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2.
MMWR Morb Mortal Wkly Rep ; 69(19): 582-586, 2020 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-32407305

RESUMEN

Although mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) is preventable through antiretroviral treatment (ART) during pregnancy and postpartum, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 160,000 new HIV infections occurred among children in 2018 (1). Child survival and HIV-free survival rates* are standard measures of progress toward eliminating MTCT† (2). Nationally representative Population-based HIV Impact Assessment (PHIA)§ survey data, pooled from eight sub-Saharan African countries¶ were used to calculate survival probability among children aged ≤3 years by maternal HIV status during pregnancy and HIV-free survival probability among children aged ≤3 years born to women with HIV infection, stratified by maternal ART** status during pregnancy. Survival probability was significantly lower among children born to women with HIV infection (94.7%) than among those born to women without HIV infection (97.6%). HIV-free survival probability of children born to women with HIV infection differed significantly by the timing of initiation of maternal ART: 93.0% among children whose mothers received ART before pregnancy, 87.8% among those whose mothers initiated ART during pregnancy, and 53.4% among children whose mothers did not receive ART during pregnancy. Focusing on prevention of HIV acquisition and, among women of reproductive age with HIV infection, on early diagnosis of HIV infection and ART initiation when applicable, especially before pregnancy, can improve child survival and HIV-free survival.


Asunto(s)
Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Tasa de Supervivencia/tendencias , África del Sur del Sahara/epidemiología , Fármacos Anti-VIH/uso terapéutico , Preescolar , Femenino , Infecciones por VIH/mortalidad , Infecciones por VIH/transmisión , Humanos , Lactante , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Masculino , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico
3.
Rev Med Suisse ; 16(690): 744-748, 2020 Apr 15.
Artículo en Francés | MEDLINE | ID: mdl-32301309

RESUMEN

Medical advances in the treatment of HIV over the last 35 years mean that people living with HIV (PLHIV) now have a life expectancy close to that of the general population. Further, when successfully treated, PLHIV cannot transmit the virus. Despite this, HIV-related stigma remains widespread, including within healthcare settings. Stigma is not a vague sociological notion but represents a real threat to public health, with repercussions for both PLHIV and HIV-negative individuals. Stigma has been shown to have a negative impact on HIV prevention, testing, access to health services, and on the healthcare management of PLHIV. Taking stigma into consideration is essential, both in meeting the medical and psycho-social needs of PLHIV and in order to effectively combat HIV/AIDS.


Asunto(s)
Infecciones por VIH/psicología , Salud Pública , Estigma Social , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Síndrome de Inmunodeficiencia Adquirida/psicología , Síndrome de Inmunodeficiencia Adquirida/transmisión , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Seronegatividad para VIH , Seropositividad para VIH/diagnóstico , Seropositividad para VIH/psicología , Seropositividad para VIH/transmisión , Humanos
4.
J Behav Med ; 43(3): 341-345, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32333185

RESUMEN

Our public health approaches to addressing COVID-19 are heavily dependent on social and behavioral change strategies to halt transmissions. To date, biomedical forms of curative and preventative treatments for COVID-19 are at best limited. Four decades into the HIV epidemic we have learned a considerable amount of information regarding social and behavioral approaches to addressing disease transmission. Here we outline broad, scoping lessons learned from the HIV literature tailored to the nature of what we currently know about COVID-19. We focus on multiple levels of intervention including intrapersonal, interpersonal, community, and social factors, each of which provide a reference point for understanding and elaborating on social/behavioral lessons learned from HIV prevention and treatment research. The investments in HIV prevention and treatment research far outweigh any infectious disease in the history of public health, that is, until now with the emergence of COVID-19.


Asunto(s)
Terapia Conductista/métodos , Infecciones por Coronavirus/epidemiología , Coronavirus , Transmisión de Enfermedad Infecciosa/prevención & control , Infecciones por VIH/prevención & control , Conductas Relacionadas con la Salud , Pandemias/prevención & control , Neumonía Viral/epidemiología , Betacoronavirus , Control de Enfermedades Transmisibles , Trazado de Contacto , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/transmisión , Brotes de Enfermedades/prevención & control , Infecciones por VIH/epidemiología , Infecciones por VIH/terapia , Infecciones por VIH/transmisión , Humanos , Neumonía Viral/prevención & control , Neumonía Viral/terapia , Neumonía Viral/transmisión , Vigilancia en Salud Pública , Distancia Social , Estigma Social
5.
Artículo en Inglés | MEDLINE | ID: mdl-32236386

RESUMEN

The aim of study was to assess the prevalence of Treponema pallidum and HIV infection in Amerindian people (Mbya Guarani) over the age of 11 in Puerto Iguazu (Argentina) and to describe the contact tracking of cases. The method was a cross-sectional study in the Mbya Guarani people living in three villages of Puerto Iguazu (community A, pop. 1,146; community B, pop. 369; and community C, pop. 149). Participants were randomly invited to participate in the survey and in blood testing. Of the 551 participants, 48 were infected by T. pallidum (8.71%; 95% confidence interval [CI] 7.38-10.04). The infection prevalence decreased with age, standing at 9.66% in the 11-19 age group, 8.42% in 20-39 age group and 4.54% in people aged 40 and older. We tracked 130 contacts for the 48 T. pallidum cases; 39/40 (97.5%) sexual contacts tested positive for syphilis. Among the 90 children born to infected mothers, 76 aged 18 months or older tested negative, while 8/14 younger children were still at risk for congenital syphilis. There were four cases of HIV infection (0.72%, 95% CI 0.31-1.13). Prevalence of T. pallidum infection and HIV infection are relevant in this indigenous community of Argentina, representing a public health concern.


Asunto(s)
Trazado de Contacto/estadística & datos numéricos , Infecciones por VIH/epidemiología , Indios Sudamericanos/estadística & datos numéricos , Sífilis/epidemiología , Adolescente , Adulto , Argentina/epidemiología , Niño , Estudios Transversales , Femenino , Estudios de Seguimiento , Infecciones por VIH/diagnóstico , Infecciones por VIH/transmisión , Humanos , Lactante , Masculino , Prevalencia , Estudios Seroepidemiológicos , Sífilis/diagnóstico , Sífilis/transmisión , Adulto Joven
6.
BMC Infect Dis ; 20(1): 195, 2020 Mar 06.
Artículo en Inglés | MEDLINE | ID: mdl-32138673

RESUMEN

BACKGROUND: Antiretroviral therapy (ART) demonstrates high efficacy in reducing the risk of HIV transmission to sexual partners. However, it is not clear if the use of pre-exposure prophylaxis (PrEP) in HIV-1-serodiscordant couples is necessary during natural conception when the HIV-positive partner exhibits a suppressed viral load. The purpose of this study was to assess the role of PrEP during natural conception in this population. METHODS: A retrospective, multicenter study was conducted in a cohort of HIV-1-serodiscordant couples (positive man, negative woman) with childbearing desires. HIV-positive male partners were treated with ART and achieved viral suppression for more than half a year. The HIV-negative female partners were either treated with PrEP or not treated with PrEP, and outcomes were compared between the two treatment groups. RESULTS: Of 246 HIV-1-serodiscordant couples in whom the HIV-positive partner achieved viral suppression, 104 seronegative women were treated with PrEP during natural conception and 142 seronegative women were not treated with PrEP. There were 410 condom-less sexual acts in couples treated with PrEP and 615 condom-less sexual acts in couples not treated with PrEP. We observed no instances of HIV transmission in HIV-1-serodiscordant couples with or without the use of PrEP during the process of natural conception. CONCLUSIONS: Our results show that PrEP had minimal influence in reducing the risk of HIV transmission during natural conception in HIV-1-serodiscordant couples with a stably suppressed viral load. Thus, it may be an acceptable option for HIV-negative partners to not use PrEP during the process of natural conception if the HIV-positive partner has achieved viral suppression for more than half a year.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Fertilización/fisiología , Infecciones por VIH/transmisión , Profilaxis Pre-Exposición , Carga Viral/efectos de los fármacos , Adulto , Condones/estadística & datos numéricos , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Seropositividad para VIH/tratamiento farmacológico , Seropositividad para VIH/transmisión , VIH-1 , Humanos , Masculino , Estudios Retrospectivos , Parejas Sexuales
7.
BMC Infect Dis ; 20(1): 235, 2020 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-32192458

RESUMEN

BACKGROUND: Loss to follow-up (LTFU) deprives HIV-exposed infants the lifesaving care required and results in exposing HIV free infants to virus requisition risk. We aimed to determine the rate of LTFU, postnatal mother-to-child HIV-transmission (MTCT) and to identify maternal factors associated with LTFU among HIV-exposed infants enrolled at Mbarara Regional Referral Hospital PMTCT clinic. METHODS: Study participants were infants born to HIV-positive mothers enrolled in the PMTCT clinic for HIV care at Mbarara Regional Referral Hospital. While access database in the Early Infant Diagnosis (EID) clinic provided data on infants, the open medical record system database at the ISS clinic provided that for mothers. Infants were classified as LTFU if they had not completed their follow-up schedule by 18 months of age. At 18 months, an infant is expected to receive a rapid diagnostic test before being discharged from the PMTCT clinic. Postnatal MTCT of HIV was calculated as a proportion of infants followed and tested from birth to 18 months of age. Logistic regression was used to determine possible associations between mothers' characteristics and LTFU. In-depth interviews of mothers of LTFU infants and health workers who attend to the HIV-exposed infants were carried out to identify factors not captured in the electronic database. RESULTS: Out of 1624 infants enrolled at the clinic, 533 (33%) were dropped for lack of mother's clinic identification number, 18 (1.1%) were either dead or transferred out. Out of 1073 infants analysed, 515 (48%) were LTFU by 18 months of age while out of the 558 who completed their follow-up schedule, 20 (3.6%) tested positive for HIV. Young age of mother, far distance to hospital and non-use of family planning were identified as outstanding factors responsible for LTFU. In addition, in-depth interviews revealed facility-level factors such as "waiting time" which would not be found in routine client databases. CONCLUSION: This study has revealed a high rate of loss to follow up among HIV-exposed infants enrolled at Mbarara Regional Referral hospital PMTCT clinic. Young maternal age, long distance to health facility and failure to use family planning were significantly associated with LTFU. Incorporating family planning services in the ART and PMTCT clinics could reduce loss to follow-up of HIV exposed infants. Young mothers should be targeted with information on the importance of completing the EID follow-up schedule and also, their clinic identification number be gotten at each visit.


Asunto(s)
Infecciones por VIH/diagnóstico , Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa , Perdida de Seguimiento , Madres , Adulto , Factores de Edad , Instituciones de Atención Ambulatoria , Diagnóstico Precoz , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Embarazo , Derivación y Consulta , Estudios Retrospectivos , Factores de Riesgo , Uganda , Adulto Joven
8.
PLoS One ; 15(3): e0227878, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32142515

RESUMEN

HIV prevention has evolved dramatically since the 1990s. The ABC trilogy (abstinence, be faithful, use a condom) has expanded to incorporate a range of biomedical prevention strategies, including voluntary medical male circumcision, pre- and post-exposure prophylaxis, and treatment-as-prevention, and to accommodate structural and combination prevention approaches. This study examines how young Africans from five epidemiologically and socio-culturally diverse countries (Swaziland, Kenya, Nigeria, Burkina Faso and Senegal) made sense of the evolving prevention of sexual transmission of HIV between 1997 and 2014. It uses a distinctive data source: 1,343 creative narratives submitted to HIV-themed scriptwriting competitions by young people aged 10-24. The study triangulates between analysis of quantifiable characteristics of the narratives, thematic qualitative analysis, and narrative-based approaches. Over time, HIV prevention themes become less prominent. Condoms are represented less often from 2008, though representations become more favourable. Biomedical prevention is all but absent through 2014. While prevention strategies may be described as effective in narratorial commentary, they are rarely depicted as preventing HIV, but are evoked instead in moralistic cautionary tales or represented as ineffective. Over time, an increasing proportion of protagonists are female. One in five narratives acknowledge structural drivers of HIV, but these are generally either disempowering or condemn characters for failing to prevent HIV in the face of often overwhelming structural challenges. In the context of combination prevention, there is a need to disseminate an empowering cultural narrative that models successful use of HIV prevention strategies despite structural constraints and avoids blaming and stigma.


Asunto(s)
Infecciones por VIH/prevención & control , Narración , Estigma Social , Adolescente , África/epidemiología , Niño , Condones , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Heterosexualidad , Humanos , Masculino , Profilaxis Posexposición/estadística & datos numéricos , Profilaxis Pre-Exposición/estadística & datos numéricos , Prevalencia , Adulto Joven
9.
MMWR Morb Mortal Wkly Rep ; 69(10): 260-264, 2020 Mar 13.
Artículo en Inglés | MEDLINE | ID: mdl-32163381

RESUMEN

Since implementation of Standard Precautions* for the prevention of bloodborne pathogen transmission in 1985, health care-associated transmission of human immunodeficiency virus (HIV) in the United States has been rare (1). In October 2017, the New York City Department of Health and Mental Hygiene (NYCDOHMH) and the New York State Department of Health (NYSDOH) were notified by a clinician of a diagnosis of acute HIV infection in a young adult male (patient A) without recognized risk factors (i.e., he was monogamous, had an HIV-negative partner, and had no injection drug use) who had recently been hospitalized for a chronic medical condition. The low risk coupled with the recent hospitalization and medical procedures prompted NYSDOH, NYCDOHMH, and CDC to investigate this case as possible health care-associated transmission of HIV. Among persons with known HIV infection who had hospitalization dates overlapping those of patient A, one person (patient B) had an HIV strain highly similar to patient A's strain by nucleotide sequence analysis. The sequence relatedness, combined with other investigation findings, indicated a likely health care-associated transmission. Nucleotide sequence analysis, which is increasingly used for detecting HIV clusters (i.e., persons with closely related HIV strains) and to inform public health response (2,3), might also be used to identify possible health care-associated transmission of HIV to someone with health care exposure and no known HIV risk factors (4).


Asunto(s)
Infección Hospitalaria/diagnóstico , Infecciones por VIH/diagnóstico , Infecciones por VIH/transmisión , Análisis de Secuencia de ARN , Resultado Fatal , VIH-1/genética , VIH-2/genética , Hospitalización , Humanos , Masculino , New York , ARN Viral/genética , Insuficiencia Renal Crónica/terapia
10.
Mem Inst Oswaldo Cruz ; 115: e190461, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32187328

RESUMEN

Phylogenetic analyses were crucial to elucidate the origin and spread of the pandemic human immunodeficiency virus type 1 (HIV-1) group M virus, both during the pre-epidemic period of cryptic dissemination in human populations as well as during the epidemic phase of spread. The use of phylogenetics and phylodynamics approaches has provided important insights to track the founder events that resulted in the spread of HIV-1 strains across vast geographic areas, specific countries and within geographically restricted communities. In the recent years, the use of phylogenetic analysis combined with the huge availability of HIV sequences has become an increasingly important approach to reconstruct HIV transmission networks and understand transmission dynamics in concentrated and generalised epidemics. Significant efforts to obtain viral sequences from newly HIV-infected individuals could certainly contribute to detect rapidly expanding HIV-1 lineages, identify key populations at high-risk and understand what public health interventions should be prioritised in different scenarios.


Asunto(s)
Infecciones por VIH/transmisión , VIH-1/genética , Filogeografía , Animales , Análisis por Conglomerados , Gorilla gorilla , Infecciones por VIH/virología , Humanos , Filogenia
11.
Nat Commun ; 11(1): 976, 2020 02 20.
Artículo en Inglés | MEDLINE | ID: mdl-32080169

RESUMEN

HIV prevalence varies markedly throughout Africa, and it is often presumed areas of higher HIV prevalence (i.e., hotspots) serve as sources of infection to neighboring areas of lower prevalence. However, the small-scale geography of migration networks and movement of HIV-positive individuals between communities is poorly understood. Here, we use population-based data from ~22,000 persons of known HIV status to characterize migratory patterns and their relationship to HIV among 38 communities in Rakai, Uganda with HIV prevalence ranging from 9 to 43%. We find that migrants moving into hotspots had significantly higher HIV prevalence than migrants moving elsewhere, but out-migration from hotspots was geographically dispersed, contributing minimally to HIV burden in destination locations. Our results challenge the assumption that high prevalence hotspots are drivers of transmission in regional epidemics, instead suggesting that migrants with high HIV prevalence, particularly women, selectively migrate to these areas.


Asunto(s)
Infecciones por VIH/epidemiología , Adolescente , Adulto , Estudios de Cohortes , Emigración e Inmigración , Femenino , Infecciones por VIH/transmisión , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Población Rural , Migrantes , Uganda/epidemiología , Adulto Joven
12.
PLoS One ; 15(2): e0229592, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32106255

RESUMEN

BACKGROUND: Adherence to antiretroviral therapy (ART), especially during the postpartum period, remains a major challenge in the efforts towards eliminating mother-to-child transmission of HIV. This study examined the levels and determinants of postpartum adherence to ART among mothers with HIV in the Eastern Cape, South Africa. METHODS: In this cross-sectional analytical study, we interviewed 495 postpartum women with HIV between January and May 2018. We measured postpartum adherence using six questions probing participants' adherence behaviours since child birth. We categorised the adherence behaviours into complete adherence (mothers who reported no missed episode(s) of ART since child birth) and suboptimal adherence (mothers with any missed episode(s) of ART). Adjusted and unadjusted logistic regression models were used to examine the determinants of postpartum adherence to ART. RESULTS: Overall, 63.9% reported complete adherence during the postpartum period but the rates varied by socio-demographic and behavioural characteristics. The adjusted logistic regression analysis showed that younger mothers were 70% less likely to report complete adherence to ART compared to mothers aged 40 and above. Likewise, mothers who currently use alcohol were 53% less likely to report complete postpartum adherence to ART compared to those who did not use alcohol. However, mothers who knew their partner's status were twice more likely to report complete postpartum adherence compared to those who did not. There was no statistically significant relationship between ART adherence and breastfeeding durations. CONCLUSION: Postpartum adherence to ART is suboptimal in the study setting, and younger mothers and those who use alcohol have a lower odds of complete adherence. Knowing a partner's status improves adherence, but infant feeding practices did not influence postpartum adherence behaviours. It is critical to design and strengthen interventions which target young mothers and alcohol users. Also, HIV sero-status disclosure should be encouraged among mothers to facilitate partner support.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Adulto , Estudios de Cohortes , Estudios Transversales , Femenino , Infecciones por VIH/transmisión , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Modelos Logísticos , Cumplimiento de la Medicación/estadística & datos numéricos , Periodo Posparto , Embarazo , Estudios Prospectivos , Sudáfrica , Encuestas y Cuestionarios , Adulto Joven
13.
Medicine (Baltimore) ; 99(6): e18776, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028390

RESUMEN

Liangshan Yi Autonomous Prefecture in Southwest China has a high human immunodeficiency virus (HIV) prevalence rate. This study examined the changing modes of HIV transmission among women with new HIV infections and explored the spatial heterogeneities in the factors associated with heterosexual transmission in this minority region.The data consisting of women with new HIV infections from 2011 to 2014 were collected from multiple sources. New infections were identified by BED capture enzyme immunoassay. The Bayesian hierarchical model was used to estimate the proportion of women with new HIV infections via heterosexual transmission across all townships in the Prefecture. A geographically weighted regression (GWR) model was utilized to investigate spatial variations in the sociodemographic characteristics associated with the changing modes of HIV transmission.An analytical sample of 927 women with new HIV infections was constructed and utilized to investigate the changing mode of HIV transmission. The rate of heterosexual transmission among women with new HIV infections in 2011 was below 20%. However, by 2014 this rate dramatically increased to nearly 80%. Among sociodemographic characteristics, GWR results revealed significant ethnic differences in heterosexual HIV transmission between Yi women and women in other ethnic groups, with Yi women demonstrating a lower risk of infection through heterosexual transmission. However, such ethnic differences were observed only in 30% of the townships in the Prefecture. Moreover, having a primary education decreased the odds of heterosexual transmission, which was observed in about 56% of the townships. Also, being involved in occupations other than agriculture or animal husbandry and being single or married decreased the odds of HIV infection through heterosexual contact among women, which did not significantly vary across the Prefecture.Heterosexual transmission was the predominant mode of HIV transmission among women in the Prefecture, and this transformation was clearly marked by a fast-growing trend and a spatial diffusion pattern. Spatial variations also existed in sociodemographic factors that were associated with the changing modes of HIV transmission.


Asunto(s)
Infecciones por VIH/epidemiología , Conducta Sexual , Adulto , China/epidemiología , Bases de Datos Factuales , Demografía , Femenino , Infecciones por VIH/transmisión , Humanos , Prevalencia , Análisis de Regresión , Factores Socioeconómicos , Salud de la Mujer
15.
PLoS One ; 15(2): e0228849, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32045444

RESUMEN

INTRODUCTION: As HIV is very effectively acquired during condomless receptive anal intercourse (AI) with serodiscordant and viremic partners, the practice could contribute to the high prevalence among female sex workers (FSW) in eSwatini (formerly known as Swaziland). We aim to estimate the proportion reporting AI (AI prevalence) among Swazi FSW and to identify the correlates of AI practice in order to better inform HIV prevention interventions among this population. METHODS: Using respondent-driven sampling (RDS), 325 Swazi FSW were recruited in 2011. We estimated the prevalence of AI and AI with inconsistent condom use in the past month with any partner type, and inconsistent condom use during AI and vaginal intercourse (VI) by partner type. Univariate and multivariable logistic regression models were used to identify behavioural and structural correlates associated with AI and AI with inconsistent condom use. RESULTS: RDS-adjusted prevalence of AI and AI with inconsistent condom use was high, at 44%[95% confidence interval (95%CI):35-53%]) and 34%[95%CI:26-42%], respectively and did not vary by partner type. HIV prevalence was high in this sample of FSW (70%), but knowledge that AI increases HIV acquisition risk low, with only 10% identifying AI as the riskiest sex act. Those who reported AI were more likely to be better educated (adjusted odds ratio(aOR) = 1.92[95%CI:1.03-3.57]), to have grown up in rural areas (aOR = 1.90[95%CI:1.09-3.32]), have fewer new clients in the past month (aOR = 0.33[95%CI:0.16-0.68]), and for last sex with clients to be condomless (aOR = 2.09[95%CI:1.07-4.08]). Although FSW reporting AI in past month were more likely to have been raped (aOR = 1.95[95%CI:1.05-3.65]) and harassed because of being a sex worker (aOR = 2.09[95%CI:1.16-3.74]), they were also less likely to have ever been blackmailed (aOR = 0.50[95%CI:0.25-0.98]) or been afraid to walk in public places (aOR = 0.46[95%CI:0.25-0.87]). Correlates of AI with inconsistent condom use were similar to those of AI. CONCLUSIONS: AI is commonly practised and condom use is inconsistent among Swazi FSW. Sex act data are needed to determine how frequently AI is practiced. Interventions to address barriers to condom use are needed, as are biomedical interventions that reduce acquisition risk during AI.


Asunto(s)
Trabajadores Sexuales/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Adolescente , Adulto , Condones/estadística & datos numéricos , Esuatini/epidemiología , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Prevalencia , Trabajadores Sexuales/psicología , Parejas Sexuales , Encuestas y Cuestionarios , Adulto Joven
16.
Am J Public Health ; 110(3): 394-400, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31944835

RESUMEN

Objectives. To assess and control a potential outbreak of HIV among people who inject drugs in Western North Carolina.Methods. Disease intervention specialists offered testing for hepatitis B and hepatitis C, harm reduction materials, and linkage to care to 7 linked people recently diagnosed with HIV who also injected drugs. Contacts were offered the same services and HIV testing. HIV genotype analysis was used to characterize HIV spread. We assessed testing and care outcomes by using state surveillance information.Results. Disease intervention specialists contacted 6 of 7 linked group members and received information on 177 contacts; among 96 prioritized contacts, 42 of 96 (44%) were exposed to or diagnosed with hepatitis C, 4 of 96 (4%) had hepatitis B, and 14 of 96 (15%) had HIV (2 newly diagnosed during the investigation). HIV genotype analysis suggested recent transmission to linked group members and 1 contact. Eleven of 14 with HIV were virally suppressed following the outbreak response.Conclusions. North Carolina identified and rapidly responded to an HIV outbreak among people reporting injecting drugs. Effective HIV care, the availability of syringe exchange services, and the rapid response likely contributed to controlling this outbreak.


Asunto(s)
Brotes de Enfermedades/prevención & control , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Abuso de Sustancias por Vía Intravenosa , Adulto , Trazado de Contacto/métodos , Femenino , VIH/clasificación , VIH/genética , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Reducción del Daño , Hepatitis B/epidemiología , Hepatitis C/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Programas de Intercambio de Agujas , North Carolina/epidemiología
17.
Nat Commun ; 11(1): 147, 2020 01 09.
Artículo en Inglés | MEDLINE | ID: mdl-31919342

RESUMEN

During HIV infection, cell-to-cell transmission results in endosomal uptake of the virus by target CD4+ T cells and potential exposure of the viral ssRNA genome to endosomal Toll-like receptors (TLRs). TLRs are instrumental in activating inflammatory responses in innate immune cells, but their function in adaptive immune cells is less well understood. Here we show that synthetic ligands of TLR8 boosted T cell receptor signaling, resulting in increased cytokine production and upregulation of surface activation markers. Adjuvant TLR8 stimulation, but not TLR7 or TLR9, further promoted T helper cell differentiation towards Th1 and Th17. In addition, we found that endosomal HIV induced cytokine secretion from CD4+ T cells in a TLR8-specific manner. TLR8 engagement also enhanced HIV-1 replication and potentiated the reversal of latency in patient-derived T cells. The adjuvant TLR8 activity in T cells can contribute to viral dissemination in the lymph node and low-grade inflammation in HIV patients. In addition, it can potentially be exploited for therapeutic targeting and vaccine development.


Asunto(s)
Infecciones por VIH/inmunología , VIH-1/inmunología , Células TH1/inmunología , Células Th17/inmunología , Receptor Toll-Like 8/metabolismo , Línea Celular , Infecciones por VIH/transmisión , Humanos , Inmunidad Innata/inmunología , Transducción de Señal/inmunología , Receptor Toll-Like 8/inmunología
18.
Nat Commun ; 11(1): 70, 2020 01 07.
Artículo en Inglés | MEDLINE | ID: mdl-31911610

RESUMEN

Vertical transmission accounts for most human immunodeficiency virus (HIV) infection in children, and treatments for newborns are needed to abrogate infection or limit disease progression. We showed previously that short-term broadly neutralizing antibody (bNAb) therapy given 24 h after oral exposure cleared simian-human immunodeficiency virus (SHIV) in a macaque model of perinatal infection. Here, we report that all infants given either a single dose of bNAbs at 30 h, or a 21-day triple-drug ART regimen at 48 h, are aviremic with almost no virus in tissues. In contrast, bNAb treatment beginning at 48 h leads to tight control without adaptive immune responses in half of animals. We conclude that both bNAbs and ART mediate effective post-exposure prophylaxis in infant macaques within 30-48 h of oral SHIV exposure. Our findings suggest that optimizing the treatment regimen may extend the window of opportunity for preventing perinatal HIV infection when treatment is delayed.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Anticuerpos Neutralizantes/administración & dosificación , Anticuerpos Anti-VIH/administración & dosificación , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Síndrome de Inmunodeficiencia Adquirida del Simio/prevención & control , Inmunidad Adaptativa , Animales , Modelos Animales de Enfermedad , Femenino , Infecciones por VIH/inmunología , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , VIH-1/inmunología , VIH-1/fisiología , Humanos , Macaca , Macaca mulatta , Masculino , Profilaxis Posexposición , Síndrome de Inmunodeficiencia Adquirida del Simio/inmunología , Síndrome de Inmunodeficiencia Adquirida del Simio/transmisión , Virus de la Inmunodeficiencia de los Simios/inmunología , Virus de la Inmunodeficiencia de los Simios/fisiología
20.
PLoS One ; 15(1): e0226237, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31914165

RESUMEN

INTRODUCTION: Approximately two-thirds of HIV-infected individuals reside in sub-Saharan Africa. The region accounts for 68% of the new HIV infections occurring worldwide with almost one-half of these infections being among young adults aged 12-24 years. Cowan and colleagues conducted a community-based, multi-component HIV intervention aimed at youth in rural Zimbabwe. Despite some changes in knowledge and attitudes, the community-based intervention did not affect the prevalence of HIV or HSV-2. We selected this frequently cited study for replication since it incorporates individual-, community-, and structural- level intervention components that are often considered in global HIV/AIDS prevention programs. Additionally, the intervention could be easily scaled-up, which is especially important in the context of limited resources. Although this study indicated no intervention effects in reducing HIV, the authors acknowledged some key methodological challenges. Our replication analysis provided important insights regarding the impact of these challenges to the interpretation of the results of this study. METHODS: Our replication study focused on replicating Cowan's findings and assessing the robustness of Cowan's results to alternative analytical models based on their study design. We determined how out-migration occurring during Cowan's study may have affected the population characteristics, the intervention exposure level, and the study findings. While the original intervention targeted knowledge and attitudes as a mechanism to decrease HIV/HSV-2, the Cowan study evaluated the intervention effects on knowledge, attitudes, and prevalence of HIV or HSV-2 separately. To better identify the pathway describing the interrelationship among the intervention and knowledge, attitudes, and prevalence of HIV or HSV-2, we assessed whether increases in knowledge or attitudes were associated with decreased HIV or HSV-2 prevalence. RESULTS: We replicated the original findings with minor discrepancies during the pure replication. Our additional analyses revealed that the study population characteristics changed over time in ways that may have affected outcomes. These changes also affected the levels of intervention exposure, with 48.7% males and 75.5% females of the intervention group receiving low-level exposure. Both genders with higher level intervention exposure experienced higher increments in multiple knowledge, attitude, and sexual risk behavior outcomes. Unfortunately, these did not translate to a significant reduction in HIV or HSV-2 regardless of the level and combination of knowledge and attitude domains. However, males receiving high-level intervention exposure compared to control indicated significantly lower odds of having HIV or HSV-2 under a Bayesian modeling paradigm. CONCLUSIONS: Our findings suggest a more robust conclusion on the study intervention effects. Further study based on a design that more consistently maximizes the exposure level of the intervention is necessary and should ideally be an evaluated goal in similar studies. Evaluation of the intervention impact for key subgroups of the target population is important and would better advise the use and scale-up of the evaluated interventions in various contexts. Our observation of a consistent lack of relationship between knowledge/attitudes and HIV/HSV-2 suggests a need to explore and include relevant additional and or complementary interventions, e.g., promoting effective skills in reducing risky sexual behaviors and addressing cultural and structural bottlenecks that may reduce HIV/HSV-2 risk among youth.


Asunto(s)
Servicios de Salud Comunitaria/métodos , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud , Herpes Genital/prevención & control , Educación del Paciente como Asunto , Adolescente , Adulto , Teorema de Bayes , Femenino , VIH/aislamiento & purificación , Infecciones por VIH/transmisión , Infecciones por VIH/virología , Herpes Genital/transmisión , Herpes Genital/virología , Herpesvirus Humano 2/aislamiento & purificación , Humanos , Masculino , Conducta de Reducción del Riesgo , Adulto Joven , Zimbabwe
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