जर्नल ऑफ एड्स एंड क्लिनिकल रिसर्च

Objective: Syphilis incidence has been steadily increasing among HIV-infected men in the United States, representing an important public health challenge to HIV prevention. Clinic-based HIV prevention interventions are available but may need to be revisited in response to syphilis epidemic. We wanted to better understand the current epidemiology of syphilis in rural HIV-infected men who routinely received HIV risk-reduction counseling in order to plan more effective HIV prevention strategies in clinical care. Methods: We conducted a retrospective cohort study to examine factors associated with syphilis infections in rural HIV-infected men who received sexually transmitted disease screening and HIV risk-reduction counseling during HIV primary care from January 2008 to June 2013. We assessed patients’ demographic, clinical, behavioral and psychosocial characteristics and performed a multivariable exact logistic regression to identify factors related to syphilis. Results: Despite routine risk screening and HIV risk-reduction counseling, a total of 51 syphilis infections were diagnosed among 702 HIV-infected men (5 patients were diagnosed ≥ 2 episodes). The majority of the study participants was sexually active and reported at least one unsafe sexual behavior, mainly inconsistent condom use. Younger age (<35 years, adjusted odds ratio (aOR)=3.09), higher educational attainment (some college or above, aOR=3.72), and perception that the partner may have sex with other people (aOR=3.10) were significantly associated with syphilis infection. Non-injection drug use was related to syphilis in HIV-infected men who have sex with men (aOR=2.86). Discussion: Some HIV-infected men, especially young, educated men, or those who perceived that their partners may have sex with other people, continue to have high-risk behaviors that increase their own risks of acquiring syphilis and may also facilitate HIV transmission. New strategies need to be developed for HIV primary care providers to help HIV-infected patients maintain safer sex practices.

In August 2010, we diagnosed a Multicentric Castleman’s Disease (MCD) in a HIV+ patient with generalized lymphadenopathy, splenomegaly and pericardial effusion. A few days before the onset of symptoms, the patient had started anti-retroviral therapy with Abacavir/Lamivudine (ABC/3TC) +Ritonavir-boosted Atazanavir (ATV/r). During the hospitalization he developed a severe pancytopenia with liver failure, and he started immediately the Therapy with steroids, Ganciclovir, and Rituximab. At the 46 months follow-up, the patient is asymptomatic, his biochemical values are essentially normal with a complete regression of the superficial and deep lymphadenopathies.

Objective: Urban teens disproportionately impacted by HIV may not seek HIV testing. The objectives of this study are to determine factors that impact HIV testing among sexually active and non-sexually active teens seeking care in an urban academic setting; whether teens with high levels of self-efficacy are more likely to receive HIV testing; and whether an teen's ability to cope impacts positive attitudes toward testing.

Methods: We conducted a cross-sectional survey of 228 HIV negative adolescent and young adult participants age 12-21 who received care in an academic urban primary care clinic in Baltimore, Maryland.

Results: Most youth reported being sexually active (N=146, 64%) and reported having been tested at that day's visit (N=135, 85%). Provider recommendation was significantly associated with higher odds of testing among sexually active teens (OR 3.5, 95% CI 1.07-11.7) and those with no prior sexual history (OR 5.89, 95% CI 1.40-24.9), while high HIV stigma was associated with lower odds of testing (OR 0.17, 95% CI 0.04-0.77) among youth with no prior sexual history. Sexually active teens with a positive attitude toward HIV testing were more likely to be older (late: 6.3 (1.0-40)), report intention to be tested in 6 months (OR 7.11, 95% CI 1.48-34.2), and have higher HIV coping self-efficacy (OR 1.12, 95% CI 1.00-1.26).

Conclusions: Provider recommendation may be the most important independent factor for testing in teens, regardless of sexual history, while HIV-related stigma may be an important factor for teens with no prior sexual history and thus may be perceived to have little or no risk for HIV acquisition. In sexually active youth, older age, intention to be tested for HIV and the ability to cope with a positive diagnosis likely dictates adolescent attitudes toward engagement in HIV testing, although it may not directly correspond with HIV testing behavior.

Objective: Recent studies have demonstrated the efficacy of antiretroviral preexposure prophylaxis (PrEP) for prevention of HIV-1 infection. The purpose of this study was to identify barriers to PrEP use among high HIV-risk men who have sex with men in Denver, Colorado.

Methods: A 19 question Likert-scale survey was used to assess knowledge of PrEP; attitudes towards cost, side effects, and alternative prevention methods; and the effects of PrEP on sexual behaviors and practices. The survey was administered at study entry and six months later to HIV seronegative, men who have sex with men and male-tofemale transgendered women who have sex with men and participate in high-risk sexual behavior.

Results: Between June and September 2013, 65 participants from the metropolitan Denver area completed the survey. Median age was 36 years (range; 20-52 years); 88% were white, 6% Hispanic, and 1.5% African American; 65% had at least a college degree or higher and 27% had more than high school education. The reported number of sexual partners in the past six months ranged from zero to 150 partners (median 3 partners) and 75% reported condom use during all sexual encounters. Although 72.3% reported prior knowledge of PrEP only five participants (7.7%) reported ever using PrEP in the past. Participants were most likely (93.8%) to use PrEP in the future if they were in a monogamous relationship with an HIV-infected partner and least likely to use PrEP if it required out-of-pocket costs (10.7%). Younger age was associated with decreased odds of future PrEP use even if PrEP was provided free of charge (OR 0.2, 95% CI 0.1, 1.0). Higher number of sexual partners in the preceding six months was associated with decreased odds of using condoms if taking PrEP in the future (aOR 0.2; 95% CI 0.1, 0.8). No changes in survey responses were noted between baseline and six months.

Conclusions: PrEP usage was uncommon among men at high risk for sexual acquisition of HIV infection and cost of antiretroviral drugs was a major barrier to future PrEP use. If PrEP is to have major impact on transmission of HIV-1, expanded efforts to decrease cost and increase community awareness of PrEP safety and efficacy are needed.

Over 35 million people are infected currently with the Human Immunodeficiency Virus (HIV), of whom 30-50% will experience Distal Sensory Polyneuropathy (DSP), usually causing paresthesiae and neuropathic pain, particularly in the feet. This presentation is identical to patients with Diabetic DSP. Current regimens for treating neuropathic pain have limited benefits. Thus, a deeper understanding of the mechanisms of HIV-DSP is imperative to permit the rational development of new therapies. Transgenic mice expressing the HIV-1 viral protein R (Vpr) show footpad epidermal denervation and allodynia as observed in HIV-infected patients. We found that exogenous Vpr inhibits axon outgrowth, causes hyperexcitability and increases cytosolic calcium in cultured dorsal root ganglion neurons (DRGN). Exposure of DRGN to nerve growth factor (NGF) or modulating NGF signaling pathways before Vpr treatment can block its effects. These findings will be extended to in vivo models to determine if altering the NGF signaling pathway can prevent Vprinduced denervation and allodynia.

Background: Guillain-Barré syndrome (GBS) has been reported in HIV-positive individuals, but the incidence and characteristics in this group of patients has not systematically been investigated beyond case reports and retrospective series. The aim of this study was to compare the incidence and characteristics of GBS in HIV positive and -negative individuals. Methods: We performed a prospective, comparative study over a 3 ½ year period in the Western Cape province of South Africa. All adult patients with GBS were included and classified into 2 groups based on HIV status. The two groups were compared with regards to clinical, electrophysiological and laboratory features. Patients were followed until stable or recovered, for a maximum of 12 months. Results: 28 patients were included in the study, of which 15 were HIV-positive. Using estimated HIV prevalence data for the same geographical area during the study period, the incidence of GBS in HIV-positive patients was calculated to be 18.74, 95% CI [7.69, 40.60] times higher than in HIV-negative patients. Except for the frequency of hyponatraemia, there were no statistically significant differences between the 2 groups with regards to presenting features, severity of illness, GBS subtypes, and treatment response. GBS occurred in all stages of HIV infection, and was the presenting feature of HIV infection in 13 patients. Interpretation: The incidence of GBS is strikingly increased in HIV infection. The reason for this is still uncertain, but can probably be explained by immune dysregulation. HIV infection does not appear to influence the short term outcome of GBS.

Objectives: The health and prevention benefits of antiretroviral therapies (ART), delivered as part of comprehensive HIV care programs remain unrealized for men who have sex with men (MSM). This multilevel study explores the correlates of drop-off from the HIV care continuum in an international study of MSM, taking into account individual and regional differences in access to and utilization of care.

Methods: We conducted a study of the continuum of HIV diagnosis and care among 6095 MSM using data collected from an international online survey of MSM conducted in 2012. In this model of the HIV treatment cascade, we treated each point along the continuum as an outcome variable. We then investigated the relationships between clinical care outcomes and a set of demographic and psychosocial factors that were hypothesized to correlate with the outcomes using bivariate and multivariable statistical techniques.

Results: Among MSM living with HIV for longer than 12 months (n=632), 50%(n=319) were virologically suppressed. Among MSM recently infected with HIV (n=91), the proportion was relatively smaller at 33%. Significant correlates of being on ART and retained in care included: accessibility of HIV treatment; comfort with a healthcare provider; and engagement in a gay community. Perceptions of homophobia were negatively associated with being on ART and being retained in care.

Conclusions: These findings underscore the need for service delivery models that sensitively address HIV among MSM. Public health officials should adopt comprehensive HIV programs that include mutually reinforcing components and that address varying needs of MSM newly diagnosed and living with HIV. Comprehensive HIV programs must also support the critical role communities play in linking and retaining MSM into HIV services. Further studies validating the findings in country-specific contexts are warranted.

Background: Studies of Antiretroviral Therapy program in Africa have shown high incidence rate of opportunistic infections in both Antiretroviral Therapy receiving and Pre ART Human Immunodeficiency Virus infected patients. However, incidence of opportunistic infections and factors that contribute for development of it were poorly described in Ethiopia especially in the study area.

Objective: To determine the effect of HAART on incidence rate of opportunistic infections among HIV-positive adults in Public Health facilities of Arba Minch town. Method: Retrospective cohort study was used and the required sample size was 464. Study participants were selected randomly from the list of adult people living with HIV attending the public health facilities for ART. Univariate analysis was used to describe patients’ baseline and follow up characteristics. Kaplan-Meier survival and log rank test were used to estimate survival and compare survival curves respectively. Cox proportional-hazard regression model was used to determine independent predictors of incidence of opportunistic infections.

Result: A total of 464 patients (232 in each cohort) contribute for 898.12 person years of follow up. The incidence of opportunistic infections was 55.8 per 100 person year and 3.4 per 100 person year of follow up in pre ART and HAART cohorts respectively. Being on HAART decreased occurrence of opportunistic infections by 93%. In contrary being male, being widowed, substance use, rural residence and having baseline CD4 count of 350-499 cells/μl are independent predictors of increased risk of opportunistic infections.

Conclusion: The incidence of opportunistic infection was higher in pre ART cohort. Male gender, being widowed, substance use, rural residence and having baseline CD4 count of 350-499 cells/μl were independent predictors of increased risk of opportunistic infections.

Background: United Kingdom has reported the largest documented outbreak of lymphogranuloma venereum (LGV), a re-emerging sexually transmitted infection (STI) which is primarily seen in HIV-positive men who have sex with men (MSM). A diagnostic service was established in response to the outbreak linked to a voluntary LGV Enhanced Surveillance system. We examined the performance of this novel surveillance system to identify utility in tracking a re-emerging infection.

Methods: We described laboratory data on samples and surveillance data from case reports for LGV from 2004- 2010. We performed a cross-sectional analysis comparing clinical and behavioural characteristics of HIV-positive and HIV-negative/unknown LGV cases diagnosed in MSM using multivariable logistic regression models with generalised estimating equations to control for repeat infections.

Results: LGV Surveillance data were available for 87% (1,370/1,581) of LGV cases (after de-duplication). There were 1,342 episodes in 1,281 MSM, most of whom were known to be HIV-positive (1,028/1,281, 80.2%,). HIV-positive men reported a shorter duration of symptoms (aOR 0.5; 95%CI 0.3, 0.8 for reporting more than a week compared to a week or less) in comparison to HIV-negative/unknown MSM, and were more likely to report unprotected receptive anal intercourse (aOR 2.7; 95% CI 1.3, 5.8).

Conclusion: The surveillance identified the population at greater risk of infection based on higher levels of risk behaviour in HIV-positive LGV cases. However, there was diagnostic bias towards HIV-positive LGV cases who presented with a shorter duration of symptoms when compared to HIV-negative/unknown LGV cases.

Introduction: Dyslipidemia is becoming one of the common problems in human immunodeficiency virus infected patients receiving antiretroviral therapy. Data on lipid profile derangements induced by antiretroviral treatment in Ethiopia is scarce. The aim of this study was to assess the prevalence and patterns of lipid profile abnormalities among patients taking first line antiretroviral therapy in Tikur Anbesa hospital, Addis Ababa, Ethiopia.

Methods: comparative cross sectional study was conducted between August and December 2012 in Tikur Anbesa Specialized Hospital in Addis Ababa. The study population consisted of 70 HIV positive individuals who had been receiving first line ART regimen for at least 6 months (treatment group) and 71 individuals with diagnosed HIV infection and who were not yet receiving antiretroviral therapy. An interviewer administered structured questionnaire was used to collect information. Lipid profile was determined after overnight fasting and dyslipidemia was diagnosed according to the United State National Cholesterol Education Program III criteria. Data comparison used chi-square test, Student t-test and logistic regressions.

Result: The prevalence of dyslipidemia was higher in antiretroviral treatment group (80%) as compared to antiretroviral treatment naïve groups (57.7%). Total cholesterol >200 mg/dL was 45.7% in Antiretroviral Therapy groups and 21.1% in Antiretroviral Therapy naïve groups. Similarly low density lipoprotein cholesterol > 130 mg/dL was 40% vs 29.6%, triglyceride >150 mg/dL; 40% vs 32.4%, and high density lipoprotein cholesterol <40; 22.9% vs 16.9% in Antiretroviral Therapy and Antiretroviral Therapy naïve groups respectively, showing more lipid alteration in ART group. Use of ART was also significantly associated with high total cholesterol (>200 mg/dL) (p<0.002), total cholesterol / high density lipoprotein cholesterol ratio >5(P<0.026), an established risk indicator of coronary artery disease and triglyceride / high density lipoprotein cholesterol ratio > 2.4(p<0.036).

Conclusion: Higher prevalence of dyslipidemia was observed among Antiretroviral Therapy treated groups as compared to ART naïve groups. Therefore lipid profiles should be screened in Antiretroviral Therapy treated populations periodically to monitor any changes in lipid profile.