Frequency of hepatitis D virus with different hepatitis B virus serological markers and coinfections in hospital patients from Argentina: synchronous testing of anti-HDV antibodies and HDV RNA.

BACKGROUND: Hepatitis D virus (HDV) RNA-positive cases with total anti-HDV antibodies nonreactive were documented. Moreover, HDV infection was observed in subjects with occult hepatitis B virus infection. The prevalence of HDV infection in Argentina is low; however, further research in different populations is needed. OBJECTIVE: This study aimed to perform synchronous HDV detection in reactive hepatitis B virus patients treated in a public hospital in the province of Buenos Aires, Argentina, some of whom were coinfected with hepatitis C virus and/or HIV. A total of 189 hepatitis B virus-reactive serum samples with or without hepatitis C virus and/or HIV coinfection were synchronously analyzed for anti-HDV antibodies and HDV RNA. RESULTS: HDV prevalence was 4.2% with HDV RNA found in 61 samples, most of which were nonreactive to anti-HDV antibodies and hepatitis B surface antigen. Genotype 1 was identified in all HDV sequences. Moreover, triple and quadruple infections were observed, showing a high frequency of HDV infection in hospitalized patients not following the recommended diagnostic algorithm. CONCLUSIONS: This study is evidence that the synchronous testing of anti-HDV antibodies and HDV RNA is necessary for the diagnosis of HDV infection in Argentina. Finally, further research is necessary to identify high-risk populations and improve prevention and control strategies for triple and quadruple infections and their potential consequences.

HIV prevalence among cervical (pre)cancer diagnoses in Suriname: a retrospective population study / Prevalencia del VIH en los casos diagnosticados de lesiones cervicouterinas (pre)cancerosas en Suriname: estudio poblacional retrospectivo / Prevalência de HIV em pacientes diagnosticadas com lesões cervicais (pré-) cancerosas no Suriname: estudo populacional retrospectivo

[ABSTRACT]. Objective. To determine the prevalence of HIV in women with (pre)cancerous cervical lesions in Suriname and their retention in care. Methods. A retrospective population study including all women diagnosed with (pre)invasive cervical intraepithelial neoplasia (CIN I to III or cervical cancer) in the only pathology department, during 2010–2020. The HIV test coverage and the HIV positivity ratio were determined through matching pathology data with the national HIV test database. The relation between retention in HIV care up to 2022 and different covariates was determined through Kaplan–Meier survival analysis and log-rank tests. Results. There were 2 901 (1 395 CIN I, 396 CIN II, 444 CIN III, and 666 cervical cancer) diagnoses of (pre) invasive cervical neoplasia. An overall HIV test coverage of 57.5% and a positivity ratio of 5.8% were found, with no difference among the (pre)cancer stages. The undiagnosed prevalence (women not previously known HIV-positive at cervical diagnosis) was 1.6% and 2.9% among precancer and cancer diagnoses, respectively. The median time in care of women with cervical cancer was 8 months for those not on antiretroviral therapy (ART) and 4 years for those starting ART. Among women with precancer stages this was 5 and 10 years, respectively (p < 0.05). Conclusions. HIV testing, followed by treatment initiation when found HIV-positive, should be prioritized in women diagnosed with cervical neoplasia. This will enhance the individual clinical outcomes and facilitate the control of the HIV epidemic in Suriname.

[RESUMEN]. Objetivo. Determinar la prevalencia del VIH en mujeres con lesiones cervicouterinas (pre)cancerosas en Suriname y su permanencia en la atención de salud. Métodos. Estudio poblacional retrospectivo en el que se incluyó a todas las mujeres a las que se diagnosticó una neoplasia intraepitelial cervicouterina (pre)invasiva (NIC I a III o cáncer cervicouterino) en el único departamento de anatomía patológica, entre el 2010 y el 2020. La cobertura de las pruebas del VIH y la tasa de positividad para el VIH se determinaron mediante el cotejo de los datos anatomopatológicos con la base de datos nacional de pruebas del VIH. La relación entre la permanencia en los servicios de atención a la infección por el VIH hasta el 2022 y las distintas covariables se determinó mediante un análisis de supervivencia de Kaplan-Meier y pruebas de orden logarítmico. Resultados. Hubo 2901 diagnósticos de neoplasia cervicouterina (pre)invasiva (1395 de NIC I, 396 de NIC II, 444 de NIC III y 666 de cáncer cervicouterino). Se observó una cobertura general de las pruebas del VIH del 57,5% y una tasa de positividad del 5,8%, sin diferencias entre los estadios de las lesiones precancerosas. La prevalencia no diagnosticada (mujeres sin positividad conocida previa para el VIH en el momento del diagnóstico del cáncer cervicouterino) fue del 1,6% y el 2,9% en las diagnosticadas de lesiones precancerosas y cáncer, respectivamente. La mediana del tiempo de permanencia en la atención de salud de las mujeres con cáncer cervicouterino fue de 8 meses en las que no recibían tratamiento antirretroviral y de 4 años en las que lo iniciaban. En el caso de las mujeres en estadio precancerosos fue de 5 y 10 años, respectivamente (p <0,05). Conclusiones. La realización de las pruebas del VIH, seguidas de un inicio del tratamiento al detectar un resultado positivo para el VIH, debe ser una prioridad en el caso de las mujeres a las que se diagnostica una neoplasia cervicouterina. Esto permitirá mejorar los resultados clínicos individuales y contribuirá al control de la epidemia de la infección por el VIH en Suriname.

[RESUMO]. Objetivo. Determinar a prevalência de infecção pelo HIV em mulheres com lesões cervicais (pré-)cancerosas no Suriname e a retenção dessas pacientes no cuidado. Métodos. Estudo populacional retrospectivo incluindo todas as mulheres diagnosticadas com neoplasia intraepitelial cervical (pré-)invasiva (NIC I a III ou câncer do colo do útero) em um único serviço de patologia no período de 2010 a 2020. Os dados de patologia foram cruzados com a base nacional de dados de testes de HIV para determinar a cobertura de testagem do HIV e o índice de positividade. A relação entre a retenção no cuidado do HIV até 2022 e diferentes covariáveis foi determinada por meio da análise de sobrevivência de Kaplan-Meier e testes de log-rank. Resultados. Houve 2901 diagnósticos de neoplasia cervical (pré-)invasiva (1395 NIC I, 396 NIC II, 444 NIC III e 666 casos de câncer do colo do útero). A cobertura geral do teste de HIV foi de 57,5%, com um índice de positividade de 5,8%, e não houve diferença entre os estágios da lesão cervical. A prevalência não diagnosticada (mulheres que não sabiam ser soropositivas para o HIV no momento do diagnóstico da lesão cervical) foi de 1,6% e 2,9% para os diagnósticos de lesões pré-cancerosas e cancerosas, respectivamente. O tempo mediano de tratamento de mulheres com câncer do colo do útero foi de 8 meses entre as que não receberam terapia antirretroviral (TARV) e de 4 anos entre as que iniciaram TARV. Entre as mulheres com lesões précancerosas, esses períodos foram de 5 e 10 anos, respectivamente (p < 0,05). Conclusões. A testagem de HIV, seguida de início do tratamento em caso de resultado positivo, deve ser priorizada em mulheres diagnosticadas com neoplasia cervical. Isso melhorará os resultados clínicos individuais e facilitará o controle da epidemia de HIV no Suriname.

A Rare Case Report of Skin Infection Caused by Nocardia brasiliensis in an HIV Patient.

BACKGROUND: In October 2023, our hospital confirmed a case of a patient with HIV with concurrent infection with Nocardia brasiliensis. A patient with HIV developed a lump on the surface of the dorsum of his left hand without any obvious cause. He used a nail clipper to trim it. Due to improper disinfection and treatment methods, the condition worsened, and he subsequently sought medical attention at our hospital. A series of clinical laboratory tests were conducted based on the patient's medical history, symptoms, and signs. Based on the test results, a reasonable clinical treatment plan was adopted, ultimately achieving satisfactory treatment outcomes for the patient. METHODS: Clinical implementation of pus bacterial culture and identification (matrix-assisted laser desorption/ ionization time-of-flight mass spectrometry, MALDI-TOF MS), serum anti HIV detection, and Treponema pallidum antibody detection. Additional related auxiliary examinations: blood routine, liver function, kidney function, CRP, electrolytes. RESULTS: Blood routine and CRP (venous blood): White blood cell count 16.00 x 109/L, total number of lymphocytes 3.73 x 109/L, total monocyte count 1.66 x 109/L, total number of neutrophils 10.37 x 109/L, total number of basophils 0.10 x 109/L, average platelet volume 8.8 fL, whole blood high-sensitivity C-reactive protein 46.44 mg/L, urine routine: protein+-. Liver function test: Albumin 37.7 g/L, aspartate aminotransferase 55.5 U/L, alanine aminotransferase 63.7 U/L, blood lipid test: triglycerides 2.22 mmol/L, high-density lipoprotein cholesterol 0.77 mmol/L, coagulation function test: fibrinogen test 5.69 g/L, lymphocyte subgroup analysis: T4/T8 cell ratio 0.78, total mature T cell count 2.501 x 109/L, T8 cell count 1.351 x 109/L, B cell count 0.574 x 109/L. Serum pathogen test: anti HIV positive, Treponema pallidum antibody 214.70 IU/mL, unheated serum reactive hormone test positive (1:8). Gram staining of pus: a large number of Gram positive bacteria were found, arrange in a branching form, weak acid-fast staining: positive, pus culture and bacteria identified (MALDI-TOF MS): Nocardia brasiliensis. Clinical treatment includes trimethoprim/sulfamethoxazole 800 mg/160 mg po q12 hours, local wet compress with Baiduobang ointment, and abscess incised and drained. Seven days later, the patient had a circular ulcer on the left back without any new pustules. Slightly elevated skin temperature, no tenderness, and no purulent or bloody secretions. His condition had improved and he was discharged. Follow up infectious disease specialist hospitals treat HIV, syphilis, and other related diseases. CONCLUSIONS: Patients with HIV are prone to various types of infections, even rare bacteria, as their immune function decreases. At present, there are few reports about a patient with HIV with concurrent infection with Nocardia brasiliensis. This case can provide reference for clinical diagnosis and treatment of related diseases in the future. In addition, with the popularity of new identification methods such as mass spectrometry, laboratories should pay attention to traditional staining methods and use microscopes to detect pathogens.

Coinfections and In-Hospital Mortality in a Group of Patients With HIV/AIDS: A Longitudinal Study.

Human immunodeficiency virus (HIV) is a global public health problem. Coinfections in HIV patients are frequent complications that increase their mortality. The aim of this study was to assess coinfections and in-hospital mortality in a group of patients infected with HIV in Colombia. A retrospective longitudinal study was carried out. Patients treated in 4 highly complex clinics in Colombia between 2015 and 2023 were included. The cases were identified from International Classification of Diseases codes related to HIV. Sociodemographic, clinical, laboratory and pharmacological variables were collected. Descriptive, bivariate, and multivariable analyses were performed. Of the 249 patients identified, 79.1% were men, and the median age was 38.0 years. Approximately 81.1% had a diagnosis of acquired immune deficiency syndrome (AIDS). Coinfections caused by Mycobacterium tuberculosis (24.1%) and Treponema pallidum (20.5%) were the most frequent. A total of 20.5% of the patients had sepsis, 12.4% had septic shock, and the fatality rate was 15.7%. Antibiotics and antifungals were used in 88.8% and 53.8%, respectively, of the patients. Patients with a diagnosis of HIV before admission, those infected with M. tuberculosis, and those who presented with sepsis were more likely to die, whereas patients who received antiretroviral agent treatment before admission presented a lower risk. In this study, most HIV patients were in an advanced stage of the disease. Coinfection with M. tuberculosis was common and was associated with an increased risk of death. Previous HIV diagnosis and sepsis also increased the risk. Approximately half of the patients with a previous HIV diagnosis were receiving antiretroviral therapy and had a better prognosis.

[Pancreatic tuberculosis]. / Tuberculosis pancreática.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. It is currently considered a public health problem due to the socioeconomic conditions of the world population and the increase in other infections such as that due to Human Immunodeficiency Virus (HIV). Pulmonary involvement is the most common form of clinical presentation, although in recent decades extrapulmonary involvement has increased. Among these, digestive disorders represent less than 10%. We present a case of exclusive pancreatic tuberculosis, in the context of an immunocompromised patient. A 43-year-old man with a history of HIV with a low CD4 count and high viral load, without antiretroviral treatment, with one-month history of symptoms characterized by low-grade fever associated with weight loss and nonspecific abdominal pain. An abdominal tomography was performed which showed a collection in the tail of the pancreas; the puncture revealed material with positive culture for M. tuberculosis. Antifimic and antiretroviral treatment was started with a good response. Primary pancreatic tuberculosis is an uncommon extrapulmonary form, given that it is a gland that would be biologically protected by the enzymes it produces. We highlight the rarity of the case and although the prognosis is good with anti-tuberculosis treatment, it could be fatal without correct diagnosis and treatment. The high index of suspicion of pancreatic tuberculosis by the physician and the performance of fine needle aspiration puncture to obtain histopathological evidence are important for a correct diagnosis, especially in HIV patients.

La tuberculosis es una enfermedad infectocontagiosa producida por el Mycobacterium tuberculosis. Actualmente se considera un problema de salud pública debido a las condiciones socioeconómicas de la población mundial y al incremento de otras infecciones causantes de inmunosupresión, como el virus de la inmunodeficiencia humana (HIV). La afección pulmonar es la forma de presentación clínica más frecuente aunque en las últimas décadas el compromiso extrapulmonar se ha visto incrementado. Dentro de este la afección digestiva representa menos del 10%. Presentamos un caso de localización exclusivamente pancreática en un paciente inmunocomprometido. Varón de 43 años HIV positivo, con bajo recuento de CD4 y alta carga viral, sin tratamiento antirretroviral, consultó por cuadro de un mes de evolución caracterizado por registros subfebriles asociado a pérdida de peso y dolor abdominal inespecífico. Se realizó tomografía de abdomen la cual arrojó colección en cola de páncreas, y posteriormente punción del material con rescate en cultivo de M. tuberculosis. Se inició tratamiento antifímico y antirretroviral con buena respuesta al mismo. La tuberculosis pancreática primaria es una forma extrapulmonar infrecuente, dado que es una glándula que estaría biológicamente protegida por las enzimas que origina. Destacamos la infrecuencia del caso y aunque el pronóstico es bueno con el tratamiento antifímico, podría ser fatal sin un diagnóstico y tratamiento correctos. El alto índice de sospecha de tuberculosis pancreática por parte del médico y la realización de punción aspiración con aguja fina (PAAF) para obtener evidencia histopatológica son importantes para un diagnóstico correcto, especialmente en pacientes HIV.

A cascade of care for diabetes in people living with HIV in a tertiary care center in Mexico City.

BACKGROUND: Diabetes affects 4.5% of people living with HIV in Mexico. This study aims to describe the diabetes cascade of care (DMC) in people with HIV in a tertiary center in Mexico City. METHODS: We conducted a single-center review of people with HIV aged over 18, using medical records of active people enrolled at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) HIV Clinic (HIVC). Our analysis focused on their last visit to describe the DMC, aiming to identify gaps in control goals. We included people who had a consultation within the 12 months preceding May 2020. RESULTS: Out of the 2072 active people, medical records were available for 2050 (98.9%). Among these, 326 people (15.9%) had fasting glucose (FG) abnormalities, of which 133 (40.7%) had diabetes. The prevalence of diabetes among people with HIV was of 6.4% (133/2050). Regarding the DMC, the following proportions of people achieved control goals: 133/133 (100%) received medical care in the last 12 months, 123/123 (100%) had blood pressure (BP) <140/90 mmHg, 73/132 (55.3%) had LDL cholesterol (c-LDL) <100 mg/dl, 63/132 (47.7%) had FG <130 mg/dl, 50/116 (43.1%) had glycosylated hemoglobin (HbA1c) <7%. ABC goals (HbA1c <7%, c-LDL <100 mg/dl, BP <140/90 mmHg) were met in 28/109 (25.6%) people. 126/133 (94%) people with HIV achieved HIV-viral load <50 copies/mL. CONCLUSIONS: Despite the high rate of viral suppression among people with HIV and diabetes, significant challenges remain in achieving comprehensive diabetes control. These findings highlight the need for targeted interventions to improve metabolic outcomes and the overall management of diabetes in people with HIV.

Unveiling ancestral threads: Exploring CCR5 ∆32 mutation frequencies in Colombian populations for HIV/AIDS therapeutics.

AIDS remains a significant global health challenge since its emergence in 1981, with millions of deaths and new cases every year. The CCR5 ∆32 genetic deletion confers immunity to HIV infection by altering a cell membrane protein crucial for viral entry. Stem cell transplants from homozygous carriers of this mutation to HIV-infected individuals have resulted in viral load reduction and disease remission, suggesting a potential therapeutic avenue. This study aims to investigate the relationship between genetic ancestry and the frequency of the CCR5 ∆32 mutation in Colombian populations, exploring the feasibility of targeted donor searches based on ancestry composition. Utilizing genomic data from the CÓDIGO-Colombia consortium, comprising 532 individuals, the study assessed the presence of the CCR5 ∆32 mutation and examined if the population was on Hardy-Weinberg equilibrium. Individuals were stratified into clusters based on African, American, and European ancestry percentages, with logistic regression analysis performed to evaluate the association between ancestry and mutation frequency. Additionally, global genomic databases were utilized to visualize the worldwide distribution of the mutation. The findings revealed a significant positive association between European ancestry and the CCR5 ∆32 mutation frequency, underscoring its relevance in donor selection. African and American ancestry showed negative but non-significant associations with CCR5 ∆32 frequency, which may be attributed to the study's limitations. These results emphasize the potential importance of considering ancestry in donor selection strategies, reveal the scarcity of potential donors in Colombia, and underscore the need to consider donors from other populations with mainly European ancestry if the CCR5 ∆32 stem cell transplant becomes a routine treatment for HIV/AIDS in Colombia.

Integrase strand transfer inhibitors resistance-associated mutations in HIV-infected pregnant women.

OBJECTIVE: To date, no data exist regarding the prevalence of integrase inhibitor (INSTI) resistance-associated mutations (HIVDRM) in HIV-infected pregnant women (HPW) in Latin America. We describe the prevalence and transmissibility of integrase HIVDRM in a historical cohort of INSTI-naïve HPW from Argentina (n=56) with Next Generation Sequencing (NGS). METHODS: Bioinformatics analysis was performed by HyDRA software for 20%, 10%, 5%, 2%, and 1% sensitivity thresholds. We calculated the mutational viral load for each INSTI-HIVDRM, considering those with >1000 c/mL as of high risk of transmissibility. RESULTS: The predominant HIV subtype was BF (78.5%). Major HIVDRM were not detected with the population sequencing 20% filter. With a 1% threshold, the prevalence increased to 8.9%; Y143C/S, E92G, E138K, and T66I mutations were found. The median (range) mutational load (expressed in c/mL) was: 355 (50.2-11705); with only 1 case >1000 c/mL Accessory mutations (G163R/K, T97A) were detected mostly with a 20% sensitivity threshold with an overall prevalence of 23.2%; the median (IQR) mutational load was: 23929 (4009-63158) c/mL; all of them above 1000 c/mL. CONCLUSIONS: Our results show evidence of the presence of major INSTI-HIVDRM as aleatory mutations and a high frequency of accessory mutations with potential transmissibility in HPW.

Assessing a Couples-Based, Digital HIV Serostatus-Neutral Intervention (Para Ti, Para Mí, Para Nosotros) for Adult Cisgender Sexual Minority Male Couples in Lima, Peru: Protocol for a 6-Month Pilot Randomized Controlled Trial.

BACKGROUND: HIV disproportionately affects sexual minority men (SMM; eg, gay, bisexual, and other men who have sex with men) in Lima, Peru; epidemiological data estimate that 32% to 39% of new HIV infections occur among adult cisgender SMM within primary partnerships (ie, male couples). Most HIV prevention-care research in Lima, Peru, has focused on SMM as individuals and not couples. To help address this critical gap in prevention care, we developed Para Ti, Para Mí, Para Nosotros (P3): a couples-based, digital HIV serostatus-neutral intervention (DHI) for adult cisgender SMM couples in Lima, Peru. The P3 DHI is designed to facilitate couples with skill-building, communication, decision-making, and working together to form and adhere to a detailed prevention care plan that aligns with their explicit sexual agreement. The P3 DHI is theoretically informed, self-guided, directed, sequential, and fully automated. OBJECTIVE: This pilot randomized controlled trial (RCT) aims to examine the preliminary effects of P3 on couples' formation and adherence to a detailed prevention care plan containing evidence-based strategies that also aligns with their explicit sexual agreement over time. In addition, the feasibility of enrollment and retention and couples' acceptability of P3 will be assessed. METHODS: The research implements a prospective, 6-month pilot RCT with a 3-month delayed control condition. After baseline, 60 enrolled SMM couples will be randomized to 1 of 2 conditions. Couples randomized to the unmatched, delayed control condition will receive access to the P3 DHI to use during the last 3 months of the trial after the 3-month assessment. Couples randomized to the immediate intervention condition will immediately receive access to the P3 DHI for 6 months. Study assessments will occur at baseline and months 3 and 6. Descriptive, comparative, qualitative, and longitudinal analyses using generalized linear mixed-effect, multilevel, and actor-partner interdependence models will be conducted to address the specific aims. RESULTS: The 6-month pilot RCT is ongoing. Recruitment, enrollment, and data collection began in January 2023 and ended in April 2024. A total of 74 adult cisgender SMM couples met all inclusion criteria, provided consent, and were enrolled in the pilot RCT. Retention was 92% (68/74) at month 6. Data are currently being analyzed to address the 3 specific aims regarding feasibility, acceptability, and preliminary efficacy. CONCLUSIONS: Findings from this research will reveal whether couples deemed the P3 DHI to be acceptable. Findings will also highlight the preliminary efficacy of the P3 DHI on couples managing their vulnerability to HIV and other sexually transmitted infections (STIs) over time via alignment of their prevention-care plan and sexual agreement. Trial findings will help shape the future direction of the P3 DHI while addressing the existing gap in prevention and care services for couples in the local context. TRIAL REGISTRATION: ClinicalTrials.gov NCT05873855; https://clinicaltrials.gov/study/NCT05873855. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/63106.

Linfohistiocitosis hemofagocítica en niño con virus de inmunodeficiencia humana en contexto de coinfecciones virales oportunistas / Hemophagocytic lymphohistiocytosis in a child with human immunodeficiency virus in the setting of opportunistic viral co-infections

La linfohistiocitosis hemofagocítica (LHH) es una entidad rara que se caracteriza por un estado hiperinflamatorio secundario a la activación desregulada del sistema inmune con compromiso multisistémico. Puede ser primaria o hereditaria, o estar desencadenada por diversas enfermedades. La mortalidad sin tratamiento oportuno es del 50 % de los casos. Se presenta el caso de una paciente de 1 año y 8 meses con diagnóstico reciente de infección por virus de inmunodeficiencia humana en estadio sida. Cursó internación para estudio e inicio de tratamiento antirretroviral durante la cual presentó múltiples intercurrencias infectológicas e inmunológicas. Se destacan dos episodios de linfohistiocitosis hemofagocítica en contexto de inmunodeficiencia adquirida no controlada y coinfecciones oportunistas. El objetivo de este reporte es destacar la importancia de la sospecha de LHH para un diagnóstico y tratamiento pertinente

Hemophagocytic lymphohistiocytosis (HLH) is a rare condition characterized by a hyperinflammatory state secondary to dysregulated immune activity with multisystem involvement. HLH may be primary or hereditary, or triggered by various diseases. Mortality without a timely treatment reaches 50% of the cases. Here we describe the case of a 1-year and 8-month-old female patient with a recent diagnosis of human immunodeficiency virus infection in the AIDS stage. She was hospitalized for assessment and initiation of antiretroviral therapy during which she developed multiple intercurrent infectious and immune conditions. Two episodes of hemophagocytic lymphohistiocytosis in the setting of uncontrolled acquired immunodeficiency and opportunistic co-infections stand out. The objective of this case report is to highlight the importance of suspecting HLH for a relevant diagnosis and treatment.

Adaptation and validation of the Adherence Barriers Questionnaire for HIV Patients on Antiretroviral Therapy (ABQ-HIV) for the Brazilian context.

Despite significant advancements in antiretroviral therapy (ART) for HIV, adherence remains a challenge. While Brazil has validated scales for treatment adherence, few assess treatment adherence barriers. This underscores the necessity for validated questionnaires on adherence barriers to identify patient-specific challenges and enhance strategies for ART adherence. This study aimed to adapt and validate the Adherence Barriers Questionnaire for HIV Patients on Antiretroviral Therapy (ABQ-HIV), a 17-item questionnaire assessing the adherence barriers to ART, for the Brazilian context and to evaluate its psychometric properties in HIV patients. A methodological study on the psychometric properties and factorial structure of ABQ-HIV was conducted. The study followed seven steps: consent of the original authors, two translations, synthesis of the translations, expert committee, back-translation, pre-test, and reliability test. A high content validity index (0.93) was achieved with the expert committee. The study sample consisted of 230 adults with HIV, with 37.0 (29.3-45.0) years as the median age (IQR), and 52.2% were male. The exploratory factor analysis with a three subscales structure of 17 items showed good interpretability (Bartlett's sphericity (1167.2 [136]; p < 0.001) and Kaiser-Meyer-Olkin = 0.602) and internal consistency (α = 0.76; Ω = 0.76). The fit indicators were satisfactory (χ2 = 89.931; df = 88; p > 0.005; RMSEA = 0.010; RMSR = 0.07; CFI = 0.996; GFI = 0.940; AGFI = 0.907; NNFI = 0.995). The Brazilian version of ABQ-HIV is a potential instrument for identifying specific barriers to adherence to ART in adults living with HIV in Brazil.

Induced abortion incidence and associated factors in a cohort of women living with HIV in Rio De Janeiro, Brazil, 1996-2016.

BACKGROUND: Abortion is a public health problem in Latin America and is more common among women living with HIV. OBJECTIVE: to verify the incidence and factors associated with induced abortion in a cohort of women living with HIV assisted in a reference service for care for individuals with HIV/AIDS in Rio de Janeiro/Brazil. METHODS: Prospective cohort during the period 1996-2016. We estimated the incidence of induced abortions during follow-up in the cohort by calculating person-time incidence rates [per 100 persons-years (PY)] and investigated the factors associated with the outcome "induced abortion" using a generalized linear mixed model. RESULTS: 753 women and 210 pregnancies were included in the present analysis. We estimated an induced abortion incidence rate of 0.68/100 persons-years (95% confidence interval [CI]: 0.47; 0.94) in the study period, with a significant reduction after 2006. The main factors associated with an induced abortion were currently living with a partner (adjusted OR [AdjOR] 0.32 95% CI: 0.10-0.98), number of children (2 children AdjOR 0.12, 95% CI: 0.02-0.95) and the type of antiretroviral treatment used (regimen without Efavirenz: AdjOR: 0.11, 95% CI 0.02-0.70). CONCLUSIONS: We showed a significant reduction in the incidence of induced abortions in a cohort of women living with HIV in Rio de Janeiro, Brazil, probably due to a decrease in the incidence of pregnancies observed in the same period. The factors associated with a lower occurrence of induced abortion suggest a good integration between the clinical and reproductive assistance offered to those women.

Unity is strength: creation and future actions for a consortium for HIV cure research in Latin America and the Caribbean 'Lac-Cura'.

The development of effective HIV cure strategies is crucial. However, most research in this area has been concentrated in high-income countries, underscoring the need to expand efforts to regions like Latin America and the Caribbean (LAC), which face distinct biomedical, social, political, and economic challenges. Data on LAC's participation in HIV cure research, along with stakeholder perceptions, reveal that the work being done in the region is scarce, fragmented, scattered, and characterized by limited resources and infrastructure. Establishing a regional consortium of basic researchers, clinicians, social scientists, and community members in LAC could be a key step in integrating the region into the global HIV cure landscape. We have already begun laying the groundwork for its creation and propose to name it 'LAC-Cura'-short for 'Latin America and the Caribbean HIV Cure Consortium'.

[Impure blood: specialists, institutions, and cultural authority in the context of AIDS in Brazil]. / Sangue impuro: especialistas, instituições e autoridade cultural no contexto da Aids no Brasil.

In this article, we examine the concept of cultural authority in the context of the professionalization/corporatization of medicine at the end of the 20th century, and its political and moral contours since the HIV/AIDS epidemic in São Paulo. Based on journalistic articles collected from the newspaper O Estado de São Paulo (1986-1989), we seek to highlight the place of medical expertise, examining the discourses produced about the disease in Brazil, in bases that show the emergence of social actors, disputes for credibility and the clinical authority under challenge. We analyze public narratives about AIDS, situating the place of authority. We argue that such discourses, in the context of sexual panic, did not occur outside a dynamic of therapeutic/clinical authority and the profession's own norms, which also immediately made visible the role of physicians, specialists and other health professionals, in dialogue with the moral grammar of the socially current illness. The conclusions illustrate the link between Brazilian medicine at the end of the century and the local-global history of AIDS, concentrating historical and political movements that disputed the scientific and moral meanings of the disease, fractured by the clash between authorities in the scientific, sanitary and clinical fields.

Neste artigo examinamos o conceito de autoridade cultural no contexto da profissionalização/corporativização da medicina no final do século XX e seus contornos políticos e morais desde a epidemia de HIV/Aids em São Paulo. A partir de matérias jornalísticas recolhidas do jornal O Estado de São Paulo (1986-1989), buscamos dar relevo ao lugar do especialismo médico, examinando os discursos produzidos sobre a doença, no Brasil, em bases que evidenciam a emergência de atores sociais, disputas por credibilidade e a autoridade clínica sob contestação. Analisamos as narrativas públicas sobre a Aids, situando o lugar da autoridade. Argumentamos que tais discursos, no contexto do pânico sexual, não ocorriam fora de uma dinâmica de autoridade terapêutica/clínica e das normatizações próprias da profissão, que também tornavam imediatamente visível o papel dos médicos, especialistas e demais profissionais de saúde, em diálogo com a gramática moral da doença socialmente corrente. As conclusões ilustram a vinculação da medicina brasileira de fins do século com a história local-global da Aids, concentrando movimentos históricos e políticos que disputavam os sentidos científicos e morais da doença, fraturados pelo embate entre autoridades no campo científico, sanitário e clínico.

Identification of HIV infection in two solid organ recipients three years after transplantation / Identificación de infección por el virus de la inmunodeficiencia humana en dos receptores de órgano sólido tres años después del trasplante

Routine screening of organ donors to detect human immunodeficiency virus (HIV) infection has detected the rare transmission of the virus through organ transplantation. However, despite routine screening, HIV transmission remains a risk in organ transplantation since, unlike tissues, solid organs cannot be processed, disinfected, or modified to inactivate infectious pathogens. A case of possible transmission of HIV by organ transplant is described below, from a previously seronegative donor to two recipients.

El examen de rutina de los donantes de órganos para detectar la infección por el virus de la inmunodeficiencia humana (HIV) ha hecho que la transmisión del virus mediante el trasplante de órganos sea poco común. Sin embargo, a pesar de las pruebas de detección de rutina, la transmisión del HIV continúa siendo un riesgo del trasplante de órganos ya que, a diferencia de los tejidos, los órganos sólidos no se pueden procesar, desinfectar, ni modificar para inactivar patógenos infecciosos. A continuación, se describe un caso de posible transmisión de HIV por trasplante de órganos de un donante previamente seronegativo a dos de sus receptores.

Bacterial sexually transmitted infections among men who have sex with men and transgender women using oral pre-exposure prophylaxis in Latin America (ImPrEP): a secondary analysis of a prospective, open-label, multicentre study.

BACKGROUND: The global burden of sexually transmitted infections (STIs) poses a challenge in the context of HIV pre-exposure prophylaxis (PrEP) programmes. We aimed to explore factors associated with prevalent, incident, and recurrent STIs in men who have sex with men (MSM) and transgender women on PrEP in Brazil, Mexico, and Peru. METHODS: ImPrEP was a prospective, single-arm, open-label, multicentre study that enrolled MSM and transgender women in the context of the public health systems of Brazil (14 sites), Mexico (four sites), and Peru (ten sites) between February, 2018, and June, 2021. Eligibility criteria followed regional PrEP guidelines at the study start, including participants aged 18 years and older, not living with HIV, and reporting at least one of the following in the previous 6 months: condomless anal sex (CAS), anal sex with partner(s) living with HIV, any bacterial STI, or transactional sex. Eligible participants were screened and enrolled on the same day to receive daily oral PrEP (tenofovir disoproxil fumarate 300 mg and emtricitabine 200 mg). We assessed three outcomes: prevalent bacterial STIs, incident bacterial STIs, and recurrent bacterial STIs. Testing occurred at baseline and quarterly for syphilis, anorectal chlamydia, and anorectal gonorrhoea. Behavioural data were collected at baseline and quarterly. The study was registered with the Brazilian Registry of Clinical Trials, U1111-1217-6021. FINDINGS: Among all 9509 participants included in the ImPrEP study (3928 [41·3%] in Brazil, 3288 [34·6%] in Mexico, and 2293 [24·1%] in Peru), 8525 (89·7%) had available STI results at baseline and were included in the prevalent STI analysis, and 7558 (79·5%) had available STI results during follow-up and were included in the incident and recurrent STI analyses. 2184 (25·6%) of 8525 participants had any bacterial STI at baseline. STI incidence during follow-up was 31·7 cases per 100 person-years (95% CI 30·7-32·7), with the highest rate for anorectal chlamydia (11·6 cases per 100 person-years, 95% CI 11·0-12·2), followed by syphilis (10·5 cases per 100 person-years, 9·9-11·1) and anorectal gonorrhoea (9·7 cases per 100 person-years, 9·2-10·3). Although only 2391 (31·6%) of 7558 participants had at least one STI during follow-up, 915 (12·1%) participants had recurrent diagnoses, representing 2328 (61·2%) of 3804 incident STI diagnoses. Characteristics associated with prevalent, incident, and recurrent STIs included younger age, multiple sex partners, receptive CAS, substance use, and previous STI diagnoses at baseline (incident or recurrent only). INTERPRETATION: Our findings underscore the nuanced dynamics of STI transmission among MSM and transgender women across Latin America, highlighting an urgent need for tailored interventions to mitigate STI burden effectively, especially among the most susceptible individuals. FUNDING: Unitaid, WHO, and ministries of health (Brazil, Mexico, and Peru). TRANSLATIONS: For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.

Description of the new HIV-1 intersubtype B/C circulating recombinant form (CRF146_BC) detected in Brazil.

BACKGROUND: The human immunodeficiency virus 1 (HIV-1) infections in Brazil are predominantly caused by two subtypes, B and C. OBJECTIVES: Here we present the characterisation of a novel HIV-1 recombinant form, indicating a new Brazilian CRF_BC, named CRF146_BC. METHODS: RDP, JphMM and Simplot recombination tools were used to evaluate the mosaic pattern. FINDINGS: In this work, we identified three HIV-1 nucleotide sequences previously classified as unique recombinant forms (URFs), plus one new partial genome sharing the same BC recombination pattern. The mosaic genome is almost entirely represented by the subtype C sequence, with a small subtype B recombination region in the pol gene, at the Integrase level. The phylogenetic analyses strongly indicate a common origin between the strains, which were isolated in Rio Grande do Sul, Rio de Janeiro and Bahia states. MAIN CONCLUSIONS: Thus, the new HIV-1 CRF146_BC is circulating in three different Brazilian regions: South, Southeast and Northeast.

HIV-1 controllers exhibit an enhanced antiretroviral innate state characterised by overexpression of p21 and MCPIP1 and silencing of ERVK-6 RNA expression.

BACKGROUND: Human immunodeficiency virus (HIV)-1 infection can activate the expression of human endogenous retroviruses (HERVs), particularly HERV-K (HML-2). HIV controllers (HICs) are rare people living with HIV (PLWHs) who naturally control HIV-1 replication and overexpress some cellular restriction factors that negatively regulate the LTR-driven transcription of HIV-1 proviruses. OBJECTIVES: To understand the ability of HICs to control the expression of endogenous retroviruses. METHODS: We measured endogenous retrovirus type K6 (ERVK-6) RNA expression in peripheral blood mononuclear cells (PBMCs) of HICs (n = 23), antiretroviral (ART)-suppressed subjects (n = 8), and HIV-1-negative (NEG) individuals (n = 10) and correlated the transcript expression of ERVK-6 with multiple HIV-1 cellular restriction factors. FINDINGS: Our study revealed that ERVK-6 RNA expression in PBMCs from HICs was significantly downregulated compared with that in both the ART and NEG control groups. Moreover, we detected that ERVK-6 RNA levels in PBMCs across all groups were negatively correlated with the expression levels of p21 and MCPIP1, two cellular restriction factors that limit the activation of macrophages and T cells by downregulating the activity of NF-kB. MAIN CONCLUSIONS: These findings support the hypothesis that HICs activate innate antiviral mechanisms that may simultaneously downregulate the transcription of both exogenous (HIV-1) and endogenous (ERVK-6) retroviruses. Future studies with larger cohorts should be performed to confirm this hypothesis and to explore the role of p21 and MCPIP1 in regulating HERV-K expression in physiological and pathological conditions.

Cervical precancer and invasive cancer among women living with HIV in Latin America: A systematic review and meta-analysis.

BACKGROUND: Data on the occurrence of cervical precancer and cancer among women living with HIV (WLHIV) in Latin American countries (LAC) are scarce and highly heterogeneous. METHODS: We conducted a systematic review summarizing data about the incidence/prevalence of invasive cervical cancer (CC) and high-grade precancerous lesions among WLHIV in LAC. Literature in PubMed and LILACS was searched. The primary outcome was invasive cancer incidence, and prevalence of high-grade lesions as key indicators for the WHO CC elimination strategy. Individual reports on invasive cancer incidence and prevalence of precancerous lesions were obtained, and a random effects meta-analysis was conducted for the latter. RESULTS: In total, 34,343 WLHIV from four studies reporting CC incidence in seven LAC were included, and 6079 WLHIV from 17 studies reporting prevalence of precancerous lesions in three LAC were included. CC incidence ranged between 136.0 and 398.4 per 100,000 WLHIV (with or without antiretroviral therapy). The weighted prevalence of high-grade lesions was 4.1% (95%CI: 3.8%-6.0%) with a double peak at ages 20-24 and 35-39 years. Differences in prevalence of high-grade lesions were also observed by screening approach: co-testing (11.9%), colposcopy (6.0%), cytology (4.2%), and HPV tests (3.2%). CONCLUSIONS: The high incidence of invasive cancer and prevalence of high-grade lesions underline challenges to reach the WHO's elimination goal of CC incidence below four per 100,000 among WLHIV. Moreover, the high prevalence of high-grade lesions at younger ages than in the general population is a call to accelerate the implementation of the new WHO screening recommendations in WLHIV.

From HIV to Mpox: Socio-discursive Analysis of Communicable Diseases, Stigma, and Pathologization in Sexual Minorities in Brazil.

Discrimination and stigma are significant barriers to healthcare for the LGBTQIAPN+ community, necessitating a deeper analysis of their sociocultural causes. There is a notable gap in the literature regarding the understanding of socio-discursive representations and their impact on the stigmatization and pathologization of sexual minorities in the context of communicable diseases. This study aims to discuss the understanding of the sociodiscursive aspects of the health-disease process, particularly in stigmatized infectious diseases affecting the LGBTQIAPN+ community. The focus is on examining how news articles, or the set of analyzed texts (corpus), shape these perceptions. We conducted documentary research with a qualitative and discursive approach using news articles retrieved from Google NewsⓇ about diseases affecting the LGBTQIAPN+ population from 2011 to 2022. The analysis was based on critical discourse analysis, processed using MAXQDA and IRAMUTEQ software. The identified representations predominantly align with biomedical ideology, manifesting in a discourse that normalizes and medicalizes (normative-curative discourse), and notable for its pathologizing and stigmatizing nature. Six classes were found: Ethical professional dilemmas facing stigma, infection and contamination of the LGBT+ population, prejudice and discrimination in the form of information, stigma related to sexual behavior/orientation, Vulnerability and stigma related to infectious diseases, and strategies for minimizing health risk/stigma for the LGBT+ public. The most relevant analytical categories were related to infectious diseases and sexual identity. These themes were identified, indicating that media representations reinforce stigma and maintain unequal health practices (verticalization) for the LGBT+ community. Understanding these patterns within a broader historical context is crucial for promoting health education and strategies that challenge internalized prejudice. The need to reformulate cultural norms and develop health information and education policies is urgent. These policies should be led by professionals with a comprehensive and humanized vision, addressing the diverse needs of the LGBT+ population.