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.

Mathieu Nacher, Antoine Adenis, Florence Huber, Edouard Hallet, Philippe Abboud, Emilie Mosnier, Bastien Bideau, Christian Marty, Aude Lucarelli, Vanessa Morel, François Lacapère, Loïc Epelboin, Pierre Couppié

by Mathieu Nacher, Antoine Adenis, Florence Huber, Edouard Hallet, Philippe Abboud, Emilie Mosnier, Bastien Bideau, Christian Marty, Aude Lucarelli, Vanessa Morel, François Lacapère, Loïc Epelboin, Pierre Couppié Background Given the great efforts put into the strategic objective of reducing the proportion of HIV-infected patients that are undiagnosed, the aim of the present study was to review the temporal trends between 1997 and 2016 for median estimates of infection duration and median CD4 count at diagnosis for the main patient origins in French Guiana. Methods CD4 cell count at HIV sero-conversion and square root of CD4 cell decline were obtained using the CD4 decline in a cohort of HIV-infected persons in the UK, fitting random effect (slope and intercept) multilevel linear regression models. Multivariate analysis used robust regression for modeling the delay between estimated HIV seroconversion and diagnosis and quantile regression for CD4 at HIV diagnosis. Results The median interval between the estimated HIV seroconversion and HIV diagnosis was 8 years for patients fromBrazil, 4.5 years for those from Haiti, 6.6 years for those from Suriname, 3.3 years for patients from Guyana, and 3.1 years for French patients. A simple robust regression model with French patients as reference group adjusting for sex and age at the time of diagnosis showed that the interval was significantly longer for Brazilian (β = +3.7 years, P = 0.001), Surinamese (β = +4.2 years, p

Abstract Background The burden of mother-to-child transmission rate of HIV is high and risk factors are common in Ethiopia. This systematic review and meta-analysis intended to provide the pooled estimation of mother-to-child transmission rate and its risk factors in Ethiopia. Methods We searched PubMed, Google Scholar, EMBASE and Web of Science electronic databases for all available references. We included observational studies including case-control, cohort, and cross-sectional studies. The search was further limited to studies conducted in Ethiopia and publish in English. Heterogeneity was checked using the I2 statistic. Egger’s test and the funnel plot were used to assess publication bias. A meta-analysis using a weighted inverse variance random-effects model was performed. Results A total of 18 studies with 6253 individuals were included in this systematic review and meta-analysis. Of these, 14 studies with 4624 individuals were used to estimate the prevalence. The estimated pooled prevalence of mother-to-child transmission of HIV was 11.4% (95% CI = 9.1–13.7). The pooled adjusted odds ratio (AOR) of mother-to-child transmission of HIV for the infants from rural area was 3.8 (95% CI = 1.4 to 6.3), infants delivered at home was 3.2 (95% CI = 1.2 to 5.2), infant didn’t take antiretroviral prophylaxis was 5.8 (95% CI = 1.5 to 10.3), mother didn’t take antiretroviral prophylaxis was 6.1 (95% CI = 2.5 to 9.6), mothers didn’t receive PMTCT intervention was 5.1 (95% CI = 1.6, 8.6), and on mixed feeding was 4.3 (95% CI = 1.8 to 6.7). Conclusions This systematic review and meta-analysis showed that mother-to-child transmission rate of HIV was high in Ethiopia. Being from the rural residence, home delivery, not taking antiretroviral prophylaxis, the absence of PMTCT intervention, and mixed infant feeding practices increased the risk of HIV transmission. Trial registration It is registered in the Prospero database: (PROSPERO 2017: CRD42017078232).

Champenois, Karen; Seng, Rémonie; Persoz, Anne; Essat, Asma; Gaud, Catherine; Laureillard, Didier; Robineau, Olivier; Duvivier, Claudine; Yazdanpanah, Yazdan; Goujard, Cécile; Meyer, Laurence; for the ANRS PRIMO cohort study group

Background: With the advent of treatment as prevention of HIV infection (TasP), we assessed trends in sexual behaviours between 2000 and 2017 among HIV-infected MSM enrolled in the French ANRS PRIMO cohort. Methods: At each cohort visit, a clinical questionnaire including laboratory values was completed and a self-administered questionnaire was used to collect sexual behaviours, that is, the number, type (steady/casual) and HIV status (positive or negative/unknown) of partners, and condom use. The possible influence of viral load (undetectable/detectable) measured at the preceding visit on the evolution over time of sexual behaviour was assessed with logistic regression models fitted by generalized estimating equations (GEE), taking into account longitudinal data. Results: We analyzed data from 10657 follow-up visits by 1364 MSM. Overall, whatever the considered behavioural variable: at least one sexual partner, steady and/or casual, condomless sex with steady, casual partners, serodiscordant or not, we observed a calendar increase with a particularly more marked rise from 2010 (P …

Hoy, Jennifer F.; Richardson, Robyn; Ebeling, Peter R.; Rojas, Jhon; Pocock, Nicholas; Kerr, Stephen J.; Martinez, Esteban; Carr, Andrew; for the ZEST Study Investigators.

Objective: To compare the effects of switching tenofovir disoproxil fumarate (TDF) or treatment with an intravenous bisphosphonate on bone mineral density (BMD) in HIV-positive adults with low bone mass. Design: Two-year, randomised, open-label study at 10 sites in Australia and Spain. Participants: Of 112 adults on TDF-based antiretroviral therapy (ART) screened, 87 with low BMD (T-score …

Xia Wang, Adam Bourne, Pulin Liu, Jiangli Sun, Thomas Cai, Gitau Mburu, Matteo Cassolato, Bangyuan Wang, Wang Zhou

by Xia Wang, Adam Bourne, Pulin Liu, Jiangli Sun, Thomas Cai, Gitau Mburu, Matteo Cassolato, Bangyuan Wang, Wang Zhou Background Oral pre-exposure prophylaxis (PrEP) is recommended as an additional prevention choice for men who have sex with men (MSM) at substantial risk of HIV. The aim of this study was to evaluate the extent, and reasons, for MSM’s willingness to use oral PrEP in Wuhan and Shanghai, China. Methods Between May and December 2015, a cross-sectional survey was conducted among 487 MSM recruited through snowball sampling in physical locations frequented by MSM and through social media applications. Exploratory factor analysis was used to group reasons for being willing or not willing to use PrEP. Chi-square tests were used to explore bivariate associations between groupings of reasons for being willing or unwilling to use PrEP, and key sociodemographic and sexual-behavioral characteristics of MSM. Results Overall, 71.3% of respondents were willing to use PrEP. The most commonly reported reasons for being willing to use PrEP were preventing HIV infection (91.6%), taking responsibility for own sexual health (72.6%) and protecting family members from harm (59.4%). The main reasons for being unwilling to use PrEP were being worried about side effects (72.9%), the necessity of taking PrEP for long periods of time (54.3%) and cost (40.4%). Individual characteristics that influenced the type of reasons given for being willing or unwilling to use PrEP included being married to a woman, having a regular sex partner, rates of condom use with regular and casual sex partners, and the number of casual sex partners. Conclusion The introduction of PrEP in China could benefit from promotion campaigns that emphasize its role in preventing HIV infection, in taking responsibility for own sexual health, and in protecting family members from potential harm. To reduce uptake barriers, it will be essential to provide accurate information to potential PrEP users about the mild and short-term nature of side effects, and the possibility of taking PrEP only during particular periods of life when the risk of HIV exposure might be highest.

Chui Ching Wong, Siew Hoon Lim, Chai Teng Tan, Sook Yin Lui, Yee Leng Lee, Kwai Peng Chan

by Chui Ching Wong, Siew Hoon Lim, Chai Teng Tan, Sook Yin Lui, Yee Leng Lee, Kwai Peng Chan In view of recent revised recommendations for human immunodeficiency virus (HIV) confirmatory testing, the performance of 3 HIV confirmatory assays was compared. Using the HIV Blot 2.2 (MP-WB), the INNO-LIA HIV I/II Score (INNO), and the Geenius HIV 1/2 Confirmatory Assay (Geenius), we tested 199 HIV-1 positive, 161 HIV negative, 65 HIV western blot indeterminate, 26 HIV seroconversion, 34 early HIV infection and 4 HIV-2 positive archived specimens. We show that all 3 assays had comparable test sensitivity in the detection of HIV-1 positive cases. However, less non-specific reactivity was observed with the INNO and Geenius assays, where both of them were able to resolve MP-WB indeterminate cases. When early HIV cases were considered, INNO and Geenius were more likely to confirm an early-stage infection as positive. Nevertheless, overall poor sensitivity (25.5% - 44.7%) of these assays for the detection of early cases was observed, likely because these cases had very low or non-detectable levels of HIV antibodies. Hence, further testing by a nucleic acid test or a p24 antigen test of specimens reactive on screening with a fourth generation Ag/Ab assay that are negative on confirmatory testing for HIV-specific antibody, may be useful. In conclusion, INNO and Geenius had comparable test performance, although the ease of use and shorter assay time for Geenius may make it the preferred choice for laboratories. In that regard, of note is our observation of non-specific reactivity of lipaemic specimens to the HIV-2 gp140 band in the Geenius assay, which should prompt caution when interpreting results of such specimens.

Alemnesh H. Mirkuzie

by Alemnesh H. Mirkuzie About 40% of the new HIV infections in Ethiopia are among children < 15 years of age. The great majority of these infections occur through Mother-to-child HIV transmission (MTCT). For prevention of MTCT, the national guidelines has been revised to incorporate scientific advances in HIV prevention, treatment and care. Since 2005, the country has been implementing a peer mentor programme called Mother Support Group (MSG), which provides psychosocial and adherence support for HIV positive mothers. This study examined implementation of PMTCT guidelines revisions and outcomes of HIV exposed babies in the MSG in Addis Ababa. Retrospective routine data were collected between 2005 and August 2013 from seven randomly selected primary health facilities. Odds ratios and 95% confidence intervals were calculated using logistic regression models. Several guidelines revisions were made between 2001 and 2013 in HIV testing approaches, prophylactic antiretroviral options, infant feeding recommendations and infant HIV testing algorithms. Revisions on the CD4 thresholds were associated with a significant increase in the proportion of women initiating antiretroviral treatment from 0 in 2005 to 62% in 2013. Revisions in infant feeding recommendations led to a 92.3% reported practice of exclusive breastfeeding in 2013 compared to 60.9% in 2005. Two and four percent of the HIV exposed babies were HIV positive by six and 18 months respectively. Not receiving prophylactic ART and receiving mixed feeding were independent predictors for babies having an HIV positive antibody test at 18 months. The rate of HIV status disclosure increased significantly year by year. Over the years, the PMTCT recommendations have moved from having a solo focus on PMTCT to holistic and inclusive approaches emphasizing survival beyond HIV prevention. The data reflect favourable outcomes of HIV exposed babies in terms of averted MTCT though serious gaps in data quality remain. For successful implementation of Option-B plus, the identified gaps in the MSG need to be addressed.

Adamma Aghaizu, Jennifer Tosswill, Daniela De Angelis, Helen Ward, Gwenda Hughes, Gary Murphy, Valerie Delpech

by Adamma Aghaizu, Jennifer Tosswill, Daniela De Angelis, Helen Ward, Gwenda Hughes, Gary Murphy, Valerie Delpech Introduction The HIV epidemic in England is largely concentrated among heterosexuals who are predominately black African and men who have sex with men (MSM). We present for the first time trends in annual HIV incidence for adults attending sexual health clinics, where 80% of all HIV diagnoses are made. Methods We identified newly diagnosed incident HIV using a recent infection testing algorithm (RITA) consisting of a biomarker (AxSYM assay, modified to determine antibody avidity), epidemiological and clinical information. We estimated HIV incidence using the WHO RITA formula for cross-sectional studies, with HIV testing data from sexual health clinics as the denominator. Results From 2009 to 2013, each year, between 9,700 and 26,000 black African heterosexuals (of between 161,000 and 231,000 heterosexuals overall) were included in analyses. For the same period, annually between 19,000 and 55,000 MSM were included. Estimates of HIV incidence among black Africans increased slightly (although non-significantly) from 0.15% (95% C.I.0.05%-0.26%) in 2009 to 0.19% (95% C.I.0.04%-0.34%) in 2013 and was 4-5-fold higher than among all heterosexuals among which it remained stable between 0.03% (95% C.I.0.02%-0.05%) and 0.05% (95% C.I.0.03%-0.07%) over the period. Among MSM incidence was highest and increased (non-significantly) from 1.24% (95%C.I 0.96–1.52%) to 1.46% (95% C.I 1.23%-1.70%) after a peak of 1.52% (95%C.I 1.30%-1.75%) in 2012. Conclusion These are the first nationwide estimates for trends in HIV incidence among black African and heterosexual populations in England which show black Africans, alongside MSM, remain disproportionately at risk of infection. Although people attending sexual health clinics may not be representative of the general population, nearly half of black Africans and MSM had attended in the previous 5 years. Timely and accurate incidence estimates will be critical in monitoring the impact of the reconfiguration of sexual health services in England, and any prevention programmes such as pre-exposure prophylaxis.

Patrick D. M. C. Katoto , Friedrich Thienemann , André N. H. Bulabula , Tonya M. Esterhuizen , Aimé B. Murhula , Pierre P. M. Lunjwire , Dieudonné M. Bihehe , Jean B. Nachega

Abstract Objective To determine the prevalence of and risk factors for metabolic syndrome (MS) in HIV‐infected adults at three urban clinics in Bukavu, Democratic Republic of the Congo. Design Cross‐sectional study. Methods From July to September 2016, baseline socio‐demographics, risk factors and clinical characteristics were collected using a structured questionnaire or extracted from medical records. Fasting blood sugar and lipids were measured. MS was defined per the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) and the International Diabetes Federation (IDF) criteria. Adjusted odds ratio (OR) was generated through multivariate logistic regression models. Results Of 495 participants, 356 (72%) were women and 474 (95.8%) were receiving antiretroviral therapy (ART). The median age (years) [interquartile range (IQR)] was 43 [36–51]. The overall prevalence of MS per NECP/ATP III and IDF criteria was 27% [95% CI: 20–35%] or 30% [95% CI: 23–38%], respectively. In a multivariate logistic regression, low physical activity (OR 2.47, 95% CI: 1.40–4.36); daily exposure to biomass fuel smoke (BMF) for more than 2 h (OR 2.18, 95% CI: 1.01–4.68); protease inhibitor containing ART (OR: 2.96, 95% CI: 1.07–8.18); and stavudine‐containing ART regimen (OR: 2.57, 95% CI: 1.11–5.93) were independently associated with MS. Conclusions MS was highly prevalent in this hospital‐based study population. Beside known traditional risk factors and contribution of specific ART regimens to MS, daily exposure to BMF is new and of specific concern, necessitating targeted urgent prevention and management interventions.

Helene L. Grønborg , Sanne Jespersen , Johanne H. Egedal , Faustino G. Correia , Candida Medina , Henrik Krarup , Bo L. Hønge , Christian Wejse , for , Amabelia Rodrigues , David da Silva , Zacarias da Silva , Ines Oliviera‐Souto , Lars Østergaard , Alex Laursen , Peter Aaby , Anders Fomsgaard , Christian Erikstrup

Abstract Objectives To describe the prevalence of CMV in a cohort of HIV infected individuals in Guinea‐Bissau, West Africa and to evaluate differences in patients’ clinical characteristics associated with their CMV status. Methods Newly diagnosed HIV infected adults were invited to participate in this cross‐sectional study, from May until December 2015. Enrolled patients were interviewed and underwent a full physical examination focusing on CMV disease manifestations. Blood samples were analysed for CMV serology, QuantiFERON‐CMV response and CMV DNA. Mortality follow‐up were registered for one year after inclusion. Results In total, 180 patients were enrolled. Anti‐CMV IgG positivity was found in 100% (138/138) and 2.8% (4/138) were anti‐CMV IgM positive. A positive QuantiFERON‐CMV response was found in 85.7% (60/70) of the patients and 60.6% (83/137) had CMV viraemia. QuantiFERON‐CMV response and detectable CMV DNA were associated with lower CD4 cell count, older age and upper gastrointestinal complaints. During one year of follow‐up, the IRR for death among CMV DNA positive patients was 1.5 (P = 0.5). Conclusions CMV coinfection was detected among all enrolled patients and CMV viraemia was highly prevalent. Only age and upper gastrointestinal complaints were associated with the patients’ CMV status.

Marie Marcelle Deschamps , Deanna Jannat‐Khah , Vanessa Rouzier , Jerry Bonhomme , Julma Pierrot , Myung Hee Lee , Elaine Abrams , Jean Pape , Margaret L. McNairy

Summary Objective To evaluate mother and infant outcomes in the largest prevention of mother‐to‐child‐transmission (PMTCT) programme in Haiti in order to identify gaps towards elimination of HIV and syphilis. Methods Based on retrospective data from HIV+ pregnant women and their infants enrolled in PMTCT care from 1999 to 2014, we assessed maternal enrolment in PMTCT, receipt of antiretrovirals before delivery, maternal retention through delivery as well as infant enrolment in PMTCT, HIV testing and HIV infection. Four PMTCT programme periods were compared: period 1 (1999–2004, mono ARV), period 2 (2005–2009, dual ARV), period 3 (2010–2012, Option B) and period 4 (Oct 2012–2014, Option B+). Kaplan–Meier methods were used to assess retention in PMTCT care. Results Among 4665 pregnancies, median age was 27 years and median CD4+ was 494 cells/μl (IQR 328–691). A total of 75% of women received antiretrovirals before delivery, and 73% were retained in care through delivery. Twenty‐two percent of women were lost before delivery,…

John R. Su, Carmen Ng, Paige W. Lewis, Maria V. Cano

by John R. Su, Carmen Ng, Paige W. Lewis, Maria V. Cano Human immunodeficiency virus (HIV) causes immune dysregulation, potentially affecting response to vaccines in infected persons. We investigated if unexpected adverse events (AEs) or unusual patterns of AEs after vaccination were reported among HIV-positive persons. We searched for domestic reports among HIV-positive persons to the Vaccine Adverse Event Reporting System (VAERS) during 1990–2016. We analyzed reports by age group (…

Campos, Nicole G.; Lince-Deroche, Naomi; Chibwesha, Carla J.; Firnhaber, Cynthia; Smith, Jennifer S.; Michelow, Pam; Meyer-Rath, Gesine; Jamieson, Lise; Jordaan, Suzette; Sharma, Monisha; Regan, Catherine; Sy, Stephen; Liu, Gui; Tsu, Vivien; Jeronimo, Jose; Kim, Jane J.

Background: Women with HIV face an increased risk of human papillomavirus (HPV) acquisition and persistence, cervical intraepithelial neoplasia, and invasive cervical cancer. Our objective was to determine the cost-effectiveness of different cervical cancer screening strategies among women with HIV in South Africa. Methods: We modified a mathematical model of HPV infection and cervical disease to reflect co-infection with HIV. The model was calibrated to epidemiologic data from HIV-infected women in South Africa. Clinical and economic data were drawn from in-country data sources. The model was used to project reductions in the lifetime risk of cervical cancer and incremental cost-effectiveness ratios (ICERs) of Pap and HPV DNA screening and management algorithms beginning at HIV diagnosis, at one-, two-, or three-year intervals. Strategies with an ICER below South Africa’s 2016 per capita GDP (US$5,270) were considered ‘cost-effective.’ Results: HPV testing followed by treatment (test-and-treat) at two-year intervals was the most effective strategy that was also cost-effective, reducing lifetime cancer risk by 56·6% with an ICER of US$3,010 per year of life saved (YLS). Other cost-effective strategies included Pap (referral threshold: HSIL+) at one-, two-, and three-year intervals, and HPV test-and-treat at three-year intervals. Pap (ASCUS+), HPV testing with 16/18 genotyping, and HPV testing with Pap or visual triage of HPV-positive women were less effective and more costly than alternatives. Conclusion: Considering per capita GDP as the benchmark for cost-effectiveness, HPV test-and-treat is optimal in South Africa. At lower cost-effectiveness benchmarks, Pap (HSIL+) would be optimal. 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: Nicole G. Campos, Center for Health Decision Science, 718 Huntington Avenue, Boston, MA 02115; Phone: 617-432-2019; Fax: 617-432-0190; E-mail: ncampos@hsph.harvard.edu Conflicts of Interest and Source of Funding: This study was funded by the US National Cancer Institute (U01CA199334) and The Bill & Melinda Gates Foundation (OPP1086544). The funders had no role in study design; data collection, analysis, or interpretation; decision to publish; or preparation of the manuscript. The costing work that preceded this study was made possible by the generous support of the American people through the United States Agency for International Development (USAID), award number AID-674-A-12-00029. The contents are the responsibility of the Health Economics and Epidemiology Research Office, a Division of the Wits Health Consortium (Pty) Ltd and do not necessarily reflect the views of USAID or the United States Government. NGC reports grants from the Bill & Melinda Gates Foundation during the conduct of the study. NLD has nothing to disclose. CJC has nothing to disclose. CF has nothing to disclose. JSS has nothing to disclose. PM has nothing to disclose. GMR has nothing to disclose. LJ has nothing to disclose. SJ has nothing to disclose. MS has nothing to disclose. CR reports grants from the Bill & Melinda Gates Foundation during the conduct of the study. SS reports grants from the Bill & Melinda Gates Foundation during the conduct of the study. GL has nothing to disclose. VT reports grants from the Bill & Melinda Gates Foundation during the conduct of the study. JJ was a consultant for Qiagen Inc. and Global Good Fund I, LLC; he was the co-owner and Deputy Manager of Onco Prev International, a Peruvian company, from 2012 through March 2017. Onco Prev International offers cervical cancer screening services and in 2016 also began positioning for distribution of medical devices including colposcopes and the Liger thermocoagulator. Onco Prev International did not commercialize any medical instrument during the time JJ was part of the company. JJK reports grants from the Bill & Melinda Gates Foundation during the conduct of the study. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

Kerkerian, Genevieve; Kestler, Mary; Carter, Allison; Wang, Lu; Kronfli, Nadine; Sereda, Paul; Roth, Eric; Milloy, M-J; Pick, Neora; Money, Deborah; Webster, Kath; Hogg, Robert S; de Pokomandy, Alexandra; Loutfy, Mona; Kaida, Angela

Background: In North America, women have lower engagement across the HIV cascade of care compared with men. Among women living with HIV (WLWH) in Canada, we measured the prevalence and correlates of attrition across cascade stages overall, and by key sub-populations. Methods: We analyzed baseline survey data regarding six nested stages of the HIV cascade among 1,424 WLWH enrolled in the Canadian HIV Sexual and Reproductive Health Cohort Study (CHIWOS), including: linked to care, retained in care, initiated antiretroviral therapy (ART), current ART use, ART adherence (≥90%), and viral suppression (…

Côté H, Hsieh A.

Montejano R, Stella-Ascariz N, Monge S, et al.

AbstractBackgroundTenofovir is a potent inhibitor of human telomerase. The clinical relevance of this inhibition is unknown.MethodsProspective cohort of HIV-1 infected participants with suppressed virological replication, comparing whole blood telomere length (measured by quantitative multiplex PCR) of participants with current exposure versus never exposed to tenofovir disoproxil fumarate.Results172 participants included: 67 in the tenofovir disoproxil fumarate (TDF)-group and 105 in the non-TDF group [75 receiving two nucleosides (69 abacavir), 25 receiving a completely nucleos(t)ide sparing regimen, and 5 receiving lamivudine as the only nucleoside]. After two years mean blood telomere length increased significantly in both groups. The TDF group had significantly smaller gains in telomere length than the non-TDF group. In the analysis restricted to participants receiving nucleos(t)ide reverse transcriptase inhibitors, TDF exposure was not associated with an independent negative effect. In the non-TDF group participants treated with two nucleosides had also significantly smaller gains in telomere length than those receiving completely nucleos(t)ide reverse transcriptase sparing regimens or lamivudine as the only nucleosideDiscussionin HIV-infected adults with prolonged virological suppression treatment with TDF or abacavir was associated with smaller gains in blood telomere length after two years of follow-up.

Shan Z, Clish C, Hua S, et al.

AbstractWe examined associations of 5 plasma choline metabolites with carotid plaque among 520 HIV-infected and 217 HIV-uninfected participants (112 incident plaque cases) over 7 years. After multivariable adjustment, higher gut microbiota-related metabolite trimethylamine-N-oxide (TMAO) was associated with an increased risk of carotid plaque in HIV-infected participants (risk ratio=1.25 [95% CI, 1.05-1.50] per standard deviation increment; P=0.01). TMAO was positively correlated with biomarkers of monocyte activation and inflammation (sCD14, sCD163). Further adjustment for these biomarkers attenuated the association between TMAO and carotid plaque (P=0.08). Among HIV-infected individuals, plasma TMAO was associated with carotid atherosclerosis progression, partially through immune activation and inflammation.

Paul J. Collini

American Journal of Respiratory and Critical Care Medicine, Volume 197, Issue 12, Page 1604-1615, June 15, 2018.

Peters, Lars; Laut, Kamilla; Resnati, Chiara; Del Campo, Santos; Leen, Clifford; Falconer, Karolin; Trofimova, Tatyana; Paduta, Dzmitry; Gatell, Jose; Rauch, Andri; Lacombe, Karine; Domingo, Pere; Chkhartishvili, Nikoloz; Zangerle, Robert; Matulionyte, Raimonda; Mitsura, Viktar; Benfield, Thomas; Zilmer, Kai; Khromova, Irina; Lundgren, Jens; Rockstroh, Jürgen; Mocroft, Amanda; for the EuroSIDA Study Group

Background and aims: To investigate the uptake of HCV therapy among HIV/HCV coinfected patients in the pan-European EuroSIDA study between 2011-2016. Methods: All HCV-RNA+ patients were included. Baseline was defined as latest of anti-HCV+, January 2011 or enrolment in EuroSIDA. The incidence of starting first IFN-free direct-acting antiviral (DAA) therapy was calculated. Factors associated with starting IFN-free DAA were determined by Poisson regression. Results: Among 4308 HCV-RNA+ patients (1255, 970, 663, 633, 787 from South, West, North, Central East and East Europe, respectively) with 11863 person years of follow up (PYFU), 1113 (25.8%) started any HCV therapy. Among patients with ≥F3 fibrosis, >50% in all regions remained untreated. The incidence (per 1000 PYFU, 95% CI) of starting DAA increased from 7.8 (5.9 – 9.8) in 2014 to 135.2 (122.0 – 148.5) in 2015 and 128.9 (113.5 – 144.3) in 2016. The increase was highest in North and West and intermediate in South, but remained modest in Central East and Eastern Europe. After adjustment, females, individuals from Central East or East, genotype 3, antiretroviral therapy naïve and those with detectable HIV-RNA were less likely to start DAA. Older persons, those with HCV-RNA >500.000 IU/ml and those with more advanced liver fibrosis were more likely to start DAA. Conclusions: Uptake of DAA therapy among HIV/HCV coinfected patients increased considerably in Western Europe between 2014 and 2016, but was modest in Central East and East. In all regions more than 50% with ≥F3 fibrosis remained untreated. Women were less likely to start DAA. Correspondence to Lars Peters, CHIP, Department of Infectious Diseases, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark. Tel: +45 3545 5764; fax: +45 35 45 57 58; e-mail: lars.peters@regionh.dk Received 1 March, 2018 Revised 22 May, 2018 Accepted 27 May, 2018 Copyright © 2018 Wolters Kluwer Health, Inc.

Valverde, Eduardo E.; Beer, Linda; Johnson, Christopher H.; Baugher, Amy

Discrimination in healthcare settings is a barrier to healthcare engagement. We analyzed two nationally representative datasets to assess change in discrimination in healthcare settings reported by HIV patients from 1996 to 2011–2013. Perceived discrimination in healthcare settings significantly decreased over time, from 24% in 1996 to 15% in 2011–2013. Improvements over time in HIV clinicians’ engagement in prevention discussions with patients following federal agencies’ recommendations may have been a contributing factor. Correspondence to Eduardo E. Valverde, DrPH, Centers for Disease Control and Prevention, Division of Global HIV & TB, 1600 Clifton Road, NE, Mail Stop E-04, Atlanta, GA 30329. Tel: +404 639 2048; e-mail: evalverde@cdc.gov Received 4 April, 2018 Revised 4 May, 2018 Accepted 14 May, 2018 Copyright © 2018 Wolters Kluwer Health, Inc.