Randomized-trial data on the risks and benefits of antiretroviral therapy (ART) as compared with zidovudine and single-dose nevirapine to prevent transmission of the human immunodeficiency virus (HIV) in HIV-infected pregnant women with high CD4 counts are lacking.

Data from randomized trials are lacking on the benefits and risks of initiating antiretroviral therapy in patients with asymptomatic human immunodeficiency virus (HIV) infection who have a CD4+ count of more than 350 cells per cubic millimeter.

Progressive immune dysfunction and the acquired immunodeficiency syndrome (AIDS) develop in most persons with untreated infection with human immunodeficiency virus type 1 (HIV-1) but in only approximately 20 to 30% of persons infected with HIV type 2 (HIV-2); among persons infected with both types, the natural history of disease progression is poorly understood.

Antiretroviral preexposure prophylaxis is a promising approach for preventing human immunodeficiency virus type 1 (HIV-1) infection in heterosexual populations.

The optimal time for the initiation of antiretroviral therapy for asymptomatic patients with human immunodeficiency virus (HIV) infection is uncertain.

There is considerable genetic diversity among viruses of different subtypes (designated A to J) in the major group of human immunodeficiency virus type 1 (HIV-1), the form of HIV that is dominant in the global epidemic. If available, HIV-1 sequences pre-dating the recognition of AIDS could be crucial in defining the time of origin and the subsequent evolution of these viruses in humans. The oldest known case of HIV-1 infection was reported to be that of a sailor from Manchester who died of an AIDS-like illness in 1959; however, the authenticity of this case has not been confirmed. Genetic analysis of sequences from clinical materials obtained from 1971 to 1976 from members of a Norwegian family infected earlier than 1971 showed that they carried viruses of the HIV-1 outlier group, a variant form that is mainly restricted to West Africa. Here we report the amplification and characterization of viral sequences from a 1959 African plasma sample that was previously found to be HIV-1 seropositive. Multiple phylogenetic analyses not only authenticate this case as the oldest known HIV-1 infection, but also place its viral sequence near the ancestral node of subtypes B and D in the major group, indicating that these HIV-1 subtypes, and perhaps all major-group viruses, may have evolved from a single introduction into the African population not long before 1959.

Maxime J. Jean, Dawei Zhou, Guillaume Fiches, Weili Kong, Huachao Huang, Andrei Purmal, Katerina Gurova, Netty G. Santoso, Jian Zhu

Abstract A cure for human immunodeficiency virus type‐1 (HIV‐1) has been hampered by the limitation of current combination antiretroviral therapy (cART) to address the latent reservoirs in HIV‐1 patients. One strategy proposed to eradicate these reservoirs is the “shock and kill” approach, where latency‐reversing agents (LRAs) are used to reactivate and promote viral cell death and/or immune killing of reactivated cells. Here, we report that curaxin CBL0137, an anti‐tumor compound, can potentiate TNFα‐mediated reactivation of latently infected HIV‐1cell lines. Additionally, the single use of CBL0137 is sufficient to reactivate HIV‐1 latent reservoirs in peripheral mononuclear cells (PBMCs) isolated from HIV‐1 positive, cART‐treated, aviremic patients. Thus, CBL0137 possesses capabilities as a LRA and could be considered for the “shock and kill” approach. This article is protected by copyright. All rights reserved.

John, Steven A.; Robles, Gabriel; Starks, Tyrel J.; Rendina, H. Jonathon

Background: Epidemiology research is limited on the characteristics of HIV pre-exposure prophylaxis (PrEP) using couples. Setting: United States nationwide sample recruited online in 2017. Methods: HIV-negative/unknown gay, bisexual, and other men who have sex with men (GBMSM) with HIV-negative/unknown partners (n=3140) were asked about individual and main partner PrEP uptake. Men were coded into five groups: 1) neither participant nor partner on PrEP, 2) partner only on PrEP, 3) participant only on PrEP, 4) both on PrEP, and 5) unknown partner PrEP use. We examined associations of demographics, relationship factors, condomless anal sex (CAS) with main and causal partners, bacterial sexually transmitted infection (BSTI) diagnoses, and sexual positioning with reported dyadic PrEP use using fully-adjusted multinomial logistic regressions. Results: PrEP use was 3.2% for the partner only, 5.7% for the participant only, and 4.9% for both participant and partner; 5.6% reported not knowing their partner’s PrEP use status. Men who reported any CAS with their main partner or any CAS with male casual partners were both more likely to be classified in the dyadic PrEP use group compared to the neither on PrEP group. Compared to monogamous, men in open arrangements were more likely to be classified in each of the three PrEP groups compared to the neither on PrEP group. Six-month BSTI prevalence was 2.8%, 8.1%, 8.3%, 15.6%, and 4.0% for the five groups, respectively. Conclusions: PrEP use occurred during times of higher risk behavior engagement, but further efforts are needed to expand PrEP use to more partnered GBMSM. Author to whom correspondence should be addressed; Address: 695 Park Avenue, Room N611, New York, NY 10065; Phone: 212-206-7919; Fax: 212-206-7994; Email: hrendina@hunter.cuny.edu Conflicts of Interest and Source of Funding: Funding: Steven A. John was supported by the Center for AIDS Intervention Research (CAIR) and the National Institute of Mental Health (P30-MH052776, PI: Jeffrey A. Kelly). Gabriel Robles received support from the National Institute on Drug Abuse (R01-DA045613-01S1, PI: Tyrel J. Starks, Awardee: Gabriel Robles). H. Jonathon Rendina was supported in part by a career development award from the National Institute on Drug Abuse (K01-DA039060; PI: H. Jonathon Rendina). Data collection for this paper was supported in part by the Fordham HIV and Drug Abuse Prevention Research Ethics Training Institute (RETI), a training grant sponsored by the National Institute on Drug Abuse (R25-DA031608, PI: Celia B. Fisher). The authors also acknowledge the generous funding provided by the offices of the President, the Provost, and the Dean of Arts & Sciences of Hunter College, CUNY; additional support was also provided by Hunter College’s Center for HIV/AIDS Educational Studies & Training (CHEST). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, Fordham RETI, Medical College of Wisconsin, or Hunter College, CUNY. Conflict of Interest: The authors declare that they have no conflict of interest. Previous meeting where part of these data were presented: International Association of Providers of AIDS Care (IAPAC) Conference, Miami, FL. June 8-10, 2018. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Johnson, Margaret; Kumar, Princy; Molina, Jean-Michel; Rizzardini, Giuliano; Cahn, Pedro; Bickel, Markus; Mallolas, Josep; Zhou, Yan; Morais, Cristiana; Kumar, Sushma; Sklar, Peter; Hanna, George J; Hwang, Carey; Greaves, Wayne; for the DRIVE-SHIFT Study Group

Background: Doravirine is a novel, non-nucleoside reverse transcriptase inhibitor (NNRTI) with demonstrated efficacy in treatment-naïve adults with HIV-1. Methods: In this open-label, active-controlled, non-inferiority trial, adults with HIV-1 virologically suppressed for ≥6 months on 2 NRTIs plus a boosted protease inhibitor (PI), boosted elvitegravir, or an NNRTI were randomized (2:1) to switch to once-daily, single-tablet doravirine 100mg with lamivudine 300mg and tenofovir disoproxil fumarate 300mg (DOR/3TC/TDF) or to continue their current therapy (Baseline Regimen) for 24 weeks. The primary endpoint was the proportion of participants with HIV-1 RNA…

Jessica M, Sales.; Carrie, Cwiak.; Lisa B, Haddad.; Ashley, Phillips.; Leah, Powell.; Ilyssa, Tamler.; Anandi N, Sheth.

Background: Safety net family planning clinics provide vital care for women in high HIV burden areas and may be ideal PrEP delivery sites. Yet, many family planning providers lack knowledge about PrEP. Setting: Four safety net family planning clinics in Atlanta, Georgia. Methods: We provided a 1.5-hour PrEP informational training for 28 providers working in these sites. To assess the training’s impact on PrEP counseling, we enrolled 500 female patients post-training (47%…

Jackson Mukonzo, Eleni Akillu, Vincent Marconi, Raymond F. Schinazi

Butt A, Yan P, Aslam S, et al.

AbstractBackgroundEffect of interferon-based therapies for HCV upon risk of diabetes is controversial. Effect of newer directly acting antiviral agents (DAA) upon this risk is unknown. We sought to determine the effect of HCV treatment upon the risk and incidence of diabetes.MethodsUsing the ERCHIVES database for persons with chronic HCV infection (n=242,680), we identified those treated with a pegylated interferon and ribavirin regimen (PEG/RBV, n=4764) or a DAA-containing regimen (21,279), after excluding those with diabetes at baseline, HIV or hepatitis B virus coinfection and those treated with both PEG/RBV and DAA regimens. Age/race/sex/propensity score matched controls (1:1) were also identified.ResultsDiabetes incidence rates/1,000 person-years [95% CI] were 20.6(19.6,21.6) among untreated, 19.8[18.3,21.4] among PEG/RBV and 9.89[8.7,11.1] among DAA treated persons (P

Jessica M. Stempel, Andres L. Mora Carpio, Daniel Puga, Sarah Perloff

We present a case of a 63-year old female without significant past medical history who presented 3 weeks after returning from a 3-month trip to West Africa having not taken antimicrobial prophylaxis for malaria. She reported 2 weeks of flu-like symptoms and altered mental status. She denied high-risk sexual activities or receiving blood transfusions while abroad. Initial laboratory workup revealed hemolysis and acute kidney injury. On peripheral smear, several erythrocytes contained ring-shaped trophozoites, with an estimated parasitemia of 3%.

Newman D, Rahman M, Brantley A, et al.

AbstractBackgroundInterventions to prevent HIV in women include screening, partner notification, promoting condoms, and pre-exposure prophylaxis (PrEP). Identifying a woman’s risk of acquiring HIV can help guide intervention recommendations.MethodsWe used data from Louisiana’s STI and HIV registries to study 13- to 59-year-old women following their first diagnosis of syphilis, (or if none) gonorrhea, or (if none) chlamydia during 2000—2015. We measured rates of HIV reported subsequent to their STI (through 2016). Rates for women without STI were estimated by subtracting women with STI from reported cases and from Census estimates for the population. PrEP cost was estimated as $11,000 per year, and effectiveness was estimated as 100%.ResultsFirst STI were: syphilis (6,574), gonorrhea (64,995), or chlamydia (140,034). These 211,603 women had 1,865,488 person-years of follow-up and 969 HIV diagnoses. Women with no STI had 5,186 HIV diagnoses over 24,359,397 person-years. Rates of HIV diagnosis (per 100,000 person-years) were higher for women after syphilis (177.3), gonorrhea (73.2), or chlamydia (35.4) compared to women with no STI (22.4). Providing PrEP to all women diagnosed with syphilis or gonorrhea would cost $7,371,111,000 and could have prevented 546 HIV diagnoses. Limiting PrEP to one year after syphilis or gonorrhea diagnosis would cost $963,847,334 but only 143 HIV diagnoses were within 2 years after a syphilis or gonorrhea diagnosis.ConclusionsRates of HIV diagnosis were high after women had STI, but not high enough to make PrEP cost-effective for them. Most women diagnosed with HIV did not have previously reported STI.

John Ategeka, Razack Wasswa, Peter Olwoch, Abel Kakuru, Paul Natureeba, Atis Muehlenbachs, Moses R. Kamya, Grant Dorsey, Gabrielle Rizzuto

by John Ategeka, Razack Wasswa, Peter Olwoch, Abel Kakuru, Paul Natureeba, Atis Muehlenbachs, Moses R. Kamya, Grant Dorsey, Gabrielle Rizzuto Background Preterm birth (PTB) is a leading cause of neonatal mortality and longer-term morbidity. Acute chorioamnionitis (ACA) is a common cause of PTB, however, there are limited data on the prevalence of ACA and its association with PTB in resource limited settings. Methods Data and samples came from a clinical trial evaluating novel strategies for the prevention of malaria in HIV infected pregnant women in Uganda. Women were enrolled between 12–28 weeks of gestation and followed through delivery. For each placenta delivered, three placental tissue types (membrane roll, umbilical cord and chorionic plate/villous parenchyma) were collected. Slides were assessed for diagnosis of maternal and fetal ACA by microscopic evaluation of neutrophilic infiltration using a standardized grading scale. The primary outcomes were PTB (…

Abstract Background The identification and management of cardiovascular risk factors became a major clinical issue among HIV-infected individuals in the post-cART era. As in the past decades the link between acute infections and cardiovascular diseases became clear in the general population, we sorted to investigate the role of severe infections on incident cardiovascular diseases (CVDs) among HIV-infected individuals. Methods HIV-infected individuals aged ≥18 years, with no history of CVD were followed from January 2000 to December 2013 until the occurrence of the first CVD event, death or end of study, whichever occurred first. To explore the effect of severe infections on the incidence of CVD we used extended Cox regression models and stratified post-hospitalization follow-up time into three periods:  12 months post discharge. Results One hundred-eighty four persons from 3384 HIV-infected individuals developed incident CVD events during the follow-up (incidence rate = 11.10/1000 PY (95%CI: 9.60–12.82)). Risk of an incident CVD was 4-fold higher at

Williams, Emily C.; McGinnis, Kathleen A.; Tate, Janet P.; Matson, Theresa E.; Rubinsky, Anna D.; Bobb, Jennifer F.; Lapham, Gwen T.; Edelman, E. Jennifer; Catz, Sheryl L.; Satre, Derek D.; Bryant, Kendall J.; Marshall, Brandon D.L.; Kraemer, Kevin L.; Bensley, Kara M.; Richards, Julie E.; Skanderson, Melissa; Justice, Amy C.; Fiellin, David A.; Bradley, Katharine A.

Background: Alcohol use influences HIV disease severity via multiple mechanisms. Whether HIV disease severity is sensitive to changes in alcohol use among people with HIV (PWH) is understudied. Setting: National Veterans Health Administration. Methods: Pairs of AUDIT-C screens within 9-15 months (2/1/08-9/30/14) were identified among PWH from the Veterans Aging Cohort Study (VACS). Initial and follow-up VACS Index 2.0 pairs obtained 0-270 days after initial and follow-up AUDIT-Cs, respectively, determined change in VACS Index 2.0, a composite HIV severity measure. Change in VACS Index 2.0 was regressed on AUDIT-C change scores (-12 to +12) adjusted for demographics, initial VACS Index 2.0, and days between VACS Index measures. Results: Among 23,297 PWH (76,202 observations), most had no (51%) or low-level (38%) alcohol use initially. Most (54%) had no subsequent change; 21% increased and 24% decreased drinking. Initial VACS Index 2.0 scores ranged from 0-134, change scores ranged from -65 to +73, with average improvement of 0.76 points (SD 9.48). AUDIT-C change was associated with VACS Index 2.0 change (p

Calabrese, Sarah K; Willie, Tiara C; Galvao, Rachel W; Tekeste, Mehrit; Dovidio, John F; Safon, Cara B; Blackstock, Oni; Taggart, Tamara; Kaplan, Clair; Caldwell, Abigail; Kershaw, Trace S

Background: US Centers for Disease Control and Prevention (CDC) clinical guidelines for HIV pre-exposure prophylaxis (PrEP) are widely utilized to assess patients’ PrEP eligibility. The guidelines include two versions of criteria – guidance summary criteria and recommended indications criteria – that diverge in a potentially critical way for heterosexually active women: Both require women’s knowledge of their own risk behavior, but the recommended indications also require women’s knowledge of their partners’ HIV risk or recognition of a potentially asymptomatic sexually transmitted infection (STI). This study examined women’s PrEP eligibility according to these two different versions of criteria across risk and motivation categories. Setting/Methods: HIV-negative women (n=679) recently engaged in care at Connecticut Planned Parenthood centers were surveyed online in 2017. The survey assessed PrEP eligibility by both versions of CDC criteria, HIV risk indicators, PrEP motivation indicators, and sociodemographic characteristics. Results: Participants were mostly non-Hispanic White (33.9%) or Black (35.8%) and low-income (…

Sereti, Irini; Gulick, Roy M.; Krishnan, Sonya; Migueles, Stephen A.; Palfreeman, Adrian; Touzeau-Römer, Veronique; Belloso, Waldo H.; Emery, Sean; Law, Matthew G.; for the INSIGHT START Study Group

Abstract: Background: The benefit of immediate antiretroviral therapy (ART) at CD4 >500 cells/ìL was established in the Strategic Timing of Antiretroviral Treatment (START) study. The benefits and risks of immediate ART in participants with low pre-treatment viremia, including virologic suppressors, was further assessed. Setting: Randomized prospective international study Methods: START participants with enrollment viremia…

Kaida, Angela; Kabakyenga, Jerome; Bwana, Mwebesa; Bajunirwe, Francis; Muyindike, Winnie; Bennett., Kara; Kembabazi, Annet; Haberer, Jessica E.; Boum, Yap; Martin, Jeffrey N.; Hunt, Peter W.; Bangsberg, David R.; Matthews., Lynn T.

Background: Many men with HIV express fertility intentions and nearly half have HIV-uninfected sexual partners. We measured partner pregnancy among a cohort of men accessing antiretroviral therapy (ART) in Uganda. Methods: Self-reported partner pregnancy incidence and bloodwork (CD4, HIV-RNA) were collected quarterly. Interviewer-administered questionnaires assessed men’s sexual and reproductive health annually and repeated at time of reported pregnancy (2011-2015). We measured partner pregnancy incidence overall, by pregnancy intention, and by reported partner HIV-serostatus. We assessed viral suppression (≤400 copies/mL) during the peri-conception period. Cox proportional hazard regression with repeated events identified predictors of partner pregnancy. Results: Among 189 men, baseline median age was 39.9 years [IQR:34.7,47.0], years on ART was 3.9 [IQR:0.0,5.1], and 51% were virally suppressed. Over 530.2 person-years of follow-up, 63 men reported 85 partner pregnancies (incidence=16.0/100 person-years); 45% with HIV-serodifferent partners. By three years of follow-up, 30% of men reported a partner pregnancy, with no difference by partner HIV-serostatus (p=0.75). 69% of pregnancies were intended, 18% wanted but mis-timed, and 8% unwanted. 78% of men were virally suppressed prior to pregnancy report. Men who were younger (aHR:0.94/year;95%CI:0.89-0.99), had incomplete primary education (aHR:2.95;95%CI:1.36-6.40), and reported fertility desires (aHR:2.25;95%CI:1.04-4.85) had higher probability of partner pregnancy. Conclusion: A high incidence of intended partner pregnancy highlights the need to address men’s reproductive goals within HIV care. Nearly half of pregnancy partners were at-risk for HIV and one-quarter of men were not virally suppressed during peri-conception. Safer conception care provides opportunity to support men’s health and reproductive goals, while preventing HIV transmission to women and infants. Corresponding author: Angela Kaida Faculty of Health Sciences, Simon Fraser University Blusson Hall Rm 10522, 8888 University Drive Burnaby, B.C. V5A 1S6 CANADA Phone: +1 778-782-9068 Email: kangela@sfu.ca E-mail addresses of authors: AK: kangela@sfu.ca, JK: jkabakyenga@gmail.com, MB: mwebesa_bwana@yahoo.com, FB: fbaj@yahoo.com, WM: wmuyindike@gmail.com, KB: karabstat@gmail.com, AK: akembabazi2005@yahoo.com, JEH: JHABERER@partners.org, YB: yap.boum2@gmail.com, JNM: Martin@psg.ucsf.edu, PWH: peter.hunt@ucsf.edu, DRB: bangsber@ohsu.edu, LTM: LTMATTHEWS@mgh.harvard.edu Meetings where some of these data have been previously presented: Some of these data have been previously presented at the International AIDS Conference (AIDS2016) in Durban, South Africa. July 18-22, 2016 [Oral Poster Abstract THPDC0106]. Sources of support: We gratefully acknowledge our funders: NICHD (R21-HD069194), NIMH (R01-MH54907, K23-MH095655, K24-MH87227), NIH P30-AI027763, and the Canada-Sub Saharan Africa (CANSSA) HIV/AIDS Network. Competing interests:All authors declare no competing interests. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Davey, Dvora Joseph; Wall, Kristin Marie; Serrao, Claire; Prins, Marlien; Feinberg, Madaline; Mtonjana, Ntokozo; Hlophe, Khanyo; Zuma, Lindiwe; Sejake, Senate; Malone, Todd

Background: There is an imperative need for innovative interventions to identify people living with HIV and initiate them on antiretroviral therapy (ART). The objective of this study was to determine the feasibility of providing index partner/child testing of people living with HIV. Methods: We trained 86 nurses and counsellors in 56 public health facilities in six high HIV burden Districts in 2017 to provide index partner/child testing (tracing and testing of partners/children of people living with HIV). We collected programmatic data including index partner/child HIV positivity by age, gender and location of testing. In sub-analyses, we evaluated factors associated with identifying HIV-positive partners and children in separate models using multivariable logistic regression. Results: We tested 16,033 partners and children of index patients between October 2017 and June 2018. Most of those tested were female (61%) and 20-39 years old (39%). Overall, 6.4% were 10-14 years old, 9.5% were 15-19 years; 8% were >50 years. HIV positivity was 38% (95% CI=36%-40%). In children ages 10-14, 13% were HIV-infected (95% CI=11%-14%). In subanalyses, HIV positivity in partners was associated with their increased age (adjusted odds ratio [aOR] for increase in 5-year age category=1.21; 95% CI=1.04, 1.42), female gender (aOR=1.38; 95% CI=1.04, 1.82) and bringing the partner in for HIV testing vs. referring the partner through the provider or recommending testing to the partner (aOR=1.94, 95% CI=1.43, 2.63), adjusting for location of testing. Almost all patients diagnosed (97%) were referred to ART. Conclusion: Providing index partner/child testing was feasible and we identified a very high yield when testing partners/children of index patients. Index partner/child testing should be offered to all patients living with HIV to improve case finding. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Corresponding Author: Dr. Dvora Joseph Davey University of California, Los Angeles Department of Epidemiology, School of Public Health 650 Charles E Young Dr S, Los Angeles, CA 90095, USA Telephone: 310-701-1526 or +27 829430578 Email: dvoradavey@ucla.edu Conflicts of interest: No conflicts of interest are declared by the authors. Sources of funding: This publication is made possible by the generous support of the American people through the United Stated Agency for International Development (USAID) under Cooperative Agreement No. AID-674-A-12-00016; Systems Strengthening for Better HIV/TB Patient Outcomes. The contents are the responsibility of BroadReach and do not necessarily reflect the views of USAID or the United States Government. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Nyamathi, Adeline N.; Shin, Sanghyuk S.; Sinha, Sanjeev; Carpenter, Catherine L.; Garfin, Dana Rose; RK, Padma; Yadav, Kartik; Ekstrand, Maria L.

Background: Women living with HIV (WLH) in rural communities face challenges to obtaining treatment and accurate disease-related information. Nutritional deficits exacerbate disease progression. Setting: WLH were recruited from primary-health centers in rural India. Method: A quasi-experimental trial of a comprehensive Accredited Social Health Activist (ASHA)-supported intervention compared four distinct ASHA-based programs [1) standard education alone (SE); 2) nutrition education (+NE); 3) nutrition supplements (+NS); or 4) nutrition education and nutrition supplements (+NENS)] on key disease and nutrition-related outcomes [CD4 count, body mass index (BMI), serum albumin and hemoglobin]. Assessments occurred at baseline, and months 6 (immediately post-intervention), 12, and 18. Multilevel modeling examined effects of program (group) over time. Findings: Among 600 WLH enrolled (n=150 per arm), mean age, CD4 count and BMI (kg/m2) were 34.31, 447.42, and 20.09, and 30.4 respectively, at baseline. At 18-month follow-up, Program 4 (+NENS) experienced greatest improvements in CD4 counts compared to Program 1 (+SE) (adjusted difference=223.81, 95% CI=170.29, 277.32). For BMI, Programs 3 (+NS; adjusted difference=2.33, 95% CI, 1.39, 3.26) and 4 (+NENS; adjusted difference=2.14, 95% CI, 1.17, 3.12) exhibited greater gains compared to Program 1 (+SE). Programs 3 and 4 were not significantly different from each other (adjusted difference=-0.18, 95% CI, -1.12, 0.76). Hemoglobin and serum albumin also improved over time; Program 4 (+NENS) exhibited the greatest gains. Conclusions: A low-cost ASHA-supported behavioral and nutritional intervention improved outcomes for WLH. Gains were sustained at 18-month follow-up. Similar approaches may help improve HIV and other infectious disease-related outcomes in vulnerable populations. Trial Registration: ClinicalTrials.gov: NCT02136082 Correspondence Should Be Addressed To: Adeline M. Nyamathi, ANP, PhD, FAAN Distinguished Professor, Founding Dean Sue & Bill Gross School of Nursing University of California, Irvine Email: anyamath@uci.edu +1 949 824 8932 252D Berk Hall Irvine, CA 92697 No authors have any conflicts of interests to disclose. Research was funded by National Institute of Mental Health of the National Institutes of Health under award number R01MH098729 to Dr. Adeline M. Nyamathi. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Hammoud, Mohamed A.; Vaccher, Stefanie; Jin, Fengyi; Bourne, Adam; Maher, Lisa; Holt, Martin; Bavinton, Benjamin R.; Haire, Bridget; Degenhardt, Louisa; Grulich, Andrew; Prestage, Garrett P.

Background: HIV pre-exposure prophylaxis (PrEP) is a highly effective biomedical HIV prevention strategy, yet some gay and bisexual men (GBM) who are eligible to access PrEP are not using it. We report the incidence of PrEP uptake, factors predicting its initiation, and identify characteristics associated with non-uptake of PrEP among Australian GBM who meet the eligibility criteria. Methods: The Following Lives Undergoing Change (Flux) Study is a national, online, prospective observational study among GBM focusing on licit and illicit drug use. Participants (N=1257) responded to baseline and six-monthly follow-up questionnaires. Incidence per 100 person-years and incidence rate ratios of PrEP initiation are presented. Multivariate Poisson regression was used to examine associations with PrEP initiation, and logistic regression to examine associations with non-uptake of PrEP among eligible GBM. Results: Among GBM who met the eligibility criteria, 69.8% of men did not commence PrEP. Factors independently associated with non-uptake of PrEP were younger age, living in an Australian state without a PrEP trial, lower social engagement with other gay men, less use of illicit party drugs, or use illicit party drugs for sex, and less likely to engaged in HIV sexual risk behaviours such as group sex or any condomless anal intercourse. Conclusions: Despite meeting formal eligibility criteria for PrEP, men who were relatively less sexually active or less socially connected were less likely to initiate PrEP. Men who did not initiate PrEP may assess their risk as insufficient relative to others to warrant using PrEP because they engaged in less frequent ‘risky’ behaviours. Corresponding Author: Mohamed Ahmed Hammoud, BPsych(Hons) The Kirby Institute, UNSW Australia Sydney, New South Wales AUSTRALIA Declaration of interest: The Flux Study is funded by an Australian Research Council Discovery Project. In 2018, the study was partly funded by the Gilead Australia Fellowship: Research Grants Program. The funders of this study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Cottrell M, Prince H, Schauer A, et al.

AbstractFeminizing hormone therapy (FHT) may interact with HIV PrEP. We found transgender women taking FHT exhibited a 7-fold lower rectal tissue ratio of PrEP’s active metabolites vs competing deoxynucleotides compared to cisgender women and men (p=0.03) that inversely correlated with estradiol (ρ=-0.79; p

McMorrow M, Tempia S, Walaza S, et al.

AbstractDuring 2011-2016, we conducted surveillance for severe respiratory illness in infants. HIV exposure statistically significantly increased the risk of RSV-associated hospitalization in infants aged

Simon Blankley, Tadele Gashu, Bilal Ahmad, Abi kebra Belaye, Lucia Ringtho, Anita Mesic, Simukai Zizhou, Esther C. Casas

by Simon Blankley, Tadele Gashu, Bilal Ahmad, Abi kebra Belaye, Lucia Ringtho, Anita Mesic, Simukai Zizhou, Esther C. Casas Introduction HIV continues to be one of the leading causes of infectious death worldwide and presentation with advanced HIV disease is associated with increased morbidity and mortality. Recommendations for the management of advanced HIV disease include prompt screening and treatment of opportunistic infections, rapid initiation of ART and intensified adherence support. We present treatment outcomes of a cohort of patients presenting with advanced HIV disease in a semi-urban Zimbabwean polyclinic. Methods Retrospective cohort analysis of adult patients enrolled for care at Epworth polyclinic, Zimbabwe between 2007 and end June 2016. Treatment outcomes at 6 and 12 months were recorded. Multivariate logistical regression analysis was undertaken to identify risk factors for presentation with advanced HIV Disease (CD4 count less than 200 cells/mm3 or WHO stage 3 or 4) and risks for attrition at 12 months. Results 16,007 anti-retroviral therapy naive adult patients were included in the final analysis, 47.4% of whom presented with advanced HIV disease. Patients presenting with advanced HIV disease had a higher mortality rate at 12 months following enrollment compared to early stage patients (5.11% vs 0.45%). Introduction of a package of differentiated care for patients with a CD4 count of less than 100 cells/mm3 resulted in diagnosis of cryptococcal antigenaemia in 7% of patients and a significant increase in the diagnosis of TB, although there was no significant difference in attrition at 6 or 12 months for these patients compared to those enrolled prior to the introduction of the differentiated care. Conclusions The burden of advanced HIV disease remained high over the study period in this semi-urban polyclinic in Zimbabwe. Introduction of a package of differentiated care for those with advanced HIV disease increased the diagnosis of opportunistic infections and represents a model of care which can be replicated in other polyclinics in the resource constrained Zimbabwean context.…