HIV

Abstract Background Opportunistic infections (OIs) are the leading cause of morbidity and mortality among children living with human immunodeficiency virus (HIV). For better treatments and interventions, current and up-to-date information concerning occurrence of opportunistic infections in HIV-infected children is crucial. However, studies regarding the incidence of common opportunistic infections in HIV-infected children in Ethiopia are very limited. Hence, this study aimed to determine the incidence of opportunistic infections among HIV-infected children on antiretroviral therapy (ART) at Debre Markos Referral Hospital. Methods A facility-based retrospective cohort study was undertaken at Debre Markos Referral Hospital for the period of January 1, 2005 to March 31, 2019. A total of 408 HIV-infected children receiving ART were included. Data from HIV-infected children charts were extracted using a data extraction form adapted from ART entry and follow-up forms. Data were entered using Epi-data™ Version 3.1 and analyzed using Stata™ Version 14. The Kaplan Meier survival curve was used to estimate the opportunistic infections free survival time. Both bi-variable and multivariable Cox proportional hazard models were fitted to identify the predictors of opportunistic infections. Results This study included the records of 408 HIV-infected children-initiated ART between the periods of January 1, 2005 to March 31, 2019. The overall incidence rate of opportunistic infections during the follow-up time was 9.7 (95% CI: 8.13, 11.48) per 100 child-years of observation. Tuberculosis at 29.8% was the most commonly encountered OI at follow-up. Children presenting with advanced disease stage (III and IV) (AHR: 1.8, 95% CI: 1.2, 2.7), having “fair” or “poor” ART adherence (AHR: 2.6, 95% CI: 1.8, 3.8), not taking OI prophylaxis (AHR:1.6, 95% CI: 1.1, 2.4), and CD4 count or % below the threshold (AHR:1.7, 95% CI: 1.1, 2.6) were at a higher risk of developing opportunistic infections. Conclusions In this study, the incidence rate of opportunistic infections among HIV-infected children remained high. Concerning predictors, such as advanced disease stage (III and IV), CD4 count or % below the threshold, “fair” or “poor” ART adherence, and not taking past OI prophylaxis were found to be significantly associated with OIs.…

Jaclyn K. Mann, Erasha Rajkoomar, Steven W. Jin, Qiniso Mkhize, Omolara Baiyegunhi, Pholisiwe Mbona, Mark A. Brockman, Thumbi Ndung'u

Journal of Medical Virology, Volume 0, Issue ja, -Not available-.

Hiransuthikul A, , Himmad L, et al.

AbstractBackgroundDrug-drug interactions (DDI) between feminizing hormone therapy (FHT) and antiretroviral therapy (ART) is a major concern among transgender women (TGW) that may lead to sub-optimal ART adherence and inappropriate FHT dosage. To evaluate potential DDI between FHT and ART, we measured intensive pharmacokinetic parameters (PK) of blood tenofovir (TFV), efavirenz (EFV), and estradiol (E2).MethodsTwenty newly-diagnosed HIV-positive TGW were enrolled. FHT (estradiol valerate 2 mg and cyproterone acetate 25 mg) were prescribed at baseline until week 5 and restarted at week 8. ART (tenofovir disoproxil fumarate/emtricitabine/efavirenz 300/200/600 mg) was initiated at week 3. Intensive E2 PK were measured at weeks 3 (without ART) and 5 (with ART), and intensive TFV and EFV PK were measured at weeks 5 (with FHT) and 8 (without FHT).ResultsMedian (IQR) age and body mass index were 25.5 (22.5-31.0) years and 20.6 (19.3-23.1) kg/m2, respectively. The differences in GMR (90%CI) of E2 AUC, Cmax, and C24 at week 5 versus week 3 were 0.72 (0.64-0.81), p

Huang Y, Tao G, Smith D, et al.

AbstractBackgroundDaily oral preexposure prophylaxis (PrEP) is highly effective in preventing HIV infection if used adherently throughout periods of HIV risk. We estimated PrEP persistence among cohorts of persons with commercial or Medicaid insurance.MethodsWe analyzed data from the IBM MarketScan Research Database to identify persons aged 18-64 years who initiated PrEP between 2012−2017. We assessed PrEP persistence by calculating the time period that each person continued filling PrEP prescriptions until there was a gap in prescription fills >30 days. We used Kaplan-Meier time-to-event methods to estimate the proportion of PrEP users who persisted with PrEP at 3, 6, and 12 months after initiation, and constructed Cox proportional hazards models to determine patient characteristics associated with non-persistence.ResultsWe studied 11,807 commercially insured and 647 Medicaid insured persons with PrEP prescriptions. Commercially insured patients persisted for median time of 13.7 months (95% CI 13.3−14.1), compared to 6.8 months (95% CI 6.1−7.6) among Medicaid patients. Additionally, female sex, younger age, residence in rural location, and black race were associated with shorter persistence. After adjusting for covariates, we found that female sex (Hazard Ratio [HR]=1.81; 95% CI 1.56−2.11) and younger age (18-24 years: HR=2.38; 95% CI 2.11−2.69) predicted non-persistence.ConclusionsMore than half of commercially insured persons who initiated PrEP persisted with it for 12 months, compared to a third of those with Medicaid. A better understanding of reasons for non-persistence is important to support persistent PrEP use, and to develop interventions designed for the diverse needs of at-risk populations.

Flax, Valerie L.; Kasasa, Simon; Ssendagire, Steven; Lane, Charlotte; Atuyambe, Lynn; Lance, Peter M.; Ssengooba, Freddie; Draru, Joyce; Bobrow, Emily A.

Background: The Partnership for HIV-Free Survival (PHFS) in Uganda used a quality improvement (QI) approach to integrate the prevention of mother-to-child transmission (MTCT) of HIV, maternal and child health, and nutrition services, with the goal of increasing the retention of mother-baby pairs in care and decreasing vertical transmission of HIV. Methods: This evaluation of PHFS used a retrospective longitudinal design to assess the program’s association with four outcomes. Data were extracted from patient records from 2011 (before the program) to 2018 (after the program) at 18 demonstration, 18 scale-up, and 24 comparison facilities. Difference-in-differences analyses were conducted with significance set at p0.15 or a continued improvement after PHFS. Results: PHFS was associated with an increase in exclusive breastfeeding (EBF) (p=0.08), 12-month retention in care (p

Weiss, Kevin M.; Prasad, Pragati; Ramaraju, Ramya; Zlotorzynska, Maria; Jenness, Samuel M.

Background: A 2015 CDC analysis estimated that 24.7% of sexually active men who have sex with men (MSM) had indications for HIV preexposure prophylaxis (PrEP) based on 2014 US Public Health Service (USPHS) clinical practice guidelines. Given that the USPHS revised these guidelines in 2017, updated estimates of the fraction of MSM indicated for PrEP overall and stratified by demographic factors and geography are needed to scale-up PrEP for MSM in the US. Methods: We conducted a national web-based study of 4904 MSM aged 15–65 who had ever had sex with another man between July 2017 and January 2019. We estimated the percentage of HIV-negative, sexually active MSM meeting USPHS indications for PrEP by demographic category. Results: Of 3511 sexually active, HIV-negative MSM, 34.0% (95% CI: 32.4, 35.6) met USPHS indications for PrEP, with percentages consistent across US census region and varying slightly by race/ethnicity (Black: 32.2%, White: 33.7%, Hispanic: 36.4%, Other: 33.6%). Among individuals meeting USPHS PrEP indications, 93.5% reported condomless anal intercourse in the prior 6 months. Among all survey respondents, PrEP eligibility was lowest among non-Hispanic black (18.4%) and younger respondents (15-17: 4.1%; 18-24: 18.1%). Conclusions: Estimated percentages of MSM meeting indications for PrEP exceeded the previous CDC estimate across race/ethnicity, age, and census regions, with one-third of adult, sexually active, HIV-negative MSM exhibiting indications for PrEP. This study suggests, given current guidelines for PrEP indications, that a different fraction of eligible MSM could be receiving PrEP than previously estimated. Corresponding Author: Emory University, 1520 Clifton Road, Atlanta, GA 30322. samuel.m.jenness@emory.edu. Conflicts of Interest: The authors declare no conflicts of interest. Funding: This work was supported by National Institutes of Health grants R21 MH112449 and R01 AI138783, and a grant from the MAC AIDS Fund. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Turner, DeAnne; Lockhart, Elizabeth; Wang, Wei; Shore, Robert; Daley, Ellen M.; Marhefka, Stephanie L.

Background: Pre-exposure Prophylaxis (PrEP) is an important option for HIV prevention, but the approach has reached a limited number of people at risk for HIV infection. Methods: A mixed methods concurrent triangulation design was employed to investigate unobserved subgroups of staff who provide community-based, publicly funded HIV testing in Florida (USA). PrEP implementation groups, or classes, were determined using Latent Class Analysis (LCA). Generalized linear mixed models were used to estimate PrEP implementation as a function of staff characteristics. In-depth interviews based on the Consolidated Framework for Implementation Research were analyzed thematically. Results: Based on fit statistics and theoretical relevance, a 3-class LCA was selected. Class one (“Universal”) staff were highly likely to talk about PrEP with their clients, regardless of client eligibility. Class two (“Eligibility dependent”) staff were most likely to discuss PrEP if they believed their client was eligible. Class three (“Limited”) staff sometimes spoke to clients about PrEP, but not systematically. In multivariate analyses, only race and sexual orientation remained significant predictors of PrEP implementation group. Staff who identified as a racial or sexual minority were less likely to be in the Limited group than their heterosexual or White counterparts. Age, gender, ever having taken PrEP, and HIV status did not impact the odds of being in a specific PrEP implementation group. Conclusions: A subset of HIV testing staff differentially discuss PrEP based on perceived client eligibility; others inconsistently talk to clients about PrEP. Targeted training based on PrEP implementation groups may be beneficial. Corresponding author: DeAnne Turner, PhD, MPH, Post-doctoral Fellow, Center for Interdisciplinary Research on AIDS, Yale University, 135 College St. Suite 200, New Haven CT 06510, Telephone: (727) 515-8187, Email: deanne.turner@yale.edu Conflicts of interest: none declared Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Abstract Background Hepatitis B is a major concern in Africa, especially in HIV-infected patients. Unfortunately, access to hepatitis B virus (HBV) testing and adequate treatment remains a challenge in the continent. We investigated HBV testing, treatment, and virologic suppression in HIV-infected patients followed up as part of Cameroon’s national antiretroviral programme. Methods A cross-sectional survey was performed in adult patients receiving antiretroviral therapy (ART) in 19 hospitals in the Centre and Littoral regions in Cameroon. The proportions of patients tested for hepatitis B surface antigen (HBsAg) prior to the study were compared among all study hospitals using the Chi-square test. The association of individual and hospital-related characteristics with HBV testing and virologic suppression was assessed using multilevel logistic regression models. Results Of 1706 patients (women 74%, median age 42 years, median time on ART 3.9 years), 302 (17.7%) had been tested for HBsAg prior to the study. The proportion of HBV-tested patients ranged from 0.8 to 72.5% according to the individual hospital (p 

Abstract Background Anticipated HIV stigma, i.e., the expectation of adverse experiences from one’s seroconversion, is associated with both negative psychological and behavioral outcomes. We know little about anticipated HIV stigma’s relationship with emerging technologies, such as HIV self-testing (HIVST) and online sex-seeking platforms, that have become popular among populations that are disproportionately affected by HIV/AIDS. This study examined correlates of anticipated HIV stigma among Chinese men who have sex with men (MSM). Methods In July 2016, MSM, who were ≥ 16 years old and self-reported as HIV negative or unknown, were recruited from a gay mobile phone application in China. Information regarding socio-demographics, sexual behaviors, sexual health service utilization, and anticipated HIV stigma were collected. Anticipated HIV stigma (i.e., negative attitude toward future stigmatization of HIV seroconversion by others) was measured as the mean score from a 7-item Likert-scale ranging from 1 (low) to 4 (high). Generalized linear models were conducted to examine the factors associated with the anticipated HIV stigma scores. Results Overall, 2006 men completed the survey. Most men completed high school (1308/2006, 65.2%) and had an annual personal income of ≤9200 USD (1431/2006, 71.3%). The mean anticipated HIV stigma score for the participants was 2.98 ± 0.64. Using social media to seek sexual partners was associated with higher anticipated HIV stigma (Adjusted β = 0.11, 95% confidence interval (CI): 0.05 to 0.17, p = 0.001). HIV self-testing (Adjusted β = − 0.07, 95%CI: − 0.13 to − 0.01, p = 0.02) and having disclosed one’s sexual orientation to a healthcare provider (Adjusted β = − 0.16, 95%CI: − 0.22 to − 0.96, p 

Li Shen, Cuisong Wu, Jun Zhang, Hong Xu, Xiaoxia Liu, Xiao Wu, Ting Wang, Lingxiang Mao

Long non-coding RNAs (lncRNAs) are defined as a class of RNA molecules with a length of more than 200 nucleotides that are not translated into protein, and are known to participate in a variety of biological processes. They have recently been implicated as having roles in viral infections, and several research groups have identified that complex interactions exist between lncRNAs and the progression of human immunodeficiency virus (HIV) infection. LncRNAs derived from both the human host and HIV itself are emerging as key regulators of various cellular functions, playing crucial roles in virus–host interactions and viral pathogenesis.

Abstract Background Life expectancy of people living with HIV (PLWH) is increasing. Effective biomedical prevention methods (treatment as prevention and preexposure prophylaxis) are being widely implemented in high-income nations. Therefore, research into quality of life, including sexual adjustment, is of increasing importance to HIV care. Yet, sexual adjustment of PLWH has been neglected in past research. We propose a new model of sexual adjustment to HIV which explores the dynamic process, facilitators and barriers characterising sexual life of PLWH overtime. Method Thirty PLWH (19 male, 11 female) recruited from two HIV treatment centres as well as community groups, completed semi-structured interviews which were audio-recorded and transcribed verbatim for analysis using grounded theory. Results The model of sexual adjustment to HIV is the first to establish how undue fears of transmission of HIV during sex and/or fear of rejection by sexual partners determine initial sexual behaviour after diagnosis and also sexual adjustment over time. Within the model, sexual adjustment to HIV is facilitated by factors which assist PLWH to overcome such fears, including: partner acceptance, peer, community and health professional support, and accurate knowledge of risk of transmission including of undetectable viral load and pre-exposure prophylaxis. Adjustment is inhibited when undue fears of transmission and of rejection persist long term, resulting in maladaptive behaviours to cope with such fears including avoidance of sex and problematic drug and alcohol use. Conclusion This model offers clear directions for promoting sexual adjustment to HIV. Health professionals should: (a) assess and intervene for sexual quality of life (not just risk) among PLWH; (b) be aware that serosorting facilitates adjustment in the short to medium term, but may interfere with adjustment long-term, (c) promote opportunities for positive connection between PLWH, and (d) intervene directly with PLWH and HIV negative sexual partners to promote accurate risk of transmission knowledge, including how this applies to their own sexual practices, and whether they are experiencing undue fear of transmission over time.…

Sun J, Brown T, Tong W, et al.

AbstractBackgroundSusceptibility to metabolic diseases may be influenced by mitochondrial genetic variability among people living with HIV (PLWH), but remains unexplored in African-ancestry populations. We investigated the association between mitochondrial DNA (mtDNA) haplogroups and β-cell function (HOMA-B), insulin resistance (HOMA-IR), and incident diabetes mellitus (DM) among black women with or at risk for HIV.MethodsWomen without DM who had fasting glucose (FG) and insulin (FI) data for ≥2 visits were included. Haplogroups were inferred from genotyping data using HaploGrep. HOMA-B and HOMA-IR were calculated using FG and FI. Incident DM was defined by a combination of FG ≥126 mg/dL, use of DM medication, DM diagnosis, or HbA1c ≥6.5%. We compared HOMA-B, HOMA-IR, and incident DM by haplogroups and assessed the association between HOMA-B and HOMA-IR and DM by haplogroup.ResultsOf 1288 women (933 HIV+, 355 HIV-), PLWH had higher initial HOMA-B and HOMA-IR than people without HIV (PWOH). PLWH with haplogroup L2 had slower decline in HOMA-B per year (Pinteraction=0.02) and lower risk of incident DM (Hazard Ratio [HR]: 0.51, 95% CI: 0.32, 0.82) than PLWH with other haplogroups after adjustment for age, body mass index, cART use, CD4 cell counts, and HIV RNA. The impact of HOMA-IR on incident DM was less significant in those with haplogroup L2 compared to non-L2 (HR 1.28 [95% CI: 0.70, 2.38] vs 4.13 [95% CI: 3.28, 5.22], pinteraction

Kuhn L.

Taylor B, Sapién H.

Zhang Y, Wymant C, Laeyendecker O, et al.

AbstractBackgroundPhylogenetic analysis can be used to assess HIV transmission in populations. We inferred the direction of HIV transmission using whole-genome HIV sequences from couples with known linked infection and known transmission direction.MethodsComplete next generation sequencing (NGS) data were obtained for 105 unique index-partner sample pairs from 32 couples enrolled in the HIV Prevention Trials Network (HPTN) 052 trial (up to two samples/person). Index samples were obtained up to 5.5 years before partner infection; partner samples were obtained near the time of seroconversion. The bioinformatics method, phyloscanner, was used to infer transmission direction. Analyses were performed using samples from individual sample pairs, samples from all couples (one sample/person; group analysis) and all available samples (multi-sample group analysis). Analysis was also performed using NGS data from defined regions of the HIV genome (gag, pol, env).ResultsUsing whole-genome NGS data, transmission direction was inferred correctly (index to partner) for 98/105 (93.3%) of the individual sample pairs, 99/105 (94.3%) sample pairs using group analysis, and 31 (96.9%) of the 32 couples using multi-sample group analysis. There were no cases where the incorrect transmission direction (partner to index) was inferred. The accuracy of the method was higher with greater time between index and partner sample collection. Pol region sequences performed better than env or gag sequences for inferring transmission direction.ConclusionsWe demonstrate the potential of a phylogenetic method to infer the direction of HIV transmission between two individuals using whole-genome and pol NGS data.

Gilliams, Elizabeth A; Ammirati, Rachel J; Nguyen, Minh LT; Shahane, Amit A; Farber, Eugene W; Marconi, Vincent C

Background: Early palliative care addresses biopsychosocial needs for people living with HIV in an outpatient setting. We sought to describe patients referred to a palliative care program and compare the medical outcomes of emergency department (ED) visits, hospitalizations, primary care visits, and viral load suppression among patients enrolled in the program, to patients who did not enroll (no-show group). Setting: We completed a retrospective cohort study at an urban, academically- affiliated HIV primary care clinic. Methods: Data were collected from electronic medical records. Descriptive statistics characterized patient demographics at baseline, comorbidities, and reasons for referral to palliative care. Viral load suppression, rates of ED visits, hospitalizations, primary care visits, and retention in care were compared between the palliative and no-show groups. Results: The most common reasons for referral were chronic pain management and medication/appointment adherence. Median percent of viral load measurements suppressed increased over time, but did not differ statistically between groups (Pre: 28.6% and 15.5%, post: 70.8% and 50.0%, palliative and no-show groups respectively). Median rates of ED visits and hospitalizations were low and were not impacted by palliative care. Rates of primary care visit attendance remained stable in the palliative group (4.6/year) but declined in the no-show group (3.5/year), p

Kapelios, Chris J.; Argyris, Antonios A.; Protogerou, Athanase D.; Katsarolis, Ioannis; Arida, Aikaterini; Papadopoulou, Martha; Ntaroutsou, Eirini; Kitas, George; Sfikakis, Petros P.; Psichogiou, Mina

Background: People living with HIV (PLWH) are at high cardiovascular disease (CVD) risk. Traditional CVD risk scores do not accurately reflect their CVD risk. Non-invasive subclinical vascular damage (SVD) biomarkers are valid surrogates of CVD and able to stratify CVD risk. Setting: We tested whether 4 widely applied CVD risk scores (Framingham [FRS], Atherosclerotic Cardiovascular Disease [ASCVD], Data Collection on Adverse Effects of Anti-HIV Drugs Study [D:A:D] and Greek-specific European Society of Cardiology [ESC] risk scores) are associated with or detect the presence, incidence and progression of arteriosclerosis, atheromatosis and arterial hypertrophy in PLWH and uninfected individuals. Methods: We prospectively examined (at baseline and 3-year follow-up) 10 different arterial sites applying 5 different non-invasive vascular biomarkers and measured all 4 CVD risk scores at baseline. Results: In both PLWH (n=138) and uninfected (n=664) individuals the CVD risk scores (except the ESC) performed differently but reasonably well in identifying the presence of SVD, but all scores failed to predict the incidence/progression of overall SVD. The most clinically useful biomarkers (carotid plaque/atheromatosis) revealed that in PLWH only the FRS was able to stratify the progression (11% of the low risk, 33.3% of the medium risk and 0% of the high-risk group). Conclusions: This extensive vascular phenotyping study demonstrated the clear need to incorporate vascular imaging in CVD risk stratification, in addition to designing more accurate HIV-specific CVD risk models. The use of FRS would further enable treatment optimization and CVD prevention strategies in PLWH at medium CVD risk, since one-third of carotid atheromatosis progresses within 3 years. Corresponding author: Mina Psichogiou, M.D., Ph.D. First Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University Athens School of Medicine, Athens, Greece 17 Agiou Thoma Street, 11 527, Athens, Greece Tel: +30 6932475847 Fax: +30 2132061049 e-mail: mpsichog@med.uoa.gr Conflicts of Interest and Source of Funding: MP received speaking and research grants from Gilead, travel grants from Gilead, GSK, MSD and served on speakers’ bureau or advisory boards for Gilead, MSD, GSK. The project was supported by Gilead Sciences Hellas. Gilead Sciences was not involved in the study design, roll-out, data collection and data analysis. The other authors have nothing to declare. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Abstract Background Incidence of anal and oral infections with Human Papillomavirus (HPV) is increasing, particularly among Human Immunodeficiency Virus-positive (HIV+) men. HPV type 16 has exhibited the highest incidence and only limited data is available on other prevalent types, variants of HPV16, as well as associated factors. We were interested in identifying prevalent HPV types, variants of type 16, as well as factors associated with HPV16 infections in the oral cavity of HIV+ men who have sex with men (MSM). Methods A cross-sectional study of oral cavity samples from HIV+ MSM, that in a previous study were identified as positive for HPV16 in the anal canal. Cells from the oral cavity (102 samples, paired with 102 from the anal canal of same patient) were used to extract DNA and detect HPV infections using INNO-LiPA HPV Genotyping Extra II, and PCR. From these, 80 samples (paired, 40 anal and 40 oral) were used to identify variants of type 16 by sequencing. Statistical differences were estimated by the X2 test, and p values equal to or less than 0.05 were considered significant. SPSS ver. Twenty-four statistical software (IBM Corp) was used. Results We found a high prevalence of High-Risk HPV (HR-HPV) and Low-Risk HPV (LR-HPV). Patients were positive in the oral cavity for HR types; 16, 39 and 18 (80.4, 61.8 and 52.9% respectively) and LR types 11 and 6 (53.9 and 34.3% respectively). Surprisingly, only European variants of type 16 were found in the oral cavity, although American Asian (22.5%) and African (2.5%) variants were identified in the anal canal. The analysis showed that CD4 counts could be the most important risk factor associated with HR-HPV infections in the oral cavity, anal canal or both anatomical regions. The risk of infection of the oral cavity with type 18 increased in men diagnosed with HIV for more than 6 years. Conclusions Prevalence of both HR and LR HPV’s in the oral cavity of Mexican HIV+ MSM is very high. The fact that only European variants of HPV16 were found in the oral cavity suggest a possible tropism not previously described.…

Sossen B, Broger T, Kerkhoff A, et al.

AbstractReducing diagnostic delay is key towards decreasing tuberculosis-associated deaths in people living with HIV. In tuberculosis patients with retrospective urine testing, the point-of-care Fujifilm SILVAMP TB LAM (FujiLAM) could have rapidly diagnosed tuberculosis in up to 89% who died. In FujiLAM negative patients, the probability of 12-week survival was 86-97%.

Stephenson, Rob; Bratcher, Anna; Mimiaga, Matthew J; Garofalo, Robert; Hidalgo, Marco A; Hoehnle, Samuel; Sullivan, Patrick S

Background: Among men who have sex with men (MSM), there is now clear evidence that the risk of HIV transmission through condomless sex when the HIV-positive partner is virally suppressed is effectively zero. However, an understanding of the accuracy of reporting of viral load among serodiscordant same-sex male couples is missing from the literature. Setting: This analysis uses data from the baseline sample of Stronger Together, a randomized controlled efficacy trial of an innovative dyadic intervention to enhance antiretroviral therapy adherence for HIV serodiscordant male couples in three US cities (Atlanta, Boston and Chicago). Methods: Biomarker-confirmed and self-reported measures of viral load were used to assess the accuracy of self-report of viral suppression. In this descriptive analysis, the percentage of men who inaccurately reported being virally suppressed is compared across demographic, relationship and HIV care characteristics. Results: Results confirm those of other recent studies that have shown relatively high levels of inaccuracy in reporting of viral suppression. Although 72.5% of men could accurately report their viral load status, 20% reported that they were virally suppressed when they did not have a biomarker confirmed measure of viral suppression. Conclusion: These results highlight the need to provide interventions to MSM living with HIV to support access to care and ensure current knowledge of viral load, and to continue to support primary prevention of HIV through condom use and pre-exposure prophylaxis (PrEP). For couples, particularly serodiscordant male couples, interventions that can teach the couple how to collaborate to achieve and maintain viral suppression for the positive partner are an urgent and pragmatic programmatic priority that can equip couples with the knowledge required to correctly implement U=U strategies. Address for Correspondence & Request for Reprints: Rob Stephenson, PhD MSc MA Center for Sexuality and Health Disparities 400 North Ingalls, rm 4170A Ann Arbor, Michigan, 48109 Tel: 734 615 0149 Fax: 734 647 2416 Email: rbsteph@umich.edu Conflicts of interest: The authors have no conflicts of interest to declare. Funding Sources: This publication was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD075655 (mPIs: Garofalo, Mimiaga, and Stephenson). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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.