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1.
Int J STD AIDS ; : 956462420938485, 2020 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-32753001

RESUMO

Despite widespread prevalence of lubricant use and rectal douching for receptive anal intercourse (RAI) among men who have sex with men (MSM), research evaluating the association of these behaviors with sexually transmitted infections (STIs) is limited. This is an observational analysis of a longitudinal cohort of predominantly Black/Latino MSM in Los Angeles. Every six months from August 2014 to January 2018, participants received STI screening and surveys evaluating lubricant use, douching, substance use, and sexual risk behaviors. General estimating equations evaluated the association between consistent lubricant use and douching for RAI with positive rectal Neisseria gonorrhoeae, Chlamydia trachomatis, and/or syphilis (positive STI). Among 313 participants across 552 study visits, 16.5% (91/552) had positive STI. Consistent lubricant use was reported in 52.7% (243/552) and rectal douching in 57.6% (318/552) of study visits. Consistent lubricant use was associated with STI diagnosis (adjusted OR [AOR] 1.81; 95% CI 1.11-2.96; p = 0.018). Each episode of rectal douching before RAI was associated with 2% increased odds of positive STI (AOR 1.02; 95% CI 1.00-1.04; p = 0.041). Among this cohort of HIV-positive and high-risk HIV-negative MSM, lubricant use and douching was common and independently associated with an STI, suggesting the utility of prevention messaging around barrier methods/condoms for sexual encounters involving douching/lubricant use.

2.
Clin Infect Dis ; 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32766725

RESUMO

BACKGROUND: Novel treatment strategies to slow the continued emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae are urgently needed. A molecular assay that predicts in vitro ciprofloxacin susceptibility is now available but has not been systematically studied in human infections. METHODS: Using a genotypic polymerase chain reaction assay to determine the status of the N. gonorrhoeae gyrase subunit A serine 91 codon, we conducted a multisite prospective clinical study of the efficacy of a single oral dose of ciprofloxacin 500 mg in patients with culture-positive gonorrhea. Follow-up specimens for culture were collected to determine microbiological cure 5-10 days post-treatment. RESULTS: Of the 106 subjects possessing culture-positive infections with wild-type gyrA serine N. gonorrhoeae genotype, the efficacy of single-dose oral ciprofloxacin treatment in the per-protocol population was 100% (95% 1-sided confidence interval, 97.5-100%). CONCLUSIONS: Resistance-guided treatment of N. gonorrhoeae infections with single-dose oral ciprofloxacin was highly efficacious. The widespread introduction and scale-up of gyrA serine 91 genotyping in N. gonorrhoeae infections could have substantial medical and public health benefits in settings where the majority of gonococcal infections are ciprofloxacin susceptible. CLINICAL TRIALS REGISTRATION: NCT02961751.

3.
J Infect Dis ; 222(Supplement_1): S63-S69, 2020 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-32645158

RESUMO

BACKGROUND: People with human immunodeficiency virus (PWH) face increased risks for heart failure and adverse heart failure outcomes. Myocardial steatosis predisposes to diastolic dysfunction, a heart failure precursor. We aimed to characterize myocardial steatosis and associated potential risk factors among a subset of the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) participants. METHODS: Eighty-two PWH without known heart failure successfully underwent cardiovascular magnetic resonance spectroscopy, yielding data on intramyocardial triglyceride (IMTG) content (a continuous marker for myocardial steatosis extent). Logistic regression models were applied to investigate associations between select clinical characteristics and odds of increased or markedly increased IMTG content. RESULTS: Median (Q1, Q3) IMTG content was 0.59% (0.28%, 1.15%). IMTG content was increased (> 0.5%) among 52% and markedly increased (> 1.5%) among 22% of participants. Parameters associated with increased IMTG content included age (P = .013), body mass index (BMI) ≥ 25 kg/m2 (P = .055), history of intravenous drug use (IVDU) (P = .033), and nadir CD4 count < 350 cells/mm³ (P = .055). Age and BMI ≥ 25 kg/m2 were additionally associated with increased odds of markedly increased IMTG content (P = .049 and P = .046, respectively). CONCLUSIONS: A substantial proportion of antiretroviral therapy-treated PWH exhibited myocardial steatosis. Age, BMI ≥ 25 kg/m2, low nadir CD4 count, and history of IVDU emerged as possible risk factors for myocardial steatosis in this group. CLINICAL TRIALS REGISTRATION: NCT02344290; NCT03238755.

4.
Gerontologist ; 2020 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-32556123

RESUMO

BACKGROUND AND OBJECTIVES: Conversion therapies to minimize same-sex attractions are classified as a dangerous practice by numerous scientific institutions in the United States. These practices may contribute to poor long-term psychosocial health, thereby interrupting processes of healthy aging. Few studies have examined psychosocial differences between persons with and without prior experiences of conversion therapy. We assessed associations between prior conversion therapy experiences and psychosocial health among midlife and older men who have sex with men (MSM; age 40+ years). RESEARCH DESIGN AND METHODS: Participants included a multicity sample of MSM (N = 1156) enrolled in the Multicenter AIDS Cohort Study completed health surveys (2016-2019) as part of their bi-annual study visits. Using multivariable regressions, we investigated the associations of prior conversion therapy with current depressive symptoms, internalized homophobia, post-traumatic stress, and cumulative psychosocial conditions. Using a trait-level measure (e.g., life purpose and perseverance), we tested whether resilience moderated these associations. RESULTS: The full sample was predominantly Non-Hispanic White with a mean age of 62.6 years. Fifteen percent of men (n = 171/1156) reported prior conversion therapy. In multivariable models, men exposed to conversion therapy were more likely to have depressive symptoms and above-average internalized homophobia. Men exposed to conversion therapy had 2 to 2.5 times the odds of reporting 1 and ≥2 psychosocial conditions, respectively, compared with those who reported 0 conditions. Resilience did not moderate these associations. DISCUSSION AND IMPLICATIONS: Conversion therapies are non-affirming social stressors for MSM and may compromise critical psychosocial aspects of healthy aging among MSM.

5.
J Infect Dis ; 2020 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-32504091

RESUMO

BACKGROUND: In the United States, human papillomavirus (HPV) vaccination has been recommended for young adult men who have sex with men (MSM) since 2011. METHODS: The Vaccine Impact in Men (VIM) study surveyed MSM and transgender women aged 18-26 years in 3 U.S. cities during 2016-2018. Self-collected anal swab and oral rinse specimens were assessed for 37 types of HPV DNA. We compared HPV prevalence among vaccinated and unvaccinated participants and determined adjusted prevalence ratios (aPR) and confidence intervals (CI). RESULTS: Among 1,767 participants, 704 (39.8%) self-reported receiving HPV vaccine. Median age at vaccination (18.7 years) was older than age at first sex (15.7 years). Quadrivalent vaccine-type HPV was detected in anal or oral specimens from 475 (26.9%) participants. Vaccine-type HPV prevalence was lower among vaccinated (22.9%) compared with unvaccinated (31.6%) participants; aPR for those who initiated vaccination at ≤18 years was 0.41 (95% CI: 0.24-0.57) and at >18 years was 0.82 (95% CI: 0.67-0.98). Vaccine effectiveness for at least one HPV vaccine dose at age ≥18 years or >18 years was 59% and 18%, respectively. CONCLUSIONS: Findings suggest real-world effectiveness of HPV vaccination among young adult MSM. This effect was stronger with younger age at vaccination.

6.
AIDS Care ; 32(2): 186-192, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31663365

RESUMO

Young MSM, especially ethnic and racial minority young MSM, bear a disproportionate burden of new HIV infections. This group also has the highest rates of undiagnosed infection and lowest rates of viral suppression. Previous research indicates that young MSM are testing for HIV too late, which may explain why rates of new HIV infection are rising in young Hispanic MSM and not falling in young Black and White MSM despite advances in preventive medications. Analysis of our sample showed an overall average age at first HIV test of approximately 26. The average age at first HIV test was 25.5 years for Black/African American individuals, 24.7 years for Hispanic individuals, and 28 years for White individuals. More testing resources and innovative outreach methods are needed to increase rates of testing among young MSM.

8.
Drug Alcohol Depend ; 207: 107770, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31841750

RESUMO

BACKGROUND: The objective of this study was to examine depressive symptoms overtime and quantify the variance in symptoms attributable to substance use among a cohort of HIV-positive and HIV-negative men. METHODS: Participants were enrolled in an NIH/NIDA funded cohort, with 534 men resulting in 1,888 visits between August 2014 and June 2018. Participants were between 18 and 45 years, and half were HIV-positive. At baseline and semi-annual visits, information was collected on depressive symptoms, sexual behaviors, and substance use. Changes overtime in symptom scores were evaluated using individual growth curve modeling. RESULTS: The average CES-D20 score was 19.5 (SD = 12.7). Depressive symptoms were highest among daily/weekly methamphetamine users (56% vs. 39% occasional users and 27% non-users; p value<.01). Factors independently associated with depressive symptoms included methamphetamine use (adjusted OR = 1.5; 95% CI 1.1-2.3) and transactional sex (adjusted OR = 1.8; 95% CI 1.4-2.5). Based on growth curve modeling, methamphetamine was the most influential predictor of depressive symptoms, accounting for 10% of individual variance (p value<.01). Declines in depressive symptoms were noted for heavy users of a number of drugs, except for methamphetamine. For instance, those reporting daily/weekly heroin had a 3.38 point decline in CESD20 scores overtime (p value = 0.01). However, heavy methamphetamine users had much higher CESD20 scores and their scores remained high overtime (p value for change = 0.91). CONCLUSIONS: The prevalence of depressive symptoms among this cohort of HIV-negative and HIV-positive MSM was high, especially among frequent methamphetamine users. These findings suggest that reducing methamphetamine use may have the potential to reduce depressive symptoms.

9.
Clin Infect Dis ; 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31879782

RESUMO

BACKGROUND: Most guidelines recommend rapid treatment initiation for newly diagnosed, HIV-1-infected patients but prospective US data are limited. The DIAMOND (NCT03227861) study using darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) 800/150/200/10 mg is a phase 3 prospective study evaluating efficacy/safety of a single-tablet regimen in a rapid initiation model of care. METHODS: Adults aged ≥18 years began D/C/F/TAF ≤14 days from diagnosis without screening/baseline results; as results became available, participants not meeting predefined safety/resistance stopping rules continued. Primary endpoint was virologic response (HIV-1 RNA <50 copies/mL; intent-to-treat; US Food and Drug Administration [FDA] snapshot) at Week 48; participant satisfaction was measured via HIV Treatment Satisfaction Questionnaire status version (HIVTSQs). RESULTS: Of 109 participants, 87% were male, 32% black/African American, median (range) age was 28 (19-66) years, 25% of participants had HIV-1 RNA ≥100,000 copies/mL, 21% had CD4+ cell count <200 cells/µL, and 31% enrolled ≤48 hours from diagnosis. At Week 48, 97 (89%) participants completed the study and 92 (84%) achieved HIV-1 RNA <50 copies/mL (FDA snapshot). There were no protocol-defined virologic failures; incidences of adverse events (AEs) and adverse drug reactions (33%) were low, no serious AEs were study drug-related, and 1 (<1%) participant discontinued due to study drug-related AE. The overall HIVTSQs score at Week 48 was 58 (maximum: 60). CONCLUSIONS: At Week 48, a high proportion of participants starting D/C/F/TAF achieved HIV-1 RNA <50 copies/mL and very few discontinued therapy. D/C/F/TAF was well tolerated, no participants discontinued due to baseline resistance stopping criteria, and high treatment satisfaction among participants was recorded.

10.
Sci Rep ; 9(1): 14840, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619731

RESUMO

Methamphetamine (MA) use is a major public health problem in the United States, especially among people living with HIV (PLWH). Many MA-induced neurotoxic effects are mediated by inflammation and gut microbiota may play a role in this process, yet the effects of MA on the microbiome have not been adequately explored. Therefore, we performed 16S rRNA gene sequencing on rectal swab samples from 381 men who have sex with men, 48% of whom were PLWH and 41% of whom used MA. We compared microbiome composition between MA users and non-users while testing for potential interactions with HIV and controlling for numerous confounders using inverse probability of treatment weighting. We found that MA use explained significant variation in overall composition (R2 = 0.005, p = 0.008) and was associated with elevated Finegoldia, Parvimonas, Peptoniphilus, and Porphyromonas and reduced Butyricicoccus and Faecalibacterium, among others. Genera including Actinomyces and Streptobacillus interacted with HIV status, such that they were increased in HIV+ MA users. Finegoldia and Peptoniphilus increased with increasing frequency of MA use, among others. In summary, MA use was associated with a microbial imbalance favoring pro-inflammatory bacteria, including some with neuroactive potential and others that have previously been associated with poor HIV outcomes.

11.
AIDS Behav ; 23(10): 2730-2740, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30953305

RESUMO

We conducted a records-based cohort study of patients who initiated pre-exposure prophylaxis (PrEP) at a large federally qualified health center in Los Angeles, CA to characterize patterns of PrEP use, identify correlates of PrEP discontinuation, and calculate HIV incidence. Of 3121 individuals initiating PrEP between 2014 and 2017, 42% (n = 1314) were active (i.e., had a current PrEP prescription) in April 2018. HIV incidence was 0.1/100 person-years among active PrEP patients, compared to 2.1/100 person-years among patients who discontinued. Compared to patients accessing PrEP through government programs with no prescription copay, risk of discontinuation was higher among those with private insurance (ARR = 1.4, 95% CI 1.2, 1.7), or no insurance (ARR = 4.5, 95% CI 3.2, 6.4). Sixty-three percent of active PrEP patients had gaps between PrEP prescriptions, averaging one gap per year (median length = 65 days). Increasing access to free or low-cost PrEP can improve PrEP continuity.


Assuntos
Fármacos Anti-HIV/economia , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Seguro Saúde , Profilaxia Pré-Exposição/economia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Adolescente , Adulto , Idoso , Fármacos Anti-HIV/administração & dosagem , Estudos de Coortes , Seguimentos , Infecções por HIV/economia , Humanos , Incidência , Estudos Longitudinais , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , Profilaxia Pré-Exposição/estatística & dados numéricos , Adulto Jovem
12.
AIDS Care ; 31(10): 1228-1233, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30894013

RESUMO

PrEP's potential benefit for men who have sex with men (MSM) who use stimulants may be limited by adherence or prescriber willingness to recommend PrEP due to concerns of non-compliance. Using data from PATH-PrEP, a 48-week study evaluating PrEP for MSM in Los Angeles, we modeled an interaction between stimulant use and condomless sex with multiple partners (CAS-MP) on prevention-effective dried blood spot tenofovir-diphosphate concentrations. At week 4, participants reporting stimulant use and CAS-MP had a decreased odds of prevention-effective adherence compared to non-stimulant use and non-CAS-MP (AOR 0.15, 95% CI 0.04-0.57). From week 4-48, participants reporting stimulant use and CAS-MP had increased odds of prevention-effective adherence (AOR 1.06 per week, 95%CI 1.01-1.12). Participants reporting CAS-MP without stimulant use had no significant change in prevention-effective adherence (AOR 0.99 per week, 95%CI 0.96-1.02). Stimulant use moderated the association of CAS-MP on prevention-effective PrEP adherence over time.


Assuntos
Antirretrovirais/administração & dosagem , Estimulantes do Sistema Nervoso Central/uso terapêutico , Preservativos/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/estatística & dados numéricos , Adesão à Medicação , Profilaxia Pré-Exposição/métodos , Parceiros Sexuais , Tenofovir/administração & dosagem , Adenina/análogos & derivados , Adulto , Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Homossexualidade Masculina/psicologia , Humanos , Estudos Longitudinais , Los Angeles , Masculino , Organofosfatos , Tenofovir/uso terapêutico , Sexo sem Proteção
13.
Cancer Cytopathol ; 127(4): 247-257, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30913381

RESUMO

BACKGROUND: An anal histological high-grade squamous intraepithelial lesion (hHSIL) is an anal cancer precursor. Experts recommend Dacron swab anal cytology as a primary screen for anal hHSILs, especially among human immunodeficiency virus-infected and -uninfected men who have sex with men (MSM). Studies have shown that Dacron cytology inaccurately predicts anal hHSILs and results in unnecessary diagnostic procedures. Nylon-flocked (NF) swabs have been shown to trap pathogens and cells well. Thus, this study compared test characteristics of anal cytology using NF and Dacron swab collection protocols to predict anal hHSILs. METHODS: A single-visit, randomized clinical trial compared NF and Dacron swab anal cytology specimens to predict high-resolution anoscopy and biopsy-diagnosed anal hHSILs. Data for 326 gay men, bisexual men, other MSM, and male-to-female transgender women contributed descriptive and tabular statistics with which unadjusted and fully adjusted logistic regression models were constructed. The models estimated the odds of hHSILs, test accuracy (area under the curve [AUC]) and sensitivity, and specificity as well as the positive and negative predictive values of abnormal NF and Dacron cytology for predicting hHSILs. RESULTS: In the fully adjusted model, the sensitivities for NF and Dacron cytology were nearly equal (48% vs 47%), but the specificity was higher with NF cytology (76% vs 69%). Comparisons of the areas under receiver operating characteristic curves showed that NF cytology alone predicted hHSILs better than the covariate model (AUC, 0.69 vs 0.63; P = .02), but NF and Dacron cytology comparisons showed no statistically significant differences (AUC, 0.69 vs 0.67; P = .3). CONCLUSIONS: NF cytology and Dacron cytology provide modest sensitivity, but NF cytology has higher specificity and accuracy, and this is important for lowering the costs of population-based screening.


Assuntos
Neoplasias do Ânus/patologia , Citodiagnóstico/instrumentação , Homossexualidade Masculina/estatística & dados numéricos , Manejo de Espécimes/instrumentação , Lesões Intraepiteliais Escamosas/patologia , Pessoas Transgênero/estatística & dados numéricos , Neoplasias do Ânus/virologia , Citodiagnóstico/métodos , Feminino , Seguimentos , Infecções por HIV/complicações , Infecções por HIV/virologia , HIV-1/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Nylons/química , Polietilenotereftalatos/química , Prognóstico , Minorias Sexuais e de Gênero , Manejo de Espécimes/métodos , Lesões Intraepiteliais Escamosas/virologia
14.
AIDS ; 33(5): 793-804, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30649052

RESUMO

OBJECTIVE: We employed a high-dimensional covariate adjustment method in microbiome analysis to better control for behavioural and clinical confounders, and in doing so examine the effects of HIV on the rectal microbiome. DESIGN: Three hundred and eighty-three MSM were grouped into four HIV viremia categories: HIV negative (n = 200), HIV-positive undetectable (HIV RNA < 20 copies/ml; n = 66), HIV-positive suppressed (RNA 20-200 copies/ml; n = 72) and HIV-positive viremic (RNA > 200 copies/ml; n = 45). METHODS: We performed 16S rRNA gene sequencing on rectal swab samples and used inverse probability of treatment-weighted marginal structural models to examine differences in microbial composition by HIV viremia category. RESULTS: HIV viremia explained a significant amount of variability in microbial composition in both unadjusted and covariate-adjusted analyses (R = 0.011, P = 0.02). Alterations in bacterial taxa were more apparent with increasing viremia. Relative to the HIV-negative group, HIV-positive undetectable participants showed depletions in Brachyspira, Campylobacter and Parasutterella, while suppressed participants demonstrated depletions in Barnesiella, Brachyspira and Helicobacter. The microbial signature of viremic men was most distinct, showing enrichment in inflammatory genera Peptoniphilus, Porphyromonas and Prevotella and depletion of Bacteroides, Brachyspira and Faecalibacterium, among others. CONCLUSION: Our study shows that, after accounting for the influence of multiple confounding factors, HIV is associated with dysbiosis in the gastrointestinal microbiome in a dose-dependent manner. This analytic approach may allow for better identification of true microbial associations by limiting the effects of confounding, and thus improve comparability across future studies.


Assuntos
Disbiose/virologia , Microbioma Gastrointestinal/imunologia , Infecções por HIV/imunologia , Homossexualidade Masculina , Microbiota/imunologia , Reto/microbiologia , Reto/virologia , Viremia/imunologia , Adulto , Disbiose/fisiopatologia , Infecções por HIV/fisiopatologia , Humanos , Masculino , RNA Ribossômico 16S/análise , Análise de Sequência de RNA , Sexo sem Proteção/estatística & dados numéricos
15.
JMIR Res Protoc ; 8(1): e10807, 2019 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-30650057

RESUMO

BACKGROUND: Early treatment studies have shown that prompt treatment of HIV with combination antiretroviral therapy (cART) can limit the size of latent viral reservoirs, thereby providing clinical and public health benefits. Studies have demonstrated that adolescents have a greater capacity for immune reconstitution than adults. Nevertheless, adolescents who acquired HIV through sexual transmission have not been included in early treatment studies because of challenges in identification and adherence to cART. OBJECTIVE: This study aimed to identify and promptly treat with cART youth aged 12 to 24 years in Los Angeles and New Orleans who have acute, recent, or established HIV infection, as determined by Fiebig stages 1 to 6 determined by viral RNA polymerase chain reaction, p24 antigen presence, and HIV-1 antigen Western blot. The protocol recommends treatment on the day of diagnosis when feasible. Surveillance and dedicated behavioral strategies are used to retain them in care and optimize adherence. Through serial follow-up, HIV biomarkers and response to antiretroviral therapy (ART) are assessed. The study aims to assess viral dynamics, decay and persistence of viral reservoirs over time, and correlate these data with the duration of viral suppression. METHODS: A total of 72 youth (36 acutely infected and 36 treatment naïve controls) are enrolled across clinical sites using a current community-based strategy and direct referrals. Youth are prescribed ART according to the standard of care HIV-1 management guidelines and followed for a period of 2 years. Assessments are conducted at specific time points throughout these 2 years of follow-up for monitoring of adherence to ART, viral load, magnitude of HIV reservoirs, and presence of coinfections. RESULTS: The study began enrolling youth in July 2017 across study sites in Los Angeles and New Orleans. As of September 30, 2018, a total of 37 youth were enrolled, 12 with recently acquired, 16 with established HIV infection as determined by Fiebig staging, and 9 pending determination of Fiebig status. Recruitment and enrollment are ongoing. CONCLUSIONS: We hypothesize that the size of the HIV reservoir and immune activation markers will be different across groups treated with cART, that is, those with acute or recent HIV infection and those with established infection. Adolescents treated early who are virally suppressed will have diminished HIV reservoirs than those with established infection. These youth may be potential candidates for a possible HIV vaccine and additional HIV remission intervention trials. Our study will inform future studies of viral remission strategies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/10807.

17.
Sex Transm Dis ; 46(2): 105-111, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30640212

RESUMO

BACKGROUND: Among men who have sex with men (MSM) the relationship between sexually transmitted infections (STIs) and cannabis use is not well established. We assessed cannabis use, sexual behavior, and STIs including human immunodeficiency virus (HIV) in a diverse cohort of young MSM. METHODS: In Los Angeles, the mSTUDY cohort conducted visits every 6 months with 512 MSM between 2014 and 2017 collecting demographics, sexual behaviors, and reports of frequency of substance use. Each visit conducted testing for gonorrhea, chlamydia, and syphilis via blood, urine, and pharyngeal and rectal swabs by PCR, Human immunodeficiency virus was assessed using rapid tests for HIV-negatives and viral load for HIV-positives. We analyzed the relationship between cannabis use, sexual behaviors and STIs/HIV across 1535 visits. RESULTS: Significantly fewer participants tested positive for STIs at visits when reporting the previous 6 months use of only cannabis (11.7%) compared with no drugs (16.3%) or other drugs (20.0%, P = 0.01). Fewer MSM reporting only cannabis use than no or other drug use had been incarcerated, had incarcerated partners, experienced interpersonal violence, and were HIV-positive. In multivariable analyses visits with positive STIs were associated with other drug use (adjusted odds ratio, 1.69; 95% confidence interval, 1.03-2.78) but not use of cannabis only or no drug use after controlling for age, HIV status, new sex partners, and number of sex partners. CONCLUSIONS: When MSM reported using cannabis exclusively fewer STIs were detected and lower risk sexual engagements reported than when MSM reported no drug or other drug use.


Assuntos
Infecções por HIV/transmissão , Homossexualidade Masculina , Abuso de Maconha/virologia , Comportamento Sexual , Doenças Sexualmente Transmissíveis/etiologia , Adulto , Estudos de Coortes , Gonorreia/transmissão , Humanos , Los Angeles , Masculino , Fatores de Risco , Assunção de Riscos , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/microbiologia , Doenças Sexualmente Transmissíveis/virologia , Transtornos Relacionados ao Uso de Substâncias , Sífilis/transmissão , Adulto Jovem
18.
Sex Transm Dis ; 46(1): e3-e4, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30216232

RESUMO

Gyrase A genotyping reliably predicts Neisseria gonorrhoeae susceptibility to ciprofloxacin. It is unknown whether concurrent infections at different anatomic sites harbor different susceptibility profiles. We found a 3.2% frequency of discordant gyrase A genotypes among concurrent but anatomically separate N. gonorrhoeae infections diagnosed at 2 laboratories in Los Angeles.


Assuntos
DNA Girase/genética , Genótipo , Gonorreia/microbiologia , Neisseria gonorrhoeae/enzimologia , Neisseria gonorrhoeae/genética , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Ciprofloxacino/farmacologia , Farmacorresistência Bacteriana , Humanos , Los Angeles , Testes de Sensibilidade Microbiana , Neisseria gonorrhoeae/efeitos dos fármacos , Estudos Retrospectivos
19.
Am J Public Health ; 108(S4): S277-S283, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30383431

RESUMO

OBJECTIVES: To quantify sexual orientation and gender identity (SOGI) disparities in incidence of HIV, other sexually transmitted infections (STIs), and viral hepatitis. METHODS: We performed a records-based study of 19 933 patients visiting a federally qualified health center in Los Angeles, California, between November 2016 and October 2017 that examined HIV, STIs, and viral hepatitis incidence proportions. We created multivariable logistic regression models to examine the association between incidence proportions and SOGI among people living with HIV and HIV-negative patients. RESULTS: Among those who were HIV-negative at baseline (n = 16 757), 29% tested positive for any STI during the study period, compared with 38% of people living with HIV. Stratified by birth sex, STI positivity was 32% among men and 11% among women. By SOGI, STI positivity was 35% among gay and bisexual cisgender men, 15% among heterosexual cisgender men, 11% among cisgender women, 25% among transgender women, 13% among gay and bisexual transgender men, 3% among heterosexual transgender men, and 26% among nonbinary people. CONCLUSIONS: Stratifying by SOGI highlighted disparities that are obscured when stratifying by birth sex. Public Health Implications. To monitor and reduce disparities, health jurisdictions should include SOGI data with infectious disease reporting.


Assuntos
Identidade de Gênero , Hepatite Viral Humana/epidemiologia , Doenças Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Disparidades em Assistência à Saúde , Humanos , Incidência , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
Am J Public Health ; 108(10): 1408-1417, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30138062

RESUMO

OBJECTIVES: To characterize uptake of HIV preexposure prophylaxis (PrEP) in a community setting and to identify disparities in PrEP use by demographic and behavioral factors associated with increased HIV risk. METHODS: We conducted a cross-sectional study of 19 587 men who have sex with men and transgender people visiting a Los Angeles, California, clinic specializing in lesbian, gay, bisexual, and transgender care between August 2015 and February 2018 by using clinical care data. RESULTS: Seventy percent of patients met PrEP eligibility criteria, while 10% reported PrEP use. Using sex drugs, reporting both condomless anal intercourse and recent sexually transmitted infection, older age, and higher education level were associated with higher odds of PrEP use given eligibility. Latino or Asian race/ethnicity and bisexual orientation were associated with lower odds of PrEP use given eligibility. Higher odds of perceived need were associated with demographic risk factors but PrEP use was not similarly elevated. CONCLUSIONS: Discrepancies between PrEP eligibility, perceived need, and use reveal opportunities to improve PrEP delivery in community settings. Public Health Implications. Efforts are needed to facilitate PrEP uptake in populations with highest HIV incidence.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Conscientização , Infecções por HIV/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde , Profilaxia Pré-Exposição , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Estudos Transversais , Feminino , Homossexualidade Masculina , Humanos , Los Angeles , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Minorias Sexuais e de Gênero , Pessoas Transgênero
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