factors associated with marital status among spouse after diagnosed in newly reported HIV cases in China, 2014].

Objective: To analyze the factors associated with divorce or separation when one of the spouse diagnosed and newly reported as HIV positive, in China. Methods: Data from the Chinese HIV/AIDS Comprehensive Response Information Management System, by December 31, 2015 were used for collection on newly reported HIV cases regarding their baseline information in 2014 and follow-up within one year, among couples and above 18 year olds. HIV cases were divided into divorce/separation group and married group according to their marriage dynamics in one year after being diagnosed as HIV positive. Multivariate logistic regressions were used to analyze potential factors associated with divorce or separation after the diagnoses made. Results: A total of 31 708 HIV cases were included in this study. 22.5% (7 134/31 708) of them got divorced or separated in one year after diagnose being made. 81.6% (25 864/31 708) of them had couples tested in one year after diagnose made and 10.0% (2 599/25 864) of them got divorced or separated. Among 18.4% (5 844/31 708) of the HIV cases who did not have their couples tested in one year after the diagnoses, 77.6% (4 535/5 844) got divorced or separated. For those who did not have their couples tested in one year after the diagnose. Data from the multivariate logistic regression analysis showed that factors as those who were older than 45 (46-60 yr.: OR=1.28, 95%CI: 1.03-1.58; ≥61 yr.: OR=1.83, 95%CI: 1.41-2.37), with Han ethnicity (OR=1.56, 95%CI: 1.34-1.83), with high school education or above (OR=1.55, 95%CI: 1.27-1.90), non-farmers or non-rural laborers (OR=1.34, 95%CI: 1.17-1.54), infected through injecting drug use (OR=1.33, 95% CI: 1.03-1.71), men who had sex with men (OR=1.49, 95% CI: 1.20-1.86), or with childless (OR=2.35, 95%CI: 1.78-3.09) etc. were more likely to be divorced or separated after the diagnoses being made, among those who had their couples tested in one year after the diagnoses. Results from the multivariate logistic regression analysis showed that factors as those who were above 60 year olds (OR=1.32, 95%CI: 1.12-1.56), with Han ethnicity (OR=1.27, 95%CI: 1.13-1.44), with high school education or above (OR=1.26, 95%CI: 1.11-1.43), non-farmers or non-rural labors (OR=1.37, 95%CI: 1.25-1.51), infected through having sex with men (OR=1.38, 95%CI: 1.25-1.54), or without a child (OR=1.48, 95% CI: 1.27-1.71), were more likely to be divorced or separated after the diagnoses. Conclusion: A certain proportion of HIV cases got divorced or separated in one year after the diagnosis was made. The proportions of divorce or separation were different among populations. Interventions targeting reducing divorce or separation in certain populations should be integrated into routine care system to reduce the HIV transmission.

Study of Patterns and Markers of Human Immune Deficiency Virus -1 (HIV-1) Progression and Unemployment Rate among Patients from Alexandria, Egypt.

Middle East and North Africa (MENA) new HIV cases show the highest increase among all regions in the world. Even though Egypt has a low prevalence among the general population (< 0.02%), a national HIV epidemic occurs in certain population risk groups. The current study was conducted to asses clinical and immunological disease progression; following up viral load (VL) and detecting delta-32 CCR5 genotype polymorphism in selected cases, determining unemployment rate and identify predictors of employment for HIV-cases. A cross sectional design was adopted. HIV infected cases attending Alexandria Fever Hospital (AFH) for one year. Interview questionnaire and four CD+4 counts were done for all patients, HIV VL and delta-32 CCR5 polymorphism were done for selected cases. Sexual transmission and drug abuse are the most important risk factors. Infectious comorbidity increases the rate of HIV progression. CD4+ count at the end of the study; CD+4 (4), count was significantly higher than all other CD4+ readings among the whole cohort and among the treated group. Also, VL at the end of the study; VL(2), was significantly higher than VL(1) among the untreated group. Unemployment rate was 40%. Male gender and obtaining vocational training were significant predictors of employment. It can be concluded that having a family member living with HIV and drug abusers are high risk groups for HIV acquisition. Factors responsible for progression of HIV should be further investigated. Antiretroviral therapy is very effective in checking HIV replication rate, delaying the progression of HIV, reconstituting the immune response and should be available for all cases detected.

Factors associated with marital status among spouse after diagnosed in newly reported HIV cases in China, 2014 / 中华流行病学杂志

Objective To analyze the factors associated with divorce or separation when one of the spouse diagnosed and newly reported as HIV positive,in China.Methods Data from the Chinese HIV/AIDS Comprehensive Response Information Management System,by December 31,2015 were used for collection on newly reported HIV cases regarding their baseline information in 2014 and follow-up within one year,among couples and above 18 year olds.HIV cases were divided into divorce/separation group and married group according to their marriage dynamics in one year after being diagnosed as HIV positive.Multivariate logistic regressions were used to analyze potential factors associated with divorce or separation after the diagnoses made.Results A total of 31 708 HIV cases were included in this study.22.5％ (7 134/31 708) of them got divorced or separated in one year after diagnose being made.81.6％ (25 864/31 708) of them had couples tested in one year after diagnose made and 10.0％ (2 599/25 864) of them got divorced or separated.Among 18.4％ (5 844/31 708) of the HIV cases who did not have their couples tested in one year after the diagnoses,77.6％ (4 535/ 5 844) got divorced or separated.For those who did not have their couples tested in one year after the diagnose.Data from the multivariate logistic regression analysis showed that factors as those who were older than 45 (46-60 yr.:OR=1.28,95％CI:1.03-1.58;≥61 yr.:OR=1.83,95％CI:1.41-2.37),with Han ethnicity (OR=1.56,95％CI:1.34-1.83),with high school education or above (OR=1.55,95％CI:1.27-1.90),non-farmers or non-rural laborers (OR=1.34,95％CI:1.17-1.54),infected through injecting drug use (OR=1.33,95％CI:1.03-1.71),men who had sex with men (OR=1.49,95％CI:1.20-1.86),or with childless (OR=2.35,95％CI:1.78-3.09) etc.were more likely to be divorced or separated after the diagnoses being made,among those who had their couples tested in one year after the diagnoses.Results from the multivariate logistic regression analysis showed that factors as those who were above 60 year olds (OR=1.32,95％CI:1.12-1.56),with Han ethnicity (OR=1.27,95％CI:1.13-1.44),with high school education or above (OR=1.26,95％ CI:1.11-1.43),non-farmers or non-rural labors (OR=1.37,95％CI:1.25-1.51),infected through having sex with men (OR=1.38,95％ CI:1.25-1.54),or without a child (OR=1.48,95％ CI:1.27-1.71),were more likely to be divorced or separated after the diagnoses.Conclusion A certain proportion of HIV cases got divorced or separated in one year after the diagnosis was made.The proportions of divorce or separation were different among populations.Interventions targeting reducing divorce or separation in certain populations should be integrated into routine care system to reduce the HIV transmission.

Factors associated with marital status among spouse after diagnosed in newly reported HIV cases in China, 2014 / 中华流行病学杂志

Objective To analyze the factors associated with divorce or separation when one of the spouse diagnosed and newly reported as HIV positive,in China.Methods Data from the Chinese HIV/AIDS Comprehensive Response Information Management System,by December 31,2015 were used for collection on newly reported HIV cases regarding their baseline information in 2014 and follow-up within one year,among couples and above 18 year olds.HIV cases were divided into divorce/separation group and married group according to their marriage dynamics in one year after being diagnosed as HIV positive.Multivariate logistic regressions were used to analyze potential factors associated with divorce or separation after the diagnoses made.Results A total of 31 708 HIV cases were included in this study.22.5％ (7 134/31 708) of them got divorced or separated in one year after diagnose being made.81.6％ (25 864/31 708) of them had couples tested in one year after diagnose made and 10.0％ (2 599/25 864) of them got divorced or separated.Among 18.4％ (5 844/31 708) of the HIV cases who did not have their couples tested in one year after the diagnoses,77.6％ (4 535/ 5 844) got divorced or separated.For those who did not have their couples tested in one year after the diagnose.Data from the multivariate logistic regression analysis showed that factors as those who were older than 45 (46-60 yr.:OR=1.28,95％CI:1.03-1.58;≥61 yr.:OR=1.83,95％CI:1.41-2.37),with Han ethnicity (OR=1.56,95％CI:1.34-1.83),with high school education or above (OR=1.55,95％CI:1.27-1.90),non-farmers or non-rural laborers (OR=1.34,95％CI:1.17-1.54),infected through injecting drug use (OR=1.33,95％CI:1.03-1.71),men who had sex with men (OR=1.49,95％CI:1.20-1.86),or with childless (OR=2.35,95％CI:1.78-3.09) etc.were more likely to be divorced or separated after the diagnoses being made,among those who had their couples tested in one year after the diagnoses.Results from the multivariate logistic regression analysis showed that factors as those who were above 60 year olds (OR=1.32,95％CI:1.12-1.56),with Han ethnicity (OR=1.27,95％CI:1.13-1.44),with high school education or above (OR=1.26,95％ CI:1.11-1.43),non-farmers or non-rural labors (OR=1.37,95％CI:1.25-1.51),infected through having sex with men (OR=1.38,95％ CI:1.25-1.54),or without a child (OR=1.48,95％ CI:1.27-1.71),were more likely to be divorced or separated after the diagnoses.Conclusion A certain proportion of HIV cases got divorced or separated in one year after the diagnosis was made.The proportions of divorce or separation were different among populations.Interventions targeting reducing divorce or separation in certain populations should be integrated into routine care system to reduce the HIV transmission.

The Holy Grail: The search for undiagnosed cases is paramount in improving the cascade of care among people living with HIV.

Highly Active Antiretroviral Therapy (HAART) has transformed the nature of HIV/AIDS from an imminent death sentence to a chronic manageable condition. There is a growing interest in the potential impact of "treatment as prevention" - a notion that expanded coverage with HAART would substantially reduce morbidity and mortality from HIV, and secondarily HIV transmission at the population level. However, undiagnosed and undocumented HIV cases cannot benefit from HAART and are more likely to experience HIV-related morbidity and untimely mortality. Late diagnosis of HIV remains prevalent and represents missed opportunities for early linkage to and engagement in care. In the absence of a vaccine and cure for HIV, undiagnosed HIV cases represent the biggest challenge yet in the fight against HIV/AIDS. As such, identifying them should be a priority of HIV prevention programs.