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1.
MMWR Morb Mortal Wkly Rep ; 69(3): 63-66, 2020 Jan 24.
Artículo en Inglés | MEDLINE | ID: mdl-31971928

RESUMEN

Since 2014, the recommended laboratory testing algorithm for diagnosing human immunodeficiency virus (HIV) infection has included a supplemental HIV-1/HIV-2 differentiation test to confirm infection type on the basis of the presence of type-specific antibodies (1). Correctly identifying HIV-1 and HIV-2 infections is vital because their epidemiology and clinical management differ. To describe the percentage of diagnoses for which an HIV-1/HIV-2 differentiation test result was reported and to categorize HIV type based on laboratory test results, 2010-2017 data from CDC's National HIV Surveillance System (NHSS) were analyzed. During 2010-2017, a substantial increase in the number of HIV-1/HIV-2 differentiation test results were reported to NHSS, consistent with implementation of the HIV laboratory-based testing algorithm recommended in 2014. However, >99.9% of all HIV infections identified in the United States were categorized as HIV-1, and the number of HIV-2 diagnoses (mono-infection or dual-infection) remained extremely low (<0.03% of all HIV infections). In addition, the overall number of false positive HIV-2 test results produced by the HIV-1/HIV-2 differentiation increased. The diagnostic value of a confirmatory antibody differentiation test in a setting with sensitive and specific screening tests and few HIV-2 infections might be limited. Evaluation and consideration of other HIV tests approved by the Food and Drug Administration (FDA) that might increase efficiencies in the CDC and Association of Public Health Laboratories-recommended HIV testing algorithm are warranted.


Asunto(s)
Pruebas Diagnósticas de Rutina/métodos , Infecciones por VIH/diagnóstico , Infecciones por VIH/virología , VIH-2/aislamiento & purificación , Adolescente , Adulto , Algoritmos , Femenino , Infecciones por VIH/epidemiología , Humanos , Laboratorios , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiología , Adulto Joven
2.
MMWR Morb Mortal Wkly Rep ; 69(2): 35-39, 2020 Jan 17.
Artículo en Inglés | MEDLINE | ID: mdl-31945033

RESUMEN

Transgender women* in the United States are disproportionately affected by human immunodeficiency virus (HIV) infection because of multiple factors, including stigma related to gender identity, unstable housing, limited employment options, and high-risk behaviors, such as sex work, unprotected receptive anal intercourse, and injection drug use, that tend to increase their vulnerability to becoming infected with HIV (1,2). In a recent meta-analysis of 88 U.S. studies conducted during 2006-2017, the mean estimated laboratory-confirmed prevalence of HIV infection among transgender women was 14.2%, and the mean self-reported prevalence estimate was 21.0% (3). The Ending the HIV Epidemic initiative calls for accelerating the implementation of evidence-based strategies in the right geographic areas targeted to the right persons to end the HIV epidemic in the United States (4). HIV partner services are effective strategies offered by public health workers to persons with a diagnosis of HIV infection (index persons) and their sex or needle-sharing partners (partners), who are notified of potential HIV exposure and offered HIV testing and related services. CDC analyzed HIV partner services data submitted by 61 health departments† during 2013-2017. Among 208,304 index persons, 1,727 (0.8%) were transgender women. Overall, 71.5% of index transgender women were interviewed for partner services, which was lower than that for all index persons combined (81.1%). Among 1,089 transgender women named as partners by index persons, 71.2% were notified of potential HIV exposure, which was lower than that for all partners combined (77.1%). Fewer than half (46.5%) of notified transgender women partners were tested for HIV, and approximately one in five (18.6%) of those who were tested received a new diagnosis of HIV infection, slightly higher than for all partners combined (17.6%). Additional efforts are needed to effectively implement partner services among transgender women and identify those whose infection with HIV is undiagnosed, provide timely prevention and care services, reduce HIV transmission, and contribute to ending the HIV epidemic.


Asunto(s)
Prestación de Atención de Salud , Infecciones por VIH/terapia , Parejas Sexuales , Personas Transgénero , Adolescente , Adulto , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Estados Unidos/epidemiología , Adulto Joven
4.
Medicine (Baltimore) ; 99(2): e18525, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914025

RESUMEN

Human immunodeficiency virus (HIV) testing is important for prevention and treatment. Ending the HIV epidemic is unattainable if significant proportions of people living with HIV remain undiagnosed, making HIV testing critical for prevention and treatment. The Centers for Disease Control and Prevention (CDC) recommends routine HIV testing for persons aged 13 to 64 years in all health care settings. This study builds on prior research by estimating the extent to which HIV testing occurs during physician office and emergency department (ED) post 2006 CDC recommendations.We performed an unweighted and weighted cross-sectional analysis using pooled data from 2 nationally representative surveys namely National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 2009 to 2014. We assessed routine HIV testing trends and predictive factors in physician offices and ED using multi-stage statistical survey procedures in SAS 9.4.HIV testing rates in physician offices increased by 105% (5.6-11.5 per 1000) over the study period. A steeper increase was observed in ED with a 191% (2.3-6.7 per 1000) increase. Odds ratio (OR) for HIV testing in physician offices were highest among ages 20 to 29 ([OR] 7.20, 99% confidence interval [CI: 4.37-11.85]), males (OR 1.34, [CI: 0.91-0.93]), African-Americans (OR 2.97, [CI: 2.05-4.31]), Hispanics (OR 1.80, [CI: 1.17-2.78]), and among visits occurring in the South (OR 2.06, [CI: 1.23-3.44]). In the ED, similar trends of higher testing odds persisted for African Americans (OR 3.44, 99% CI 2.50-4.73), Hispanics (OR 2.23, 99% CI 1.65-3.01), and Northeast (OR 2.24, 99% CI 1.10-4.54).While progress has been made in screening, HIV testing rates remains sub-optimal for ED visits. Populations visiting the ED for routine care may suffer missed opportunities for HIV testing, which delays their entry into HIV medical care. To end the epidemic, new approaches for increasing targeted routine HIV testing for populations attending health care settings is recommended.


Asunto(s)
Epidemias/prevención & control , Infecciones por VIH/epidemiología , VIH/aislamiento & purificación , Tamizaje Masivo/métodos , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Estudios Transversales , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/etnología , Infecciones por VIH/prevención & control , Encuestas de Atención de la Salud/métodos , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Consultorios Médicos/estadística & datos numéricos , Pruebas Serológicas/métodos , Pruebas Serológicas/estadística & datos numéricos , Estados Unidos/epidemiología , Adulto Joven
5.
J Forensic Sci ; 65(1): 160-165, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31343744

RESUMEN

The characteristics of mental disorders, as well as deficiencies in their treatment, must be properly defined. This was a prospective, longitudinal, observational study, in which all men referred to a penitentiary psychiatric consultation of three penitentiary centers in Spain were invited to participate. Those who consented to participation (1328) were interviewed at the baseline timepoint and at intervals for up to 3 years. The presence of mental disorders was high: 68.2% had a cluster B personality disorder, 14% had an affective and/or anxiety disorders, 13% had schizophrenia, and over 80% had a dual disorder. Polypharmacy was the norm. Moreover, the health care received in prison did not match that provided in the community in terms of quantity and quality. These results should help to facilitate the design of mental healthcare provision for prisoners, focusing on both the most frequent patient profiles and equality of care.


Asunto(s)
Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Servicios de Salud Mental/organización & administración , Prisioneros/psicología , Prisiones , Adulto , Coinfección , Femenino , Infecciones por VIH/epidemiología , Hepatitis C Crónica/epidemiología , Humanos , Estudios Longitudinales , Masculino , Polifarmacia , Estudios Prospectivos , Psicotrópicos/uso terapéutico , España/epidemiología , Trastornos Relacionados con Sustancias/epidemiología
6.
BMC Infect Dis ; 19(1): 1019, 2019 Dec 02.
Artículo en Inglés | MEDLINE | ID: mdl-31791253

RESUMEN

BACKGROUND: Chronic hepatitis C is a major public health burden. With new interferon-free direct-acting agents (showing sustained viral response rates of more than 98%), elimination of HCV seems feasible for the first time. However, as HCV infection often remains undiagnosed, screening is crucial for improving health outcomes of HCV-patients. Our aim was to assess the long-term cost-effectiveness of a nationwide screening strategy in Germany. METHODS: We used a Markov cohort model to simulate disease progression and examine long-term population outcomes, HCV associated costs and cost-effectiveness of HCV screening. The model divides the total population into three subpopulations: general population (GEP), people who inject drugs (PWID) and HIV-infected men who have sex with men (MSM), with total infection numbers being highest in GEP, but new infections occurring only in PWIDs and MSM. The model compares four alternative screening strategies (no/basic/advanced/total screening) differing in participation and treatment rates. RESULTS: Total number of HCV-infected patients declined from 275,000 in 2015 to between 125,000 (no screening) and 14,000 (total screening) in 2040. Similarly, lost quality adjusted life years (QALYs) were 320,000 QALYs lower, while costs were 2.4 billion EUR higher in total screening compared to no screening. While incremental cost-effectiveness ratio (ICER) increased sharply in GEP and MSM with more comprehensive strategies (30,000 EUR per QALY for total vs. advanced screening), ICER decreased in PWIDs (30 EUR per QALY for total vs. advanced screening). CONCLUSIONS: Screening is key to have an efficient decline of the HCV-infected population in Germany. Recommendation for an overall population screening is to screen the total PWID subpopulation, and to apply less comprehensive advanced screening for MSM and GEP.


Asunto(s)
Erradicación de la Enfermedad , Hepatitis C/prevención & control , Tamizaje Masivo/economía , Tamizaje Masivo/métodos , Adulto , Antivirales/economía , Antivirales/uso terapéutico , Estudios de Cohortes , Análisis Costo-Beneficio , Pruebas Diagnósticas de Rutina/economía , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Erradicación de la Enfermedad/economía , Erradicación de la Enfermedad/métodos , Erradicación de la Enfermedad/estadística & datos numéricos , Consumidores de Drogas/estadística & datos numéricos , Femenino , Alemania/epidemiología , Infecciones por VIH/diagnóstico , Infecciones por VIH/economía , Infecciones por VIH/epidemiología , Costos de la Atención en Salud , Hepacivirus/genética , Hepacivirus/aislamiento & purificación , Hepatitis C/diagnóstico , Hepatitis C/economía , Hepatitis C/epidemiología , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/economía , Hepatitis C Crónica/epidemiología , Hepatitis C Crónica/prevención & control , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Vigilancia de la Población/métodos , Años de Vida Ajustados por Calidad de Vida , Minorías Sexuales y de Género/estadística & datos numéricos
7.
BMC Infect Dis ; 19(1): 1017, 2019 Dec 02.
Artículo en Inglés | MEDLINE | ID: mdl-31791265

RESUMEN

BACKGROUND: Early diagnosis and treatment of neurosyphilis is of great significance for regression. There is no gold standard for the diagnosis of neurosyphilis. We did this study to explore the factors associated with the clinical diagnosis of neurosyphilis and assess their accuracy for the diagnosis of neurosyphilis. METHODS: We retrospectively reviewed 100 cases of syphilis patients who underwent lumbar puncture at a major dermatology hospital in Guangzhou, China between April 2013 and November 2016. Fifty patients who were clinically diagnosed with neurosyphilis were selected as case group. Control group consisted of 50 general syphilis patients who were matched with age and gender. The records of patients were reviewed to collect data of socio-demographic information, clinical symptom, and laboratory indicators. Multivariable logistic regression was used to explore diagnostic indictors, and ROC analysis was used to assess diagnostic accuracy. RESULTS: Neurological symptoms (odds ratio (OR) = 59.281, 95% CI:5.215-662.910, P = 0.001), cerebrospinal fluid (CSF) Treponema pallidum particle agglutination (TPPA) titer (OR = 1.004, 95% CI:1.002-1.006, P < 0.001), CSF protein (OR = 1.005, 95% CI:1.000-1.009, P = 0.041), and CSF white blood cell (WBC) (OR = 1.120, 95% CI:1.017-1.233, P = 0.021) were found to be statistically associated with neurosyphilis. In ROC analysis, CSF TPPA titer had a sensitivity of 90%, a specificity of 84%, and an area under curve (AUC) of 0.941. CONCLUSION: CSF TPPA can potentially be considered as an alternative test for diagnosis of neurosyphilis. Combining with neurological symptoms, CSF protein, CSF WBC, the diagnosis would have a higher sensitivity.


Asunto(s)
Seronegatividad para VIH , Neurosífilis/diagnóstico , Adulto , Estudios de Casos y Controles , China/epidemiología , Pruebas Diagnósticas de Rutina/métodos , Pruebas Diagnósticas de Rutina/normas , Femenino , Infecciones por VIH/líquido cefalorraquídeo , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Neurosífilis/líquido cefalorraquídeo , Neurosífilis/complicaciones , Neurosífilis/epidemiología , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Sensibilidad y Especificidad , Sífilis/líquido cefalorraquídeo , Sífilis/complicaciones , Sífilis/diagnóstico , Sífilis/epidemiología , Treponema pallidum
8.
BMC Infect Dis ; 19(1): 1022, 2019 Dec 02.
Artículo en Inglés | MEDLINE | ID: mdl-31791273

RESUMEN

BACKGROUND: Few countries in sub-Saharan Africa know the magnitude of their HIV epidemic among people who inject drugs (PWID). This was the first study in Mozambique to measure prevalence of HIV, HBV, and HCV, and to assess demographic characteristics and risk behaviors in this key population. METHODS: We used respondent-driven sampling (RDS) to conduct a cross-sectional behavioral surveillance survey of PWID in two cities of Mozambique lasting six months. Participants were persons who had ever injected drugs without a prescription. Participants completed a behavioral questionnaire and provided blood specimens for HIV, hepatitis B surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV) testing. We performed RDS-adjusted analysis in R 3.2 using RDSAT 7.1 weights. RESULTS: We enrolled 353 PWID in Maputo and 139 in Nampula/Nacala; approximately 95% of participants were men. Disease prevalence in Maputo and Nampula/Nacala, respectively, was 50.1 and 19.9% for HIV, 32.1 and 36.4% for HBsAg positivity, and 44.6 and 7.0% for anti-HCV positivity. Additionally, 8% (Maputo) and 28.6% (Nampula/Nacala) of PWID reported having a genital sore or ulcer in the 12 months preceding the survey. Among PWID who injected drugs in the last month, 50.3% (Maputo) and 49.6% (Nampula/Nacala) shared a needle at least once that month. Condomless sex in the last 12 months was reported by 52.4% of PWID in Maputo and 29.1% in Nampula/Nacala. Among PWID, 31.6% (Maputo) and 41.0% (Nampula/Nacala) had never tested for HIV. In multivariable analysis, PWID who used heroin had 4.3 (Maputo; 95% confidence interval [CI]: 1.2, 18.2) and 2.3 (Nampula/Nacala; 95% CI: 1.2, 4.9) greater odds of having HIV. CONCLUSION: Unsafe sexual behaviors and injection practices are frequent among PWID in Mozambique, and likely contribute to the disproportionate burden of disease we found. Intensified efforts in prevention, care, and treatment specific for PWID have the potential to limit disease transmission.


Asunto(s)
Consumidores de Drogas/estadística & datos numéricos , Infecciones por VIH/epidemiología , Hepatitis B/epidemiología , Hepatitis C/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adolescente , Adulto , Anciano , Ciudades/epidemiología , Estudios Transversales , Epidemias , Femenino , Infecciones por VIH/sangre , Seropositividad para VIH/epidemiología , Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/análisis , Antígenos de Superficie de la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/inmunología , Hepatitis C/sangre , Humanos , Masculino , Persona de Mediana Edad , Mozambique/epidemiología , Vigilancia de la Población/métodos , Prevalencia , Asunción de Riesgos , Estudios Seroepidemiológicos , Conducta Sexual/estadística & datos numéricos , Encuestas y Cuestionarios/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adulto Joven
9.
Pan Afr Med J ; 34: 57, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31803343

RESUMEN

Introduction: Chronic suppurative otitis media is a global middle ear disease with quality of life as economic implications, which are worse felt in low and middle income (LAMI) countries; thus the need for myringoplasty. This study aimed to explore audiological function in a group of adults following myringoplasty in South Africa, with an exploration of the possible influence of factors such as HIV/AIDS and type of surgical technique on hearing outcomes. Methods: Within a retrospective chart review research design, 41 participant files for a six-year period from two academic hospitals in Johannesburg, South Africa, were reviewed. Data were analysed using both descriptive and inferential statistics. Results: Participant files comprised of 16 males and 25 females between 18-63 years. Findings revealed that clinically, overall hearing improved post-operatively, as indicated by improved tympanometry findings, pure tone air-conduction and speech reception thresholds. Descriptively, the predictors of improved hearing outcomes post-operatively appeared to be HIV negative status and butterfly cartilage inlay surgery as a surgical technique adopted. Although clinically, hearing outcomes improved post-operatively at all air-conduction frequencies tested; these clinical improvements were only statistically significant at specific frequencies. Conclusion: Current findings provide useful initial evidence on the benefits of myringoplasty from the South African context; particularly because of the HIV/AIDS prevalence and its potential influence on middle ear disease and its management. Prospective efficacy studies with bigger sample sizes are recommended, with early identification strategies for middle ear disease to reduce the need for myringoplasty seriously considered bearing in mind the resource constraints.


Asunto(s)
Pruebas de Impedancia Acústica/métodos , Miringoplastia/métodos , Otitis Media Supurativa/cirugía , Adolescente , Adulto , Enfermedad Crónica , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Otitis Media Supurativa/fisiopatología , Calidad de Vida , Estudios Retrospectivos , Sudáfrica , Resultado del Tratamiento , Adulto Joven
10.
Pan Afr Med J ; 34: 62, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31803344

RESUMEN

Introduction: Ninety-one percent of global Human Immunodeficiency Virus (HIV) infection in children occurs in sub-Saharan Africa. Provider Initiated Testing and Counselling (PITC) Strategy is a means of reducing missed opportunities for HIV exposed or infected children. The present study determined the prevalence of HIV infection using PITC Strategy among children seen at the Paediatric Emergency Unit of Federal Medical Centre (FMC), Ido-Ekiti, and the possible route of transmission. Methods: Cross-sectional study on prevalence of HIV infection using PITC model. 530 new patients whose HIV serostatus were unknown and aged 15 years or below were recruited consecutively and offered HIV testing. Serial algorithm testing for HIV infection using Determine HIV-1/2 and Uni-Gold rapid test kits was adopted. Seropositive patients younger than eighteen months had HIV Deoxyribonucleic Acid Polymerase Chain Reaction (HIV DNA PCR) test for confirmation. Results: Twenty-four (4.5%) of the 530 patients were confirmed to have HIV infection; of whom 19 (79.2%) were less than 18 months of old; with age range of 5 to 156 months. Fifteen (62.5%) of the infected children were females; likewise, the gender specific infection rate was higher (%) among the females compared with (%) among the males. Two of the HIV infected children's mothers were late, while the remaining 22 mothers (%) were HIV seropositive. Mother-to-child-transmission was the most likely route of transmission in the children. Conclusion: PITC strategy is vital to the early diagnosis and effective control of HIV infection in children. However, this cannot be totally effective if PMTCT is not optimized.


Asunto(s)
Consejo/métodos , Infecciones por VIH/epidemiología , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Tamizaje Masivo/métodos , Adolescente , Niño , Preescolar , Estudios Transversales , Diagnóstico Precoz , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/transmisión , Humanos , Lactante , Masculino , Nigeria/epidemiología , Prevalencia , Factores Sexuales
11.
MMWR Morb Mortal Wkly Rep ; 68(48): 1117-1123, 2019 Dec 06.
Artículo en Inglés | MEDLINE | ID: mdl-31805031

RESUMEN

BACKGROUND: Approximately 38,000 new human immunodeficiency virus (HIV) infections occur in the United States each year; these infections can be prevented. A proposed national initiative, Ending the HIV Epidemic: A Plan for America, incorporates three strategies (diagnose, treat, and prevent HIV infection) and seeks to leverage testing, treatment, and preexposure prophylaxis (PrEP) to reduce new HIV infections in the United States by at least 90% by 2030. Targets to reach this goal include that at least 95% of persons with HIV receive a diagnosis, 95% of persons with diagnosed HIV infection have a suppressed viral load, and 50% of those at increased risk for acquiring HIV are prescribed PrEP. Using surveillance, pharmacy, and other data, CDC determined the current status of these three initiative strategies. METHODS: CDC analyzed HIV surveillance data to estimate annual number of new HIV infections (2013-2017); estimate the percentage of infections that were diagnosed (2017); and determine the percentage of persons with diagnosed HIV infection with viral load suppression (2017). CDC analyzed surveillance, pharmacy, and other data to estimate PrEP coverage, reported as a percentage and calculated as the number of persons who were prescribed PrEP divided by the estimated number of persons with indications for PrEP. RESULTS: The number of new HIV infections remained stable from 2013 (38,500) to 2017 (37,500) (p = 0.448). In 2017, an estimated 85.8% of infections were diagnosed. Among 854,206 persons with diagnosed HIV infection in 42 jurisdictions with complete reporting of laboratory data, 62.7% had a suppressed viral load. Among an estimated 1.2 million persons with indications for use of PrEP, 18.1% had been prescribed PrEP in 2018. CONCLUSION: Accelerated efforts to diagnose, treat, and prevent HIV infection are needed to achieve the U.S. goal of at least 90% reduction in the number of new HIV infections by 2030.


Asunto(s)
Infecciones por VIH/prevención & control , Tamizaje Masivo/estadística & datos numéricos , Profilaxis Pre-Exposición/estadística & datos numéricos , Carga Viral/estadística & datos numéricos , Adolescente , Adulto , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiología , Adulto Joven
12.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1392-1397, 2019 Nov 10.
Artículo en Chino | MEDLINE | ID: mdl-31838810

RESUMEN

Objective: To analyze the epidemiological characteristics of HIV-infected pregnant women and exposed infant in Guangdong province and identify the factors associated with infant HIV infection through mother-to-child transmission. Methods: National Information System for Prevention of mother-to-child HIV Transmission and Early Infant Diagnosis Information Management Platform were used to collect the individual information about HIV-infected pregnant women and exposed infants who were delivered in Guangdong from January 1, 2014 to December 31 in 2017. The differences in pregnant women's demographic data, history of pregnancy and childbirth, the utilization of mother-to-child transmission prevention services and early infant diagnosis between the infected HIV exposed infants and uninfected HIV exposed infants were compared, and univariate and multivariate logistic regression analyses were conducted to identify the factors associated with mother-to-child HIV transmission. Results: Among 349 HIV infected pregnant women, the proportions of the pregnant women whose HIV infection status were confirmed before pregnancy, during pregnancy and at or after childbirth were 30.4% (106/349), 49.6% (173/349) and 20.0% (70/349) respectively. The proportions of those with sexual partners whose HIV infection status were unknown and those receiving no antiviral treatment were 39.5% (138/349) and 13.2% (46/349) respectively. Among the HIV exposed infants, the mother-to-child transmission rate was 4.2%(15/353), the HIV exposed infants had the first or second early diagnosis tests within 44 (P(25)-P(75): 42-50) days and 96 (P(25)-P(75): 92-106) days after birth, respectively. Univariate logistic regression analysis indicated that the risk for mother-to-child HIV transmission increased in those whose HIV infection status were confirmed at or after childbirth compared with before pregnancy (OR=5.72, 95%CI: 1.52-21.61) and in the group that antiviral treatment was given to either mothers or infants compared with the group that antiviral treatment was given to both mothers and infants (OR=33.56, 95%CI: 9.04-124.55), while there was lower mother-to-child HIV transmission risk in artificial feeding group compared with breast feeding group (OR=0.07, 95%CI: 0.01-0.76). Conclusion: The risk of mother-to-child HIV transmission in Guangdong can be effectively reduced by the measures of early diagnosis, antiviral treatment and artificial feeding as well as the improvement of mother-to-child transmission prevention service.


Asunto(s)
Infecciones por VIH/diagnóstico , Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/epidemiología , Adulto , Antirretrovirales/uso terapéutico , China/epidemiología , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Lactante , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Mujeres Embarazadas
13.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1476-1480, 2019 Nov 10.
Artículo en Chino | MEDLINE | ID: mdl-31838824

RESUMEN

Through the effort in nearly 40 years of Tanzania, the total number of reported cases, the prevalence of HIV/AIDS and the number of death have declined, while the number of patients receiving antiretroviral therapy has increased significantly in Tanzania. At the same time, however, there are new challenges that require more attention, such as the HIV spread to rural areas, middle and lower social classes, and female teenagers. Although the overall performance of the HIV/AIDS prevention and control response is great, there is still a need to survey the new trends of this disease at the micro-level in Tanzania. In addition, there is a necessity of interdisciplinary concern due to the prevalence of heterosexual anal sex in Tanzania.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/epidemiología , Epidemias , Infecciones por VIH/epidemiología , Vigilancia de la Población/métodos , Población Rural , Síndrome de Inmunodeficiencia Adquirida/transmisión , Adolescente , Adulto , Femenino , Infecciones por VIH/transmisión , Humanos , Masculino , Persona de Mediana Edad , Conducta Sexual , Factores Socioeconómicos , Población Suburbana , Tanzanía/epidemiología
14.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1487-1491, 2019 Nov 10.
Artículo en Chino | MEDLINE | ID: mdl-31838826

RESUMEN

HIV molecular network is a recently reported method for studying the transmission characteristics of HIV-infected people. Countries have used this method to conduct a large number of researches on transmission relations, transmission hotspots and epidemic surveillance for the purpose of providing evidence for precise AIDS intervention and control. At present, there are three major methods for constructing molecular networks in the world, i.e. genetic distance method based on pairwise alignment, phylogenetic node support method, and joint parameter method based on the two methods. This paper reviews the progress of the three methods for constructing HIV molecular network to study the transmission characteristics of HIV-infected patients, in order to provide data support for the prevention and control of HIV. Since the emergence of the molecular network method, Beijing, Shanghai, Zhejiang, Sichuan and other provinces in China have reported relevant research results using molecular network analysis, which provided scientific data for further precise AIDS prevention and control. Recent international studies have also predicted that molecular network based transmission cluster detection is expected to become a new method to stop AIDS epidemic.


Asunto(s)
Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , VIH-1/clasificación , VIH-1/genética , Síndrome de Inmunodeficiencia Adquirida , Beijing , China , Infecciones por VIH/diagnóstico , Infecciones por VIH/genética , VIH-1/aislamiento & purificación , Humanos , Modelos Moleculares , Epidemiología Molecular , Filogenia
17.
Medicine (Baltimore) ; 98(50): e18232, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31852085

RESUMEN

Transgender people continue to be at high-risk for HIV acquisition, but little is known about the characteristics of their sexual partners. To address this gap, we examined sociodemographic and sexual characteristics of cisgender men who have sex with men (MSM) on pre-exposure prophylaxis (PrEP) reporting transgender sexual partners.A cohort of 392 MSM in southern California in a randomized clinical trial for PrEP adherence were followed from 2013 to 2016. Multivariable generalized estimating equation and logistic models identified characteristics of MSM reporting transgender sexual partners and PrEP adherence.Only 14 (4%) MSM reported having transgender sexual partners. MSM were more likely to report transgender partners if they were African American, had incident chlamydia, reported injection drug-using sexual partners, or received items for sex. Most associations remained significant in the multivariable model: African American (adjusted odds ratio [AOR] 11.20, P = .01), incident chlamydia (AOR 3.71, P = .04), and receiving items for sex (AOR 5.29, P = .04). There were no significant differences in PrEP adherence between MSM reporting transgender partners and their counterpart.MSM who report transgender sexual partners share characteristics associated with individuals with high HIV prevalence. Identifying this group distinct from larger cohorts of MSM could offer new HIV prevention opportunities for this group of MSM and the transgender community.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/prevención & control , Homosexualidad Masculina/psicología , Prevención Primaria/métodos , Conducta Sexual , Parejas Sexuales , Personas Transgénero , Adulto , Estudios de Seguimiento , Infecciones por VIH/epidemiología , Humanos , Incidencia , Masculino , Cumplimiento de la Medicación , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos/epidemiología
18.
Rev Soc Bras Med Trop ; 53: e20190282, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31859952

RESUMEN

INTRODUCTION: Despite the success of antiretrovirals, human immunodeficiency virus (HIV) coinfections continue to cause mortality. We investigated the prevalence of coinfections in women with HIV/acquired immunodeficiency syndrome in Sergipe, Brazil. METHODS: We conducted a cross-sectional study. The coinfections investigated were syphilis, hepatitis B and C, toxoplasmosis, rubella, tuberculosis, and cytomegalovirus. RESULTS: Among the 435 women, 85 (19.5%) had coinfections. The most prevalent was HIV/syphilis, followed by tuberculosis, toxoplasmosis, hepatitis C, hepatitis B, and rubella. Additionally, 300 (96.2%) were seropositive for cytomegalovirus immunoglobulin G. CONCLUSIONS: Despite significant progress in the treatment for people with HIV, coinfections continued to affect this population.


Asunto(s)
Infecciones por VIH/epidemiología , Hepatitis B/epidemiología , Hepatitis C/epidemiología , Rubéola (Sarampión Alemán)/epidemiología , Toxoplasmosis/epidemiología , Tuberculosis/epidemiología , Adolescente , Adulto , Anciano , Brasil/epidemiología , Coinfección , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Prevalencia , Factores Socioeconómicos , Adulto Joven
19.
BMC Infect Dis ; 19(1): 1076, 2019 Dec 21.
Artículo en Inglés | MEDLINE | ID: mdl-31864297

RESUMEN

BACKGROUND: HIV voluntary counseling and testing (VCT) is a crucial gateway to all strategies related to care, prevention and treatment of human immunodeficiency virus (HIV) infection. Nevertheless, utilization of voluntary counselling and testing (VCT) service among adults is very low in Ethiopia. The objective of this study is to identify determinants associated with VCT utilization among adult women aged 15-49 in Ethiopia. METHODS: A cross-sectional study was conducted based on data taken from the Ethiopian Demographic Health Survey (EDHS) 2016. Using cluster sampling, 14,369 women aged 15-49 years were selected from all the nine administrative regions and two city administrations. Logistic regression was used to analyze factors associated with HIV VCT utilization. RESULTS: Overall prevalence of ever tested for HIV was 53% (95% CI, 52, 54). Aged 20-44, ever married, being at higher socio economic position (SEP) and having risky sexual behavior were factors which are positively associated with VCT utilization. Being Muslims in urban and protestants in rural were factors significantly and negatively associated with VCT utilization. Those who had stigmatizing attitude both in urban and rural and who had comprehensive knowledge in rural were less likely to utilize VCT service. CONCLUSION: VCT utilization among women in Ethiopia is demonstrating better improvement in recent years. However, stigmatizing attitude continued to be among the major factors, which are negatively affecting VCT uptake among women in Ethiopia. Concerted efforts should be made by all stakeholders to mitigate stigma, improve socio economic inequities and increase awareness on the benefit of VCT in controlling HIV in the society. In this aspect, the role of religious leader, schools, health extension workers and community leaders should not be undermined.


Asunto(s)
Consejo/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Tamizaje Masivo/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Adolescente , Adulto , Estudios Transversales , Etiopía/epidemiología , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Encuestas Epidemiológicas , Humanos , Tamizaje Masivo/psicología , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Estigma Social , Factores Socioeconómicos , Adulto Joven
20.
MMWR Morb Mortal Wkly Rep ; 68(47): 1089-1095, 2019 Nov 29.
Artículo en Inglés | MEDLINE | ID: mdl-31774743

RESUMEN

Human immunodeficiency virus (HIV) case-based surveillance (CBS) systematically and continuously collects available demographic and health event data (sentinel events*) about persons with HIV infection from diagnosis and, if available, throughout routine clinical care until death, to characterize HIV epidemics and guide program improvement (1,2). Surveillance signals such as high viral load, mortality, or recent HIV infection can be used for rapid public health action. To date, few standardized assessments have been conducted to describe HIV CBS systems globally (3,4). For this assessment, a survey was disseminated during May-July 2019 to all U.S. President's Emergency Plan for AIDS Relief (PEPFAR)-supported countries with CDC presence† (46) to describe CBS implementation and identify facilitators and barriers. Among the 39 (85%) countries that responded,§ 20 (51%) have implemented CBS, 15 (38%) were planning implementation, and four (10%)¶ had no plans for implementation. All countries with CBS reported capturing information at the point of diagnosis, and 85% captured sentinel event data. The most common characteristic (75% of implementation countries) that facilitated implementation was using a health information system for CBS. Barriers to CBS implementation included lack of country policies/guidance on mandated reporting of HIV and on CBS, lack of unique identifiers to match and deduplicate patient-level data, and lack of data security standards. Although most surveyed countries reported implementing or planning for implementation of CBS, these barriers need to be addressed to implement effective HIV CBS that can inform the national response to the HIV epidemic.


Asunto(s)
Salud Global/economía , Infecciones por VIH/epidemiología , Vigilancia de la Población , Países en Desarrollo , Humanos , Cooperación Internacional , Estados Unidos
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