Trends in HIV Testing Among US Adults, Aged 18-64 Years, 2011-2017.

In 2006, Centers for Disease Control and Prevention (CDC) recommended HIV screening in healthcare or clinical settings for all persons aged 13-64 years and annual rescreening for populations at high risk for HIV. We used the Behavioral Risk Factor Surveillance System to describe the prevalence and trends of ever tested for HIV and tested for HIV in the past 12 months among US adults. The percentage of ever tested increased from 42.9% in 2011 to 45.9% in 2017; testing in the past 12 months increased from 13.2% in 2011 to 14.8% in 2017. Despite these increases, less than half of US adults have ever been tested for HIV over ten years after CDC's recommendations. Increasing the prevalence of routine HIV screening and rescreening among individuals at high risk will reduce the number of undiagnosed persons with HIV infection and thus prevent new HIV infections-a key strategy in the Ending the HIV Epidemic initiative.

Tendência temporal dos casos de HIV/aids no estado de Minas Gerais, 2007 a 2016 / Tendencia temporal de los casos de VIH/sida en el estado de Minas Gerais, Brasil, 2007-2016 / Temporal trend of HIV/AIDS cases in the state of Minas Gerais, Brazil, 2007-2016

Objetivo: analisar a tendência temporal dos coeficientes de incidência, detecção e mortalidade pelo vírus da imunodeficiência humana (HIV) e síndrome da imunodeficiência adquirida (aids) no estado de Minas Gerais, de 2007 a 2016. Métodos: estudo de séries temporais, com dados do Sistema de Informação de Agravos de Notificação (Sinan), por regressão de Prais-Winsten. Resultados: no período estudado, foram notificados 35.349 casos,entre os quais predominou a transmissão por via sexual (81,7%); destes, 50,3% foram entre heterossexuais e 22,8% entre homossexuais. Houve aumento da taxa de incidência de aids (variação anual 1,6%; IC95%0,0;3,3) e de detecção de HIV+ (variação anual 60,3%; IC95%22,9;109,0). A taxa de mortalidade foi estacionária. O percentual de notificações pelo critério HIV+ aumentou de 3,8% em 2007 para 65,1% em 2016. Conclusão: a tendência de crescimento da detecção de HIV coincide com a estratégia para identificação dos casos; a incidência de aids foi crescente.

Objetivo: analizar la tendencia temporal de los coeficientes de incidencia, detección y mortalidad por el Virus de la Inmunodeficiencia Humana (VIH) y Síndrome de Inmunodeficiencia Adquirida (Sida) en el estado de Minas Gerais, entre 2007-2016. Métodos: estudio de las series temporales de casos notificados del Sistema de Información de Agravamientos de Notificación (Sinan) por la regresión de Prais-Winsten. Se utilizó estadística descriptiva y análisis de series temporales. Resultados: había 35.349 casos y predominio de contaminación por vía sexual (81,7%), en heterosexuales (50,3%) y homosexuales (22,8%). Aumentó la tendencia de la incidencia de sida y detección de VIH +, con variación anual del 1,6% y del 60,3% (p <0,05), respectivamente. La mortalidad fue estacionaria. Aumentaron las notificaciones por el criterio de VIH +. Conclusión: el aumento de la tendencia de detección de VIH +, indica que la estrategia para identificación de portadores se ha mostrado apropiada, pero la incidencia de sida continua creciente.

Objective: to analyze the temporal trend of Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) incidence, detection and mortality coefficients in the state of Minas Gerais between 2007 and 2016. Methods: this was a time series study of data held on the Notifiable Health Conditions Information System (Sinan) using Prais-Winsten regression. Results: in the period studied, 35,349 cases were notified, with predominance of sexually transmitted cases (81.7%), 50.3% of which were heterosexual cases and 22.8% were homosexual cases. AIDS incidence increased (annual change 1.6%; 95%CI 0.0;3.3) as did HIV detection (annual change 60.3%; 95%CI 22.9;109.0). The mortality rate was stationary; HIV+ notifications increased from 3.8% in 2007 to 65.1% in 2016. Conclusion: the growing trend of HIV+ detection coincided with the government strategy to identify cases. AIDS incidence increased.

Recent levels and trends in HIV incidence rates among adolescent girls and young women in ten high-prevalence African countries: a systematic review and meta-analysis.

BACKGROUND: The roll-out of antiretroviral therapy (ART) has changed contexts of HIV risk, but the influence on HIV incidence among young women is not clear. We aimed to summarise direct estimates of HIV incidence among adolescent girls and young women since ART and before large investments in targeted prevention for those in sub-Saharan Africa. METHODS: We did a systematic review and meta-analysis. We searched MEDLINE, Embase, Web of Science, Global Health, and CINAHL for studies reporting HIV incidence data from serological samples collected among females aged 15-24 years in ten countries (Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe) that were selected for DREAMS investment in 2015. We only included articles published in English. Our main outcome was to summarise recent levels and trends in HIV incidence estimates collected between 2005 and 2015, published or received from study authors, by age and sex, and pooled by region. FINDINGS: 51 studies were identified from nine of the ten DREAMS countries; no eligible studies from Lesotho were identified. Directly observed HIV incidence rates were lowest among females aged 13-19 years in Kumi, Uganda (0·38 cases per 100 person-years); and directly observed HIV incidence rates were highest in KwaZulu-Natal, South Africa (7·79 per 100 person-years among females aged 15-19 years, and 8·63 in those aged 20-24 years), among fishing communities in Uganda (12·40 per 100 person-years in females aged 15-19 years and 4·70 in those aged 20-24 years), and among female sex workers aged 18-24 years in South Africa (13·20 per 100 person-years) and Zimbabwe (10·80). In pooled rates from the general population studies, the greatest sex differentials were in the youngest age groups-ie, females aged 15-19 years compared with male peers in both southern African (pooled relative risk 5·94, 95% CI 3·39-10·44) and eastern African countries (3·22, 1·51-6·87), and not significantly different among those aged 25-29 years in either region. Incidence often peaked earlier (during teenage years) among high-risk groups compared with general populations. Since 2005, HIV incidence among adolescent girls and young women declined in Rakai (Uganda) and Manicaland (Zimbabwe), and also declined among female sex workers in Kenya, but not in the highest-risk communities in South Africa and Uganda. INTERPRETATION: Few sources of direct estimates of HIV incidence exist in high-burden countries and trend analyses with disaggregated data for age and sex are rare but indicate recent declines among adolescent girls and young women. In some of the highest-risk settings, however, little evidence exists to suggest ART availability and other efforts slowed transmission by 2016. Despite wide geographical diversity in absolute levels of incidence in adolescent girls and young women, risk relative to males persisted in all settings, with the greatest sex differentials in the youngest age groups. To end new infections among the growing population of adolescents in sub-Saharan Africa, prevention programmes must address gender inequalities driving excessive risk among adolescent girls. FUNDING: This work was conducted as part of a planning grant funded by the Bill & Melinda Gates Foundation.

Characteristics of and Trends in HIV Diagnoses in the Deep South Region of the United States, 2012-2017.

HIV prevention goals in the United States include reducing new HIV infections among people in the South Census region (commonly referred as the South). Using data reported to the National HIV Surveillance System, we examined trends in HIV diagnoses in the South, including the Deep South and Other South, during 2012-2017. Although diagnosis rates declined in all regions during the time period, declines were greater in all other regions compared to the Deep South, with the exception of the West region. Moreover, the South continues to have a diagnosis rate 50% higher (65% higher in the Deep South) than that of any other region. Diagnoses in the Deep South increased among some groups, including men who have sex with men, persons aged 25-34 years and Hispanics/Latinos. These findings highlight the need to further strengthen interventions in the South, particularly among communities of color and young adults.

Solicitud de serologías de VIH en atención primaria: encuesta a profesionales de Medicina y de Enfermería / Request for HIV serology in primary care: A survey of medical and nursing professionals

Introducción: En la Comunidad de Madrid existe un 42,7% de retraso diagnóstico de VIH. La atención primaria es la puerta de entrada al sistema sanitario y se desconoce la frecuencia de serologías solicitadas por estos profesionales. Los objetivos fueron conocer la frecuencia y factores asociados a la solicitud de serologías de VIH por profesionales de medicina y de enfermería de atención primaria de la Comunidad de Madrid. Método: Mediante encuesta on-line, se preguntó por la solicitud de serologías para VIH en los últimos 12 meses, a profesionales que participaron en el estudio de evaluación de estrategias de diagnóstico precoz de VIH en consultas de atención primaria de la Comunidad de Madrid (ESTVIH). La asociación entre la solicitud de serologías y las características sociodemográficas y de práctica clínica de los profesionales se cuantificó mediante odds ratio ajustadas (ORa) según regresión logística. Resultados: Se obtuvieron 264 encuestas (59,5% medicina). El 82,2% de profesionales medicina y el 18,7% de enfermería refirieron haber solicitado alguna serología de VIH en los últimos 12 meses (mediana de 15 y 2 serologías solicitadas, respectivamente). En medicina esta petición se asoció con sexo masculino (ORa: 2,95; IC95%: 0,82-10,56) y estar entrenado para dar consejo pre-post prueba de VIH (ORa: 2,42; IC95%: 0,84-6,93); en enfermería se asoció con edad (<50años; ORa: 2,75; IC95%: 0,97-7,75) y tiempo trabajado en atención primaria (>13años; ORa: 3,02; IC95%: 1,07-8,52). Conclusión: Es necesario promover la solicitud de pruebas de VIH y el entrenamiento pre-post prueba de VIH en profesionales de medicina y enfermería de atención primaria

Introduction: In the Community of Madrid there is 42.7% late HIV diagnosis. Primary care is the gateway to the health system and the frequency of serological tests requested by these professionals is unknown. The objectives were to establish the frequency of requests for HIV serology by medical and nursing primary care professionals in the Community of Madrid and the factors associated with these requests. Method: An 'on-line' survey was conducted, asking professionals who participated in the evaluation study of strategies to promote early diagnosis of HIV in primary care in the Community of Madrid (ESTVIH) about the number of HIV-serology tests requested in the last 12 months. The association between HIV-serology requesting and the sociodemographic and clinical practice characteristics of the professionals was quantified using adjusted odds ratios (aOR) according to logistic regression. Results: 264 surveys (59.5% physicians). Eighty-two point two percent of medical and 18.7% of nursing professionals reported requesting at least one HIV-serology in the last 12 months (median: 15 and 2 HIV-serology request, respectively). The doctors associated the request with: being male (aOR: 2.95; 95% CI: 0.82-10.56), being trained in pre-post HIV test counselling (aOR: 2.42; 95% CI: 0.84-6.93) and the nurses with: age (<50 years; aOR: 2.75; 95% CI: 0.97-7.75), and number of years working in primary care (>13 years; aOR: 3.02; 95% CI: 1.07-8.52). Conclusion: It is necessary to promote HIV testing and training in pre-post HIV test counselling for medical and nursing professionals in primary care centres

Profile of HIV serodiscordant couples in a tertiary care center.

BACKGROUND: Globally, 36.7 million people are infected with Human Immunodeficiency Virus (HIV). Of these 36.7 million people, 2.1 million are in India. Integrated counseling and testing centers are the cornerstones of early access to prevention and support services. The term "serodiscordant couple" refers to a couple where one partner is HIV-positive and the other HIV-negative. AIM: To study the serodiscordance rates in a cohort of people attending integrated counseling and testing center. MATERIALS AND METHODS: Aretrospective descriptive study of data from integrated counseling and testing center from January 2013 to December 2014 was done. RESULTS: Of the 7489 persons tested, 306 persons were positive for HIV (192 males and 114 females) with a prevalence of 4 percent. Of the 126 couples tested, serodiscordance was found in 46 couples, while 80 couples were seroconcordant. The overall prevalence of HIV serodiscordance was 36.5 percent. Male positive and female negative couples (M+ F-) were 35 (76.0%) and female positive and male negative (F+ M-) were 11 (23.9%). Discordant M+ F- couples were significantly higher than discordant F+ M- couples (P < 0.001). Most participants were aged between 21 and 40 years. The average age of men was 41.91 years and that of women was 34.21 years. The average age difference between life partners was 7.7 years. Significant association was seen between age and gender, as females were found to be younger (P value = 0.001). LIMITATION: Information regarding years of married life, number of sex partners or sexual behavior pre- and post-detection were not collected. Thus, our data present only the magnitude of serodiscordance in a cohort but does not analyze the other predictors of serodiscordance. CONCLUSION: Serodiscordant relationships occur more commonly in India than is presumed. Our study highlights the profile of serodiscordant couples in this part of the country. Effective measures to prevent transmission of HIV within a serodiscordant relationship are necessary steps in halting the HIV epidemic.

Trends in human immunodeficiency virus diagnoses among men who have sex with men in North America, Western Europe, and Australia, 2000-2014.

PURPOSE: The aim of the article was to investigate recent trends in human immunodeficiency virus (HIV) diagnosis rates among men who have sex with men (MSM) in high-income countries in North America, Western Europe, and Australia. METHODS: Data on annual rates of HIV diagnoses among MSM aged 15 to 65 years from 2000 to 2014 were collected from 13 high-income countries. Joinpoint regression software was used to empirically determine country-specific trend periods. Trends in HIV diagnosis rates and in the proportion of diagnoses occurring in young MSM aged 15 to 24 years were analyzed using Poisson regression and log-binomial regression, respectively. RESULTS: Six countries experienced an increasing trend from 2000 to 2007-08 followed by either a stable or declining trend through 2014. Five countries had recently increasing trends, and two countries had one stable trend from 2000 to 2014. All 13 countries experienced increases in the proportion of diagnoses occurring in young MSM. CONCLUSIONS: Since 2008, half of the 13 high-income countries examined experienced stable or decreasing trends. Still, some countries continue to experience increasing HIV trends, and young MSM are increasingly represented among new diagnoses. Efforts to support early sexual health promotion, reduce barriers to pre-exposure prophylaxis, and improve care engagement for young MSM are critical to addressing current HIV trends.

National Trends in Sexual Behavior, Substance Use and HIV Testing Among United States Men Who have Sex with Men Recruited Online, 2013 Through 2017.

The American Men's Internet Survey (AMIS) is conducted annually with 10,000 men age 15 + who have sex with men (MSM). Modeling was used with 39,863 AMIS surveys from 4 cycles between December 2013 to February 2017 to identify temporal trends in sexual behavior, substance use, and testing behavior (within 12 months preceding interview) stratified by participants' self-reported HIV status. HIV-negative/unknown status MSM had significant increases in condomless anal intercourse (CAI), marijuana use, use of other illicit substances, sexually transmitted infection (STI) diagnoses, and HIV or STI testing (testing only increased among MSM age 25 +). HIV-negative/unknown status MSM had significant decrease in CAI with an HIV-positive or unknown status partner. HIV-positive MSM had significant increases in CAI, methamphetamine use, and STI diagnoses/testing. Although encouraging, the few indicators of improvement in HIV/STI sexual health practices are not consistently seen across sub-groups of MSM and may be counteracted by growing proportions of MSM engaging in CAI and acquiring STIs.

Estimated HIV Inter-test Interval Among People at High Risk for HIV Infection in the U.S.

INTRODUCTION: Knowing the HIV testing frequency and its temporal changes are central to evaluate public adherence to HIV testing recommendations and performance of HIV prevention programs. This study intended to estimate the mean HIV inter-test interval (ITI) and monitor its trends among men who have sex with men (MSM); people who inject drugs (PWID); and high-risk heterosexuals (HRH). METHODS: Using National HIV Behavioral Surveillance data collected during 2008-2015, this analysis estimated the mean HIV ITI for each year by race/ethnicity and age among MSM, PWID, and HRH who reported the most recent HIV test date. Separate statistical models based on renewal process theory were fit using PROC NLIN with Newton-Raphson method. Estimated mean HIV ITI lengths were compared using the z-test. RESULTS: Estimated HIV ITI generally decreased in the past decade among MSM, PWID, and HRH who reported the most recent HIV test date. In most recent study years, estimated HIV ITI (in months) ranged from 5.8 to 12.5 among MSM, from 9.0 to 13.1 among PWID, and from 15.3 to 26.7 among HRH. Within each risk group, estimated HIV ITI was shortest among blacks and individuals aged 18-24 years. CONCLUSIONS: People at high risk for HIV infection who ever tested for HIV tested more frequently in the past decade. Most recently, MSM and PWID largely adhered to the Centers for Disease Control and Prevention's HIV testing recommendations, but HRH tested less frequently. Identifying factors associated with infrequent testing among HRH may provide information for future HIV testing initiatives.

Reflexiones sobre el infradiagnóstico y la primoinfección por VIH / Reflections on underdiagnosis and primary HIV infection

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Serología del virus de inmunodeficiencia humana (VIH) en atención primaria, ¿debe ser rutinaria en España? / Human Immunodeficienciy Virus (HIV) testing in primary care. Should it be routine in Spain?

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Roles y desafíos de mujeres jefas de hogar con VIH/Sida / Roles and challenges of female heads of household with HIV/AIDS

Objetivo Caracterizar los roles y desafíos que enfrentan las mujeres con VIH, líderes de hogar, del Valle del Cauca, Colombia. Método Cualitativo exploratorio, basado en la Teoría Fundada. Los datos fueron recolectados a través de entrevistas en profundidad a 13 mujeres con VIH, jefas de hogar con edades entre los 19 y los 46 años que viven en las ciudades de Cali y Buenaventura. Resultados Los principales roles asumidos por las mujeres son el cuidado de sus hijos, el sostenimiento del hogar, las expresiones de afecto, el apoyo frente a diferentes situaciones de la vida y los procedimientos administrativos relacionados con el acceso a los servicios de salud. Entre los desafíos se mencionan aquellos aspectos relacionados con la crianza, ser modelo de autocuidado, acompañar y liderar el diagnóstico y la adherencia al tratamiento de quienes tienen menores VIH positivos, dar a conocer el diagnóstico, proveer las mejores condiciones de vida, y el proveer acceso a bienes y servicios. Conclusiones Los resultados del estudio resaltan los desafíos y roles que enfrentan las mujeres al vivir con una enfermedad crónica y que aún sigue estando cargados de estigma y discriminación. Se evidencian los aspectos sociales, económicos, culturales y en salud relacionados con las inequidades y desigualdades en salud, asociadas al género y al acceso a los servicios en salud, al trabajo decente y educación.(AU)

Objective To characterize the roles and challenges that female heads of households with HIV in Valle del Cauca, Colombia assume. Method A qualitative exploratory method, based on Grounded Theory was conducted. Data were collected through in depth interviews to 13 women with HIV, heads of household with ages between 19 and 46,who live in the cities of Cali and Buenaventura. Results The main roles assumed by women are taking care of their children and their homes, expressing affection, providing support during different life events and administrative procedures related to health care services access. The challenges expressed by these women include aspects related to parenting, being a self-care role model, accompanying and leading the diagnosis and adherence to the treatment children with HIV, revealing the diagnosis, providing the best living conditions, and providing access to goods and services. Conclusions The results of the study highlight the challenges that women living with a chronic illness, that is still loaded with stigma and discrimination, have to face. The social, economic, cultural and health aspects related to the inequities and inequalities in health, to gender and access to health services, to decent work and to education are made clear in this work.(AU)

Increased HIV testing among hospitalized patients who declined testing in the emergency department.

Health-care systems have serial encounters with many of the same patients across care settings; however, few studies have examined the role of reoffering HIV testing after a patient declines. We assessed whether an intervention to increase HIV testing among hospitalized patients was associated with increased testing among those who declined a test while in the Emergency Department (ED). We studied 8-week periods pre- and post-implementation of an electronic medical record (EMR)-based intervention to increase HIV testing among hospitalized patients. We included all patients 21-64 years old who had no prior HIV test, declined HIV testing in the ED, and were subsequently hospitalized. We used logistic regression to test for an association between time of hospital admission (pre- vs. post-intervention) and whether an HIV test was performed prior to discharge. Pre- and post-implementation, 220 and 218 patients who declined HIV testing in the ED were hospitalized, respectively. There were no significant demographic or clinical differences among patients pre- and post-implementation. Pre- and post-implementation, the median proportion of patients tested weekly was 6.7% (IQR 6.5%, 10.0%) and 41.4% (IQR 33.3%, 41.9%), respectively (aOR 6.2: 95%CI: 3.6, 10.6). HIV testing increased among hospitalized patients who declined a test in the ED after implementation of an EMR-based intervention. Almost half of the patients who declined testing in the ED ultimately underwent testing after it was reoffered during hospitalization, suggesting that the decision to undergo HIV testing is a dynamic process. Leveraging EMR resources may be an effective tool for expanding HIV testing, and testing should be reoffered to patients who previously declined.

Providing ART to HIV Seropositive Persons Who Use Drugs: Progress in New York City, Prospects for "Ending the Epidemic".

New York City has experienced the largest HIV epidemic among persons who use psychoactive drugs. We examined progress in placing HIV seropositive persons who inject drugs (PWID) and HIV seropositive non-injecting drug users (NIDU) onto antiretroviral treatment (ART) in New York City over the last 15 years. We recruited 3511 PWID and 3543 NIDU from persons voluntarily entering drug detoxification and methadone maintenance treatment programs in New York City from 2001 to 2014. HIV prevalence declined significantly among both PWID and NIDU. The percentage who reported receiving ART increased significantly, from approximately 50 % (2001-2005) to approximately 75 % (2012-2014). There were no racial/ethnic disparities in the percentages of HIV seropositive persons who were on ART. Continued improvement in ART uptake and TasP and maintenance of other prevention and care services should lead to an "End of the AIDS Epidemic" for persons who use heroin and cocaine in New York City.

Trends in HIV surveillance data in the EU/EEA, 2005 to 2014: new HIV diagnoses still increasing in men who have sex with men.

Human immunodeficiency virus (HIV) transmission remains significant in Europe. Rates of acquired immunodeficiency syndrome (AIDS) have declined, but not in all countries. New HIV diagnoses have increased among native and foreign-born men who have sex with men. Median CD4(+) T-cell count at diagnosis has increased, but not in all groups, and late diagnosis remains common. HIV infection and AIDS can be eliminated in Europe with resolute prevention measures, early diagnosis and access to effective treatment.

Trends in HIV Testing Among U.S. Older Adults Prior to and Since Release of CDC's Routine HIV Testing Recommendations: National Findings from the BRFSS.

OBJECTIVE: This study examined temporal trends in HIV testing among U.S. older adults (50-64 years of age) before and after the release of CDC's routine HIV testing recommendations in 2006. METHODS: The sample (n=872,797; 51.4% female) comprised 2003-2010 Behavioral Risk Factor Surveillance System respondents in the oldest categories to which the recommendations apply: 50-54 years (34.5%, n=301,519), 55-59 years (34.1%, n=297,865), and 60-64 years (31.3%, n=273,413). We calculated (1) four-year pooled prevalences of past-year HIV testing before and after 2006, when the recommendations were released; and (2) annual prevalences of HIV testing overall and by age category from 2003-2010. Using weighted, multivariable logistic regression analyses, we examined binary (pre- vs. post-recommendations) and annual changes in testing, controlling for covariates. We stratified the data by recent doctor visits, examined racial/ethnic differences, and tested for linear and quadratic temporal trends. RESULTS: Overall and within age categories, the pooled prevalence of past-year HIV testing decreased following release of the recommendations (p<0.001). The annual prevalence decreased monotonically from 2003 (5.5%) to 2006 (3.6%) (b=-0.16, p<0.001) and then increased immediately after release of the recommendations, but decreased to 3.7% after 2009 (b=0.01, p<0.001). By race/ethnicity, testing increased over time among non-Hispanic black people only. Annual prevalence also increased among respondents with recent doctor visits. CONCLUSION: CDC's HIV testing recommendations were associated with a reversal in the downward trend in past-year HIV testing among older adults; however, the gains were neither universal nor sustained over time.

¿Es posible curar la infección por VIH? / Is it possible to cure HIV infection?

El tratamiento antirretroviral ha logrado normalizar las expectativas de vida de las personas infectadas por VIH, pero no logra la curación de la enfermedad. Se han identificado obstáculos que impiden la curación con solo tratamiento antirretroviral, que incluyen la existencia de un reservorio de células latentemente infectadas, la replicación vírica persistente en tejidos y los santuarios anatómicos. Se persigue como principal estrategia de curación la administración de fármacos que reactiven el virus latente para de este modo eliminar el reservorio celular. Los ensayos clínicos en marcha han mostrado la prueba de concepto, pero aún no se ha demostrado la eficacia de estos fármacos en disminuir el tamaño del reservorio (AU)

Antiretroviral therapy has significantly improved the life expectancy in HIV-infected people, but it cannot cure the disease by itself. Several barriers have been identified for the cure of HIV infection, including a reservoir of latently infected cells, persistent viral replication in tissues, and anatomical sanctuaries. The main strategy proposed for the cure of HIV consists on the administration of drugs that, through the reactivation of latent HIV, would eliminate the cell reservoir. Ongoing clinical trials have shown the proof of concept, but the efficacy of these drugs in decreasing the reservoir size has not been proved so far (AU)

Policy modeling to support administrative decisionmaking on the New York state HIV testing law.

A recent New York law requires medical providers to offer HIV tests as part of routine care. We developed a system dynamics simulation model of the HIV testing and care system to help administrators understand the law's potential epidemic impact, resource needs, strategies to improve implementation, and appropriate outcome indicators for future policy evaluations once postlaw data become available. Policy modeling allowed us to synthesize information from numerous sources including quantitative administrative data sets and practitioners' content expertise, structure the information to be viewed both numerically and visually, and organize consensus for decisionmaking purposes. This case illustrates how policy modeling can provide an integrated framework for administrators to examine policy problems in complex systems, particularly when data time lags limit pre--post comparisons and key outcomes cannot be measured directly.

Contributions of an intensive HIV prevention programme in increasing HIV testing among men who have sex with men in Andhra Pradesh, India.

The objective of this study was to identify the factors associated with uptake of HIV testing and to assess their relative contributions in increasing HIV testing. Data are drawn from two rounds of cross-sectional Integrated Behavioural and Biological Assessment (IBBA) surveys of self-identified men who have sex with men (MSM) from Andhra Pradesh, India, recruited through probability-based sampling in 2005-2006 and 2009-2010 (IBBA1, n = 1621; IBBA2, n = 1608, respectively). Logistic regression model was used to assess the relationship between socio-demographic characteristics, sexual behaviours, programme exposure and HIV testing. Significant factors were further parsed using decomposition analysis to examine the contribution of different components of that factor towards the change in HIV testing. There was a significant increase in the proportion of MSM reporting HIV testing from IBBA1 to IBBA2. Higher literacy levels, being 25-34 years old, being a kothi (predominantly receptive), engaging in both commercial and non-commercial sexual relationships and intervention programme exposure contributed the most to the increase in HIV testing.

[Microbiological diagnosis of human immunodeficiency virus infection]. / Diagnóstico microbiológico de la infección por el virus de la inmunodeficiencia humana.

This document attempts to update the main tasks and roles of the Clinical Microbiology laboratory in HIV diagnosis and monitoring. The document is divided into three parts. The first deals with HIV diagnosis and how serological testing has changed in the last few years, aiming to improve diagnosis and to minimize missed opportunities for diagnosis. Technological improvements for HIV Viral Load are shown in the second part of the document, which also includes a detailed description of the clinical significance of low-level and very low-level viremia. Finally, the third part of the document deals with resistance to antiretroviral drugs, incorporating clinical indications for integrase and tropism testing, as well as the latest knowledge on minority variants.