Distinguishing repeated polymerase chain reaction positivity from re-infections in COVID-19.

BACKGROUND: Possibility of reinfection with SARS-CoV-2 changes our view on herd immunity and vaccination and can impact worldwide quarantine policies. We performed real-time polymerase chain reaction (RT-PCR) follow-up studies on recovered patients to assess possible development of reinfections and re-positivity. METHODS: During a 6-month period, 202 PCR-confirmed recovering COVID-19 patients entered this study. Follow-up RT-PCR tests and symptom assessment were performed 1 month after the initial positive results. Patients who tested negative were tested again 1 and 3 months later. The serum IgG and IgM levels were measured in the last follow-up session. RESULTS: In the first two follow-up sessions, 82 patients continued their participation, of which four patients tested positive. In the second follow-up 44 patients participated, three of whom tested positive. None of the patients who tested positive in the first and second follow-up session were symptomatic. In the last session, 32 patients were tested and four patients were positive, three of them were mildly symptomatic and all of them were positive for IgG. CONCLUSIONS: A positive RT-PCR in a recovering patient may represent reinfection. While we did not have the resources to prove reinfection by genetic sequencing of the infective viruses, we believe presence of mild symptoms in the three patients who tested positive over 100 days after becoming asymptomatic, can be diagnosed as reinfection. The immune response developed during the first episode of infection (e.g., IgG or T-cell mediated responses that were not measured in our study) may have abated the symptoms of the reinfection, without providing complete protection.

Patterns of high-risk behaviors associated with HIV among male prisoners: A latent class analysis.

Background: Acquired Immunodeficiency Syndrome (AIDS) is one of the most important health challenges worldwide. Moreover, the prevalence of the Human Immunodeficiency Virus (HIV) infection differs among Iranian prisoners and the general population. The present study aimed to identify the patterns of HIV-related high-risk behaviors in male prisoners. Methods: In this cross-sectional study, 2832 inmates were examined for HIV-related high-risk behaviors. The required data were collected using a questionnaire on high-risk behaviors, including a history of heterosexual and homosexual intercourse, and a history of drug use disorders. A Latent Class Analysis (LCA) was performed to analyze the obtained data in WinLTA software. Results: Five latent classes were defined for the male prisoners, as follows: low-risk (20%), moderate-risk (23%), Injection Drug Use (IDU) (8%), heterosexual intercourse/methamphetamine use (38%), and high-risk (11%). The LCA results revealed that high-risk sexual behaviors, IDU, and sharing injection equipment in prisons significantly influence the classification. The obtained data suggested that a history of imprisonment was not frequent in class 2 (OR=1.0033, %95CI:0.9936-1.01) and class 4 members (OR=1.0053, %95CI:0.9929-1.0179). However, it was more prevalent in class 3 (OR=1.0164, %95CI:1.0068-1.0262), and 5 (OR=1.0211, %95CI:1.0129-1.0293). Heterosexual contact had the highest prevalence (75%) in this regard. The results showed that the lowest prevalence of high-risk behaviors was associated with morphine use (0.3%). Among illicit drugs, methamphetamine was the most prevalent drug (42%) in the studied subjects. Conclusion: The present study indicated a high prevalence of high-risk sexual behaviors and methamphetamine use in the investigated participants. We observed the co-occurrence of HIV-related high-risk behaviors in male prisoners. Thus, providing safe sex education for prisoners is highly recommended. It is also necessary to pursue care programs about IDU as a key risk factor for HIV transmission in prisons.

Identifying and Validating Requirements of a Mobile-Based Self-Management System for People Living with HIV.

BACKGROUND: Due to the widespread use of mobile technology and the low cost of this technology, implementing a mobile-based self-management system can lead to adherence to the medication regimens and promotion of the health of people living with HIV (PLWH). We aimed to identify requirements of a mobile-based self-management system, and validate them from the perspective of infectious diseases specialists. METHOD: This is a mixed-methods study that carried out in two main phases. In the first phase, we identified requirements of a mobile-based self-management system for PLWH. In the second phase, identified requirements were validated using a researcher made questionnaire. The statistical population was infectious diseases specialists affiliated to Tehran University of Medical Sciences. The collected data were analyzed using SPSS statistical software (version 19), and descriptive statistics. RESULTS: By full-text review of selected studies, we determined requirements of a mobile-based self-management system in four categories: demographic, clinical, strategically and technical capabilities. According to the findings, 6 data elements for demographic category, 11 data elements for clinical category, 10 items for self-management strategies, and 11 features for technical capabilities were selected. CONCLUSION: Using the identified preferences, it is possible to design and implement a mobile-based self-management system for HIV-positive people. Developing a mobile-based self-management system is expected to progress the skills of self-management PLWH, improve of medication regimen adherence, and facilitate communication with healthcare providers.

Mobile-Based Applications and Functionalities for Self-Management of People Living with HIV.

BACKGROUND: Due to the chronicity of HIV/AIDS and the increased number of people living with HIV (PLWH), these people need the innovative and practical approaches to take advantage of high-quality healthcare services. The objectives of this scoping review were to identify the mobile-based applications and functionalities for self-management of people living with HIV. METHODS: We conducted a comprehensive search of PubMed, Scopus, Science direct, Web of Science and Embase databases for literature published from 2010 to 2017. Screening, data abstraction, and methodological quality assessment were done in duplicate. RESULTS: Our search identified 10 common mobile-based applications and 8 functionalities of these applications for self-management of people living with HIV. According to the findings, "text-messaging" and "reminder" applications were more addressed in reviewed articles. Moreover, the results indicated that "medication adherence" was the common functionality of mobile-based applications for PLWH. CONCLUSION: Inclusive evidence supports the use of text messaging as a mobile-based functionality to improve medication adherence and motivational messaging. Future mobile-based applications in the healthcare industry should address additional practices such as online chatting, social conversations, physical activity intervention, and supply chain management.

Demographic, Clinical and Laboratory Profiles of HIV Infected Patients Admitted into Imam Khomeini Hospital of Tehran, Iran.

OBJECTIVE: The aim of this study was to report the epidemiological, clinical and laboratory profiles of HIV-infected patients who admitted to HIV/AIDS laboratory of Imam Khomeini Hospital in Tehran, Iran. METHODS: HIV positive patients referred to the HIV/AIDS reference laboratory between December 2012 to March 2013 were included in the study. Their demographic characteristics, behavioral and personal history were assessed. Ninety nine patients' files from the medical records at the Voluntary Counseling and Testing Center (VCT) were selected and evaluated. Data was analyzed using SPSS for Windows Version 16. We used Pearson's chi-squared, one-way ANOVA and post hoc tests to examine differences in proportions. RESULTS: Of 99 participants in the present study, 68.7% were males, the mean age of the patients was 36±1.2 years and about 60% were married and almost half of them were self-employed. The most common transmission route was injection drug use. There was a statistically significant difference in CD4 count among different age groups (P = 0.028). Also, there was significant association between CD4 count and narcotic types (F=3.71, P = 0.012). Patients who used opium, had significantly higher CD4 than who used two or more narcotics (P = 0.005). CONCLUSION: Our findings are helpful in understanding the demographic, clinical and laboratory profile of people living with HIV/AIDS. Consideration of useful interventions for high- risk groups and paying more attention to socio demographic background are needed for health care providers.

High prevalence of chronic hepatitis B infection among injection drug users in Iran: the need to increase vaccination of adults at risk.

We measured the prevalence of HBV surface antigen (HBsAg) among male injection drug users (IDUs) in Detention, Tehran, Iran. A cross-sectional survey included 499 male IDUs arrested by police during a predetermined police sweep in Tehran (February, 2006). A questionnaire was filled out for each individual. Blood specimens were collected for HBsAg testing. Prevalence of HBsAg was 5.8% (95% CI 3.6-7.9). The majority of chronic HBV infections, 69.2%, were among adults age 25 to 34 years. The high prevalence of HBsAg highlights the need for special efforts to increase vaccination among adult populations at risk for HBV infection in order to reducing continuing transmission and stave off future high burden of disease.