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1.
Medicine (Baltimore) ; 100(15): e25403, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33847637

RESUMEN

ABSTRACT: Brain atrophy has been observed in perinatally HIV-infected patients (PHIV) despite initiation on combined antiretroviral treatment (cART), but neuroimaging studies are limited. We aimed to evaluate cortical thickness (CT) and subcortical gray matter (GM) volumes of PHIV youths with stable immunovirological situation and with a normal daily performance.A prospective cross-sectional study was conducted. A total of 25 PHIV patients on cART and 25 HIV-negative (HIV-) controls matched by age, sex, level of education, and socioeconomic status underwent a magnetic resonance imaging scan. CAT12 toolbox was used to extract CT values from T1w images using parcellations from Desikan-Killiany atlas (DK40). To measure regional brain volumes, native segmented images were parceled in regions of interest according to the Neuromorphometrics Atlas. Neuropsychological assessment and psychopathological symptoms were documented.Fifty participants were included (60% females, median age 20 years [interquartile range, IQR 19-23], 64% Whites). No differences regarding neuropsychological tests or psychopathological symptoms were found between groups (all P > .05). All participants presented an average performance in the Fluid Intelligence (FI) test (PHIV mean: -0.12, HIV- mean: 0.24), When comparing CT, PHIV-infected patients showed thinner cortices compared with their peers in fusiform gyrus (P = .000, P = .009), lateral-orbitofrontal gyrus (P = .006, P = .0024), and right parsobitalis gyrus (P = .047). Regarding subcortical GM volumes, PHIV patients showed lower right amygdala (P = .014) and left putamen (P = .016) volumes when compared with HIV- controls. Within the PHIV group, higher CD4 count was associated with higher volumes in right putamen (B = 0.00000038, P = .045). Moreover, increased age at cART initiation and lower nadir CD4 count was associated with larger volumes in left accumbens (B = 0.0000046, P = .033; B = -0.00000008, P = .045, respectively).PHIV patients showed thinner cortices of areas in temporal, orbito-frontal and occipital lobes and lower volumes of subcortical GM volumes when compared with the HIV- control group, suggesting cortical and subcortical brain alterations in otherwise neuroasymptomatic patients. Nevertheless, larger and longitudinal studies are required to determine the impact of HIV on brain structure in PHIV patients and to further identify risk and protective factors that could be implicated.


Asunto(s)
Sustancia Gris/patología , Infecciones por VIH/fisiopatología , Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Factores de Edad , Antirretrovirales/uso terapéutico , Atrofia , Ganglios Basales/diagnóstico por imagen , Ganglios Basales/patología , Recuento de Linfocito CD4 , Estudios Transversales , Femenino , Sustancia Gris/diagnóstico por imagen , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Imagen por Resonancia Magnética , Masculino , Estudios Prospectivos , Factores Socioeconómicos , Adulto Joven
2.
J Int AIDS Soc ; 24(4): e25697, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33821553

RESUMEN

INTRODUCTION: The COVID-19 pandemic is impacting HIV care globally, with gaps in HIV treatment expected to increase HIV transmission and HIV-related mortality. We estimated how COVID-19-related disruptions could impact HIV transmission and mortality among men who have sex with men (MSM) in four cities in China, over a one- and five-year time horizon. METHODS: Regional data from China indicated that the number of MSM undergoing facility-based HIV testing reduced by 59% during the COVID-19 pandemic, alongside reductions in ART initiation (34%), numbers of all sexual partners (62%) and consistency of condom use (25%), but initial data indicated no change in viral suppression. A mathematical model of HIV transmission/treatment among MSM was used to estimate the impact of disruptions on HIV infections/HIV-related deaths. Disruption scenarios were assessed for their individual and combined impact over one and five years for 3/4/6-month disruption periods, starting from 1 January 2020. RESULTS: Our model predicted new HIV infections and HIV-related deaths would be increased most by disruptions to viral suppression, with 25% reductions (25% virally suppressed MSM stop taking ART) for a three-month period increasing HIV infections by 5% to 14% over one year and deaths by 7% to 12%. Observed reductions in condom use increased HIV infections by 5% to 14% but had minimal impact (<1%) on deaths. Smaller impacts on infections and deaths (<3%) were seen for disruptions to facility HIV testing and ART initiation, but reduced partner numbers resulted in 11% to 23% fewer infections and 0.4% to 1.0% fewer deaths. Longer disruption periods (4/6 months) amplified the impact of disruption scenarios. When realistic disruptions were modelled simultaneously, an overall decrease in new HIV infections occurred over one year (3% to 17%), but not for five years (1% increase to 4% decrease), whereas deaths mostly increased over one year (1% to 2%) and five years (1.2 increase to 0.3 decrease). CONCLUSIONS: The overall impact of COVID-19 on new HIV infections and HIV-related deaths is dependent on the nature, scale and length of the various disruptions. Resources should be directed to ensuring levels of viral suppression and condom use are maintained to mitigate any adverse effects of COVID-19-related disruption on HIV transmission and control among MSM in China.


Asunto(s)
/epidemiología , Infecciones por VIH/prevención & control , Homosexualidad Masculina , China/epidemiología , Infecciones por VIH/transmisión , Humanos , Masculino , Sexo Seguro
3.
Am Fam Physician ; 103(7): 407-416, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33788514

RESUMEN

The HIV epidemic is an important public health priority. Transmissions continue to occur despite effective therapies that make HIV preventable and treatable. Approximately one-half of people with HIV are not receiving suppressive antiretroviral therapy (ART). Starting ART early, followed by continuous lifetime treatment, most effectively achieves durable virologic suppression and restoration of immune function that can improve clinical outcomes and prevent transmission to partners who are seronegative. National treatment guidelines include ART options that can be offered immediately after diagnosis, even before the results of baseline HIV drug-resistance testing are available. Initial ART selection should be guided by co-occurring conditions, including viral hepatitis, medications, and other factors such as pregnancy. Identifying and addressing psychosocial barriers to care is a key element of ensuring long-term adherence to treatment. The initial physical examination typically reveals no clinical manifestations of HIV in the absence of advanced disease. A comprehensive laboratory evaluation, including HIV viral load and CD4 lymphocyte monitoring, is necessary to guide decision-making for treatment, opportunistic infection prophylaxis, and vaccinations. The initial management of people with HIV presents a unique opportunity for family physicians to improve patients' long-term health care and reduce HIV transmissions.


Asunto(s)
Antirretrovirales/uso terapéutico , Terapia Antirretroviral Altamente Activa/métodos , Infecciones por VIH/terapia , Guías de Práctica Clínica como Asunto , Infecciones Oportunistas Relacionadas con el SIDA/prevención & control , Neoplasias del Ano/diagnóstico , Recuento de Linfocito CD4 , Manejo de la Enfermedad , Detección Precoz del Cáncer , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/transmisión , Vacunas contra la Hepatitis A/uso terapéutico , Vacunas contra Hepatitis B/uso terapéutico , Hepatitis Viral Humana/diagnóstico , Hepatitis Viral Humana/prevención & control , Herpes Zóster/prevención & control , Vacuna contra el Herpes Zóster/uso terapéutico , Humanos , Vacunas contra la Influenza/uso terapéutico , Gripe Humana/prevención & control , Masculino , Tamizaje Masivo , Cumplimiento de la Medicación , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/uso terapéutico , Infecciones por Pneumocystis/prevención & control , Enfermedades de Transmisión Sexual/diagnóstico , Tuberculosis/diagnóstico , Neoplasias del Cuello Uterino/diagnóstico , Carga Viral
5.
Pan Afr Med J ; 38: 26, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33777294

RESUMEN

Introduction: Mozambique has a generalized HIV epidemic, among pregnant women, HIV prevalence is estimated at 15.8% with a vertical transmission rate of 14%, more than double global targets. We evaluate electronic national health information system (SIS-MA) performance to verify if the data flow procedures met its objectives and evaluated the prevention of mother-to-child transmission (PMTCT) surveillance system to access its attributes and usefulness. Methods: we conducted a descriptive, cross-sectional evaluation of the PMTCT surveillance system in eight facilities in Gaza and Inhambane provinces using the centers for disease control and prevention guidelines (2001). For data quality, we cross-referenced patient registries from health facilities against the SIS-MA. We also interviewed 34 health technicians, using a Likert scale, to assess the following attributes of the PMTCT surveillance system: simplicity, stability, flexibility, acceptability, timeliness and data quality, usefulness of the system and knowledge of PMTCT. Results: regarding the simplicity measure, we verified that the registry books contain more than 30 variables. The system was 83% flexible in maintaining functionality with the introduction of new health facilities in the system. The completeness of the data was 50% and concordance of data from the register book and monthly reports was 89%. Conclusion: the PMTCT SIS-MA is useful in supporting the collection, analysis, interpretation and continuous and systematic dissemination of health data that are used to define and monitor public health policies in Mozambique. However, continued efforts are needed to improve data quality to ensure that the SIS-MA can adequately monitor the PMTCT program and contribute to reduced vertical transmission.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/prevención & control , Infecciones por VIH/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/virología , Síndrome de Inmunodeficiencia Adquirida/transmisión , Estudios Transversales , Femenino , Infecciones por VIH/transmisión , Sistemas de Información en Salud , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Mozambique , Vigilancia de la Población , Embarazo , Prevalencia , Sistema de Registros , Encuestas y Cuestionarios
6.
Lancet HIV ; 8(3): e175-e180, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33662266

RESUMEN

There is widespread unawareness and disbelief regarding the evidence-based conclusion that people who have a sustained undetectable HIV viral load cannot sexually transmit HIV-ie, undetectable=untransmittable (U=U). Long-standing, misguided fear about HIV transmission persists; consequently, so does the policing of sexual expression and the penalisation of pleasure faced by people with HIV. Many people with HIV with an undetectable viral load have unnecessarily abstained from condomless sex, avoided serodifferent partnering, and had anxiety about onward sexual transmission due to perceived HIV risk that is now known to be non-existent. Some health professionals have refrained from correcting this misinformation because of concerns that people with HIV will engage in more condomless sex or have more sexual partners upon learning of U=U. Withholding information about U=U is thus rooted in behavioural assumptions and is scientifically unfounded. Moreover, withholding such information violates medical ethics, perpetuates health inequities, and infringes on the sexual health and human rights of people with HIV. Health professionals and the broader public health community have an ethical responsibility to actively address misinformation about HIV transmission and disseminate the U=U message to all people.


Asunto(s)
Comunicación , Infecciones por VIH/diagnóstico , Infecciones por VIH/transmisión , Conducta Sexual/estadística & datos numéricos , Carga Viral/estadística & datos numéricos , Condones , Infecciones por VIH/tratamiento farmacológico , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Riesgo , Asunción de Riesgos , Parejas Sexuales , Sexo Inseguro/psicología
7.
AIDS Patient Care STDS ; 35(2): 33-38, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33571048

RESUMEN

Breastfeeding (BF) in mothers living with HIV (MLWH) is still discussed controversially in resource-rich settings. In Germany, where formula feeding is recommended for MLWH single BF cases have been reported, but no systematic data collection and analysis are available so far. This study, titled HELENE, aims to fill this data gap. A questionnaire covering the course of BF was distributed by a graduate student visiting each study site. Information was collected from patient files and by personal communication with the health care provider. Primary study objectives were the duration of BF and the maternal antiretroviral treatment (ART). Fifteen treatment centers across Germany contributed a total of 42 BF cases, observed from May 2009 to July 2020. There was an increasing number of BF cases over time. The median duration of BF was 20 weeks varying from single BF of colostrum to 104 weeks. All BF women except one elite controller received ART: 39% non-nucleoside reverse transcriptase inhibitor-, 37% INSTI-, 29% protease inhibitor-based regimens; one woman was on maraviroc. Thirty-nine percent of the ART regimens included drugs that were not recommended by the German-Austrian pregnancy guidelines. Our findings highlight the diversity of BF cases in Germany in terms of duration, maternal ART, and monitoring. Since the number of BF cases is increasing, guidelines are obliged to implement more detailed recommendations on BF, the monitoring of BF mothers, and the follow-up of the infants. There is an urgent need for prospective national and European data collections to further improve HIV prevention of mother-to-child transmission (PMTCT) in the setting of BF.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Lactancia Materna/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Fármacos Anti-VIH/administración & dosificación , Niño , Femenino , Alemania , Infecciones por VIH/transmisión , Infecciones por VIH/virología , Humanos , Lactante , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Estudios Prospectivos , Carga Viral
8.
Curr Opin HIV AIDS ; 16(2): 115-120, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33625042

RESUMEN

PURPOSE OF REVIEW: This review considers the potential and demonstrated impacts of SARS-CoV-2 on the sexually transmissible infection (STI)/HIV transmission. RECENT FINDINGS: COVID-19 increases the vulnerability of those at highest risk of acquiring STI/HIV. Altered health-seeking behaviour, reductions in STI/HIV clinic capacity, service disruptions and redeployment of human resources to assist COVID-19 control efforts have impacted on STI/HIV control programmes. Reports of reduced STI incidence are emerging, but it is hard to determine whether this is real or due to decreased testing during COVID-19 lockdown periods. Fear of COVID-19 and implemented control measures have altered STI/HIV transmission dynamics. Sexual health services adapted to the pandemic by reducing face-to-face patient encounters in favour of telehealth and mail-based initiatives as well as more stringent triage practice. Many sexual health and HIV treatment services now operate at reduced capacity and experience ongoing service disruptions, which necessarily translates into poorer outcomes for patients and their communities. SUMMARY: In the short-term, COVID-19 related sexual behaviour change is driving STI/HIV transmission downwards. However, the impacts of the global COVID-19 response on sexual health-seeking behaviour and STI/HIV services threaten to drive STI/HIV transmission upwards. Ultimately, the expected rebound in STI/HIV incidence will require an appropriate and timely public health response. VIDEO ABSTRACT: http://links.lww.com/COID/A31.


Asunto(s)
/epidemiología , Infecciones por VIH/epidemiología , Enfermedades de Transmisión Sexual/epidemiología , Infecciones por VIH/transmisión , Humanos , Incidencia , Conducta Sexual , Parejas Sexuales , Enfermedades de Transmisión Sexual/transmisión
9.
Lancet HIV ; 8(4): e206-e215, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33617783

RESUMEN

BACKGROUND: During the COVID-19 pandemic, men who have sex with men (MSM) in the USA have reported similar or fewer sexual partners and reduced HIV testing and care access compared with before the pandemic. Pre-exposure prophylaxis (PrEP) use has also declined. We aimed to quantify the potential effect of COVID-19 on HIV incidence and HIV-related mortality among US MSM. METHODS: We used a calibrated, deterministic, compartmental HIV transmission model for MSM in Baltimore (MD, USA) and available data on COVID-19-related disruptions to HIV services to predict effects of reductions in sexual partners (0%, 25%, 50%), condom use (5%), HIV testing (20%), viral suppression (10%), PrEP initiations (72%), PrEP adherence (9%), and antiretroviral therapy (ART) initiations (50%). In our main analysis, we modelled disruptions due to COVID-19 starting Jan 1, 2020, and lasting 6 months. We estimated the median change in cumulative new HIV infections and HIV-related deaths among MSM over 1 and 5 years, compared with a base case scenario without COVID-19-related disruptions. FINDINGS: A 25% reduction in sexual partners for 6 months among MSM in Baltimore, without HIV service changes, could reduce new HIV infections by median 12·2% (95% credible interval 11·7 to 12·8) over 1 year and median 3·0% (2·6 to 3·4) over 5 years. In the absence of changes in sexual behaviour, the 6-month estimated reductions in condom use, HIV testing, viral suppression, PrEP initiations, PrEP adherence, and ART initiations combined are predicted to increase new HIV infections by median 10·5% (5·8 to 16·5) over 1 year, and by median 3·5% (2·1 to 5·4) over 5 years. Disruptions to ART initiations and viral suppression are estimated to substantially increase HIV-related deaths (ART initiations by median 1·7% [0·8 to 3·2], viral suppression by median 9·5% [5·2 to 15·9]) over 1 year, with smaller proportional increases over 5 years. The other individual disruptions (to HIV testing, PrEP and condom use, PrEP initiation, and partner numbers) were estimated to have little effect on HIV-related deaths (<1% change over 1 or 5 years). A 25% reduction in sexual partnerships is estimated to offset the effect of the combined service disruptions on new HIV infections (change over 1 year: median -3·9% [-7·4 to 1·0]; over 5 years: median 0·0% [-0·9 to 1·4]), but not on HIV deaths (change over 1 year: 11·0% [6·2 to 17·7]; over 5 years: 2·6% [1·5 to 4·3]). INTERPRETATION: Maintaining access to ART and adherence support is of the utmost importance to maintain viral suppression and minimise excess HIV-related mortality due to COVID-19 restrictions in the USA, even if disruptions to services are accompanied by reductions in sexual partnerships. FUNDING: National Institutes of Health.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Condones/estadística & datos numéricos , Infecciones por VIH/epidemiología , Modelos Estadísticos , Profilaxis Pre-Exposición/estadística & datos numéricos , Adolescente , Adulto , Afroamericanos , Terapia Antirretroviral Altamente Activa , Baltimore/epidemiología , Grupo de Ascendencia Continental Europea , Infecciones por VIH/etnología , Infecciones por VIH/mortalidad , Infecciones por VIH/transmisión , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Homosexualidad Masculina , Humanos , Incidencia , Masculino , Pronóstico , Asunción de Riesgos , Parejas Sexuales , Análisis de Supervivencia
10.
Lancet Psychiatry ; 8(4): 301-309, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33640039

RESUMEN

BACKGROUND: Opioid agonist treatment (OAT) reduces many of the harms associated with opioid dependence. We use mathematical modelling to comprehensively evaluate the overall health benefits of OAT in people who inject drugs in Perry County (KY, USA), Kyiv (Ukraine), and Tehran (Iran). METHODS: We developed a dynamic model of HIV and hepatitis C virus (HCV) transmission, incarceration, and mortality through overdose, injury, suicide, disease-related and other causes. The model was calibrated to site-specific data using Bayesian methods. We evaluated preventable drug-related deaths (deaths due to HIV, HCV, overdose, suicide, or injury) averted over 2020-40 for four scenarios, added incrementally, compared with a scenario without OAT: existing OAT coverage (setting-dependent; community 4-11%; prison 0-40%); scaling up community OAT to 40% coverage; increasing average OAT duration from 4-14 months to 2 years; and scaling up prison-based OAT. OUTCOMES: Drug-related harms contributed differentially to mortality across settings: overdose contributed 27-47% (range of median projections) of preventable drug-related deaths over 2020-40, suicide 6-17%, injury 3-17%, HIV 0-59%, and HCV 2-18%. Existing OAT coverage in Tehran (31%) could have a substantial effect, averting 13% of preventable drug-related deaths, but will have negligible effect (averting <2% of preventable drug-related deaths) in Kyiv and Perry County due to low OAT coverage (<4%). Scaling up community OAT to 40% could avert 12-24% of preventable drug-related deaths, including 13-22% of overdose deaths, with greater effect in settings with significant HIV mortality (Tehran and Kyiv). Improving OAT retention and providing prison-based OAT would have a significant additional effect, averting 27-51% of preventable drug-related deaths. INTERPRETATION: OAT can substantially reduce drug-related harms, particularly in settings with HIV epidemics in people who inject drugs. Maximising these effects requires research and investment into achieving higher coverage and provision and longer retention of OAT in prisons and the community. FUNDING: UK National Institute for Health Research, US National Institute on Drug Abuse.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Trastornos Relacionados con Opioides/tratamiento farmacológico , Prisiones/organización & administración , Abuso de Sustancias por Vía Intravenosa/mortalidad , Adulto , Sobredosis de Droga/mortalidad , Sobredosis de Droga/prevención & control , Femenino , Infecciones por VIH/mortalidad , Infecciones por VIH/transmisión , Hepatitis C/mortalidad , Hepatitis C/transmisión , Humanos , Irán/epidemiología , Masculino , Persona de Mediana Edad , Modelos Teóricos , Trastornos Relacionados con Opioides/mortalidad , Suicidio/prevención & control , Suicidio/estadística & datos numéricos , Ucrania/epidemiología , Estados Unidos/epidemiología
11.
BMC Infect Dis ; 21(1): 160, 2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-33557775

RESUMEN

BACKGROUND: The widespread use of antiretroviral therapy (ART) has resulted in the development of transmitted drug resistance (TDR), which reduces ART efficacy. We explored TDR prevalence and its associated risk factors in newly diagnosed individuals in Guangxi. METHODS: We enrolled 1324 participants who were newly diagnosed with HIV-1 and had not received ART at voluntary counselling and testing centres (VCT) in Guangxi, China, who had not received ART. Phylogenetic relationship, transmission cluster, and genotypic drug resistance analyses were performed using HIV-1 pol sequences. We analysed the association of demographic and virological factors with TDR. RESULTS: In total, 1151 sequences were sequenced successfully, of which 83 (7.21%) showed evidence of TDR. Multivariate logistic regression analysis revealed that there was significant difference between the prevalence of TDR and unmarried status (adjusted odds ratio (aOR) = 2.41, 95% CI: 1.23-4.71), and CRF08_BC subtype (aOR = 2.03, 95% CI: 1.13-3.64). Most cases of TDR were related to resistance to non-nucleoside reverse transcriptase inhibitors (4.87%) and V179E was the most common mutation detected. We identified a total of 119 HIV transmission clusters (n = 585, 50.8%), of which 18 (15.1%) clusters showed evidence of TDR (36, 41.86%). Three clusters were identified that included drug-resistant individuals having a transmission relationship with each other. The following parameters were associated with TDR transmission risk: Unmarried status, educational level of junior high school or below, and CRF08_BC subtype may be a risk of the transmission of TDR. CONCLUSIONS: Our findings indicated that moderate TDR prevalence and highlighted the importance of continuous TDR monitoring and designing of strategies for TDR mitigation.


Asunto(s)
Farmacorresistencia Viral/genética , Infecciones por VIH/diagnóstico , VIH-1/genética , Adulto , Antirretrovirales/uso terapéutico , China , Femenino , Genotipo , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/transmisión , VIH-1/clasificación , VIH-1/aislamiento & purificación , Humanos , Modelos Logísticos , Masculino , Filogenia , Prevalencia , Factores de Riesgo , Productos del Gen pol del Virus de la Inmunodeficiencia Humana/genética
12.
AIDS Educ Prev ; 33(1): 62-72, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33617321

RESUMEN

We have tracked belief in the effectiveness of HIV treatment as prevention (TasP) among Australian gay and bisexual men (GBM) since 2013. National, online cross-sectional surveys of GBM were conducted every 2 years during 2013-2019. Trends and associations were analyzed using multivariate logistic regression. Data from 4,903 survey responses were included. Belief that HIV treatment prevents transmission increased from 2.6% in 2013 to 34.6% in 2019. Belief in the effectiveness of TasP was consistently higher among HIV-positive participants than other participants. In 2019, higher levels of belief in TasP were independently associated with university education, being HIV-positive, using pre-exposure prophylaxis, knowing more HIV-positive people, being recently diagnosed with a sexually transmitted infection (STI) and use of post-exposure prophylaxis. Belief that HIV treatment prevents transmission has increased substantially among Australian GBM, but remains concentrated among HIV-positive GBM, those who know HIV-positive people, and GBM who use antiretroviral-based prevention.


Asunto(s)
Bisexualidad/psicología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Conocimientos, Actitudes y Práctica en Salud , Homosexualidad Masculina/psicología , Hombres/psicología , Profilaxis Pre-Exposición/métodos , Enfermedades de Transmisión Sexual/prevención & control , Adulto , Australia , Estudios Transversales , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Humanos , Masculino , Persona de Mediana Edad , Profilaxis Posexposición , Profilaxis Pre-Exposición/estadística & datos numéricos , Asunción de Riesgos , Conducta Sexual , Parejas Sexuales , Minorías Sexuales y de Género , Encuestas y Cuestionarios , Sexo Inseguro
13.
mSphere ; 6(1)2021 02 17.
Artículo en Inglés | MEDLINE | ID: mdl-33597174

RESUMEN

Many viruses, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and human immunodeficiency virus (HIV), have a structure consisting of spikes protruding from an underlying spherical surface. Research in biological and colloidal sciences has revealed secrets of why spikes exist on virus surfaces. Specifically, the spikes favor virus attachment on surfaces via receptor-specific interactions (RSIs), mediate the membrane fusion, and determine or change viral tropism. The spikes also facilitate viruses to approach surfaces before attachment and subsequently escape back to the environment if RSIs do not occur (i.e., easy come and easy go). Therefore, virus spikes create the paradox of having a large capacity for binding with cells (high infectivity) and meanwhile great mobility in the environment. Such structure-function relationships have important implications for the fabrication of virus-like particles and analogous colloids (e.g., hedgehog- and raspberry-like particles) for applications such as the development of antiviral vaccines and drug delivery.


Asunto(s)
/transmisión , /patogenicidad , Glicoproteína de la Espiga del Coronavirus/metabolismo , Animales , VIH/metabolismo , VIH/patogenicidad , Infecciones por VIH/transmisión , Humanos , Proteínas Virales/metabolismo , Tropismo Viral/fisiología , Internalización del Virus
14.
Obstet Gynecol Clin North Am ; 48(1): 53-74, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33573790

RESUMEN

Viral infections are common complications of pregnancy. Although some infections have maternal sequelae, many viral infections can be perinatally transmitted to cause congenital or chronic infection in fetuses or infants. Treatments of such infections are geared toward reducing maternal symptoms and complications and toward preventing maternal-to-child transmission of viruses. The authors review updates in the treatment of herpes simplex virus, cytomegalovirus, hepatitis B and C viruses, human immunodeficiency virus, and COVID-19 during pregnancy.


Asunto(s)
Transmisión Vertical de Enfermedad Infecciosa , Complicaciones Infecciosas del Embarazo/terapia , Virosis/terapia , Virosis/transmisión , Adulto , Antivirales/uso terapéutico , /transmisión , Infecciones por Citomegalovirus/terapia , Infecciones por Citomegalovirus/transmisión , Femenino , Infecciones por VIH/terapia , Infecciones por VIH/transmisión , Hepatitis B/terapia , Hepatitis B/transmisión , Hepatitis C/terapia , Hepatitis C/transmisión , Herpes Simple/terapia , Herpes Simple/transmisión , Humanos , Lactante , Embarazo , Complicaciones Infecciosas del Embarazo/virología
15.
BMC Infect Dis ; 21(1): 93, 2021 Jan 21.
Artículo en Inglés | MEDLINE | ID: mdl-33478415

RESUMEN

BACKGROUND: HIV-transmitted drug resistance (TDR) is found in antiretroviral therapy (ART)-naïve populations infected with HIV-1 with TDR mutations and is important for guiding future first- and second-line ART regimens. We investigated TDR and its effect on CD4 count in ART-naïve youths from the China-Myanmar border near the Golden Triangle to better understand TDR and effectively guide ART. METHODS: From 2009 to 2017, 10,832 HIV-1 infected individuals were newly reported along the Dehong border of China, 573 ART-naïve youths (16 ~ 25 y) were enrolled. CD4 counts were obtained from whole blood samples. HIV pol gene sequences were amplified from RNA extracted from plasma. The Stanford REGA program and jpHMM recombination prediction tool were used to determine genotypes. TDR mutations (TDRMs) were analyzed using the Stanford Calibrated Population Resistance tool. RESULTS: The most common infection route was heterosexuals (70.51%), followed by people who inject drugs (PWID, 19.20%) and men who have sex with men (MSM) (8.90%). The distribution of HIV genotypes mainly included the unique recombinant form (URF) (44.08%), 38.68% were CRFs, 13.24% were subtype C and 4.04% were subtype B. The prevalence of TDR increased significantly from 2009 to 2017 (3.48 to 9.48%) in ART-naïve youths (4.00 to 13.16% in Burmese subjects, 3.33 to 5.93% in Chinese subjects), and the resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs), and protease inhibitors (PIs) were 3.49, 2.62, and 0.52%, respectively. Most (94.40%, n = 34) of HIV-1-infected patients with TDRM had mutation that conferred resistance to a single drug class. The most common mutations Y181I/C and K103N, were found in 7 and 9 youths, respectively. The mean CD4 count was significantly lower among individuals with TDRMs (373/mm3 vs. 496/mm3, p = 0.013). CONCLUSIONS: The increase in the prevalence of HIV-1 TDR increase and a low CD4 count of patients with TDRMs in the China-Myanmar border suggests the need for considering drug resistance before initiating ART in HIV recombination hotspots.


Asunto(s)
Fármacos Anti-VIH/farmacología , Farmacorresistencia Viral , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , VIH-1/aislamiento & purificación , Adolescente , Adulto , Recuento de Linfocito CD4 , China/epidemiología , Farmacorresistencia Viral/genética , Femenino , Genes pol/genética , Genotipo , Infecciones por VIH/diagnóstico , Infecciones por VIH/transmisión , VIH-1/efectos de los fármacos , VIH-1/genética , Humanos , Masculino , Mutación , Mianmar/epidemiología , Prevalencia , Adulto Joven
16.
Viruses ; 13(2)2021 01 25.
Artículo en Inglés | MEDLINE | ID: mdl-33503987

RESUMEN

Molecular investigation of primary HIV infections (PHI) is crucial to describe current dynamics of HIV transmission. Aim of the study was to investigate HIV transmission clusters (TC) in PHI referred during the years 2013-2020 to the National Institute for Infectious Diseases in Rome (INMI), that is the Lazio regional AIDS reference centre, and factors possibly associated with inclusion in TC. These were identified by phylogenetic analysis, based on population sequencing of pol; a more in depth analysis was performed on TC of B subtype, using ultra-deep sequencing (UDS) of env. Of 270 patients diagnosed with PHI during the study period, 229 were enrolled (median follow-up 168 (IQR 96-232) weeks). Median age: 39 (IQR 32-48) years; 94.8% males, 86.5% Italians, 83.4% MSM, 56.8% carrying HIV-1 subtype B. Of them, 92.6% started early treatment within a median of 4 (IQR 2-7) days after diagnosis; median time to sustained suppression was 20 (IQR 8-32) weeks. Twenty TC (median size 3, range 2-9 individuals), including 68 patients, were identified. A diagnosis prior to 2015 was the unique factor associated with inclusion in a TC. Added value of UDS was the identification of shared quasispecies components in transmission pairs within TC.


Asunto(s)
Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , VIH-1/genética , Adulto , Femenino , Genotipo , Infecciones por VIH/diagnóstico , VIH-1/clasificación , VIH-1/aislamiento & purificación , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Epidemiología Molecular , Filogenia , ARN Viral/genética , Productos del Gen env del Virus de la Inmunodeficiencia Humana/genética , Productos del Gen pol del Virus de la Inmunodeficiencia Humana/genética
17.
Int J Med Sci ; 18(3): 846-851, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33437221

RESUMEN

In the last 50 years we have experienced two big pandemics, the HIV pandemic and the pandemic caused by SARS-CoV-2. Both pandemics are caused by RNA viruses and have reached us from animals. These two viruses are different in the transmission mode and in the symptoms they generate. However, they have important similarities: the fear in the population, increase in proinflammatory cytokines that generate intestinal microbiota modifications or NETosis production by polymorphonuclear neutrophils, among others. They have been implicated in the clinical, prognostic and therapeutic attitudes.


Asunto(s)
/epidemiología , Infecciones por VIH/epidemiología , VIH-1/patogenicidad , Pandemias/historia , /patogenicidad , /inmunología , /transmisión , Citocinas/sangre , Citocinas/inmunología , Trampas Extracelulares/inmunología , Trampas Extracelulares/metabolismo , Miedo , Carga Global de Enfermedades/estadística & datos numéricos , Infecciones por VIH/inmunología , Infecciones por VIH/psicología , Infecciones por VIH/transmisión , VIH-1/inmunología , VIH-1/aislamiento & purificación , Historia del Siglo XX , Historia del Siglo XXI , Interacciones Huésped-Patógeno/inmunología , Humanos , Mediadores de Inflamación/sangre , Mediadores de Inflamación/inmunología , Mortalidad , Neutrófilos/inmunología , Neutrófilos/metabolismo , Pandemias/estadística & datos numéricos , Pronóstico , /aislamiento & purificación
18.
AIDS ; 35(2): 307-316, 2021 02 02.
Artículo en Inglés | MEDLINE | ID: mdl-33394673

RESUMEN

OBJECTIVE: To describe changes in maternal viral control over time in South African women living with HIV (WLHIV) using surveillance data from the National Health Laboratory Service's Corporate Data Warehouse (NHLS CDW). DESIGN: A retrospective cohort analysis of maternal viral load during pregnancy and up to 15 months postpartum was performed amongst WLHIV (15-49 years) within the public-health sector between 2016 and 2017. METHODS: HIV and pregnancy-related test data were used to create a synthetic cohort of pregnant WLHIV from the NHLS CDW. Syphilis-screening, in association with ward type and/or postpregnancy cervical screening and/or birth HIV test and/or positive ß-hCG, was used as a proxy for pregnancy. The syphilis-screening date marked the first antenatal care visit (fANC). Fractional polynomial models described viral load evolution from fANC up to 15 months postdelivery. Piecewise linear regression models determined factors associated with viral load decline. FINDINGS: Among 178 319 pregnant WLHIV, 345 174 viral load tests were performed [median = 2 (IQR: 2-3) per woman]. At fANC, 85 545 (48%) women were antiretroviral therapy (ART) experienced; 88 877 (49.8%) were not and 3897 (2.2%) unknown. Proportions of viraemia (viral load ≥50 copies/ml) were 39 756 (53.6%) at first viral load performed during pregnancy, 14 780 (36.9%) at delivery and 24 328 (33.5%) postpartum. Maternal age at least 25 years, CD4+ cell count at least 500 cells/µl and viral load less than 50 copies/ml at baseline predicted sustained viral load suppression during follow-up. CONCLUSION: Despite high-ART coverage among pregnant women in South Africa, only 63% of WLHIV achieved viral load less than 50 copies/ml at delivery. Maternal viral load monitoring requires prioritization for maternal health and eMTCT.


Asunto(s)
Infecciones por VIH , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo , Neoplasias del Cuello Uterino , Niño , Detección Precoz del Cáncer , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/transmisión , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Estudios Retrospectivos , Sudáfrica , Carga Viral
19.
Viruses ; 13(1)2021 Jan 16.
Artículo en Inglés | MEDLINE | ID: mdl-33467166

RESUMEN

HIV-1 subtype CRF01_AE is the second most predominant strain in Bulgaria, yet little is known about the molecular epidemiology of its origin and transmissibility. We used a phylodynamics approach to better understand this sub-epidemic by analyzing 270 HIV-1 polymerase (pol) sequences collected from persons diagnosed with HIV/AIDS between 1995 and 2019. Using network analyses at a 1.5% genetic distance threshold (d), we found a large 154-member outbreak cluster composed mostly of persons who inject drugs (PWID) that were predominantly men. At d = 0.5%, which was used to identify more recent transmission, the large cluster dissociated into three clusters of 18, 12, and 7 members, respectively, five dyads, and 107 singletons. Phylogenetic analysis of the Bulgarian sequences with publicly available global sequences showed that CRF01_AE likely originated from multiple Asian countries, with Vietnam as the likely source of the outbreak cluster between 1988 and 1990. Our findings indicate that CRF01_AE was introduced into Bulgaria multiple times since 1988, and infections then rapidly spread among PWID locally with bridging to other risk groups and countries. CRF01_AE continues to spread in Bulgaria as evidenced by the more recent large clusters identified at d = 0.5%, highlighting the importance of public health prevention efforts in the PWID communities.


Asunto(s)
Genotipo , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Infecciones por VIH/virología , VIH-1/clasificación , VIH-1/genética , Adolescente , Adulto , Anciano , Bulgaria/epidemiología , Femenino , Variación Genética , Infecciones por VIH/prevención & control , VIH-1/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Epidemiología Molecular , Filogenia , Filogeografía , Vigilancia en Salud Pública , Virus Reordenados , Recombinación Genética , Adulto Joven
20.
BMJ Case Rep ; 14(1)2021 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-33408101

RESUMEN

Highly active antiretroviral therapy (HAART) has dramatically lowered rates of mother-to-child HIV transmission among patients with access to treatment. Barriers to complete viral suppression increase rates of transmission, even with only low levels of viral replication. Here, we present the case of a pregnant patient who developed a detectable viral load in pregnancy, thought to be related to calcium supplement consumption or emesis while using a dolutegravir-based HAART regimen. Ultimately, with adjustments, the patient again reached an undetectable viral load and had an uncomplicated perinatal and neonatal outcome. We discuss new data on the use of dolutegravir in pregnancy and precautions for maintaining viral suppression while on antiretroviral therapy in pregnancy.


Asunto(s)
Fármacos Anti-VIH/farmacología , Terapia Antirretroviral Altamente Activa/métodos , Infecciones por VIH/tratamiento farmacológico , Medicamentos sin Prescripción/farmacología , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Adulto , Fármacos Anti-VIH/uso terapéutico , Recuento de Linfocito CD4 , Carbonato de Calcio/farmacología , Interacciones Farmacológicas , Femenino , Infecciones por VIH/sangre , Infecciones por VIH/transmisión , Infecciones por VIH/virología , VIH-1/aislamiento & purificación , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Carga Viral/efectos de los fármacos , Vitaminas/farmacología , Vómitos/inducido químicamente
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