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.

Becker, Marissa L; Bhattacharjee, Parinita; Blanchard, James F; Cheuk, Eve; Isac, Shajy; Musyoki, Helgar K; Gichangi, Peter; Aral, Sevgi; Pickles, Michael; Sandstrom, Paul; Ma, Huiting; Mishra, Sharmistha

Background: Adolescent girls and young women (AGYW) experience high rates of HIV early in their sexual life-course. We estimated the prevalence of HIV-associated vulnerabilities at first sex, and their association with lifetime gender-based violence (GBV) and HIV. Methods: We conducted a cross-sectional bio-behavioural survey among AGYW (14-24 years) in Mombasa, Kenya in 2015. We compared the prevalence of first sex vulnerabilities across AGYW who self-identified as engaging in sex work (N=408), transactional sex (N=177) or casual sex (N=714); and used logistic regression to identify age-adjusted associations between first sex vulnerabilities and outcomes (GBV after first sex; HIV). Results: The median age at first sex was 16 years (IQR 14 - 18). 43.6% received gifts or money at first sex; 41.2% and 11.2% experienced a coerced and forced first sex respectively. First sex vulnerabilities were generally more common among AGYW in sex work. GBV (prevalence 23.8%) and HIV (prevalence 5.6%) were associated with first sex before age 15 (GBV AOR 1.4, 95% CI 1.0-1.9; HIV AOR 1.9, 95% CI 1.1-1.3); before or within 1 year of menarche (GBV AOR 1.3, 95% CI 1.0-1.7; HIV AOR 2.1, 95% CI 1.3-3.6); and receipt of money (GBV AOR 1.9, 95% CI 1.4-2.5; HIV AOR 2.0, 95% CI 1.2-3.4). Conclusion: HIV-associated vulnerabilities begin at first sex and potentially mediate an AGYW’s trajectory of risk. HIV prevention programmes should include structural interventions that reach AGYW early, and screening for a history of first sex vulnerabilities could help identify AGYW at risk of ongoing GBV and HIV. This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Corresponding Author: Marissa Becker Centre for Global Public Health Rady Faculty of Health Sciences University of Manitoba R070 Med Rehab Bldg 771 McDermot Avenue Winnipeg, Manitoba R3E 0T6 marissa.becker@umanitoba.ca phone: + 1 204 272 3123 Fax: + 1 204 789 3718 Conflicts of Interest and Sources of Funding: The authors declare no conflicts of interest. This study was funded by an operating grant (MOP-13044) from the Canadian Institutes of Health Research (CIHR) and analyses funded via CIHR grant FDN 13455. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

M. Tchuenche, M. M. Gill, L. Bollinger, L. Mofenson, M. Phalatse, M. Nchephe, M. Mokone, V. Tukei, A. Tiam, S. Forsythe

by M. Tchuenche, M. M. Gill, L. Bollinger, L. Mofenson, M. Phalatse, M. Nchephe, M. Mokone, V. Tukei, A. Tiam, S. Forsythe Background Infants with HIV infection, particularly those infected in utero, who do not receive antiretroviral therapy (ART) have high mortality in the first year of life. Virologic diagnostic testing is recommended by the World Health Organization between ages 4 and 6 weeks after birth. However, adding very early infant diagnosis (VEID) testing at birth has been suggested to enable earlier diagnosis and rapid treatment of in utero infection. We assessed the costs of adding VEID to the standard 6-week testing in Lesotho where coverage of PMTCT services is nearly universal. Methods Retrospective cost data were collected at eight health-care facilities in three districts participating in an observational prospective study that included birth testing as well as at the National Reference Laboratory in Lesotho, to investigate the cost-per-infection identified. Extrapolating to the national level, it was possible to estimate the impact of VEID on the identification of HIV-infected infants. Results The unit cost-per-VEID test in Lesotho in 2015 was $40.50. Major cost drivers were supplies/commodities (46%) and clinical labor (22%). In 2015, 66.3% of cohort study infants born at study facilities underwent VEID; one out of 199 infants had a positive HIV DNA PCR test at birth (0.5% potential in utero infection), yielding a cost of $8,060 per HIV-positive infant identified. Sensitivity analysis showed costs based on Lesotho costing data ranged from $810 to $16,194 per-infected child with varying in utero infection rates from 5% and 0.25%, respectively. With 11,157 HIV-exposed births nationally from pregnant women on PMTCT, 66.3% VEID coverage, and 0.5% in utero infection, 37 infants infected with HIV could have been identified at birth in 2015 and 8 early infant deaths potentially averted with immediate ART compared with waiting for 6-week testing. Conclusion If Lesotho costing data from this pilot study were applied to different epidemic circumstances, the cost-per-infected child identified by adding VEID birth testing to standard 6-week testing was lowest when in utero infection rates were high (when HIV prevalence is high and PMTCT coverage is low).

Suliang Chen, Xinli Lu, Guangyi Bai, Yuqi Zhang, Baojun Li, Wei Wang, Liang Liang, Lin Ma, Yan Li, Xiaofeng Wang, Yingying Wang, Cuiying Zhao, Hongru Zhao

by Suliang Chen, Xinli Lu, Guangyi Bai, Yuqi Zhang, Baojun Li, Wei Wang, Liang Liang, Lin Ma, Yan Li, Xiaofeng Wang, Yingying Wang, Cuiying Zhao, Hongru Zhao We conducted an investigation of blood management in which blood transfusion recipients underwent molecular biological analysis, to trace the possible source of HIV infection. Epidemiological investigation was carried out among HIV-infected individuals. Blood transfusion recipients infected with HIV were tracked for the date of transfusion, reason for transfusion, hospital where transfusion was received, source of blood, components of transfusion, number of transfusions, and transfusion volume. A total of 285 blood transfusion recipients infected with HIV-1 were detected in Hebei over the study period, with 42.81% (122/285) detected through clinical diagnostic testing. These cases showed a concentrated distribution in southern Hebei, with local outbreak characteristics. A census of the population in Shahe County, which had a high concentration of cases, revealed that recipients of blood transfusions had an HIV infection rate of 15.54% (92/592). Post-transfusion infection frequently occurred among blood transfusion recipients at township medical institutions, with a peak in 1995. Owing to late detection of HIV infection among blood transfusion recipients, the rates of spousal transmission and mother-to-child transmission reached 20.87% and 28.05%, respectively. Around 1995, community medical institutions did not screen for HIV antibodies among paid blood donors, which was an important cause of the outbreak of HIV-1 infection among blood transfusion recipients. Our findings indicate that cases of blood transfusion-related infection decreased rapidly with gradual improvement in the HIV screening system for blood donors that began in 1995, particularly after full implementation of HIV nucleic acid testing of volunteer blood donors was begun in 2015.

Peter Ssebutinde, Imelda T. Kyamwanga, Eleanor Turyakira, Stephen Asiimwe, Francis Bajunirwe

by Peter Ssebutinde, Imelda T. Kyamwanga, Eleanor Turyakira, Stephen Asiimwe, Francis Bajunirwe Background The prevalence of HIV infection among older persons is increasing yet older age at initiation of antiretroviral therapy (ART) may be associated with poorer treatment outcomes including mortality. However, majority of these studies have been done in the western world and there is limited data in resource limited settings. Our study used routinely collected health facility data to assess trends in age at initiation of ART, the effect of age at ART initiation on mortality and immunological response at a large urban hospital in south western Uganda. Methods We conducted a retrospective records review of patients attending the HIV clinic at Mbarara Regional Referral Hospital in western Uganda. We retrieved records for 8,533 patients who started ART between January 2006 and December 2012. Their data had been collected and stored as part of the larger International Epidemiological Database for the Evaluation of AIDS (IeDEA). Age was stratified into three categories namely; 18–34 (young adults), 35–49 (mid-age) and 50 years or older (older adults). Survival analysis procedures with Kaplan-Meier’s plots were used to calculate the survival probability with mortality as the endpoint and Poisson regression analysis used to determine the adjusted relative risks (RR) of mortality. Results The proportion of young adults and patients at WHO stage I initiating ART increased steadily over the 7-year period. Older age at ART initiation (> = 50 years) was associated with a higher risk of mortality with adjusted relative risk (RR) at 1.63, (95% CI 1.26–2.11) compared to younger age. Male gender, WHO stages III and IV, lower CD4 count and lower body mass index were also all independently and significantly associated with higher risk for mortality. Older adults also had a poorer immunological response RR = 1.79 (95% CI 0.89–3.58) but was not statistically significant. Conclusions Following ART initiation, older adults compared to the young, have a higher risk of mortality. This age group should be targeted first for ‘screen and treat’ approach. Optimization of ART treatment regimens for this age group is also required to reduce mortality and improve immunological response.

José Moreira, Ariane Paixão, Juliana Oliveira, Waldir Jaló, Ofélio Manuel, Rafaela Rodrigues, Alexandra Oliveira, Leonardo Tinoco, João Lima, Beatriz Grinsztejn, Valdiléa G. Veloso, André M. Japiassú, Cristiane C. Lamas

To compare the discriminatory capacity of the quick Sequential Organ Failure Assessment (qSOFA) versus the Systemic Inflammatory Response Syndrome (SIRS) score for predicting 30-day mortality and intensive care unit (ICU) admission in patients with suspicion of infection at an HIV reference center.

Abstract Background Tuberculosis, bacterial community-acquired pneumonia (CAP), and Pneumocystis jirovecii pneumonia (PJP) are the three commonest causes of hospitalisation in HIV-infected adults. Prompt diagnosis and treatment initiation are important to reduce morbidity and mortality, but are hampered by limited diagnostic resources in resource poor settings. C-reactive protein (CRP) and procalcitonin have shown diagnostic utility for respiratory tract infections, however few studies have focussed on their ability to distinguish between tuberculosis, CAP, and PJP in HIV-infected inpatients. Methods We evaluated the diagnostic accuracy of CRP and procalcitonin, compared with composite reference standards, to discriminate between the three target infections in adult HIV-infected inpatients in two district level hospitals in Cape Town, South Africa. Participants were admitted with current cough and danger signs in accordance with the WHO algorithm for tuberculosis in seriously ill HIV-infected patients. Study clinicians were blinded to CRP and procalcitonin results. Results Two hundred forty-eight participants met study case definitions: 133 with tuberculosis, 61 with CAP, 16 with PJP, and 38 with mixed infection. In the 210 particpants with single infections the differences in median CRP and procalcitonin concentrations between the three infections were statistically significant, but distributions overlapped considerably. CRP and procalcitonin concentrations were highest in the CAP group and lowest in the PJP group. CRP and procalcitonin cut-offs with sensitivities of ≥90% were found for all three target infection pairs, but corresponding specificities were low. Highest receiver operating characteristic areas under the curve for CRP and procalcitonin were for PJP versus tuberculosis and PJP versus CAP (0.68 and 0.71, and 0.74 and 0.69 respectively). Conclusions CRP and procalcitonin showed limited value in discriminating between the three target infections due to widely overlapping distributions, but diagnostic accuracy was higher for discriminating PJP from CAP or tuberculosis. Our findings show limitations for CRP and procalcitonin, particularly for discriminiation of tuberculosis form CAP, however they may have greater diagnostic utility as part of a panel of biomarkers or in clinical prediction rules.

Spivak, A. M., Nell, R. A., Petersen, M., Martins, L., Sebahar, P., Looper, R. E., Planelles, V.

Antiretroviral therapy (ART) does not cure HIV-1 infection due to the persistence of proviruses in long-lived resting T cells. Strategies targeting these latently infected cells will be necessary to eradicate HIV-1 in infected individuals. Protein kinase C (PKC) activation is an effective mechanism to reactivate latent proviruses, and allows for recognition and clearance of infected cells by the immune system. Several ingenol compounds, naturally occurring PKC agonists, have been described to have potent latency reversal activity. We sought to optimize this activity by synthesizing a library of novel ingenols via esterification of the C3 hydroxyl group of the ingenol core, which itself is inactive for latency reversal. Newly synthesized ingenol derivatives were evaluated for latency reversal activity, cellular activation and cytotoxicity alongside commercially available ingenols (ingenol-3,20-dibenzoate, ingenol 3-hexanoate and ingenol-3-angelate) in HIV latency cell lines and resting CD4+ T cells from aviremic participants. Among the synthetic ingenols that we produced, we identified several compounds that demonstrate high efficacy and represent promising leads as latency reversal agents for HIV-1 eradication.

Raymond, Stéphanie; Delaugerre, Constance; Nicot, Florence; Assoumou, Lambert; Lancar, Rémi; Beniguel, Lydie; Izopet, Jacques; the ANRS 146 OPTIMAL study group

Next-generation sequencing is a sensitive method for determining HIV-1 tropism but there is a lack of data on the quantification of X4 variants. We evaluated MiSeq and 454 GS-Junior platforms for determining HIV-1 tropism and for quantifying X4 variants. Both platforms were 93% concordant for determining HIV-1 tropism and correlated well for determining the proportion of X4 variants (Spearman correlation, ρ = 0.748; p …

Cui, Hualu; Geng, Wenqing; Sun, Hong; Han, Xiaoxu; An, Minghui; Jiang, Yongjun; Zhang, Zining; Chen, Zhiwei; Xu, Junjie; Hu, Qinghai; Zhao, Bin; Zhou, Bennan; Shang, Hong

Objective: CRF01_AE is the most prevalent human immunodeficiency virus-1 (HIV-1) subtype among men who have sex with men (MSM) in China. However, the characteristics and underlying mechanism of the accelerated CD4+ T-cell decline in CRF01_AE-infected MSM remain incompletely understood. Design: A long-term prospective follow-up study was conducted with 1338 MSM at risk of HIV-1 infection in Northeast China. MSM with primary HIV-1 CRF01_AE infection were identified and followed for 3–6 years to explore the determinants of rapid CD4+ T-cell decline. Methods: Tropism was determined in primary infection by both SGA-based genotypic prediction using four different algorithms and phenotypic determination using clinical isolates. Serial isolates were used to determine phenotype of coreceptor switch. HLA genotypes and T-cell activation markers were determined. Results: Fifty-nine MSM primarily infected with HIV-1 CRF01_AE were discovered and recruited for the follow-up study. CCR5-utilizing (R5) viruses accounted for up to 98% of HIV-1 CRF01_AE infections in Northeast China. Survival analysis indicated 39.5% of the subjects underwent coreceptor switch within 3 years post infection. After adjustment for other potential risk factors, linear mixed-effect models demonstrated patients experienced R5 to CXCR4-utilizing/dual-tropic (X4/DM) coreceptor switch within three years post-infection underwent a faster CD4+ T-cell decline compared to those without coreceptor switch. Conclusions: Primary HIV-1 CRF01_AE infection among MSM in Northeast China is characterized by R5 viral infection and early R5 to X4/DM coreceptor switch which is associated with rapid CD4+ T-cell decline. The findings highlight the importance of immediate treatment among the CRF01_AE-infected MSM. Correspondence to Hong Shang, Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, 110001, China. Tel: +86 24 8328 2634; fax: +86 24 8328 2634; e-mail: hongshang100@hotmail.com Received 14 March, 2016 Accepted 2 July, 2018 Copyright © 2018 Wolters Kluwer Health, Inc.

Antonio, Marilia B.; Cuba, Gabriel T.; Vasconcelos, Ricardo P.; Alves, Ana Paula P.S.; da Silva, Bruna Oliveira; Avelino-Silva, Vivian Iida

Background: Although doxycycline is widely used as alternative to benzathine penicillin for the treatment of early and late latent syphilis, data on serological response following treatment with doxycycline among HIV-infected patients is limited. Methods: In this study, we analyzed serological response to syphilis treatment with doxycycline among HIV-infected patients treated during a benzathine penicillin shortage period and compared with treatment response among patients treated with benzathine penicillin. Cases with neurosyphilis and those treated with suboptimal doses or with concurrent medications in association with benzathine penicillin or doxycycline were excluded. Results: 50 patients treated with doxycycline from Sep/2014-Dec/2016 were compared to 115 patients treated with benzathine penicillin for early, late latent or latent syphilis of unknown duration. Patients treated with doxycycline were slightly older (median 49 years old, 95% CI 43–56) compared to penicillin group (median 44 years old, 95% CI 37–50; p = 0.007). Groups had no statistically significant differences regarding sex, HIV suppression under treatment and syphilis stages. Serological response to treatment, defined as a non-reagent VDRL or a ≥4-fold reduction in VDRL titers measured 6–12 months after treatment was seem in 72% (95% CI 58–84) of patients treated with doxycycline and 70% (95% CI 60–78) of patients treated with penicillin (p = 0.753). Conclusions: We found no statistically significant differences in serological response to treatment with doxycycline or benzathine penicillin among HIV-infected patients with early, late latent or latent syphilis of unknown duration. Our findings suggest doxycycline is an acceptable treatment to HIV-infected patients with non-tertiary stages of syphilis. Correspondence to Marilia B. Antonio, Av. Dr. Eneas de Carvalho Aguiar, 470, ZIP code 05403-000 Sao Paulo, SP, Brazil. E-mail: bordignon.mba@gmail.com Received 18 April, 2018 Accepted 27 June, 2018 Copyright © 2018 Wolters Kluwer Health, Inc.

Ditte Steiniche , Sanne Jespersen , Candida Medina , Fatima Corona Sanha , Christian Wejse , Bo Langhoff Hønge ,

Abstract Objectives To estimate the magnitude of mortality and loss to follow‐up and describe predictors of mortality among HIV‐infected children in Guinea‐Bissau. Methods Retrospective follow‐up study among HIV‐infected children under 15 years of age at the largest HIV‐clinic in Guinea‐Bissau from 2006–2016. A multivariate Cox proportional hazards model was used to identify predictors of mortality. Results 525 children were included in the analysis: 371 (70.7%) with HIV‐1, 17 (3.2%) with HIV‐2, 25 (4.8%) with HIV‐1/2, and 112 (21.3%) with HIV of unknown type. At diagnosis, the median age was 3.5 years, 44.7% met the WHO criteria for severe immunodeficiency by age based on CD4 cell count, and 59.4% were underweight. The median follow‐up time was 6 months. Despite the availability of antiretroviral treatment, the mortality rate was 10.4 deaths per 100 person‐years of follow‐up. Within the first year of follow‐up, 11.0% died, 3.1% were transferred and 38.8% were lost to follow‐up, leaving 47.1% in follow‐up. Severe immunodeficiency (adjusted hazard ratio (aHR) = 2.52, 95% CI: 1.22‐5.21) and underweight (aHR = 3.14, 95% CI: 1.40‐7.02) were independent predictors of mortality. Conclusions This study reveals a high rate of early mortality and loss to follow‐up among HIV‐infected children in Guinea‐Bissau. Initiatives to improve patient retention are urgently needed. This article is protected by copyright. All rights reserved.

Fitzgerald F, Lhomme E, Harris K, et al.

AbstractObjectiveImmune activation is associated with morbidity/mortality in HIV-infection despite antiretroviral therapy (ART). We investigated whether microbial translocation drives immune activation in HIV-infected Ugandan children.MethodsNineteen markers of immune activation/inflammation were measured over 96 weeks in HIV-infected Ugandan children in CHAPAS-3 (ISRCTN69078957) and HIV-uninfected age-matched controls. Microbial translocation was assessed using molecular techniques including next-generation sequencing.ResultsOf 249 children included, 120 were HIV-infected ART-naïve and 22 ART-experienced (median (IQR) age 2.8(1.7-4.0) and 6.5(5.9-9.2) years; median baseline CD4% 20(14-24) and 35(31-39)). 107 were HIV-uninfected controls. Median (IQR) CD4% increase was 17(12-22) at week-96 in ART-naïve children, and viral load was

Abstract Background Talaromyces marneffei (T. marneffei) is a thermal dimorphic pathogenic fungus that often causes fatal opportunistic infections in human immunodeficiency virus (HIV)-infected patients. Although T. marneffei-infected cases have been increasingly reported among non-HIV-infected patients in recent years, no cases of T. marneffei infection have been reported in pulmonary sarcoidosis patients. In this case, we describe a T. marneffei infection in an HIV-negative patient diagnosed with pulmonary sarcoidosis. Case presentation A 41-year-old Chinese man who had pre-existing pulmonary sarcoidosis presented with daily hyperpyrexia and cough. Following a fungal culture from bronchoalveolar lavage (BAL), the patient was diagnosed with T. marneffei infection. A high-resolution computed tomography (HRCT) chest scan revealed bilateral lung diffuse miliary nodules, multiple patchy exudative shadows in the bilateral superior lobes and right inferior lobes, air bronchogram in the consolidation of the right superior lobe, multiple hilar and mediastinal lymphadenopathies and local pleural thickening. After 3 mos of antifungal therapy, the patient’s pulmonary symptoms rapidly disappeared, and the physical condition improved markedly. A subsequent CT re-examination demonstrated that foci were absorbed remarkably after treatment. The patient is receiving follow-up therapy and assessment for a cure. Conclusion This case suggested that clinicians should pay more attention to non-HIV-related lung infections in patients with pulmonary sarcoidosis. Early diagnosis and treatment with antifungal therapy can improve the prognosis of T. marneffei infection.

Delaugerre, Constance; Rodriguez, Christophe; Capitant, Catherine; Nere, Marie-Laure; Mercier-Darty, Mélanie; Carette, Diane; Pialoux, Gilles; Cotte, Laurent; Charreau, Isabelle; Molina, Jean-Michel; and the IPERGAY study group

Background: The IPERGAY ANRS trial showed that on-demand pre-exposure prophylaxis (PrEP) with tenofovir (TDF) and emtricitabine (FTC) was highly effective in preventing HIV infection among highly exposed men who have sex with men. Here we analyzed drug resistance-associated mutations (RAMs) among all participants who acquired HIV infection during this trial. Methods: Resistance was analyzed on frozen plasma at the time of HIV diagnosis among participants enrolled in the double-blind and open-label phases of the ANRS IPERGAY trial. Adherence was measured by pill counting and by plasma tenofovir and FTC assay. Reverse transcriptase (RT) sequencing was performed, using population-based and ultradeep sequencing (454 GS Flex). Results: During the trial, 31 participants were diagnosed with HIV-1 infection (subtype B, 64.5%), using antigen/antibody immune assay in 29 cases and plasma HIV RNA assay in two. The median plasma HIV-1 RNA level was 5.52 log10 copies/ml. Twelve participants were tested for drug resistance before starting PrEP (6 assigned to TDF/FTC, 13 to placebo). Primary resistance to nucleoside RT inhibitors (zidovudine) and/or non-nucleoside RT inhibitors was detected in 6 participants (19%; 95% CI: 7 – 42). No major or minor TDF- or FTC-resistant variants were detected. Conclusion: No TDF or FTC resistance-associated mutations were found among participants who acquired HIV in the ANRS IPERGAY trial. Correspondence to Constance Delaugerre, Paris, FRANCE. E-mail: constance.delaugerre@sls.aphp.fr Received 30 January, 2018 Revised 12 March, 2018 Accepted 19 March, 2018 Copyright © 2018 Wolters Kluwer Health, Inc.

Price, Jennifer C.; Seaberg, Eric C.; Stosor, Valentina; Witt, Mallory D.; Lellock, Carling D.; Thio, Chloe L.

The utility of longitudinal AST-to-platelet ratio index (APRI), a surrogate for hepatic fibrosis, is unknown. We compared APRI up to 9 years before liver-related death among 57 cases of viral hepatitis-infected men (91% HIV+) to matched controls. APRI was stable among controls but among cases increased 4.6%/year from 9 to 3 years pre-death (p = 0.10) and 30%/year during the 3 years pre-death (p …

Kamitani, Emiko; Wichser, Megan E.; Adegbite, Adebukola H.; Mullins, Mary M.; Johnson, Wayne D.; Crouch, Pierre-Cedric; Sipe, Theresa Ann

When combining results from all published surveys, about one in nine global study participants (10.7%) reported ever using PrEP by 2017, a significant increase since U.S. FDA approval in 2012 (OR = 1.6/year, p …

Lledó, Gema M.; Carrasco, Itziar; Benítez-Gutiérrez, Laura M.; Arias, Ana; Royuela, Ana; Requena, Silvia; Cuervas-Mons, Valentín; de Mendoza, Carmen

Background: Treatment with direct-acting antivirals (DAA) eradicates HCV from most chronic carriers. Information on regression of liver fibrosis and the influence of HIV is scarce in cured patients. Methods: All consecutive HCV-infected individuals treated with DAA at our institution were examined. Hepatic elastography was performed at baseline and at the time of SVR12. Liver fibrosis regression was defined as a shift from advanced fibrosis (Metavir F3-F4) to null-mild fibrosis (F0-F2) and/or a reduction >30% KPa. APRI and FIB-4 scores were calculated in parallel. Results: A total of 260 patients were treated with DAA. All but 14 achieved SVR12 and represented the study population. HIV confection was present in 42%. At baseline, 57.2% had advanced liver fibrosis with a median of 11 kPa, FIB-4 of 2.4, and APRI of 0.95. At the time of SVR12, a median reduction of 2.1 kPa (p …

Qiang Chen, Yanming Sun, Weidong Sun, Mingqiang Hao, Guiying Li, Xueli Su, Ruolei Xin, Hongyan Lu

by Qiang Chen, Yanming Sun, Weidong Sun, Mingqiang Hao, Guiying Li, Xueli Su, Ruolei Xin, Hongyan Lu Background Sexual transmission of HIV among men who have sex with men (MSM) increased markedly in China during the past decade. HIV incidence is a critical indicator in HIV surveillance and we use a HIV-1 BED-capture-enzyme immunoassay (BED-CEIA) to examine the incidence among MSM in Beijing from 2008 to 2016. Risk factors related to recent HIV infection were also assessed. Methods Consecutive cross-sectional surveys on MSM were conducted yearly from 2008 through 2016. Demographic and behaviors data were collected. HIV status was determined and HIV positive specimens were tested for recent infection using BED-CEIA. Specimens with ODn values≤0.8 were considered recently infected, HIV incidence rates and prevalence were then calculated. Risk factors associated with recent HIV infection were assessed by univariate and multivariable logistic regression. Results From 2008 to 2016, the numbers of eligible participants in the nine consecutive years ranged from 472 to 616. All the 261 eligible HIV-positive specimens were subjected to recent HIV infection testing. HIV prevalence ranged from 5.0% (3.3%-6.8%) to 10.2% (7.8%-12.7%), and incidence ranged from 1.57% (0.19%-2.95%) to 6.63% (3.65%-9.61%). MSM who never or sometimes used condoms during anal sex with men in the past 6 months (aOR = 1.515, 95%CI: 1.016–2.257, p = 0.041), or having syphilis infection (aOR = 1.561, 95%CI: 0.946–2.575, p = 0.081) were more likely to be recently infected with HIV. Being a Beijing resident (aOR = 0.409, 95%CI: 0.212–0.790, p = 0.008), or having only one male anal sex partner in the past 6 months (aOR = 0.467, 95%CI: 0.220–0.994, p = 0.048) were associated with a lower risk for recent HIV infection. Conclusions The HIV incidence fluctuated among MSM in Beijing. Unprotected anal sex, having multiple sex partners, being a non-registered Beijing resident and having a syphilis infection play important roles in the recent HIV infection. Effective intervention measures for HIV and syphilis control and prevention should be continuously strengthened.

Yohannes Ejigu, Biniyam Tadesse

by Yohannes Ejigu, Biniyam Tadesse Introduction HIV testing during pregnancy provides an entry point to prevention of mother-to-child transmission of HIV and to access treatment for HIV positive women. The study aimed to assess the uptake of HIV testing during pregnancy and associated factors among Ethiopian women. Methods We analyzed the 2016 Ethiopian Demographic and Health Survey dataset. Women who gave birth within one year prior to the survey were included in the analysis. Uptake of HIV testing during pregnancy is defined as receiving HIV testing service during pregnancy and/or at the time of delivery and knew the test results. Adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) were calculated by using step-wise backward logistic regression analyses to identify factors associated with HIV testing during pregnancy. Results A total of 2114 women who were pregnant in the last one year prior to the survey were included in the analysis. Of these, only 35.1% were tested for HIV and received the test results during pregnancy. About one third of women who had antenatal care follow-up missed the opportunity to be tested for HIV. Compared to women who had no formal education, those who had primary level education (AOR = 1.55; 95% CI: 1.12–2.15), secondary level education (AOR = 2.56 95%CI: 1.36–3.82), or higher education (AOR = 3.95, 95%CI: 1.31–11.95) were more likely to be tested for HIV during pregnancy. Similarly, having awareness about mother-to-child transmission of HIV (AOR = 2.03, 95%CI: 1.48–2.78), and living in urban areas (AOR = 3.30, 95%CI: 1.39–7.85) were positively and independently associated with uptake of HIV during pregnancy. Women who have stigmatizing attitude towards HIV positive people were less likely to be tested for HIV (AOR = 0.57, 95%CI: 0.40–0.79). Conclusion Uptake of HIV testing during pregnancy is low. Missed opportunity among women who had antenatal care visits was very high. Integrating HIV testing with antenatal care services, improving HIV testing service quality and access are essential to increase uptake of HIV testing during pregnancy and reach the goal of eliminating MTCT.

Stephanie Gati, Rhoda Chetty, Douglas Wilson and Jacqueline M. Achkar

Abstract. Human immunodeficiency virus (HIV) infection is a major risk factor for the development of active tuberculosis (TB), one of the deadliest infectious diseases globally. The high mortality associated with the disease can be reduced by early diagnosis and prompt antituberculous treatment initiation. Facilities in TB-endemic regions are increasing the use of nucleic acid amplification (e.g., GeneXpert), which provides rapid results but may have suboptimal sensitivity in HIV-associated TB. Our objective was to evaluate the current practices for TB diagnosis at Edendale Hospital, a large regional hospital in KwaZulu-Natal, South Africa—a TB-endemic region with high HIV prevalence. In this cross-sectional study, all adult inpatients newly started on TB treatment at Edendale were identified over a 6-week period. Demographics, clinical information, diagnostic test results, and outcomes were documented. Pulmonary TB (PTB), extrapulmonary TB (EXTB), and PTB + EXTB were defined as disease evidence in the lungs, other organs, or both, respectively. Ninety-four cases were identified, of which 83% were HIV-associated. Only 30% of all TB patients were microbiologically confirmed, consisting of 7/16 (44%) HIV-uninfected and 21/78 (27%) HIV-infected TB patients. Smear microscopy and mycobacterial culture were seldom ordered. Ultrasound was performed in about one-third of suspected EXTB cases and was valuable in identifying abdominal TB. In this clinical setting with a high incidence of HIV-associated TB, TB diagnosis was more commonly based on clinical assessment and imaging results than on mycobacterial gold standard test confirmation.