A paediatric and perinatal HIV/AIDS leadership initiative in Kingston, Jamaica.

PubMed

Christie, C D C

2004-10-01

In Jamaica 1-2% of pregnant women are HIV-positive; 876 HIV-positive pregnant women will deliver and at least 283 newly infected HIV-infected infants will be born in 2003; HIV/AIDS is the leading cause of death in children aged one to four years. We describe a collaborative "Town and Gown" programme to address the paediatric and perinatal HIV epidemic in Kingston. A team of academic and government healthcare personnel, comprising paediatricians, obstetricians, public health practitioners, nurses, microbiologists, data management and information technology personnel collaborated to address this public health emergency. A five-point plan was implemented This comprised leadership and training of a core group of paediatric/perinatal HIVprofessionals to serve Greater Kingston and St Catherine and be a model for the rest of Jamaica. Mother-to-child transmission of HIV/AIDS is prevented by counselling and HIV-testing women in the antenatal clinics, giving azidothymidine (AZT) to HIV pregnant women beginning at 28 weeks gestation, throughout labour and to the HIV-exposed infants for the first six weeks of life. A unified parallel programme for identifying the HIV-infected infant and delivering paediatric HIV care at the major paediatric centres was implemented In three years, over 30,000 pregnant women are being tested for HIV; 600 HIV-exposed babies are being identified and about 140 paediatric HIV infections will be prevented The team is building research capacity which emphasizes a strong outcomes-based research agenda and implementation of clinical trials. We are collaborating, locally, regionally and internationally. Collaboratively, the mission of reducing mother-to-child transmission of HIV/AIDS and improving the quality of life for those already living and affected by HIV/AIDS can be achieved.

Perinatal transmission of human papilomavirus DNA

PubMed Central

Rombaldi, Renato L; Serafini, Eduardo P; Mandelli, Jovana; Zimmermann, Edineia; Losquiavo, Kamille P

2009-01-01

of HPV-DNA and the immunodepression of maternal variables (HIV, p = 0.007). Finally, the study suggests that perinatal transmission of HPV-DNA occurred in 24.5% (n = 12/49) of the cases studied. PMID:19545396

Childhood adversity increases the risk of onward transmission from perinatal HIV-infected adolescents and youth in South Africa.

PubMed

Kidman, Rachel; Nachman, Sharon; Dietrich, Janan; Liberty, Afaaf; Violari, Avy

2018-05-01

Repeated exposure to childhood adversity (abuse, neglect and other traumas experienced before age 18) can have lifelong impacts on health. For HIV-infected adolescents and youth, such impacts may include onward transmission of HIV. To evaluate this possibility, the current study measured the burden of childhood adversity and its influence on risky health behaviors among perinatally-infected adolescents and youth. We surveyed 250 perinatally-infected adolescents and youth (13-24 years) receiving care in Soweto, South Africa. Both male and female participants reported on childhood adversity (using the ACE-IQ), sexual behavior, and psychosocial state. Viral load was also abstracted from their charts. We used logistic regressions to test the association between cumulative adversity and behavioral outcomes. Half the sample reported eight or more adversities. Overall, 72% experienced emotional abuse, 59% experienced physical abuse, 34% experienced sexual abuse, 82% witnessed domestic violence, and 91% saw someone being attacked in their community. A clear gradient emerged between cumulative adversities and behavioral risk. Having experienced one additional childhood adversity raised the odds of risky sexual behavior by almost 30% (OR 1.27, 95% CI 1.09-1.48). Viral suppression was poor overall (31% had viral loads >400 copies/ml), but was not related to adversity. Adversity showed a robust relationship to depression and substance abuse. Childhood adversity is common, influences the current health of HIV-positive adolescents and youth, and puts their sexual partners at risk for HIV infection. Greater primary prevention of childhood adversity and increased access to support services (e.g., mental health) could reduce risk taking among HIV-positive adolescents and youth. Copyright © 2018 Elsevier Ltd. All rights reserved.

Adolescents with perinatally acquired HIV: emerging behavioral and health needs for long-term survivors.

PubMed

Koenig, Linda J; Nesheim, Steven; Abramowitz, Susan

2011-10-01

Because of widespread availability of highly active antiretroviral therapy in the developed world, a large proportion of children with perinatally acquired HIV have survived to adolescence and young adulthood. Although their survival is remarkable, many now experience the long-term effects of HIV infection and its treatment. Further, as these youths have entered adolescence, more is known about the impact of normative developmental transitions on health maintenance behaviors. Although perinatally infected adolescents are healthier than they were a decade or more ago, they are significantly experienced with antiretroviral therapy, with increased virological resistance and other consequences of extended antiretroviral use. Three behavioral health challenges have been documented in the first cohort of long-term survivors: decreased medication adherence, sexual debut and accompanying pregnancy and transmission risk, and mental health problems. These issues are consistent with a developmental press for autonomy, mature sexual relationships and future planning, but must be carefully managed to preserve health. Adolescents with perinatally acquired HIV require coordinated multidisciplinary support services - including adherence support, reproductive health counseling addressing both pregnancy planning and disease transmission, and mental health and educational/vocational planning - so that they can fully benefit from treatment advances. (C) 2011 Lippincott Williams & Wilkins, Inc.

Infant feeding options, other nonchemoprophylactic factors, and mother-to-child transmission of HIV in Zambia.

PubMed

Torpey, Kwasi; Kabaso, Mushota; Weaver, Mark A; Kasonde, Prisca; Mukonka, Victor; Bweupe, Maximillian; Mukundu, Jonathan; Mandala, Justin

2012-01-01

The role of antiretroviral drugs in the prevention of mother-to-child transmission (PMTCT) of HIV is well known. The objective of this study is to explore how nonchemoprophylactic factors, including infant feeding practices, mother's HIV status disclosure, mode and place of delivery, infant gender, and maternal age, are related to MTCT. The study analyzed program data of DNA polymerase chain reaction (PCR) results from dried blood spot samples and selected client information from perinatally exposed infants aged 0 to 12 months. A total of 8237 samples were analyzed. In all, 84% of the mothers ever breast-fed their children. In instances where both mother and baby received intervention, the transmission rates of HIV were higher among those who are still breast-feeding after 6 to 12 months. Disclosure, location, and mode of delivery did not have an effect on the transmission rates of HIV when both mother and baby received prophylaxis. Nonchemoprophylaxis factors, especially breast-feeding, play a key role in perinatal transmission of HIV.

The uptake of integrated perinatal prevention of mother-to-child HIV transmission programs in low- and middle-income countries: a systematic review.

PubMed

Tudor Car, Lorainne; Brusamento, Serena; Elmoniry, Hoda; van Velthoven, Michelle H M M T; Pape, Utz J; Welch, Vivian; Tugwell, Peter; Majeed, Azeem; Rudan, Igor; Car, Josip; Atun, Rifat

2013-01-01

The objective of this review was to assess the uptake of WHO recommended integrated perinatal prevention of mother-to-child transmission (PMTCT) of HIV interventions in low- and middle-income countries. We searched 21 databases for observational studies presenting uptake of integrated PMTCT programs in low- and middle-income countries. Forty-one studies on programs implemented between 1997 and 2006, met inclusion criteria. The proportion of women attending antenatal care who were counseled and who were tested was high; 96% (range 30-100%) and 81% (range 26-100%), respectively. However, the overall median proportion of HIV positive women provided with antiretroviral prophylaxis in antenatal care and attending labor ward was 55% (range 22-99%) and 60% (range 19-100%), respectively. The proportion of women with unknown HIV status, tested for HIV at labor ward was 70%. Overall, 79% (range 44-100%) of infants were tested for HIV and 11% (range 3-18%) of them were HIV positive. We designed two PMTCT cascades using studies with outcomes for all perinatal PMTCT interventions which showed that an estimated 22% of all HIV positive women attending antenatal care and 11% of all HIV positive women delivering at labor ward were not notified about their HIV status and did not participate in PMTCT program. Only 17% of HIV positive antenatal care attendees and their infants are known to have taken antiretroviral prophylaxis. The existing evidence provides information only about the initial PMTCT programs which were based on the old WHO PMTCT guidelines. The uptake of counseling and HIV testing among pregnant women attending antenatal care was high, but their retention in PMTCT programs was low. The majority of women in the included studies did not receive ARV prophylaxis in antenatal care; nor did they attend labor ward. More studies evaluating the uptake in current PMTCT programs are urgently needed.

Mother-to-child transmission of HIV-2 infection from 1986 to 2007 in the ANRS French Perinatal Cohort EPF-CO1.

PubMed

Burgard, M; Jasseron, C; Matheron, S; Damond, F; Hamrene, K; Blanche, S; Faye, A; Rouzioux, C; Warszawski, J; Mandelbro, L

2010-10-01

Management of pregnant women with human immunodeficiency virus (HIV) type 2 infection remains unclear because of its low prevalence and important differences from HIV-1. Pregnant women monoinfected with HIV-2 or HIV-1 and their infants enrolled in the prospective, national, multicenter French Perinatal Cohort between 1986 and 2007. Overall, 2.6% (223/8660) of mothers were infected with HIV-2, and they accounted for 3.1% (367/ 11841) of the total births. Most were born in sub-Saharan Africa. A higher proportion of HIV-2-infected mothers than HIV-1-infected mothers had no symptoms, had received no antiretroviral therapy at conception (85.9% vs 66.7%), and had received no antiretroviral therapy during pregnancy (42.8% vs 19.9%), particularly highly active antiretroviral therapy (HAART) (79.7% vs 46.1%), and they had higher CD4 cell counts near delivery (median, 574 vs 452 cells/mm3; P < .01). If antiretroviral therapy was used, it was started at a later gestational age for HIV- 2-infected mothers (median, 28 vs 25 weeks; P < .01). HIV-2-infected mothers were more likely to deliver vaginally (67.9% vs 49.3%) and to breastfeed (3.6% vs 0.6%; P < .01), and their infants less frequently received postexposure prophylaxis. In the period 2000-2007, the proportion with viral load <100 copies/mL at delivery was 90.5% of HIV-2-infected mothers, compared with 76.2% of HIV-1-infected mothers (P=.1). There were 2 cases of transmission: 1 case in 1993 occurred following maternal primary infection, and the other case occurred postnatally in 2002 and involved a mother with severe immune deficiency. The mother-to-child transmission rate for HIV-2 was 0.6% (95% confidence interval, 0.07%-2.2%). Care for HIV-2-infected pregnant women rests on expert opinion. The mother-to-child transmission residual rate (0.07%-2.2%) argues for systematic treatment: protease inhibitor-based HAART for women requiring antiretrov

Substance Use and the Development of Sexual Risk Behaviors in Youth Perinatally Exposed to HIV

PubMed Central

Bauermeister, José A.; Santamaria, E. Karina; Dolezal, Curtis; Mellins, Claude A.

2015-01-01

Objective To examine the longitudinal association between sexual behavior and substance use in perinatally HIV-infected (PHIV+) and perinatally HIV-exposed-but-uninfected (PHIV−) youth. Methods Growth curve modeling was used with data from N = 340 PHIV-exposed youth (60.6% PHIV+; 9–22 years) to estimate the onset of penetrative and unprotected sex across time, adding alcohol and marijuana use trajectories as time-varying covariates and examining HIV-status differences. Results The odds of penetrative or unprotected sex more than doubled across time. Alcohol and marijuana use significantly increased the odds of engaging in sex and unprotected sex, with no HIV-status differences. The association between unprotected sex and alcohol use was less salient for PHIV+ than PHIV− youth. Conclusions Similar to youth from other populations, PHIV+ and PHIV− youth are increasingly engaging in sex and substance use as they age. Targeted interventions to prevent sexual risk behavior and further HIV transmission should address the influence of substance use. PMID:25476800

Maternal HIV-1 envelope–specific antibody responses and reduced risk of perinatal transmission

PubMed Central

Permar, Sallie R.; Fong, Youyi; Vandergrift, Nathan; Fouda, Genevieve G.; Gilbert, Peter; Parks, Robert; Jaeger, Frederick H.; Pollara, Justin; Martelli, Amanda; Liebl, Brooke E.; Lloyd, Krissey; Yates, Nicole L.; Overman, R. Glenn; Shen, Xiaoying; Whitaker, Kaylan; Chen, Haiyan; Pritchett, Jamie; Solomon, Erika; Friberg, Emma; Marshall, Dawn J.; Whitesides, John F.; Gurley, Thaddeus C.; Von Holle, Tarra; Martinez, David R.; Cai, Fangping; Kumar, Amit; Xia, Shi-Mao; Lu, Xiaozhi; Louzao, Raul; Wilkes, Samantha; Datta, Saheli; Sarzotti-Kelsoe, Marcella; Liao, Hua-Xin; Ferrari, Guido; Alam, S. Munir; Montefiori, David C.; Denny, Thomas N.; Moody, M. Anthony; Tomaras, Georgia D.; Gao, Feng; Haynes, Barton F.

2015-01-01

Despite the wide availability of antiretroviral drugs, more than 250,000 infants are vertically infected with HIV-1 annually, emphasizing the need for additional interventions to eliminate pediatric HIV-1 infections. Here, we aimed to define humoral immune correlates of risk of mother-to-child transmission (MTCT) of HIV-1, including responses associated with protection in the RV144 vaccine trial. Eighty-three untreated, HIV-1–transmitting mothers and 165 propensity score–matched nontransmitting mothers were selected from the Women and Infants Transmission Study (WITS) of US nonbreastfeeding, HIV-1–infected mothers. In a multivariable logistic regression model, the magnitude of the maternal IgG responses specific for the third variable loop (V3) of the HIV-1 envelope was predictive of a reduced risk of MTCT. Neutralizing Ab responses against easy-to-neutralize (tier 1) HIV-1 strains also predicted a reduced risk of peripartum transmission in secondary analyses. Moreover, recombinant maternal V3–specific IgG mAbs mediated neutralization of autologous HIV-1 isolates. Thus, common V3-specific Ab responses in maternal plasma predicted a reduced risk of MTCT and mediated autologous virus neutralization, suggesting that boosting these maternal Ab responses may further reduce HIV-1 MTCT. PMID:26053661

The Uptake of Integrated Perinatal Prevention of Mother-to-Child HIV Transmission Programs in Low- and Middle-Income Countries: A Systematic Review

PubMed Central

Tudor Car, Lorainne; Brusamento, Serena; Elmoniry, Hoda; van Velthoven, Michelle H. M. M. T.; Pape, Utz J.; Welch, Vivian; Tugwell, Peter; Majeed, Azeem; Rudan, Igor; Car, Josip; Atun, Rifat

2013-01-01

Background The objective of this review was to assess the uptake of WHO recommended integrated perinatal prevention of mother-to-child transmission (PMTCT) of HIV interventions in low- and middle-income countries. Methods and Findings We searched 21 databases for observational studies presenting uptake of integrated PMTCT programs in low- and middle-income countries. Forty-one studies on programs implemented between 1997 and 2006, met inclusion criteria. The proportion of women attending antenatal care who were counseled and who were tested was high; 96% (range 30–100%) and 81% (range 26–100%), respectively. However, the overall median proportion of HIV positive women provided with antiretroviral prophylaxis in antenatal care and attending labor ward was 55% (range 22–99%) and 60% (range 19–100%), respectively. The proportion of women with unknown HIV status, tested for HIV at labor ward was 70%. Overall, 79% (range 44–100%) of infants were tested for HIV and 11% (range 3–18%) of them were HIV positive. We designed two PMTCT cascades using studies with outcomes for all perinatal PMTCT interventions which showed that an estimated 22% of all HIV positive women attending antenatal care and 11% of all HIV positive women delivering at labor ward were not notified about their HIV status and did not participate in PMTCT program. Only 17% of HIV positive antenatal care attendees and their infants are known to have taken antiretroviral prophylaxis. Conclusion The existing evidence provides information only about the initial PMTCT programs which were based on the old WHO PMTCT guidelines. The uptake of counseling and HIV testing among pregnant women attending antenatal care was high, but their retention in PMTCT programs was low. The majority of women in the included studies did not receive ARV prophylaxis in antenatal care; nor did they attend labor ward. More studies evaluating the uptake in current PMTCT programs are urgently needed. PMID:23483887

[Results of the implementation of three national guidelines for the prevention of HIV vertical transmission in Instituto Nacional Materno Perinatal. Lima, Peru].

PubMed

Velásquez, Carlos

2011-01-01

A retrospective analysis is performed in three successive periods between the years 1996 and 2009, in order to evaluate the impact of the implementation of three national guidelines for the prevention of the vertical transmission of HIV. 275 births were included in 13 years. Significant statistical differences were found in the percentage of HIV cases in the children exposed to the virus between the three periods: 15% during the period in which only zidovudine (AZT) was administered to the pregnant woman, 6.4% during the second period (administration of AZT to the pregnant woman not fulfilling HAART initiation criteria and HAART to those fulfilling criteria for this treatment), and 4% during the third period in which HAART was applied to all pregnant women with HIV infection. 95% of pregnant women ended their pregnancy by cesarean section and the 100% of children received infant formula. Changes made in national guidelines have produced a positive impact in the decrease of HIV infected children in the Instituto Nacional Materno Perinatal in Peru.

Interim outcomes for a community-based program to prevent perinatal HIV transmission.

PubMed

Santelli, J S; Celentano, D D; Rozsenich, C; Crump, A D; Davis, M V; Polacsek, M; Augustyn, M; Rolf, J; McAlister, A L; Burwell, L

1995-06-01

The AIDS Prevention for Pediatric Life Enrichment (APPLE) project is a community-based program to prevent perinatal HIV infection by preventing infection in women. One project component tested a primary prevention model developed from principles of cognitive social learning theory which used street outreach and community-targeted small media materials to increase the use of condoms. Formative research was used to explore community perceptions about HIV/AIDS and to design media materials. Program evaluation employed a two-community, time series, quasi-experimental design. Annual street surveys samples individuals in areas where they were likely to encounter outreach workers. Baseline surveys found substantial pre-programmatic behavior change. After two years considerable APPLE name recognition (40%), contact with media materials (63%), and contact with outreach workers (36%) were found and norms reflecting social acceptability of condoms were more positive among women in the intervention community. Condom use at last sexual encounter rose in both communities but was significantly higher in the intervention community. Condom use also was higher among women who reported exposure to either small media or small media plus street outreach. Other self-reported HIV-prevention behaviors did not show change in the initial period.

Neurometabolite Alterations Associated With Cognitive Performance in Perinatally HIV-Infected Children.

PubMed

Van Dalen, Yvonne W; Blokhuis, Charlotte; Cohen, Sophie; Ter Stege, Jacqueline A; Teunissen, Charlotte E; Kuhle, Jens; Kootstra, Neeltje A; Scherpbier, Henriette J; Kuijpers, Taco W; Reiss, Peter; Majoie, Charles B L M; Caan, Matthan W A; Pajkrt, Dasja

2016-03-01

Despite treatment with combination antiretroviral therapy (cART), cognitive impairment is still observed in perinatally HIV-infected children. We aimed to evaluate potential underlying cerebral injury by comparing neurometabolite levels between perinatally HIV-infected children and healthy controls. This cross-sectional study evaluated neurometabolites, as measured by Magnetic Resonance Spectroscopy (MRS), in perinatally HIV-infected children stable on cART (n = 26) and healthy controls (n = 36).Participants were included from a cohort of perinatally HIV-infected children and healthy controls, matched group-wise for age, gender, ethnicity, and socio-economic status. N-acetylaspartate (NAA), glutamate (Glu), myo-inositol (mI), and choline (Cho) levels were studied as ratios over creatine (Cre). Group differences and associations with HIV-related parameters, cognitive functioning, and neuronal damage markers (neurofilament and total Tau proteins) were determined using age-adjusted linear regression analyses.HIV-infected children had increased Cho:Cre in white matter (HIV-infected = 0.29 ± 0.03; controls = 0.27 ± 0.03; P value = 0.045). Lower nadir CD4+ T-cell Z-scores were associated with reduced neuronal integrity markers NAA:Cre and Glu:Cre. A Centers for Disease Control and Prevention (CDC) stage C diagnosis was associated with higher glial markers Cho:Cre and mI:Cre. Poorer cognitive performance was mainly associated with higher Cho:Cre in HIV-infected children, and with lower NAA:Cre and Glu:Cre in healthy controls. There were no associations between neurometabolites and neuronal damage markers in blood or CSF.Compared to controls, perinatally HIV-infected children had increased Cho:Cre in white matter, suggestive of ongoing glial proliferation. Levels of several neurometabolites were associated with cognitive performance, suggesting that MRS may be a useful method to assess cerebral changes potentially linked to cognitive outcomes.

HIV Transmission

PubMed Central

Shaw, George M.; Hunter, Eric

2012-01-01

HIV-1 is transmitted by sexual contact across mucosal surfaces, by maternal-infant exposure, and by percutaneous inoculation. For reasons that are still incompletely understood, CCR5-tropic viruses (R5 viruses) are preferentially transmitted by all routes. Transmission is followed by an orderly appearance of viral and host markers of infection in the blood plasma. In the acute phase of infection, HIV-1 replicates exponentially and diversifies randomly, allowing for an unambiguous molecular identification of transmitted/founder virus genomes and a precise characterization of the population bottleneck to virus transmission. Sexual transmission of HIV-1 most often results in productive clinical infection arising from a single virus, highlighting the extreme bottleneck and inherent inefficiency in virus transmission. It remains to be determined if HIV-1 transmission is largely a stochastic process whereby any reasonably fit R5 virus can be transmitted or if there are features of transmitted/founder viruses that facilitate their transmission in a biologically meaningful way. Human tissue explant models of HIV-1 infection and animal models of SIV/SHIV/HIV-1 transmission, coupled with new challenge virus strains that more closely reflect transmitted/founder viruses, have the potential to elucidate fundamental mechanisms in HIV-1 transmission relevant to vaccine design and other prevention strategies. PMID:23043157

Factors associated with mother-to-child transmission of HIV-1 despite a maternal viral load <500 copies/ml at delivery: a case-control study nested in the French perinatal cohort (EPF-ANRS CO1).

PubMed

Tubiana, Roland; Le Chenadec, Jerome; Rouzioux, Christine; Mandelbrot, Laurent; Hamrene, Karima; Dollfus, Catherine; Faye, Albert; Delaugerre, Constance; Blanche, Stephane; Warszawski, Josiane

2010-02-15

The rate of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) type 1 is as low as 0.5% in non-breast-feeding mothers who delivered at term while receiving antiretroviral therapy with a plasma viral load <500 copies/mL. This situation accounted for 20% of the infected children born during the period 1997-2006 in the French Perinatal Cohort. We aimed to identify factors associated with such residual transmission risk. We performed a case-control study nested in the aforementioned subpopulation of the French Perinatal Cohort. Nineteen case patients (transmitters) and 60 control subjects (nontransmitters) were included. Case patients and control subjects did not differ by geographical origin, gestational age at HIV diagnosis, type of antiretroviral therapy received, or elective Cesarean delivery. Case patients were less often receiving treatment at the time that they conceived pregnancy than control subjects (16% vs 45%; P=.017). A lower proportion of case patients had a viral load <500 copies/mL, compared with control subjects, at 14 weeks (0% vs 38.1%; P=.02), 28 weeks (7.7% vs 62.1%; P=.005), and 32 weeks: (21.4% vs 71.1%; P=.004). The difference remained significant when we restricted analysis to the 10 of 16 intrapartum transmission cases. In a multivariate analysis at 30+/-4 weeks adjusted for viral load, CD4(+) T cell count, and time at antiretroviral therapy initiation, viral load was the only factor independently associated with MTCT of HIV (adjusted odds ratio, 23.2; 95% confidence interval, 3.5-553; P<.001). Early and sustained control of viral load is associated with a decreasing residual risk of MTCT of HIV-1. Guidelines should take into account not only CD4(+) T cell count and risk of preterm delivery, but also baseline HIV-1 load for deciding when to start antiretroviral therapy during pregnancy.

Regional brain gray and white matter changes in perinatally HIV-infected adolescents☆

PubMed Central

Sarma, Manoj K.; Nagarajan, Rajakumar; Keller, Margaret A.; Kumar, Rajesh; Nielsen-Saines, Karin; Michalik, David E.; Deville, Jaime; Church, Joseph A.; Thomas, M. Albert

2013-01-01

Despite the success of antiretroviral therapy (ART), perinatally infected HIV remains a major health problem worldwide. Although advance neuroimaging studies have investigated structural brain changes in HIV-infected adults, regional gray matter (GM) and white matter (WM) volume changes have not been reported in perinatally HIV-infected adolescents and young adults. In this cross-sectional study, we investigated regional GM and WM changes in 16 HIV-infected youths receiving ART (age 17.0 ± 2.9 years) compared with age-matched 14 healthy controls (age 16.3 ± 2.3 years) using magnetic resonance imaging (MRI)-based high-resolution T1-weighted images with voxel based morphometry (VBM) analyses. White matter atrophy appeared in perinatally HIV-infected youths in brain areas including the bilateral posterior corpus callosum (CC), bilateral external capsule, bilateral ventral temporal WM, mid cerebral peduncles, and basal pons over controls. Gray matter volume increase was observed in HIV-infected youths for several regions including the left superior frontal gyrus, inferior occipital gyrus, gyrus rectus, right mid cingulum, parahippocampal gyrus, bilateral inferior temporal gyrus, and middle temporal gyrus compared with controls. Global WM and GM volumes did not differ significantly between groups. These results indicate WM injury in perinatally HIV-infected youths, but the interpretation of the GM results, which appeared as increased regional volumes, is not clear. Further longitudinal studies are needed to clarify if our results represent active ongoing brain infection or toxicity from HIV treatment resulting in neuronal cell swelling and regional increased GM volume. Our findings suggest that assessment of regional GM and WM volume changes, based on VBM procedures, may be an additional measure to assess brain integrity in HIV-infected youths and to evaluate success of current ART therapy for efficacy in the brain. PMID:24380059

Knowledge, attitudes, and practices regarding antiretroviral management, reproductive health, sexually transmitted infections, and sexual risk behavior among perinatally HIV-infected youth in Thailand.

PubMed

Lolekha, Rangsima; Boon-Yasidhi, Vitharon; Leowsrisook, Pimsiri; Naiwatanakul, Thananda; Durier, Yuitiang; Nuchanard, Wipada; Tarugsa, Jariya; Punpanich, Warunee; Pattanasin, Sarika; Chokephaibulkit, Kulkanya

2015-01-01

More than 30% of perinatally HIV-infected children in Thailand are 12 years and older. As these youth become sexually active, there is a risk that they will transmit HIV to their partners. Data on the knowledge, attitudes, and practices (KAP) of HIV-infected youth in Thailand are limited. Therefore, we assessed the KAP of perinatally HIV-infected youth and youth reporting sexual risk behaviors receiving care at two tertiary care hospitals in Bangkok, Thailand and living in an orphanage in Lopburi, Thailand. From October 2010 to July 2011, 197 HIV-infected youth completed an audio computer-assisted self-interview to assess their KAP regarding antiretroviral (ARV) management, reproductive health, sexual risk behaviors, and sexually transmitted infections (STIs). A majority of youth in this study correctly answered questions about HIV transmission and prevention and the importance of taking ARVs regularly. More than half of the youth in this study demonstrated a lack of family planning, reproductive health, and STI knowledge. Girls had more appropriate attitudes toward safe sex and risk behaviors than boys. Although only 5% of the youth reported that they had engaged in sexual intercourse, about a third reported sexual risk behaviors (e.g., having or kissing boy/girlfriend or consuming an alcoholic beverage). We found low condom use and other family planning practices, increasing the risk of HIV and/or STI transmission to sexual partners. Additional resources are needed to improve reproductive health knowledge and reduce risk behavior among HIV-infected youth in Thailand.

Oral lesions in HIV+/AIDS adolescents perinatally infected undergoing HAART.

PubMed

Gaitán-Cepeda, Luis-Alberto; Domínguez-Sánchez, Anitza; Pavía-Ruz, Noris; Muñoz-Hernández, Rocío; Verdugo-Díaz, Roberto; Valles-Medina, Ana-María; Meráz-Acosta, Héctor

2010-07-01

To assess the prevalence of the oral lesions related to HIV-infection (HIV-OL) in HIV+/AIDS adolescents (=13 years old), and the differences with HIV+/AIDS children (=3 - <13 years old) perinatally infected. 25 HIV+/AIDS adolescents and 62 HIV+/AIDS children, undergoing Highly Active Antiretroviral Therapy, were orally examined. HIV-OL was diagnosed in accordance with EC-Clearinghouse-World Health Organization. The patients were classifies with respect to their immune status in relation with the CD4+ cell counts as moderately immunodeficient; mildly immunodeficient and severely immunodeficient in accordance to the revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years (CDC-USA). The virological status was established in relation to the copies of RNA-HIV-1/mL as follows: with undetectable viral load (UDVL); with low viral load and with high viral load. A chi-square test was performed (p<0.05 IC95%). The prevalence of HIV-OL in HIV+/AIDS adolescents was 20% while in HIV/AIDS children was 30.6% (p>0.05). Oral candidiasis was the most prevalent oral lesion in both groups. Association (p<0.05) of a high prevalence of HIV-OL and oral candidiasis with a high viral load was observed in both study groups. Adolescents perinatally HIV-infected have a high prevalence of HIV-OL. Oral Candidiasis still is the most frequent oral opportunistic infection. Oral lesions could have association to viral failure in HIV+/AIDS adolescents undergoing HAART.

Executive Functioning in Children and Adolescents With Perinatal HIV Infection and Perinatal HIV Exposure.

PubMed

Nichols, Sharon L; Chernoff, Miriam C; Malee, Kathleen M; Sirois, Patricia A; Woods, Steven P; Williams, Paige L; Yildirim, Cenk; Delis, Dean; Kammerer, Betsy

2016-12-01

Executive functions (EFs) are critical for management of life activities, but few studies have evaluated EFs in children and adolescents with perinatally acquired HIV (PHIV), who are at risk for problems in academics, behavior, and medication adherence. We compared EFs in youth with PHIV and in perinatally HIV-exposed but uninfected (PHEU) youth. Four Delis-Kaplan Executive Function System (D-KEFS) subtests were administered to 173 youth with PHIV and 85 PHEU youth, aged 9 to <19 years, who were enrolled in the Pediatric HIV/AIDS Cohort Study (PHACS) Memory and Executive Functioning Study. Youth with PHIV, with or without history of a Centers for Disease Control and Prevention Class C (AIDS-defining) condition (PHIV/C [n = 45] and PHIV/non-C [n = 128], respectively), were compared with each other and with PHEU youth. Among youth with PHIV, associations with measures of current and past disease severity were evaluated using adjusted linear regression models. The PHIV/C group (mean age, 15.5 years), compared with the PHIV/non-C and PHEU groups (mean ages, 14.5 and 12.9 years, respectively), were significantly slower on the Inhibition and Color Naming/Reading Combined conditions of the Color-Word Interference subtest and made more errors on Inhibition; differences between the PHIV/C and PHEU groups persisted in adjusted models. No differences in adjusted means for fluency or problem-solving were found. The PHIV/non-C and PHEU groups did not differ on any measure. Associations of specific EF measures with HIV RNA viral load, CD4-positive T-lymphocyte percentage, and age at greatest disease severity were observed. Youth with PHIV and previous AIDS-defining conditions performed more poorly on some EF measures. Relationships of EF development with the degree and timing of disease severity require further study. Implications for long-term outcomes and interventions are important avenues for follow-up. © The Author 2016. Published by Oxford University Press on behalf of

A cross-sectional study of the magnitude, barriers, and outcomes of HIV status disclosure among women participating in a perinatal HIV transmission study, "the Nevirapine Repeat Pregnancy study".

PubMed

Kiweewa, Flavia M; Bakaki, Paul M; McConnell, Michelle S; Musisi, Maria; Namirembe, Constance; Nakayiwa, Frances; Kusasira, Fiona; Nakintu, Dorothy; Mubiru, Michael C; Musoke, Philippa; Fowler, Mary Glenn

2015-09-29

HIV status disclosure is a difficult emotional task for HIV-infected persons and may create the opportunity for both social support and rejection. In this study, we evaluated the proportions, patterns, barriers and outcomes of HIV- 1 status disclosure among a group of women in Uganda. An exit interview was conducted one year post-partum for 85 HIV-infected women who participated in a study of HIV-1 transmission rates among NVP-experienced compared with NVP-naïve women in "The Nevirapine Repeat Pregnancy (NVP-RP) Study" at the Makerere University-Johns Hopkins University Research Collaboration, Kampala-Uganda, between June 2004 and June 2006. Of the 85 women interviewed, 99 % had disclosed their HIV status to at least one other person. Disclosure proportions ranged between 1 % to employer(s) and 69 % to a relative other than a parent. Only 38 % of the women had disclosed to their sex partners. Women with an HIV-infected baby were more likely than those with an uninfected baby to disclose to their sex partner, OR 4.9 (95 % CI, 2.0 -11.2), and women were less likely to disclose to a partner if they had previously disclosed to another relative than if they had not, OR 0.19 (95 % CI, 0.14-0.52). The most common reasons for non-disclosure included fear of separation from the partner and subsequent loss of financial support 34 %, and not living with the partner (not having opportunities to disclose) 26 %. While most women (67 %) reported getting social support following disclosure, 22 % reported negative outcomes (neglect, separation from their partners, and loss of financial support). Following disclosure of HIV status, 9 % of women reported that their partner (s) decided to have an HIV test. Results from this study show high overall HIV disclosure proportions and how this disclosure of HIV status can foster social support. However, proportions of disclosure specifically to male sex partners were low, which suggests the need for interventions aimed at increasing male

Stigma, Depression, and Substance Use Problems Among Perinatally HIV-Infected Youth in South Africa.

PubMed

Earnshaw, Valerie A; Kidman, Rachel C; Violari, Avy

2018-06-16

A growing population of youth who acquired HIV from their mothers are surviving into adulthood. This group is unique in that they experience both internalized stigma (due to their HIV status) and associative stigma (due to their mothers' HIV status). Results of a cross-sectional survey of 250 perinatally HIV-infected South African youth suggests that internalized stigma is associated with greater risk of depression, and associative stigma is associated with greater risk of depression and substance use problems. Interventions currently focus on internalized stigma; this study highlights the importance of also addressing associative stigma to improve outcomes among perinatally HIV-infected youth.

Reticence in disclosure of HIV infection and reasons for bereavement: impact on perinatally infected adolescents' mental health and understanding of HIV treatment and prevention in Johannesburg, South Africa.

PubMed

Woollett, Nataly; Black, Vivian; Cluver, Lucie; Brahmbhatt, Heena

2017-07-01

Survival rates of perinatally infected HIV-positive adolescents (PIA) are increasing in sub-Saharan Africa. There is a gap in understanding how disclosure and bereavement have an impact on PIA beliefs and understanding of their HIV infection and its management. In-depth interviews were conducted with 25 purposively selected adolescents aged 13-19 years from 5 public health clinics in Johannesburg, South Africa. Data were analysed using NVivo 10 using a thematic approach. PIA experience incomplete disclosure both of their HIV status and reasons for their bereavements, which limits their understanding of how they became infected, vertical transmission and prevention options like prevention of mother-to-child transmission (PMTCT). Most participants were orphaned and were experiencing complicated grieving (i.e., engaged in unresolved tasks of grieving) which had a negative impact on their mental health, and ability to accept their HIV status and adhere to treatment. PIA need improved communication regarding vertical transmission and how they became HIV-positive, as well as reasons for death of their loved ones to properly understand their HIV status and engage effectively in management. Honest communication about how relatives died and truthful engagement in the process of disclosure of HIV status is necessary to reduce stigma and complicated grieving, and improve mental health in this population.

Fetal Allostimulation of Maternal Cells: A Potential Mechanism for Perinatal HIV Transmission following Obstetrical Hemorrhage

PubMed Central

Wang, Guangwu; Izadpanah, Nazanin; Kitchen, Christina M.R.

2008-01-01

Abstract Our aim was to elucidate the mechanism by which HIV transmission is increased following obstetrical hemorrhage. We investigated whether fetal allostimulation of maternal cells, which could occur following fetal-to-maternal hemorrhage, increases proliferation, HIV replication, and cellular activation. Peripheral blood mononuclear cells (PBMCs) were collected from HIV-infected mothers and their infants to assess maternal-fetal allostimulation. Responses were compared to allostimulation with unrelated donors. Maternal and fetal cells were cocultured to assess allogeneic stimulation. Cell proliferation was measured by [3H]thymidine incorporation and cell activation was assessed via fluorochrome-labeled antibody staining and flow cytometric analysis. Virus production from HIV-infected maternal cells was quantitated by p24 enzyme-linked immunosorbent assay or by branched chain DNA assay. Allostimulation with fetal cells led to maternal cell proliferation. In women with unsuppressed viral loads, virus release was also enhanced following allostimulation of maternal cells with fetal cells. Fetal cells are capable of allogeneically stimulating maternal cells, with responses comparable to those seen following allostimulation with unrelated donors. Allostimulation of maternal cells by fetal cells results in statistically significant increases in proliferation and enhanced HIV replication, suggesting a possible physiological mechanism for mother-to-child transmission of HIV in women with obstetrical hemorrhage. PMID:19102686

Variable uptake of recommended interventions to reduce mother-to-child transmission of HIV in Australia, 1982-2005.

PubMed

Giles, Michelle L; McDonald, Ann M; Elliott, Elizabeth J; Ziegler, John B; Hellard, Margaret E; Lewin, Sharon R; Kaldor, John M

2008-08-04

To analyse the uptake of interventions known to reduce the risk of perinatal HIV transmission among Australian women with HIV infection (who knew their HIV status before delivery), and identify predictors of uptake. Retrospective analysis of perinatal HIV surveillance data in Australia. Women reported as having HIV infection and having given birth to a child (1982-2005) were identified through three mechanisms: an informal network of clinicians (1982-1993); an active surveillance program through paediatricians (since 1993); and state health department reports of children born to women newly diagnosed with HIV (since 1995). Uptake of interventions - avoidance of breastfeeding (after 1985), use of zidovudine during pregnancy (after 1994), and elective caesarean section (after 1999). Factors associated with uptake of these interventions were identified by univariate and multivariate analyses. 367 live births were reported in 291 women with HIV infection. Among the subgroup diagnosed with HIV infection before delivery, 4/255 (1.6%) elected to breastfeed (post 1985), 44/185 (24%) did not receive zidovudine (after 1994), and 41/118 (35%) did not have an elective caesarean section (after 1999). In multivariate analysis, there were significant differences in uptake of zidovudine and elective caesarean section according to year of birth and state in which the birth took place. In Australia between 1982 and 2005, uptake of interventions to reduce mother-to-child transmission of HIV was high. There were significant differences associated with use of zidovudine and mode of delivery according to location of delivery and year of birth.

Genetic analysis of human immunodeficiency virus type 1 envelope V3 region isolates from mothers and infants after perinatal transmission.

PubMed Central

Ahmad, N; Baroudy, B M; Baker, R C; Chappey, C

1995-01-01

The human immunodeficiency virus type 1 (HIV-1) sequences from variable region 3 (V3) of the envelope gene were analyzed from seven infected mother-infant pairs following perinatal transmission. The V3 region sequences directly derived from the DNA of the uncultured peripheral blood mononuclear cells from infected mothers displayed a heterogeneous population. In contrast, the infants' sequences were less diverse than those of their mothers. In addition, the sequences from the younger infants' peripheral blood mononuclear cell DNA were more homogeneous than the older infants' sequences. All infants' sequences were different but displayed patterns similar to those seen in their mothers. In the mother-infant pair sequences analyzed, a minor genotype or subtype found in the mothers predominated in their infants. The conserved N-linked glycosylation site proximal to the first cysteine of the V3 loop was absent only in one infant's sequence set and in some variants of two other infants' sequences. Furthermore, the HIV-1 sequences of the epidemiologically linked mother-infant pairs were closer than the sequences of epidemiologically unlinked individuals, suggesting that the sequence comparison of mother-infant pairs done in order to identify genetic variants transmitted from mother to infant could be performed even in older infants. There was no evidence for transmission of a major genotype or multiple genotypes from mother to infant. In conclusion, a minor genotype of maternal virus is transmitted to the infants, and this finding could be useful in developing strategies to prevent maternal transmission of HIV-1 by means of perinatal interventions. PMID:7815476

Anxiety and depression symptoms in young people with perinatally acquired HIV and HIV affected young people in England.

PubMed

Le Prevost, Marthe; Arenas-Pinto, Alejandro; Melvin, Diane; Parrott, Francesca; Foster, Caroline; Ford, Deborah; Evangeli, Michael; Winston, Alan; Sturgeon, Kate; Rowson, Katie; Gibb, Diana M; Judd, Ali

2018-08-01

Adolescents with perinatal HIV (PHIV) may be at higher risk of anxiety and depression than HIV negative young people. We investigated prevalence of anxiety and depression symptoms in 283 PHIV and 96 HIV-affected (HIV-negative) young people in England recruited into the Adolescents and Adults Living with Perinatal HIV (AALPHI) cohort. We used Hospital Anxiety and Depression Scale (HADS) scores and linear regression investigated predictors of higher (worse) scores.115 (41%) and 29 (30%) PHIV and HIV-affected young people were male, median age was 16 [interquartile range 15,18] and 16 [14,18] years and 241 (85%) and 71 (74%) were black African, respectively. There were no differences in anxiety and depression scores between PHIV and HIV-affected participants. Predictors of higher anxiety scores were a higher number of carers in childhood, speaking a language other than English at home, lower self-esteem, ever thinking life was not worth living and lower social functioning. Predictors of higher depression scores were male sex, death of one/both parents, school exclusion, lower self-esteem and lower social functioning. In conclusion, HIV status was not associated with anxiety or depression scores, but findings highlight the need to identify and support young people at higher risk of anxiety and depression.

Anxiety and depression symptoms in young people with perinatally acquired HIV and HIV affected young people in England

PubMed Central

Le Prevost, Marthe; Arenas-Pinto, Alejandro; Melvin, Diane; Parrott, Francesca; Foster, Caroline; Ford, Deborah; Evangeli, Michael; Winston, Alan; Sturgeon, Kate; Rowson, Katie; Gibb, Diana M.; Judd, Ali

2018-01-01

ABSTRACT Adolescents with perinatal HIV (PHIV) may be at higher risk of anxiety and depression than HIV negative young people. We investigated prevalence of anxiety and depression symptoms in 283 PHIV and 96 HIV-affected (HIV-negative) young people in England recruited into the Adolescents and Adults Living with Perinatal HIV (AALPHI) cohort. We used Hospital Anxiety and Depression Scale (HADS) scores and linear regression investigated predictors of higher (worse) scores.115 (41%) and 29 (30%) PHIV and HIV-affected young people were male, median age was 16 [interquartile range 15,18] and 16 [14,18] years and 241 (85%) and 71 (74%) were black African, respectively. There were no differences in anxiety and depression scores between PHIV and HIV-affected participants. Predictors of higher anxiety scores were a higher number of carers in childhood, speaking a language other than English at home, lower self-esteem, ever thinking life was not worth living and lower social functioning. Predictors of higher depression scores were male sex, death of one/both parents, school exclusion, lower self-esteem and lower social functioning. In conclusion, HIV status was not associated with anxiety or depression scores, but findings highlight the need to identify and support young people at higher risk of anxiety and depression. PMID:29502430

Knowledge and perceptions of sexual and reproductive health and HIV among perinatally HIV-infected adolescents in rural China.

PubMed

Mu, Weiwei; Zhao, Yan; Khoshnood, Kaveh; Cheng, Yuewu; Sun, Xin; Liu, Xia; Xu, Wenqing; Wang, Shuiwang; Ma, Ye; Zhang, Fujie

2015-01-01

Due to the success of highly active antiretroviral therapy, more children infected with HIV perinatally are living to adolescence. This brings new challenges on sexual and reproductive health (SRH) needs and psychosocial support specific to adolescents. To improve such efforts on long-term care of this vulnerable population, we assessed SRH and HIV knowledge and perceptions among perinatally HIV-infected adolescents (PHIVA). This descriptive cross-sectional study was conducted between July and September 2013 in a rural HIV clinic. A structured questionnaire focusing on SRH and HIV was administered to 124 PHIVA attending quarterly medical visit. Multivariable logistic regression was used to detect associated factors with knowledge acquisition. Among participants, 79% had never discussed puberty development or sexuality with parents. Over 50% had never heard of condoms and 20% reported not having any informational source of SRH and HIV knowledge. Only 5% correctly answered all questions regarding HIV knowledge and pregnancy, with 18% correctly answered questions regarding contraception. Adolescents older than age of 15 and who had been disclosed of HIV status were more likely to acquire correct knowledge of SRH and HIV. Most PHIVA did not report having access to comprehensive information on SRH and HIV, in part because of the early death of caretakers or unfavorable family status. Further integration of SRH services with HIV treatment programs is needed to provide comprehensive care for adolescents and prepare them for the transition to adult care.

Associations of low vitamin D and elevated parathyroid hormone concentrations with bone mineral density in perinatally HIV-infected children

USDA-ARS?s Scientific Manuscript database

Background: Perinatally HIV-infected (PHIV) children have, on average, lower bone mineral density (BMD) than perinatally HIV-exposed uninfected (PHEU) and healthy children. Low 25-hydroxy vitamin D [25(OH)D] and elevated parathyroid hormone (PTH) concentrations may lead to suboptimal bone accrual. ...

Cancer Among Children With Perinatal Exposure to HIV and Antiretroviral Medications--New Jersey, 1995-2010.

PubMed

Ivy, Wade; Nesheim, Steve R; Paul, Sindy M; Ibrahim, Abdel R; Chan, Miranda; Niu, Xiaoling; Lampe, Margaret A

2015-09-01

Concerns remain regarding the cancer risk associated with perinatal antiretroviral (ARV) exposure among infants. No excessive cancer risk has been found in short-term studies. Children born to HIV-infected women (HIV-exposed) in New Jersey from 1995 to 2008 were identified through the Enhanced HIV/AIDS Reporting System and cross-referenced with data from the New Jersey State Cancer Registry to identify new cases of cancer among children who were perinatally exposed to ARV. Matching of individuals in the Enhanced HIV/AIDS Reporting System to the New Jersey State Cancer Registry was conducted based on name, birth date, Social Security number, residential address, and sex using AutoMatch. Age- and sex-standardized incidence ratio (SIR) and exact 95% confidence intervals (CIs) were calculated using New Jersey (1979-2005) and US (1999-2009) cancer rates. Among 3087 children (29,099 person-years; median follow-up: 9.8 years), 4 were diagnosed with cancer. Cancer incidence among HIV-exposed children who were not exposed to ARV prophylaxis (22.5 per 100,000 person-years) did not differ significantly from the incidence among children who were exposed to any perinatal ARV prophylaxis (14.3 per 100,000 person-years). Furthermore, the number of cases observed among individuals exposed to ARV did not differ significantly from cases expected based on state (SIR = 1.21; 95% CI: 0.25 to 3.54) and national (SIR = 1.27; 95% CI: 0.26 to 3.70) reference rates. Our findings are reassuring that current use of ARV for perinatal HIV prophylaxis does not increase cancer risk. We found no evidence to alter the current federal guidelines of 2014 that recommend ARV prophylaxis of HIV-exposed infants.

"There's No Place Like Home": Perceptions of Home-Based HIV Testing in Lesotho

ERIC Educational Resources Information Center

Mantell, J. E.; DiCarlo, A. L.; Remien, R. H.; Zerbe, A.; Morris, D.; Pitt, B.; Nkonyana, J. P.; Abrams, E. J.; El-Sadr, W.

2014-01-01

HIV testing has the potential to reduce HIV transmission by identifying and counseling individuals with HIV, reducing risk behaviors, linking persons with HIV to care and earlier treatment, and reducing perinatal transmission. In Lesotho, a high HIV prevalence country in which a large proportion of the population has never tested for HIV,…

Mental health treatment patterns in perinatally HIV-infected youth and controls.

PubMed

Chernoff, Miriam; Nachman, Sharon; Williams, Paige; Brouwers, Pim; Heston, Jerry; Hodge, Janice; Di Poalo, Vinnie; Deygoo, Nagamah Sandra; Gadow, Kenneth D

2009-08-01

Youths perinatally infected with HIV often receive psychotropic medication and behavioral treatment for emotional and behavioral symptoms. We describe patterns of intervention for HIV-positive youth and youth in a control group in the United States. Three hundred nineteen HIV-positive youth and 256 controls, aged 6 to 17 years, enrolled in the International Maternal Adolescent AIDS Clinical Trials 1055, a prospective, 2-year observational study of psychiatric symptoms. One hundred seventy-four youth in the control group were perinatally exposed to HIV, and 82 youth were uninfected children living in households with HIV-positive members. Youth and their primary caregivers completed Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-referenced symptom-rating scales. Children's medication and behavioral psychiatric intervention histories were collected at entry. We evaluated the association of past or current psychiatric treatment with HIV status, baseline symptoms, and impairment by using multiple logistic regression, controlling for potential confounders. HIV-positive youth and youth in the control group had a similar prevalence of psychiatric symptoms (61%) and impairment (14% to 15%). One hundred four (18%) participants received psychotropic medications (stimulants [14%], antidepressants [6%], and neuroleptic agents [4%]), and 127 (22%) received behavioral treatment. More HIV-positive youth than youth in the control group received psychotropic medication (23% vs 12%) and behavioral treatment (27% vs 17%). After adjusting for symptom class and confounders, HIV-positive children had twice the odds of children in the control group of having received stimulants and >4 times the odds of having received antidepressants. Caregiver-reported symptoms or impairment were associated with higher odds of intervention than reports by children alone. HIV-positive children are more likely to receive mental health interventions than control-group children

Missed Opportunities for Repeat HIV Testing in Pregnancy: Implications for Elimination of Mother-to-Child Transmission in the United States.

PubMed

Liao, Caiyun; Golden, William Christopher; Anderson, Jean R; Coleman, Jenell S

2017-01-01

HIV testing is an effective intervention that is used for reducing perinatal HIV transmission. Centers for Disease Control and Prevention recommends a second HIV test during the third trimester of pregnancy for women in settings with an elevated HIV incidence (≥17 cases per 100,000 person-years). We conducted a retrospective cohort study at a single hospital in Baltimore, Maryland, to determine whether a second HIV test was done and to compare HIV retesting with mandated syphilis retesting. Of women who delivered at this hospital, 98.8% received prenatal care. Descriptive, bivariate, and multivariable analyses were performed. Among 1632 women, mean age was 27.6 years (standard deviation: 6.3), 59.6% were black, and 55.5% were single. HIV retesting was done in 28.4% of women, which was significantly less often compared with the state-mandated syphilis retesting (78.7%, p < 0.001). The odds of having an HIV retest were 15 times higher among women who received prenatal care at a teaching clinic [adjusted odds ratio (aOR): 15.58; 95% confidence interval (CI): 11.12-21.81], and they were lower among women with private insurance (aOR: 0.54, 95% CI: 0.34-0.86). The odds of having a syphilis retest were twice as high among women who received prenatal care at a faculty practice (aOR: 2.17; 95% CI: 1.53-3.09), and they were lower among women with private insurance (aOR: 0.61, 95% CI: 0.43-0.88). Emphasizing an "opt-out" HIV retesting approach through state laws may minimize risk perception, and this is one strategy that can be considered in areas of high HIV incidence to reach the goal of eliminating perinatal HIV transmission in the United States.

Lamivudine-zidovudine combination for prevention of maternal-infant transmission of HIV-1.

PubMed

Mandelbrot, L; Landreau-Mascaro, A; Rekacewicz, C; Berrebi, A; Bénifla, J L; Burgard, M; Lachassine, E; Barret, B; Chaix, M L; Bongain, A; Ciraru-Vigneron, N; Crenn-Hébert, C; Delfraissy, J F; Rouzioux, C; Mayaux, M J; Blanche, S

2001-04-25

Zidovudine reduces maternal-infant transmission of human immunodeficiency virus 1 (HIV-1) infection by two thirds. Combination antiretroviral therapies are potentially more effective prevention. To assess the safety of perinatal lamivudine-zidovudine therapy, especially in children, and its effects on viral load, acquisition of drug resistance, and maternal-infant transmission of HIV-1 in a nonbreastfeeding population. The Agence Nationale de Recherches sur le SIDA (ANRS) 075 Study, an open-label, nonrandomized intervention trial conducted in the context of an ongoing observational cohort study in 48 sites in France. A total of 445 HIV-1-infected pregnant women were enrolled as the study cohort from February 1997 to September 1998; controls consisted of 899 pregnant women who had received zidovudine monotherapy in May 1994 to February 1997 as standard care. The study cohort received lamivudine in addition to the standard Pediatric AIDS Clinical Trial Group 076 Study zidovudine prophylaxis regimen. Lamivudine was initiated in women at 32 weeks' gestation through delivery at 150 mg twice per day orally; children received lamivudine, 2 mg/kg twice per day for 6 weeks. HIV-1 infection status and tolerance of therapy in children through age 18 months; maternal plasma HIV-1 RNA levels through 6 weeks after delivery. The transmission rate in the study group was 1.6% (7/437; 95% confidence interval [CI], 0.7%-3.3%). In a multivariable analysis, transmission in the study group was 5-fold lower than in controls. In the study group, maternal plasma HIV-1 RNA level was less than 500 copies/mL at delivery in 74%; the median decrease was 1.24 (range, -1.63 to 3.40) log(10) copies/mL. The M184V lamivudine resistance mutation was detected at 6 weeks after delivery in specimens from 52 of 132 women. The most frequent serious adverse events in children were neutropenia and anemia, requiring blood transfusion in 9 children and premature treatment discontinuation in 19. Two uninfected

Intestinal Integrity Biomarkers in Early Antiretroviral-Treated Perinatally HIV-1-Infected Infants.

PubMed

Koay, Wei Li A; Lindsey, Jane C; Uprety, Priyanka; Bwakura-Dangarembizi, Mutsa; Weinberg, Adriana; Levin, Myron J; Persaud, Deborah

2018-05-12

Biomarkers of intestinal integrity (intestinal fatty acid binding protein (iFABP) and zonulin), were compared in early antiretroviral-treated, HIV-1-infected (HIV+; n=56) African infants and HIV-exposed but uninfected (HEU; n=53) controls. Despite heightened inflammation and immune activation in HIV+ infants, iFABP and zonulin levels at three months of age were not different from those in HEU infants, and largely not correlated with inflammatory and immune activation biomarkers. However, zonulin levels increased, and became significantly higher in HIV+ compared to HEU infants by five months of age despite ART-suppression. These findings have implications for intestinal integrity biomarker profiling in perinatal HIV-1 infection.

Sexual Behavior and Perceived Peer Norms: Comparing Perinatally HIV-Infected and HIV-Affected Youth

ERIC Educational Resources Information Center

Bauermeister, Jose A.; Elkington, Katherine; Brackis-Cott, Elizabeth; Dolezal, Curtis; Mellins, Claude Ann

2009-01-01

A large proportion of perinatally HIV-infected (PHIV) children are becoming adolescents and exploring their sexuality. This study explored the prevalence of sexual behaviors (kissing, touching, engaging in oral sex, or having vaginal/anal intercourse) in a sample of predominantly ethnic minority youths (N = 339; 54.1% Black and 30.4% Latino; 51%…

Concurrency and HIV transmission network characteristics among MSM with recent HIV infection.

PubMed

Pines, Heather A; Wertheim, Joel O; Liu, Lin; Garfein, Richard S; Little, Susan J; Karris, Maile Y

2016-11-28

Sexual partner concurrency is common among MSM and may increase the probability of HIV transmission during recent (acute or early) infection. We examined the relationship between concurrency and HIV transmission network characteristics (proxies for HIV transmission) among MSM with recent HIV infection. Observational study integrating behavioral, clinical, and molecular epidemiology. We inferred a partial HIV transmission network using 986 HIV-1 pol sequences obtained from HIV-infected individuals in San Diego, California (1996-2015). We further analyzed data from 285 recently HIV-infected MSM in the network who provided information on up to three sexual partners in the past 3 months, including the timing of intercourse with each partner. Concurrency was defined as sexual partners overlapping in time. Logistic and negative binomial regressions were used to investigate the link between concurrency and HIV transmission network characteristics (i.e. clustering and degree or number of connections to others in the network) among these MSM. Of recently HIV-infected MSM (n = 285), 54% reported concurrent partnerships and 54% were connected by at least one putative transmission link to others (i.e. clustered) in the network (median degree = 1.0; interquartile range: 0.0-3.0). Concurrency was positively associated with HIV transmission network clustering (adjusted odds ratio = 1.83, 95% confidence interval: 1.08, 3.10) and degree (adjusted incidence rate ratio = 1.48, 95% confidence interval: 1.02, 2.15). Our findings provide empirical evidence consistent with the hypothesis that concurrency facilitates HIV transmission during recent infection. Interventions to mitigate the impact of concurrency on HIV transmission may help curb the HIV epidemic among MSM.

Higher rates of triple-class virological failure in perinatally HIV-infected teenagers compared with heterosexually infected young adults in Europe.

PubMed

Judd, A; Lodwick, R; Noguera-Julian, A; Gibb, D M; Butler, K; Costagliola, D; Sabin, C; van Sighem, A; Ledergerber, B; Torti, C; Mocroft, A; Podzamczer, D; Dorrucci, M; De Wit, S; Obel, N; Dabis, F; Cozzi-Lepri, A; García, F; Brockmeyer, N H; Warszawski, J; Gonzalez-Tome, M I; Mussini, C; Touloumi, G; Zangerle, R; Ghosn, J; Castagna, A; Fätkenheuer, G; Stephan, C; Meyer, L; Campbell, M A; Chene, G; Phillips, A

2017-03-01

The aim of the study was to determine the time to, and risk factors for, triple-class virological failure (TCVF) across age groups for children and adolescents with perinatally acquired HIV infection and older adolescents and adults with heterosexually acquired HIV infection. We analysed individual patient data from cohorts in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE). A total of 5972 participants starting antiretroviral therapy (ART) from 1998, aged < 20 years at the start of ART for those with perinatal infection and 15-29 years for those with heterosexual infection, with ART containing at least two nucleoside reverse transcriptase inhibitors (NRTIs) and a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a boosted protease inhibitor (bPI), were followed from ART initiation until the most recent viral load (VL) measurement. Virological failure of a drug was defined as VL > 500 HIV-1 RNA copies/mL despite ≥ 4 months of use. TCVF was defined as cumulative failure of two NRTIs, an NNRTI and a bPI. The median number of weeks between diagnosis and the start of ART was higher in participants with perinatal HIV infection compared with participants with heterosexually acquired HIV infection overall [17 (interquartile range (IQR) 4-111) vs. 8 (IQR 2-38) weeks, respectively], and highest in perinatally infected participants aged 10-14 years [49 (IQR 9-267) weeks]. The cumulative proportion with TCVF 5 years after starting ART was 9.6% [95% confidence interval (CI) 7.0-12.3%] in participants with perinatally acquired infection and 4.7% (95% CI 3.9-5.5%) in participants with heterosexually acquired infection, and highest in perinatally infected participants aged 10-14 years when starting ART (27.7%; 95% CI 13.2-42.1%). Across all participants, significant predictors of TCVF were those with perinatal HIV aged 10-14 years, African origin, pre-ART AIDS, NNRTI-based initial regimens, higher pre-ART viral load and lower pre-ART CD4

Psychosocial challenges facing women living with HIV during the perinatal period in rural Uganda.

PubMed

Ashaba, Scholastic; Kaida, Angela; Coleman, Jessica N; Burns, Bridget F; Dunkley, Emma; O'Neil, Kasey; Kastner, Jasmine; Sanyu, Naomi; Akatukwasa, Cecilia; Bangsberg, David R; Matthews, Lynn T; Psaros, Christina

2017-01-01

The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being of mothers living with HIV and their children. The goal of this study was to explore psychosocial challenges experienced by women living with HIV (WLWH) during pregnancy and the postpartum. We conducted individual in-depth interviews with 20 WLWH recruited from an HIV treatment cohort study in Mbarara, Uganda as part of a larger study exploring perinatal depression. We conducted content analyses to identify themes related to challenges of WLWH during pregnancy and the postpartum. Participants had a median age of 33 years [IQR: 28-35], a median of 3 living children [IQR: 2-5], and 95% had achieved HIV-RNA suppression. Challenges were organized around the following themes: HIV -related stigma from health professionals, HIV status disclosure dilemma, unintended pregnancy and intimate partner violence, HIV and environmental structural barriers and distress and fear related to maternal and child health. Stigma centered on discrimination by health care professionals and personal shame associated with being pregnant as a WLWH. This led to difficulty engaging in HIV care, particularly when coupled with structural barriers, such as lack of transportation to clinic. Participants experienced intimate partner violence and lacked support from their partners and family members. Distress and fear about the health and uncertainty about the future of the unborn baby due to maternal deteriorating physical health was common. The perinatal period is a time of stress for WLWH. Challenges experienced by WLWH may compromise successful engagement in HIV care and may reduce quality of life for women and their children. Strategies aimed at alleviating the challenges of WLWH should involve the larger structural environment including partners, family and community member as well as policy

Psychosocial challenges facing women living with HIV during the perinatal period in rural Uganda

PubMed Central

Ashaba, Scholastic; Burns, Bridget F.; Dunkley, Emma; O’Neil, Kasey; Kastner, Jasmine; Sanyu, Naomi; Akatukwasa, Cecilia; Bangsberg, David R.

2017-01-01

The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being of mothers living with HIV and their children. The goal of this study was to explore psychosocial challenges experienced by women living with HIV (WLWH) during pregnancy and the postpartum. We conducted individual in-depth interviews with 20 WLWH recruited from an HIV treatment cohort study in Mbarara, Uganda as part of a larger study exploring perinatal depression. We conducted content analyses to identify themes related to challenges of WLWH during pregnancy and the postpartum. Participants had a median age of 33 years [IQR: 28–35], a median of 3 living children [IQR: 2–5], and 95% had achieved HIV-RNA suppression. Challenges were organized around the following themes: HIV -related stigma from health professionals, HIV status disclosure dilemma, unintended pregnancy and intimate partner violence, HIV and environmental structural barriers and distress and fear related to maternal and child health. Stigma centered on discrimination by health care professionals and personal shame associated with being pregnant as a WLWH. This led to difficulty engaging in HIV care, particularly when coupled with structural barriers, such as lack of transportation to clinic. Participants experienced intimate partner violence and lacked support from their partners and family members. Distress and fear about the health and uncertainty about the future of the unborn baby due to maternal deteriorating physical health was common. The perinatal period is a time of stress for WLWH. Challenges experienced by WLWH may compromise successful engagement in HIV care and may reduce quality of life for women and their children. Strategies aimed at alleviating the challenges of WLWH should involve the larger structural environment including partners, family and community member as well as

Predicting Arrest in a Sample of Youth Perinatally Exposed to HIV: The Intersection of HIV and Key Contextual Factors.

PubMed

Elkington, Katherine S; Peters, Zachary; Choi, C Jean; Bucek, Amelia; Leu, Cheng-Shiun; Abrams, Elaine J; Mellins, Claude A

2017-11-22

We examined the role of youth HIV status and other key factors on past-year arrest in perinatally HIV-exposed but uninfected (PHIV-) and perinatally HIV-infected (PHIV+) youth using data from a multi-site study of psychosocial behaviors in PHIV-exposed urban youth (N = 340; 61% PHIV+; 51% female; ages 9-16 at baseline). Youth and caregivers were administered 5 interviews, spanning approximately 7.5 years. Using longitudinal logistic mixed-effect models, we explored the association between past year arrest, internal [e.g., substance use disorder (SUD)] and external (e.g., neighborhood arrest rates) contextual factors, and social-regulation processes (e.g., in-school/work). Arrest rates increased from 2.6 to 19.7% across follow-ups; there were no differences in arrest over time by HIV status. In the final model, odds of arrest were greater for youth who were male, with SUD, ≥ 18 years old, with high levels of city stress, and neither in school nor employed. PHIV-exposed, urban youth have much higher rates of arrest than national samples. Lack of differences in arrest by HIV status suggests key contextual factors are more important in promoting arrest.

Heterosexual transmission of HIV in Greece.

PubMed

Roumelioutou-Karayannis, A; Nestoridou, K; Mandalaki, T; Stefanou, T; Papaevangelou, G

1988-06-01

To provide further evidence for the heterosexual transmission of the acquired immunodeficiency syndrome (AIDS) in Greece we examined 53 Greek female steady heterosexual partners of 53 anti-HIV-positive men. Human immunodeficiency virus (HIV) transmission was estimated by the detection of anti-HIV antibodies. Our results showed that 27.8% (5 of 18) of the female partners of bisexuals, 33.3% (2 of 6) of intravenous drug abusers (IVDA), and 100% (4 of 4) of those who had lived for a long time in Africa were found anti-HIV positive. In contrast, only 4% (1 of 25) of the studied sexual partners of hemophiliac carriers were found to be HIV seropositive. The use of condoms seemed to be the most important factor in reducing HIV transmission. According to our results the duration of sexual relationships and the practice of anal intercourse did not increase the possibility of seroconversion. These results confirm the heterosexual transmission of HIV. However, further studies should be conducted to evaluate the relative role of various risk factors and the overall importance of heterosexual spread of HIV infections.

Immunity to Measles, Mumps, and Rubella in US Children With Perinatal HIV Infection or Perinatal HIV Exposure Without Infection

PubMed Central

Siberry, George K.; Patel, Kunjal; Bellini, William J.; Karalius, Brad; Purswani, Murli U.; Burchett, Sandra K.; Meyer, William A.; Sowers, Sun Bae; Ellis, Angela; Van Dyke, Russell B.

2015-01-01

Background. Children with perinatal human immunodeficiency virus (HIV) infection (PHIV) may not be protected against measles, mumps, and rubella (MMR) because of impaired initial vaccine response or waning immunity. Our objectives were to estimate seroimmunity in PHIV-infected and perinatally HIV-exposed but uninfected (HEU) children and identify predictors of immunity in the PHIV cohort. Methods. PHIV and HEU children were enrolled in the Pediatric HIV/AIDS Cohort Study (PHACS) at ages 7–15 years from 2007 to 2009. At annual visits, demographic, laboratory, immunization, and clinical data were abstracted and serologic specimens collected. Most recent serologic specimen was used to determine measles seroprotection by plaque reduction neutralization assay and rubella seroprotection and mumps seropositivity by enzyme immunoassay. Sustained combination antiretroviral therapy (cART) was defined as taking cART for at least 3 months. Results. Among 428 PHIV and 221 HEU PHACS participants, the prevalence was significantly lower in PHIV children for measles seroprotection (57% [95% confidence interval {CI}, 52%–62%] vs 99% [95% CI, 96%–100%]), rubella seroprotection (65% [95% CI, 60%–70%] vs 98% [95% CI, 95%–100%]), and mumps seropositivity (59% [95% CI, 55%–64%] vs 97% [95% CI, 94%–99%]). On multivariable analysis, greater number of vaccine doses while receiving sustained cART and higher nadir CD4 percentage between last vaccine dose and serologic testing independently improved the cumulative prediction of measles seroprotection in PHIV. Predictors of rubella seroprotection and mumps seropositivity were similar. Conclusions. High proportions of PHIV-infected children, but not HEU children, lack serologic evidence of immunity to MMR, despite documented immunization and current cART. Effective cART before immunization is a strong predictor of current seroimmunity. PMID:26060291

Immunity to Measles, Mumps, and Rubella in US Children With Perinatal HIV Infection or Perinatal HIV Exposure Without Infection.

PubMed

Siberry, George K; Patel, Kunjal; Bellini, William J; Karalius, Brad; Purswani, Murli U; Burchett, Sandra K; Meyer, William A; Sowers, Sun Bae; Ellis, Angela; Van Dyke, Russell B

2015-09-15

Children with perinatal human immunodeficiency virus (HIV) infection (PHIV) may not be protected against measles, mumps, and rubella (MMR) because of impaired initial vaccine response or waning immunity. Our objectives were to estimate seroimmunity in PHIV-infected and perinatally HIV-exposed but uninfected (HEU) children and identify predictors of immunity in the PHIV cohort. PHIV and HEU children were enrolled in the Pediatric HIV/AIDS Cohort Study (PHACS) at ages 7-15 years from 2007 to 2009. At annual visits, demographic, laboratory, immunization, and clinical data were abstracted and serologic specimens collected. Most recent serologic specimen was used to determine measles seroprotection by plaque reduction neutralization assay and rubella seroprotection and mumps seropositivity by enzyme immunoassay. Sustained combination antiretroviral therapy (cART) was defined as taking cART for at least 3 months. Among 428 PHIV and 221 HEU PHACS participants, the prevalence was significantly lower in PHIV children for measles seroprotection (57% [95% confidence interval {CI}, 52%-62%] vs 99% [95% CI, 96%-100%]), rubella seroprotection (65% [95% CI, 60%-70%] vs 98% [95% CI, 95%-100%]), and mumps seropositivity (59% [95% CI, 55%-64%] vs 97% [95% CI, 94%-99%]). On multivariable analysis, greater number of vaccine doses while receiving sustained cART and higher nadir CD4 percentage between last vaccine dose and serologic testing independently improved the cumulative prediction of measles seroprotection in PHIV. Predictors of rubella seroprotection and mumps seropositivity were similar. High proportions of PHIV-infected children, but not HEU children, lack serologic evidence of immunity to MMR, despite documented immunization and current cART. Effective cART before immunization is a strong predictor of current seroimmunity. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee

Longitudinal Evaluation of Language Impairment in Youth With Perinatally Acquired Human Immunodeficiency Virus (HIV) and Youth With Perinatal HIV Exposure

PubMed Central

Redmond, Sean M.; Yao, Tzy-Jyun; Russell, Jonathan S.; Rice, Mabel L.; Hoffman, Howard J.; Siberry, George K.; Frederick, Toni; Purswani, Murli; Williams, Paige L.

2016-01-01

Background Language impairment (LI) risk is increased for perinatally acquired human immunodeficiency virus-infected (PHIV) and perinatally exposed to HIV but uninfected (PHEU) youth. This study evaluates the persistence of LI in these groups. Methods The Clinical Evaluation of Language Fundamentals was repeated on participants of the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol 18 months postbaseline. Regression models identified factors associated with change in standardized score (SC) and the resolution or development of LI. Results Of 319 participants, 112 had LI at baseline. Upon re-evaluation, SCs were highly stable and changes were similar in PHIV (n = 212) and PHEU (n = 107) participants. Those with family history of language delays had a 2.39 point lower mean increase in SCs than those without, after controlling for demographic and socioeconomic factors and baseline LI status. Among PHIV participants, CD4 count <350 cells/mm3 was associated with lower mean SC change (4.32 points), and exposure to combination antiretroviral therapy (cART) or protease inhibitors (PIs) was associated with a higher mean SC change (5.93 and 4.19 points, respectively). Initial LI was persistent in most cases (78%); 20 new cases occurred (10%). Female sex was associated with higher odds of LI resolution. Among PHIV, duration and baseline cART and history of PI use were associated with LI resolution; higher percentage of detectable viral loads before baseline was associated with lower odds of resolution. Conclusions The PHIV and PHEU youth are at risk for persistent LI, and family history of language delays was a risk factor for persistence of problems. Measures of successful HIV treatment predicted more favorable outcomes among PHIV youth. PMID:27856674

Age at Virologic Control Influences Peripheral Blood HIV Reservoir Size and Serostatus in Perinatally-Infected Adolescents

PubMed Central

Persaud, Deborah; Patel, Kunjal; Karalius, Brad; Rainwater-Lovett, Kaitlin; Ziemniak, Carrie; Ellis, Angela; Chen, Ya Hui; Richman, Douglas; Siberry, George K.; Van Dyke, Russell B.; Burchett, Sandra; Seage, George R.; Luzuriaga, Katherine

2014-01-01

Importance Combination antiretroviral therapy (cART) initiated within several weeks of HIV infection in adults limits proviral reservoirs that preclude HIV cure. Biomarkers of restricted proviral reservoirs may aid in the monitoring of HIV remission or cure. Objectives To quantify peripheral blood proviral reservoir size in perinatally HIV-infected adolescents and to identify correlates of limited proviral reservoirs. Design, Setting, and Participants A cross-sectional study including 144 perinatally HIV-infected (PHIV+) youth (median age: 14.3 years), enrolled in the US-based Pediatric HIV/AIDS Cohort Study, on durable (median: 10.2 years) cART, stratified by age at virologic control. Main Outcome and Measures The primary endpoint was peripheral blood mononuclear cell (PBMC) proviral load following virologic control at different ages. Correlations between proviral load and markers of active HIV production (HIV-specific antibodies, 2-long terminal repeat (2-LTR) circles), and markers of immune activation and inflammation were also assessed. Results Proviral reservoir size was markedly reduced in the PHIV+ youth who achieved virologic control by age 1 year (4.2 [interquartile range, 2.6-8 6] copies per 1 million PBMCs) compared to those who achieved virologic control between 1-5 years of age (19.4 [interquartile range, 5.5-99.8] copies per 1 million PBMCs) or after age 5 years (−(70.7 [interquartile range, 23.2-209.4] copies per 1 million PBMCs; P < .00l). A proviral burden <10 copies/million PBMCs was measured in 11 (79%), 20 (40%), and 13 (18%) participants with virologic control at ages <1 year, 1-5 years, and >5 years, respectively (p<0.001). Lower proviral load was associated with undetectable 2-LTR circles (p<0.001) and HIV negative or indeterminate serostatus (p<0.001), but not with concentrations of soluble immune activation markers CD14 and CD163. Conclusions and Relevance Early effective cART along with prolonged virologic suppression after perinatal HIV

HIV-1 transmission linkage in an HIV-1 prevention clinical trial

DOE Office of Scientific and Technical Information (OSTI.GOV)

Leitner, Thomas; Campbell, Mary S; Mullins, James I

2009-01-01

HIV-1 sequencing has been used extensively in epidemiologic and forensic studies to investigate patterns of HIV-1 transmission. However, the criteria for establishing genetic linkage between HIV-1 strains in HIV-1 prevention trials have not been formalized. The Partners in Prevention HSV/HIV Transmission Study (ClinicaITrials.gov NCT00194519) enrolled 3408 HIV-1 serodiscordant heterosexual African couples to determine the efficacy of genital herpes suppression with acyclovir in reducing HIV-1 transmission. The trial analysis required laboratory confirmation of HIV-1 linkage between enrolled partners in couples in which seroconversion occurred. Here we describe the process and results from HIV-1 sequencing studies used to perform transmission linkage determinationmore » in this clinical trial. Consensus Sanger sequencing of env (C2-V3-C3) and gag (p17-p24) genes was performed on plasma HIV-1 RNA from both partners within 3 months of seroconversion; env single molecule or pyrosequencing was also performed in some cases. For linkage, we required monophyletic clustering between HIV-1 sequences in the transmitting and seroconverting partners, and developed a Bayesian algorithm using genetic distances to evaluate the posterior probability of linkage of participants sequences. Adjudicators classified transmissions as linked, unlinked, or indeterminate. Among 151 seroconversion events, we found 108 (71.5%) linked, 40 (26.5%) unlinked, and 3 (2.0%) to have indeterminate transmissions. Nine (8.3%) were linked by consensus gag sequencing only and 8 (7.4%) required deep sequencing of env. In this first use of HIV-1 sequencing to establish endpoints in a large clinical trial, more than one-fourth of transmissions were unlinked to the enrolled partner, illustrating the relevance of these methods in the design of future HIV-1 prevention trials in serodiscordant couples. A hierarchy of sequencing techniques, analysis methods, and expert adjudication contributed to the linkage

Oral microbiota in youth with perinatally acquired HIV infection.

PubMed

Starr, Jacqueline R; Huang, Yanmei; Lee, Kyu Ha; Murphy, C M; Moscicki, Anna-Barbara; Shiboski, Caroline H; Ryder, Mark I; Yao, Tzy-Jyun; Faller, Lina L; Van Dyke, Russell B; Paster, Bruce J

2018-05-31

Microbially mediated oral diseases can signal underlying HIV/AIDS progression in HIV-infected adults. The role of the oral microbiota in HIV-infected youth is not known. The Adolescent Master Protocol of the Pediatric HIV/AIDS Cohort Study is a longitudinal study of perinatally HIV-infected (PHIV) and HIV-exposed, uninfected (PHEU) youth. We compared oral microbiome levels and associations with caries or periodontitis in 154 PHIV and 100 PHEU youth. Species richness and alpha diversity differed little between PHIV and PHEU youth. Group differences in average counts met the significance threshold for six taxa; two Corynebacterium species were lower in PHIV and met thresholds for noteworthiness. Several known periodontitis-associated organisms (Prevotella nigrescens, Tannerella forsythia, Aggregatibacter actinomycetemcomitans, and Filifactor alocis) exhibited expected associations with periodontitis in PHEU youth, associations not observed in PHIV youth. In both groups, odds of caries increased with counts of taxa in four genera, Streptococcus, Scardovia, Bifidobacterium, and Lactobacillus. The microbiomes of PHIV and PHEU youth were similar, although PHIV youth seemed to have fewer "health"-associated taxa such as Corynebacterium species. These results are consistent with the hypothesis that HIV infection, or its treatment, may contribute to oral dysbiosis.

Prevalence of Periodontal Diseases in a Multicenter Cohort of Perinatally HIV-Infected and HIV-exposed and Uninfected Youth

PubMed Central

Ryder, Mark I.; Yao, Tzy-Jyun; Russell, Jonathan S.; Moscicki, Anna-Barbara; Shiboski, Caroline H.

2016-01-01

Aims To compare the prevalence and severity of periodontal diseases between 180 perinatally HIV-infected (PHIV) and 118 perinatally HIV-exposed and uninfected (PHEU) youth in a cross-sectional study conducted at 11 clinical sites in the United States and Puerto Rico from the Adolescent Master Protocol (AMP) study of the Pediatric HIV/AIDS cohort study (PHACS) network. Methods Several analyses were conducted, employing the current CDC/AAP classification for periodontitis and incorporating a definition of gingivitis based on a bleeding on probing threshold, and analyses based on more detailed whole mouth, intraoral regionally, site-based, and tooth-based criteria of bleeding on probing, plaque levels, pockets depths and clinical attachment levels. Results After adjusting for plaque control habits, and behavioral and sociodemographic factors, there were no significant differences in periodontal diseases between the PHIV and PHEU youth using any of these criteria. For PHIV youth, there was no significant association between parameters of periodontal disease and current HIV status. Conclusions While no significant differences in periodontal parameters were noted between the PHIV and PHEU youth, the influence of antiretroviral therapy on merits further exploration in this cohort in a longitudinal study. PMID:27801947

Body fat distribution in perinatally HIV-infected and HIV-exposed but uninfected children in the era of highly active antiretroviral therapy: outcomes from the Pediatric HIV/AIDS Cohort Study

USDA-ARS?s Scientific Manuscript database

Associations between abnormal body fat distribution and clinical variables are poorly understood in pediatric HIV disease. Our objective was to compare total body fat and its distribution in perinatally HIV-infected and HIV-exposed but uninfected (HEU) children and to evaluate associations with clin...

Does maternal HSV-2 coinfection increase mother-to-child transmission of HIV? A systematic review.

PubMed

Sivarajah, Vishalini; Venus, Kevin; Yudin, Mark H; Murphy, Kellie E; Morrison, Steven A; Tan, Darrell Hs

2017-12-01

Reducing HIV mother-to-child transmission (MTCT) is critical to ending the HIV pandemic. Reports suggest that herpes simplex virus-2 (HSV-2), a common coinfection in HIV-infected individuals, is associated with increased MTCT, but results have been conflicting. We conducted a systematic review of observational studies to quantify the magnitude of this relationship (PROSPERO no. CRD42016043315). We searched Medline (1981 to June week 3, 2016), EMBASE (1981 to week 26, 2016), relevant conferences (2013-2016) and bibliographies of identified studies for cohort and case-control studies enrolling HIV-positive women during pregnancy or peripartum that quantified the effect of HSV-2 infection on MTCT. The primary outcome was the risk of perinatal HIV transmission associated with maternal HSV-2 status. Risk of bias was evaluated using a standardised tool, and results were meta-analysed where appropriate using a random-effects model, with studies weighted using the inverse variance method. From 2103 hits, 112 studies were considered for inclusion, and 10 were ultimately included. Of the included studies, three used a case-control design, three were retrospective cohorts and four were prospective cohorts. Risk of bias was low in three studies, moderate in six and high in one. The median sample size was 278.5 mother-infant pairs (range: 48-1513). The most common strategy for classifying maternal HSV-2 status was type-specific serology (n=6), followed by genital shedding (n=3) or genital culture (n=3), clinical diagnosis of herpes (n=2) or genital ulcer disease (n=1). Results from five studies that provided quantitative estimates of the association between HSV-2 seropositivity and MTCT were meta-analysed, yielding a pooled unadjusted OR=1.17 (95% CI=0.69 to 1.96, I 2 =58%). Three of these studies further considered key confounding variables, specifically antiretroviral use and/or viral load (n=3), and mode of delivery (n=2), yielding a pooled adjusted OR=1.57 (95% CI=1.17 to 2

Accurate and inaccurate HIV transmission beliefs, stigmatizing and HIV protection motivation in northern Thailand.

PubMed

Boer, H; Emons, P A A

2004-02-01

We assessed the relation between accurate beliefs about HIV transmission and inaccurate beliefs about HIV transmission and emotional reactions to people with AIDS (PWA) and AIDS risk groups, stigmatizing attitudes and motivation to protect from HIV. In Chiang Rai, northern Thailand, 219 respondents filled in a structured questionnaire assessing accurate and inaccurate HIV transmission beliefs, emotional reactions towards PWA and AIDS risk groups, stigmatizing attitudes and motivation to protect from HIV according to variables from Protection Motivation Theory. Complete accurate beliefs about documented modes of HIV transmission were present in 47% of the respondents, while 26% of the respondents held one or more inaccurate beliefs about HIV transmission. Incomplete beliefs about documented modes of transmission were significantly related to stigmatizing beliefs towards people with AIDS (PWA), to lower vulnerability of HIV infection and lower self-efficacy in protection. Those who held inaccurate beliefs about HIV transmission reported more fear towards PWA and homosexuals and more irritation towards PWA and commercial sex workers. Persons who held inaccurate beliefs about HIV transmission also reported more stigmatizing attitudes, perceived AIDS as less severe, perceived a lower vulnerability and were less motivated to use condoms. Results of this study suggest that inaccurate beliefs about HIV transmission are related to fear and stigmatizing and undermine HIV prevention behaviour.

Longitudinal Evaluation of Language Impairment in Youth With Perinatally Acquired Human Immunodeficiency Virus (HIV) and Youth With Perinatal HIV Exposure.

PubMed

Redmond, Sean M; Yao, Tzy-Jyun; Russell, Jonathan S; Rice, Mabel L; Hoffman, Howard J; Siberry, George K; Frederick, Toni; Purswani, Murli; Williams, Paige L

2016-12-01

Language impairment (LI) risk is increased for perinatally acquired human immunodeficiency virus-infected (PHIV) and perinatally exposed to HIV but uninfected (PHEU) youth. This study evaluates the persistence of LI in these groups. The Clinical Evaluation of Language Fundamentals was repeated on participants of the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol 18 months postbaseline. Regression models identified factors associated with change in standardized score (SC) and the resolution or development of LI. Of 319 participants, 112 had LI at baseline. Upon re-evaluation, SCs were highly stable and changes were similar in PHIV (n = 212) and PHEU (n = 107) participants. Those with family history of language delays had a 2.39 point lower mean increase in SCs than those without, after controlling for demographic and socioeconomic factors and baseline LI status. Among PHIV participants, CD4 count <350 cells/mm 3 was associated with lower mean SC change (4.32 points), and exposure to combination antiretroviral therapy (cART) or protease inhibitors (PIs) was associated with a higher mean SC change (5.93 and 4.19 points, respectively). Initial LI was persistent in most cases (78%); 20 new cases occurred (10%). Female sex was associated with higher odds of LI resolution. Among PHIV, duration and baseline cART and history of PI use were associated with LI resolution; higher percentage of detectable viral loads before baseline was associated with lower odds of resolution. The PHIV and PHEU youth are at risk for persistent LI, and family history of language delays was a risk factor for persistence of problems. Measures of successful HIV treatment predicted more favorable outcomes among PHIV youth. © The Author 2016. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

HIV-Associated Cognitive Impairment in Perinatally Infected Children: A Meta-analysis.

PubMed

Phillips, Nicole; Amos, Taryn; Kuo, Caroline; Hoare, Jacqueline; Ipser, Jonathan; Thomas, Kevin G F; Stein, Dan J

2016-11-01

Research shows, conclusively, that perinatal HIV infection has negative effects on cognitive functioning of children and adolescents. However, the extent of these cognitive impairments is unknown. Current literature does not document specific cognitive domains most affected in HIV-infected children and adolescents. To systematically review and meta-analyze the degree of cognitive impairment, and the specific cognitive domains affected, in children and adolescents with perinatally acquired HIV infection. We systematically searched 5 electronic bibliographic databases, namely: PubMed, PsychINFO, Academic Search Premier, Scopus, and WorldCat, by using a search protocol specifically designed for this study. Studies were selected on the basis of set a priori eligibility criteria. Titles, abstracts, and full texts were assessed by 2 independent reviewers. Data from included studies were extracted into Microsoft Excel by 2 independent reviewers. Twenty-two studies were identified for inclusion in the systematic review and of this, 6 studies were included in the meta-analysis. Results from the meta-analysis indicated that working memory and executive function were the domains most affected by the HIV virus. Only 27% of the included studies were suitable to enter into the meta-analysis. There was significant geographic bias in published studies, with only 32% (7/22) of included studies from sub-Saharan Africa. The evidence supports an association between HIV infection in children and adolescents and cognitive impairment in the domains of working memory, executive function and processing speed, with effect size estimates also providing some support for deficits in visual memory and visual-spatial ability. Copyright © 2016 by the American Academy of Pediatrics.

HIV rapid testing as a key strategy for prevention of mother-to-child transmission in Brazil

PubMed Central

Veloso, Valdiléa G; Bastos, Francisco I; Portela, Margareth Crisóstomo; Grinsztejn, Beatriz; João, Esau Custodio; da Silva Pilotto, Jose Henrique; Araújo, Ana Beatriz Busch; Santos, Breno Riegel; da Fonseca, Rosana Campos; Kreitchmann, Regis; Derrico, Monica; Friedman, Ruth Khalili; Cunha, Cynthia B; Morgado, Mariza Gonçalves; Saines, Karin Nielsen; Bryson, Yvonne J

2015-01-01

OBJECTIVE To assess the feasibility of HIV rapid testing for pregnant women at maternity hospital admission and of subsequent interventions to reduce perinatal HIV transmission. METHODS Study based on a convenience sample of women unaware of their HIV serostatus when they were admitted to delivery in public maternity hospitals in Rio de Janeiro and Porto Alegre, Brazil, between March 2000 and April 2002. Women were counseled and tested using the Determine HIV1/2 Rapid Test. HIV infection was confirmed using the Brazilian algorithm for HIV infection diagnosis. In utero transmission of HIV was determined using HIVDNA-PCR. There were performed descriptive analyses of sociodemographic data, number of previous pregnancies and abortions, number of prenatal care visits, timing of HIV testing, HIV rapid test result, neonatal and mother-to-child transmission interventions, by city studied. RESULTS HIV prevalence in women was 6.5% (N=1,439) in Porto Alegre and 1.3% (N=3.778) in Rio de Janeiro. In Porto Alegre most of women were tested during labor (88.7%), while in Rio de Janeiro most were tested in the postpartum (67.5%). One hundred and forty-four infants were born to 143 HIV-infected women. All newborns but one in each city received at least prophylaxis with oral zidovudine. It was possible to completely avoid newborn exposure to breast milk in 96.8% and 51.1% of the cases in Porto Alegre and Rio de Janeiro, respectively. Injectable intravenous zidovudine was administered during labor to 68.8% and 27.7% newborns in Porto Alegre and Rio de Janeiro, respectively. Among those from whom blood samples were collected within 48 hours of birth, in utero transmission of HIV was confirmed in 4 cases in Rio de Janeiro (4/47) and 6 cases in Porto Alegre (6/79). CONCLUSIONS The strategy proved feasible in maternity hospitals in Rio de Janeiro and Porto Alegre. Efforts must be taken to maximize HIV testing during labor. There is a need of strong social support to provide this

Factors influencing antiretroviral treatment suboptimal adherence among perinatally HIV-infected adolescents in Thailand

PubMed Central

Munir, Kerim; Kanabkaew, Cheeraya; Le Coeur, Sophie

2017-01-01

Background Existing studies have suggested decreased adherence and rebound in mortality in perinatally HIV-infected adolescents receiving antiretroviral therapy (ART) as compared to adults and young children. Methods We used both quantitative and qualitative approaches to identify factors influencing adherence among perinatally infected adolescents in Thailand. We analyzed data from 568 pairs of perinatally infected adolescents (aged 12–19) and their primary caregivers in the Teens Living With Antiretrovirals (TEEWA) study, a cross-sectional survey conducted in 2010–2012. We also conducted 12 in-depth interviews in 2014 with infected adolescents or their primary caregivers to elicit experiences of living with long-term ART. Results From the quantitative analysis, a total of 275 (48.4%) adolescents had evidence of suboptimal adherence based on this composite outcome: adolescents self-reported missing doses in the past 7 days, caregiver rating of overall adherence as suboptimal, or latest HIV-RNA viral load ≥1000 copies/ml. In multivariate logistic regression analysis, younger age, having grandparents or extended family members as the primary caregiver, caregiver-assessed poor intellectual ability, having a boy/girlfriend, frequent online chatting, self-reported unhappiness and easiness in asking doctors questions were significantly associated with suboptimal adherence. From the in-depth interviews, tensed relationships with caregivers, forgetfulness due to busy schedules, and fear of disclosing HIV status to others, especially boy/girlfriends, were important contributors to suboptimal adherence. Social and emotional support and counseling from peer group was consistently reported as a strong adherence-promoting factor. Conclusion Our findings highlight unique barriers of ART adherence among the perinatally infected adolescents. Future interventions should be targeted at helping adolescents to improve interpersonal relationships and build adaptive skills in

Psychosocial Implications of HIV Serostatus Disclosure to Youth with Perinatally Acquired HIV

PubMed Central

Dolezal, Curtis; Marhefka, Stephanie L.; Hoffman, Susie; Ahmed, Yasmeen; Elkington, Katherine; Mellins, Claude A.

2011-01-01

Abstract Recommendations suggest that older children and adolescents perinatally infected with HIV (PHIV+) be informed of their HIV diagnosis; however, delayed disclosure is commonly reported. This study examined the prevalence and timing of HIV disclosure to PHIV+ adolescents and the associations between the timing of disclosure and psychological functioning and other behavioral outcomes. Recruitment took place at four medical centers in New York City between December 2003 and December 2008. This sample included data from 196 PHIV+ youth and their caregivers: 50% of youth were male, 58% African American, 42% Hispanic, with a mean age of 12.71 years. According to caregiver reports, 70% of the PHIV+ youth knew their HIV diagnosis. Youths who had been told were more likely to be older; youths with a Spanish-speaking Latino caregiver and whose caregivers had a grade school education were told at an older age. Youths who had been told their HIV status were significantly less anxious than those who had not been told; there were no other differences in psychological functioning. Youths who knew their status for longer reported higher intentions to self-disclose to potential sex partners. In multivariate analyses only demographic differences associated with timing of disclosure remained. In summary, PHIV+ youth who had been told their HIV status did not show an increase of psychological problems and were more likely to have intentions to self-disclose to sexual partners. Yet, almost one third was entering puberty without important information regarding their illness. Caregivers need support to address factors impeding HIV disclosure. PMID:21323530

Factors influencing the experience of sexual and reproductive healthcare for female adolescents with perinatally-acquired HIV: a qualitative case study.

PubMed

Mwalabu, Gertrude; Evans, Catrin; Redsell, Sarah

2017-12-08

Young people living with perinatally-acquired HIV require age-appropriate support regarding sex and relationships as they progress towards adulthood. HIV affects both genders but evidence suggests that young women are particularly vulnerable to sexual abuse and more prone to engaging in sexual behaviours to meet their daily survival needs. This can result in poor sexual and reproductive health (SRH) outcomes. HIV services in Malawi provide support for young women's HIV-related clinical needs, but it is unclear whether there is sufficient provision for their SRH needs as they become adults. This paper explores the sex and relationship experiences of young women growing up with perinatally-acquired HIV in order to understand how to improve SRH care and associated outcomes. A qualitative case study approach was adopted in which each 'case' comprised a young woman (15-19 years) with perinatally acquired HIV, a nominated caregiver and service provider. Participants were purposively selected from three multidisciplinary centres providing specialised paediatric/adolescent HIV care in Malawi. Data was collected for 14 cases through in-depth interviews (i.e. a total of 42 participants) and analysed using within-case and cross-case approaches. The interviews with adolescents were based on an innovative visual method known as 'my story book' which encouraged open discussion on sensitive topics. Young women reported becoming sexually active at an early age for different reasons. Some sought a sense of intimacy, love, acceptance and belonging in these relationships, noting that they lacked this at home and/or within their peer groups. For others, their sexual activity was more functional - related to meeting survival needs. Young women reported having little control over negotiating safer sex or contraception. Their priority was preventing unwanted pregnancies yet several of the sample already had babies, and transfer to antenatal services created major disruptions in their

Changes in Substance Use Symptoms Across Adolescence in Youth Perinatally Infected with HIV

PubMed Central

Elkington, K. S.; Bauermeister, J. A.; Bucek, A.; Dolezal, C.; Leu, C. S.; Mellins, C. A.

2016-01-01

The paper utilizes data collected at three time points in a longitudinal study of perinatally HIV-infected (PHIV+) and a comparison group of perinatally exposed but HIV-uninfected (PHEU) youths in the United States (N = 325). Using growth curve modeling, the paper examines changes in substance use symptoms among PHIV+ and PHEU youths as they transition through adolescence, and assesses the individual and contextual factors associated with the rate of change in substance use symptoms. Findings indicate that substance use symptoms increased over time among PHIV+ youths, but not among PHEU youths. The rate of change in these symptoms was positively associated with an increasing number of negative life events. Study findings underscore the need for early, targeted interventions for PHIV+ youths, and interventions to reduce adversities and their deleterious effects in vulnerable populations. PMID:27371136

The global transmission network of HIV-1.

PubMed

Wertheim, Joel O; Leigh Brown, Andrew J; Hepler, N Lance; Mehta, Sanjay R; Richman, Douglas D; Smith, Davey M; Kosakovsky Pond, Sergei L

2014-01-15

Human immunodeficiency virus type 1 (HIV-1) is pandemic, but its contemporary global transmission network has not been characterized. A better understanding of the properties and dynamics of this network is essential for surveillance, prevention, and eventual eradication of HIV. Here, we apply a simple and computationally efficient network-based approach to all publicly available HIV polymerase sequences in the global database, revealing a contemporary picture of the spread of HIV-1 within and between countries. This approach automatically recovered well-characterized transmission clusters and extended other clusters thought to be contained within a single country across international borders. In addition, previously undescribed transmission clusters were discovered. Together, these clusters represent all known modes of HIV transmission. The extent of international linkage revealed by our comprehensive approach demonstrates the need to consider the global diversity of HIV, even when describing local epidemics. Finally, the speed of this method allows for near-real-time surveillance of the pandemic's progression.

Young adults perinatally infected with HIV perform more poorly on measures of executive functioning and motor speed than ethnically matched healthy controls.

PubMed

Willen, Elizabeth J; Cuadra, Anai; Arheart, Kristopher L; Post, M J D; Govind, Varan

2017-03-01

Perinatal HIV is associated with significant neurocognitive morbidities, but few studies have examined cognitive impact of early HIV infection on patients surviving to adulthood. The purpose of this study was to evaluate neurocognitive outcomes among a cohort of perinatally infected young adults. Individuals between the ages of 18 and 24 with perinatal infection were recruited for this cross-sectional study along with similarly aged healthy controls. Participants completed an MRI and brief neuropsychological assessment battery. Multivariate analysis of covariance controlling for age, gender, race/ethnicity, and education was completed to detect differences between the HIV+ and control groups. Multivariable linear regression was performed to assess HIV-associated factors potentially impacting neuropsychological findings among the HIV+ group. Twenty-nine HIV+ young adults and 13 healthy controls were included in the study. After adjusting for age and sociodemographic variables, the HIV+ group scored lower on attention/working memory (Digit Span (p = .008) and Letter-Number Sequencing (p = .038)), set-shifting (DKEFS Trail Making Test Condition 4 (p = .026) and motor speed (DKEFS Trail Making Test Condition 5 (p = .003)). For the HIV+ group, nadir CD4 was associated with better Letter-Number Sequencing score (p = .029) and use of highly active antiretroviral therapy was associated with better performance on Category Fluency (p = .040). After controlling for sociodemographic variables, executive dysfunction persists among young adults with perinatal HIV infection in comparison to controls. Future studies to further elucidate the impact of executive dysfunction on independent living and functional outcomes are indicated.

Factors Associated with the Academic Achievement of Perinatally HIV-Infected Elementary and Middle School Children

ERIC Educational Resources Information Center

Ellis, Walter L.

2004-01-01

It is well documented that perinatally HIV-infected children experience difficulty in learning as well as behavioral and social problems in the school setting. While the research is mixed on the effect of the HIV virus on behavioral and social problems, it is much clearer on the effect of this virus on learning. This exploratory study identifies…

Men's hopes, fears and challenges in engagement in perinatal health and the prevention of mother-to-child transmission of HIV in rural Kenya.

PubMed

Musoke, Pamela; Hatcher, Abigail; Rogers, Anna Joy; Achiro, Lillian; Bukusi, Elizabeth; Darbes, Lynae; Kwena, Zachary; Oyaro, Patrick; Weke, Elly; Turan, Janet M

2018-02-21

Male involvement in antenatal care has been shown to improve health outcomes for women and infants. However, little is known about how best to encourage male partners to support essential perinatal health activities. We explored men's perceptions of facilitators and barriers to involvement in antenatal care and HIV prevention including fears, hopes and challenges. Forty in-depth interviews were conducted with the male partners of HIV-positive and HIV-negative pregnant women in southwest Kenya. Most male partners believed engaging in pregnancy health-related activities was beneficial for keeping families healthy. However, thematic analysis revealed several obstacles that hindered participation. Poor couple relationship dynamics seemed negatively to influence male engagement. Some men were apprehensive that clinic staff might force them to test for HIV and disclose the results; if HIV-positive, men feared being labelled as 'victimisers' in situations of serodiscordancy, and described fears of abandonment by their wives. Some men avoided accompanying their wives, citing local culture as rationale for avoiding the 'effeminate' act of antenatal care attendance. Amidst these obstacles, some men chose to use their partners' HIV status as proxy for their own. Findings suggest that improving male engagement in essential maternal and child health-related activities will require addressing both structural and interpersonal barriers.

Dating Violence Against HIV-Infected Youth in South Africa: Associations With Sexual Risk Behavior, Medication Adherence, and Mental Health.

PubMed

Kidman, Rachel; Violari, Avy

2018-01-01

As perinatal HIV-infected youth become sexually active, the potential for onward transmission becomes an increasing concern. In other populations, intimate partner violence (IPV) is a risk factor for HIV acquisition. We build on this critical work by studying the role of IPV in facilitating onward transmission among HIV-infected youth-an important step toward effective intervention. Soweto, South Africa. Self-report surveys were completed by 129 perinatal HIV-infected female youth (aged 13-24 years). We calculated the IPV prevalence and used logistic models to capture the association between IPV and health outcomes known to facilitate onward HIV transmission (eg, risky sex, poor medication adherence, depression, and substance abuse). A fifth of perinatal HIV-infected participants reported physical and/or sexual IPV in the past year; one-third reported lifetime IPV. Childhood adversity was common and positively associated with IPV. Past-year physical and/or sexual IPV was positively correlated with high-risk sex [odds ratio (OR) = 8.96; 95% confidence interval (CI): 2.78 to 28.90], pregnancy (OR = 6.56; 95% CI: 1.91 to 22.54), poor medication adherence to antiretroviral therapy (OR = 5.37; 95% CI: 1.37 to 21.08), depression (OR = 4.25; 95% CI: 1.64 to 11.00), and substance abuse (OR = 4.11; 95% CI: 1.42 to 11.86). Neither past-year nor lifetime IPV was associated with viral load or HIV status disclosure to a partner. We find that IPV may increase risk for onward HIV transmission in perinatal HIV-infected youth by both increasing engagement in risky sexual behaviors and lowering medication adherence. HIV clinics should consider integrating primary IPV prevention interventions, instituting routine IPV screening, and collocating services for victims of violence.

Placental Mitochondrial Toxicity, Oxidative Stress, Apoptosis, and Adverse Perinatal Outcomes in HIV Pregnancies Under Antiretroviral Treatment Containing Zidovudine.

PubMed

Hernández, Sandra; Catalán-García, Marc; Morén, Constanza; García-Otero, Laura; López, Marta; Guitart-Mampel, Mariona; Milisenda, José; Coll, Oriol; Cardellach, Francesc; Gratacós, Eduard; Miró, Òscar; Garrabou, Glòria

2017-08-01

To determine whether mitochondrial, oxidative, and apoptotic abnormalities in placenta derived from HIV and combined antiretroviral therapy (cART) containing zidovudine (AZT) could be associated with adverse perinatal outcome. Cross-sectional, controlled, observational study. We studied obstetric results and mitochondrial, oxidative, and apoptotic state in placenta of 24 treated HIV-infected and 32 -uninfected pregnant women. We measured mitochondrial DNA (mtDNA) content by quantitative reverse transcriptase-polymerase chain reaction (mtND2/n18SrRNA), oxidative stress by the spectrophotometric quantification of lipid peroxidation and apoptosis by Western blot analysis of active caspase-3 respect to β-actin content and analysis of the terminal deoxynucleotidyl transferase dUTP nick end labeling. Global adverse perinatal outcome (defined as preterm delivery or/and small newborns for gestational age) was significantly increased in HIV pregnancies [or 6.7 (1.3-33.2); P < 0.05]. mtDNA content in HIV-infected women was significantly depleted (39.20% ± 2.78%) with respect to controls (0.59 ± 0.03 vs. 0.97 ± 0.07; P < 0.001). A significant 29.50% ± 9.14% increase in oxidative stress was found in placentas of HIV-infected women (23.23 ± 1.64 vs. 17.94 ± 1.03; P < 0.01). A trend toward 41.18% ± 29.41% increased apoptosis active caspase-3/β-actin was found in HIV patients (0.48 ± 0.10 vs. 0.34 ± 0.05; P = not significant), confirmed by transferase dUTP nick end labeling assay. Adverse perinatal outcome did not correlate mitochondrial, oxidative, or apoptotic findings. Placentas of HIV-infected pregnant women under AZT cART showed evidence of mtDNA depletion, increased oxidative stress levels, and apoptosis suggestive of secondary mitochondrial failure, potential base of associated adverse perinatal outcome. Despite the fact that further demonstration of causality would need new approaches and bigger sample sizes, AZT-sparing cART should be considered in the context

Effects of Perinatal HIV Infection and Early Institutional Rearing on Physical and Cognitive Development of Children in Ukraine

ERIC Educational Resources Information Center

Dobrova-Krol, Natasha A.; van IJzendoorn, Marinus H.; Bakermans-Kranenburg, Marian J.; Juffer, Femmie

2010-01-01

To study the effects of perinatal HIV-1 infection and early institutional rearing on the physical and cognitive development of children, 64 Ukrainian uninfected and HIV-infected institutionalized and family-reared children were examined (mean age = 50.9 months). Both HIV infection and institutional care were related to delays in physical and…

Viral Suppression and Resistance in a Cohort of Perinatally-HIV Infected (PHIV+) Pregnant Women

PubMed Central

Cruz, Maria Letícia; Santos, Edwiges; Benamor Teixeira, Maria de Lourdes; Poletti, Monica; Sousa, Carolina; Gouvea, Maria Isabel; Nielsen-Saines, Karin; João, Esaú

2016-01-01

Our objective was to describe viral suppression and antiretroviral (ARV) resistance mutations in an ongoing cohort of perinatally-infected HIV+ (PHIV+) pregnant women. Descriptive analysis was performed using SPSS 18.0. From 2011 to 2014, we followed 22 PHIV+ pregnant women. Median age at prenatal entry was 19 years (Interquartile range (IQR) 17.6–21.0); 86% had an AIDS diagnosis; 81% had disclosed their HIV status to partner 11. The median age at HIV diagnosis was 8.3 y (IQR 4.0–13.6), the median age at sexual debut was 16 years (IQR 14–18). At the time of prenatal care initiation, four (18%) were on their first antiretroviral treatment (ART), eight (36%) in their second regimen and nine (41%) in their third regimen or beyond, and one had no data. Seventeen of 22 (77%) had HIV-viral load (VL) > 50 copies/mL at prenatal care entry, 16 had a genotyping exam performed. Seventeen of 22 PHIV+ had VL results near delivery: 7/17 (41%) had VL < 50 copies/mL. Among those who had genotyping at prenatal entry, 11/16 (69%) had mutations associated with ARV resistance. The most frequent major mutations were K103N, M184V, T215, M41L, D67N at reverse transcriptase gene and M46, I54V and V82A at protease gene. No vertical transmissions occurred. Management of pregnancy among PHIV+ is challenging. Individualized ART are needed to achieve viral suppression in a highly ART-exposed subpopulation. PMID:27338425

Viral Suppression and Resistance in a Cohort of Perinatally-HIV Infected (PHIV+) Pregnant Women.

PubMed

Cruz, Maria Letícia; Santos, Edwiges; Benamor Teixeira, Maria de Lourdes; Poletti, Monica; Sousa, Carolina; Gouvea, Maria Isabel; Nielsen-Saines, Karin; João, Esaú

2016-06-07

Our objective was to describe viral suppression and antiretroviral (ARV) resistance mutations in an ongoing cohort of perinatally-infected HIV+ (PHIV+) pregnant women. Descriptive analysis was performed using SPSS 18.0. From 2011 to 2014, we followed 22 PHIV+ pregnant women. Median age at prenatal entry was 19 years (Interquartile range (IQR) 17.6-21.0); 86% had an AIDS diagnosis; 81% had disclosed their HIV status to partner 11. The median age at HIV diagnosis was 8.3 y (IQR 4.0-13.6), the median age at sexual debut was 16 years (IQR 14-18). At the time of prenatal care initiation, four (18%) were on their first antiretroviral treatment (ART), eight (36%) in their second regimen and nine (41%) in their third regimen or beyond, and one had no data. Seventeen of 22 (77%) had HIV-viral load (VL) > 50 copies/mL at prenatal care entry, 16 had a genotyping exam performed. Seventeen of 22 PHIV+ had VL results near delivery: 7/17 (41%) had VL < 50 copies/mL. Among those who had genotyping at prenatal entry, 11/16 (69%) had mutations associated with ARV resistance. The most frequent major mutations were K103N, M184V, T215, M41L, D67N at reverse transcriptase gene and M46, I54V and V82A at protease gene. No vertical transmissions occurred. Management of pregnancy among PHIV+ is challenging. Individualized ART are needed to achieve viral suppression in a highly ART-exposed subpopulation.

"Don't tell him you have HIV unless he's 'the one'": romantic relationships among adolescents and young adults with perinatal HIV infection.

PubMed

Fair, Cynthia; Albright, Jamie

2012-12-01

Individuals with perinatally-acquired HIV (PHIV) are surviving into young adulthood. Previous literature has explored the sexual behavior of those with PHIV. However, their perspectives on navigating romantic relationships are not well understood. Semi-structured interviews were conducted with 35 young adults living with PHIV recruited from two pediatric infectious disease clinics in the southeast United States. The majority of participants were African American (n=27, 77.2%), female (n=23, 65.7%), and the mean age was 20.7 (range 15-30) years. Questions focused on experiences with dating and romantic relationships as well as relationship advice for others living with HIV. Transcribed interviews were coded for emergent themes. Qualitative analyses revealed that the majority of participants have dated and struggled with their HIV status in their intimate relationships. The majority of those who disclosed their HIV status to past partners had experienced some form of rejection. However, several participants reported receiving support upon disclosure. Some individuals had never disclosed to a romantic partner, but carefully managed intimacy by delaying dating, terminating relationships, and "taking it slow." Advice fell into two broad categories: "be safe" which referred to the physical protection of self and partners, as well as emotional protection from possible rejection. The second advice category was basic encouragement which stressed the importance for young adults living with HIV to have hope that they would find a supportive partner and to be patient. The focus of education must include not only transmission risk factors, but also developing and maintaining healthy relationships in the context of a highly stigmatized illness.

Mother-to-child transmission of HIV-1: advances and controversies of the twentieth centuries.

PubMed

Scarlatti, G

2004-01-01

Mother-to-child transmission (MTCT) is the overwhelming source of HIV-1 infection in young children. According to the World Health Organization (WHO), during the year 2003, despite effective antiretroviral (ARV) therapy, there were approximately 700,000 new infections in children worldwide, the majority of whom were from resource-limited countries. Alternative protocols to the long-course and complex regimens of ARV drugs, which in high-income countries have almost eradicated HIV MTCT, have been shown to reduce early transmission rates by 38-50%. However, the accumulation of drug resistance and the long-term toxicities of ARVs mean that alternative approaches need to be developed. Furthermore, transmission via breastfeeding, which accounts for one third of all transmission events, can reduce the benefits of short-course therapies given to women for the prevention of MTCT. The complex mechanisms and determinants of HIV-1 MTCT and its prevention in the different routes of transmission are still not completely understood. Despite the large contribution that many international agencies have made during the past 10-15 years in support of observational and intervention trials, as well as basic scientific research, HIV-1 MTCT intervention trials and basic research often are not integrated, leading to the generation of a fragmented picture. Maternal RNA levels, CD4+ T-cell counts, mode of delivery and gestational age were shown to be independent factors associated with transmission. However, these markers are only partial surrogates and cannot be used as absolute predictors of MTCT of HIV-1. Studies on the role of viral characteristics, immune response and host genomic polymorphisms did not always achieve conclusive results. Although CCR5-using viruses are preferentially carried by HIV-1 infected women as well as transmitted to their infants, the 32-basepair deletion of the CCR5 gene was not shown to influence perinatal MTCT. X4 viruses are apparently hampered in MTCT

[Psychosocial issues in HIV positive women during the perinatal period].

PubMed

Diagne Gueye, N-R; Dollfus, C; Tabone, M-D; Hervé, F; Courcoux, M-F; Vaudre, G; Trocmé, N; Leverger, G

2007-05-01

To study the feelings of HIV infected mothers during the perinatal period regarding circumstances of HIV diagnosis, disclosure to partner and fear of contamination. A study based upon personal interviews was carried out from November 2003 to January 2004 upon routine pediatric outpatient visits for infants born to HIV positive mothers. This study included 54 women of which 70% were from Sub-Saharan Africa. Fifty-nine per cent discovered their HIV status during a pregnancy. Seventy-seven per cent of partners were informed of maternal status. Among the women reluctant to inform their partner, the main reasons given were fear of violence and separation. Seventy-two per cent of interviewed women refused their spouses to be informed by the medical staff. Medical care during pregnancy (moral support, delivery) was judged as good by a majority of women (90%) who found the behavior of the staff mostly satisfactory. Final child serology remains the most definitive test for mothers, 47% of whom fear the risk of a potential postnatal contamination of their children. In these isolated women, many of whom have recently discovered their HIV status, a multidisciplinary approach including psychosocial support is essential.

The Burden of Oral Disease among Perinatally HIV-Infected and HIV-Exposed Uninfected Youth

PubMed Central

Yao, Tzy-Jyun; Ryder, Mark I.; Russell, Jonathan S.; Dominy, Stephen S.; Patel, Kunjal; McKenna, Matt; Van Dyke, Russell B.; Seage, George R.; Hazra, Rohan

2016-01-01

Objective To compare oral health parameters in perinatally HIV-infected (PHIV) and perinatally HIV-exposed but uninfected youth (PHEU). Methods In a cross-sectional substudy within the Pediatric HIV/AIDS Cohort Study, participants were examined for number of decayed teeth (DT), Decayed, Missing, and Filled Teeth (DMFT), oral mucosal disease, and periodontal disease (PD). Covariates for oral health parameters were examined using zero-inflated negative binomial regression and ordinal logistic regression models. Results Eleven sites enrolled 209 PHIV and 126 PHEU. Higher DT scores were observed in participants who were PHIV [Adjusted Mean Ratio (aMR) = 1.7 (95% CI 1.2–2.5)], female [aMR = 1.4 (1.0–1.9)], had no source of regular dental care [aMR = 2.3 (1.5–3.4)], and had a high frequency of meals/snacks [≥5 /day vs 0–3, aMR = 1.9 (1.1–3.1)] and juice/soda [≥5 /day vs 0–3, aMR = 1.6 (1.1–2.4)]. Higher DMFT scores were observed in participants who were older [≥19, aMR = 1.9 (1.2–2.9)], had biological parent as caregiver [aMR = 1.2 (1.0–1.3)], had a high frequency of juice/soda [≥5 /day vs 0–3, aMR = 1.4 (1.1–1.7)] and a low saliva flow rate [mL/min, aMR = 0.8 per unit higher (0.6–1.0)]. Eighty percent had PD; no differences were seen by HIV status using the patient-based classifications of health, gingivitis or mild, moderate, or severe periodontitis. No associations were observed of CD4 count and viral load with oral health outcomes after adjustment. Conclusions Oral health was poor in PHIV and PHEU youth. This was dismaying since most HIV infected children in the U.S. are carefully followed at medical health care clinics. This data underscore the need for regular dental care. As PHIV youth were at higher risk for cavities, it will be important to better understand this relationship in order to develop targeted interventions. PMID:27299992

Long-term outcomes in adolescents perinatally infected with HIV-1 and followed up since birth in the French perinatal cohort (EPF/ANRS CO10).

PubMed

Dollfus, C; Le Chenadec, J; Faye, A; Blanche, S; Briand, N; Rouzioux, C; Warszawski, J

2010-07-15

BACKGROUND. Increasing numbers of children perinatally infected with human immunodeficiency virus (HIV) are reaching adolescence, largely because of advances in treatment over the past 10 years, but little is known about their current health status. We describe here the living conditions and clinical and immunovirologic outcomes at last evaluation among this pioneering generation of adolescents who were born before the introduction of prophylaxis for vertical transmission and whose infections were diagnosed at a time when treatment options were limited. METHODS. The eligible population consisted of HIV-1-infected children who were born before December 1993 and who were included at birth in the prospective national French Perinatal Cohort (EPF/ANRS CO10). RESULTS. Of the 348 eligible children, 210 (60%; median age, 15 years) were still alive and regularly followed up. Current treatment was highly active antiretroviral therapy (HAART) in 77% and 2 nucleoside analogues in 5.0%; 16% had stopped treatment, and 2% had never been treated. The median CD4 cell count was 557 cells/microL, and 200 cells/microL was exceeded in 94% of patients. The median viral load was 200 copies/mL. Viral load was undetectable in 43% of the adolescents and in 54.5% of those receiving HAART. Median height, weight, and body mass index were similar to French reference values for age, and school achievement was similar to nationwide statistics. Better immunologic status was associated with being younger and with having begun HAART earlier. Undetectable viral load was associated with maternal geographic origin and current HAART. CONCLUSIONS. Given the limited therapeutic options available during the early years of these patients' lives and the challenge presented by treatment adherence during adolescence, the long-term outcomes among this population are encouraging.

How does mother-to-child transmission of HIV differ among African populations? Lessons from MBL2 genetic variation in Zimbabweans.

PubMed

Mhandire, Kudakwashe; Pharo, Gavin; Kandawasvika, Gwendolene Q; Duri, Kerina; Swart, Marelize; Stray-Pedersen, Babill; Dandara, Collet

2014-07-01

Mannose binding lectin (MBL) is a pathogen pattern recognition protein involved in antimicrobial activities. Variation in MBL2 gene has been extensively implicated in differential outcomes of infectious diseases in studies conducted outside Africa, but virtually very little is known on the role of this candidate gene in the African continent. We investigated human genetic variations in MBL2 in a Zimbabwean pediatric population and their putative associations with HIV infection in perinatally exposed children. One hundred and four children aged 7 to 9 years comprising 68 perinatally exposed to HIV (32 who were born infected and 36 who were uninfected) and 36 unexposed controls were recruited. DNA samples were genotyped for MBL2 polymorphisms using PCR-RFLP and sequencing. HIV infected children had markedly variable and significantly lower mean height (p=0.03) and weight (p=0.005) when compared to the uninfected children. Using all samples, frequencies for MBL2 genetic variants for the Zimbabwean population were calculated. Twelve single nucleotide polymorphisms were observed and minor alleles occurred with the following frequencies: -550C>G (G: 0.02), -435G>A (A: 0.08), -428A>C (C: 0.39), -394A>G (A: 0.39), -328AGAGAA ins/del (AGAGAA ins: 0.44), -245G>A (A: 0.05), -221C>G (C: 0.12), -111A>T (T: 0.10), -70C>T (C: 0.46), +4C>T (C: 0.45), novel -595G>A (A: 0.02), and 170G>A (0.24). We found that the MBL2 +4T variant displayed a trend for association with reduced risk of HIV transmission from mother-to-child but the remaining vast majority of the genetic markers did not show a significant association. We conclude (1) the MBL2 gene is highly polymorphic in the Zimbabwean population, and (2) MBL2 genetic variation does not appear to play a major role in influencing the risk of mother-to-child HIV transmission in our study sample. These observations contest the hitherto significant role of this candidate gene for HIV transmission from mother-to-child in non

Sexual Health Knowledge in a Sample of Perinatally HIV-infected and Perinatally-exposed Uninfected Youth

PubMed Central

Gromadzka, Olga; Santamaria, E. Karina; Benavides, Jessica M.; Dolezal, Curtis; Elkington, Katherine S.; Leu, Cheng-Shiun; McKay, Mary; Abrams, Elaine J.; Wiznia, Andrew; Bamji, Mahrukh; Ann Mellins, Claude

2015-01-01

This study describes sexual health knowledge in perinatally HIV-infected (PHIV+) and perinatally-exposed uninfected (PHIV-) ethnic-minority youth, ages 9–16 years, residing in NYC (n=316). Data on youth sexual health knowledge (e.g., pregnancy, STDs, birth control) and caregiver-adolescent communication about sexual health were examined. Participants in both groups answered only 35% of the sexual health knowledge questions correctly (mean=6.6/19). Higher scores were found among youth who reported more communication about sex with caregivers (vs. those who did not report talking about sex with caregivers; 8.54 vs. 5.84, p<.001) and among PHIV+ youth who were aware of their status (vs. PHIV+ youth who were not; 7.27 vs. 4.70, p<.001). Age was positively correlated with sexual health knowledge (beta=.489, p<.001). Both PHIV+ and PHIV− youth had poor sexual health knowledge, suggesting a need for sexual health education for both groups. Data suggest that interventions focused on caregiver-child risk communication may be important for prevention. PMID:26855617

Transmission clustering among newly diagnosed HIV patients in Chicago, 2008 to 2011: using phylogenetics to expand knowledge of regional HIV transmission patterns

PubMed Central

Lubelchek, Ronald J.; Hoehnen, Sarah C.; Hotton, Anna L.; Kincaid, Stacey L.; Barker, David E.; French, Audrey L.

2014-01-01

Introduction HIV transmission cluster analyses can inform HIV prevention efforts. We describe the first such assessment for transmission clustering among HIV patients in Chicago. Methods We performed transmission cluster analyses using HIV pol sequences from newly diagnosed patients presenting to Chicago’s largest HIV clinic between 2008 and 2011. We compared sequences via progressive pairwise alignment, using neighbor joining to construct an un-rooted phylogenetic tree. We defined clusters as >2 sequences among which each sequence had at least one partner within a genetic distance of ≤ 1.5%. We used multivariable regression to examine factors associated with clustering and used geospatial analysis to assess geographic proximity of phylogenetically clustered patients. Results We compared sequences from 920 patients; median age 35 years; 75% male; 67% Black, 23% Hispanic; 8% had a Rapid Plasma Reagin (RPR) titer ≥ 1:16 concurrent with their HIV diagnosis. We had HIV transmission risk data for 54%; 43% identified as men who have sex with men (MSM). Phylogenetic analysis demonstrated 123 patients (13%) grouped into 26 clusters, the largest having 20 members. In multivariable regression, age < 25, Black race, MSM status, male gender, higher HIV viral load, and RPR ≥ 1:16 associated with clustering. We did not observe geographic grouping of genetically clustered patients. Discussion Our results demonstrate high rates of HIV transmission clustering, without local geographic foci, among young Black MSM in Chicago. Applied prospectively, phylogenetic analyses could guide prevention efforts and help break the cycle of transmission. PMID:25321182

HIV Transmission Dynamics Among Foreign-Born Persons in the United States.

PubMed

Valverde, Eduardo E; Oster, Alexandra M; Xu, Songli; Wertheim, Joel O; Hernandez, Angela L

2017-12-15

In the United States (US), foreign-born persons are disproportionately affected by HIV and differ epidemiologically from US-born persons with diagnosed HIV infection. Understanding HIV transmission dynamics among foreign-born persons is important to guide HIV prevention efforts for these populations. We conducted molecular transmission network analysis to describe HIV transmission dynamics among foreign-born persons with diagnosed HIV. Using HIV-1 polymerase nucleotide sequences reported to the US National HIV Surveillance System for persons with diagnosed HIV infection during 2001-2013, we constructed a genetic distance-based transmission network using HIV-TRACE and examined the birth region of potential transmission partners in this network. Of 77,686 people, 12,064 (16%) were foreign born. Overall, 28% of foreign-born persons linked to at least one other person in the transmission network. Of potential transmission partners, 62% were born in the United States, 31% were born in the same region as the foreign-born person, and 7% were born in another region of the world. Most transmission partners of male foreign-born persons (63%) were born in the United States, whereas most transmission partners of female foreign-borns (57%) were born in their same world region. These finding suggests that a majority of HIV infections among foreign-born persons in our network occurred after immigrating to the United States. Efforts to prevent HIV infection among foreign-born persons in the United States should include information of the transmission networks in which these individuals acquire or transmit HIV to develop more targeted HIV prevention interventions.

Maternal Factors Influencing Perinatal Transmission of HIV Infection

DTIC Science & Technology

1990-01-01

PET Chronic hypertension Eclampsia 17. IUGR 17. 18. Preterm Labor 18. 19. 3rd Trimester Bleeding 19. a) Placenta Previa b) Abruptio Placenta 20...Obstetrics/Gynecology, and laboratory procedures including those for maternal/neonatal drug screening and for handling and processing tissue ( placenta ...amniocentesis Is n done as a part of this study. After delivery, the placenta (afterbirth) will be examined for evidence of HIV infection (AIDS virus). Blood

Impact of insurance coverage on HIV transmission potential among antiretroviral therapy-treated youth living with HIV.

PubMed

Wood, Sarah; Ratcliffe, Sarah; Gowda, Charitha; Lee, Susan; Dowshen, Nadia L; Gross, Robert

2018-04-24

To identify the prevalence of high HIV transmission potential in a cohort of youth living with HIV (YLWH), and determine the impact of insurance coverage on potential for HIV transmission. Retrospective cohort study of antiretroviral therapy (ART)-treated YLWH at a US adolescent HIV clinic, 2002-2015. The primary exposure was presence or absence of insurance, defined as private, public or pharmacy-only coverage. The primary outcome was high HIV transmission potential, defined as time-concurrent incident bacterial sexually transmitted infections (STI) (gonorrhea, chlamydia or syphilis) and HIV RNA greater than 1500 copies/ml. Marginal structural models adjusting for baseline demographic covariates, prior history of STI and time-varying retention in care assessed the relationship between insurance status and HIV transmission potential. Participants (n = 240) were followed for a median of 22 (IQR 8.1-49) months after ART initiation, and were predominately African-American men and transgender women who have sex with men, with a median age at HIV diagnosis of 19 years (IQR 17-21). We identified 37 (15%) participants with at least one episode of high HIV transmission potential. Insurance coverage was associated with a greater than 50% lower odds of high HIV transmission potential (aOR 0.46, 95% CI 0.26-0.84), and history of STI at or before entry to HIV care conferred more than three-fold higher odds of high transmission potential (aOR 3.21, 95% CI 1.55-6.63). We found 15% of YLWH to have episodic high HIV transmission potential despite receiving ART. Insurance coverage, including pharmacy-only benefits, was protective against transmission risk, suggesting a pivotal role for universal ART coverage in treatment as prevention.

α-Defensins in the Prevention of HIV Transmission Among Breastfed Infants

PubMed Central

Kuhn, Louise; Trabattoni, Daria; Kankasa, Chipepo; Semrau, Katherine; Kasonde, Prisca; Lissoni, Francesca; Sinkala, Moses; Ghosh, Mrinal; Vwalika, Cheswa; Aldrovandi, Grace M.; Thea, Donald M.; Clerici, Mario

2006-01-01

Summary: α-Defensins have been observed to have anti-HIV activity but have not been investigated in relation to mother-to-child HIV transmission. We measured the concentration of α-defensins in breast milk of HIV-positive mothers and tested whether the concentrations were associated with HIV transmission. A nested case-control study of 32 HIV-positive women who transmitted HIV to their infants and 52 randomly selected HIV-positive women who did not transmit HIV to their infants was conducted in Lusaka, Zambia. α-Defensins were detected in most (79%) of the milk samples tested. Concentrations of α-defensins increased as breast milk HIV RNA quantity increased, and breast milk HIV RNA quantity was, in turn, a strong and significant predictor of HIV transmission. After adjustment for milk HIV RNA quantity, however, α-defensin concentration was significantly associated with a decreased risk of intrapartum and postnatal HIV transmission (odds ratio = 0.3, 95% confidence interval: 0.09-0.93). Our data suggest that there may be a role for α-defensins in prevention of HIV transmission to breastfed infants. PMID:15905728

Perinatally acquired HIV infection accelerates epigenetic aging in South African adolescents.

PubMed

Horvath, Steve; Phillips, Nicole; Heany, Sarah J; Kobor, Michael S; Lin, David Ts; Myer, Landon; Zar, Heather J; Stein, Dan J; Levine, Andrew J; Hoare, Jacqueline

2018-05-08

Recent studies demonstrate that infection with the Human Immunodeficiency Virus-1 (HIV) is associated with accelerated aging effects in adults according to a highly accurate epigenetic biomarker of aging known as epigenetic clock. However, it not yet known whether epigenetic age acceleration occurs as early as adolescence in perinatally HIV-infected (PHIV+) youth. Observational study of PHIV and HIV-uninfected adolescents enrolled in the Cape Town Adolescent Antiretroviral Cohort (CTAAC) Study. The Illumina EPIC array was used to generate blood DNA methylation data from 204 PHIV and 44 age-matched, uninfected (HIV-) adolescents aged 9 to 12 years old. The epigenetic clock software and method was used to estimate two measures of epigenetic age acceleration. Each participant completed a comprehensive neuropsychological test battery upon enrolment to CTAAC. HIV is associated with biologically older blood in PHIV+ adolescents according to both measures of epigenetic age acceleration. One of the measures, extrinsic epigenetic age acceleration, is negatively correlated with measures of cognitive functioning (executive functioning, working memory, processing speed). Overall, our results indicate that epigenetic age acceleration in blood can be observed in PHIV+ adolescents and that these epigenetic changes accompany poorer cognitive functioning.

Fertility intentions among HIV-infected, sero-concordant Kenyan couples in Nyanza Province, Kenya

PubMed Central

Dworkin, Shari; Harrington, Elizabeth; Kwena, Zachary; Onono, Maricianah; Bukusi, Elizabeth; Cohen, Craig R.; Grossma, Daniel; Newmann, Sara J.

2013-01-01

Research in sub-Saharan Africa has shown significant diversity in how HIV influences infected couples’ fertility intentions. Supporting HIV-infected, sero-concordant couples in sub-Saharan Africa to make informed choices about their fertility options has not received sufficient attention. In-depth interviews were conducted among 23 HIV-positive, sero-concordant married couples in Kenya, to better understand how HIV impacted fertility intentions. HIV compelled many to reconsider fertility plans, sometimes promoting childbearing intentions in some individuals but often reducing fertility plans among most, largely due to fears of early death, health concerns, stigma, perinatal HIV transmission and financial difficulties (particularly in men). Preferences for sons and large families influenced some couples’ intentions to continue childbearing, although none had discussed their intentions with health care providers. Additional support and services for HIV-infected, sero-concordant couples are needed. Family planning counselling should be tailored to the unique concerns of HIV-infected couples, addressing perinatal transmission but also individual, couple-level, and socio-cultural fertility expectations. Community-level programmes are needed to reduce stigma and make HIV-infected couples more comfortable in discussing fertility intentions with health care providers. PMID:23885924

Transmission and prevention of HIV among heterosexual populations in Australia.

PubMed

Persson, Asha; Brown, Graham; McDonald, Ann; Körner, Henrike

2014-06-01

In Australia, unlike much of the rest of the world, HIV transmission through heterosexual contact remains a relatively rare occurrence. In consequence, HIV-prevention efforts have been firmly focused on male-to-male sex as the most frequent source of HIV transmission. There are emerging signs that this epidemiological landscape may be shifting, which raises questions about current and future HIV prevention strategies. Over the past decade, national surveillance data have shown an increase in HIV notifications for which exposure to HIV was attributed to heterosexual contact. This paper offers an epidemiological and sociocultural picture of heterosexual HIV transmission in Australia. We outline recent trends in heterosexually acquired HIV and discuss specific factors that shape transmission and prevention among people at risk of HIV infection through heterosexual contact. To illustrate the contextual dynamics surrounding HIV in this diverse population, we detail two key examples: HIV among people from minority ethnic backgrounds in New South Wales; and overseas-acquired HIV among men in Western Australia. We argue that, despite their differences, there are significant commonalities across groups at risk of HIV infection through heterosexual contact, which not only provide opportunities for HIV prevention, but also call for a rethink of the dominant HIV response in Australia.

Cognitive Function in Young Persons With and Without Perinatal HIV in the AALPHI Cohort in England: Role of Non-HIV-Related Factors.

PubMed

Judd, Ali; Le Prevost, Marthe; Melvin, Diane; Arenas-Pinto, Alejandro; Parrott, Francesca; Winston, Alan; Foster, Caroline; Sturgeon, Kate; Rowson, Katie; Gibb, Di M

2016-11-15

 There is limited evidence about the cognitive performance of older adolescents with perinatally acquired human immunodeficiency virus (HIV) compared with HIV-negative (HIV-) adolescents.  A total of 296 perinatally HIV-infected (PHIV+) and 97 HIV- adolescents (aged 12-21 and 13-23 years, respectively) completed 12 tests covering 6 cognitive domains. The HIV- participants had PHIV+ siblings and/or an HIV-infected mother. Domain-specific and overall (NPZ-6) z scores were calculated for PHIV+ participants, with or without Centers for Disease Control and Prevention (CDC) stage C disease, and HIV- participants. Linear regression was performed to explore predictors of NPZ-6.  One hundred twenty-five (42%) of the PHIV+ and 31 (32%) of the HIV- participants were male; 251 (85%) and 69 (71%), respectively, were black African; and their median ages (interquartile range) were 16 (15-18) and 16 (14-18) years, respectively. In PHIV+ participants, 247 (86%) were receiving antiretroviral therapy, and 76 (26%) had a previous CDC C diagnosis. The mean (standard deviation) NPZ-6 score was -0.81 (0.99) in PHIV+ participants with a CDC C diagnosis (PHIV+/C), -0.45 (0.80) in those without a CDC C diagnosis (PHIV+/no C), and -0.32 (0.76) in HIV- participants (P < .001). After adjustment, there was no difference in NPZ-6 scores between PHIV+/no C and HIV- participants (adjusted coefficient, -0.01; 95% confidence interval, -.22 to .20). PHIV+/C participants scored below the HIV- group (adjusted coefficient, -0.44; -.70 to -.19). Older age predicted higher NPZ-6 scores, and black African ethnicity and worse depression predicted lower NPZ-6 scores. In a sensitivity analysis including PHIV+ participants only, no HIV-related factors apart from a CDC C diagnosis were associated with NPZ-6 scores.  Cognitive performance was similar between PHIV+/no C and HIV- participants and indicated relatively mild impairment compared with normative data. The true impact on day-to-day functioning

Chlamydia and Gonorrhea in HIV-Infected Pregnant Women and Infant HIV Transmission.

PubMed

Adachi, Kristina; Klausner, Jeffrey D; Bristow, Claire C; Xu, Jiahong; Ank, Bonnie; Morgado, Mariza G; Watts, D Heather; Weir, Fred; Persing, David; Mofenson, Lynne M; Veloso, Valdilea G; Pilotto, Jose Henrique; Joao, Esau; Nielsen-Saines, Karin

2015-10-01

Sexually transmitted infections (STIs) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) can lead to adverse pregnancy and neonatal outcomes. The prevalence of STIs and its association with HIV mother-to-child transmission (MTCT) were evaluated in a substudy analysis from a randomized, multicenter clinical trial. Urine samples from HIV-infected pregnant women collected at the time of labor and delivery were tested using polymerase chain reaction testing for the detection of CT and NG (Xpert CT/NG; Cepheid, Sunnyvale, CA). Infant HIV infection was determined by HIV DNA polymerase chain reaction at 3 months. Of the 1373 urine specimens, 249 (18.1%) were positive for CT and 63 (4.6%) for NG; 35 (2.5%) had both CT and NG detected. Among 117 cases of HIV MTCT (8.5% transmission), the lowest transmission rate occurred among infants born to CT- and NG-uninfected mothers (8.1%) as compared with those infected with only CT (10.7%) and both CT and NG (14.3%; P = 0.04). Infants born to CT-infected mothers had almost a 1.5-fold increased risk for HIV acquisition (odds ratio, 1.47; 95% confidence interval, 0.9-2.3; P = 0.09). This cohort of HIV-infected pregnant women is at high risk for infection with CT and NG. Analysis suggests that STIs may predispose to an increased HIV MTCT risk in this high-risk cohort of HIV-infected women.

Chlamydia and Gonorrhea in HIV-infected Pregnant Women and Infant HIV Transmission

PubMed Central

Adachi, Kristina; Klausner, Jeffrey D.; Bristow, Claire C.; Xu, Jiahong; Ank, Bonnie; Morgado, Mariza G; Watts, D. Heather; Weir, Fred; Persing, David; Mofenson, Lynne M.; Veloso, Valdilea G.; Pilotto, Jose Henrique; Joao, Esau; Nielsen-Saines, Karin

2015-01-01

BACKGROUND Sexually transmitted infections (STIs) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) can lead to adverse pregnancy and neonatal outcomes. STI prevalence and its association with HIV mother-to-child transmission (MTCT) were evaluated in a sub-study analysis from a randomized, multi-center clinical trial. METHODOLOGY Urine samples from HIV-infected pregnant women collected at the time of labor and delivery were tested using polymerase chain reaction (PCR) testing for the detection of CT and NG (Xpert® CT/NG, Cepheid, Sunnyvale, CA). Infant HIV infection was determined by HIV DNA PCR at 3 months. RESULTS Of the 1373 urine specimens, 249 (18.1%) were positive for CT and 63 (4.6%) for NG; 35 (2.5%) had both CT and NG detected. Among 117 cases of HIV MTCT (8.5% transmission) the lowest transmission rate occurred among infants born to CT and NG uninfected mothers (8.1%) as compared to those infected with only CT (10.7%) and both CT and NG (14.3%), (p = 0.04). Infants born to CT-infected mothers had almost a 1.5-fold increased risk for HIV acquisition (OR 1.47, 95% CI 0.9–2.3, p=0.09). CONCLUSION This cohort of HIV-infected pregnant women are at high risk for infection with CT and NG. Analysis suggests that STIs may predispose to an increased HIV MTCT risk in this high risk cohort of HIV-infected women. PMID:26372927

Pilot Assessment of Brain Metabolism in Perinatally HIV-Infected Youths Using Accelerated 5D Echo Planar J-Resolved Spectroscopic Imaging.

PubMed

Iqbal, Zohaib; Wilson, Neil E; Keller, Margaret A; Michalik, David E; Church, Joseph A; Nielsen-Saines, Karin; Deville, Jaime; Souza, Raissa; Brecht, Mary-Lynn; Thomas, M Albert

2016-01-01

To measure cerebral metabolite levels in perinatally HIV-infected youths and healthy controls using the accelerated five dimensional (5D) echo planar J-resolved spectroscopic imaging (EP-JRESI) sequence, which is capable of obtaining two dimensional (2D) J-resolved spectra from three spatial dimensions (3D). After acquisition and reconstruction of the 5D EP-JRESI data, T1-weighted MRIs were used to classify brain regions of interest for HIV patients and healthy controls: right frontal white (FW), medial frontal gray (FG), right basal ganglia (BG), right occipital white (OW), and medial occipital gray (OG). From these locations, respective J-resolved and TE-averaged spectra were extracted and fit using two different quantitation methods. The J-resolved spectra were fit using prior knowledge fitting (ProFit) while the TE-averaged spectra were fit using the advanced method for accurate robust and efficient spectral fitting (AMARES). Quantitation of the 5D EP-JRESI data using the ProFit algorithm yielded significant metabolic differences in two spatial locations of the perinatally HIV-infected youths compared to controls: elevated NAA/(Cr+Ch) in the FW and elevated Asp/(Cr+Ch) in the BG. Using the TE-averaged data quantified by AMARES, an increase of Glu/(Cr+Ch) was shown in the FW region. A strong negative correlation (r < -0.6) was shown between tCh/(Cr+Ch) quantified using ProFit in the FW and CD4 counts. Also, strong positive correlations (r > 0.6) were shown between Asp/(Cr+Ch) and CD4 counts in the FG and BG. The complimentary results using ProFit fitting of J-resolved spectra and AMARES fitting of TE-averaged spectra, which are a subset of the 5D EP-JRESI acquisition, demonstrate an abnormal energy metabolism in the brains of perinatally HIV-infected youths. This may be a result of the HIV pathology and long-term combinational anti-retroviral therapy (cART). Further studies of larger perinatally HIV-infected cohorts are necessary to confirm these findings.

Preventing Mother-to-Child Transmission of HIV

MedlinePlus

... HIV Transmission in the United States: Introduction General Principles Regarding Use of Antiretroviral Drugs During Pregnancy: Overview and Teratogenicity Management of Infants Born to Women with HIV Infection: ...

Testing the Sexually Abused Child for the HIV Antibody: Issues for the Social Worker.

ERIC Educational Resources Information Center

Gellert, George A.; And Others

1993-01-01

Discusses identifying children infected with human immunodeficiency virus (HIV) through sexual abuse. Reviews testing guidelines. Sees social workers contributing to test decision making when perinatal HIV transmissions is possibility, when assailant may be tested, and when parents/legal guardians insist on testing child. Discusses family…

Perinatal acquisition of drug-resistant HIV-1 infection: mechanisms and long-term outcome

PubMed Central

Delaugerre, Constance; Chaix, Marie-Laure; Blanche, Stephane; Warszawski, Josiane; Cornet, Dorine; Dollfus, Catherine; Schneider, Veronique; Burgard, Marianne; Faye, Albert; Mandelbrot, Laurent; Tubiana, Roland; Rouzioux, Christine

2009-01-01

Background Primary-HIV-1-infection in newborns that occurs under antiretroviral prophylaxis that is a high risk of drug-resistance acquisition. We examine the frequency and the mechanisms of resistance acquisition at the time of infection in newborns. Patients and Methods We studied HIV-1-infected infants born between 01 January 1997 and 31 December 2004 and enrolled in the ANRS-EPF cohort. HIV-1-RNA and HIV-1-DNA samples obtained perinatally from the newborn and mother were subjected to population-based and clonal analyses of drug resistance. If positive, serial samples were obtained from the child for resistance testing. Results Ninety-two HIV-1-infected infants were born during the study period. Samples were obtained from 32 mother-child pairs and from another 28 newborns. Drug resistance was detected in 12 newborns (20%): drug resistance to nucleoside reverse transcriptase inhibitors was seen in 10 cases, non-nucleoside reverse transcriptase inhibitors in two cases, and protease inhibitors in one case. For 9 children, the detection of the same resistance mutations in mothers' samples (6 among 10 available) and in newborn lymphocytes (6/8) suggests that the newborn was initially infected by a drug-resistant strain. Resistance variants were either transmitted from mother-to-child or selected during subsequent temporal exposure under suboptimal perinatal prophylaxis. Follow-up studies of the infants showed that the resistance pattern remained stable over time, regardless of antiretroviral therapy, suggesting the early cellular archiving of resistant viruses. The absence of resistance in the mother of the other three children (3/10) and neonatal lymphocytes (2/8) suggests that the newborns were infected by a wild-type strain without long-term persistence of resistance when suboptimal prophylaxis was stopped. Conclusion This study confirms the importance of early resistance genotyping of HIV-1-infected newborns. In most cases (75%), drug resistance was archived in

AIDS following mother-to-child transmission of HIV-2.

PubMed

Morgan, G; Wilkins, H A; Pepin, J; Jobe, O; Brewster, D; Whittle, H

1990-09-01

Mother-to-child infection with HIV-2 is thought to be rare, and there have been few previous reports of transmission by this route. Reports of morbidity associated with HIV-2 infection in children are also rare. We describe eight children born to mothers who were infected with HIV-2; five developed AIDS, and three were still seropositive at 17-49 months of age. The only apparent route of HIV-2 transmission was from mother to child, except for one child who had been transfused. Three of the children with AIDS died, all having decreased CD4+ lymphocytes and mitogen responses. Further studies are needed to determine the prevalence and natural history of mother-to-child transmission of HIV-2.

Missed opportunities for prevention of perinatal transmission of hepatitis B: A retrospective cohort study

PubMed Central

van Schalkwyk, Julie; Nourmoussavi, Melica; Massey, Andrea; Gustafson, Reka; Brodkin, Elizabeth; Petric, Martin; Krajden, Mel; Dobson, Simon; Buxton, Jane; Bigham, Mark; Pick, Neora; Schreiber, Richard; Sherlock, Christopher H; Money, Deborah; Yoshida, Eric M

2014-01-01

BACKGROUND: Perinatal transmission of hepatitis B virus (HBV) can occur despite postexposure prophylaxis (PEP). Recent literature suggests that antiviral treatment during pregnancy when maternal HBV DNA levels are elevated can further decrease vertical transmission. However, HBV DNA screening is not routinely performed antenatally. OBJECTIVE: To determine the rates of HBV prevalence and perinatal transmission in an antenatal cohort. METHODS: A retrospective review of public health records (December 2008 to December 2010) was performed for both mothers and newborns. RESULTS: A total of 725 mother-infant pairs were included. Of these, 574 of 715 (80%) women had antenatal hepatitis B e antigen (HBeAg) testing performed, and 127 of 574 (22%) were HBeAg positive (HBeAg+). Of babies born to hepatitis B surface antigen-positive (HBsAg+) mothers, only 573 of 725 (79%) received complete PEP. In addition, 172 of 725 (24%) infants did not receive post-PEP blood testing or were lost to follow-up. Of the 552 infants with results available, seven cases (1.3%) of mother-to-child HBV transmission were observed, six of which involved infants born to HBeAg+ women. CONCLUSIONS: Our findings suggest that routine HBeAg screening could identify a subset of mother-infant pairs among HBsAg+ pregnant women who are at higher risk for vertical HBV transmission. Determination of viral load in expectant HBeAg+ mothers may provide more precise insight into HBV transmission to their infants. PMID:25390612

Barriers to uptake of prevention of mother-to-child transmission of HIV services among mothers of vertically infected HIV-seropositive infants in Makurdi, Nigeria

PubMed Central

Anígilájé, Emmanuel Ademola; Ageda, Bem Ruben; Nweke, Nnamdi Okechukwu

2016-01-01

Background Perinatal transmission of human immunodeficiency virus (HIV) continues in Nigeria because of the poor use of prevention of mother-to-child transmission of HIV (PMTCT) services. This study reports on the barriers preventing mothers of vertically infected HIV-seropositive infants to use the PMTCT services at the Federal Medical Centre, Makurdi, Nigeria. Methods This is a descriptive study conducted between January and April, 2014. A quantitative survey was applied to detect barriers along the PMTCT services cascade among 52 mothers of vertically infected HIV-seropositive infants. This includes 22 women who attended antenatal care at the Federal Medical Centre (designated as Group A mothers) and 30 women who did not receive any form of PMTCT service (Group B mothers). The study was supplemented with a focused group discussion involving 12 discussants from the two groups. Results In the quantitative assessment: among the Group A mothers, falling asleep was the most common reason (n=22, 100%) for missing therapeutic/prophylactic antiretroviral medicine; financial constraint (n=22, 100%) was the most common reason for antenatal care visit defaults; and a lot of the mothers (n=11, 50.0%) did not give nevirapine to their newborns because they delivered at home. Among Group B mothers, unawareness of HIV-seropositive status was the most common reason (n=28, 93.3%) given for not accessing PMTCT services. In the qualitative study: noninvolvement of male partners, stigma and discrimination experienced by HIV-seropositive mothers, financial constraints in couples, involvement of traditional birth attendants in antenatal care and delivery of HIV-infected women, unawareness of HIV-seropositive status by pregnant women, poor health system, and the lack of funding for PMTCT services at private and rural health facilities were the major barriers preventing the use of PMTCT services. Conclusion In order to reduce the missed opportunities for PMTCT interventions in Makurdi

Prosecution of non-disclosure of HIV status: Potential impact on HIV testing and transmission among HIV-negative men who have sex with men.

PubMed

Kesler, Maya A; Kaul, Rupert; Loutfy, Mona; Myers, Ted; Brunetta, Jason; Remis, Robert S; Gesink, Dionne

2018-01-01

Non-disclosure criminal prosecutions among gay, bisexual and other men who have sex with men (MSM) are increasing, even though transmission risk is low when effective antiretroviral treatment (ART) is used. Reduced HIV testing may reduce the impact of HIV "test and treat" strategies. We aimed to quantify the potential impact of non-disclosure prosecutions on HIV testing and transmission among MSM. MSM attending an HIV and primary care clinic in Toronto completed an audio computer-assisted self-interview questionnaire. HIV-negative participants were asked concern over non-disclosure prosecution altered their likelihood of HIV testing. Responses were characterized using cross-tabulations and bivariate logistic regressions. Flow charts modelled how changes in HIV testing behaviour impacted HIV transmission rates controlling for ART use, condom use and HIV status disclosure. 150 HIV-negative MSM were recruited September 2010 to June 2012. 7% (9/124) were less or much less likely to be tested for HIV due to concern over future prosecution. Bivariate regression showed no obvious socio/sexual demographic characteristics associated with decreased willingness of HIV testing to due concern about prosecution. Subsequent models estimated that this 7% reduction in testing could cause an 18.5% increase in community HIV transmission, 73% of which was driven by the failure of HIV-positive but undiagnosed MSM to access care and reduce HIV transmission risk by using ART. Fear of prosecution over HIV non-disclosure was reported to reduce HIV testing willingness by a minority of HIV-negative MSM in Toronto; however, this reduction has the potential to significantly increase HIV transmission at the community level which has important public health implications.

Prosecution of non-disclosure of HIV status: Potential impact on HIV testing and transmission among HIV-negative men who have sex with men

PubMed Central

Kaul, Rupert; Loutfy, Mona; Myers, Ted; Brunetta, Jason; Gesink, Dionne

2018-01-01

Background Non-disclosure criminal prosecutions among gay, bisexual and other men who have sex with men (MSM) are increasing, even though transmission risk is low when effective antiretroviral treatment (ART) is used. Reduced HIV testing may reduce the impact of HIV “test and treat” strategies. We aimed to quantify the potential impact of non-disclosure prosecutions on HIV testing and transmission among MSM. Methods MSM attending an HIV and primary care clinic in Toronto completed an audio computer-assisted self-interview questionnaire. HIV-negative participants were asked concern over non-disclosure prosecution altered their likelihood of HIV testing. Responses were characterized using cross-tabulations and bivariate logistic regressions. Flow charts modelled how changes in HIV testing behaviour impacted HIV transmission rates controlling for ART use, condom use and HIV status disclosure. Results 150 HIV-negative MSM were recruited September 2010 to June 2012. 7% (9/124) were less or much less likely to be tested for HIV due to concern over future prosecution. Bivariate regression showed no obvious socio/sexual demographic characteristics associated with decreased willingness of HIV testing to due concern about prosecution. Subsequent models estimated that this 7% reduction in testing could cause an 18.5% increase in community HIV transmission, 73% of which was driven by the failure of HIV-positive but undiagnosed MSM to access care and reduce HIV transmission risk by using ART. Conclusions Fear of prosecution over HIV non-disclosure was reported to reduce HIV testing willingness by a minority of HIV-negative MSM in Toronto; however, this reduction has the potential to significantly increase HIV transmission at the community level which has important public health implications. PMID:29489890

The Oral Mucosa Immune Environment and Oral Transmission of HIV/SIV

PubMed Central

Wood, Lianna F.; Chahroudi, Ann; Chen, Hui-Ling; Jaspan, Heather B.; Sodora, Donald L.

2013-01-01

Summary The global spread of human immunodeficiency virus (HIV) is dependent on the ability of this virus to efficiently cross from one host to the next by traversing a mucosal membrane. Unraveling how mucosal exposure of HIV results in systemic infection is critical for the development of effective therapeutic strategies. This review focuses on understanding the immune events associated with the oral route of transmission (via breastfeeding or sexual oral intercourse), which occurs across the oral and/or gastrointestinal mucosa. Studies in both humans and simian immunodeficiency virus (SIV) monkey models have identified viral changes and immune events associated with oral HIV/SIV exposure. This review covers our current knowledge of HIV oral transmission in both infants and adults, the use of SIV models in understanding early immune events, oral immune factors that modulate HIV/SIV susceptibility (including mucosal inflammation), and interventions that may impact oral HIV transmission rates. Understanding the factors that influence oral HIV transmission will provide the foundation for developing immune therapeutic and vaccine strategies that can protect both infants and adults from oral HIV transmission. PMID:23772613

Puberty in perinatal HIV-1 infection: a multicentre longitudinal study of 212 children.

PubMed

de Martino, M; Tovo, P A; Galli, L; Gabiano, C; Chiarelli, F; Zappa, M; Gattinara, G C; Bassetti, D; Giacomet, V; Chiappini, E; Duse, M; Garetto, S; Caselli, D

2001-08-17

To define age at entry into Tanner stages in children with perinatal HIV-1 infection. Multicentre longitudinal study including 212 perinatally HIV-1-infected children (107 girls and 105 boys) followed-up during puberty (from 8 and 9 years onwards in girls and boys, respectively). Healthy children (843 girls and 821 boys) provided reference percentiles. P2 or B2 stages in girls and P2 or G2 stages in boys defined onset of puberty. The cumulative probability [95% confidence limit (CI)] of entry into each stage at different ages was estimated by the Kaplan-Meier product-limit method; differences were evaluated by log rank test. Relationships were tested using the Spearman's rank correlation coefficient. Ages of girls [years (95%CI)] at P2 [12.9 (12.6-13.2)], P3 [13.4 (13.0-13.8)], P4 [14.6 (14.0-15.2)], B2 [12.7 (12.2-13.2)], B3 [13.3 (12.8-14.0)] and B4 [14.6 (14.0-15.2)] stages were > 97th percentile (> or = 21 month delay) of controls. Ages of boys [years (95%CI)] at P2 [12.6 (12.1-13.1)], P3 [13.9 (13.4-14.4)], P4 [14.9 (14.2-15.6)], G2 [12.1 (11.5-12.7)], G3 [13.6 (13.1-14.1)] and G4 [14.9 (14.1-15.7)] stages were at the 75-97th percentiles (< or = 15 month delay). Age at onset of puberty was not related to clinical and immunological condition, antiretroviral treatment, weigh for height and age at onset of severe disease or immune suppression. Perinatal HIV-1 infection interferes with sexual maturation. The mechanisms by which this occurs should be elucidated and intervention strategies designed. Intervention could save much psychological distress, since associated linear growth failure can exacerbate adolescents' feelings of being different and unwell.

HIV transmission law in the age of treatment-as-prevention.

PubMed

Haire, Bridget; Kaldor, John

2015-12-01

Evidence that treating people with HIV early in infection prevents transmission to sexual partners has reframed HIV prevention paradigms. The resulting emphasis on HIV testing as part of prevention strategies has rekindled the debate as to whether laws that criminalise HIV transmission are counterproductive to the human rights-based public health response. It also raises normative questions about what constitutes 'safe(r) sex' if a person with HIV has undetectable viral load, which has significant implications for sexual practice and health promotion. This paper discusses a recent high-profile Australian case where HIV transmission or exposure has been prosecuted, and considers how the interpretation of law in these instances impacts on HIV prevention paradigms. In addition, we consider the implications of an evolving medical understanding of HIV transmission, and particularly the ability to determine infectiousness through viral load tests, for laws that relate to HIV exposure (as distinct from transmission) offences. We conclude that defensible laws must relate to appreciable risk. Given the evidence that the transmissibility of HIV is reduced to negligible level where viral load is suppressed, this needs to be recognised in the framing, implementation and enforcement of the law. In addition, normative concepts of 'safe(r) sex' need to be expanded to include sex that is 'protected' by means of the positive person being virally suppressed. In jurisdictions where use of a condom has previously mitigated the duty of the person with HIV to disclose to a partner, this might logically also apply to sex that is 'protected' by undetectable viral load. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

[HIV-1 virus transmission through maternal milk].

PubMed

Avila, M M; Gazpio, M; Liberatore, D; Casanueva, E; Camarieri, G; Libonatti, O; Martínez Peralta, L

2000-01-01

Human immunodeficiency virus type 1 (HIV-1) may be vertically transmitted during the pre, peri or postpartum period. Postnatal transmission as well as an increased risk of vertical transmission with breastfeeding has been shown for HIV-1 in several reports. Breastfeeding was here analyzed as a risk of HIV-1 transmission in a group of infants born to HIV-1 infected mothers. Among the 215 children studied in our population a significant difference was detected between those who were breastfed vs those who were bottle fed and finally became infected (p < 0.000000, R.R. = 4.29). We also report the case of a postnatal infection in a baby born to an HIV-1 seropositive father and a seronegative mother. Due to the risk of infection of the mother she had been thoroughly controlled when pregnant and after delivery. Mother and child were negative when retested at delivery, and at 10 months post-partum. At the age of 32 months the child attended the outpatient clinic with generalized lymphadenopathy and right parotitis. HIV-1 infection was then confirmed in both mother and child. At that time it was discovered that the baby had been breastfed up to the age of 24 months. This is the first reported child in Argentina whose infection may undoubtedly be attributed to breastfeeding.

HIV-1 Encephalopathy among Perinatally Infected Children: Neuropathogenesis and Response to Highly Active Antiretroviral Therapy

ERIC Educational Resources Information Center

Mitchell, Charles D.

2006-01-01

HIV-1 encephalopathy among perinatally infected children in the United States was initially defined by a classic triad of findings that included: (1) developmental delay, (2) secondary or acquired microcephaly, and (3) pyramidal tract neuromotor deficits. The most severe form of this disorder typically occurred among young children who developed…

EFFECT OF HIV PREVENTION AND TREATMENT PROGRAM ON HIV AND HCV TRANSMISSION AND HIV MORTALITY AT AN INDONESIAN NARCOTIC PRISON.

PubMed

Nelwan, Erni J; Indrati, Agnes K; Isa, Ahmad; Triani, Nurlita; Alam, Nisaa Nur; Herlan, Maria S; Husen, Wahid; Pohan, Herdiman T; Alisjahbana, Bachti; Meheus, Andre; Van Crevel, Reinout; van der Ven, Andre Jam

2015-09-01

Validated data regarding HIV-transmission in prisons in developing countries is scarce. We examined sexual and injecting drug use behavior and HIV and HCV transmission in an Indonesian narcotic prison during the implementation of an HIV prevention and treatment program during 2004-2007 when the Banceuy Narcotic Prison in Indonesia conducted an HIV transmission prevention program to provide 1) HIV education, 2) voluntary HIV testing and counseling, 3) condom supply, 4) prevention of rape and sexual violence, 5) antiretroviral treatment for HIV-positive prisoners and 6) methadone maintenance treatment. During a first survey that was conducted between 2007 and 2009, new prisoners entered Banceuy Narcotics Prison were voluntary tested for HIV and HCV-infection after written informed consent was obtained. Information regarding sexual and injecting risk behavior and physical status were also recorded at admission to the prison. Participants who tested negative for both HIV and HCV during the first survey were included in a second survey conducted during 2008-2011. During both surveys, data on mortality among HIV-seropositive patients were also recorded. All HIV-seropositive participants receive treatment for HIV. HIV/ AIDS-related deaths decreased: 43% in 2006, 18% in 2007, 9% in 2008 and 0% in 2009. No HIV and HCV seroconversion inside Banceuy Narcotic Prison were found after a median of 23 months imprisonment (maximum follow-up: 38 months). Total of 484.8 person-years observation was done. Participants reported HIV transmission risk-behavior in Banceuy Prison during the second survey was low. After implementation of HIV prevention and treatment program, no new HIV or HCV cases were detected and HIV-related mortality decreased.

Reproductive health and lifestyle factors associated with health-related quality of life among perinatally HIV-infected adolescents in Uganda.

PubMed

Mbalinda, Scovia Nalugo; Kiwanuka, Noah; Kaye, Dan K; Eriksson, Lars E

2015-10-21

With increased survival of perinatally HIV - infected adolescents due to antiretroviral therapy (ART), the focus of HIV care has shifted to health-related quality of life (HRQoL) as a measure of disease progression, effects of ART co-morbidity and prognosis. We assessed factors associated with better HRQoL in perinatally HIV -infected adolescents in Uganda by determining the associations between sexual and reproductive health (SRH) or lifestyle experiences on HRQoL. In a cross-sectional study, data on SRH, lifestyle experiences, socio demographic factors, communication with parents on sexuality and satisfaction of SRH services in ART clinics were collected from 614 HIV perinatally infected adolescents aged 10-19 using an interviewer-administered survey questionnaire. HRQoL data were collected using the Medical Outcomes Study HIV Health Survey instrument (MOS-HIV). Factors associated with better HRQoL were analysed using multiple logistic regression. The mean age was 16.2 ± 2.1 years, 362 (58.8 %) were females and 210 (34.2 %) were sexually active. Adolescents on ART were twice likely to present with better physical health (AOR = 2.07, 95 % CI: 1.24-3.46) and four times more likely to present with better mental health (AOR = 3.9, 95 % CI: 2.22-6.92) than those who were not on ART. There were no statistically significant associations between SRH (ever had sex, ever been pregnant, condom use, contraceptive use) or life style factors and physical health or mental health. Those with secondary or tertiary education were more likely to present with a better mental health (AOR = 5.3, 95 % CI: 1.86-15.41) compared those who had attained primary or no education. Participants who desired to have a child in future more likely (AOR 1.7, 95 % CI: 1.05-3.00) to present with a better mental health. Lack of communication with guardians on sexuality (AOR = 0.6, 95 % CI: 0.40-0.89), or dissatisfaction with SRH services (AOR 0.34, 95 % CI: 0.18-0.62) were

Sexual and Drug Use Behavior in Perinatal HIV-Infected Youth: Mental Health and Family Influences

ERIC Educational Resources Information Center

Mellins, Claude A.; Elkington, Katherine S.; Brackis-Cott, Elizabeth; Bauermeister, Jose A.; Dolezal, Curtis; McKay, Mary; Wiznia, Andrew; Bamji, Mahrukh; Abrams, Elaine J.

2009-01-01

A study found that youth and caregiver mental health problem have greater impact than key environmental factors and family functioning on sex and drug use risk behaviors in perinatally human immunodeficiency virus (HIV)-infected (PHIV+) and PHIV- youths. No differences in the rates of sexual risk behavior and substance use were observed between…

Progress towards elimination of HIV mother-to-child transmission in the Dominican Republic from 1999 to 2011.

PubMed

Lorenzo, Osvaldo; Beck-Sagué, Consuelo M; Bautista-Soriano, Claudia; Halpern, Mina; Roman-Poueriet, José; Henderson, Nora; Perez-Then, Eddy; Abreu-Perez, Rosa; Soto, Solange; Martínez, Luis; Rives-Gray, Sarah; Veras, Bienvenido; Connolly, Maureen; Callender, Greer Brittany; Nicholas, Stephen W

2012-01-01

In 1999, prevention of mother-to-child transmission (pMTCT) using antiretrovirals was introduced in the Dominican Republic (DR). Highly active antiretroviral therapy (HAART) was introduced for immunosuppressed persons in 2004 and for pMTCT in 2008. To assess progress towards MTCT elimination, data from requisitions for HIV nucleic acid amplification tests for diagnosis of HIV infection in perinatally exposed infants born in the DR from 1999 to 2011 were analyzed. The MTCT rate was 142/1,274 (11.1%) in 1999-2008 and 12/302 (4.0%) in 2009-2011 (P < .001), with a rate of 154/1,576 (9.8%) for both periods combined. This decline was associated with significant increases in the proportions of women who received prenatal HAART (from 12.3% to 67.9%) and infants who received exclusive formula feeding (from 76.3% to 86.1%) and declines in proportions of women who received no prenatal antiretrovirals (from 31.9% to 12.2%) or received only single-dose nevirapine (from 39.5% to 19.5%). In 2007, over 95% of DR pregnant women received prenatal care, HIV testing, and professionally attended delivery. However, only 58% of women in underserved sugarcane plantation communities (2007) and 76% in HIV sentinel surveillance hospitals (2003-2005) received their HIV test results. HIV-MTCT elimination is feasible but persistent lack of access to critical pMTCT measures must be addressed.

HIV-associated cognitive disorders in perinatally infected children and adolescents: a novel composite cognitive domains score.

PubMed

Phillips, Nicole J; Hoare, Jacqueline; Stein, Dan J; Myer, Landon; Zar, Heather J; Thomas, Kevin G F

2018-04-22

Accurate assessment of HIV-associated cognitive disorders in perinatally infected children and adolescents is challenging. Assessments of general intellectual functioning, or global cognition, may not provide information regarding domain-specific strengths and weaknesses, and may therefore fail to detect, impaired trajectories of development within particular cognitive domains. We compare the efficacy of global cognitive scores to that of composite cognitive domain scores in detecting cognitive disorders in a sample of perinatally HIV-infected children, and a demographically matched HIV negative control group, drawn from the Cape Town Adolescent Antiretroviral Cohort (CTAAC) study. All children were administered a comprehensive neuropsychological test battery. Using data from that test battery, we created ten separate composite cognitive domains: general intellectual functioning, attention, working memory, visual memory, verbal memory, language, visual spatial ability, motor coordination, processing speed and executive function. Within each domain, each test bore a high level of association with each of the other tests in that domain (Cronbach's α ≥ .70 for all domains). We found that composite domain scores calculated on whole-sample data were significantly higher than those calculated using control-sample data. Our comparison of a global cognitive score to composite domain scores suggested that the latter provided more detailed information (regarding strengths, weaknesses, areas of impairment), and when compared to global scores, were more sensitive in detecting HIV-associated cognitive disorders, and were able to distinguish HIV-infected patients from uninfected controls. Hence, we recommend using this method of composite cognitive domains scores, rather than global aggregate scores, when assessing cognitive function in paediatric HIV. This method provides a convenient and relatively accurate assessment that might help with cross-cultural and cross

Pregnancy incidence and outcomes in women with perinatal HIV infection.

PubMed

Byrne, Laura; Sconza, Rebecca; Foster, Caroline; Tookey, Pat A; Cortina-Borja, Mario; Thorne, Claire

2017-07-31

To estimate the incidence of first pregnancy in women living with perinatally acquired HIV (PHIV) in the United Kingdom and to compare pregnancy management and outcomes with age-matched women with behaviourally acquired HIV (BHIV). The National Study of HIV in Pregnancy and Childhood is a comprehensive, population-based surveillance study that collects demographic and clinical data on all pregnant women living with HIV, their children, and all HIV-infected children in the United Kingdom and Ireland. The incident rate ratio of first pregnancy was calculated for all women of reproductive age who had been reported to the National Study of HIV in Pregnancy and Childhood as vertically infected children. These women and their pregnancies were compared to age-matched pregnant women with BHIV. Of the 630 women with PHIV reported in the United Kingdom as children, 7% (45) went on to have at least one pregnancy, with 70 pregnancies reported. The incident rate ratio of first pregnancy was 13/1000 woman-years. The BHIV comparison group comprised 118 women (184 pregnancies). Women with PHIV were more likely to be on combined antiretroviral therapy at conception and have a lower baseline CD4 cell count (P < 0.01 for both). In adjusted analysis, PHIV and a low baseline CD4 cell count were risk factors for detectable viral load near delivery; older age at conception and being on combined antiretroviral therapy at conception reduced this risk. Women with PHIV in the United Kingdom have a low pregnancy incidence, but those who become pregnant are at risk of detectable viral load near delivery, reflecting their often complex clinical history, adherence, and drug resistance issues.

Preventing Mother-to-Child Transmission of HIV in Resource-Limited Settings: The Elizabeth Glaser Pediatric AIDS Foundation Experience

PubMed Central

Sripipatana, Tabitha; Turner, Abigail Norris; Hoblitzelle, Chuck; Robinson, Joanna; Wilfert, Catherine

2009-01-01

Objectives. In September 1999, the Elizabeth Glaser Pediatric AIDS Foundation initiated a multicountry, service-based programmatic effort in the developing world to reduce perinatally acquired HIV infection. We review 6½ years of one of the world's largest programs for the prevention of mother-to-child transmission (PMTCT) of HIV. Methods. Each PMTCT facility records patient data in antenatal clinics and labor and delivery settings about counseling, testing, HIV status, and antiretroviral prophylaxis and submits the data to foundation staff. Results. More than 2.6 million women have accessed foundation-affiliated services through June 2006. Overall, 92.9% of women who received antenatal care or were eligible for PMTCT services in labor and delivery have been counseled, and 82.8% of those counseled accepted testing. Among women identified as HIV positive, 75.0% received antiretroviral prophylaxis (most a single dose of nevirapine), as did 45.6% of their infants. Conclusions. The foundation's experience has demonstrated that opt-out testing, supplying mothers with medication at time of diagnosis, and providing the infant dose early have measurably improved program efficiency. PMTCT should be viewed as an achievable paradigm and an essential part of the continuum of care. PMID:18703458

Moral Agency and the Sexual Transmission of HIV

ERIC Educational Resources Information Center

O'Leary, Ann; Wolitski, Richard J.

2009-01-01

Sexual transmission of HIV occurs because an infected person has unprotected sex with a previously uninfected person. The majority of HIV infections are transmitted by individuals who are unaware of their infection, and most persons who are diagnosed with HIV significantly reduce or eliminate risk behaviors once they learn they have HIV. However,…

HIV-1 subtype C is not associated with higher risk of heterosexual HIV-1 transmission: a multinational study among HIV-1 serodiscordant couples.

PubMed

Kahle, Erin; Campbell, Mary; Lingappa, Jairam; Donnell, Deborah; Celum, Connie; Ondondo, Raphael; Mujugira, Andrew; Fife, Kenneth; Mugo, Nelly; Kapiga, Saidi; Mullins, James I; Baeten, Jared M

2014-01-14

HIV-1 subtype C has emerged as the most prevalent strain of HIV-1 worldwide, leading to speculation that subtype C may be more transmissible than other subtypes. We compared the risk of HIV-1 transmission for subtype C versus non-C subtypes (A, D, G and recombinant forms) among heterosexual African HIV-1 serodiscordant couples. We conducted a nested case-control analysis using data from two prospective cohort studies of heterosexual HIV-1 serodiscordant couples from six countries in eastern and southern Africa. Cases (N = 121) included incident HIV-1 transmissions that were established as linked within the serodiscordant partnership by viral sequencing; controls (N = 501) were nontransmitting HIV-1-infected partners. Subtype was determined for partial env and gag genes. Multiple logistic regression controlled for age and gender of the HIV-1-nfected partner and self-reported unprotected sex. Plasma and genital HIV-1 RNA concentrations were compared between subtype C and non-C subtypes using generalized estimating equations. HIV-1 subtype C was not associated with increased risk of HIV-1 transmission compared with non-C subtypes: env adjusted odds ratio (adjOR) 1.14 [95% confidence interval (CI) 0.74-1.75, P = 0.6] and gag adjOR 0.98 (95% CI 0.63-1.52, P = 0.9). Plasma and genital HIV-1 RNA levels did not differ significantly for subtype C versus non-C. In a geographically diverse population of heterosexual African HIV-1 serodiscordant couples, subtype C was not associated with greater risk of HIV-1 transmission compared with non-C subtypes, arguing against the hypothesis that subtype C is more transmissible compared with other common subtypes.

Characterization of HIV Transmission in South-East Austria.

PubMed

Hoenigl, Martin; Chaillon, Antoine; Kessler, Harald H; Haas, Bernhard; Stelzl, Evelyn; Weninger, Karin; Little, Susan J; Mehta, Sanjay R

2016-01-01

To gain deeper insight into the epidemiology of HIV-1 transmission in South-East Austria we performed a retrospective analysis of 259 HIV-1 partial pol sequences obtained from unique individuals newly diagnosed with HIV infection in South-East Austria from 2008 through 2014. After quality filtering, putative transmission linkages were inferred when two sequences were ≤1.5% genetically different. Multiple linkages were resolved into putative transmission clusters. Further phylogenetic analyses were performed using BEAST v1.8.1. Finally, we investigated putative links between the 259 sequences from South-East Austria and all publicly available HIV polymerase sequences in the Los Alamos National Laboratory HIV sequence database. We found that 45.6% (118/259) of the sampled sequences were genetically linked with at least one other sequence from South-East Austria forming putative transmission clusters. Clustering individuals were more likely to be men who have sex with men (MSM; p<0.001), infected with subtype B (p<0.001) or subtype F (p = 0.02). Among clustered males who reported only heterosexual (HSX) sex as an HIV risk, 47% clustered closely with MSM (either as pairs or within larger MSM clusters). One hundred and seven of the 259 sequences (41.3%) from South-East Austria had at least one putative inferred linkage with sequences from a total of 69 other countries. In conclusion, analysis of HIV-1 sequences from newly diagnosed individuals residing in South-East Austria revealed a high degree of national and international clustering mainly within MSM. Interestingly, we found that a high number of heterosexual males clustered within MSM networks, suggesting either linkage between risk groups or misrepresentation of sexual risk behaviors by subjects.

Risk factors for vertical transmission of hepatitis C virus: a single center experience with 710 HCV-infected mothers.

PubMed

Garcia-Tejedor, Amparo; Maiques-Montesinos, Vicente; Diago-Almela, Vicente José; Pereda-Perez, Antonio; Alberola-Cuñat, Vicente; López-Hontangas, José Luís; Perales-Puchalt, Alfredo; Perales, Alfredo

2015-11-01

The aim of this study was to analyze the risk factors on the perinatal transmission of hepatitis C virus (HCV). A retrospective cohort study with 711 infants born to 710 HCV-infected mothers was conducted at the Hospital La Fe, in Valencia, Spain, from 1986 to 2011. As potential risk factors for transmission we analyzed: maternal age, mode of acquisition of HCV infection, HIV co-infection, antiretroviral treatment against HIV, CD4 cell count, HIV and HCV viral load, liver enzyme levels during pregnancy, smoking habit, gestational age, intrapartum invasive procedures, length of rupture of membranes, length of labor, mode of delivery, episiotomy, birth weight, newborn gender and type of feeding. Overall perinatal HCV transmission rate was 2.4%. The significant risk factors related with HCV transmission were maternal virus load >615copies/mL (OR 9.3 [95% CI 1.11-78.72]), intrapartum invasive procedures (OR 10.1 [95% CI 2.6-39.02]) and episiotomy (OR 4.2 [95% CI 1.2-14.16]). HIV co-infection and newborn female were near significance (p=0.081 and 0.075, respectively). Invasive procedures as fetal scalp blood sampling or internal electrode and episiotomy increase vertical transmission of HCV, especially in patients with positive HCV RNA virus load at delivery. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Bleeding injuries in professional football: estimating the risk for HIV transmission.

PubMed

Brown, L S; Drotman, D P; Chu, A; Brown, C L; Knowlan, D

1995-02-15

To determine the risk for bleeding injuries in professional football and to estimate the risk for transmission of the human immunodeficiency virus (HIV) through such injuries. A prospective, observational study. Professional football players from 11 teams of the National Football League were observed during 155 regular season games from September through December 1992. The frequencies of bleeding injuries were calculated in association with environmental and athletic factors. Using this information, HIV prevalence, and data on transmission of HIV in other circumstances, the risk for transmission of HIV during football games was estimated. 575 bleeding injuries (average, 3.7 per game for each team) involving 538 players (average, 3.5 players on each team per game) were observed. Approximately 88% of the bleeding injuries were abrasions; the remainder were lacerations. Bleeding injuries were markedly more frequent during games played on artificial surfaces, during games played in domed stadiums, and on teams with a final win/loss percentage of 0.500 or lower. Using data on the prevalence of HIV among college men and rates of HIV transmission in the health care setting, the risk for HIV transmission to each player was estimated to be less than 1 per 85 million game contacts. Although injuries occur in professional football competitions, bleeding injuries, especially lacerations, occur infrequently. We estimate that the risk for HIV transmission during such competition is extremely remote. The role of artificial playing surfaces on the incidence or severity of bleeding injuries should be investigated.

Increasing Adolescent HIV Prevalence in Eastern Zimbabwe – Evidence of Long-Term Survivors of Mother-to-Child Transmission?

PubMed Central

Eaton, Jeffrey W.; Garnett, Geoffrey P.; Takavarasha, Felicia R.; Mason, Peter R.; Robertson, Laura; Schumacher, Christina M.; Nyamukapa, Constance A.; Gregson, Simon

2013-01-01

Recent data from the Manicaland HIV/STD Prevention Project, a general-population open HIV cohort study, suggested that between 2004 and 2007 HIV prevalence amongst males aged 15–17 years in eastern Zimbabwe increased from 1.20% to 2.23%, and in females remained unchanged at 2.23% to 2.39%, while prevalence continued to decline in the rest of the adult population. We assess whether the more likely source of the increase in adolescent HIV prevalence is recent sexual HIV acquisition, or the aging of long-term survivors of perinatal HIV acquisition that occurred during the early growth of the epidemic. Using data collected between August 2006 and November 2008, we investigated associations between adolescent HIV and (1) maternal orphanhood and maternal HIV status, (2) reported sexual behaviour, and (3) reporting recurring sickness or chronic illness, suggesting infected adolescents might be in a late stage of HIV infection. HIV-infected adolescent males were more likely to be maternal orphans (RR = 2.97, p<0.001) and both HIV-infected adolescent males and females were more likely to be maternal orphans or have an HIV-infected mother (male RR = 1.83, p<0.001; female RR = 16.6, p<0.001). None of 22 HIV-infected adolescent males and only three of 23 HIV-infected females reported ever having had sex. HIV-infected adolescents were 60% more likely to report illness than HIV-infected young adults. Taken together, all three hypotheses suggest that recent increases in adolescent HIV prevalence in eastern Zimbabwe are more likely attributable to long-term survival of mother-to-child transmission rather than increases in risky sexual behaviour. HIV prevalence in adolescents and young adults cannot be used as a surrogate for recent HIV incidence, and health systems should prepare for increasing numbers of long-term infected adolescents. PMID:23950938

Characterization of HIV Transmission in South-East Austria

PubMed Central

Kessler, Harald H.; Haas, Bernhard; Stelzl, Evelyn; Weninger, Karin; Little, Susan J.; Mehta, Sanjay R.

2016-01-01

To gain deeper insight into the epidemiology of HIV-1 transmission in South-East Austria we performed a retrospective analysis of 259 HIV-1 partial pol sequences obtained from unique individuals newly diagnosed with HIV infection in South-East Austria from 2008 through 2014. After quality filtering, putative transmission linkages were inferred when two sequences were ≤1.5% genetically different. Multiple linkages were resolved into putative transmission clusters. Further phylogenetic analyses were performed using BEAST v1.8.1. Finally, we investigated putative links between the 259 sequences from South-East Austria and all publicly available HIV polymerase sequences in the Los Alamos National Laboratory HIV sequence database. We found that 45.6% (118/259) of the sampled sequences were genetically linked with at least one other sequence from South-East Austria forming putative transmission clusters. Clustering individuals were more likely to be men who have sex with men (MSM; p<0.001), infected with subtype B (p<0.001) or subtype F (p = 0.02). Among clustered males who reported only heterosexual (HSX) sex as an HIV risk, 47% clustered closely with MSM (either as pairs or within larger MSM clusters). One hundred and seven of the 259 sequences (41.3%) from South-East Austria had at least one putative inferred linkage with sequences from a total of 69 other countries. In conclusion, analysis of HIV-1 sequences from newly diagnosed individuals residing in South-East Austria revealed a high degree of national and international clustering mainly within MSM. Interestingly, we found that a high number of heterosexual males clustered within MSM networks, suggesting either linkage between risk groups or misrepresentation of sexual risk behaviors by subjects. PMID:26967154

Multiplayer games and HIV transmission via casual encounters.

PubMed

Tully, Stephen; Cojocaru, Monica-Gabriela; Bauch, Chris T

2017-04-01

Population transmission models have been helpful in studying the spread of HIV. They assess changes made at the population level for different intervention strategies. To further understand how individual changes affect the population as a whole, game-theoretical models are used to quantify the decision-making process. Investigating multiplayer nonlinear games that model HIV transmission represents a unique approach in epidemiological research. We present here 2-player and multiplayer noncooperative games where players are defined by HIV status and age and may engage in casual (sexual) encounters. The games are modelled as generalized Nash games with shared constraints, which is completely novel in the context of our applied problem. Each player's HIV status is known to potential partners, and players have personal preferences ranked via utility values of unprotected and protected sex outcomes. We model a player's strategy as their probability of being engaged in a casual unprotected sex encounter (USE), which may lead to HIV transmission; however, we do not incorporate a transmission model here. We study the sensitivity of Nash strategies with respect to varying preference rankings, and the impact of a prophylactic vaccine introduced in players of youngest age groups. We also study the effect of these changes on the overall increase in infection level, as well as the effects that a potential prophylactic treatment may have on age-stratified groups of players. We conclude that the biggest impacts on increasing the infection levels in the overall population are given by the variation in the utilities assigned to individuals for unprotected sex with others of opposite HIV status, while the introduction of a prophylactic vaccine in youngest age group (15-20 yr olds) slows down the increase in HIV infection.

Bottlenecks in HIV-1 transmission: insights from the study of founder viruses.

PubMed

Joseph, Sarah B; Swanstrom, Ronald; Kashuba, Angela D M; Cohen, Myron S

2015-07-01

HIV-1 infection typically results from the transmission of a single viral variant, the transmitted/founder (T/F) virus. Studies of these HIV-1 variants provide critical information about the transmission bottlenecks and the selective pressures acting on the virus in the transmission fluid and in the recipient tissues. These studies reveal that T/F virus phenotypes are shaped by stochastic and selective forces that restrict transmission and may be targets for prevention strategies. In this Review, we highlight how studies of T/F viruses contribute to a better understanding of the biology of HIV-1 transmission and discuss how these findings affect HIV-1 prevention strategies.

Bottlenecks in HIV-1 transmission: insights from the study of founder viruses

PubMed Central

Joseph, Sarah B.; Swanstrom, Ronald; Kashuba, Angela D. M.; Cohen, Myron S.

2016-01-01

HIV-1 infection typically results from the transmission of a single viral variant, the transmitted/founder (T/F) virus. Studies of these HIV-1 variants provide critical information about the transmission bottlenecks and the selective pressures acting on the virus in the transmission fluid and in the recipient tissues. These studies reveal that T/F virus phenotypes are shaped by stochastic and selective forces that restrict transmission and may be targets for prevention strategies. In this Review, we highlight how studies of T/F viruses contribute to a better understanding of the biology of HIV-1 transmission and discuss how these findings affect HIV-1 prevention strategies. PMID:26052661

Prevalence of Drug-Resistance Mutations and Non–Subtype B Strains Among HIV-Infected Infants From New York State

PubMed Central

Karchava, Marine; Pulver, Wendy; Smith, Lou; Philpott, Sean; Sullivan, Timothy J.; Wethers, Judith; Parker, Monica M.

2010-01-01

Summary Prevalence studies indicate that transmission of drug-resistant HIV has been rising in the adult population, but data from the perinatally infected pediatric population are limited. In this retrospective study, we sequenced the pol region of HIV from perinatally infected infants diagnosed in New York State in 2001–2002. Analyses of drug resistance, subtype diversity, and perinatal antiretroviral exposure were conducted, and the results were compared with those from a previous study of HIV-infected infants identified in 1998–1999. Eight of 42 infants (19.1%) had provirus carrying at least 1 drug-resistance mutation, an increase of 58% over the 1998–1999 results. Mutations conferring resistance to nucleoside reverse transcriptase inhibitors, nonnucleoside reverse transcriptase inhibitors, and protease inhibitors were detected in 7.1%, 11.9%, and 2.4% of specimens, respectively. Consistent with previous results, perinatal antiretroviral exposure was not associated with drug resistance (P = 0.70). Phylogenetic analysis indicated that 16.7% of infants were infected with a non–subtype B strain of HIV. It seems that drug-resistant and non–subtype B strains of HIV are becoming increasingly common in the perinatally infected population. Our results highlight the value of resistance testing for all HIV-infected infants upon diagnosis and the need to consider subtype diversity in diagnostic and treatment strategies. PMID:16868498

The efficacy of serostatus disclosure for HIV Transmission risk reduction.

PubMed

O'Connell, Ann A; Reed, Sandra J; Serovich, Julianne A

2015-02-01

Interventions to assist HIV+ persons in disclosing their serostatus to sexual partners can play an important role in curbing rates of HIV transmission among men who have sex with men (MSM). Based on the methods of Pinkerton and Galletly (AIDS Behav 11:698-705, 2007), we develop a mathematical probability model for evaluating effectiveness of serostatus disclosure in reducing the risk of HIV transmission and extend the model to examine the impact of serosorting. In baseline data from 164 HIV+ MSM participating in a randomized controlled trial of a disclosure intervention, disclosure is associated with a 45.0 % reduction in the risk of HIV transmission. Accounting for serosorting, a 61.2 % reduction in risk due to disclosure was observed in serodisconcordant couples. The reduction in risk for seroconcordant couples was 38.4 %. Evidence provided supports the value of serostatus disclosure as a risk reduction strategy in HIV+ MSM. Interventions to increase serostatus disclosure and that address serosorting behaviors are needed.

The Efficacy of Serostatus Disclosure for HIV Transmission Risk Reduction

PubMed Central

O’Connell, Ann A.; Serovich, Julianne A.

2015-01-01

Interventions to assist HIV+ persons in disclosing their serostatus to sexual partners can play an important role in curbing rates of HIV transmission among men who have sex with men (MSM). Based on the methods of Pinkerton and Galletly (AIDS Behav 11:698–705, 2007), we develop a mathematical probability model for evaluating effectiveness of serostatus disclosure in reducing the risk of HIV transmission and extend the model to examine the impact of serosorting. In baseline data from 164 HIV+ MSM participating in a randomized controlled trial of a disclosure intervention, disclosure is associated with a 45.0 % reduction in the risk of HIV transmission. Accounting for serosorting, a 61.2 % reduction in risk due to disclosure was observed in serodisconcordant couples. The reduction in risk for seroconcordant couples was 38.4 %. Evidence provided supports the value of serostatus disclosure as a risk reduction strategy in HIV+ MSM. Interventions to increase serostatus disclosure and that address serosorting behaviors are needed. PMID:25164375

HIV transmission risk among HIV seroconcordant and serodiscordant couples: dyadic processes of partner selection.

PubMed

Eaton, Lisa A; West, Tessa V; Kenny, David A; Kalichman, Seth C

2009-04-01

Selecting sex partners of the same HIV status or serosorting is a sexual risk reduction strategy used by many men who have sex with men. However, the effectiveness of serosorting for protection against HIV is potentially limited. We sought to examine how men perceive the protective benefits of factors related to serosorting including beliefs about engaging in serosorting, sexual communication, and perceptions of risk for HIV. Participants were 94 HIV negative seroconcordant (same HIV status) couples, 20 HIV serodiscordant (discrepant HIV status) couples, and 13 HIV positive seroconcordant (same HIV status) couples recruited from a large gay pride festival in the southeastern US. To account for nonindependence found in the couple-level data, we used multilevel modeling which includes dyad in the analysis. Findings demonstrated that participants in seroconcordant relationships were more likely to believe that serosorting reduces concerns for condom use. HIV negative participants in seroconcordant relationships viewed themselves at relatively low risk for HIV transmission even though monogamy within relationships and HIV testing were infrequent. Dyadic analyses demonstrated that partners have a substantial effect on an individual's beliefs and number of unprotected sex partners. We conclude that relationship partners are an important source of influence and, thus, intervening with partners is necessary to reduce HIV transmission risks.

A Prospective Study of the Onset of Sexual Behavior and Sexual Risk in Youth Perinatally Infected With HIV

PubMed Central

Bauermeister, José A.; Elkington, Katherine S.; Robbins, Reuben N.; Kang, Ezer; Mellins, Claude A.

2011-01-01

Perinatally HIV-infected (PHIV+) youth are surviving into adolescence and young adulthood. Understanding the sexual development of PHIV+ youth is vital to providing them with developmentally appropriate HIV prevention programs. Using pooled data (N = 417) from two longitudinal studies focused on HIV among youth (51% female; 39% HIV+) and their caregivers (92% female; 46% HIV+), we compared the rate of sexual onset during adolescence across four youth-caregiver combinations: PHIV+ youth with HIV+ caregivers (12%); PHIV+ youth with HIV− caregivers (27%); HIV− youth with HIV+ caregivers (34%); and HIV− youth with HIV-caregivers (27%). Youth with HIV− caregivers were more likely than other youth-caregiver groups to have had their sexual onset. Youth with HIV+ caregivers reported a slower rate of onset of penetrative sex across the adolescent years. We discuss our findings by highlighting the role that both youth and caregiver HIV status play in the onset of sexual behavior across adolescence. PMID:21797715

Progress towards Elimination of HIV Mother-to-Child Transmission in the Dominican Republic from 1999 to 2011

PubMed Central

Lorenzo, Osvaldo; Beck-Sagué, Consuelo M.; Bautista-Soriano, Claudia; Halpern, Mina; Roman-Poueriet, José; Henderson, Nora; Perez-Then, Eddy; Abreu-Perez, Rosa; Soto, Solange; Martínez, Luis; Rives-Gray, Sarah; Veras, Bienvenido; Connolly, Maureen; Callender, Greer Brittany; Nicholas, Stephen W.

2012-01-01

In 1999, prevention of mother-to-child transmission (pMTCT) using antiretrovirals was introduced in the Dominican Republic (DR). Highly active antiretroviral therapy (HAART) was introduced for immunosuppressed persons in 2004 and for pMTCT in 2008. To assess progress towards MTCT elimination, data from requisitions for HIV nucleic acid amplification tests for diagnosis of HIV infection in perinatally exposed infants born in the DR from 1999 to 2011 were analyzed. The MTCT rate was 142/1,274 (11.1%) in 1999–2008 and 12/302 (4.0%) in 2009–2011 (P < .001), with a rate of 154/1,576 (9.8%) for both periods combined. This decline was associated with significant increases in the proportions of women who received prenatal HAART (from 12.3% to 67.9%) and infants who received exclusive formula feeding (from 76.3% to 86.1%) and declines in proportions of women who received no prenatal antiretrovirals (from 31.9% to 12.2%) or received only single-dose nevirapine (from 39.5% to 19.5%). In 2007, over 95% of DR pregnant women received prenatal care, HIV testing, and professionally attended delivery. However, only 58% of women in underserved sugarcane plantation communities (2007) and 76% in HIV sentinel surveillance hospitals (2003–2005) received their HIV test results. HIV-MTCT elimination is feasible but persistent lack of access to critical pMTCT measures must be addressed. PMID:23251074

The Effect of Prophylaxis on Pediatric HIV Costs

PubMed Central

Wilson, Leslie S.; Hensic, Lori; Paoli, Carly J.; Basu, Rituparna; Christenson, Maria; Moskowitz, Judith K.; Wara, Diane

2011-01-01

The objective of this study was to determine and compare the cost to treat HIV(+) and HIV(−) pediatric patients both before and after HIV prophylaxis became the standard of care. Retrospective chart review of a pediatric HIV/AIDS specialty clinic’s medical charts was conducted for clinical and healthcare utilization data on 125 children diagnosed from 1986–2007. Mean HIV-related costs were compared using bootstrapped t-tests for children born in the pre-prophylaxis (1979–1993) and prophylaxis eras (1994–2007). Patients were also stratified into two categories based on death during the follow-up period. Lastly, national cost-savings were estimated using mean costs, national number of at-risk births and national perinatal HIV transmission rates in each era. For HIV(+) children, mean annual per patient treatment cost was $15,067 (95% CI: $10,169–$19,965) in the pre-prophylaxis era (n=40) and $14,959 (95% CI: $9,140–$20,779) in the prophylaxis era (n=14), difference not statistically significant (p>0.05). For HIV(−) children, mean annual per patient treatment cost was $204 (95% CI: −$219–$627) for the pre-prophylaxis era (n=2) and $427 (95% CI: $277–$579) for the prophylaxis era (n=69), different statistically significant (p<0.05). A projected cost-savings of $16–23 million annually in the US was observed due to the adoption of prophylaxis treatment guidelines in pediatric HIV care. The prophylaxis era of pediatric HIV treatment has been successful in decreasing perinatal HIV transmission and mortality, as reflected by clinical trials and national cost-savings data, and emphasizes the value of the rapid adoption of evidence-based practice guidelines. PMID:21780991

The role of extra-couple HIV transmission in sub-Saharan Africa

PubMed Central

Bellan, Steve E.; Fiorella, Kathryn J.; Melesse, Dessalegn Y.; Getz, Wayne M.; Williams, Brian G.; Dushoff, Jonathan

2013-01-01

Summary Background The proportion of heterosexual HIV transmission in Sub-Saharan Africa that occurs within cohabiting partnerships, as opposed to among single people, or in extra-couple relationships, is a subject of active debate. This question is of immediate importance. As plans to use antiretroviral drugs as a strategy for population-level prevention progress, understanding the importance of different transmission routes is critical to targeting intervention efforts. Methods We built a mechanistic HIV transmission model using data from Demographic and Health Surveys covering 27,201 cohabiting couples from 18 sub-Saharan African countries with information on couple duration, age at sexual debut, and HIV serostatus. We combined this model with estimates of HIV survival times and country-specific estimates of HIV prevalence and ART coverage. We then estimated the proportion of observed infections in surveyed cohabiting couples that occurred prior to couple formation, between couple members, and through extra-couple intercourse. Findings We estimate that extra-couple transmission accounts for between 27-61% and 21-51% of all infected males and females, respectively, in surveyed couples, with the ranges given reflecting inter-country variation. We project that over the next year extra-couple transmission will account for 30-65% and 10-47% of new incident HIV infections in males and females, respectively, in cohabiting couples. Our results also suggest that the directionality of transmission within couples is largely from males to females; however, females experience a very high-risk period prior to couple formation. Interpretation Due to the large contribution of extra-couple transmission, HIV prevention interventions should target the general sexually active population, and not just serodiscordant couples. PMID:23391466

Role of Semen on Vaginal HIV-1 Transmission and Maraviroc Protection

PubMed Central

Council, Olivia D.; Swanson, Michael D.; Spagnuolo, Rae Ann

2015-01-01

We used bone marrow/liver/thymus (BLT) humanized mice to establish the effect of semen on vaginal HIV infection and on the efficacy of topically applied maraviroc. Our results demonstrate that vaginal transmission of cell-free HIV occurs efficiently in the presence of semen and that topically applied maraviroc efficiently prevents HIV transmission in the presence of semen. We also show that semen has no significant effect on the transmission of transmitted/founder viruses or cell-associated viruses. PMID:26392489

Deformed Subcortical Structures Are Related to Past HIV Disease Severity in Youth With Perinatally Acquired HIV Infection.

PubMed

Lewis-de Los Angeles, C Paula; Alpert, Kathryn I; Williams, Paige L; Malee, Kathleen; Huo, Yanling; Csernansky, John G; Yogev, Ram; Van Dyke, Russell B; Sowell, Elizabeth R; Wang, Lei

2016-12-01

Combination antiretroviral therapy has led to increased survival among youth with perinatally acquired HIV (PHIV). However, cognitive deficits continue to be common. Histopathological studies in adults have found HIV concentrated in subcortical structures, which are involved in sensory processing, movement, and higher-order cognition that emerges with development. We conducted magnetic resonance imaging and cognitive testing in 40 youth with PHIV at one site of the Adolescent Master Protocol of the Pediatric HIV/AIDS Cohort Study. We collected HIV disease-severity measures and substance-use reports. Subcortical volume and shape deformation were generated with FreeSurfer-Initiated Large Deformation Diffeomorphic Metric Mapping. Inward shape deformation was defined as negative displacement. We evaluated associations of subcortical shape deformation with past HIV severity after adjustment for sex, age at neuroimaging, age at HIV severity marker, and substance use. We examined associations between subcortical deformation and cognitive function. Negative correlations between shape deformation and peak HIV viral load (VL) were found in clusters in the caudate tail, globus pallidus, lateral putamen, and anterior and medial thalamus. Positive correlations between shape deformation and nadir CD4-positive T-lymphocyte percentage (CD4%) were found in clusters in the medial and posterior thalamus. Inward deformation in caudate and thalamic clusters correlated with worse cognition. Youth with PHIV have demonstrable subcortical shape deformation related to past HIV severity and cognition; inward deformation was associated with higher peak VL, lower nadir CD4%, and worse cognition. Identifying subcortical deformation may inform clinical practice for early intervention to help improve cognitive outcomes and assess the neuroefficacy of combination antiretroviral therapy in youth with PHIV. © The Author 2016. Published by Oxford University Press on behalf of the Pediatric

Drug-Drug Interactions, Effectiveness, and Safety of Hormonal Contraceptives in Women Living with HIV.

PubMed

Scarsi, Kimberly K; Darin, Kristin M; Chappell, Catherine A; Nitz, Stephanie M; Lamorde, Mohammed

2016-11-01

Family planning options, including hormonal contraceptives, are essential for improving reproductive health among the more than 17 million women living with HIV worldwide. For these women, prevention of unintended pregnancy decreases maternal and child mortality, as well as reduces the risk of perinatal HIV transmission. Similarly, treatment of HIV with antiretroviral therapy (ART) is essential for reducing morbidity and mortality among HIV-positive individuals, as well as preventing HIV transmission between sexual partners or from mother to child. Importantly, despite the benefits of hormonal contraceptives, barriers to effective family planning methods exist for HIV-positive women. Specifically, drug-drug interactions can occur between some antiretroviral medications and some hormonal contraceptives, which may influence both contraceptive efficacy and tolerability. In addition, safety concerns have been raised about the impact of hormonal contraceptives on HIV disease progression, tolerability, and the risk of female-to-male HIV transmission. This review article summarizes the potential for drug-drug interactions, tolerability, and contraceptive effectiveness when hormonal contraceptives are combined with ART. In addition, the evidence surrounding the influence of hormonal contraceptives on HIV transmission and HIV disease progression in women living with HIV are summarized.

Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis.

PubMed

Donnell, Deborah; Baeten, Jared M; Kiarie, James; Thomas, Katherine K; Stevens, Wendy; Cohen, Craig R; McIntyre, James; Lingappa, Jairam R; Celum, Connie

2010-06-12

High plasma HIV-1 RNA concentrations are associated with increased risk of HIV-1 transmission. Initiation of antiretroviral therapy (ART) reduces plasma HIV-1 concentrations. We aimed to assess the effect of ART use by patients infected with HIV-1 on risk of transmission to their uninfected partners. Participants in our prospective cohort analysis were from a randomised placebo-controlled trial that enrolled heterosexual African adults who were seropositive for both HIV-1 and herpes simplex virus type 2, and their HIV-1 seronegative partners. At enrolment, HIV-1 infected participants had CD4 counts of 250 cells per microL or greater and did not meet national guidelines for ART initiation; during 24 months of follow-up, CD4 counts were measured every 6 months and ART was initiated in accordance with national guidelines. Uninfected partners were tested for HIV-1 every 3 months. The primary outcome was genetically-linked HIV-1 transmission within the study partnership. We assessed rates of HIV-1 transmission by ART status of infected participants. 3381 couples were eligible for analysis. 349 (10%) participants with HIV-1 initiated ART during the study, at a median CD4 cell count of 198 (IQR 161-265) cells per microL. Only one of 103 genetically-linked HIV-1 transmissions was from an infected participant who had started ART, corresponding to transmission rates of 0.37 (95% CI 0.09-2.04) per 100 person-years in those who had initiated treatment and 2.24 (1.84-2.72) per 100 person-years in those who had not-a 92% reduction (adjusted incidence rate ratio 0.08, 95% CI 0.00-0.57, p=0.004). In participants not on ART, the highest HIV-1 transmission rate (8.79 per 100 person-years) was from those with CD4 cell counts lower than 200 cells per microL. In couples in whom the untreated HIV-1 infected partner had a CD4 cell count greater than 200 cells per microL, 66 (70%) of 94 transmissions occurred when plasma HIV-1 concentrations exceeded 50 000 copies per mL. Low CD4 cell

Morbidity and Mortality of a Cohort of Peruvian HIV-infected Children 2003-2012.

PubMed

Baker, Amira N; Bayer, Angela M; Viani, Rolando M; Kolevic, Lenka; Sim, Myung-Shin; Deville, Jaime G

2018-06-01

Data on pediatric HIV in Peru are limited. The National Institute of Child Health (Instituto Nacional de Salud del Niño: INSN) cares for the most HIV-infected children under the age of 18 years in the country. We describe the outcomes of children seen at INSN's HIV clinic over the 10 years when antiretroviral therapy and prevention of mother-to-child transmission (PMTCT) interventions became available in 2004. We conducted a retrospective review of INSN HIV clinic patients between 2003 and 2012. Deidentified data were collected and analyzed. A total of 280 children were included: 50.0% (140/280) were male; 80.0% (224/280) lived in metropolitan Lima. Perinatal transmission was the mode of HIV infection in 91.4% (256/280) of children. Only 17% (32/191) of mothers were known to be HIV-infected at delivery; of these mothers, 41% (13/32) were receiving antiretroviral therapy at delivery, 72% (23/32) delivered by Cesarean section and 47% (15/32) of their infants received antiretroviral prophylaxis. Median age at HIV diagnosis for all children was 35.7 months (interquartile range 14.5-76.8 months), and 67% (143/213) had advanced disease (clinical stage C). After HIV diagnosis, the most frequent hospitalization discharge diagnoses were bacterial pneumonia, chronic malnutrition, diarrhea, anemia and tuberculosis. Twenty-four patients (8.6%) died at a median age of 77.4 months. Most cases of pediatric HIV were acquired via perinatal transmission; few mothers were diagnosed before delivery; and among mothers with known HIV status, PMTCT was suboptimal even after national PMTCT policy was implemented. Most children were diagnosed with advanced disease. These findings underscore the need for improving early pediatric HIV diagnosis and treatment, as well as PMTCT strategies.

"I definitely want grandbabies": Caregivers of adolescents with perinatally-acquired HIV reflect on dating and childbearing.

PubMed

Fair, Cynthia D; Albright, Jamie N; Clark, Devon M; Houpt, Bethany

2016-12-01

Parents and caregivers of typically developing teens are often a source of information about sexual health and relationships. However, little is known about the information offered to adolescents with perinatally acquired HIV (APHIV) by caregivers who may provide support and guidance to their teen as they explore sexuality and childbearing. This qualitative exploratory study involved the in-depth interviews of 18 caregivers (17 females), including biological mothers (9), relatives (5), and adoptive/foster mothers (4), who care for APHIV. Interviews explored views regarding their adolescent's engagement in romantic relationships, sexual behaviors, and childbearing. The guardian's knowledge of mother-to-child-transmission (MTCT) was also assessed for accuracy. Transcribed interviews were coded for emergent themes. Analyses indicated that the majority of caregivers discussed sexual health and dating with their adolescent. However, guidance regarding disclosure to partners of the adolescent's HIV status varied. Some biological mothers and all relatives cautioned against disclosure, contrary to foster/adoptive mothers. Most caregivers wanted their adolescent to experience parenthood. Reasons affirming childbearing included the belief their child would be a good parent and wanted to experience parenthood, childbearing as a normative experience, and decreased HIV-related stigma. Biological mothers and most relatives did not know the risk of MTCT, as opposed to all foster/adoptive mothers who accurately stated the risk was 1% to 2%. The type of guardian influenced the nature of shared information related to disclosure and risk of MTCT. Sexual and reproductive health education should be provided to caregivers because they could be an important source of information for APHIV. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Enhanced Heterosexual Transmission Hypothesis for the Origin of Pandemic HIV-1

PubMed Central

de Sousa, João Dinis; Alvarez, Carolina; Vandamme, Anne-Mieke; Müller, Viktor

2012-01-01

HIV-1 M originated from SIVcpz endemic in chimpanzees from southeast Cameroon or neighboring areas, and it started to spread in the early 20th century. Here we examine the factors that may have contributed to simian-to-human transmission, local transmission between humans, and export to a city. The region had intense ape hunting, social disruption, commercial sex work, STDs, and traffic to/from Kinshasa in the period 1899–1923. Injection treatments increased sharply around 1930; however, their frequency among local patients was far lower than among modern groups experiencing parenteral HIV-1 outbreaks. Recent molecular datings of HIV-1 M fit better the period of maximal resource exploitation and trade links than the period of high injection intensity. We conclude that although local parenteral outbreaks might have occurred, these are unlikely to have caused massive transmission. World War I led to additional, and hitherto unrecognized, risks of HIV-1 emergence. We propose an Enhanced Heterosexual Transmission Hypothesis for the origin of HIV-1 M, featuring at the time and place of its origin a coincidence of favorable co-factors (ape hunting, social disruption, STDs, and mobility) for both cross-species transmission and heterosexual spread. Our hypothesis does not exclude a role for parenteral transmission in the initial viral adaptation. PMID:23202448

High uptake of exclusive breastfeeding and reduced early post-natal HIV transmission.

PubMed

Kuhn, Louise; Sinkala, Moses; Kankasa, Chipepo; Semrau, Katherine; Kasonde, Prisca; Scott, Nancy; Mwiya, Mwiya; Vwalika, Cheswa; Walter, Jan; Tsai, Wei-Yann; Aldrovandi, Grace M; Thea, Donald M

2007-12-26

Empirical data showing the clear benefits of exclusive breastfeeding (EBF) for HIV prevention are needed to encourage implementation of lactation support programs for HIV-infected women in low resource settings among whom replacement feeding is unsafe. We conducted a prospective, observational study in Lusaka, Zambia, to test the hypothesis that EBF is associated with a lower risk of postnatal HIV transmission than non-EBF. As part of a randomized trial of early weaning, 958 HIV-infected women and their infants were recruited and all were encouraged to breastfeed exclusively to 4 months. Single-dose nevirapine was provided to prevent transmission. Regular samples were collected from infants to 24 months of age and tested by PCR. Detailed measurements of actual feeding behaviors were collected to examine, in an observational analysis, associations between feeding practices and postnatal HIV transmission. Uptake of EBF was high with 84% of women reporting only EBF cumulatively to 4 months. Post-natal HIV transmission before 4 months was significantly lower (p = 0.004) among EBF (0.040 95% CI: 0.024-0.055) than non-EBF infants (0.102 95% CI: 0.047-0.157); time-dependent Relative Hazard (RH) of transmission due to non-EBF = 3.48 (95% CI: 1.71-7.08). There were no significant differences in the severity of disease between EBF and non-EBF mothers and the association remained significant (RH = 2.68 95% CI: 1.28-5.62) after adjusting for maternal CD4 count, plasma viral load, syphilis screening results and low birth weight. Non-EBF more than doubles the risk of early postnatal HIV transmission. Programs to support EBF should be expanded universally in low resource settings. EBF is an affordable, feasible, acceptable, safe and sustainable practice that also reduces HIV transmission providing HIV-infected women with a means to protect their children's lives. ClinicalTrials.gov NCT00310726.

HIV status disclosure to perinatally-infected adolescents in Zimbabwe: a qualitative study of adolescent and healthcare worker perspectives.

PubMed

Kidia, Khameer K; Mupambireyi, Zivai; Cluver, Lucie; Ndhlovu, Chiratidzo E; Borok, Margaret; Ferrand, Rashida A

2014-01-01

Due to the scale up of antiretroviral therapy, increasing numbers of HIV-infected children are living into adolescence. As these children grow and surpass the immediate threat of death, the issue of informing them of their HIV status arises. This study aimed to understand how perinatally-infected adolescents learn about their HIV-status as well as to examine their preferences for the disclosure process. In-depth interviews were conducted with 31 (14 male, 17 female) perinatally-infected adolescents aged 16-20 at an HIV clinic in Harare, Zimbabwe, and focused on adolescents' experiences of disclosure. In addition, 15 (1 male, 14 female) healthcare workers participated in two focus groups that were centred on healthcare workers' practices surrounding disclosure in the clinic. Purposive sampling was used to recruit participants. A coding frame was developed and major themes were extracted using grounded theory methods. Healthcare workers encouraged caregivers to initiate disclosure in the home environment. However, many adolescents preferred disclosure to take place in the presence of healthcare workers at the clinic because it gave them access to accurate information as well as an environment that made test results seem more credible. Adolescents learned more specific information about living with an HIV-positive status and the meaning of that status from shared experiences among peers at the clinic. HIV-status disclosure to adolescents is distinct from disclosure to younger children and requires tailored, age-appropriate guidelines. Disclosure to this age group in a healthcare setting may help overcome some of the barriers associated with caregivers disclosing in the home environment and make the HIV status seem more credible to an adolescent. The study also highlights the value of peer support among adolescents, which could help reduce the burden of psychosocial care on caregivers and healthcare workers.

HIV transmission risk behavior among HIV-positive patients receiving antiretroviral therapy in KwaZulu-Natal, South Africa.

PubMed

Shuper, Paul A; Kiene, Susan M; Mahlase, Gethwana; MacDonald, Susan; Christie, Sarah; Cornman, Deborah H; Fisher, William A; Greener, Ross; Lalloo, Umesh G; Pillay, Sandy; van Loggerenberg, Francois; Fisher, Jeffrey D

2014-08-01

The aim of this investigation was to identify factors associated with HIV transmission risk behavior among HIV-positive women and men receiving antiretroviral therapy (ART) in KwaZulu-Natal, South Africa. Across 16 clinics, 1,890 HIV+ patients on ART completed a risk-focused audio computer-assisted self-interview upon enrolling in a prevention-with-positives intervention trial. Results demonstrated that 62 % of HIV-positive patients' recent unprotected sexual acts involved HIV-negative or HIV status unknown partners. For HIV-positive women, multivariable correlates of unprotected sex with HIV-negative or HIV status unknown partners were indicative of poor HIV prevention-related information and of sexual partnership-associated behavioral skills barriers. For HIV-positive men, multivariable correlates represented motivational barriers, characterized by negative condom attitudes and the experience of depressive symptomatology, as well as possible underlying information deficits. Findings suggest that interventions addressing gender-specific and culturally-relevant information, motivation, and behavioral skills barriers could help reduce HIV transmission risk behavior among HIV-positive South Africans.

Understanding the effects of different HIV transmission models in individual-based microsimulation of HIV epidemic dynamics in people who inject drugs

PubMed Central

MONTEIRO, J.F.G.; ESCUDERO, D.J.; WEINREB, C.; FLANIGAN, T.; GALEA, S.; FRIEDMAN, S.R.; MARSHALL, B.D.L.

2017-01-01

SUMMARY We investigated how different models of HIV transmission, and assumptions regarding the distribution of unprotected sex and syringe-sharing events (‘risk acts’), affect quantitative understanding of HIV transmission process in people who inject drugs (PWID). The individual-based model simulated HIV transmission in a dynamic sexual and injecting network representing New York City. We constructed four HIV transmission models: model 1, constant probabilities; model 2, random number of sexual and parenteral acts; model 3, viral load individual assigned; and model 4, two groups of partnerships (low and high risk). Overall, models with less heterogeneity were more sensitive to changes in numbers risk acts, producing HIV incidence up to four times higher than that empirically observed. Although all models overestimated HIV incidence, micro-simulations with greater heterogeneity in the HIV transmission modelling process produced more robust results and better reproduced empirical epidemic dynamics. PMID:26753627

Immunology of Pediatric HIV Infection

PubMed Central

Tobin, Nicole H.; Aldrovandi, Grace M.

2013-01-01

Summary Most infants born to human immunodeficiency virus (HIV)-infected women escape HIV infection. Infants evade infection despite an immature immune system and, in the case of breastfeeding, prolonged repetitive, exposure. If infants become infected, the course of their infection and response to treatment differs dramatically depending upon the timing (in utero, intrapartum, or during breastfeeding) and potentially the route of their infection. Perinatally acquired HIV infection occurs during a critical window of immune development. HIV’s perturbation of this dynamic process may account for the striking age-dependent differences in HIV disease progression. HIV infection also profoundly disrupts the maternal immune system upon which infants rely for protection and immune instruction. Therefore, it is not surprising that infants who escape HIV infection still suffer adverse effects. In this review, we highlight the unique aspects of pediatric HIV transmission and pathogenesis with a focus on mechanisms by which HIV infection during immune ontogeny may allow discovery of key elements for protection and control from HIV. PMID:23772619

Group Intervention to Reduce HIV Transmission Risk Behavior Among Persons Living With HIV/AIDS

ERIC Educational Resources Information Center

Kalichman, Seth C.; Rompa, David; Cage, Marjorie

2005-01-01

Results of a randomized controlled trial show that a behavioral intervention grounded in social cognitive theory reduces unprotected sexual behaviors among men and women living with HIV infection, with the greatest reductions in HIV transmission risk behaviors occurring with non-HIV-positive sex partners. In this article, the authors describe the…

Preferential in-utero transmission of HIV-1 subtype C as compared to HIV-1 subtype A or D.

PubMed

Renjifo, Boris; Gilbert, Peter; Chaplin, Beth; Msamanga, Gernard; Mwakagile, Davis; Fawzi, Wafaie; Essex, Max

2004-08-20

To determine whether different HIV-1 genotypes present in a single cohort, in Dar es Salaam, Tanzania, showed differences in timing for transmission from mothers to their infants. We determined the maternal viral load, transmission time, and the HIV-1 envelope (env) subtype of 253 HIV-1-infected infants enrolled in a randomized double-blind placebo-controlled trial to examine the efficacy of vitamins in decreasing mother-to-child transmission in Tanzania. Classification of HIV-1 positivity in utero was based on PCR results at birth. Infants were classified as intrapartum infected if they scored negative for the sample collected at birth and positive for the sample collected at 6 weeks of age. We found significant differences in the distribution of transmission time according to subtype. A higher proportion of HIV-1 with subtype C env (C-env) was transmitted in utero than HIV-1 with subtype A env (A-env), subtype D env (D-env), or both combined. The identification of patterns of mother-to-child transmission times among HIV-1 genotypes may be useful in the selection of drug regimens for chemoprophylaxis. Based on our results, the efficacy of regimens administered only at labor may not protect as large a fraction of infants born in geographical regions with subtype C-env epidemics as compared to epidemics in regions where subtypes A-env and D-env predominate in the population.

Public Health Service Guidelines for the Management of Health-Care Worker Exposures to HIV and Recommendations for Postexposure Prophylaxis. Vol. 47/No. RR-7.

DTIC Science & Technology

1998-05-15

needlestick injury. J Infect Dis 1993;168:1589-92. 25. Cao Y, Krogstad P, Korber BT, et al. Maternal HIV-1 viral load and vertical transmission of...pregnant women infected with HIV-1 for maternal health and for reducing perinatal HIV-1 transmission in the United States. MMWR 1998;47(no. RR-2). 87...Director Hospital Infections Program William R. Jarvis, M.D. Acting Director The production of this report as an MMWR serial publication was coordinated

[HIV and syphilis coinfection in pregnancy and vertical HIV transmission: a study based on epidemiological surveillance data].

PubMed

Acosta, Lisiane M W; Gonçalves, Tonantzin Ribeiro; Barcellos, Nêmora Tregnago

2016-12-01

To estimate the rate of HIV and syphilis coinfection among pregnant women living in Porto Alegre, Brazil, as well as the association of coinfection with vertical HIV transmission and socioeconomic variables. This analytical retrospective cross-sectional study employed data from the regular epidemiological surveillance system for the period from 2010 to 2013. Data were obtained regarding pregnant women with HIV and exposed children, syphilis in pregnancy, and congenital syphilis. The study population included 1 500 HIV-positive women with deliveries from 2010 to 2013. Of these, 155 (10.3%) were also infected with syphilis, corresponding to an HIV and syphilis coinfection rate of 10.2% (± 1.5%). The coinfected group had lower education levels, higher prevalence of black women, and greater HIV exposure related to drug use by the woman or a partner. Coinfected women had more delayed HIV diagnosis (for example, during childbirth) and greater prevalence of lacking prenatal care (44%). Crude analysis showed an association between vertical HIV transmission and HIV and syphilis co-infection (PR = 2.1; 95%CI: 1.21-3.74; P = 0.01) that persisted in the adjusted analysis. A profile of increased vulnerability was identified among pregnant women with HIV and syphilis coinfection. A positive impact of the treatment to reduce congenital syphilis and eliminate vertical transmission of HIV depends on enhanced access to qualified health care.

[Viral failure in infants perinatally infected with HIV: A double punishment].

PubMed

Trocmé, N; Courcoux, M-F; Tabone, M-D; Hervé, F; Bui, E; Faucher, P; Selleret, L; Lebrette, M-G; Leverger, G; Dollfus, C

2017-04-01

Considering the remarkable efficacy of the strategies for preventing mother-to-child transmission of HIV infection (PMTCT), failures are rare in high-resource countries and deserve further investigation. Moreover, infants have been found to be at increased risk of viral failure. We analyzed the factors related to the children's environment, including maternal psychological factors that may be associated with viral failure in children diagnosed before the age of 1 year. Retrospective study of all HIV-infected infants, born in France between July 2003 and July 2013, diagnosed before the age of 1 year, cared for in a single reference center, comparing the group of children in viral success to the group of children presenting at least one episode of viral failure, using data available in their medical, psychological and social files. Out of 1061 infants included in the prospective PMTCT follow-up, eight infants were found HIV-positive and an additional six cases were referred from other centers before the age of 1 year, for a total of 14 children born to 13 mothers. Seven children presented durable optimal viral control (VL<50 c/mL) whereas seven others did not reach or maintain optimal viral control over time. The main difference between the two groups was the presence among the mothers of children with viral failure of severe psychological disorders, leading to treatment adherence problems in the mothers who were aware of their HIV status before pregnancy, and difficulties in giving their children's treatments correctly. Although seroconversion during pregnancy is responsible for a significant proportion of residual transmission in high-resource countries, severe psychological or psychiatric conditions in HIV-positive mothers play an important role on the risk of both MTC residual transmission and viral failure in their infants. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Small for gestational age birth outcomes in pregnant women with perinatally acquired HIV.

PubMed

Jao, Jennifer; Sigel, Keith M; Chen, Katherine T; Rodriguez-Caprio, Gabriela; Posada, Roberto; Shust, Gail; Wisnivesky, Juan; Abrams, Elaine J; Sperling, Rhoda S

2012-04-24

To compare small for gestational age (SGA) birth weight in children born to women with perinatally acquired HIV (PAH) vs. those with behaviorally acquired HIV (BAH). Retrospective cohort study of HIV-infected pregnant women who received care and delivered a live born at a single hospital in New York City from January 2004 to April 2011. We collected data via chart review on demographics, behavioral risk factors, HIV clinical markers, antiretroviral therapy (ART), mode of HIV acquisition, and pregnancy outcomes on study participants. We compared rates of these exposures among participants by method of HIV acquisition. Generalized Estimating Equation was applied to evaluate the effect of HIV acquisition type on SGA birth weight, adjusting for potential confounders. Of 87 live births evaluated, 17 were born to 14 women with PAH. Overall, 20 (23%) were SGA. Eight of these SGA neonates were born preterm. Live births to women with PAH were more likely to be born SGA in our unadjusted analysis [odds ratio (OR) = 4.13, 95% confidence interval (CI) = 1.38-12.41). After adjusting for mother's age, substance use during pregnancy, nadir CD4 cell count during pregnancy, viral suppression at delivery, and second-line ART use during pregnancy, this relationship persisted with an adjusted OR of 5.7 (95% CI = 1.03-31.61). In comparison to infants born to women with BAH, infants born to women with PAH were at high risk for compromised intrauterine growth. Future studies are warranted to determine possible causal mechanisms.

Antiretroviral Resistance and Pregnancy Characteristics of Women with Perinatal and Nonperinatal HIV Infection.

PubMed

Lazenby, Gweneth B; Mmeje, Okeoma; Fisher, Barbra M; Weinberg, Adriana; Aaron, Erika K; Keating, Maria; Luque, Amneris E; Willers, Denise; Cohan, Deborah; Money, Deborah

2016-01-01

Objective. To compare HIV drug resistance in pregnant women with perinatal HIV (PHIV) and those with nonperinatal HIV (NPHIV) infection. Methods. We conducted a multisite cohort study of PHIV and NPHIV women from 2000 to 2014. Sample size was calculated to identify a fourfold increase in antiretroviral (ARV) drug resistance in PHIV women. Continuous variables were compared using Student's t-test and Wilcoxon rank-sum tests. Categorical variables were compared using χ (2) and Fisher's exact tests. Univariate analysis was used to determine factors associated with antiretroviral drug resistance. Results. Forty-one PHIV and 41 NPHIV participants were included. Women with PHIV were more likely to have drug resistance than those with NPHIV ((55% versus 17%, p = 0.03), OR 6.0 (95% CI 1.0-34.8), p = 0.05), including multiclass resistance (15% versus 0, p = 0.03), and they were more likely to receive nonstandard ARVs during pregnancy (27% versus 5%, p = 0.01). PHIV and NPHIV women had similar rates of preterm birth (11% versus 28%, p = 0.08) and cesarean delivery (47% versus 46%, p = 0.9). Two infants born to a single NPHIV woman acquired HIV infection. Conclusions. PHIV women have a high frequency of HIV drug resistance mutations, leading to nonstandard ARVs use during pregnancy. Despite nonstandard ARV use during pregnancy, PHIV women did not experience increased rates of adverse pregnancy outcomes.

Perinatal Outcomes, Including Mother-to-Child Transmission of HIV, and Child Mortality and Their Association with Maternal Vitamin D Status in Tanzania

PubMed Central

Mehta, Saurabh; Hunter, David J.; Mugusi, Ferdinand M.; Spiegelman, Donna; Manji, Karim P.; Giovannucci, Edward L.; Hertzmark, Ellen; Msamanga, Gernard I.; Fawzi, Wafaie W.

2009-01-01

Background Vitamin D is a strong immunomodulator and may protect against adverse pregnancy outcomes, mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV), and child mortality. Methods A total of 884 HIV-infected pregnant women who were participating in a vitamin supplementation trial in Tanzania were monitored to assess pregnancy outcomes and child mortality. The association of these outcomes with maternal vitamin D status at enrollment was examined in an observational analysis. Results No association was observed between maternal vitamin D status and adverse pregnancy outcomes, including low birth weight and preterm birth. In multivariate models, a low maternal vitamin D level (<32 ng/mL) was associated with a 50% higher risk (95% confidence interval [CI], 2%–120%) of MTCT of HIV at 6 weeks, a 2-fold higher risk of MTCT of HIV through breast-feeding among children who were HIV uninfected at 6 weeks (95% CI, 1.08–3.82), and a 46% higher overall risk of HIV infection (95% CI, 11%–91%). Children born to women with a low vitamin D level had a 61% higher risk of dying during follow-up (95% CI, 25%–107%). Conclusions If found to be efficacious in randomized trials, vitamin D supplementation could prove to be an inexpensive method of reducing the burden of HIV infection and death among children, particularly in resource-limited settings. PMID:19673647

The relationship between female genital mutilation and HIV transmission in sub-Saharan Africa.

PubMed

Olaniran, Abimbola A

2013-12-01

Female genital mutilation (FGM) is an age-old practice that has since been linked with many health problems. This review aims to highlight some of the controversies trailing the relationship between FGM and HIV transmission in sub-Saharan Africa. A literature search was conducted on the subject matter. This was done using articles published in English while limiting the geographical coverage to sub-Saharan Africa. Three themes were noted. These themes include: Direct causal link between FGM and HIV transmission; indirect causal link between FGM and HIV transmission and a negative or no association between FGM and HIV transmission. While many of the arguments are within scientific reasoning, the researches supporting the views seem to lack the necessary objectivity. This study underscored the need for a more objective lens in viewing and conducting research on the relationship between FGM and HIV transmission in sub-Saharan Africa.

National HIV Testing Day at CDC-funded HIV counseling, testing, and referral sites--United States, 1994-1998.

PubMed

2000-06-23

CDC-funded human immunodeficiency virus (HIV) counseling, testing, and referral sites are an integral part of national HIV prevention efforts (1). Voluntary counseling, testing, and referral opportunities are offered to persons at risk for HIV infection at approximately 11,000 sites, including dedicated HIV counseling and testing sites, sexually transmitted disease (STD) clinics, drug-treatment centers, hospitals, and prisons. Services also are offered to women in family planning and prenatal/obstetric clinics to increase HIV prevention efforts among women and decrease the risk for perinatal HIV transmission. To increase use of HIV counseling, testing, and referral services by those at risk for HIV infection, in 1995, the National Association of People with AIDS designated June 27 each year as National HIV Testing Day. This report compares use of CDC-funded counseling, testing, and referral services the week before and the week of June 27 from 1994 through 1998 and documents the importance of a national public health campaign designed to increase knowledge of HIV serostatus.

Dynamic sex roles among men who have sex with men and transmissions from primary HIV infection.

PubMed

Alam, Shah Jamal; Romero-Severson, Ethan; Kim, Jong-Hoon; Emond, Gilbert; Koopman, James S

2010-09-01

Previous studies estimating the fraction of transmissions from persons with primary HIV have not focused on the effects of switching sex role in male homosexual populations. Such behavioral fluctuations can increase the contribution of primary HIV in the overall population. We modeled HIV transmission with 8 compartments defined by 4 behavioral groups, with different anal-insertive and anal-receptive combinations, and 2 stages of infection. We explored the effects of fluctuating behavioral categories on endemic prevalence and the fraction of transmissions from primary HIV. We varied transition rates to develop the theory on how behavioral fluctuation affects infection patterns, and we used the transition rates in a Netherlands cohort to assess overall effects in a real setting. The dynamics of change in behavior-group status over time observed in the Netherlands cohort amplifies the prevalence of infection and the fraction of transmissions from primary HIV, resulting in the highest proportions of transmissions being from people with primary HIV. Fluctuation between dual- or receptive-role periods and no-anal-sex periods mainly determines this amplification. In terms of the total transmissions, the dual-role risk group is dominant. Fluctuation between insertive and receptive roles decreases the fraction of transmissions from primary HIV, but such fluctuation is infrequently observed. The fraction of transmissions from primary HIV is considerably raised by fluctuations in insertive and receptive anal sex behaviors. This increase occurs even when primary HIV or later infection status does not influence risk behavior. Thus, it is not simply biology but also behavior patterns and social contexts that determine the fraction of transmissions from primary HIV. Moreover, each primary HIV transmission has a larger population effect than each later infection transmission because the men to whom one transmits from primary HIV carry on more chains of transmissions than the men

HIV pre-exposure prophylaxis for women and infants prevents vaginal and oral HIV transmission in a preclinical model of HIV infection.

PubMed

Kovarova, Martina; Shanmugasundaram, Uma; Baker, Caroline E; Spagnuolo, Rae Ann; De, Chandrav; Nixon, Christopher C; Wahl, Angela; Garcia, J Victor

2016-11-01

Approximately 1.5 million HIV-positive women become pregnant annually. Without treatment, up to 45% will transmit HIV to their infants, primarily through breastfeeding. These numbers highlight that HIV acquisition is a major health concern for women and children globally. They also emphasize the urgent need for novel approaches to prevent HIV acquisition that are safe, effective and convenient to use by women and children in places where they are most needed. 4'-Ethynyl-2-fluoro-2'-deoxyadenosine, a potent NRTI with low cytotoxicity, was administered orally to NOD/SCID/γc -/- mice and to bone marrow/liver/thymus (BLT) humanized mice, a preclinical model of HIV infection. HIV inhibitory activity in serum, cervicovaginal secretions and saliva was evaluated 4 h after administration. 4'-Ethynyl-2-fluoro-2'-deoxyadenosine's ability to prevent vaginal and oral HIV transmission was evaluated using highly relevant transmitted/founder viruses in BLT mice. Strong HIV inhibitory activity in serum, cervicovaginal secretions and saliva obtained from animals after a single oral dose of 4'-ethynyl-2-fluoro-2'-deoxyadenosine (10 mg/kg) demonstrated efficient drug penetration into relevant mucosal sites. A single daily oral dose of 4'-ethynyl-2-fluoro-2'-deoxyadenosine resulted in efficient prevention of vaginal and oral HIV transmission after multiple high-dose exposures to transmitted/founder viruses in BLT humanized mice. Our data demonstrated that 4'-ethynyl-2-fluoro-2'-deoxyadenosine efficiently prevents both vaginal and oral HIV transmission. Together with 4'-ethynyl-2-fluoro-2'-deoxyadenosine's relatively low toxicity and high potency against drug-resistant HIV strains, these data support further clinical development of 4'-ethynyl-2-fluoro-2'-deoxyadenosine as a potential pre-exposure prophylaxis agent to prevent HIV transmission in women and their infants. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial

Impact of Pre-adapted HIV Transmission

PubMed Central

Carlson, Jonathan M.; Du, Victor Y.; Pfeifer, Nico; Bansal, Anju; Tan, Vincent Y.F.; Power, Karen; Brumme, Chanson J.; Kreimer, Anat; DeZiel, Charles E.; Fusi, Nicolo; Schaefer, Malinda; Brockman, Mark A.; Gilmour, Jill; Price, Matt A.; Kilembe, William; Haubrich, Richard; John, Mina; Mallal, Simon; Shapiro, Roger; Frater, John; Harrigan, P. Richard; Ndung’u, Thumbi; Allen, Susan; Heckerman, David; Sidney, John; Allen, Todd M.; Goulder, Philip J.R.; Brumme, Zabrina L.; Hunter, Eric; Goepfert, Paul A.

2016-01-01

Human Leukocyte Antigen class I (HLA) restricted CD8+ T lymphocyte (CTL) responses are critical to HIV-1 control. Although HIV can evade these responses, the longer-term impact of viral escape mutants remains unclear, since these variants can also reduce intrinsic viral fitness. To address this question, we here develop a metric to determine the degree of HIV adaptation to an HLA profile. We demonstrate that transmission of viruses pre-adapted to the HLA molecules expressed in the recipient is associated with impaired immunogenicity, elevated viral load and accelerated CD4 decline. Furthermore, the extent of pre-adaptation among circulating viruses explains much of the variation in outcomes attributed to expression of certain HLA alleles. Thus, viral pre-adaptation exploits “holes” in the immune response. Accounting for these holes may be critical for vaccine strategies seeking to elicit functional responses from viral variants, and to HIV cure strategies requiring broad CTL responses to achieve successful eradication of HIV reservoirs. PMID:27183217

Prevention Strategies Against HIV Transmission: A Proactive Approach.

PubMed

Carrion, Antonio J; Miles, Jovan D; Mosley, Juan F; Smith, Lillian L; Prather, April S; Gurley, Marcus M; Phan, Linh D; Everton, Emily C

2018-02-01

Human immunodeficiency virus (HIV) has now transformed into a manageable chronic condition. Highly active antiretroviral therapy (HAART) has proven efficacious at controlling the disease progression. Based on compelling evidence, the Department of Health and Human Services (DHHS) and the Infectious Disease Society of America (IDSA) developed guidelines for the management of persons infected with HIV. However, there are approximately 50 000 new cases of HIV in the United States each year. In this article, we review proactive methods to reduce the transmission of HIV, which include reinforcing patient education, gel-coated condoms that destroy HIV, HIV vaccinations, and adequately utilizing pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP). Further development and consistent utilization of innovative prevention tools can significantly reduce the incidence of HIV infections regardless of HIV status.

Knowledge of AIDS and HIV transmission among drug users in Rio de Janeiro, Brazil

PubMed Central

2011-01-01

Background Proper knowledge of HIV transmission is not enough for people to adopt protective behaviors, but deficits in this information may increase HIV/AIDS vulnerability. Objective To assess drug users' knowledge of HIV/AIDS and the possible association between knowledge and HIV testing. Methods A Cross-sectional study conducted in 2006/7 with a convenience sample of 295 illicit drug users in Rio de Janeiro, assessing knowledge on AIDS/HIV transmission and its relationship with HIV testing. Information from 108 randomly selected drug users who received an educational intervention using cards illustrating situations potentially associated with HIV transmission were assessed using Multidimensional Scaling (MDS). Results Almost 40% of drug users reported having never used condoms and more than 60% reported not using condoms under the influence of substances. Most drug users (80.6%) correctly answered that condoms make sex safer, but incorrect beliefs are still common (e.g. nearly 44% believed HIV can be transmitted through saliva and 55% reported that HIV infection can be transmitted by sharing toothbrushes), with significant differences between drug users who had and who had not been tested for HIV. MDS showed queries on vaginal/anal sex and sharing syringes/needles were classified in the same set as effective modes of HIV transmission. The event that was further away from this core of properly perceived risks referred to blood donation, perceived as risky. Other items were found to be dispersed, suggesting inchoate beliefs on transmission modes. Conclusions Drug users have an increased HIV infection vulnerability compared to the general population, this specific population expressed relevant doubts about HIV transmission, as well as high levels of risky behavior. Moreover, the findings suggest that possessing inaccurate HIV/AIDS knowledge may be a barrier to timely HIV testing. Interventions should be tailored to such specific characteristics. PMID:21324119

Human Herpesviruses as Copathogens of HIV Infection, Their Role in HIV Transmission, and Disease Progression

PubMed Central

Munawwar, Arshi; Singh, Sarman

2016-01-01

Of eight human herpesviruses (HHVs), often, only herpes simplex virus types 1 (HSV-1) and 2 (HSV-2) find mention in medical literature as both of these viruses are commonly associated with genital lesions and oral ulcers, commonly known as cold sores. However, role of human herpesviruses as copathogens and in aggravation and in the transmission of other human diseases, especially the Acquired immunodeficiency syndrome (HIV/AIDS) has only very recently been recognized. Therefore, screening and treating subclinical HHV infections may offer slowing of HIV infection, disease progression, and its transmission. Beside HSV-1 and HSV-2, HHV-3 a causative agent of herpes zoster remained one of the first manifestations of HIV disease before the era of highly active antiretroviral therapy (HAART). HHV-5 also known as human Cytomegalovirus infection remains a significant risk factor for HIV-associated mortality and morbidity even in HAART era. It is proposed that Cytomegalovirus viremia could be a better predictor of HIV disease progression than CD4+ T-lymphocyte count. The role of HHV-4 or Epstein–Burr virus and HHV-6, HHV-7, and HHV-8 is still being investigated in HIV disease progression. This review provides insight into the current understanding about these 8 HHVs, their co-pathogenesis, and role in HIV/AIDS disease progression. The review also covers recent literature in favor and against administering anti-HHV treatment along with HAART for slower AIDS progression and interrupted sexual transmission. PMID:27013807

HIV in Southern Africa.

PubMed

Hensle, K

1998-01-01

This article discusses transmission of HIV/AIDS in Southern Africa. Five of the six countries with the highest rates of HIV infection in the world during the 1990s are in Southern Africa. Projected life expectancies are dropping due to AIDS. The population at risk is aged 15-40 years. 93-95% of all HIV infections in this age group in sub-Saharan Africa are transmitted heterosexually; by 1996, 50% were women. The second most common mode of transmission is perinatal. In Botswana, HIV infection rates increased from 6% to 30% during 1991-93 among pregnant women at prenatal clinics. 43% were HIV positive in Francistown, Botswana. Populations are vulnerable to HIV infections when risk taking sexual behavior is practiced. Risk taking sexual behavior has increased due to social, cultural, and family uprooting; lower access to health and social services; and gender imbalances among domestic and international migrant populations. Women are at risk due to their inability to ask their partners to practice safer sex. Migrants' travel to job opportunities in urban areas and neighboring countries encourages the practice of several sexual partners. The rapid spread is also attributed to a special viral subtype C that spreads more rapidly through vaginal intercourse. Treatment with AZT during pregnancy reduces transmission to infants by 66%. Breast feeding transmits HIV from mothers to infants. Social instability and civil conflicts contribute to the spread. Expensive, time consuming infrastructure development is necessary to combat AIDS. Misinformation and inaction will only lead to more deaths.

Psychosocial adjustment in perinatally human immunodeficiency virus infected or exposed children – a Retrospective Cohort Study

PubMed Central

Zalwango, Sarah K; Kizza, Florence N; Nkwata, Allan K; Sekandi, Juliet N; Kakaire, Robert; Kiwanuka, Noah; Whalen, Christopher C; Ezeamama, Amara E

2016-01-01

Objective To determine whether perinatal HIV infection and exposure adversely affected psychosocial adjustment (PA) between 6 and 18 years of life (i.e. during school-age and adolescence). Methods We enrolled 58 perinatally HIV-infected, 56 HIV-exposed uninfected and 54 unexposed controls from Kampala, Uganda. Perinatal HIV status was determined by 18 months of age using a DNA-polymerase chain-reaction test and was confirmed via HIV rapid diagnostic test at psychosocial testing when the children were 6 to 18 years old. Five indicators of PA (depressive symptoms, distress, hopelessness, positive future orientation and esteem) were measured using validated, culturally adapted and translated instruments. Multivariable linear regression analyses estimated HIV-status-related percent differences (β) in PA indicators and corresponding 95% confidence intervals (CIs). Results During school-age and adolescence, positive outlook (β=−3.8, 95% CI: −7.2, −0.1) and self-esteem (β=−4.3, 95% CI: −6.7, −1.8) scores were significantly lower, whereas depressive (β=11.4, 95% CI: 3.3, 19.5) and distress (β=12.3, 95% CI: 5.9, 18.7) symptoms were elevated for perinatally HIV-infected, compared to unexposed controls and exposed uninfected children. Similarly, positive outlook (β=−4.3, 95% CI: −7.3, −1.2) and self-esteem were lower for exposed controls versus HIV-unexposed children. Hopelessness was similar by perinatal HIV status. Likewise, the distress and depressive symptom levels were comparable for HIV-exposed uninfected and HIV-unexposed children. Conclusions Perinatal HIV infection predicted higher distress and depressive symptoms, while HIV-affected status (infection/exposure) predicted low self-esteem and diminished positive outlook in the long term. However, HIV-affected status had no impact on hopelessness, suggesting that psychosocial interventions as an integral component of HIV care for infected children or primary care exposed uninfected children may

Effectiveness of semen washing to prevent HIV transmission and assist pregnancy in HIV-discordant couples: a systematic review and meta-analysis

PubMed Central

Zafer, Maryam; Horvath, Hacsi; Mmeje, Okeoma; van der Poel, Sheryl; Semprini, Augusto; Rutherford, George; Brown, Joelle

2015-01-01

Objective To evaluate the effectiveness of semen washing in HIV-discordant couples in which the male partner is infected Design Systematic review and meta-analysis Setting All countries Patient(s) Forty single-arm, open label studies among HIV-discordant couples that underwent intrauterine insemination (IUI) or in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI) using washed semen Intervention(s) Semen washing followed by IUI, IVF, or IVF/ICSI Main outcome measure(s) Primary outcome: HIV transmission to HIV-uninfected women; secondary outcomes: HIV transmission to newborns and proportion of couples achieving a clinical pregnancy Result(s) No HIV transmission occurred in 11,585 cycles of assisted reproduction using washed semen among 3,994 women (95% confidence interval [CI] = 0–0.0001). Among the subset of HIV-infected men without plasma viral suppression at the time of semen washing, no HIV seroconversions occurred among 1,023 women following 2,863 cycles of assisted reproduction using washed semen (95%CI= 0–0.0006). Studies that measured HIV transmission to infants reported no cases of vertical transmission (0/1,026, 95% CI= 0–0.0029). Overall, 56.3% (2,357/4,184, 95%CI=54.8%–57.8%) of couples achieved a clinical pregnancy using washed semen. Conclusion(s) Semen washing appears to significantly reduce the risk of transmission in HIV-discordant couples desiring children, regardless of viral suppression in the male partner. There are no randomized, controlled studies or studies from low-income countries, especially those with a large burden of HIV. Continued development of lower-cost semen washing and assisted reproduction technologies is needed. Integration of semen washing into HIV prevention interventions could help further reduce the spread of HIV. PMID:26688556

Detectable signals of episodic risk effects on acute HIV transmission: Strategies for analyzing transmission systems using genetic data

PubMed Central

Alam, Shah Jamal; Zhang, Xinyu; Romero-Severson, Ethan Obie; Henry, Christopher; Zhong, Lin; Volz, Erik M.; Brenner, Bluma G.; Koopman, James S.

2013-01-01

Episodic high-risk sexual behavior is common and can have a profound effect on HIV transmission. In a model of HIV transmission among men who have sex with men (MSM), changing the frequency, duration and contact rates of high-risk episodes can take endemic prevalence from zero to 50% and more than double transmissions during acute HIV infection (AHI). Undirected test and treat could be inefficient in the presence of strong episodic risk effects. Partner services approaches that use a variety of control options will be likely to have better effects under these conditions, but the question remains: What data will reveal if a population is experiencing episodic risk effects? HIV sequence data from Montreal reveals genetic clusters whose size distribution stabilizes over time and reflects the size distribution of acute infection outbreaks (AIOs). Surveillance provides complementary behavioral data. In order to use both types of data efficiently, it is essential to examine aspects of models that affect both the episodic risk effects and the shape of transmission trees. As a demonstration, we use a deterministic compartmental model of episodic risk to explore the determinants of the fraction of transmissions during acute HIV infection (AHI) at the endemic equilibrium. We use a corresponding individual-based model to observe AIO size distributions and patterns of transmission within AIO. Episodic risk parameters determining whether AHI transmission trees had longer chains, more clustered transmissions from single individuals, or different mixes of these were explored. Encouragingly for parameter estimation, AIO size distributions reflected the frequency of transmissions from acute infection across divergent parameter sets. Our results show that episodic risk dynamics influence both the size and duration of acute infection outbreaks, thus providing a possible link between genetic cluster size distributions and episodic risk dynamics. PMID:23438430

Human breast milk: is it the best milk to prevent HIV transmission?

PubMed

Palma, Paolo

2016-04-01

A significant proportion of mother-to-child transmission (MTCT) of HIV still occurs during breastfeeding in settings where replacement feeding is unsafe and impractical. However, very few babies born to HIV-infected women and breastfed during the first 6 months of life become infected postnatally. The fact that the majority of babies who are breastfed by HIV-infected mothers remain uninfected even after several months of breastfeeding constitutes one of the major enigmas of HIV transmission via breast milk.

Acyclovir and transmission of HIV-1 from persons infected with HIV-1 and HSV-2.

PubMed

Celum, C; Wald, A; Lingappa, J R; Magaret, A S; Wang, R S; Mugo, N; Mujugira, A; Baeten, J M; Mullins, J I; Hughes, J P; Bukusi, E A; Cohen, C R; Katabira, E; Ronald, A; Kiarie, J; Farquhar, C; Stewart, G J; Makhema, J; Essex, M; Were, E; Fife, K H; de Bruyn, G; Gray, G E; McIntyre, J A; Manongi, R; Kapiga, S; Coetzee, D; Allen, S; Inambao, M; Kayitenkore, K; Karita, E; Kanweka, W; Delany, S; Rees, H; Vwalika, B; Stevens, W; Campbell, M S; Thomas, K K; Coombs, R W; Morrow, R; Whittington, W L H; McElrath, M J; Barnes, L; Ridzon, R; Corey, L

2010-02-04

Most persons who are infected with human immunodeficiency virus type 1 (HIV-1) are also infected with herpes simplex virus type 2 (HSV-2), which is frequently reactivated and is associated with increased plasma and genital levels of HIV-1. Therapy to suppress HSV-2 reduces the frequency of reactivation of HSV-2 as well as HIV-1 levels, suggesting that suppression of HSV-2 may reduce the risk of transmission of HIV-1. We conducted a randomized, placebo-controlled trial of suppressive therapy for HSV-2 (acyclovir at a dose of 400 mg orally twice daily) in couples in which only one of the partners was seropositive for HIV-1 (CD4 count, > or = 250 cells per cubic millimeter) and that partner was also infected with HSV-2 and was not taking antiretroviral therapy at the time of enrollment. The primary end point was transmission of HIV-1 to the partner who was not initially infected with HIV-1; linkage of transmissions was assessed by means of genetic sequencing of viruses. A total of 3408 couples were enrolled at 14 sites in Africa. Of the partners who were infected with HIV-1, 68% were women, and the baseline median CD4 count was 462 cells per cubic millimeter. Of 132 HIV-1 seroconversions that occurred after randomization (an incidence of 2.7 per 100 person-years), 84 were linked within couples by viral sequencing: 41 in the acyclovir group and 43 in the placebo group (hazard ratio with acyclovir, 0.92, 95% confidence interval [CI], 0.60 to 1.41; P=0.69). Suppression with acyclovir reduced the mean plasma concentration of HIV-1 by 0.25 log(10) copies per milliliter (95% CI, 0.22 to 0.29; P<0.001) and the occurrence of HSV-2-positive genital ulcers by 73% (risk ratio, 0.27; 95% CI, 0.20 to 0.36; P<0.001). A total of 92% of the partners infected with HIV-1 and 84% of the partners not infected with HIV-1 remained in the study for 24 months. The level of adherence to the dispensed study drug was 96%. No serious adverse events related to acyclovir were observed. Daily

Acyclovir and Transmission of HIV-1 from Persons Infected with HIV-1 and HSV-2

PubMed Central

Celum, Connie; Wald, Anna; Lingappa, Jairam R.; Magaret, Amalia S.; Wang, Richard S.; Mugo, Nelly; Mujugira, Andrew; Baeten, Jared M.; Mullins, James I.; Hughes, James P.; Bukusi, Elizabeth A.; Cohen, Craig R.; Katabira, Elly; Ronald, Allan; Kiarie, James; Farquhar, Carey; Stewart, Grace John; Makhema, Joseph; Essex, Myron; Were, Edwin; Fife, Kenneth H.; de Bruyn, Guy; Gray, Glenda E.; McIntyre, James A.; Manongi, Rachel; Kapiga, Saidi; Coetzee, David; Allen, Susan; Inambao, Mubiana; Kayitenkore, Kayitesi; Karita, Etienne; Kanweka, William; Delany, Sinead; Rees, Helen; Vwalika, Bellington; Stevens, Wendy; Campbell, Mary S.; Thomas, Katherine K.; Coombs, Robert W.; Morrow, Rhoda; Whittington, William L.H.; McElrath, M. Juliana; Barnes, Linda; Ridzon, Renee; Corey, Lawrence

2010-01-01

BACKGROUND Most persons who are infected with human immunodeficiency virus type 1 (HIV-1) are also infected with herpes simplex virus type 2 (HSV-2), which is frequently reactivated and is associated with increased plasma and genital levels of HIV-1. Therapy to suppress HSV-2 reduces the frequency of reactivation of HSV-2 as well as HIV-1 levels, suggesting that suppression of HSV-2 may reduce the risk of transmission of HIV-1. METHODS We conducted a randomized, placebo-controlled trial of suppressive therapy for HSV-2 (acyclovir at a dose of 400 mg orally twice daily) in couples in which only one of the partners was seropositive for HIV-1 (CD4 count, ≥250 cells per cubic millimeter) and that partner was also infected with HSV-2 and was not taking antiretroviral therapy at the time of enrollment. The primary end point was transmission of HIV-1 to the partner who was not initially infected with HIV-1; linkage of transmissions was assessed by means of genetic sequencing of viruses. RESULTS A total of 3408 couples were enrolled at 14 sites in Africa. Of the partners who were infected with HIV-1, 68% were women, and the baseline median CD4 count was 462 cells per cubic millimeter. Of 132 HIV-1 seroconversions that occurred after randomization (an incidence of 2.7 per 100 person-years), 84 were linked within couples by viral sequencing: 41 in the acyclovir group and 43 in the placebo group (hazard ratio with acyclovir, 0.92, 95% confidence interval [CI], 0.60 to 1.41; P = 0.69). Suppression with acyclovir reduced the mean plasma concentration of HIV-1 by 0.25 log10 copies per milliliter (95% CI, 0.22 to 0.29; P<0.001) and the occurrence of HSV-2–positive genital ulcers by 73% (risk ratio, 0.27; 95% CI, 0.20 to 0.36; P<0.001). A total of 92% of the partners infected with HIV-1 and 84% of the partners not infected with HIV-1 remained in the study for 24 months. The level of adherence to the dispensed study drug was 96%. No serious adverse events related to acyclovir

Episodic HIV Risk Behavior Can Greatly Amplify HIV Prevalence and the Fraction of Transmissions from Acute HIV Infection.

PubMed

Zhang, Xinyu; Zhong, Lin; Romero-Severson, Ethan; Alam, Shah Jamal; Henry, Christopher J; Volz, Erik M; Koopman, James S

2012-11-01

A deterministic compartmental model was explored that relaxed the unrealistic assumption in most HIV transmission models that behaviors of individuals are constant over time. A simple model was formulated to better explain the effects observed. Individuals had a high and a low contact rate and went back and forth between them. This episodic risk behavior interacted with the short period of high transmissibility during acute HIV infection to cause dramatic increases in prevalence as the differences between high and low contact rates increased and as the duration of high risk better matched the duration of acute HIV infection. These same changes caused a considerable increase in the fraction of all transmissions that occurred during acute infection. These strong changes occurred despite a constant total number of contacts and a constant total transmission potential from acute infection. Two phenomena played a strong role in generating these effects. First, people were infected more often during their high contact rate phase and they remained with high contact rates during the highly contagious acute infection stage. Second, when individuals with previously low contact rates moved into an episodic high-risk period, they were more likely to be susceptible and thus provided more high contact rate susceptible individuals who could get infected. These phenomena make test and treat control strategies less effective and could cause some behavioral interventions to increase transmission. Signature effects on genetic patterns between HIV strains could make it possible to determine whether these episodic risk effects are acting in a population.

Demographic but not geographic insularity in HIV transmission among young black MSM.

PubMed

Oster, Alexandra M; Pieniazek, Danuta; Zhang, Xinjian; Switzer, William M; Ziebell, Rebecca A; Mena, Leandro A; Wei, Xierong; Johnson, Kendra L; Singh, Sonita K; Thomas, Peter E; Elmore, Kimberlee A; Heffelfinger, James D

2011-11-13

To understand patterns of HIV transmission among young black MSM and others in Mississippi. Phylogenetic analysis of HIV-1 polymerase (pol) sequences from 799 antiretroviral-naive persons newly diagnosed with HIV infection in Mississippi during 2005-2008, 130 (16%) of whom were black MSM aged 16-25 years. We identified phylogenetic clusters and used surveillance data to evaluate demographic attributes and risk factors of all persons in clusters that included black MSM aged 16-25 years. We identified 82 phylogenetic clusters, 21 (26%) of which included HIV strains from at least one young black MSM. Of the 69 persons in these clusters, 59 were black MSM and seven were black men with unknown transmission category; the remaining three were MSM of white or Hispanic race/ethnicity. Of these 21 clusters, 10 included residents of one geographic region of Mississippi, whereas 11 included residents of multiple regions or outside of the state. Phylogenetic clusters involving HIV-infected young black MSM were homogeneous with respect to demographic and risk characteristics, suggesting insularity of this population with respect to HIV transmission, but were geographically heterogeneous. Reducing HIV transmission among young black MSM in Mississippi may require prevention strategies that are tailored to young black MSM and those in their sexual networks, and prevention interventions should be delivered in a manner to reach young black MSM throughout the state. Phylogenetic analysis can be a tool for local jurisdictions to understand the transmission dynamics in their areas.

Acute HIV infection transmission among people who inject drugs in a mature epidemic setting.

PubMed

Escudero, Daniel J; Lurie, Mark N; Mayer, Kenneth H; Weinreb, Caleb; King, Maximilian; Galea, Sandro; Friedman, Samuel R; Marshall, Brandon D L

2016-10-23

Estimates for the contribution of transmission arising from acute HIV infections (AHIs) to overall HIV incidence vary significantly. Furthermore, little is known about AHI-attributable transmission among people who inject drugs (PWID), including the extent to which interventions targeting chronic infections (e.g. HAART as prevention) are limited by AHI transmission. Thus, we estimated the proportion of transmission events attributable to AHI within the mature HIV epidemic among PWID in New York City (NYC). Modeling study. We constructed an interactive sexual and injecting transmission network using an agent-based model simulating the HIV epidemic in NYC between 1996 and 2012. Using stochastic microsimulations, we cataloged transmission from PWID based on the disease stage of index agents to determine the proportion of infections transmitted during AHI (in primary analyses, assumed to last 3 months). Our calibrated model approximated the epidemiological features of the mature HIV epidemic in NYC between 1996 and 2012. Annual HIV incidence among PWID dropped from approximately 1.8% in 1996 to 0.7% in 2012. Over the 16-year period, AHI accounted for 4.9% (10th/90th percentile: 0.1-12.3%) of incident HIV cases among PWID. The annualized contribution of AHI increased over this period from 3.6% in 1996 to 5.9% in 2012. Our results suggest that, in mature epidemics such as NYC, between 3% and 6% of transmission events are attributable to AHI among PWID. Current HIV treatment as prevention strategies are unlikely to be substantially affected by AHI-attributable transmission among PWID populations in mature epidemic settings.

Perceptions and Experiences about Self-Disclosure of HIV Status among Adolescents with Perinatal Acquired HIV in Poor-Resourced Communities in South Africa.

PubMed

Madiba, Sphiwe; Mokgatle, Mathildah

2016-01-01

Background. There is limited research on the disclosure experiences of adolescents with perinatal acquired HIV (PAH). The study explores how adolescents with PAH experience living with HIV and examined their perceptions and experiences regarding disclosure and onward self-disclosure to friends and sexual partners. Methods. Thematic analysis was used to analyze in-depth interviews conducted with 37 adolescents. Findings. Adolescents received disclosure about their status at mean age of 12 years. They perceived disclosure as necessary and appreciated the truthful communication they received. Adolescents have learned to accept and live with HIV, and they desired to be healthy and normal like other people. After receiving disclosure, they found their treatment meaningful, and they adhered to medication. However, they also expressed a strong message that their HIV status was truly their secret and that self-disclosure to others will take the feeling of being normal away from them because they will be treated differently. Conclusion. Adolescents maintained secrecy in order to be accepted by their peers but also to protect themselves from stigma and isolation. Given that adolescents want to be informed of their HIV status but desire controlling self-disclosure of their HIV status, these should form the basis for development of disclosure interventions.

PrEP Whores and HIV Prevention: The Queer Communication of HIV Pre-Exposure Prophylaxis (PrEP).

PubMed

Spieldenner, Andrew

2016-12-01

HIV pre-exposure prophylaxis (PrEP) has been introduced as another biomedical tool in HIV prevention. Whereas other such tools-including post-exposure prophylaxis (PEP) and interruption of perinatal transmission-have been embraced by those impacted by HIV, PrEP has been met with more conflict, especially within the gay community and HIV organizations. The "PrEP whore" has come to designate the social value and personal practices of those taking PrEP. This study examines the "PrEP whore" discourse by using queer theory and quare theory. Within these theoretical vantage points, the study explicates four discursive areas: slut shaming, dirty/clean binaries, mourning the loss of condoms, and reclaiming the inner whore. The study illuminates possible discursive strategies that lie outside of the domains of public health and within the individual and community.

Cell-Free (RNA) and Cell-Associated (DNA) HIV-1 and Postnatal Transmission through Breastfeeding

PubMed Central

Bland, Ruth M.; Danaviah, Siva; Thorne, Claire; Van de Perre, Philippe; Newell, Marie-Louise

2012-01-01

Introduction Transmission through breastfeeding remains important for mother-to-child transmission (MTCT) in resource-limited settings. We quantify the relationship between cell-free (RNA) and cell-associated (DNA) shedding of HIV-1 virus in breastmilk and the risk of postnatal HIV-1 transmission in the first 6 months postpartum. Materials and Methods Thirty-six HIV-positive mothers who transmitted HIV-1 by breastfeeding were matched to 36 non-transmitting HIV-1 infected mothers in a case-control study nested in a cohort of HIV-infected women. RNA and DNA were quantified in the same breastmilk sample taken at 6 weeks and 6 months. Cox regression analysis assessed the association between cell-free and cell-associated virus levels and risk of postnatal HIV-1 transmission. Results There were higher median levels of cell-free than cell-associated HIV-1 virus (per ml) in breastmilk at 6 weeks and 6 months. Multivariably, adjusting for antenatal CD4 count and maternal plasma viral load, at 6 weeks, each 10-fold increase in cell-free or cell-associated levels (per ml) was significantly associated with HIV-1 transmission but stronger for cell-associated than cell-free levels [2.47 (95% CI 1.33–4.59) vs. aHR 1.52 (95% CI, 1.17–1.96), respectively]. At 6 months, cell-free and cell-associated levels (per ml) in breastmilk remained significantly associated with HIV-1 transmission but was stronger for cell-free than cell-associated levels [aHR 2.53 (95% CI 1.64–3.92) vs. 1.73 (95% CI 0.94–3.19), respectively]. Conclusions The findings suggest that cell-associated virus level (per ml) is more important for early postpartum HIV-1 transmission (at 6 weeks) than cell-free virus. As cell-associated virus levels have been consistently detected in breastmilk despite antiretroviral therapy, this highlights a potential challenge for resource-limited settings to achieve the UNAIDS goal for 2015 of eliminating vertical transmission. More studies would further knowledge on

Increased Risk of HIV-1 Transmission in Pregnancy: A Prospective Study among African HIV-1 Serodiscordant Couples

PubMed Central

MUGO, Nelly R.; HEFFRON, Renee; DONNELL, Deborah; WALD, Anna; WERE, Edwin O.; REES, Helen; CELUM, Connie; KIARIE, James N.; COHEN, Craig R.; KAYINTEKORE, Kayitesi; BAETEN, Jared M.

2011-01-01

Background Physiologic and behavioral changes during pregnancy may alter HIV-1 susceptibility and infectiousness. Prospective studies exploring pregnancy and HIV-1 acquisition risk in women have found inconsistent results. No study has explored the effect of pregnancy on HIV-1 transmission risk from HIV-1 infected women to male partners. Methods In a prospective study of African HIV-1 serodiscordant couples, we evaluated the relationship between pregnancy and the risk of 1) HIV-1 acquisition among women and 2) HIV-1 transmission from women to men. Results 3321 HIV-1 serodiscordant couples were enrolled, 1085 (32.7%) with HIV-1 susceptible female partners and 2236 (67.3%) with susceptible male partners. HIV-1 incidence in women was 7.35 versus 3.01 per 100 person-years during pregnant and non-pregnant periods (hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.33–4.09). This effect was attenuated and not statistically significant after adjusting for sexual behavior and other confounding factors (adjusted HR 1.71, 95% CI 0.93–3.12). HIV-1 incidence in male partners of infected women was 3.46 versus 1.58 per 100 person-years when their partners were pregnant versus not pregnant (HR 2.31, 95% CI 1.22–4.39). This effect was not attenuated in adjusted analysis (adjusted HR 2.47, 95% CI 1.26–4.85). Conclusions HIV-1 risk increased two-fold during pregnancy. Elevated risk of HIV-1 acquisition in pregnant women appeared in part to be explained by behavioral and other factors. This is the first study to show pregnancy increased the risk of female-to-male HIV-1 transmission, which may reflect biological changes of pregnancy that could increase HIV-1 infectiousness. PMID:21785321

HIV-1 Genetic Variability in Cuba and Implications for Transmission and Clinical Progression.

PubMed

Blanco, Madeline; Machado, Liuber Y; Díaz, Héctor; Ruiz, Nancy; Romay, Dania; Silva, Eladio

2015-10-01

INTRODUCTION Serological and molecular HIV-1 studies in Cuba have shown very low prevalence of seropositivity, but an increasing genetic diversity attributable to introduction of many HIV-1 variants from different areas, exchange of such variants among HIV-positive people with several coinciding routes of infection and other epidemiologic risk factors in the seropositive population. The high HIV-1 genetic variability observed in Cuba has possible implications for transmission and clinical progression. OBJECTIVE Study genetic variability for the HIV-1 env, gag and pol structural genes in Cuba; determine the prevalence of B and non-B subtypes according to epidemiologic and behavioral variables and determine whether a relationship exists between genetic variability and transmissibility, and between genetic variability and clinical disease progression in people living with HIV/AIDS. METHODS Using two molecular assays (heteroduplex mobility assay and nucleic acid sequencing), structural genes were characterized in 590 people with HIV-1 (480 men and 110 women), accounting for 3.4% of seropositive individuals in Cuba as of December 31, 2013. Nonrandom sampling, proportional to HIV prevalence by province, was conducted. Relationships between molecular results and viral factors, host characteristics, and patients' clinical, epidemiologic and behavioral variables were studied for molecular epidemiology, transmission, and progression analyses. RESULTS Molecular analysis of the three HIV-1 structural genes classified 297 samples as subtype B (50.3%), 269 as non-B subtypes (45.6%) and 24 were not typeable. Subtype B prevailed overall and in men, mainly in those who have sex with men. Non-B subtypes were prevalent in women and heterosexual men, showing multiple circulating variants and recombinant forms. Sexual transmission was the predominant form of infection for all. B and non-B subtypes were encountered throughout Cuba. No association was found between subtypes and

Male circumcision and risk of male-to-female HIV-1 transmission: a multinational prospective study in African HIV-1-serodiscordant couples.

PubMed

Baeten, Jared M; Donnell, Deborah; Kapiga, Saidi H; Ronald, Allan; John-Stewart, Grace; Inambao, Mubiana; Manongi, Rachel; Vwalika, Bellington; Celum, Connie

2010-03-13

Male circumcision reduces female-to-male HIV-1 transmission risk by approximately 60%. Data assessing the effect of circumcision on male-to-female HIV-1 transmission are conflicting, with one observational study among HIV-1-serodiscordant couples showing reduced transmission but a randomized trial suggesting no short-term benefit of circumcision. Data collected as part of a prospective study among African HIV-1-serodiscordant couples were analyzed for the relationship between circumcision status of HIV-1-seropositive men and risk of HIV-1 acquisition among their female partners. Circumcision status was determined by physical examination. Cox proportional hazards analysis was used. A total of 1096 HIV-1-serodiscordant couples in which the male partner was HIV-1-infected were followed for a median of 18 months; 374 (34%) male partners were circumcised. Sixty-four female partners seroconverted to HIV-1 (incidence 3.8 per 100 person-years). Circumcision of the male partner was associated with a nonstatistically significant approximately 40% lower risk of HIV-1 acquisition by the female partner (hazard ratio 0.62, 95% confidence interval 0.35-1.10, P = 0.10). The magnitude of this effect was similar when restricted to the subset of HIV-1 transmission events confirmed by viral sequencing to have occurred within the partnership (n = 50, hazard ratio 0.57, P = 0.11), after adjustment for male partner plasma HIV-1 concentrations (hazard ratio 0.60, P = 0.13), and when excluding follow-up time for male partners who initiated antiretroviral therapy (hazard ratio 0.53, P = 0.07). Among HIV-1-serodiscordant couples in which the HIV-1-seropositive partner was male, we observed no increased risk and potentially decreased risk from circumcision on male-to-female transmission of HIV-1.

Sexual network drivers of HIV and herpes simplex virus type 2 transmission

PubMed Central

Omori, Ryosuke; Abu-Raddad, Laith J.

2017-01-01

Objectives: HIV and herpes simplex virus type 2 (HSV-2) infections are sexually transmitted and propagate in sexual networks. Using mathematical modeling, we aimed to quantify effects of key network statistics on infection transmission, and extent to which HSV-2 prevalence can be a proxy of HIV prevalence. Design/methods: An individual-based simulation model was constructed to describe sex partnering and infection transmission, and was parameterized with representative natural history, transmission, and sexual behavior data. Correlations were assessed on model outcomes (HIV/HSV-2 prevalences) and multiple linear regressions were conducted to estimate adjusted associations and effect sizes. Results: HIV prevalence was one-third or less of HSV-2 prevalence. HIV and HSV-2 prevalences were associated with a Spearman's rank correlation coefficient of 0.64 (95% confidence interval: 0.58–0.69). Collinearities among network statistics were detected, most notably between concurrency versus mean and variance of number of partners. Controlling for confounding, unmarried mean/variance of number of partners (or alternatively concurrency) were the strongest predictors of HIV prevalence. Meanwhile, unmarried/married mean/variance of number of partners (or alternatively concurrency), and clustering coefficient were the strongest predictors of HSV-2 prevalence. HSV-2 prevalence was a strong predictor of HIV prevalence by proxying effects of network statistics. Conclusion: Network statistics produced similar and differential effects on HIV/HSV-2 transmission, and explained most of the variation in HIV and HSV-2 prevalences. HIV prevalence reflected primarily mean and variance of number of partners, but HSV-2 prevalence was affected by a range of network statistics. HSV-2 prevalence (as a proxy) can forecast a population's HIV epidemic potential, thereby informing interventions. PMID:28514276

Antiretroviral Resistance and Pregnancy Characteristics of Women with Perinatal and Nonperinatal HIV Infection

PubMed Central

Mmeje, Okeoma; Fisher, Barbra M.; Weinberg, Adriana; Aaron, Erika K.; Keating, Maria; Luque, Amneris E.; Willers, Denise; Cohan, Deborah; Money, Deborah

2016-01-01

Objective. To compare HIV drug resistance in pregnant women with perinatal HIV (PHIV) and those with nonperinatal HIV (NPHIV) infection. Methods. We conducted a multisite cohort study of PHIV and NPHIV women from 2000 to 2014. Sample size was calculated to identify a fourfold increase in antiretroviral (ARV) drug resistance in PHIV women. Continuous variables were compared using Student's t-test and Wilcoxon rank-sum tests. Categorical variables were compared using χ 2 and Fisher's exact tests. Univariate analysis was used to determine factors associated with antiretroviral drug resistance. Results. Forty-one PHIV and 41 NPHIV participants were included. Women with PHIV were more likely to have drug resistance than those with NPHIV ((55% versus 17%, p = 0.03), OR 6.0 (95% CI 1.0–34.8), p = 0.05), including multiclass resistance (15% versus 0, p = 0.03), and they were more likely to receive nonstandard ARVs during pregnancy (27% versus 5%, p = 0.01). PHIV and NPHIV women had similar rates of preterm birth (11% versus 28%, p = 0.08) and cesarean delivery (47% versus 46%, p = 0.9). Two infants born to a single NPHIV woman acquired HIV infection. Conclusions. PHIV women have a high frequency of HIV drug resistance mutations, leading to nonstandard ARVs use during pregnancy. Despite nonstandard ARV use during pregnancy, PHIV women did not experience increased rates of adverse pregnancy outcomes. PMID:27413359

Cost-effectiveness analysis of annual Trichomonas vaginalis screening and treatment in HIV-positive women to prevent HIV transmission.

PubMed

Lazenby, Gweneth Bratton; Unal, Elizabeth Ramsey; Andrews, Annie Lintzenich; Simpson, Kit

2014-06-01

Because of a high incidence of Trichomonas infection among HIV-positive women, annual screening and treatment are recommended. Trichomonas infection is associated with a 2-fold risk of HIV transmission. The objective of this study was to determine if annual screening is cost-effective for the prevention of new HIV cases in susceptible male partners secondary to Trichomonas infection in HIV-positive women. A decision tree analysis was constructed to model the costs of Trichomonas screening, treatment, and follow-up. 200 women cycled through the model for a period of 12 months. One hundred women were unscreened and 100 were screened and treated per recommendations. Annual Trichomonas screening and treatment saves US $553 (US $475- US $645) per woman in the prevention of HIV transmission to male partners. The cost-effectiveness of this strategy was maintained across all assumptions in a sensitivity analysis. Trichomonas screening and treatment for the purpose of decreasing new HIV infections is not only cost-effective but also cost saving in HIV-positive women. If Centers for Disease Control and Prevention treatment guidelines were followed in all HIV-positive women living in the United States, the lifetime cost of new HIV infections prevented would approximate US $159,264,000 and could potentially prevent new HIV cases secondary to female-to-male transmissions.

HIV-TRACE (Transmission Cluster Engine): a tool for large scale molecular epidemiology of HIV-1 and other rapidly evolving pathogens.

PubMed

Kosakovsky Pond, Sergei L; Weaver, Steven; Leigh Brown, Andrew J; Wertheim, Joel O

2018-01-31

In modern applications of molecular epidemiology, genetic sequence data are routinely used to identify clusters of transmission in rapidly evolving pathogens, most notably HIV-1. Traditional 'shoeleather' epidemiology infers transmission clusters by tracing chains of partners sharing epidemiological connections (e.g., sexual contact). Here, we present a computational tool for identifying a molecular transmission analog of such clusters: HIV-TRACE (TRAnsmission Cluster Engine). HIV-TRACE implements an approach inspired by traditional epidemiology, by identifying chains of partners whose viral genetic relatedness imply direct or indirect epidemiological connections. Molecular transmission clusters are constructed using codon-aware pairwise alignment to a reference sequence followed by pairwise genetic distance estimation among all sequences. This approach is computationally tractable and is capable of identifying HIV-1 transmission clusters in large surveillance databases comprising tens or hundreds of thousands of sequences in near real time, i.e., on the order of minutes to hours. HIV-TRACE is available at www.hivtrace.org and from github.com/veg/hivtrace, along with the accompanying result visualization module from github.com/veg/hivtrace-viz. Importantly, the approach underlying HIV-TRACE is not limited to the study of HIV-1 and can be applied to study outbreaks and epidemics of other rapidly evolving pathogens. © The Author 2018. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Knowledge of pregnant women on transmission of HIV infection through breast feeding.

PubMed

Kasinga, F; Mogotlane, S M; van Rensburg, G H

2008-09-01

Although breast-feeding is nature's way of providing nutrition to the baby, in HIV positive mothers this has been identified as one of the means through which HIV infection is transmitted from the mother to the child. In Africa where children under the age of 5 are killed by preventable diseases like diarrhoea, the issue of HIV transmission through breast feeding poses an added huge problem. Research has, however shown that exclusive infant feeding, be it breast or formula, reduces the risk substantially. It is imperative that mothers be informed about safer methods of infant feeding so that HIV infection is kept to a minimum. The objective of the study was to explore and describe the knowledge that pregnant women had about mother to child transmission of HIV infection through breast-feeding. A non-experimental quantitative exploratory and descriptive research design was used to explore the knowledge women had on mother to child transmission of HIV infection through breast-feeding. From the data collected, it showed that although women were aware of the susceptibility of children to HIV infection if fed on breast and formula feeds simultaneously by HIV positive mothers, exclusive feeding was a problem as people associated the practise with a positive HIV status. Women who had not disclosed their HIV status and were HIV positive, found it difficult to comply with the requirement to exclusively feed their infants. These either continued with complementary feeds or did not collect the free formula milk supply preferring instead to buy the formula feeds privately. In this study it was recommended that information on transmission of HIV infection from mother to child through breast -feeding including the benefits of exclusive infant feeding, be it breast or formula, for the first three to six months be provided to the community so that relatives can support the mother on infant feeding method of choice.

HIV infection in children.

PubMed

Canosa, C A

1991-01-01

Various studies have reported rates of human immunodeficiency virus (HIV) transmission from mother to child of 13-40%. Vertical transmission occurs in utero, during delivery, or, in a small number of cases, through breast milk. Whether mothers at various stages of HIV infection experience different rates of transmission remains unknown. Maternal antibodies cross the placenta and are present from birth up to 18 months of age. The offspring of HIV-positive mothers tend to be low birthweight, under 37 weeks' gestation, and at high risk of perinatal mortality. It is likely, however, that this profile is indicative of the low socioeconomic status of most women with HIV rather than a result of infection. Also emerging is a psychosocial profile of the HIV child. These children are isolated, neglected, battered, frequently abandoned, and exhibit various degrees of mental retardation. Also common are delayed psychomotor development, loss of developmental milestones, limited attention span, poor language development, and abnormal reflexes. These features result from the interaction of low socioeconomic status, a lack of psychosocial stimulation, nutritional deficiencies, and central nervous system infections. Since HIV-infected children tend to be the offspring of drug addicts, bisexuals, and prostitutes, they are not awarded the same compassion as children afflicted with other terminal illnesses. Moreover, these children are generally neglected by groups formed to provide support to AIDS patients. Thus, it is up to the general public, the mass media, and the health care system to advocate for the needs of these neglected children.

Immunotherapies to prevent mother-to-child transmission of HIV.

PubMed

Hicar, Mark D

2013-03-01

Although pharmacological interventions have been successful in reducing prevention of maternal to child transmission (PMTCT) of HIV, there is concern that complete elimination through this mode of transmission will require other measures. Immunotherapies in infants or pregnant mothers may be able to eradicate this form of transmission. A recent vaccine trial in adults showed encouraging results, but as in most HIV safety and efficacy vaccine trials, the question of MTCT was not addressed. Concentrating transmission studies and vaccine studies in the setting of MTCT offers several advantages. MTCT has a generally reproducible known transmission rate and has been successfully used to assess pharmacological interventions on decreasing transmission. Even in resource poor settings, the infrastructure for neonatal vaccination is already in place. Although rare, both passive and active vaccination trials have been successfully completed in pediatric populations. Unfortunately, little success in affecting MTCT has been shown. Largely, a correlate of protection in any type of transmission, including MTCT, is unknown. Data supports a role for antibodies in effecting strain and transmission during MTCT. The role of antibodies in MTCT is reviewed with a focus on recent passive immunization and considerations for future studies.

Interventions for preventing late postnatal mother-to-child transmission of HIV.

PubMed

Horvath, Tara; Madi, Banyana C; Iuppa, Irene M; Kennedy, Gail E; Rutherford, George; Read, Jennifer S

2009-01-21

Worldwide, mother-to-child transmission (MTCT) of human immunodeficiency virus type 1 (HIV) represents the most common means by which children acquire HIV infection. Efficacious and effective interventions to prevent in utero and intrapartum transmission of HIV infection have been developed and implemented. However, a large proportion of MTCT of HIV occurs postnatally, through breast milk transmission. The objectives of this systematic review were to collate and assess the evidence regarding interventions to decrease late postnatal MTCT of HIV, and to determine the efficacy of such interventions in decreasing late postnatal MTCT of HIV, increasing overall survival, and increasing HIV-free survival. Electronic searches were undertaken using PubMed, EMBASE and other databases for 1980-2008. Hand searches of reference lists of pertinent reviews and studies, as well as abstracts from relevant conferences, were also conducted. Experts in the field were contacted to locate any other studies. The search strategy was iterative. Randomized clinical trials assessing the efficacy of interventions to prevent MTCT of HIV through breast milk were included in the analysis. Other trials and intervention cohort studies with relevant data also were included, but only when randomization was not feasible due to the nature of the intervention (i.e., infant feeding modality). Data regarding HIV infection status and vital status of infants born to HIV-infected women, according to intervention, were extracted from the reports of the studies. Six randomized clinical trials and one intervention cohort study were included in this review. Two trials addressed the issue of shortening the duration of (or eliminating) exposure to breast milk. In a trial of breastfeeding versus formula feeding, formula feeding was efficacious in preventing MTCT of HIV (the cumulative probability of HIV infection at 24 months was 36.7% in the breastfeeding arm and 20.5% in the formula arm [p = 0.001]), but the

Cross-sectional study of CD4: CD8 ratio recovery in young adults with perinatally acquired HIV-1 infection.

PubMed

Pollock, Katrina M; Pintilie, Hannah; Foster, Caroline; Fidler, Sarah

2018-02-01

Antiretroviral therapy (ART) has improved survival into adulthood for young people with perinatally acquired HIV-1 (yp-PaHIV), but long-term prognosis remains unclear. We hypothesized that on-going immune activation, reflected in the failure of CD4:CD8 ratio normalization would be observed in yp-PaHIV, despite ART.A cross-sectional study of routinely collected clinical data from a cohort of yp-PaHIV (≥16 years).Data were collected from records of individuals attending a specialist clinic for yp-PaHIV transitioning to adult care. CD4:CD8 ratio and proportion with CD4:CD8 ratio ≥1, demographic data and viral parameters, including HIV-1 viral load (VL) and human cytomegalovirus (CMV) IgG, were analyzed with IBM SPSS Statistics v22.A total of 115 yp-PaHIV, median (IQR) age 22.0 (20.0-24.0) years, were studied, of whom 59 were females, and the majority were Black African 75/115 (65.2%). Where measured, CMV antibodies were frequently detected (71/74, 95.9%) and CMV IgG titre was inversely associated with CD4:CD8 ratio, (Rho -0.383, P = .012). Of those taking ART, 69 out of 90 (76.7%) yp-PaHIV had suppressed HIV viremia (<50 RNA copies/mL) and recovery of CD4:CD8 ratio to ≥1 was seen in 26 out of 69 (37.7%) with suppressed HIV viremia. Persistence of low CD4:CD8 ratio was observed even in those with a CD4 count ≥500 cells/μL, where 28/52 (53.8%) had a CD4:CD8 ratio <1. Of those with suppressed viremia, the median (IQR) age for starting ART was 8.0 (5.0-12.8) years and CD4:CD8 ratio was inversely associated with age at ART start, Rho -0.348, (P = .028).In this cohort of yp-PaHIV, despite lifelong HIV infection and widespread CMV coinfection, CD4:CD8 ratio recovery rate was comparable to adults treated in acute infection. Where persistence of CD4:CD8 ratio abnormality was observed, on-going immune activation may have significance for non-AIDS outcomes. Taken together our findings indicate immune resilience to be a feature of these adult survivors of

Near real-time monitoring of HIV transmission hotspots from routine HIV genotyping: an implementation case study.

PubMed

Poon, Art F Y; Gustafson, Réka; Daly, Patricia; Zerr, Laura; Demlow, S Ellen; Wong, Jason; Woods, Conan K; Hogg, Robert S; Krajden, Mel; Moore, David; Kendall, Perry; Montaner, Julio S G; Harrigan, P Richard

2016-05-01

HIV evolves rapidly and therefore infections with similar genetic sequences are likely linked by recent transmission events. Clusters of related infections can represent subpopulations with high rates of transmission. We describe the implementation of an automated near real-time system to monitor and characterise HIV transmission hotspots in British Columbia, Canada. In this implementation case study, we applied a monitoring system to the British Columbia drug treatment database, which holds more than 32 000 anonymised HIV genotypes for nearly 9000 residents of British Columbia living with HIV. On average, five to six new HIV genotypes are deposited in the database every day, which triggers an automated reanalysis of the entire database. We extracted clusters of five or more individuals with short phylogenetic distances between their respective HIV sequences. The system generated monthly reports of the growth and characteristics of clusters that were distributed to public health officers. In June, 2014, the monitoring system detected the expansion of a cluster by 11 new cases during 3 months, including eight cases with transmitted drug resistance. This cluster generally comprised young men who have sex with men. The subsequent report precipitated an enhanced public health follow-up to ensure linkage to care and treatment initiation in the affected subpopulation. Of the nine cases associated with this follow-up, all had already been linked to care and five cases had started treatment. Subsequent to the follow-up, three additional cases started treatment and most cases achieved suppressed viral loads. During the next 12 months, we detected 12 new cases in this cluster with reduction in the onward transmission of drug resistance. Our findings show the first application of an automated phylogenetic system monitoring a clinical database to detect a recent HIV outbreak and support the ensuing public health response. By making secondary use of routinely collected HIV

Culturally Embedded Risk Factors for Cambodian Husband-Wife HIV Transmission: From Women's Point of View.

PubMed

Yang, Youngran; Lewis, Frances Marcus; Wojnar, Danuta

2016-03-01

The purpose of this study was to use interview data to examine the validity of a recently published theoretical model of HIV transmission between husband and virginal wives in rural Cambodia. This study used a qualitative description method with a sample of women diagnosed with HIV/AIDS in Phnom Penh, Cambodia. Data were collected through in-depth interviews conducted with 15 women who self-identified as having contracted HIV from their HIV-positive husbands. Interviews were conducted in Khmer, translated and back-translated for accuracy, and then coded using deductive content analysis. Trustworthiness of study results was protected through peer debriefing, coding to consensus, and maintaining an audit trail. Each conceptual domain of the prior published theoretical model of HIV transmission was validated and further elaborated by current study data: wives' acceptance of their husbands' involvement with commercial sex workers, the common practice of unprotected sex between HIV-infected spouses and uninfected wives, and wives' beliefs about the value of the ideal Khmer woman. In addition, the current study findings identified a new domain that substantially distinguished between the beliefs and attitudes held about marriage and sex by wives and spouses. Women were not passive recipients of HIV transmission; they reciprocated with behaviors that were consistent with being a good Khmer woman in rural Cambodia, all of which increased their vulnerability to HIV transmission from their HIV-infected spouses. Future interventions or programs should consider all these factors and not overly rely on simplistic educational messages about wearing barriers for HIV transmission during sex. The refined theoretical model of HIV transmission from this qualitative research can be used to formulate culturally sensitive and embedded programs for curbing intramarital HIV transmission in Cambodia among the rural poor. © 2016 Sigma Theta Tau International.

Human milk galectin-3 binding protein and breast-feeding-associated HIV transmission.

PubMed

Chan, Christina S; Kim, Hae-Young; Autran, Chloe; Kim, Jae H; Sinkala, Moses; Kankasa, Chipepo; Mwiya, Mwiya; Thea, Donald M; Aldrovandi, Grace M; Kuhn, Louise; Bode, Lars

2013-12-01

Analysis of milk from 247 HIV-infected Zambian mothers showed that galectin-3 binding protein concentrations were significantly higher among HIV-infected mothers who transmitted HIV through breast-feeding (6.51 ± 2.12 μg/mL) than among nontransmitters but were also correlated with higher milk and plasma HIV RNA copies/mL and lower CD4+ cell counts. The association between galectin-3 binding protein and postnatal transmission was attenuated after adjustment for milk and plasma HIV load and CD4+ cell counts. This suggests that although milk galectin-3 binding protein is a marker of advanced maternal disease, it does not independently modify transmission risk.

HIV-SPECIFIC SECRETORY IGA IN BREAST MILK OF HIV-POSITIVE MOTHERS IS NOT ASSOCIATED WITH PROTECTION AGAINST HIV TRANSMISSION AMONG BREAST-FED INFANTS

PubMed Central

Kuhn, Louise; Trabattoni, Daria; Kankasa, Chipepo; Sinkala, Moses; Lissoni, Francesca; Ghosh, Mrinal; Aldrovandi, Grace; Thea, Don; Clerici, Mario

2009-01-01

Objectives To test whether secretory immunoglobulin A (sIgA) to human immunodeficiency virus (HIV) antigens in breast milk of HIV-positive women is associated with protection against HIV transmission among breast-fed infants. Study design Nested, case-control design in which HIV-specific sIgA was measured in breast milk collected from 90 HIV-positive women enrolled in a study in Lusaka, Zambia. Milk samples were selected to include 26 HIV-positive mothers with infected infants (transmitters) and 64 mothers with uninfected infants (nontransmitters). Results HIV-specific sIgA was detected more often in breast milk of transmitting mothers (76.9%) than in breast milk of nontransmitting mothers (46.9%, P = .009). There were no significant associations between HIV-specific sIgA in breast milk and other maternal factors, including HIV RNA quantities in breast milk, CD4 count, and plasma RNA quantities. Conclusions HIV-specific sIgA in breast milk does not appear to be a protective factor against HIV transmission among breast-fed infants. PMID:17095329

HIV prevention and transmission myths among heterosexually active adults in low-income areas of South Florida.

PubMed

Beck, Dano W; Lalota, Marlene; Metsch, Lisa R; Cardenas, Gabriel A; Forrest, David W; Lieb, Spencer; Liberti, Thomas M

2012-04-01

Misconceptions about HIV transmission and prevention may inhibit individuals' accurate assessment of their level of risk. We used venue-based sampling to conduct a cross-sectional study of heterosexually active adults (N = 1,221) within areas exhibiting high poverty and HIV/AIDS rates in Miami-Dade and Broward counties in 2007. Two logistic regression analyses identified correlates of holding inaccurate beliefs about HIV transmission and prevention. Belief in incorrect HIV prevention methods (27.2%) and modes of transmission (38.5%) was common. Having at least one incorrect prevention belief was associated with being Hispanic compared to white (non-Hispanic), being depressed, and not knowing one's HIV status. Having at least one incorrect transmission belief was associated with being younger, heavy alcohol use, being depressed, not having seen a physician in the past 12 months, and not knowing one's HIV status. Among low-income heterosexuals, HIV prevention and transmission myths are widespread. Debunking them could have HIV prevention value.

HIV heterosexual transmission to stable sexual partners of HIV-infected Brazilian hemophiliacs.

PubMed

Nicolau, J E; Benard, G; Fonseca, L A; Casseb, J S; Sato, M N; Cianga, M; Tanji, M M; Lorenzi, T F; Duarte, A J

1996-01-01

Nineteen Brazilian HIV-infected hemophiliacs and their stable heterosexual sexual partners were studied with the aim of assessing the rate of HIV transmission in this at risk group. The mean length of relationship between couples was 7.4 years. The hemophiliac men were Class II (n = 6), III (n = 11) and IVa (n = 2) of the CDC classification. They had decreased CD4+ and elevated CD8+ cell numbers; five had p24 antigenemia. We found 3 HIV-infected women (15.8 percent) by routine and confirmatory tests, a prevalence similar to that seen in other countries. They were asymptomatic and had no detectable p24 antigenemia. The 3 seropositive women's partners were Class II and III-CDC, and had normal CD4+ and CD8+ values and no p24 antigenemia. All seronegative women also had normal CD4+ and CD8+ numbers, except for elevated CD8+ cells in three of them, but immune abnormalities had already been seen in some seronegative partners at high risk for HIV infection. Our results reinforce previous suggestions that heterosexual transmission to stable female partners occurs preferentially early after initiation of sexual exposure, and possibly when the transmitter had high levels of viremia and regular sexual activity.

Low rate of mother-to-child transmission of HIV-1 after nevirapine intervention in a pilot public health program in Yaoundé, Cameroon.

PubMed

Ayouba, Ahidjo; Tene, Gilbert; Cunin, Patrick; Foupouapouognigni, Yacouba; Menu, Elisabeth; Kfutwah, Anfumbom; Thonnon, Jocelyn; Scarlatti, Gabriella; Monny-Lobé, Marcel; Eteki, Nicole; Kouanfack, Charles; Tardy, Michèle; Leke, Robert; Nkam, Maurice; Nlend, Anne E; Barré-Sinoussi, Françoise; Martin, Paul M V; Nerrienet, Eric

2003-11-01

To determine the percentage of infected children for whom nevirapine (NVP) was used to prevent peripartum mother-to-child transmission (MTCT) of HIV in Yaoundé, Cameroon. The study was a prospective Public Health Pilot Program covering a 3-year period (January 2000-December 2002). Counseled and consenting HIV-1-positive pregnant women were given a single dose of NVP at the onset of labor. Babies were given 2 mg/kg NVP syrup within the first 72 hours of life. NVP-treated children were regularly followed up and examined for HIV-1 infection at 6-8 weeks and 5-6 months through plasma viral load (VL) quantification with the bDNA system. One hundred twenty-three children were diagnosed with perinatal HIV-1 infection at 6-8 weeks and 5-6 months. Thirteen children (10.6% [13/123]; 95% confidence interval, 5.1-16) were infected and presented with high VLs, in general >500,000 copies/mL. Two children had intermediate VLs (between 50 and 3500 copies/mL) at both time points. One hundred seven children (87%) were considered not infected at 6-8 weeks of age. Our results indicate that the HIV-1 MTCT rate 6-8 weeks after NVP administration was not >13% (16/123), thus demonstrating the effectiveness of NVP for lowering the risk of HIV-1 MTCT in real-life settings.

Near real-time monitoring of HIV transmission hotspots from routine HIV genotyping: an implementation case study

PubMed Central

Poon, Art F. Y.; Gustafson, Réka; Daly, Patricia; Zerr, Laura; Demlow, S. Ellen; Wong, Jason; Woods, Conan K; Hogg, Robert S.; Krajden, Mel; Moore, David; Kendall, Perry; Montaner, Julio S. G.; Harrigan, P. Richard

2016-01-01

Background Due to the rapid evolution of HIV, infections with similar genetic sequences are likely to be related by recent transmission events. Clusters of related infections can represent subpopulations with high rates of HIV transmission. Here we describe the implementation of an automated “near real-time” system using clustering analysis of routinely collected HIV resistance genotypes to monitor and characterize HIV transmission hotspots in British Columbia (BC). Methods A monitoring system was implemented on the BC Drug Treatment Database, which currently holds over 32000 anonymized HIV genotypes for nearly 9000 residents of BC living with HIV. On average, five to six new HIV genotypes are deposited in the database every day, which triggers an automated re-analysis of the entire database. Clusters of five or more individuals were extracted on the basis of short phylogenetic distances between their respective HIV sequences. Monthly reports on the growth and characteristics of clusters were generated by the system and distributed to public health officers. Findings In June 2014, the monitoring system detected the expansion of a cluster by 11 new cases over three months, including eight cases with transmitted drug resistance. This cluster generally comprised young men who have sex with men. The subsequent report precipitated an enhanced public health follow-up to ensure linkage to care and treatment initiation in the affected subpopulation. Of the nine cases associated with this follow-up, all had already been linked to care and five cases had started treatment. Subsequent to the follow-up, three additional cases started treatment and the majority of cases achieved suppressed viral loads. Over the following 12 months, 12 new cases were detected in this cluster with a marked reduction in the onward transmission of drug resistance. Interpretation Our findings demonstrate the first application of an automated phylogenetic system monitoring a clinical database to

High risk behavior for HIV transmission among former injecting drug users: a survey from Indonesia.

PubMed

Iskandar, Shelly; Basar, Diba; Hidayat, Teddy; Siregar, Ike M P; Pinxten, Lucas; van Crevel, Reinout; Van der Ven, Andre J A M; De Jong, Cor A J

2010-08-10

Injecting drug use is an increasingly important cause of HIV transmission in most countries worldwide, especially in eastern Europe, South America, and east and southeast Asia. Among people actively injecting drugs, provision of clean needles and opioid substitution reduce HIV-transmission. However, former injecting drug users (fIDUs) are often overlooked as a high risk group for HIV transmission. We compared HIV risk behavior among current and former injecting drug users (IDUs) in Indonesia, which has a rapidly growing HIV-epidemic largely driven by injecting drug use. Current and former IDUs were recruited by respondent driven sampling in an urban setting in Java, and interviewed regarding drug use and HIV risk behavior using the European Addiction Severity Index and the Blood Borne Virus Transmission Questionnaire. Drug use and HIV transmission risk behavior were compared between current IDUs and former IDUs, using the Mann-Whitney and Pearson Chi-square test. Ninety-two out of 210 participants (44%) were self reported former IDUs. Risk behavior related to sex, tattooing or piercing was common among current as well as former IDUs, 13% of former IDUs were still exposed to contaminated injecting equipment. HIV-infection was high among former (66%) and current (60%) IDUs. Former IDUs may contribute significantly to the HIV-epidemic in Indonesia, and HIV-prevention should therefore also target this group, addressing sexual and other risk behavior.

Timing of maternal HIV testing and uptake of Prevention of Mother-to-Child Transmission interventions among women and their infected infants in Johannesburg, South Africa

PubMed Central

Technau, Karl-Günter; Kalk, Emma; Coovadia, Ashraf; Black, Vivian; Pickerill, Sam; Mellins, Claude A.; Abrams, Elaine J.; Strehlau, Renate; Kuhn, Louise

2013-01-01

Background By 2011, South African prevention of mother-to-child transmission of HIV (PMTCT) programmes had reduced perinatal HIV transmission at 6-weeks of age to 2.7%. We investigated the profile of newly-diagnosed vertically-infected children and their mothers to identify short-falls in the PMTCT programme. Methods In this operational follow-up study, fieldworkers enrolled mothers of newly-diagnosed HIV-infected children up to 2 years of age at 5 major healthcare facilities in Johannesburg. Structured questionnaires and clinical record reviews were conducted and analysed to describe the population and assess factors associated with PMTCT uptake. Results 289 mother-child pairs were enrolled. Timing of maternal HIV diagnosis influenced PMTCT access and feeding choices, and was associated with infants’ age at HIV diagnosis (7 weeks vs. 11 weeks vs. 31 weeks where mothers tested before, during or after the pregnancy respectively; p <0.0001). Women diagnosed before pregnancy (12%) were older (median 31 years) than those diagnosed during the index pregnancy (53% - median 27 years). Women diagnosed after delivery (35%) were younger (median 25 years, p<0.0001), of lower parity, and less likely to be South African citizens. In 81 cases (29%) late maternal diagnosis precluded any PMTCT access. Where women were diagnosed during or before pregnancy, the recommended PMTCT guidelines for mother and infant were followed in 86 (61%) pairs. Conclusion Failure to diagnose maternal HIV infection before delivery was the main reason for missing PMTCT prophylaxis and early infant testing. Timely maternal diagnosis enables PMTCT uptake, but implementation and follow-up gaps require attention to improve infant outcomes. PMID:24759066

The contribution of maternal HIV seroconversion during late pregnancy and breastfeeding to mother-to-child transmission of HIV

PubMed Central

Johnson, Leigh F.; Stinson, Kathryn; Newell, Marie-Louise; Bland, Ruth M.; Moultrie, Harry; Davies, Mary-Ann; Rehle, Thomas M.; Dorrington, Rob E.; Sherman, Gayle G.

2012-01-01

Background The prevention of mother-to-child transmission (PMTCT) of HIV has been focused mainly on women who are HIV-positive at their first antenatal visit, but there is uncertainty regarding the contribution to overall transmission from mothers who seroconvert after their first antenatal visit and before weaning. Method A mathematical model was developed to simulate changes in mother-to-child transmission of HIV over time, in South Africa. The model allows for changes in infant feeding practices as infants age, temporal changes in the provision of antiretroviral prophylaxis and counselling on infant feeding, as well as temporal changes in maternal HIV prevalence and incidence. Results The proportion of MTCT from mothers who seroconverted after their first antenatal visit was 26% (95% CI: 22-30%) in 2008, or 15 000 out of 57 000 infections. It is estimated that by 2014, total MTCT will reduce to 39 000 per annum, and transmission from mothers seroconverting after their first antenatal visit will reduce to 13 000 per annum, accounting for 34% (95% CI: 29-39%) of MTCT. If maternal HIV incidence during late pregnancy and breastfeeding were reduced by 50% after 2010, and HIV screening were repeated in late pregnancy and at 6-week immunization visits after 2010, the average annual number of MTCT cases over the 2010-15 period would reduce by 28% (95% CI: 25-31%), from 39 000 to 28 000 per annum. Conclusion Maternal seroconversion during late pregnancy and breastfeeding contributes significantly to the paediatric HIV burden, and needs greater attention in the planning of PMTCT programmes. PMID:22193774

HIV Type 1 Transmission Networks Among Men Having Sex with Men and Heterosexuals in Kenya

PubMed Central

Faria, Nuno Rodrigues; Hassan, Amin; Hamers, Raph L.; Mutua, Gaudensia; Anzala, Omu; Mandaliya, Kishor; Cane, Patricia; Berkley, James A.; Rinke de Wit, Tobias F.; Wallis, Carole; Graham, Susan M.; Price, Matthew A.; Coutinho, Roel A.; Sanders, Eduard J.

2014-01-01

Abstract We performed a molecular phylogenetic study on HIV-1 polymerase sequences of men who have sex with men (MSM) and heterosexual patient samples in Kenya to characterize any observed HIV-1 transmission networks. HIV-1 polymerase sequences were obtained from samples in Nairobi and coastal Kenya from 84 MSM, 226 other men, and 364 women from 2005 to 2010. Using Bayesian phylogenetics, we tested whether sequences clustered by sexual orientation and geographic location. In addition, we used trait diffusion analyses to identify significant epidemiological links and to quantify the number of transmissions between risk groups. Finally, we compared 84 MSM sequences with all HIV-1 sequences available online at GenBank. Significant clustering of sequences from MSM at both coastal Kenya and Nairobi was found, with evidence of HIV-1 transmission between both locations. Although a transmission pair between a coastal MSM and woman was confirmed, no significant HIV-1 transmission was evident between MSM and the comparison population for the predominant subtype A (60%). However, a weak but significant link was evident when studying all subtypes together. GenBank comparison did not reveal other important transmission links. Our data suggest infrequent intermingling of MSM and heterosexual HIV-1 epidemics in Kenya. PMID:23947948

Scaling up prevention programmes to reduce the sexual transmission of HIV in China.

PubMed

Rou, Keming; Sullivan, Sheena G; Liu, Peng; Wu, Zunyou

2010-12-01

Since 2007, sex has been the major mode of HIV transmission in China, accounting for 75% of new infections in 2009. Reducing sexual transmission is a major challenge for China in controling the HIV epidemic. This article discusses the pilot programmes that have guided the expansion of sex education and behavioural interventions to reduce the sexual transmission of HIV in China. Commercial sex became prevalent across China in the early 1980s, prompting some health officials to become concerned that this would fuel an HIV epidemic. Initial pilot intervention projects to increase condom use among sex workers were launched in 1996 on a small scale and, having demonstrated their effectiveness, were expanded nationwide during the 2000s. Since then, supportive policies to expand sex education to other groups and throughout the country have been introduced and the range of targets for education programmes and behavioural interventions has broadened considerably to also include school children, college students, married couples, migrant workers and men who have sex with men. Prevention programmes for reducing sexual transmission of HIV have reasonable coverage, but can still improve. The quality of intervention needs to be improved in order to have a meaningful impact on changing behaviour to reducing HIV sexual transmission. Systematic evaluation of the policies, guidelines and intervention programmes needs to be conducted to understand their impact and to maintain adherence.

HIV Transmission: Myths about Casual Contact and Fear about Medical Procedures Persist Among Older Adults.

PubMed

Hughes, Anne K; Alford, Kristen R

2017-01-02

HIV infection among older adults is increasing. Previous research suggests that many older adults do not see themselves as at risk for HIV and that many subscribe to myths related to HIV transmission. In this focus group study (N = 48) we solicited the beliefs that older adults held about HIV. The older adults in this study were knowledgeable about how HIV is typically transmitted. However, we also identified that they subscribed to misconceptions regarding casual contact transmission and were fearful of transmission from the medical system. Educational efforts aimed at older adults must be tailored to address these persistent misconceptions.

Sexual behavior and HIV transmission risk of Ugandan adults taking antiretroviral therapy: 3 year follow-up.

PubMed

Apondi, Rose; Bunnell, Rebecca; Ekwaru, John Paul; Moore, David; Bechange, Stevens; Khana, Kenneth; King, Rachel; Campbell, James; Tappero, Jordan; Mermin, Jonathan

2011-06-19

Long-term impact of antiretroviral therapy (ART) on sexual HIV-transmission risk in Africa is unknown. We assessed sexual behavior changes and estimated HIV transmission from HIV-infected adults on ART in Uganda. Between 2003 and 2007, we enrolled and followed ART-naive HIV-infected adults in a home-based AIDS program with annual counseling and testing for cohabitating partners, participant transmission risk-reduction plans, condom distribution and prevention support for cohabitating discordant couples. We assessed participants' HIV plasma viral load and partner-specific sexual behaviors. We defined risky sex as intercourse with inconsistent/no condom use with HIV-negative or unknown serostatus partners in previous 3 months. We compared rates using Poisson regression models, estimated transmission risk using established viral load-specific transmission estimates, and documented sero-conversion rates among HIV-discordant couples. Of 928 participants, 755 (81%) had 36 months data: 94 (10%) died and 79 (9%) missing data. Sexual activity increased from 28% (baseline) to 41% [36 months (P < 0.001)]. Of sexually active participants, 22% reported risky sex at baseline, 8% at 6 months (P < 0.001), and 14% at 36 months (P = 0.018). Median viral load among those reporting risky sex was 122,500 [interquartile range (IQR) 45 100-353 000] copies/ml pre-ART at baseline and undetectable at follow-up. One sero-conversion occurred among 62 cohabitating sero-discordant partners (0.5 sero-conversions/100 person-years). At 36 months, consistent condom use was 74% with discordant partners, 55% with unknown and 46% with concordant partners. Estimated HIV transmission risk reduced 91%, from 47.3 to 4.2/1000 person-years. Despite increased sexual activity among HIV-infected Ugandans over 3 years on ART, risky sex and estimated risk of HIV transmission remained lower than baseline levels. Integrated prevention programs could reduce HIV transmission in Africa.

Effectiveness of semen washing to prevent human immunodeficiency virus (HIV) transmission and assist pregnancy in HIV-discordant couples: a systematic review and meta-analysis.

PubMed

Zafer, Maryam; Horvath, Hacsi; Mmeje, Okeoma; van der Poel, Sheryl; Semprini, Augusto E; Rutherford, George; Brown, Joelle

2016-03-01

To evaluate the effectiveness of semen washing in human immunodeficiency virus (HIV)-discordant couples in which the male partner is infected. Systematic review and meta-analysis. Not applicable. Forty single-arm open-label studies among HIV-discordant couples that underwent intrauterine insemination (IUI) or in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI) using washed semen. Semen washing followed by IUI, IVF, or IVF/ICSI. HIV transmission to HIV-uninfected women; secondary outcomes: HIV transmission to newborns and proportion of couples achieving a clinical pregnancy. No HIV transmission occurred in 11,585 cycles of assisted reproduction with the use of washed semen among 3,994 women. Among the subset of HIV-infected men without plasma viral suppression at the time of semen washing, no HIV seroconversions occurred among 1,023 women after 2,863 cycles of assisted reproduction with the use of washed semen. Studies that measured HIV transmission to infants reported no cases of vertical transmission. Overall, 56.3% of couples (2,357/4,184) achieved a clinical pregnancy with the use of washed semen. Semen washing appears to significantly reduce the risk of transmission in HIV-discordant couples desiring children, regardless of viral suppression in the male partner. There are no randomized controlled studies or studies from low-income countries, especially those with a large burden of HIV. Continued development of lower-cost semen washing and assisted reproduction technologies is needed. Integration of semen washing into HIV prevention interventions could help to further reduce the spread of HIV. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Antiretroviral Therapy for the Prevention of HIV Transmission: What Will It Take?

PubMed Central

McNairy, Margaret L.; El-Sadr, Wafaa M.

2014-01-01

The evidence in support of use of antiretroviral therapy (ART) for prevention of human immunodeficiency virus (HIV) transmission is encouraging and has stimulated optimism for achieving a dramatic change in the trajectory of the HIV epidemic. Yet, there are substantial challenges that, if not addressed, could be the Achilles’ heel for this concept. These challenges require strengthening every step of the HIV care continuum, including expansion of HIV testing to reach all those with HIV infection, effective linkage to and retention in care, timely initiation of ART, and high levels of treatment adherence with viral load suppression. Also important is the identification of individuals with acute HIV infection whose contribution to HIV transmission may be substantial. Implementation research is needed to identify strategies that address these challenges and to determine the efficacy of ART for prevention in key populations as well as to evaluate the effectiveness of combination strategies for HIV prevention at the population level. PMID:24429438

Effect of sex steroid hormones on replication and transmission of major HIV subtypes.

PubMed

Ragupathy, Viswanath; Devadas, Krishnakumar; Tang, Shixing; Wood, Owen; Lee, Sherwin; Dastyer, Armeta; Wang, Xue; Dayton, Andrew; Hewlett, Indira

2013-11-01

The HIV epidemic is expanding worldwide with an increasing number of distinct viral subtypes and circulating recombinant forms (CRFs). Out of 34 million adults living with HIV and AIDS, women account for one half of all HIV-1 infections worldwide. These gender differences in HIV pathogenesis may be attributed to sex hormones. Little is known about the role of sex hormone effects on HIV Subtypes pathogenesis. The aim of our study was to determine sex hormone effects on replication and transmissibility of HIV subtypes. Peripheral blood mononuclear cells (PBMC) and monocyte derived dendritic cells (MDDC) from male and female donors were infected with HIV subtypes A-D and CRF02_AG, CRF01_AE, MN (lab adapted), Group-O, Group-N and HIV-2 at a concentration of 5ng/ml of p24 or p27. Virus production was evaluated by measuring p24 and p27 levels in culture supernatants. Similar experiments were carried out in the presence of physiological concentrations of sex steroid hormones. R5/X4 expressions measured by flow cytometry and transmissibility was evaluated by transfer of HIV from primary dendritic cells (DC) to autologous donor PBMC. Our results from primary PBMC and MDDC from male and female donors indicate in the absence of physiological concentrations of hormone treatment virus production was observed in three clusters; high replicating virus (subtype B and C), moderate replicative virus (subtype A, D, CRF01_AE, Group_N) and least replicative virus (strain MN). However, dose of sex steroid hormone treatment influenced HIV replication and transmission kinetics in PBMC, DCs and cell lines. Such effects were inconsistent between donors and HIV subtypes. Sex hormone effects on HIV entry receptors (CCR5/CXCR4) did not correlate with virus production. Subtypes B and C showed higher replication in PBMC from males and females and were transmitted more efficiently through DC to male and female PBMC compared with other HIV-1 subtypes, HIV-1 Group O and HIV-2. These findings are

Knowledge of HIV Serodiscordance, Transmission, and Prevention among Couples in Durban, South Africa

PubMed Central

Kilembe, William; Wall, Kristin M.; Mokgoro, Mammekwa; Mwaanga, Annie; Dissen, Elisabeth; Kamusoko, Miriam; Phiri, Hilda; Sakulanda, Jean; Davitte, Jonathan; Reddy, Tarylee; Brockman, Mark; Ndung’u, Thumbi; Allen, Susan

2015-01-01

Objective Couples’ voluntary HIV counseling and testing (CVCT) significantly decreases HIV transmission within couples, the largest risk group in sub-Saharan Africa, but it is not currently offered in most HIV testing facilities. To roll out such an intervention, understanding locale-specific knowledge barriers is critical. In this study, we measured knowledge of HIV serodiscordance, transmission, and prevention before and after receipt of CVCT services in Durban. Design Pre- and post-CVCT knowledge surveys were administered to a selection of individuals seeking CVCT services. Methods Changes in knowledge scores were assessed with McNemar Chi-square tests for balanced data and generalized estimating equation methods for unbalanced data. Results The survey included 317 heterosexual black couples (634 individuals) who were primarily Zulu (87%), unemployed (47%), and had at least a secondary level education (78%). 28% of couples proved to be discordant. Only 30% of individuals thought serodiscordance between couples was possible pre‐CVCT compared to 95% post-CVCT. One-third thought there was at least one benefit of CVCT pre‐CVCT, increasing to 96% post‐CVCT. Overall, there were positive changes in knowledge about HIV transmission and prevention. However, many respondents thought all HIV positive mothers give birth to babies with AIDS (64% pre-CVCT, 59% post-CVCT) and that male circumcision does not protect negative men against HIV (70% pre-CVCT, 67% post-CVCT). Conclusions CVCT was well received and was followed by improvements in understanding of discordance, the benefits of joint testing, and HIV transmission. Country-level health messaging would benefit from targeting gaps in knowledge about serodiscordance, vertical transmission, and male circumcision. PMID:25894583

The Opposites Attract Study of viral load, HIV treatment and HIV transmission in serodiscordant homosexual male couples: design and methods.

PubMed

Bavinton, Benjamin R; Jin, Fengyi; Prestage, Garrett; Zablotska, Iryna; Koelsch, Kersten K; Phanuphak, Nittaya; Grinsztejn, Beatriz; Cooper, David A; Fairley, Christopher; Kelleher, Anthony; Triffitt, Kathy; Grulich, Andrew E

2014-09-04

Studies in heterosexual HIV serodiscordant couples have provided critical evidence on the role of HIV treatments and undetectable viral load in reducing the risk of HIV transmission. There is very limited data on the risk of transmission from anal sex in homosexual male serodiscordant couples. The Opposites Attract Study is an observational prospective longitudinal cohort study of male homosexual serodiscordant partnerships running from 2012 to 2015 and conducted in clinics throughout Australia, Brazil and Thailand. Couples attend two or more clinic visits per year. The HIV-positive partner's viral load is tested and the HIV-negative partner is tested for HIV antibodies at every clinic visit. Results from any tests for sexually transmitted infections are also collected. Detailed behavioural questionnaires are completed by both partners at the time of each visit. The primary research question is whether HIV incidence is lower in those couples where the HIV-positive partner is receiving HIV treatment compared to couples where he is not receiving treatment. A voluntary semen sub-study will examine semen plasma viral load in a subsample of HIV-positive partners in Sydney, Rio de Janeiro and Bangkok. In cases of seroconversion of the initially HIV-negative partner, phylogenetic analysis will be conducted at the end of the study on virus from stored blood samples from both partners to determine if the infection came from the HIV-positive study partner. Men in new serodiscordant relationships will specifically be targeted for recruitment. This study will provide critical data on the reduction in HIV transmission risk associated with being on HIV treatment in homosexual male serodiscordant couples in different regions of the world. Data from men in new relationships will be particularly valuable given that the highest transmission risk is in the first year of serodiscordant relationships. Furthermore, the detailed behavioural and attitudinal data from the participant

Plasma cytokine levels and risk of HIV type 1 (HIV-1) transmission and acquisition: a nested case-control study among HIV-1-serodiscordant couples.

PubMed

Kahle, Erin M; Bolton, Michael; Hughes, James P; Donnell, Deborah; Celum, Connie; Lingappa, Jairam R; Ronald, Allan; Cohen, Craig R; de Bruyn, Guy; Fong, Youyi; Katabira, Elly; McElrath, M Juliana; Baeten, Jared M

2015-05-01

A heightened proinflammatory state has been hypothesized to enhance human immunodeficiency virus type 1 (HIV-1) transmission - both susceptibility of HIV-1-exposed persons and infectiousness of HIV-1-infected persons. Using prospective data from heterosexual African couples with HIV-1 serodiscordance, we conducted a nested case-control analysis to assess the relationship between cytokine concentrations and the risk of HIV-1 acquisition. Case couples (n = 120) were initially serodiscordant couples in which HIV-1 was transmitted to the seronegative partner during the study; control couples (n = 321) were serodiscordant couples in which HIV-1 was not transmitted to the seronegative partner. Differences in a panel of 30 cytokines were measured using plasma specimens from both HIV-1-susceptible and HIV-1-infected partners. Plasma was collected before seroconversion for cases. For both HIV-1-infected and HIV-1-susceptible partners, cases and controls had significantly different mean responses in cytokine panels (P < .001, by the Hotelling T(2) test), suggesting a broadly different pattern of immune activation for couples in which HIV-1 was transmitted, compared with couples without transmission. Individually, log10 mean concentrations of interleukin 10 (IL-10) and CXCL10 were significantly higher for both HIV-1-susceptible and HIV-1-infected case partners, compared with HIV-1-susceptible and HIV-1-infected control partners (P < .01 for all comparisons). In multivariate analysis, HIV-1 transmission was significantly associated with elevated CXCL10 concentrations in HIV-1-susceptible partners (P = .001) and with elevated IL-10 concentrations in HIV-1-infected partners (P = .02). Immune activation, as measured by levels of cytokine markers, particularly elevated levels of IL-10 and CXCL1, are associated with increased HIV-1 susceptibility and infectiousness. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All

Understanding the mental health of youth living with perinatal HIV infection: lessons learned and current challenges

PubMed Central

Mellins, Claude A; Malee, Kathleen M

2013-01-01

Introduction Across the globe, children born with perinatal HIV infection (PHIV) are reaching adolescence and young adulthood in large numbers. The majority of research has focused on biomedical outcomes yet there is increasing awareness that long-term survivors with PHIV are at high risk for mental health problems, given genetic, biomedical, familial and environmental risk. This article presents a review of the literature on the mental health functioning of perinatally HIV-infected (PHIV+) adolescents, corresponding risk and protective factors, treatment modalities and critical needs for future interventions and research. Methods An extensive review of online databases was conducted. Articles including: (1) PHIV+ youth; (2) age 10 and older; (3) mental health outcomes; and (4) mental health treatment were reviewed. Of 93 articles identified, 38 met inclusion criteria, the vast majority from the United States and Europe. Results These studies suggest that PHIV+ youth experience emotional and behavioural problems, including psychiatric disorders, at higher than expected rates, often exceeding those of the general population and other high-risk groups. Yet, the specific role of HIV per se remains unclear, as uninfected youth with HIV exposure or those living in HIV-affected households displayed similar prevalence rates in some studies, higher rates in others and lower rates in still others. Although studies are limited with mixed findings, this review indicates that child-health status, cognitive function, parental health and mental health, stressful life events and neighbourhood disorder have been associated with worse mental health outcomes, while parent–child involvement and communication, and peer, parent and teacher social support have been associated with better function. Few evidence-based interventions exist; CHAMP+, a mental health programme for PHIV+ youth, shows promise across cultures. Conclusions This review highlights research limitations that

Undervaccination of Perinatally HIV-Infected and HIV-Exposed Uninfected Children in Latin America and the Caribbean

PubMed Central

Succi, Regina C. M.; Krauss, Margot R.; Harris, D. Robert; Machado, Daisy M.; de Moraes-Pinto, Maria Isabel; Mussi-Pinhata, Marisa M.; Ruz, Noris Pavia; Pierre, Russell B.; Kolevic, Lenka; Joao, Esau; Foradori, Irene; Hazra, Rohan

2013-01-01

Background Perinatally HIV-infected children (PHIV) may be at risk of undervaccination. Vaccination coverage rates among PHIV and HIV-exposed uninfected children (HEU) in Latin America and the Caribbean were compared. Methods All PHIV and HEU children born from 2002–2007 that were enrolled in a multi-site observational study conducted in Latin America and the Caribbean were included in this analysis. Children were classified as up to date (UTD) if they had received the recommended number of doses of each vaccine at the appropriate intervals by 12 and 24 months of age. Fisher’s exact test was used to analyze the data. Covariates potentially associated with a child’s HIV status were considered in multivariable logistic regression modeling. Results Of 1156 eligible children, 768 (66.4%) were HEU and 388 (33.6%) were PHIV. HEU children were significantly (p<0.01) more likely to be UTD by 12 and 24 months of age for all vaccines examined. Statistically significant differences persisted when the analyses were limited to children enrolled prior to 12 months of age. Controlling for birth weight, sex, primary caregiver education and any use of tobacco, alcohol or illegal drugs during pregnancy did not contribute significantly to the logistic regression models. Conclusions PHIV children were significantly less likely than HEU children to be UTD for their childhood vaccinations at 12 and 24 months of age, even when limited to children enrolled before 12 months of age. Strategies to increase vaccination rates in PHIV are needed. PMID:23860480

HIV-1 diversity, transmission dynamics and primary drug resistance in Angola.

PubMed

Bártolo, Inês; Zakovic, Suzana; Martin, Francisco; Palladino, Claudia; Carvalho, Patrícia; Camacho, Ricardo; Thamm, Sven; Clemente, Sofia; Taveira, Nuno

2014-01-01

To assess HIV-1 diversity, transmission dynamics and prevalence of transmitted drug resistance (TDR) in Angola, five years after ART scale-up. Population sequencing of the pol gene was performed on 139 plasma samples collected in 2009 from drug-naive HIV-1 infected individuals living in Luanda. HIV-1 subtypes were determined using phylogenetic analysis. Drug resistance mutations were identified using the Calibrated Population Resistance Tool (CPR). Transmission networks were determined using phylogenetic analysis of all Angolan sequences present in the databases. Evolutionary trends were determined by comparison with a similar survey performed in 2001. 47.1% of the viruses were pure subtypes (all except B), 47.1% were recombinants and 5.8% were untypable. The prevalence of subtype A decreased significantly from 2001 to 2009 (40.0% to 10.8%, P = 0.0019) while the prevalence of unique recombinant forms (URFs) increased > 2-fold (40.0% to 83.1%, P < 0.0001). The most frequent URFs comprised untypable sequences with subtypes H (U/H, n = 7, 10.8%), A (U/A, n = 6, 9.2%) and G (G/U, n = 4, 6.2%). Newly identified U/H recombinants formed a highly supported monophyletic cluster suggesting a local and common origin. TDR mutation K103N was found in one (0.7%) patient (1.6% in 2001). Out of the 364 sequences sampled for transmission network analysis, 130 (35.7%) were part of a transmission network. Forty eight transmission clusters were identified; the majority (56.3%) comprised sequences sampled in 2008-2010 in Luanda which is consistent with a locally fuelled epidemic. Very low genetic distance was found in 27 transmission pairs sampled in the same year, suggesting recent transmission events. Transmission of drug resistant strains was still negligible in Luanda in 2009, five years after the scale-up of ART. The dominance of small and recent transmission clusters and the emergence of new URFs are consistent with a rising HIV-1 epidemics mainly driven by heterosexual

Stimulant use patterns and HIV transmission risk among HIV-serodiscordant male couples.

PubMed

Gamarel, Kristi E; Woolf-King, Sarah E; Carrico, Adam W; Neilands, Torsten B; Johnson, Mallory O

2015-02-01

Substance use is strongly linked to HIV risk, and members of couples can have a powerful influence on each other's health behaviors. We examined whether couple-level patterns of stimulant use were differentially associated with engaging in condomless anal intercourse with primary partners and outside partners. Members of HIV serodiscordant male couples (N = 117 couples, 232 men) completed surveys, and HIV-positive men had blood drawn for viral load. Results revealed that stimulant use by only one partner in the couple was associated with a decrease in the odds of engaging in condomless anal sex with one's primary partner (AOR = 0.09, 95% CI: 0.01, 0.89). When both partners reported stimulant use, the HIV-negative partner had an increase in the odds of condomless sex with outside partners (AOR = 6.68, 95% CI: 1.09, 8.01). Understanding the role of couples' stimulant use patterns in HIV transmission risk is an important area for future research and intervention.

Factors associated with misconceptions about HIV transmission among ever-married women in Bangladesh.

PubMed

Mondal, Md Nazrul Islam; Hoque, Nazrul; Chowdhury, Md Rocky Khan; Hossain, Md Sabbir

2015-01-01

The human immunodeficiency virus (HIV) epidemic continues to be associated with misconceptions and misinformed opinions, which increase the risk of HIV transmission. Therefore, the present study aimed to identify the determinant factors among different socioeconomic and demographic factors affecting misconceptions about HIV transmission among ever-married women in Bangladesh. Data and necessary information of 9,272 ever-married women were extracted from the Bangladesh Demographic and Health Survey 2011. Three types of misconceptions were considered. Both bivariate and multivariate analyses were used as the statistical tools to determine the factors affecting misconceptions about HIV transmission. The results revealed that misconceptions are more prevalent among women who are older, less educated, have husbands who are less educated, live in rural areas, have poor economic conditions, and have less access to mass media. The respondent's age, education, husband's education, place of residence, wealth index, and exposure to mass media are significantly associated with the misconceptions. Finally, logistic regression analysis identified age, education, place of residence, wealth index, and exposure to mass media as significant predictors. Because socioeconomic factors are the key determinants of misconceptions about HIV transmission, intervention programs should be aimed at HIV prevention via education and awareness programs to reduce misconceptions as important parts of the prevention strategy.

Why are children still being infected with HIV? Experiences in the prevention of mother‐to‐child transmission of HIV in south London

PubMed Central

McDonald, C; Lambert, J; Nayagam, D; Welz, T; Poulton, M; Aleksin, D; Welch, J

2007-01-01

Objectives To evaluate the effectiveness of interventions to prevent mother‐to‐child transmission of HIV at a large teaching hospital in South East London, and to assess reasons for the small numbers of transmissions that continue to occur. Design A database of all pregnant women diagnosed as HIV positive between 1993 and 2005 was reviewed, with detailed (retrospective) case‐note review of all mother–infant pairs where HIV transmission occurred. Setting King's College Hospital, London, UK, a teaching hospital serving an ethnically diverse and socially deprived population. Results 296 pregnancies to 274 women were recorded. 9 of 296 (3.0%) women were lost to follow‐up before the end of the pregnancy. Of 287 pregnancies followed up until after delivery, 6 (2.1%) resulted in HIV infection in the infant. More recently, between 2000 and 2004, this transmission rate was even lower, at 3 in 231 (1.3%). Each of these six women had complications, including late presentation to services and defaulting follow‐up appointments, which were likely to increase the risk of HIV transmission. Four of the six transmissions occurred in utero. Conclusion The overall transmission rate of 2% attests to the efforts of the multidisciplinary care team in managing this population which is often hard to reach. Clearly, good systems are needed to trace those women who default. Further data are needed regarding in utero transmissions. PMID:17005542

Cell-to-Cell Transmission Can Overcome Multiple Donor and Target Cell Barriers Imposed on Cell-Free HIV

PubMed Central

Ilinskaya, Anna; Dorjbal, Batsukh; Truong, Rosaline; Derse, David; Uchil, Pradeep D.; Heidecker, Gisela; Mothes, Walther

2013-01-01

Virus transmission can occur either by a cell-free mode through the extracellular space or by cell-to-cell transmission involving direct cell-to-cell contact. The factors that determine whether a virus spreads by either pathway are poorly understood. Here, we assessed the relative contribution of cell-free and cell-to-cell transmission to the spreading of the human immunodeficiency virus (HIV). We demonstrate that HIV can spread by a cell-free pathway if all the steps of the viral replication cycle are efficiently supported in highly permissive cells. However, when the cell-free path was systematically hindered at various steps, HIV transmission became contact-dependent. Cell-to-cell transmission overcame barriers introduced in the donor cell at the level of gene expression and surface retention by the restriction factor tetherin. Moreover, neutralizing antibodies that efficiently inhibit cell-free HIV were less effective against cell-to-cell transmitted virus. HIV cell-to-cell transmission also efficiently infected target T cells that were relatively poorly susceptible to cell-free HIV. Importantly, we demonstrate that the donor and target cell types influence critically the extent by which cell-to-cell transmission can overcome each barrier. Mechanistically, cell-to-cell transmission promoted HIV spread to more cells and infected target cells with a higher proviral content than observed for cell-free virus. Our data demonstrate that the frequently observed contact-dependent spread of HIV is the result of specific features in donor and target cell types, thus offering an explanation for conflicting reports on the extent of cell-to-cell transmission of HIV. PMID:23308151

Mortality in perinatally HIV-infected young people in England following transition to adult care: an HIV Young Persons Network (HYPNet) audit.

PubMed

Fish, R; Judd, A; Jungmann, E; O'Leary, C; Foster, C

2014-04-01

Mortality in young people with perinatally acquired HIV infection (PHIV) following transfer to adult care has not been characterized in the UK. We conducted a multicentre audit to establish the number of deaths and associated factors. Fourteen adult clinics caring for infected young people reported deaths to 30 September 2011 on a proforma. Deaths were matched to the Collaborative HIV Paediatric Study, a clinical database of HIV-infected children in the UK/Ireland, to describe clinical characteristics in paediatric care of those who died post-transition. Eleven deaths were reported from 14 clinics which cared for 248 adults with PHIV. For the 11 deaths, the median age at transfer to adult care was 17 years (range 15-21 years), and at death was 21 years (range 17-24 years). Causes of death were suicide (two patients), advanced HIV disease (seven patients) and bronchiectasis (one patient), with one cause missing. At death, the median CD4 count was 27 cells/μL (range 0-630 cells/μL); five patients were on antiretroviral therapy (ART) but only two had a viral load < 50 HIV-1 RNA copies/mL. Nine had poor adherence when in paediatric care, continuing into adult care despite multidisciplinary support. Eight had ART resistance, although all had potentially suppressive regimens available. Nine had mental health diagnoses. Our findings highlight the complex medical and psychosocial issues faced by some adults with PHIV, with nine of the 11 deaths in our study being associated with poor adherence and advanced HIV disease. Novel adherence interventions and mental health support are required for this vulnerable cohort. © 2013 British HIV Association.

76 FR 72417 - Public Health Service Guideline for Reducing Transmission of Human Immunodeficiency Virus (HIV...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-23

... (HIV), Hepatitis B Virus (HBV), and Hepatitis C Virus (HCV) Through Solid Organ Transplantation AGENCY... Reducing Transmission of Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), and Hepatitis C Virus... Transmission of Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) through...

Exploring Migratory Dynamics on HIV Transmission: The Case of Mexicans in New York City and Puebla, Mexico

PubMed Central

Guilamo-Ramos, Vincent; McCarthy, Katharine; Muñoz-Laboy, Miguel A.; de Lourdes Rosas López, Maria

2014-01-01

Migration and population movement are increasingly viewed as important factors associated with HIV transmission risk. With growing awareness of the potential impact of migration on HIV transmission, several perspectives have emerged that posit differing dynamics of risk. We considered available data on the role of migration on HIV transmission among Mexican migrants in New York City and Puebla, Mexico. Specifically, we examined 3 distinct models of migratory dynamics of HIV transmission—namely, the structural model, the local contextual model, and the interplay model. In doing so, we reframed current public health perspectives on the role of migration on HIV transmission. PMID:24825203

Differential Transmission of HIV Traversing Fetal Oral/Intestinal Epithelia and Adult Oral Epithelia

PubMed Central

Herrera, Rossana; Veluppillai, Piri; Greenspan, Deborah; Soros, Vanessa; Greene, Warner C.; Levy, Jay A.; Palefsky, Joel M.

2012-01-01

While human immunodeficiency virus (HIV) transmission through the adult oral route is rare, mother-to-child transmission (MTCT) through the neonatal/infant oral and/or gastrointestinal route is common. To study the mechanisms of cell-free and cell-associated HIV transmission across adult oral and neonatal/infant oral/intestinal epithelia, we established ex vivo organ tissue model systems of adult and fetal origin. Given the similarity of neonatal and fetal oral epithelia with respect to epithelial stratification and density of HIV-susceptible immune cells, we used fetal oral the epithelium as a model for neonatal/infant oral epithelium. We found that cell-free HIV traversed fetal oral and intestinal epithelia and infected HIV-susceptible CD4+ T lymphocytes, Langerhans/dendritic cells, and macrophages. To study the penetration of cell-associated virus into fetal oral and intestinal epithelia, HIV-infected macrophages and lymphocytes were added to the surfaces of fetal oral and intestinal epithelia. HIV-infected macrophages, but not lymphocytes, transmigrated across fetal oral epithelia. HIV-infected macrophages and, to a lesser extent, lymphocytes transmigrated across fetal intestinal epithelia. In contrast to the fetal oral/intestinal epithelia, cell-free HIV transmigration through adult oral epithelia was inefficient and virions did not infect intraepithelial and subepithelial HIV-susceptible cells. In addition, HIV-infected macrophages and lymphocytes did not transmigrate through intact adult oral epithelia. Transmigration of cell-free and cell-associated HIV across the fetal oral/intestinal mucosal epithelium may serve as an initial mechanism for HIV MTCT. PMID:22205732

Generationing, Stealthing, and Gift Giving: The Intentional Transmission of HIV by HIV-Positive Men to their HIV-Negative Sex Partners.

PubMed

Klein, Hugh

2014-11-06

Gift giving is the process by which an HIV-positive person purposely infects an HIV-negative person with HIV, usually with that person's knowledge and consent. Little has been written about this HIV transmission practice. In this paper, two specific types of gift giving - generationing and stealthing - are explained and introduced to the scientific literature. Generationing is a type of gift giving in which one gift giver successfully infects a previously-uninfected man with HIV, and then the two men collaborate in an effort to seroconvert another man, and so forth. Stealthing is another type of gift giving in which an HIV-positive man actively tries to infect an HIV-negative man with HIV, without the latter's knowledge or consent. The present study reports on the prevalence of gift giving (4.6%) in a population of men who use the Internet specifically to identify partners for unprotected sex. The research is based on a national random sample of 332 men who have sex with men, identified from 16 websites. Data were collected via telephone interviews conducted between January 2008 and May 2009. The paper concludes with a discussion of the implications of these findings for HIV prevention and intervention efforts. Most notably, to the extent that generationing, stealthing, and gift giving occur among MSM, they represent a very high risk of HIV transmission. More work needs to be done to understand these behaviors, the factors that underlie them, and to determine how prevalent they are in the bare-backing population of MSM.

Generationing, Stealthing, and Gift Giving: The Intentional Transmission of HIV by HIV-Positive Men to their HIV-Negative Sex Partners

PubMed Central

Klein, Hugh

2014-01-01

Gift giving is the process by which an HIV-positive person purposely infects an HIV-negative person with HIV, usually with that person’s knowledge and consent. Little has been written about this HIV transmission practice. In this paper, two specific types of gift giving – generationing and stealthing – are explained and introduced to the scientific literature. Generationing is a type of gift giving in which one gift giver successfully infects a previously-uninfected man with HIV, and then the two men collaborate in an effort to seroconvert another man, and so forth. Stealthing is another type of gift giving in which an HIV-positive man actively tries to infect an HIV-negative man with HIV, without the latter’s knowledge or consent. The present study reports on the prevalence of gift giving (4.6%) in a population of men who use the Internet specifically to identify partners for unprotected sex. The research is based on a national random sample of 332 men who have sex with men, identified from 16 websites. Data were collected via telephone interviews conducted between January 2008 and May 2009. The paper concludes with a discussion of the implications of these findings for HIV prevention and intervention efforts. Most notably, to the extent that generationing, stealthing, and gift giving occur among MSM, they represent a very high risk of HIV transmission. More work needs to be done to understand these behaviors, the factors that underlie them, and to determine how prevalent they are in the bare-backing population of MSM. PMID:26973945

Analysis of Social and Genetic Factors Influencing Heterosexual Transmission of HIV within Serodiscordant Couples in the Henan Cohort

PubMed Central

Zhang, Yilei; Li, Jie; Ma, Xuejun; Li, Ning; Wang, Qi; Xue, Xiujuan; Luo, Le; Li, Zizhao; Ring, Huijun Z.; Ring, Brian Z.; Su, Li

2015-01-01

There is considerable variability between individuals in susceptibility to infection by human immunodeficiency virus (HIV). Many social, clinical and genetic factors are known to contribute to the likelihood of HIV transmission, but there is little consensus on the relative importance and potential interaction of these factors. Additionally, recent studies of several variants in chemokine receptors have identified alleles that may be predictive of HIV transmission and disease progression; however the strengths and directions of the associations of these genetic markers with HIV transmission have markedly varied between studies. To better identify factors that predict HIV transmission in a Chinese population, 180 cohabiting serodiscordant couples were enrolled for study by the Henan Center for Disease Prevention and Control, and transmission and progression of HIV infection were regularly measured. We found that anti-retroviral therapy, education level, and condom use were the most significant factors in determining likelihood of HIV transmission in this study. We also assessed ten variants in three genes (CXCL12, CCR2, and CCR5) that have been shown to influence HIV transmission. We found two tightly linked variants in CCR2 and CCR5, rs1799864 and rs1800024, have a significant positive association with transmission as recessive models (OR>10, P value=0.011). Mixed effects models showed that these genetic variants both retained significance when assessed with either treatment or condom use. These markers of transmission susceptibility may therefore serve to help stratify individuals by risk for HIV transmission. PMID:26068906

Recent trauma is associated with antiretroviral failure and HIV transmission risk behavior among HIV-positive women and female-identified transgenders.

PubMed

Machtinger, E L; Haberer, J E; Wilson, T C; Weiss, D S

2012-11-01

Trauma and posttraumatic stress disorder disproportionally affect HIV-positive women. Studies increasingly demonstrate that both conditions may predict poor HIV-related health outcomes and transmission-risk behaviors. This study analyzed data from a prevention-with-positives program to understand if socio-economic, behavioral, and health-related factors are associated with antiretroviral failure and HIV transmission-risk behaviors among 113 HIV-positive biological and transgender women. An affirmative answer to a simple screening question for recent trauma was significantly associated with both outcomes. Compared to participants without recent trauma, participants reporting recent trauma had over four-times the odds of antiretroviral failure (AOR 4.3; 95% CI 1.1-16.6; p = 0.04), and over three-times the odds of reporting sex with an HIV-negative or unknown serostatus partner (AOR 3.9; 95% CI 1.3-11.9; p = 0.02) and <100% condom use with these partners (AOR 4.5; 95% CI 1.5-13.3; p = 0.007). Screening for recent trauma in HIV-positive biological and transgender women identifies patients at high risk for poor health outcomes and HIV transmission-risk behavior.

Maintenance of an Intact Human Immunodeficiency Virus Type 1 vpr Gene following Mother-to-Infant Transmission

PubMed Central

Yedavalli, Venkat R. K.; Chappey, Colombe; Ahmad, Nafees

1998-01-01

The vpr sequences from six human immunodeficiency virus type 1 (HIV-1)-infected mother-infant pairs following perinatal transmission were analyzed. We found that 153 of the 166 clones analyzed from uncultured peripheral blood mononuclear cell DNA samples showed a 92.17% frequency of intact vpr open reading frames. There was a low degree of heterogeneity of vpr genes within mothers, within infants, and between epidemiologically linked mother-infant pairs. The distances between vpr sequences were greater in epidemiologically unlinked individuals than in epidemiologically linked mother-infant pairs. Moreover, the infants’ sequences displayed patterns similar to those seen in their mothers. The functional domains essential for Vpr activity, including virion incorporation, nuclear import, and cell cycle arrest and differentiation were highly conserved in most of the sequences. Phylogenetic analyses of 166 mother-infant pairs and 195 other available vpr sequences from HIV databases formed distinct clusters for each mother-infant pair and for other vpr sequences and grouped the six mother-infant pairs’ sequences with subtype B sequences. A high degree of conservation of intact and functional vpr supports the notion that vpr plays an important role in HIV-1 infection and replication in mother-infant isolates that are involved in perinatal transmission. PMID:9658150

Vaginal Microbiota and Sexually Transmitted Infections That May Influence Transmission of Cell-Associated HIV

PubMed Central

Cone, Richard A.

2014-01-01

Vaginal microbiota and sexually transmitted infections (STIs) are likely to influence the transmission of cell-associated human immunodeficiency virus (HIV). Lactic acid produced by Lactobacillus-dominated microbiota (Nugent score 0–3) will likely inhibit transmission, especially female-to-male transmission. In contrast, polymicrobial microbiota (Nugent score 4–10), community state types IV-A and IV-B, and STIs will likely increase transmission of cell-associated HIV. PMID:25414415

A five-year review of vertical HIV transmission in a specialized service: cross-sectional study.

PubMed

Hoffmann, Izabel Cristina; Santos, Wendel Mombaque Dos; Padoin, Stela Maris de Mello; Barros, Sonia Maria Oliveira de

2016-01-01

Healthcare professionals need to instill the process of prevention, control and treatment of people infected with HIV into care practice. Through maintaining preventive treatment among HIV-infected pregnant women, it has been demonstrated that prophylactic antiretroviral therapy, scheduled cesarean section and the prohibition of breastfeeding significantly reduce vertical HIV transmission. This study aimed to assess the rates of vertical HIV transmission in a specialized service and identify the factors associated with it. Cross-sectional study developed at the University Hospital of Santa Maria (RS), Brazil. A cross-sectional study was conducted on a sample of 198 notification forms and medical records of HIV-positive pregnant women and exposed children. The vertical transmission rate was 2.4%, and three children had been infected by vertical HIV transmission. The statistically significant risk factor was the use of injectable drugs. Delayed reporting of pregnancy, absence of antiretroviral therapy during pregnancy, lack of proper prenatal care, incapacity to perform viral load detection tests and CD4+ T cell counts and obstetric and maternal clinical complications were reported. The vertical transmission rate was high and the recommended intervention measures were not adopted in full. Adequate prophylactic measures need to be implemented in HIV-positive pregnant women prenatally and during the antenatal, delivery and postpartum periods.

Vitamin A supplements for reducing mother-to-child HIV transmission

PubMed Central

Wiysonge, Charles S; Ndze, Valantine N; Kongnyuy, Eugene J; Shey, Muki S

2017-01-01

Background Strategies to reduce the risk of mother-to-child transmission of the human immunodeficiency virus (HIV) include lifelong antiretroviral therapy (ART) for HIV-positive women, exclusive breastfeeding from birth for six weeks plus nevirapine or replacement feeding plus nevirapine from birth for four to six weeks, elective Caesarean section delivery, and avoiding giving children chewed food. In some settings, these interventions may not be practical, feasible, or affordable. Simple, inexpensive, and effective interventions (that could potentially be implemented even in the absence of prenatal HIV testing programmes) would be valuable. Vitamin A, which plays a role in immune function, is one low-cost intervention that has been suggested in such settings. Objectives To summarize the effects of giving vitamin A supplements to HIV-positive women during pregnancy and after delivery. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) up to 25 August 2017, and checked the reference lists of relevant articles for eligible studies. Selection criteria We included randomized controlled trials conducted in any setting that compared vitamin A supplements to placebo or no intervention among HIV-positive women during pregnancy or after delivery, or both. Data collection and analysis At least two review authors independently assessed study eligibility and extracted data. We expressed study results as risk ratios (RR) or mean differences (MD) as appropriate, with their 95% confidence intervals (CI), and conducted random-effects meta-analyses. This is an update of a review last published in 2011. Main results Five trials met the inclusion criteria. These were conducted in Malawi, South Africa, Tanzania, and Zimbabwe between 1995 and 2005 and none of the participants received ART. Women allocated to intervention arms received

Grappling with HIV Transmission Risks: Narratives of Rural Women in Eastern Kenya Living with HIV

PubMed Central

Kako, Peninnah M.; Stevens, Patricia E.; Karani, Anna K; Mkandawire-Valhmu, Lucy; Banda, Anne

2011-01-01

As people live longer and more productively with HIV infection, issues of agency in reducing HIV risk are particularly important for HIV-infected women living in high prevalence, under-resourced countries such as Kenya. Because of their gendered lives, in that being masculine is associated with dominance, while being feminine is associated with passiveness, women in rural Kenya must cope with continued HIV transmission risk even after knowing they are infected with HIV. In this narrative interview study, informed by theories of gender and post-colonial feminism, we examined personal accounts of HIV risk and risk reduction of 20 rural women in eastern Kenya who were living with HIV. From our analysis of the women's narratives, two major themes emerged: gender-based obstacles even in the context of a known HIV diagnosis, and struggles with economic pressures amid HIV risks. Implications for policy, programs, and research are discussed. PMID:22137546

Transmission of HIV in sexual networks in sub-Saharan Africa and Europe

NASA Astrophysics Data System (ADS)

van de Vijver, David A. M. C.; Prosperi, Mattia C. F.; Ramasco, José J.

2013-09-01

We are reviewing the literature regarding sexual networks and HIV transmission in sub-Saharan Africa and Europe. On Likoma Island in Malawi, a sexual network was reconstructed using a sociometric survey in which individuals named their sexual partners. The sexual network identified one giant component including half of all sexually active individuals. More than 25% of respondents were linked through independent chains of sexual relations. HIV was more common in the sparser regions of the network due to over-representation of groups with higher HIV prevalence. A study from KwaZulu-Natal in South-Africa collected egocentric data about sexual partners and found that new infections in women in a particular area was associated with the number of life-time partners in men. Data about sexual networks and HIV transmission are not reported in Europe. It is, however, found that the annual number of sexual partners follows a scale-free network. Phylogenetic studies that determine genetic relatedness between HIV isolates obtained from infected individuals, found that patients in the early stages of infections explain a high number of new infections. In conclusion, the limited information that is available suggest that sexual networks play a role in spread of HIV. Obtaining more information about sexual networks can be of benefit for modeling studies on HIV transmission and prevention.

Behavioural strategies to reduce HIV transmission: how to make them work better

PubMed Central

Coates, Thomas J; Richter, Linda; Caceres, Carlos

2009-01-01

This paper makes five key points. First is that the aggregate effect of radical and sustained behavioural changes in a sufficient number of individuals potentially at risk is needed for successful reductions in HIV transmission. Second, combination prevention is essential since HIV prevention is neither simple nor simplistic. Reductions in HIV transmission need widespread and sustained efforts, and a mix of communication channels to disseminate messages to motivate people to engage in a range of options to reduce risk. Third, prevention programmes can do better. The effect of behavioural strategies could be increased by aiming for many goals (eg, delay in onset of first intercourse, reduction in number of sexual partners, increases in condom use, etc) that are achieved by use of multilevel approaches (eg, couples, families, social and sexual networks, institutions, and entire communities) with populations both uninfected and infected with HIV. Fourth, prevention science can do better. Interventions derived from behavioural science have a role in overall HIV-prevention efforts, but they are insufficient when used by themselves to produce substantial and lasting reductions in HIV transmission between individuals or in entire communities. Fifth, we need to get the simple things right. The fundamentals of HIV prevention need to be agreed upon, funded, implemented, measured, and achieved. That, presently, is not the case. PMID:18687459

"I don't feel shy because I will be among others who are just like me…": The role of support groups for children perinatally infected with HIV in Zimbabwe.

PubMed

Mupambireyi, Zivai; Bernays, Sarah; Bwakura-Dangarembizi, Mutsa; Cowan, Frances M

2014-10-01

As access to paediatric antiretroviral therapy (ART) continues to improve in sub-Saharan Africa, a new historically specific cohort of HIV-perinatally infected children surviving into adolescent has emerged. Although remarkable successes have been made clinically in keeping this cohort alive and in reasonable health, their social support experiences are still unknown. The research being reported here sought to explore peer social support experiences of HIV-perinatally infected children in Harare, Zimbabwe. In this article, we draw on 56 repeat in-depth interviews (IDIs) conducted in three phases and two focus group discussions (FGDs) with HIV-infected children (11-13 years). Additional interviews were held with 10 carers. Study findings suggested that both children and carers perceive support groups as a safe social space for learning and acquiring HIV information as well as gaining confidence. Additionally, findings highlighted the importance of consistency of participation. Structural and personal barriers to access and participation in support group were also identified. We conclude that support groups are a useful resource for HIV-infected children and therefore should be supported by stable funding.

Estimating mother-to-child HIV transmission rates in Cameroon in 2011: a computer simulation approach.

PubMed

Nguefack, Hermine L Nguena; Gwet, Henri; Desmonde, Sophie; Oukem-Boyer, Odile Ouwe Missi; Nkenfou, Céline; Téjiokem, Mathurin; Tchendjou, Patrice; Domkam, Irénée; Leroy, Valériane; Alioum, Ahmadou

2016-01-12

Despite the progress in the Prevention of the Mother-to-Child Transmission of HIV (PMTCT), the paediatric HIV epidemic remains worrying in Cameroon. HIV prevalence rate for the population of pregnant women was 7.6% in 2010 in Cameroon. The extent of the paediatric HIV epidemic is needed to inform policymakers. We developed a stochastic simulation model to estimate the number of new paediatric HIV infections through MTCT based on the observed uptake of services during the different steps of the PMTCT cascade in Cameroon in 2011. Different levels of PMTCT uptake was also assessed. A discrete events computer simulation-based approach with stochastic structure was proposed to generate a cohort of pregnant women followed-up until 6 weeks post-partum, and optionally until complete breastfeeding cessation in both prevalent and incident lactating HIV-infected women. The different parameters of the simulation model were fixed using data sources available from the 2011 national registry surveys, and from external cohorts in Cameroon. Different PMTCT coverages were simulated to assess their impact on MTCT. Available data show a low coverage of PMTCT services in Cameroon in 2011. Based on a simulation approach on a population of 995, 533 pregnant women, the overall residual MTCT rate in 2011 was estimated to be 22.1% (95 % CI: 18.6%-25.2%), the 6-week perinatal MTCT rate among prevalent HIV-infected mothers at delivery is estimated at 12.1% (95% CI: 8.1%-15.1%), with an additional postnatal MTCT rate estimated at 13.3% (95% CI: 9.3%-17.8%). The MTCT rate among children whose mothers seroconverted during breastfeeding was estimated at 20.8% (95% CI: 14.1%-26.9%). Overall, we estimated the number of new HIV infections in children in Cameroon to be 10, 403 (95% CI: 9, 054-13, 345) in 2011. When PMTCT uptake have been fixed at 100%, 90% and 80%, global MTCT rate failed to 0.9% (9% CI: 0.5%-1.7%), 2.0% (95% CI: 0.9%-3.2%) and 4.3% (95% CI: 2.4%-6.7%) respectively. This model is

Differing psychological vulnerabilities among behaviourally and perinatally HIV infected adolescents in South Africa - implications for targeted health service provision.

PubMed

Sherr, L; Cluver, L D; Toska, E; He, E

2018-05-30

HIV infections are growing the fastest amongst adolescents, especially in sub Saharan Africa. On reaching adolescence, perinatally-infected youth may have different needs to those who acquired infection behaviourally. Yet both have sub-optimal adherence with implications for their own health as well as onward transmission. This study uses the world's largest community-based study of HIV-positive adolescents from the Eastern Cape, South Africa. Clinic records at N = 53 district health facilities generated a log of all ART-initiated adolescents who were then interviewed in the community: N = 1058 (90%) were tracked and participated. Ethical approval, informed consent and data collector training preceded data gathering. Inventories comprised validated measures of mental health (depression, anxiety, suicidality and internalised stigma), substance use, ART adherence, and clinic attendance. Analyses were conducted using SPSS25 and STATA15. Perinatally-infected adolescents (n = 792, 77.3%) were significantly more likely to be ART adherent (OR = 1.54 95%CI: 1.14-2.07 p = 0.005), retained in healthcare (OR = 1.59 95%CI1.18-2.14 p = 0.002), and treated well by clinic staff (OR = 2.12 95%CI1.59-3.07 p ≤ 0.001). Behaviourally-infected adolescents were more likely to be depressed (B = 0.81 p ≤ 0.001), anxious (B = 1.36 p ≤ 0.001), report internalised stigma (B = 0.91 p ≤ 0.001), express suicidal ideation (OR = 3.65 95%CI: 1.96-6.82 p ≤ 0.001) and report excessive substance use in the past year (OR = 9.37 95%CI5.73-15.35 p ≤ 0.001). Being older explained most of these differences, with female adolescents living with HIV more likely to report suicidal ideation. However, behaviourally-infected adolescents were more likely to report substance use (OR = 2.69 95%CI: 1.48-4.91 p = 0.001), depression (B = 0.406, p = 0.022), anxiety (B = 1.359, p ≤ 0.001), and internalised

The Relationship between Substance Use and HIV Transmission in Peru

PubMed Central

Massa, Alfredo A.; Rosen, Marc I.

2014-01-01

Objectives The primary aim of this article is to review literature regarding the relationship between substance use and HIV transmission in Peru. Methods Detailed search of published literature completed in PubMed and Google-Scholar and other local Peruvian publications. Mesh words: “Peru”; “substance-related-disorders”; “HIV”; “sexual-behavior” and their combinations. From 3921 articles, 150 were chosen for more careful review and only 26 were used for the review. No date limit was used in this review. Results Peruvian HIV epidemic is limited to MSM and its prevalence goes up to 33% in certain MSM-subpopulations. Transmission is mainly through sexual contact. Drug use doubled the risk for casual sex, decreased by half the chances of using condoms, increased the number of partners per year and the risk for STD’s. Peruvian HIV-positive populations have higher rates drug use and using drugs have been associated with a higher prevalence of being HIV-positive. This may be also true for other populations such as pregnant women in which there is an association between drug use and HIV. Conclusions Although the amount of Peruvian research in this area limits the review, there seems to be a relationship between using drugs, having risky-sexual-behaviors and being HIV positive in Peru. HIV-prevention strategies for Peruvians must address the link between sex and substance use. PMID:25264494

HIV-1 transmission between MSM and heterosexuals, and increasing proportions of circulating recombinant forms in the Nordic Countries.

PubMed

Esbjörnsson, Joakim; Mild, Mattias; Audelin, Anne; Fonager, Jannik; Skar, Helena; Bruun Jørgensen, Louise; Liitsola, Kirsi; Björkman, Per; Bratt, Göran; Gisslén, Magnus; Sönnerborg, Anders; Nielsen, Claus; Medstrand, Patrik; Albert, Jan

2016-01-01

Increased knowledge about HIV-1 transmission dynamics in different transmission groups and geographical regions is fundamental for assessing and designing prevention efforts against HIV-1 spread. Since the first reported cases of HIV infection during the early 1980s, the HIV-1 epidemic in the Nordic countries has been dominated by HIV-1 subtype B and MSM transmission. HIV-1 pol sequences and clinical data of 51 per cent of all newly diagnosed HIV-1 infections in Sweden, Denmark, and Finland in the period 2000-2012 ( N  = 3,802) were analysed together with a large reference sequence dataset ( N  = 4,537) by trend analysis and phylogenetics. Analysis of the eight dominating subtypes and CRFs in the Nordic countries (A, B, C, D, G, CRF01_AE, CRF02_AG, and CRF06_cpx) showed that the subtype B proportion decreased while the CRF proportion increased over the study period. A majority (57 per cent) of the Nordic sequences formed transmission clusters, with evidence of mixing both geographically and between transmission groups. Detailed analyses showed multiple occasions of transmissions from MSM to heterosexuals and that active transmission clusters more often involved single than multiple Nordic countries. The strongest geographical link was between Denmark and Sweden. Finally, Denmark had a larger proportion of heterosexual domestic spread of HIV-1 subtype B (75 per cent) compared with Sweden (49 per cent) and Finland (57 per cent). We describe different HIV-1 transmission patterns between countries and transmission groups in a large geographical region. Our results may have implications for public health interventions in targeting HIV-1 transmission networks and identifying where to introduce such interventions.

HIV-1 transmission between MSM and heterosexuals, and increasing proportions of circulating recombinant forms in the Nordic Countries

PubMed Central

Esbjörnsson, Joakim; Mild, Mattias; Audelin, Anne; Fonager, Jannik; Skar, Helena; Bruun Jørgensen, Louise; Liitsola, Kirsi; Björkman, Per; Bratt, Göran; Gisslén, Magnus; Sönnerborg, Anders; Nielsen, Claus; Medstrand, Patrik; Albert, Jan

2016-01-01

Increased knowledge about HIV-1 transmission dynamics in different transmission groups and geographical regions is fundamental for assessing and designing prevention efforts against HIV-1 spread. Since the first reported cases of HIV infection during the early 1980s, the HIV-1 epidemic in the Nordic countries has been dominated by HIV-1 subtype B and MSM transmission. HIV-1 pol sequences and clinical data of 51 per cent of all newly diagnosed HIV-1 infections in Sweden, Denmark, and Finland in the period 2000–2012 (N = 3,802) were analysed together with a large reference sequence dataset (N = 4,537) by trend analysis and phylogenetics. Analysis of the eight dominating subtypes and CRFs in the Nordic countries (A, B, C, D, G, CRF01_AE, CRF02_AG, and CRF06_cpx) showed that the subtype B proportion decreased while the CRF proportion increased over the study period. A majority (57 per cent) of the Nordic sequences formed transmission clusters, with evidence of mixing both geographically and between transmission groups. Detailed analyses showed multiple occasions of transmissions from MSM to heterosexuals and that active transmission clusters more often involved single than multiple Nordic countries. The strongest geographical link was between Denmark and Sweden. Finally, Denmark had a larger proportion of heterosexual domestic spread of HIV-1 subtype B (75 per cent) compared with Sweden (49 per cent) and Finland (57 per cent). We describe different HIV-1 transmission patterns between countries and transmission groups in a large geographical region. Our results may have implications for public health interventions in targeting HIV-1 transmission networks and identifying where to introduce such interventions. PMID:27774303

HIV Transmission Networks in the San Diego-Tijuana Border Region.

PubMed

Mehta, Sanjay R; Wertheim, Joel O; Brouwer, Kimberly C; Wagner, Karla D; Chaillon, Antoine; Strathdee, Steffanie; Patterson, Thomas L; Rangel, Maria G; Vargas, Mlenka; Murrell, Ben; Garfein, Richard; Little, Susan J; Smith, Davey M

2015-10-01

HIV sequence data can be used to reconstruct local transmission networks. Along international borders, like the San Diego-Tijuana region, understanding the dynamics of HIV transmission across reported risks, racial/ethnic groups, and geography can help direct effective prevention efforts on both sides of the border. We gathered sociodemographic, geographic, clinical, and viral sequence data from HIV infected individuals participating in ten studies in the San Diego-Tijuana border region. Phylogenetic and network analysis was performed to infer putative relationships between HIV sequences. Correlates of identified clusters were evaluated and spatiotemporal relationships were explored using Bayesian phylogeographic analysis. After quality filtering, 843 HIV sequences with associated demographic data and 263 background sequences from the region were analyzed, and 138 clusters were inferred (2-23 individuals). Overall, the rate of clustering did not differ by ethnicity, residence, or sex, but bisexuals were less likely to cluster than heterosexuals or men who have sex with men (p = 0.043), and individuals identifying as white (p ≤ 0.01) were more likely to cluster than other races. Clustering individuals were also 3.5 years younger than non-clustering individuals (p < 0.001). Although the sampled San Diego and Tijuana epidemics were phylogenetically compartmentalized, five clusters contained individuals residing on both sides of the border. This study sampled ~ 7% of HIV infected individuals in the border region, and although the sampled networks on each side of the border were largely separate, there was evidence of persistent bidirectional cross-border transmissions that linked risk groups, thus highlighting the importance of the border region as a "melting pot" of risk groups. NIH, VA, and Pendleton Foundation.

Gender inequality and HIV transmission: a global analysis.

PubMed

Richardson, Eugene T; Collins, Sean E; Kung, Tiffany; Jones, James H; Hoan Tram, Khai; Boggiano, Victoria L; Bekker, Linda-Gail; Zolopa, Andrew R

2014-01-01

The HIV pandemic disproportionately impacts young women. Worldwide, young women aged 15-24 are infected with HIV at rates twice that of young men, and young women alone account for nearly a quarter of all new HIV infections. The incommensurate HIV incidence in young - often poor - women underscores how social and economic inequalities shape the HIV epidemic. Confluent social forces, including political and gender violence, poverty, racism, and sexism impede equal access to therapies and effective care, but most of all constrain the agency of women. HIV prevalence data was compiled from the 2010 UNAIDS Global Report. Gender inequality was assessed using the 2011 United Nations Human Development Report Gender Inequality Index (GII). Logistic regression models were created with predominant mode of transmission (heterosexual vs. MSM/IDU) as the dependent variable and GII, Muslim vs. non-Muslim, Democracy Index, male circumcision rate, log gross national income (GNI) per capita at purchasing power parity (PPP), and region as independent variables. There is a significant correlation between having a predominantly heterosexual epidemic and high gender inequality across all models. There is not a significant association between whether a country is predominantly Muslim, has a high/low GNI at PPP, has a high/low circumcision rate, and its primary mode of transmission. In addition, there are only three countries that have had a generalized epidemic in the past but no longer have one: Cambodia, Honduras, and Eritrea. GII data are available only for Cambodia and Honduras, and these countries showed a 37 and 34% improvement, respectively, in their Gender Inequality Indices between 1995 and 2011. During the same period, both countries reduced their HIV prevalence below the 1% threshold of a generalized epidemic. This represents limited but compelling evidence that improvements in gender inequality can lead to the abatement of generalized epidemics. Gender inequality is an

U.S. HIV Incidence and Transmission Goals, 2020 and 2025.

PubMed

Bonacci, Robert A; Holtgrave, David R

2017-09-01

The recently updated U.S. National HIV/AIDS Strategy sets key HIV prevention and care targets for 2020, but the trajectory of the epidemic remains unclear. Authors modeled HIV incidence, prevalence, and mortality for the U.S. over 10 years to determine whether an ambitious trajectory toward "ending AIDS" by 2025 would be achievable. Authors utilized recently published 2010-2013 Centers for Disease Control and Prevention surveillance data to model HIV incidence, prevalence, and mortality. Authors applied a 90/90/90 framework (90% awareness of serostatus, 90% of diagnosed individuals in care, and 90% of individuals on antiretroviral therapy virally suppressed) by 2020 and 95/95/95 by 2025 to assess the feasibility of meeting epidemiologic targets. Analyses were conducted in 2016. With a goal of reducing infections to 21,000 new HIV infections in 2020, authors project a transmission rate of 1.74, 12,571 deaths, and a total of 1,205,515 people living with HIV. By 2025, with a target of 12,000 new HIV infections (a 69% decrease in HIV incidence), authors project a transmission rate of 0.98, 12,522 deaths, and a total of 1,220,615 people living with HIV. With a 90/90/90 framework by 2020 and a 95/95/95 framework by 2025, these epidemiologic targets would be feasible. Key programmatic milestones provide an ambitious, but important, pathway to reduce U.S. HIV incidence below 12,000 new infections by 2025. HIV incidence would decrease below mortality in 2025, marking a transition toward ending the HIV/AIDS epidemic. Such goals will require a sustained and intensified national commitment over the next decade. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Impact of Perinatally Acquired HIV Disease Upon Longitudinal Changes in Memory and Executive Functioning.

PubMed

Malee, Kathleen M; Chernoff, Miriam C; Sirois, Patricia A; Williams, Paige L; Garvie, Patricia A; Kammerer, Betsy L; Harris, Lynnette L; Nozyce, Molly L; Yildirim, Cenk; Nichols, Sharon L

2017-08-01

Little is known regarding effects of perinatally acquired HIV infection (PHIV) on longitudinal change in memory and executive functioning (EF) during adolescence despite the importance of these skills for independence in adulthood. PHIV (n = 144) and perinatally HIV-exposed uninfected youth (PHEU, n = 79), ages 12-17, completed standardized tests of memory and EF at baseline and 2 years later. Changes from baseline for each memory and EF outcome were compared between PHEU and PHIV youth with (PHIV/C, n = 39) and without (PHIV/non-C, n = 105) history of CDC class C (AIDS-defining) diagnoses. Among PHIV youth, associations of baseline and past disease severity with memory and EF performance at follow-up were evaluated using adjusted linear regression models. Participants were primarily black (79%); 16% were Hispanic; 55% were female. Mean memory and EF scores at follow-up generally fell in the low-average to average range. Pairwise comparison of adjusted mean change from baseline to follow-up revealed significantly greater change for PHIV/non-C compared with PHEU youth in only one verbal recognition task, with a difference in mean changes for PHIV/non-C versus PHEU of -0.99 (95% CI: -1.80 to -0.19; P = 0.02). Among youth with PHIV, better immunologic status at baseline was positively associated with follow-up measures of verbal recall and recognition and cognitive inhibition/flexibility. Past AIDS-defining diagnoses and higher peak viral load were associated with lower performance across multiple EF tasks at follow-up. Youth with PHIV demonstrated stable memory and EF during a 2-year period of adolescence, allowing cautious optimism regarding long-term outcomes.

Stigma Management Trajectories in Youth with Perinatally Acquired HIV and Their Families: A Qualitative Perspective.

PubMed

Proulx-Boucher, Karène; Fernet, Mylène; Blais, Martin; Lapointe, Normand; Samson, Johanne; Lévy, Joseph J; Otis, Joanne; Morin, Guylaine; Thériault, Jocelyne; Trottier, Germain

2017-09-01

This study explores how family, secrecy and silence contribute to the adoption of stigma management strategies among youth with perinatally acquired HIV (PAHIV). A qualitative method was used. Eighteen youths with PAHIV aged 13-22 years old took part in a semi-structured interview. An exploratory content analysis was performed. Analyses of interviews allowed identification of two HIV stigma management trajectories, both sensitive to the family context: [1] a consolidation of family ties, which contributes to solidarity in stigma management; and [2] a weakening or dissolution of family ties, which contributes to solitary stigma management strategy. Family conditions that support the children in their efforts to develop active stigma management strategies are described. Children likely to experience weakening or dissolution family ties must build strong bonds in the clinical environment and maintain these into adulthood so as to afford them the support they need.

Estimation of the rate of mother to child transmission of HIV in Nigeria.

PubMed

Audu, R A; Salu, O B; Musa, A Z; Onyewuche, J; Funso-Adebayo, E O; Iroha, E O; Ezeaka, V C; Adetifa, I M O; Okoeguale, B; Idigbe, E O

2006-06-01

Definitive diagnosis of HIV infection in infants < 18 months of age who were born to HIV-infected mothers is still posing some difficulty in Nigeria and other developing countries. Within this age definitive diagnosis can only be carried out by antigen based techniques which are indeed not available in these developing countries. This has resulted in the absence of authoritative data on the rate of mother-to-child transmission in these countries. Nigeria inclusive. The present pilot study was therefore carried out to generate some information on the rate of mother to child transmission in Nigeria using the PCR technique. Plasma samples were obtained from 68 children of both sexes less than 18 months of age and who were born to HIV infected mothers. The samples were collected from two pediatric departments. in Lagos and in Benin. The presence of HIV 1 RNA in each of the samples. was determined using the Amplicor Monitor V 1.5 technique (Roche Diagnostics). Data showed that HIV-1 RNA was detected in 15 of the 68 samples tested. This gave an HIV-1 RNA detection rate of 22%. Among women who had some intervention, the rate of transmission of infection was 11% while the rate among those without intervention was 30%. The 22% transmission rate recorded in this study is close to the range of 25 to 35% that has been reported in several developed and a few developing countries. A multicenter nationwide study will still be needed to determine the national mother to child transmission rate in Nigeria.

“That’s True Love:” Lived Experiences of Puerto Rican Perinatally HIV-Infected Youth within Their Families’ Context

PubMed Central

Silva-Suárez, Georgina; Bastida, Elena; Rabionet, Silvia E.; Beck-Sagué, Consuelo; Febo, Irma; Zorrilla, Carmen D.

2015-01-01

The burden of HIV affects not only HIV-infected patients but also their families and caregivers. It is also known that family support is crucial for people living with HIV. A qualitative study was conducted to explore the life experiences, within the family context, of perinatally HIV-infected (pHIV-I) youth in Puerto Rico. Twenty in-depth interviews were performed and audio-recorded. Within the family context, study participants experienced acceptance, love and support but also stigma and discrimination. They reported that family is an essential component in their lives and treatment. Losing one or both parents at a young age was considered more difficult than having HIV. Most participants who lost their parents lived with other family members. This was a challenging situation for both pHIV-I youth and their caregivers. Participants described their healthcare providers as part of their families and would like to keep in touch as they transition to adult care. Despite the challenges, participants expressed a desire to have children. Services targeted to this population should stress social support, incorporate family members into the medical process, provide special guidance and support while transitioning to adult care, and provide them with the latest information regarding HIV and reproductive options. PMID:26703639

Combining epidemiological and genetic networks signifies the importance of early treatment in HIV-1 transmission.

PubMed

Zarrabi, Narges; Prosperi, Mattia; Belleman, Robert G; Colafigli, Manuela; De Luca, Andrea; Sloot, Peter M A

2012-01-01

Inferring disease transmission networks is important in epidemiology in order to understand and prevent the spread of infectious diseases. Reconstruction of the infection transmission networks requires insight into viral genome data as well as social interactions. For the HIV-1 epidemic, current research either uses genetic information of patients' virus to infer the past infection events or uses statistics of sexual interactions to model the network structure of viral spreading. Methods for a reliable reconstruction of HIV-1 transmission dynamics, taking into account both molecular and societal data are still lacking. The aim of this study is to combine information from both genetic and epidemiological scales to characterize and analyse a transmission network of the HIV-1 epidemic in central Italy.We introduce a novel filter-reduction method to build a network of HIV infected patients based on their social and treatment information. The network is then combined with a genetic network, to infer a hypothetical infection transmission network. We apply this method to a cohort study of HIV-1 infected patients in central Italy and find that patients who are highly connected in the network have longer untreated infection periods. We also find that the network structures for homosexual males and heterosexual populations are heterogeneous, consisting of a majority of 'peripheral nodes' that have only a few sexual interactions and a minority of 'hub nodes' that have many sexual interactions. Inferring HIV-1 transmission networks using this novel combined approach reveals remarkable correlations between high out-degree individuals and longer untreated infection periods. These findings signify the importance of early treatment and support the potential benefit of wide population screening, management of early diagnoses and anticipated antiretroviral treatment to prevent viral transmission and spread. The approach presented here for reconstructing HIV-1 transmission networks

Elimination of mother-to-child transmission of HIV: lessons learned from success in Thailand.

PubMed

Thisyakorn, Usa

2017-05-01

In 1988, the generalised HIV/AIDS epidemic in Thailand began and in the same year the first HIV-exposed infant in Thailand was born at King Chulalongkorn Memorial Hospital, Bangkok. From the early to mid-1990s, an epidemic wave of HIV-infected women and infants occurred. Heterosexual HIV transmission, as described in the Asian Epidemic Model, was the major mode of spread in Thailand, causing an increasing number of HIV-infected pregnant women. The early and concerted multi-sectoral response of Thai society reduced the prevalence of HIV infection in pregnant women from 2% in the mid-1990s to 0.6% in 2015 and mother-to-child transmission of HIV (MTCT) from an estimated 20-40% to 1.9%. Thus, Thailand became the first Asian country to achieve the World Health Organization's (WHO) targets for the elimination of MTCT. In this narrative review, the key historic evolutions of the science and policy of prevention of mother-to-child transmission of HIV (PMTCT) in Thailand that addressed the four prongs of the recommended WHO PMTCT strategy are described, and the lessons learned are discussed.

Low birth weight in perinatally HIV-exposed uninfected infants: observations in urban settings in Cameroon.

PubMed

Sofeu, Casimir Ledoux; Warszawski, Josiane; Ateba Ndongo, Francis; Penda, Ida Calixte; Tetang Ndiang, Suzie; Guemkam, Georgette; Makwet, Nicaise; Owona, Félicité; Kfutwah, Anfumbom; Tchendjou, Patrice; Texier, Gaëtan; Tchuente, Maurice; Faye, Albert; Tejiokem, Mathurin Cyrille

2014-01-01

The consequences of maternal HIV infection for fetal growth are controversial. Here, we estimated the frequency of small for gestational age and gender (SGAG) among neonates born to HIV-infected or uninfected mothers and assessed the contribution, if any, of maternal HIV to the risk of SGAG. The data used were obtained from the ANRS-Pediacam cohort in Cameroon. Pairs of newborns, one to a HIV-infected mother and the other to an uninfected mother, were identified during the first week of life, and matched on gender and recruitment site from 2007-2010. SGAG was defined in line with international recommendations as a birth weight Z-score adjusted for gestational age at delivery and gender more than two standard deviations below the mean (-2SD). Considering the matched design, logistic regression modeling was adjusted on site and gender to explore the effect of perinatal HIV exposure on SGAG. Among the 4104 mother-infant pairs originally enrolled, no data on birth weight and/or gestational age were available for 108; also, 259 were twins and were excluded. Of the remaining 3737 mother-infant pairs, the frequency of SGAG was 5.3% (95%CI: 4.6-6.0), and was significantly higher among HIV-infected infants (22.4% vs. 6.3%; p<.001) and lower among HIV-unexposed uninfected infants (3.5% vs. 6.3%; p<.001) than among HIV-exposed uninfected infants. Similarly, SGAG was significantly more frequent among HIV-infected infants (aOR: 4.1; 2.0-8.1) and less frequent among HIV-unexposed uninfected infants (aOR: 0.5; 0.4-0.8) than among HIV-exposed uninfected infants. Primiparity (aOR: 1.9; 1.3-2.7) and the presence of any disease during pregnancy (aOR: 1.4; 1.0-2.0) were identified as other contributors to SGAG. Maternal HIV infection was independently associated with SGAG for HIV-exposed uninfected infants. This provides further evidence of the need for adapted monitoring of pregnancy in HIV-infected women, especially if they are symptomatic, to minimize additional risk factors for

Low Birth Weight in Perinatally HIV-Exposed Uninfected Infants: Observations in Urban Settings in Cameroon

PubMed Central

Sofeu, Casimir Ledoux; Warszawski, Josiane; Ateba Ndongo, Francis; Penda, Ida Calixte; Tetang Ndiang, Suzie; Guemkam, Georgette; Makwet, Nicaise; Owona, Félicité; Kfutwah, Anfumbom; Tchendjou, Patrice; Texier, Gaëtan; Tchuente, Maurice; Faye, Albert; Tejiokem, Mathurin Cyrille

2014-01-01

Background The consequences of maternal HIV infection for fetal growth are controversial. Here, we estimated the frequency of small for gestational age and gender (SGAG) among neonates born to HIV-infected or uninfected mothers and assessed the contribution, if any, of maternal HIV to the risk of SGAG. Methods The data used were obtained from the ANRS-Pediacam cohort in Cameroon. Pairs of newborns, one to a HIV-infected mother and the other to an uninfected mother, were identified during the first week of life, and matched on gender and recruitment site from 2007–2010. SGAG was defined in line with international recommendations as a birth weight Z-score adjusted for gestational age at delivery and gender more than two standard deviations below the mean (−2SD). Considering the matched design, logistic regression modeling was adjusted on site and gender to explore the effect of perinatal HIV exposure on SGAG. Results Among the 4104 mother-infant pairs originally enrolled, no data on birth weight and/or gestational age were available for 108; also, 259 were twins and were excluded. Of the remaining 3737 mother-infant pairs, the frequency of SGAG was 5.3% (95%CI: 4.6–6.0), and was significantly higher among HIV-infected infants (22.4% vs. 6.3%; p<.001) and lower among HIV-unexposed uninfected infants (3.5% vs. 6.3%; p<.001) than among HIV-exposed uninfected infants. Similarly, SGAG was significantly more frequent among HIV-infected infants (aOR: 4.1; 2.0–8.1) and less frequent among HIV-unexposed uninfected infants (aOR: 0.5; 0.4–0.8) than among HIV-exposed uninfected infants. Primiparity (aOR: 1.9; 1.3–2.7) and the presence of any disease during pregnancy (aOR: 1.4; 1.0–2.0) were identified as other contributors to SGAG. Conclusion Maternal HIV infection was independently associated with SGAG for HIV-exposed uninfected infants. This provides further evidence of the need for adapted monitoring of pregnancy in HIV-infected women, especially if they are

Panel: challenging criminal charges for HIV transmission and exposure.

PubMed

Edwardh, Marlys; Adam, Barry; Joncas, Lucie; Clayton, Michaela

2009-12-01

Justice Edwin Cameron, of the Constitutional Court of South Africa, served as moderator. He said that this topic was particularly relevant for "an African/Canadian setting" because African countries may use Canadian developments as justification for their efforts to address HIV transmission and exposure through criminal law. Justice Cameron said that Canada is internationally perceived as a human rights-respecting state and, thus, sets an example, particularly for African nations, on how to comply with human rights issues. He added that in this particular case, however, Canada was sending the wrong message. This article contains summaries of the four presentations made during this panel. Marlys Edwardh reviews how the Supreme Court of Canada in Cuerrier interpreted the concepts of "endangering life" and "fraud". Barry Adam discusses the notion of a "duty to disclose" and how this affects HIV prevention. Lucie Joncas examines how the Supreme Court defined "fraud" in Cuerrier and describes a case before the Quebec Court of Appeal which may turn on whether the use of a condom or having a low viral load is considered not to constitute a significant risk of transmission. Finally, Michaela Clayton describes the trend in Southern African countries to adopt laws criminalizing HIV transmission or exposure, and explains that criminalization endangers women's health and lives.

HIV-1 transmission and survival according to feeding options in infants born to HIV-infected women in Yaoundé, Cameroon.

PubMed

Njom Nlend, Anne Esther; Motaze, Annie Carole Nga; Sandie, Arsene; Fokam, Joseph

2018-02-19

Evidence of 24-months survival in the frame of prevention of mother-to-child transmission (PMTCT) cascade-care is scare from routine programs in sub-Saharan African (SSA) settings. Specifically, data on infant outcomes according to feeding options remain largely unknown by month-24, thus limiting its breath for public-health recommendations toward eliminating new pediatric HIV-1 infections and improving care. We sought to evaluate HIV-1 vertical transmission and infant survival rates according to feeding options. A retrospective cohort-study conducted in Yaounde from April 2008 through December 2013 among 1086 infants born to HIV-infected women and followed-up throughout the PMTCT cascade-care until 24-months. Infants with documented feeding option during their first 3 months of life (408 on Exclusive Breastfeeding [EBF], 663 Exclusive Replacement feeding [ERF], 15 mixed feeding [MF]) and known HIV-status were enrolled. HIV-1 vertical transmission, survival and feeding options were analyzed using Kaplan Meier Survival Estimate, Cox model and Schoenfeld residuals tests, at 5% statistical significance. Overall HIV-1 vertical transmission was 3.59% (39), and varied by feeding options: EBF (2.70%), ERF (3.77%), MF (20%), p = 0.002; without significance between EBF and ERF (p = 0.34). As expected, HIV-1 transmission also varied with PMTCT-interventions: 1.7% (10/566) from ART-group, 1.9% (8/411) from AZT-group, and 19.2% (21/109) from ARV-naïve group, p < 0.0001. Overall mortality was 2.58% (28), higher in HIV-infected (10.25%) vs. uninfected (2.29%) infants (p = 0.016); with a survival cumulative probability of 89.3% [79.9%-99.8%] vs. 96.4% [94.8%-97.9% respectively], p = 0.024. Mortality also varied by feeding option: ERF (2.41%), EBF (2.45%), MF (13.33%), p = 0.03; with a survival cumulative probability of 96% [94%-98%] in ERF, 96.4% [94.1%-98.8%] in EBF, and 86.67% [71.06%-100%] in MF, p = 0.04. Using Schoenfeld residuals test, only HIV

Absence of transmission from HIV-infected individuals with HAART to their heterosexual serodiscordant partners.

PubMed

Del Romero, Jorge; Río, Isabel; Castilla, Jesús; Baza, Begoña; Paredes, Vanessa; Vera, Mar; Rodríguez, Carmen

2015-12-01

Further studies are needed to evaluate the level of effectiveness and durability of HAART to reduce the risk of HIV sexual transmission in serodiscordant couples having unprotected sexual practices. A cross-sectional study was conducted with prospective cohort of heterosexual HIV serodiscordant couples where the only risk factor for HIV transmission to the uninfected partner (sexual partner) was the sexual relationship with the infected partner (index case). HIV prevalence in sexual partners at enrolment and seroconversions in follow-up were compared by antiretroviral treatment in the index partner, HIV plasma viral load in index cases and sexual risk exposures in sexual partners. In each visit, an evaluation of the risks for HIV transmission, preventive counselling and screening for genitourinary infections in the sexual partner was performed, as well as the determination of the immunological and virological situation and antiretroviral treatment in the index case. At enrolment no HIV infection was detected in 202 couples where the index case was taking HAART. HIV prevalence in sexual partners was 9.6% in 491 couples where the index case was not taking antiretroviral treatment (p<0.001). During follow-up there was no HIV seroconversion among 199 partners whose index case was taking HAART, accruing 7600 risky sexual exposures and 85 natural pregnancies. Among 359 couples whose index case was not under antiretroviral treatment, over 13,000 risky sexual exposures and 5 HIV seroconversions of sexual partners were recorded. The percentage of seroconversion among couples having risky sexual intercourse was 2.5 (95% confidence interval [CI]: 1.1-5.6) when the index case did not undergo antiretroviral treatment and zero (95% CI: 0-3.2) when the index case received HAART. The risk of sexual transmission of HIV from individuals with HAART to their heterosexual partners can become extremely low. Copyright © 2014. Published by Elsevier España, S.L.U.

HIV Transmission Networks in the San Diego–Tijuana Border Region

PubMed Central

Mehta, Sanjay R.; Wertheim, Joel O.; Brouwer, Kimberly C.; Wagner, Karla D.; Chaillon, Antoine; Strathdee, Steffanie; Patterson, Thomas L.; Rangel, Maria G.; Vargas, Mlenka; Murrell, Ben; Garfein, Richard; Little, Susan J.; Smith, Davey M.

2015-01-01

Background HIV sequence data can be used to reconstruct local transmission networks. Along international borders, like the San Diego–Tijuana region, understanding the dynamics of HIV transmission across reported risks, racial/ethnic groups, and geography can help direct effective prevention efforts on both sides of the border. Methods We gathered sociodemographic, geographic, clinical, and viral sequence data from HIV infected individuals participating in ten studies in the San Diego–Tijuana border region. Phylogenetic and network analysis was performed to infer putative relationships between HIV sequences. Correlates of identified clusters were evaluated and spatiotemporal relationships were explored using Bayesian phylogeographic analysis. Findings After quality filtering, 843 HIV sequences with associated demographic data and 263 background sequences from the region were analyzed, and 138 clusters were inferred (2–23 individuals). Overall, the rate of clustering did not differ by ethnicity, residence, or sex, but bisexuals were less likely to cluster than heterosexuals or men who have sex with men (p = 0.043), and individuals identifying as white (p ≤ 0.01) were more likely to cluster than other races. Clustering individuals were also 3.5 years younger than non-clustering individuals (p < 0.001). Although the sampled San Diego and Tijuana epidemics were phylogenetically compartmentalized, five clusters contained individuals residing on both sides of the border. Interpretation This study sampled ~ 7% of HIV infected individuals in the border region, and although the sampled networks on each side of the border were largely separate, there was evidence of persistent bidirectional cross-border transmissions that linked risk groups, thus highlighting the importance of the border region as a “melting pot” of risk groups. Funding NIH, VA, and Pendleton Foundation. PMID:26629540

Is there a relationship between students' knowledge of HIV/AIDS ways of transmission and their responses regarding their proximity to people living with HIV/AIDS?

PubMed

Santos, Vanessa Prado; Coelho, Maria Thereza Ávila Dantas; Macário, Estéfani Lima; Oliveira, Tâmara Cerqueira da Silva

2017-08-01

This paper aims to identify college students' knowledge of HIV ways of transmission and correlate it with their answers concerning the proximity to people living with HIV/AIDS. We applied a questionnaire from the Brazilian Ministry of Health to 591 health undergraduate students. We analyzed the 10 questions about the virus ways of transmission, evaluating the number of correct answers and verifying the association between the number of correct answers and questions related to the proximity to people living with HIV/AIDS. Most students (96%) answered correctly 7 to 10 questions related to HIV ways of transmission (Group A) and 4% answered correctly 3 to 6 questions (Group B). Correlating these two subgroups and the answers about the non-acceptance of proximity to people living with HIV/AIDS, we found significant association between Group B and the agreement that the employer should fire an employee living with HIV and the statement that they would feel uncomfortable if a child living with HIV/AIDS studied at the same school as their own children. Negative opinions concerning the proximity to people living with HIV/AIDS were less prevalent, but were correlated to the lower knowledge of HIV ways of transmission.

Taxonomy of Caribbean tourism alcohol venues: implications for HIV transmission.

PubMed

Guilamo-Ramos, Vincent; Jaccard, James; McCarthy, Katharine; Quiñones, Zahira; Lushin, Viktor; Skinner-Day, Molly; Padilla, Mark; Meisterlin, Leah

2013-09-01

Tourism areas represent ecologies of heightened HIV vulnerability characterized by a disproportionate concentration of alcohol venues. Limited research has explored how alcohol venues facilitate HIV transmission. We spatially mapped locations of alcohol venues in a Dominican tourism town and conducted a venue-based survey of key informants (n=135) focused on three facets of alcohol venues: structural features, type of patrons, and HIV risk behaviors. Using latent class analysis, we identified evidence-based typologies of alcohol venues for each of the three facets. Focused contrasts identified the co-occurrence of classes of structural features, classes of types of patrons, and classes of HIV risk behavior, thus elaborating the nature of high risk venues. We identified three categories of venue structural features, three for venue patrons, and five for HIV risk behaviors. Analysis revealed that alcohol venues with the greatest structural risks (e.g. sex work on-site with lack of HIV prevention services) were most likely frequented by the venue patron category characterized by high population-mixing between locals and foreign tourists, who were in turn most likely to engage in the riskiest behaviors. Our results highlight the stratification of venue patrons into groups who engage in behaviors of varying risk in structural settings that vary in risk. The convergence of high-risk patron groups in alcohol venues with the greatest structural risk suggests these locations have potential for HIV transmission. Policymakers and prevention scientists can use these methods and data to target HIV prevention resources to identified priority areas. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Taxonomy of Caribbean Tourism Alcohol Venues: Implications for HIV Transmission*

PubMed Central

GUILAMO-RAMOS, Vincent; JACCARD, James; MCCARTHY, Katharine; QUIÑONES, Zahira; LUSHIN, Viktor; SKINNER-DAY, Molly; PADILLA, Mark; MEISTERLIN, Leah

2013-01-01

Background Tourism areas represent ecologies of heightened HIV vulnerability characterized by a disproportionate concentration of alcohol venues. Limited research has explored how alcohol venues facilitate HIV transmission. Methods We spatially mapped locations of alcohol venues in a Dominican tourism town and conducted a venue-based survey of key informants (n=135) focused on three facets of alcohol venues: structural features, type of patrons, and HIV risk behaviors. Using latent class analysis, we identified evidence-based typologies of alcohol venues for each of the three facets. Focused contrasts identified the co-occurrence of classes of structural features, classes of types of patrons, and classes of HIV risk behavior, thus elaborating the nature of high risk venues. Results We identified three categories of venue structural features, three for venue patrons, and five for HIV risk behaviors. Analysis revealed that alcohol venues with the greatest structural risks (e.g., sex work on site with lack of HIV prevention services) were most likely frequented by the venue patron category characterized by high population-mixing between locals and foreign tourists, who were in turn most likely to engage in the riskiest behaviors. Conclusion Our results highlight the stratification of venue patrons into groups who engage in behaviors of varying risk in structural settings that vary in risk. The convergence of high-risk patron groups in alcohol venues with the greatest structural risk suggests these locations have potential for HIV transmission. Policymakers and prevention scientists can use these methods and data to target HIV prevention resources to identified priority areas. PMID:23478154

Creating an African HIV Clinical Research and Prevention Trials Network: HIV Prevalence, Incidence and Transmission

PubMed Central

Kamali, Anatoli; Price, Matt A.; Lakhi, Shabir; Karita, Etienne; Inambao, Mubiana; Sanders, Eduard J.; Anzala, Omu; Latka, Mary H.; Bekker, Linda-Gail; Kaleebu, Pontiano; Asiki, Gershim; Ssetaala, Ali; Ruzagira, Eugene; Allen, Susan; Farmer, Paul; Hunter, Eric; Mutua, Gaudensia; Makkan, Heeran; Tichacek, Amanda; Brill, Ilene K.; Fast, Pat; Stevens, Gwynn; Chetty, Paramesh; Amornkul, Pauli N.; Gilmour, Jill

2015-01-01

HIV epidemiology informs prevention trial design and program planning. Nine clinical research centers (CRC) in sub-Saharan Africa conducted HIV observational epidemiology studies in populations at risk for HIV infection as part of an HIV prevention and vaccine trial network. Annual HIV incidence ranged from below 2% to above 10% and varied by CRC and risk group, with rates above 5% observed in Zambian men in an HIV-discordant relationship, Ugandan men from Lake Victoria fishing communities, men who have sex with men, and several cohorts of women. HIV incidence tended to fall after the first three months in the study and over calendar time. Among suspected transmission pairs, 28% of HIV infections were not from the reported partner. Volunteers with high incidence were successfully identified and enrolled into large scale cohort studies. Over a quarter of new cases in couples acquired infection from persons other than the suspected transmitting partner. PMID:25602351

Mathematical modeling of transmission co-infection tuberculosis in HIV community

NASA Astrophysics Data System (ADS)

Lusiana, V.; Putra, P. S.; Nuraini, N.; Soewono, E.

2017-03-01

TB and HIV infection have the effect of deeply on assault the immune system, since they can afford to weaken host immune respone through a mechanism that has not been fully understood. HIV co-infection is the stongest risk factor for progression of M. tuberculosis to active TB disease in HIV individuals, as well as TB has been accelerated to progression HIV infection. In this paper we create a model of transmission co-infection TB in HIV community, dynamic system with ten compartments built in here. Dynamic analysis in this paper mentioned ranging from disease free equilibrium conditions, endemic equilibrium conditions, basic reproduction ratio, stability analysis and numerical simulation. Basic reproductive ratio were obtained from spectral radius the next generation matrix of the model. Numerical simulations are built to justify the results of the analysis and to see the changes in the dynamics of the population in each compartment. The sensitivity analysis indicates that the parameters affecting the population dynamics of TB in people with HIV infection is parameters rate of progression of individuals from the exposed TB class to the active TB, treatment rate of exposed TB individuals, treatment rate of infectious (active TB) individuals and probability of transmission of TB infection from an infective to a susceptible per contact per unit time. We can conclude that growing number of infections carried by infectious TB in people with HIV infection can lead to increased spread of disease or increase in endemic conditions.

Vaginal microbiota and its role in HIV transmission and infection.

PubMed

Petrova, Mariya I; van den Broek, Marianne; Balzarini, Jan; Vanderleyden, Jos; Lebeer, Sarah

2013-09-01

The urogenital tract appears to be the only niche of the human body that shows clear differences in microbiota between men and women. The female reproductive tract has special features in terms of immunological organization, an epithelial barrier, microbiota, and influence by sex hormones such as estrogen. While the upper genital tract is regarded as free of microorganisms, the vagina is colonized by bacteria dominated by Lactobacillus species, although their numbers vary considerably during life. Bacterial vaginosis is a common pathology characterized by dysbiosis, which increases the susceptibility for HIV infection and transmission. On the other hand, HIV infections are often characterized by a disturbed vaginal microbiota. The endogenous vaginal microbiota may protect against HIV by direct production of antiviral compounds, through blocking of adhesion and transmission by ligands such as lectins, and/or by stimulation of immune responses. The potential role of probiotics in the prevention of HIV infections and associated symptoms, by introducing them to the vaginal and gastrointestinal tract (GIT), is also discussed. Of note, the GIT is a site of considerable HIV replication and CD4(+) T-cell destruction, resulting in both local and systemic inflammation. Finally, genetically engineered lactobacilli show promise as new microbicidal agents against HIV. © 2013 Federation of European Microbiological Societies. Published by John Wiley & Sons Ltd. All rights reserved.

A systematic review of risk of HIV transmission through biting or spitting: implications for policy.

PubMed

Cresswell, F V; Ellis, J; Hartley, J; Sabin, C A; Orkin, C; Churchill, D R

2018-04-23

The perceived threat of HIV transmission through spitting and biting is evidenced by the increasing use of "spit hoods" by Police Forces in the UK. In addition, a draft parliamentary bill has called for increased penalties for assaults on emergency workers, citing the risk of communicable disease transmission as one justification. We aimed to review literature relating to the risk of HIV transmission through biting or spitting. A systematic literature search was conducted using Medline, Embase and Northern Lights databases and conference websites using search terms relating to HIV, AIDS, bite, spit and saliva. Inclusion and exclusion criteria were applied to identified citations. We classified plausibility of HIV transmission as low, medium, high or confirmed based on pre-specified criteria. A total of 742 abstracts were reviewed, yielding 32 articles for full-text review and 13 case reports/series after inclusion and exclusion criteria had been applied. There were no reported cases of HIV transmission related to spitting and nine cases identified following a bite, in which the majority occurred between family (six of nine), in fights involving serious wounds (three of nine), or to untrained first-aiders placing fingers in the mouth of someone having a seizure (two of nine). Only four cases were classified as highly plausible or confirmed transmission. None related to emergency workers and none were in the UK. There is no risk of transmitting HIV through spitting, and the risk through biting is negligible. Post-exposure prophylaxis is not indicated after a bite in all but exceptional circumstances. Policies to protect emergency workers should be developed with this evidence in mind. © 2018 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.

The Breadth and Titer of Maternal HIV-1-Specific Heterologous Neutralizing Antibodies Are Not Associated with a Lower Rate of Mother-to-Child Transmission of HIV-1

PubMed Central

Chaillon, Antoine; Wack, Thierry; Braibant, Martine; Mandelbrot, Laurent; Blanche, Stéphane; Warszawski, Josiane

2012-01-01

It has been hypothesized that neutralizing antibodies (NAbs) should have broad specificity to be effective in protection against diverse HIV-1 variants. The mother-to-child transmission model of HIV-1 provides the opportunity to examine whether the breadth of maternal NAbs is associated with protection of infants from infection. Samples were obtained at delivery from 57 transmitting mothers (T) matched with 57 nontransmitting mothers (NT) enrolled in the multicenter French perinatal cohort (ANRS EPF CO1) between 1990 and 1996. Sixty-eight (59.6%) and 46 (40.4%) women were infected by B and non-B viruses, respectively. Neutralization assays were carried out with TZM-bl cells, using a panel of 10 primary isolates of 6 clades (A, B, C, F, CRF01_AE, and CRF02_AG), selected for their moderate or low sensitivity to neutralization. Neutralization breadths were not statistically different between T and NT mothers. However, a few statistically significant differences were observed, with higher frequencies or titers of NAbs toward several individual strains for NT mothers when the clade B-infected or non-clade B-infected mothers were analyzed separately. Our study confirms that the breadth of maternal NAbs is not associated with protection of infants from infection. PMID:22811522

The breadth and titer of maternal HIV-1-specific heterologous neutralizing antibodies are not associated with a lower rate of mother-to-child transmission of HIV-1.

PubMed

Chaillon, Antoine; Wack, Thierry; Braibant, Martine; Mandelbrot, Laurent; Blanche, Stéphane; Warszawski, Josiane; Barin, Francis

2012-10-01

It has been hypothesized that neutralizing antibodies (NAbs) should have broad specificity to be effective in protection against diverse HIV-1 variants. The mother-to-child transmission model of HIV-1 provides the opportunity to examine whether the breadth of maternal NAbs is associated with protection of infants from infection. Samples were obtained at delivery from 57 transmitting mothers (T) matched with 57 nontransmitting mothers (NT) enrolled in the multicenter French perinatal cohort (ANRS EPF CO1) between 1990 and 1996. Sixty-eight (59.6%) and 46 (40.4%) women were infected by B and non-B viruses, respectively. Neutralization assays were carried out with TZM-bl cells, using a panel of 10 primary isolates of 6 clades (A, B, C, F, CRF01_AE, and CRF02_AG), selected for their moderate or low sensitivity to neutralization. Neutralization breadths were not statistically different between T and NT mothers. However, a few statistically significant differences were observed, with higher frequencies or titers of NAbs toward several individual strains for NT mothers when the clade B-infected or non-clade B-infected mothers were analyzed separately. Our study confirms that the breadth of maternal NAbs is not associated with protection of infants from infection.

Molecular epidemiological study of HIV-1 CRF01_AE transmission in Hong Kong.

PubMed

Chen, J H K; Wong, K H; Li, P; Chan, K C; Lee, M P; Lam, H Y; Cheng, V C C; Yuen, K Y; Yam, W C

2009-08-15

The objective of this study was to investigate the transmission history of the HIV-1 CRF01_AE epidemics in Hong Kong between 1994 and 2007. A total of 465 HIV-1 CRF01_AE pol sequences were derived from an in-house or a commercial HIV-1 genotyping system. Phylogenies of CRF01_AE sequences were analyzed by the Bayesian coalescent method. CRF01_AE patient population included 363 males (78.1%) and 102 females (21.9%), whereas 65% (314 of 465) were local Chinese. Major transmission routes were heterosexual contact (63%), followed by intravenous drug use (IDU) (19%) and men having sex with men (MSM) (17%). From phylogenetic analysis, local CRF01_AE strains were from multiple origins with 3 separate transmission clusters identified. Cluster 1 consisted mainly of Chinese male IDUs and heterosexuals. Clusters 2 and 3 included mainly local Chinese MSM and non-Chinese Asian IDUs, respectively. Chinese reference isolates available from China (Fujian, Guangxi, or Liaoning) were clonally related to our transmission clusters, demonstrating the epidemiological linkage of CRF01_AE infections between Hong Kong and China. The 3 individual local transmission clusters were estimated to have initiated since late 1980s and late 1990s, causing subsequent epidemics in the early 2000s. This is the first comprehensive molecular epidemiological study of HIV-1 CRF01_AE in Hong Kong. It revealed that MSM contact is becoming a major route of local CRF01_AE transmission in Hong Kong. Epidemiological linkage of CRF01_AE between Hong Kong and China observed in this study indicates the importance of regular molecular epidemiological surveillance for the HIV-1 epidemic in our region.

Immunisation practices in centres caring for children with perinatally acquired HIV: A call for harmonisation.

PubMed

Bamford, Alasdair; Manno, Emma C; Mellado, Maria Jose; Spoulou, Vana; Marques, Laura; Scherpbier, Henriette J; Niehues, Tim; Oldakowska, Agnieszka; Rossi, Paolo; Palma, Paolo

2016-11-04

Current national immunisation schedules differ between countries in terms of vaccine formulation, timing of vaccinations and immunisation programme funding and co-ordination. As a result, some HIV infected paediatric population may be left susceptible to vaccine preventable infections. Vaccines used in healthy population should be subjected to high quality ethical research and be explicitly validated for use in children with special vaccination needs such as those infected with HIV. This survey was completed to assess current vaccination practices and attitudes toward vaccination among pediatricians who care for vertically HIV infected children. An online questionnaire was completed by 46 experts in paediatric HIV-infection from the Paediatric European Network for Treatment of AIDS (PENTA). Data were collected between November 2013 and March 2014. 46units looking after 2465 patients completed the questionnaire. The majority of units (67%) reported that common childhood immunisation were administered by the family doctor or local health services rather than in the HIV specialist centre. Vaccination histories were mostly incomplete and difficult to obtain for 40% of the studied population. Concerns were reported regarding the use of live attenuated vaccines, such as varicella and rotavirus, and these were less frequently recommended (61% and 28% of the units respectively). Monitoring of vaccine responses was employed in a minority of centres (41%). A range of different assays were used resulting in diverse units of measurement and proposed correlates of protection. Vaccination practices for perinatally HIV-infected children vary a great deal between countries. Efforts should be made to improve communication and documentation of vaccinations in healthcare settings and to harmonise recommendations relating to additional vaccines for HIV infected children and the use of laboratory assays to guide immunisation. This will ultimately improve coverage and vaccine induced

Inferring HIV-1 Transmission Dynamics in Germany From Recently Transmitted Viruses.

PubMed

Pouran Yousef, Kaveh; Meixenberger, Karolin; Smith, Maureen R; Somogyi, Sybille; Gromöller, Silvana; Schmidt, Daniel; Gunsenheimer-Bartmeyer, Barbara; Hamouda, Osamah; Kücherer, Claudia; von Kleist, Max

2016-11-01

Although HIV continues to spread globally, novel intervention strategies such as treatment as prevention (TasP) may bring the epidemic to a halt. However, their effective implementation requires a profound understanding of the underlying transmission dynamics. We analyzed parameters of the German HIV epidemic based on phylogenetic clustering of viral sequences from recently infected seroconverters with known infection dates. Viral baseline and follow-up pol sequences (n = 1943) from 1159 drug-naïve individuals were selected from a nationwide long-term observational study initiated in 1997. Putative transmission clusters were computed based on a maximum likelihood phylogeny. Using individual follow-up sequences, we optimized our clustering threshold to maximize the likelihood of co-clustering individuals connected by direct transmission. The sizes of putative transmission clusters scaled inversely with their abundance and their distribution exhibited a heavy tail. Clusters based on the optimal clustering threshold were significantly more likely to contain members of the same or bordering German federal states. Interinfection times between co-clustered individuals were significantly shorter (26 weeks; interquartile range: 13-83) than in a null model. Viral intraindividual evolution may be used to select criteria that maximize co-clustering of transmission pairs in the absence of strong adaptive selection pressure. Interinfection times of co-clustered individuals may then be an indicator of the typical time to onward transmission. Our analysis suggests that onward transmission may have occurred early after infection, when individuals are typically unaware of their serological status. The latter argues that TasP should be combined with HIV testing campaigns to reduce the possibility of transmission before TasP initiation.

Human milk oligosaccharide concentration and risk of postnatal transmission of HIV through breastfeeding123

PubMed Central

Kuhn, Louise; Kim, Hae-Young; Hsiao, Lauren; Nissan, Caroline; Sinkala, Moses; Kankasa, Chipepo; Mwiya, Mwiya; Thea, Donald M; Aldrovandi, Grace M

2012-01-01

Background: The inefficiency of HIV breast-milk transmission may be caused by the presence of immunologically active factors, including human milk oligosaccharides (HMOs). Objective: We investigated whether HMO concentrations are associated with a reduced risk of postnatal HIV transmission. Design: A nested case-control study was conducted within a larger cohort study of HIV-infected women and their infants followed from birth to 24 mo in Lusaka, Zambia. Breast-milk samples collected at 1 mo from 81 HIV-infected women who transmitted via breastfeeding, a random sample of 86 HIV-infected women who did not transmit despite breastfeeding, and 36 uninfected breastfeeding women were selected. Total and specific HMO concentrations were measured by HPLC and compared between groups with adjustment for confounders by using logistic regression. Results: HIV-infected women with total HMOs above the median (1.87 g/L) were less likely to transmit via breastfeeding (OR: 0.45; 95% CI: 0.21, 0.97; P = 0.04) after adjustment for CD4 count and breast-milk HIV RNA concentrations; a trend toward higher concentrations of lacto-N-neotetraose being associated with reduced transmission (OR: 0.49; 95% CI: 0.23, 1.04; P = 0.06) was also observed. The proportion of 3′-sialyllactose (3′-SL) per total HMOs was higher among transmitting than among nontransmitting women (P = 0.003) and correlated with higher plasma and breast-milk HIV RNA and lower CD4 counts. Neither Secretor nor Lewis status distinguished between transmitting and nontransmitting women. Conclusions: Higher concentrations of non-3′-SL HMOs were associated with protection against postnatal HIV transmission independent of other known risk factors. Further study of these novel, potentially anti-HIV components of breast milk is warranted. This trial was registered at clinicaltrials.gov as NCT00310726. PMID:22894939

High rates of virological failure and drug resistance in perinatally HIV-1-infected children and adolescents receiving lifelong antiretroviral therapy in routine clinics in Togo

PubMed Central

Salou, Mounerou; Dagnra, Anoumou Y; Butel, Christelle; Vidal, Nicole; Serrano, Laetitia; Takassi, Elom; Konou, Abla A; Houndenou, Spero; Dapam, Nina; Singo-Tokofaï, Assetina; Pitche, Palokinam; Atakouma, Yao; Prince-David, Mireille; Delaporte, Eric; Peeters, Martine

2016-01-01

Introduction Antiretroviral treatment (ART) has been scaled up over the last decade but compared to adults, children living with HIV are less likely to receive ART. Moreover, children and adolescents are more vulnerable than adults to virological failure (VF) and emergence of drug resistance. In this study we determined virological outcome in perinatally HIV-1-infected children and adolescents receiving ART in Togo. Methods HIV viral load (VL) testing was consecutively proposed to all children and adolescents who were on ART for at least 12 months when attending HIV healthcare services for their routine follow-up visit (June to September 2014). Plasma HIV-1 VL was measured using the m2000 RealTime HIV-1 assay (Abbott Molecular, Des Plaines, IL, USA). Genotypic drug resistance was done for all samples with VL>1000 copies/ml. Results and discussion Among 283 perinatally HIV-1-infected children and adolescents included, 167 (59%) were adolescents and 116 (41%) were children. The median duration on ART was 48 months (interquartile range: 28 to 68 months). For 228 (80.6%), the current ART combination consisted of two nucleoside reverse transcriptase inhibitors (NRTIs) (zidovudine and lamivudine) and one non-nucleoside reverse transcriptase inhibitor (NNRTI) (nevirapine or efavirenz). Only 28 (9.9%) were on a protease inhibitor (PI)-based regimen. VL was below the detection limit (i.e. 40 copies/ml) for 102 (36%), between 40 and 1000 copies/ml for 35 (12.4%) and above 1000 copies/ml for 146 (51.6%). Genotypic drug-resistance testing was successful for 125/146 (85.6%); 110/125 (88.0%) were resistant to both NRTIs and NNRTIs, 1/125 (0.8%) to NRTIs only, 4/125 (3.2%) to NNRTIs only and three harboured viruses resistant to reverse transcriptase and PIs. Overall, 86% (108/125) of children and adolescents experiencing VF and successfully genotyped, corresponding thus to at least 38% of the study population, had either no effective ART or had only a single effective drug in

Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda.

PubMed

Bunnell, Rebecca; Ekwaru, John Paul; Solberg, Peter; Wamai, Nafuna; Bikaako-Kajura, Winnie; Were, Willy; Coutinho, Alex; Liechty, Cheryl; Madraa, Elizabeth; Rutherford, George; Mermin, Jonathan

2006-01-02

The impact of antiretroviral therapy (ART) on sexual risk behavior and HIV transmission among HIV-infected persons in Africa is unknown. To assess changes in risky sexual behavior and estimated HIV transmission from HIV-infected adults after 6 months of ART. A prospective cohort study was performed in rural Uganda. Between May 2003 and December 2004 a total of 926 HIV-infected adults were enrolled and followed in a home-based ART program that included prevention counselling, voluntary counseling and testing (VCT) for cohabitating partners and condom provision. At baseline and follow-up, participants' HIV plasma viral load and partner-specific sexual behaviors were assessed. Risky sex was defined as inconsistent or no condom use with partners of HIV-negative or unknown serostatus in the previous 3 months. The rates of risky sex were compared using a Poisson regression model and transmission risk per partner was estimated, based on established viral load-specific transmission rates. Six months after initiating ART, risky sexual behavior reduced by 70% [adjusted risk ratio, 0.3; 95% confidence interval (CI), 0.2-0.7; P = 0.0017]. Over 85% of risky sexual acts occurred within married couples. At baseline, median viral load among those reporting risky sex was 122 500 copies/ml, and at follow-up, < 50 copies/ml. Estimated risk of HIV transmission from cohort members declined by 98%, from 45.7 to 0.9 per 1000 person years. Providing ART, prevention counseling, and partner VCT was associated with reduced sexual risk behavior and estimated risk of HIV transmission among HIV-infected Ugandan adults during the first 6 months of therapy. Integrated ART and prevention programs may reduce HIV transmission in Africa.

Reproductive Health Decision-Making in Perinatally HIV-Infected Adolescents and Young Adults

PubMed Central

Wiener, Lori; Zadeh, Sima; Albright, Jamie; Mellins, Claude Ann; Mancilla, Michael; Tepper, Vicki; Trexler, Connie; Purdy, Julia; Osherow, Janet; Lovelace, Susan; Kapetanovic, Suad

2013-01-01

With widespread access to antiretroviral therapy in the United States, many perinatally HIV-infected (PHIV+) children are surviving into adolescence and adulthood, becoming sexually active and making decisions about their reproductive health. The literature focusing on the reproductive decisions of individuals behaviorally infected with HIV can serve as a springboard for understanding the decision-making process of PHIV+ youth. Yet, there are many differences that critically distinguish reproductive health and related decision-making of PHIV+ youth. Given the potential public health implications of their reproductive decisions, better understanding of factors influencing the decision-making process is needed to help inform the development of salient treatment and prevention interventions. To begin addressing this understudied area, a “think tank” session, comprised of clinicians, medical providers, and researchers with expertise in the area of adolescent HIV, was held in Bethesda, MD, on September 21, 2011. The focus was to explore what is known about factors that influence the reproductive decision-making of PHIV+ adolescents and young adults, determine what important data are needed in order to develop appropriate intervention for PHIV+ youth having children, and to recommend future directions for the field in terms of designing and carrying out collaborative studies. In this report, we summarize the findings from this meeting. The paper is organized around the key themes that emerged, including utilizing a developmental perspective to create an operational definition of reproductive decision-making, integration of psychosocial services with medical management, and how to design future research studies. Case examples are presented and model program components proposed. PMID:22736033

Reproductive health decision-making in perinatally HIV-infected adolescents and young adults.

PubMed

Fair, Cynthia; Wiener, Lori; Zadeh, Sima; Albright, Jamie; Mellins, Claude Ann; Mancilla, Michael; Tepper, Vicki; Trexler, Connie; Purdy, Julia; Osherow, Janet; Lovelace, Susan; Kapetanovic, Suad

2013-07-01

With widespread access to antiretroviral therapy in the United States, many perinatally HIV-infected (PHIV+) children are surviving into adolescence and adulthood, becoming sexually active and making decisions about their reproductive health. The literature focusing on the reproductive decisions of individuals behaviorally infected with HIV can serve as a springboard for understanding the decision-making process of PHIV+ youth. Yet, there are many differences that critically distinguish reproductive health and related decision-making of PHIV+ youth. Given the potential public health implications of their reproductive decisions, better understanding of factors influencing the decision-making process is needed to help inform the development of salient treatment and prevention interventions. To begin addressing this understudied area, a "think tank" session, comprised of clinicians, medical providers, and researchers with expertise in the area of adolescent HIV, was held in Bethesda, MD, on September 21, 2011. The focus was to explore what is known about factors that influence the reproductive decision-making of PHIV+ adolescents and young adults, determine what important data are needed in order to develop appropriate intervention for PHIV+ youth having children, and to recommend future directions for the field in terms of designing and carrying out collaborative studies. In this report, we summarize the findings from this meeting. The paper is organized around the key themes that emerged, including utilizing a developmental perspective to create an operational definition of reproductive decision-making, integration of psychosocial services with medical management, and how to design future research studies. Case examples are presented and model program components proposed.

Sexual Violence and HIV Transmission: Summary Proceedings of a Scientific Research Planning Meeting

PubMed Central

Klot, Jennifer F.; Auerbach, Judith D.; Berry, Miranda R.

2013-01-01

This summarizes proceedings of a Scientific Research Planning Meeting on Sexual Violence and HIV transmission, convened by the Social Science Research Council on 19–20 March 2012 at the Greentree Foundation in New York. The Meeting brought together an interdisciplinary group of basic, clinical, epidemiological and social science researchers and policy makers with the aim of: (1) examining what is known about the physiology of sexual violence and its role in HIV transmission, acquisition and pathogenesis; (2) specifying factors that distinguish risks throughout the maturation of the female genital tract, the reproductive cycle and among post-menopausal women; and (3) developing a research agenda to explore unanswered questions. The Meeting resulted in a consensus Research Agenda and White Paper that identify priorities for HIV research, policy and practice as it pertains to the role of sexual violence and genital injury in HIV transmission, acquisition and pathogenesis, particularly among women and girls. PMID:23157400

Gender inequality and HIV transmission: a global analysis

PubMed Central

Richardson, Eugene T; Collins, Sean E; Kung, Tiffany; Jones, James H; Tram, Khai Hoan; Boggiano, Victoria L; Bekker, Linda-Gail; Zolopa, Andrew R

2014-01-01

Introduction The HIV pandemic disproportionately impacts young women. Worldwide, young women aged 15–24 are infected with HIV at rates twice that of young men, and young women alone account for nearly a quarter of all new HIV infections. The incommensurate HIV incidence in young – often poor – women underscores how social and economic inequalities shape the HIV epidemic. Confluent social forces, including political and gender violence, poverty, racism, and sexism impede equal access to therapies and effective care, but most of all constrain the agency of women. Methods HIV prevalence data was compiled from the 2010 UNAIDS Global Report. Gender inequality was assessed using the 2011 United Nations Human Development Report Gender Inequality Index (GII). Logistic regression models were created with predominant mode of transmission (heterosexual vs. MSM/IDU) as the dependent variable and GII, Muslim vs. non-Muslim, Democracy Index, male circumcision rate, log gross national income (GNI) per capita at purchasing power parity (PPP), and region as independent variables. Results and discussion There is a significant correlation between having a predominantly heterosexual epidemic and high gender inequality across all models. There is not a significant association between whether a country is predominantly Muslim, has a high/low GNI at PPP, has a high/low circumcision rate, and its primary mode of transmission. In addition, there are only three countries that have had a generalized epidemic in the past but no longer have one: Cambodia, Honduras, and Eritrea. GII data are available only for Cambodia and Honduras, and these countries showed a 37 and 34% improvement, respectively, in their Gender Inequality Indices between 1995 and 2011. During the same period, both countries reduced their HIV prevalence below the 1% threshold of a generalized epidemic. This represents limited but compelling evidence that improvements in gender inequality can lead to the abatement of

Are Evolution and the Intracellular Innate Immune System Key Determinants in HIV Transmission?

PubMed Central

Sumner, Rebecca P.; Thorne, Lucy G.; Fink, Doug L.; Khan, Hataf; Milne, Richard S.; Towers, Greg J.

2017-01-01

HIV-1 is the single most important sexually transmitted disease in humans from a global health perspective. Among human lentiviruses, HIV-1 M group has uniquely achieved pandemic levels of human-to-human transmission. The requirement to transmit between hosts likely provides the strongest selective forces on a virus, as without transmission, there can be no new infections within a host population. Our perspective is that evolution of all of the virus–host interactions, which are inherited and perpetuated from host-to-host, must be consistent with transmission. For example, CXCR4 use, which often evolves late in infection, does not favor transmission and is therefore lost when a virus transmits to a new host. Thus, transmission inevitably influences all aspects of virus biology, including interactions with the innate immune system, and dictates the biological niche in which the virus exists in the host. A viable viral niche typically does not select features that disfavor transmission. The innate immune response represents a significant selective pressure during the transmission process. In fact, all viruses must antagonize and/or evade the mechanisms of the host innate and adaptive immune systems that they encounter. We believe that viewing host–virus interactions from a transmission perspective helps us understand the mechanistic details of antiviral immunity and viral escape. This is particularly true for the innate immune system, which typically acts from the very earliest stages of the host–virus interaction, and must be bypassed to achieve successful infection. With this in mind, here we review the innate sensing of HIV, the consequent downstream signaling cascades and the viral restriction that results. The centrality of these mechanisms to host defense is illustrated by the array of countermeasures that HIV deploys to escape them, despite the coding constraint of a 10 kb genome. We consider evasion strategies in detail, in particular the role of the

Recent increased identification and transmission of HIV-1 unique recombinant forms in Sweden.

PubMed

Neogi, Ujjwal; Siddik, Abu Bakar; Kalaghatgi, Prabhav; Gisslén, Magnus; Bratt, Göran; Marrone, Gaetano; Sönnerborg, Anders

2017-07-25

A temporal increase in non-B subtypes has earlier been described in Sweden by us and we hypothesized that this increased viral heterogeneity may become a hotspot for the development of more complex and unique recombinant forms (URFs) if the epidemics converge. In the present study, we performed subtyping using four automated tools and phylogenetic analysis by RAxML of pol gene sequences (n = 5246) and HIV-1 near full-length genome (HIV-NFLG) sequences (n = 104). A CD4 + T-cell decline trajectory algorithm was used to estimate time of HIV infection. Transmission clusters were identified using the family-joining method. The analysis of HIV-NFLG and pol gene described 10.6% (11/104) and 2.6% (137/5246) of the strains as URFs, respectively. An increasing trend of URFs was observed in recent years by both approaches (p = 0·0082; p < 0·0001). Transmission cluster analysis using the pol gene of all URFs identified 14 clusters with two to eight sequences. Larger transmission clusters of URFs (BF1 and 01B) were observed among MSM who mostly were sero-diagnosed in recent time. Understanding the increased appearance and transmission of URFs in recent years could have importance for public health interventions and the use of HIV-NFLG would provide better statistical support for such assessments.

Does HIV-1/AIDS-associated frontotemporal neuropathology following perinatal infection influence the development of moral behaviour?

PubMed

Gericke, G S

2008-01-01

While HIV encephalopathy and the AIDS dementia complex are considered hallmark neurologic manifestations of HIV-1 infection, increasing evidence of a continuum of nervous system involvement indicates the existence of an unrecognized number of individuals with milder, mostly cognitive and/or behavioural effects. Questions are raised whether HIV-related frontotemporal neuropathology during critical developmental stages could affect development of the brain networks documented to be involved in moral decisions, and whether this could contribute to the phenomenon of delinquency in an unknown percentage of the current generation of approximately 18-25 year old survivors of early childhood or vertically acquired HIV infection. Carefully planned and executed long term, prospective controlled studies using environmental, clinical, neurological, behavioural, genetic, immune and functional neuroimaging correlates would be required to elucidate whether HIV-specific neuropathology could indeed act as an independent risk factor for the development of a frontotemporal sociopathy syndrome. If such an association is proven, the accelerated development of neurospecific therapies should be a priority, especially for clinically and immunologically stable HIV-infected children. It may be necessary to institute such treatment as early as possible in perinatally infected cases, and maybe even during intrauterine life if HIV-1 is demonstrated to also act as a neurobehavioural teratogen for the developing fetal brain. It may, however, prove to be difficult to separate primary neurobiological from environmental factors, since the epigenetic effects on the host genome of retroviral insertion influencing behavioural gene expression characteristics, and altered gene expression following early life stresses may involve overlapping neurodevelopmental gene regulatory networks. In the meantime it remains necessary to prevent or ameliorate frequent neuropsychiatric morbidity from whatever causes.

[Molecular epidemiology and transmission of HIV-1 infection in Zhejiang province, 2015].

PubMed

Yang, J Z; Chen, W J; Zhang, W J; He, L; Zhang, J F; Pan, X H

2017-11-10

Objective: To understand the distribution of HIV-1 subtype diversity and its transmission characteristics in Zhejiang province. Methods: A total of 302 newly diagnosed HIV-1 positive patients were selected through stratified random sampling in Zhejiang in 2015. HIV-1 pol genes were sequenced successfully with reverse transcription PCR/nested PCR and phylogenetic analysis was conducted for 276 patients. Then a molecular epidemiologic study was performed combined with field epidemiological investigation. Results: Of 276 sequence samples analyzed, 122 CRF07_BC strains (44.2%), 103 CRF01_AE strains (37.3%), 17 CRF08_BC strains (6.1%), 9 B strains (3.2%), 6 CRF55_01B strains (2.2%), 5 C strains (1.8%), 1 CRF59_01B strain (0.4%), 1 CRF67_01B strain (0.4%), 1 A1 strain (0.4%), and 11 URFs strains (4.0%) were identified. Phylogenetic analysis revealed 16 clusters with only 15.1% (34/225) sequences involved among CRF07_BC and CRF01_AE strains. The clustered cases in MSM were higher than that in populations with other transmission routes. And clusters existed between the populations with different transmission routes. Conclusion: The major strains of HIV-1 in Zhejiang are CRF07_BC and CRF01_AE. The HIV subtypes showed more complexity in Zhejiang. It is necessary to strengthen the surveillance for HIV subtypes, carry out classified management and conduct effective prevention and control in the population at high risk.

Trends in attitudes toward people living with HIV, homophobia, and HIV transmission knowledge in Quebec, Canada (1996, 2002, and 2010).

PubMed

Adrien, Alix; Beaulieu, Marianne; Leaune, Viviane; Perron, Michèle; Dassa, Clément

2013-01-01

People living with HIV (PWHIV) face negative attitudes that isolate and discourage them from accessing services. Understanding negative attitudes and the social environment can lead to more effective health promotion strategies and programs. However, a scale to measure attitudes has been lacking. We developed and validated attitudes toward PWHIV Scale to examine trends in attitudes toward PWHIV in Quebec in 1996, 2002, and 2010. We also examined the relationship between negative attitudes toward PWHIV, homophobia, and knowledge about HIV transmission. The scale included 16 items and had a five-factor structure: F1 (fear of being infected), F2 (fear of contact with PWHIV), F3 (prejudicial beliefs toward groups at high risk of HIV), F4 (tolerance regarding sexual mores and behaviors), and F5 (social support for PWHIV). The validity and reliability of the scale were assessed and found to be high. Overall, Quebecers had positive attitudes toward PWHIV, with more negative attitudes observed in subgroups defined as male, ≥50 years of age, <14 years of education, higher levels of homophobia, and below-average knowledge about HIV transmission. Scores were stable between 1996 and 2002, and increased in 2010. Negative attitudes were correlated with higher levels of homophobia and lesser knowledge about HIV transmission. The lowest scores for each factor were observed in the same subgroups that had low overall scores on the Attitudes Scale. The findings from this study can be used to intensify interventions that promote compassion for PWHIV, address attitudes toward homosexuality, and encourage greater knowledge about the transmission of HIV in these subgroups.

Impact of community-based interventions on HIV knowledge, attitudes, and transmission.

PubMed

Salam, Rehana A; Haroon, Sarah; Ahmed, Hashim H; Das, Jai K; Bhutta, Zulfiqar A

2014-01-01

In 2012, an estimated 35.3 million people lived with HIV, while approximately two million new HIV infections were reported. Community-based interventions (CBIs) for the prevention and control of HIV allow increased access and ease availability of medical care to population at risk, or already infected with, HIV. This paper evaluates the impact of CBIs on HIV knowledge, attitudes, and transmission. We included 39 studies on educational activities, counseling sessions, home visits, mentoring, women's groups, peer leadership, and street outreach activities in community settings that aimed to increase awareness on HIV/AIDS risk factors and ensure treatment adherence. Our review findings suggest that CBIs to increase HIV awareness and risk reduction are effective in improving knowledge, attitudes, and practice outcomes as evidenced by the increased knowledge scores for HIV/AIDS (SMD: 0.66, 95% CI: 0.25, 1.07), protected sexual encounters (RR: 1.19, 95% CI: 1.13, 1.25), condom use (SMD: 0.96, 95% CI: 0.03, 1.58), and decreased frequency of sexual intercourse (RR: 0.76, 95% CI: 0.61, 0.96). Analysis shows that CBIs did not have any significant impact on scores for self-efficacy and communication. We found very limited evidence on community-based management for HIV infected population and prevention of mother- to-child transmission (MTCT) for HIV-infected pregnant women. Qualitative synthesis suggests that establishment of community support at the onset of HIV prevention programs leads to community acceptance and engagement. School-based delivery of HIV prevention education and contraceptive distribution have also been advocated as potential strategies to target high-risk youth group. Future studies should focus on evaluating the effectiveness of community delivery platforms for prevention of MTCT, and various emerging models of care to improve morbidity and mortality outcomes.

Disparities in achieving and sustaining viral suppression among a large cohort of HIV-infected persons in care - Washington, DC.

PubMed

Castel, Amanda D; Kalmin, Mariah M; Hart, Rachel L D; Young, Heather A; Hays, Harlen; Benator, Debra; Kumar, Princy; Elion, Richard; Parenti, David; Ruiz, Maria Elena; Wood, Angela; D'Angelo, Lawrence; Rakhmanina, Natella; Rana, Sohail; Bryant, Maya; Hebou, Annick; Fernández, Ricardo; Abbott, Stephen; Peterson, James; Wood, Kathy; Subramanian, Thilakavathy; Binkley, Jeffrey; Happ, Lindsey Powers; Kharfen, Michael; Masur, Henry; Greenberg, Alan E

2016-11-01

One goal of the HIV care continuum is achieving viral suppression (VS), yet disparities in suppression exist among subpopulations of HIV-infected persons. We sought to identify disparities in both the ability to achieve and sustain VS among an urban cohort of HIV-infected persons in care. Data from HIV-infected persons enrolled at the 13 DC Cohort study clinical sites between January 2011 and June 2014 were analyzed. Univariate and multivariate logistic regression were conducted to identify factors associated with achieving VS (viral load < 200 copies/ml) at least once, and Kaplan-Meier (KM) curves and Cox proportional hazards models were used to identify factors associated with sustaining VS and time to virologic failure (VL ≥ 200 copies/ml after achievement of VS). Among the 4311 participants, 95.4% were either virally suppressed at study enrollment or able to achieve VS during the follow-up period. In multivariate analyses, achieving VS was significantly associated with age (aOR: 1.04; 95%CI: 1.03-1.06 per five-year increase) and having a higher CD4 (aOR: 1.05, 95% CI 1.04-1.06 per 100 cells/mm(3)). Patients infected through perinatal transmission were less likely to achieve VS compared to MSM patients (aOR: 0.63, 95% CI 0.51-0.79). Once achieved, most participants (74.4%) sustained VS during follow-up. Blacks and perinatally infected persons were less likely to have sustained VS in KM survival analysis (log rank chi-square p ≤ .001 for both) compared to other races and risk groups. Earlier time to failure was observed among females, Blacks, publically insured, perinatally infected, those with longer standing HIV infection, and those with diagnoses of mental health issues or depression. Among this HIV-infected cohort, most people achieved and maintained VS; however, disparities exist with regard to patient age, race, HIV transmission risk, and co-morbid conditions. Identifying populations with disparate outcomes allows for appropriate targeting

Cognitive, academic, and behavioral correlates of medication adherence in children and adolescents with perinatally acquired HIV infection.

PubMed

Nichols, Sharon L; Montepiedra, Grace; Farley, John J; Sirois, Patricia A; Malee, Kathleen; Kammerer, Betsy; Garvie, Patricia A; Naar-King, Sylvie

2012-05-01

Medication adherence is critical to the success of antiretroviral therapies for children and youth with perinatally acquired HIV. Factors that influence successful transition of medication responsibility from caregivers to youth are poorly understood. The purpose of this study was to evaluate the relationship of medication adherence with demographic, cognitive, academic, and behavioral characteristics. Randomly selected youth, N = 151, aged 8 to 18 years, completed cognitive and academic measures, and they and their caregivers completed questionnaires assessing behavior and emotional well-being. An announced pill count and questionnaires completed by youth and their caregivers were used to evaluate adherence. Of 151 participants, 100 completed all adherence measures. Adherence rates varied by assessment method. Nonadherence (<90%) by pill count was associated with older child age, greater youth responsibility for medications, and other demographic and medication regimen variables. Verbal impairment predicted better self-reported adherence and reading problems predicted better self- and caregiver-reported adherence. Youth-reported locus of control was associated with pill count nonadherence, and poor relationships with parents were associated with youth-reported nonadherence. Consideration of youth cognitive or academic status may be helpful in evaluating medication adherence in patients with perinatally acquired HIV infection, particularly when using self- or caregiver reports to assess adherence. Vigilance for adherence problems is indicated when youth are older, responsible for medications, report poor caregiver relationships, and/or sense a lack of control over their lives.

Prevention of mother-to-child transmission of HIV: the Georgian experience.

PubMed

Tsertsvadze, Tengiz; Kakabadze, Tea; Shermadini, Ketevan; Abutidze, Akaki; Karchava, Marika; Chkhartishvili, Nikoloz; Badridze, Nino; Bokhua, Zaza; Asatiani, Tengiz

2008-09-01

The objective of this paper is to review experience in prevention of mother-to-child transmission (PMTCT) of HIV in Georgia. PMTCT is one of the strategic priorities in Georgia. The first case of HIV infection in pregnant women was reported in 1999. Starting 2005 the National Programme on PMTCT became operational. One hundred sixteen HIV voluntary counselling and testing (VCT) centers operate throughout the country at antenatal clinics. According to the National PMTCT protocol, all first time attending pregnant women are offered Voluntary Counselling and Testing (VCT). Testing on HIV/AIDS is based on identification of HIV antibodies by screening method and all positive results are referred to the Infectious Diseases, AIDS and Clinical Immunology Research Center (IDACIRC) for the further investigation (confirmation by Western Blot assay) and further management. Data collection was made retrospectively, using information from IDACIRC National HIV/AIDS Data Base, VRF for the period 1999-2007. Prevalence of HIV among pregnant women availing VCT services in 2006 was 0.03%. As of December, 2007 total 69 pregnancies of 64 women were registered at the IDACIRC. Fifty eight women (90.6%) acquired infection through heterosexual contact. None of the HIV positive women reported intravenous injection of illicit drugs. The majority of the HIV infected pregnant women had one sexual partner (90.6%). Of children delivered by 51 positive partners 41(80%) were infected through injecting drugs intravenously and 10 (20%) persons through heterosexual contacts. Throughout the period 1999-2007 14 pregnant women received PMTCT services only partially. In 2 cases children were HIV-infected. In 12 pregnancies women received AZT in about the 28th week of pregnancy. No case of HIV transmission to child was recorded in this group. In 32 cases pregnant women received full prophylaxis therapy and all children were negative for HIV infection. Among 6 pregnant women admitted at IDACIRC later than

Three-dimensional imaging of HIV-1 virological synapses reveals membrane architectures involved in virus transmission.

PubMed

Do, Thao; Murphy, Gavin; Earl, Lesley A; Del Prete, Gregory Q; Grandinetti, Giovanna; Li, Guan-Han; Estes, Jacob D; Rao, Prashant; Trubey, Charles M; Thomas, James; Spector, Jeffrey; Bliss, Donald; Nath, Avindra; Lifson, Jeffrey D; Subramaniam, Sriram

2014-09-01

HIV transmission efficiency is greatly increased when viruses are transmitted at virological synapses formed between infected and uninfected cells. We have previously shown that virological synapses formed between HIV-pulsed mature dendritic cells (DCs) and uninfected T cells contain interdigitated membrane surfaces, with T cell filopodia extending toward virions sequestered deep inside invaginations formed on the DC membrane. To explore membrane structural changes relevant to HIV transmission across other types of intercellular conjugates, we used a combination of light and focused ion beam scanning electron microscopy (FIB-SEM) to determine the three-dimensional (3D) architectures of contact regions between HIV-1-infected CD4(+) T cells and either uninfected human CD4(+) T cells or human fetal astrocytes. We present evidence that in each case, membrane extensions that originate from the uninfected cells, either as membrane sheets or filopodial bridges, are present and may be involved in HIV transmission from infected to uninfected cells. We show that individual virions are distributed along the length of astrocyte filopodia, suggesting that virus transfer to the astrocytes is mediated, at least in part, by processes originating from the astrocyte itself. Mechanisms that selectively disrupt the polarization and formation of such membrane extensions could thus represent a possible target for reducing viral spread. Our findings lead to new insights into unique aspects of HIV transmission in the brain and at T cell-T cell synapses, which are thought to be a predominant mode of rapid HIV transmission early in the infection process. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study.

PubMed

Heffron, Renee; Donnell, Deborah; Rees, Helen; Celum, Connie; Mugo, Nelly; Were, Edwin; de Bruyn, Guy; Nakku-Joloba, Edith; Ngure, Kenneth; Kiarie, James; Coombs, Robert W; Baeten, Jared M

2012-01-01

Hormonal contraceptives are used widely but their effects on HIV-1 risk are unclear. We aimed to assess the association between hormonal contraceptive use and risk of HIV-1 acquisition by women and HIV-1 transmission from HIV-1-infected women to their male partners. In this prospective study, we followed up 3790 heterosexual HIV-1-serodiscordant couples participating in two longitudinal studies of HIV-1 incidence in seven African countries. Among injectable and oral hormonal contraceptive users and non-users, we compared rates of HIV-1 acquisition by women and HIV-1 transmission from women to men. The primary outcome measure was HIV-1 seroconversion. We used Cox proportional hazards regression and marginal structural modelling to assess the effect of contraceptive use on HIV-1 risk. Among 1314 couples in which the HIV-1-seronegative partner was female (median follow-up 18·0 [IQR 12·6-24·2] months), rates of HIV-1 acquisition were 6·61 per 100 person-years in women who used hormonal contraception and 3·78 per 100 person-years in those who did not (adjusted hazard ratio 1·98, 95% CI 1·06-3·68, p=0·03). Among 2476 couples in which the HIV-1-seronegative partner was male (median follow-up 18·7 [IQR 12·8-24·2] months), rates of HIV-1 transmission from women to men were 2·61 per 100 person-years in couples in which women used hormonal contraception and 1·51 per 100 person-years in couples in which women did not use hormonal contraception (adjusted hazard ratio 1·97, 95% CI 1·12-3·45, p=0·02). Marginal structural model analyses generated much the same results to the Cox proportional hazards regression. Women should be counselled about potentially increased risk of HIV-1 acquisition and transmission with hormonal contraception, especially injectable methods, and about the importance of dual protection with condoms to decrease HIV-1 risk. Non-hormonal or low-dose hormonal contraceptive methods should be considered for women with or at-risk for HIV-1. US

Rates and Types of Psychiatric Disorders in Perinatally Human Immunodeficiency Virus-Infected Youth and Seroreverters

ERIC Educational Resources Information Center

Mellins, Claude Ann; Brackis-Cott, Elizabeth; Leu, Cheng-Shiun; Elkington, Katherine S.; Dolezal, Curtis; Wiznia, Andrew; McKay, Mary; Bamji, Mahrukh; Abrams, Elaine J.

2009-01-01

Background: The purpose of this study was to examine 1) the prevalence of psychiatric and substance use disorders in perinatally HIV-infected (HIV+) adolescents and 2) the association between HIV infection and these mental health outcomes by comparing HIV+ youths to HIV exposed but uninfected youths (HIV-) from similar communities. Methods: Data…

HIV/AIDS - pregnancy and infants

MedlinePlus

... immunodeficiency virus - children; Acquired immune deficiency syndrome - children; Pregnancy - HIV; Maternal HIV; Perinatal - HIV ... mother to the child. This can occur during pregnancy, childbirth, or when breastfeeding. Only blood, semen, vaginal ...

Effects of patient load and travel distance on HIV transmission in rural China: Implications for treatment as prevention.

PubMed

Smith, M Kumi; Miller, William C; Liu, Huixin; Ning, Chuanyi; He, Wensheng; Cohen, Myron S; Wang, Ning

2017-01-01

Sustained viral suppression through ART reduces sexual HIV transmission risk, but may require routine access to reliable and effective medical care which may be difficult to obtain in resource constrained areas. We investigated the roles of patient load and travel distance to HIV care clinic on transmission risk in HIV serodiscordant couples in Henan Province, China. Cox proportional hazard models were used to compare HIV transmission events across couples living near, medium, or farther distances from their assigned HIV care clinics, as well as those attending clinics where clinicians bore high versus low patient loads. Most (84·4%) of the 3695 serodiscordant couples lived within 10 kilometers of their assigned HIV clinic, and most (73·5%) attended clinics with patient-to-provider ratios of at least 100:1. In adjusted Cox models, attending clinics where clinicians bore average patient loads of 100 or more elevated HIV transmission risk (aHR, 1·50, 95% CI, 1·00-4·84), an effect amplified in village tier clinics (aHR = 1·55; 95% CI, 1·23-6·78). Travel distance was associated with HIV transmission only after stratification; traveling medium distances to village clinics (5-10km) increased transmission risk (aHR = 1·83, 95% CI, 1·04-3·21) whereas traveling longer distances to township or county level clinics lowered transmission risk (aHR = 0·10, 95% CI, 0·01-0·75). Higher patient loads at HIV clinics was associated with risk of HIV transmission in our population, particularly at village level clinics. Farther travel distance had divergent effects based on clinic tier, suggesting unique mechanisms operating across levels of resource availability. The resource intensity of long-term HIV treatment may place significant strains on small rural clinics, for which investments in additional support staff or time-saving tools such as point-of-care laboratory testing may bring about impactful change in treatment outcomes.

Prevention of mother-to-child HIV transmission cascade in China: a systematic review and meta-analysis

PubMed Central

Zeng, Huan; Chow, Eric P F; Zhao, Yong; Wang, Yang; Tang, Maozhi; Li, Leyu; Tang, Xue; Liu, Xi; Zhong, Yi; Wang, Ailing; Lo, Ying-Ru; Zhang, Lei

2016-01-01

Introduction The Chinese government has invested US$140 million annually on prevention of mother-to-child transmission (PMTCT) of HIV. This study evaluates the programme by examining the improvements in programme coverage HIV testing and provision of antiviral drugs along the PMTCT cascade. Methods Data for PMTCT cascade indicators were collected through a comprehensive systematic review of published peer-reviewed English and Chinese literature during 2003–2011. Meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results This study included 113 publications. HIV prevalence among pregnant women in China who accessed antenatal care (ANC) remained below 0.1% during the past decade. HIV testing coverage in pregnant women attending ANC and in HIV-exposed infants at 18 months significantly increased from 62.4% (95% CI 4.7% to 98.2%) and 22.1% (16.3% to 32.3%) in 2003 to 90.3% (88.4% to 91.8%) and 82.8% (66.9% to 99.5%) in 2011 respectively, whereas antiretroviral (ARV) prophylaxis uptake increased from 35.2% (12.2% to 47.3%) and 26.9% (24.3% to 28.9%) to 86.2% (53.2% to 97.2%) and 90.3% (85.5% to 93.7%). HIV vertical transmission rate substantially decreased from 31.8% (25.7% to 38.6%) prior to the programme to 2.3% (1.4% to 3.8%) in 2011. During 2003–2011, among 25 312 (23 995–26 644) infants born to HIV-positive mothers who received ARV prophylaxis, 975 (564–1395) were diagnosed with HIV, corresponding to an average transmission rate of 3.9% (3.2% to 4.6%). However, while including transmissions among HIV-positive pregnant women who were lost along the cascade, the average transmission rate during 2003–2011 was 17.4% (15.8% to 19.0%). Conclusions PMTCT programmes have reduced HIV mother-to-child transmission in China. Further improvements in the continuum of care remain essential in realising the full potential of the programme. PMID:25935929

Compartmentalized Cytomegalovirus Replication and Transmission in the Setting of Maternal HIV-1 Infection

PubMed Central

Slyker, Jennifer; Farquhar, Carey; Atkinson, Claire; Ásbjörnsdóttir, Kristjana; Roxby, Alison; Drake, Alison; Kiarie, James; Wald, Anna; Boeckh, Michael; Richardson, Barbra; Odem-Davis, Katherine; John-Stewart, Grace; Emery, Vincent

2014-01-01

Background. Cytomegalovirus (CMV) infection is associated with adverse outcomes in human immunodeficiency virus (HIV)–exposed infants. Determinants of vertical CMV transmission in the setting of maternal HIV-1 infection are not well-defined. Methods. CMV and HIV-1 levels were measured in plasma, cervical secretions, and breast milk of 147 HIV-1–infected women to define correlates of maternal CMV replication and infant CMV acquisition. Results. Although few women had detectable CMV in plasma (4.8%), the majority had detectable CMV DNA in cervical secretions (66%) and breast milk (99%). There was a strong association between cervical CMV detection during pregnancy and later breast milk levels (β = 0.47; P = .005). Plasma HIV-1 level and CD4 counts were associated with CMV in the cervix and breast milk. However HIV-1 levels within the cervix and breast milk were not associated with CMV within these compartments. Maternal breast milk CMV levels (hazard ratio [HR], 1.4; P = .003) and maternal CD4 < 450 cells/mm3 (HR, 1.8; P = .008) were independently associated with infant CMV acquisition; each log10 increase in breast milk CMV was associated with a 40% increase in infant infection. The breast milk CMV level required to attain a 50% probability of CMV transmission increased with higher maternal CD4 counts, increasing from 3.55 log10 CMV DNA copies/mL at a CD4 count of 350 cells/mm3 to 5.50 log10 CMV DNA copies/mL at a CD4 count of 1000 cells/mm3. Conclusions. Breast milk CMV levels and maternal CD4 count are major determinants of CMV transmission in the setting of maternal HIV-1. Maternal immune reconstitution or lowering breast milk CMV levels may reduce vertical CMV transmission. PMID:24192386

Integrated prevention of mother-to-child transmission for human immunodeficiency virus, syphilis and hepatitis B virus in China.

PubMed

Wang, Ai-Ling; Qiao, Ya-Ping; Wang, Lin-Hong; Fang, Li-Wen; Wang, Fang; Jin, Xi; Qiu, Jie; Wang, Xiao-Yan; Wang, Qian; Wu, Jiu-Ling; Vermund, Sten H; Song, Li

2015-01-01

China continues to face challenges in eliminating mother-to-child transmission of human immunodeficiency virus (HIV), syphilis and hepatitis B virus (HBV). In 2010, a programme that integrated and standardized prevention of mother-to-child transmission (PMTCT) efforts for HIV, syphilis and HBV was implemented in 1156 counties. At participating antenatal care clinics, pregnant women were offered all three tests concurrently and free of charge. Further interventions such as free treatment, prophylaxis and testing for mothers and their children were provided for HIV and syphilis. China's national PMTCT HIV programme started in 2003, at which time there were no national programmes for perinatal syphilis and HBV. In 2009, the rate of maternal-to-child transmission of HIV was 8.1% (57/702). Reported congenital syphilis was 60.8 per 100,000 live births. HBV infection was 7.2% of the overall population infected. Between 2010 and 2013 the number of pregnant women attending antenatal care clinics with integrated PMTCT services increased from 5.5 million to 13.1 million. In 2013, 12.7 million pregnant women were tested for HIV, 12.6 million for syphilis and 12.7 million for HBV. Mother-to-child transmission of HIV fell to 6.7% in 2013. Data on syphilis transmission are not yet available. Integrated PMTCT services proved to be feasible and effective, and they are now part of the routine maternal and child health services provided to infected women. The services are provided through a collaboration between maternal and child health clinics, the national and local Centers for Disease Control and Prevention, and general hospitals.

Vaginal microbiota and sexually transmitted infections that may influence transmission of cell-associated HIV.

PubMed

Cone, Richard A

2014-12-15

Vaginal microbiota and sexually transmitted infections (STIs) are likely to influence the transmission of cell-associated human immunodeficiency virus (HIV). Lactic acid produced by Lactobacillus-dominated microbiota (Nugent score 0-3) will likely inhibit transmission, especially female-to-male transmission. In contrast, polymicrobial microbiota (Nugent score 4-10), community state types IV-A and IV-B, and STIs will likely increase transmission of cell-associated HIV. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Maternal risk factors for HIV infection in infants in northeastern Brazil

PubMed Central

de Lemos, Lígia M.D.; Lippi, Joseph; Rutherford, George W.; Duarte, Gabriella S.; Martins, Nágyla G.R.; Santos, Victor S.; Gurgel, Ricardo Q.

2017-01-01

SUMMARY Introduction While the rate of vertically transmitted HIV infection has fallen in most regions of Brazil, there have been no similar decreases in northern and northeastern Brazil. Objective The objective of this study was to evaluate the risk factors associated with vertical transmission in the state of Sergipe in northeastern Brazil. Methods This was a retrospective cohort study. We recorded clinic and registry data for all HIV-infected pregnant women and exposed children diagnosed in Sergipe from 1990 to 2011. Results We identified 538 deliveries and 561 HIV-exposed infants (23 sets of twins). One hundred one (18.9%) infants were HIV-infected. In the multivariate analysis, infant antiretroviral prophylaxis was a significant protective factor (adjusted odds ratio (aOR) 0.07, 95% confidence interval (CI) 0.01–0.41, p=0.003). Breastfeeding was marginally associated with an increased odds of perinatal transmission (aOR 4.52, 95% CI 0.78–26.17, p = 0.092). The attributable risk percentage for breastfeeding over the study period was 91.0%. Transmission decreased from 91 per 100 live births before 1997 to 2 per 100 in 2011 following the adoption of the prevention protocol. Conclusion Transmission declined over the study period. The screening of pregnant women and timely initiation of prophylaxis and therapy are issues that require further attention. PMID:23791426

[Prevalence of congenital and perinatal infection in HIV positive pregnant in Belo Horizonte metropolitan region].

PubMed

Maia, Marcelle Marie Martins; Lage, Eura Martins; Moreira, Bárbara Cecília Borges; Deus, Elayne Alayne Braga de; Faria, Joanna Gonçalves; Pinto, Jorge Andrade; Melo, Victor Hugo

2015-09-01

To evaluate the prevalence of toxoplasmosis, rubella, cytomegalovirus, hepatitis B&C and syphilis (Torchs) in a cohort pregnant women and to identify the sociodemographic, clinical and laboratory factors. A total of 1,573 HIV-infected pregnant women from a Brazilian metropolitan region were studied between 1998 and 2013. The results of serological tests were available for 704 (44.8%) pregnant women. Pregnant women were considered to be Torchs positive (Gtp) when they had positive results for at least one of these infections, and to be Torchs negative (Gtn) when they had negative results for all of them. Maternal covariables were: age, marital status, educational level, time and mode of infection, CD4 lymphocyte count, viral load at delivery, and use of antiretroviral therapy (ARV). Neonatal covariables were: HIV infection, prematurity, low birth weight, neonatal complications, abortion and neonatal death. Odds ratios with 95% confidence interval were used to quantify the association between maternal and neonatal variables and the presence of Torchs. Among 704 pregnant women, 70 (9.9%; 95%CI 7.8-12.4) had positive serological tests for any Torchs factor. The individual prevalence rates were: 1.5% (10/685) for toxoplasmosis; 1.3% (8/618) for rubella; 1.3% (8/597) for cytomegalovirus; 0.9% (6/653) for hepatitis B and 3.7% (20/545) for hepatitis C; and 3.8% (25/664) for syphilis. The HIV Vertical HIV transmission was 4.6% among Gtp pregnant women and 1.2% among Gtn women. Antiretroviral therapy (ARV), vertical transmission, low birth weight and neonatal complications were significantly associated with Torchs positivity in univariate analysis. The Torchs prevalence found in the study was high for some infections. These findings emphasize the need to promote serological Torchs screening for all pregnant women, especially HIV-infected women, so that an early diagnosis can be made and treatment interventions can be implemented to prevent vertical HIV transmission.

Sexual behavior, risk perception, and HIV transmission can respond to HIV antiviral drugs and vaccines through multiple pathways.

PubMed

Tully, Stephen; Cojocaru, Monica; Bauch, Chris T

2015-10-28

There has been growing use of highly active antiretroviral treatment (HAART) for HIV and significant progress in developing prophylactic HIV vaccines. The simplest theories of counterproductive behavioral responses to such interventions tend to focus on single feedback mechanisms: for instance, HAART optimism makes infection less scary and thus promotes risky sexual behavior. Here, we develop an agent based, age-structured model of HIV transmission, risk perception, and partner selection in a core group to explore behavioral responses to interventions. We find that interventions can activate not one, but several feedback mechanisms that could potentially influence decision-making and HIV prevalence. In the model, HAART increases the attractiveness of unprotected sex, but it also increases perceived risk of infection and, on longer timescales, causes demographic impacts that partially counteract HAART optimism. Both HAART and vaccination usually lead to lower rates of unprotected sex on the whole, but intervention effectiveness depends strongly on whether individuals over- or under-estimate intervention coverage. Age-specific effects cause sexual behavior and HIV prevalence to change in opposite ways in old and young age groups. For complex infections like HIV-where interventions influence transmission, demography, sexual behavior and risk perception-we conclude that evaluations of behavioral responses should consider multiple feedback mechanisms.

Psychosocial needs of perinatally HIV-infected youths in Thailand: lessons learnt from instructive counseling.

PubMed

Manaboriboon, B; Lolekha, R; Chokephaibulkit, K; Leowsrisook, P; Naiwatanakul, T; Tarugsa, J; Durier, Y; Aunjit, N; Punpanich Vandepitte, W; Boon-Yasidhi, V

2016-12-01

Identifying psychosocial needs of perinatally HIV-infected (pHIV) youth is a key step in ensuring good mental health care. We report psychosocial needs of pHIV youth identified using the "Youth Counseling Needs Survey" (YCS) and during individual counseling (IC) sessions. pHIV youth receiving care at two tertiary-care hospitals in Bangkok or at an orphanage in Lopburi province were invited to participate IC sessions. The youths' psychosocial needs were assessed using instructive IC sessions in four main areas: general health, reproductive health, mood, and psychosocial concerns. Prior to the IC session youth were asked to complete the YCS in which their concerns in the four areas were investigated. Issues identified from the YCS and the IC sessions were compared. During October 2010-July 2011, 150 (68.2%) of 220 eligible youths participated in the IC sessions and completed the YCS. Median age was 14 (range 11-18) years and 92 (61.3%) were female. Mean duration of the IC sessions was 36.5 minutes. One-hundred and thirty (86.7%) youths reported having at least one psychosocial problem discovered by either the IC session or the YCS. The most common problems identified during the IC session were poor health attitude and self-care (48.0%), lack of life skills (44.0%), lack of communication skills (40.0%), poor antiretroviral (ARV) adherence (38.7%), and low self-value (34.7%). The most common problems identified by the YCS were lack of communication skills (21.3%), poor health attitude and self-care (14.0%), and poor ARV adherence (12.7%). Youth were less likely to report psychosocial problems in the YCS than in the IC session. Common psychosocial needs among HIV-infected youth were issues about life skills, communication skills, knowledge on self-care, ARV adherence, and self-value. YCS can identify pHIV youths' psychosocial needs but might underestimate issues. Regular IC sessions are useful to detect problems and provide opportunities for counseling.

Community-Level HIV Stigma as a Driver for HIV Transmission Risk Behaviors and Sexually Transmitted Diseases in Sierra Leone: A Population-Based Study.

PubMed

Kelly, J Daniel; Reid, Michael J; Lahiff, Maureen; Tsai, Alexander C; Weiser, Sheri D

2017-08-01

Although HIV stigma has been identified as an important risk factor for HIV transmission risk behaviors, little is known about the contribution of community-level HIV stigma to HIV transmission risk behaviors and self-reported sexually transmitted diseases (STDs) or how gender may modify associations. We pooled data from the 2008 and 2013 Sierra Leone Demographic and Health Surveys. For HIV stigma, we examined HIV stigmatizing attitudes and HIV disclosure concerns at both individual and community levels. Outcomes of HIV transmission risk behaviors were recent condom usage, consistent condom usage, and self-reported STDs. We assessed associations with multivariable logistic regressions. We also analyzed gender as an effect modifier of these associations. Of 34,574 respondents, 24,030 (69.5%) who had heard of HIV were included in this analysis. Community-level HIV stigmatizing attitudes and disclosure concerns were associated with higher odds of self-reported STDs (adjusted odds ratio = 2.07; 95% confidence interval: 1.55 to 2.77; adjusted odds ratio = 2.95; 95% confidence interval: 1.51 to 5.58). Compared with men, community-level HIV stigmatizing attitudes among women were a stronger driver of self-reported STDs (interaction P = 0.07). Gender modified the association between community-level HIV disclosure concerns and both recent and consistent condom usage (interaction P = 0.03 and P = 0.002, respectively). Community-level HIV disclosure concerns among women were observed to be a driver of risky sex and self-reported STDs. This study shows that community-level HIV stigma may be a driver for risky sex and self-reported STDs, particularly among women. Our findings suggest that community-held stigmatizing beliefs and HIV disclosure concerns among women might be important targets for HIV stigma reduction interventions.

The importance of addressing gender inequality in efforts to end vertical transmission of HIV.

PubMed

Ghanotakis, Elena; Peacock, Dean; Wilcher, Rose

2012-07-11

The recently launched "Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive" sets forth ambitious targets that will require more widespread implementation of comprehensive prevention of vertical HIV transmission (PMTCT) programmes. As PMTCT policymakers and implementers work toward these new goals, increased attention must be paid to the role that gender inequality plays in limiting PMTCT programmatic progress. A growing body of evidence suggests that gender inequality, including gender-based violence, is a key obstacle to better outcomes related to all four components of a comprehensive PMTCT programme. Gender inequality affects the ability of women and girls to protect themselves from HIV, prevent unintended pregnancies and access and continue to use HIV prevention, care and treatment services. In light of this evidence, global health donors and international bodies increasingly recognize that it is critical to address the gender disparities that put women and children at increased risk of HIV and impede their access to care. The current policy environment provides unprecedented opportunities for PMTCT implementers to integrate efforts to address gender inequality with efforts to expand access to clinical interventions for preventing vertical HIV transmission. Effective community- and facility-based strategies to transform harmful gender norms and mitigate the impacts of gender inequality on HIV-related outcomes are emerging. PMTCT programmes must embrace these strategies and expand beyond the traditional focus of delivering ARV prophylaxis to pregnant women living with HIV. Without greater implementation of comprehensive, gender transformative PMTCT programmes, elimination of vertical transmission of HIV will remain elusive.

Human immunodeficiency virus-associated disruption of mucosal barriers and its role in HIV transmission and pathogenesis of HIV/AIDS disease

PubMed Central

Tugizov, Sharof

2016-01-01

Abstract Oral, intestinal and genital mucosal epithelia have a barrier function to prevent paracellular penetration by viral, bacterial and other pathogens, including human immunodeficiency virus (HIV). HIV can overcome these barriers by disrupting the tight and adherens junctions of mucosal epithelia. HIV-associated disruption of epithelial junctions may also facilitate paracellular penetration and dissemination of other viral pathogens. This review focuses on possible molecular mechanisms of HIV-associated disruption of mucosal epithelial junctions and its role in HIV transmission and pathogenesis of HIV and acquired immune deficiency syndrome (AIDS). PMID:27583187

Thoughts, Attitudes, and Feelings of HIV-Positive MSM Associated with High Transmission-Risk Sex

ERIC Educational Resources Information Center

Skinta, Matthew D.; Murphy, Jessie L.; Paul, Jay P.; Schwarcz, Sandra K.; Dilley, James W.

2012-01-01

This study presents survey data collected from a sample of HIV-positive men (N = 182) who had high transmission-risk sex, defined as unprotected anal intercourse with a man whose HIV-status was negative or unknown, in the previous 6 months. Despite the tremendous changes in HIV treatment and their impact on people living with HIV, little recent…

Brain Imaging and Neurodevelopment in HIV-uninfected Thai Children Born to HIV-infected Mothers.

PubMed

Jahanshad, Neda; Couture, Marie-Claude; Prasitsuebsai, Wasana; Nir, Talia M; Aurpibul, Linda; Thompson, Paul M; Pruksakaew, Kanchana; Lerdlum, Sukalaya; Visrutaratna, Pannee; Catella, Stephanie; Desai, Akash; Kerr, Stephen J; Puthanakit, Thanyawee; Paul, Robert; Ananworanich, Jintanat; Valcour, Victor G

2015-09-01

Perinatal use of combination antiretroviral therapy dramatically reduces vertical (mother-to-child) transmission of HIV but has led to a growing population of children with perinatal HIV-exposure but uninfected (HEU). HIV can cause neurological injury among children born with infection, but the neuroanatomical and developmental effects in HEU children are poorly understood. We used structural magnetic resonance imaging with diffusion tensor imaging to compare brain anatomy between 30 HEU and 33 age-matched HIV-unexposed and uninfected (HUU) children from Thailand. Maps of brain volume and microstructural anatomy were compared across groups; associations were tested between neuroimaging measures and concurrent neuropsychological test performance. Mean (standard deviation) age of children was 10.3 (2.8) years, and 58% were male. All were enrolled in school and lived with family members. Intelligence quotient (IQ) did not differ between groups. Caretaker education levels did not differ, but income was higher for HUU (P < 0.001). We did not detect group differences in brain volume or diffusion tensor imaging metrics, after controlling for sociodemographic factors. The mean (95% confidence interval) fractional anisotropy in the corpus callosum was 0.375 (0.368-0.381) in HEU compared with 0.370 (0.364-0.375) in HUU. Higher fractional anisotropy and lower mean diffusivity were each associated with higher IQ scores in analyses with both groups combined. No differences in neuroanatomical or brain integrity measures were detectable in HEU children compared with age-matched and sex-matched controls (HUU children). Expected associations between brain integrity measures and IQ scores were identified suggesting sufficient power to detect subtle associations that were present.

Mother-to-child transmission of HIV in a community-based antiretroviral clinic in South Africa

PubMed Central

Fitzgerald, Felicity C; Bekker, Linda-Gail; Kaplan, Richard; Myer, Landon; Lawn, Stephen D; Wood, Robin

2014-01-01

Objective To examine the uptake of ART among pregnant women referred to an ART service and the associated rates and risk factors for vertical HIV transmission. Method Retrospective analysis of an observational cohort at a community ART clinic in Cape Town. Results Between 2002 and 2008, 367 treatment-naïve pregnant women accessed the clinic. The median age was 27.5 years, and median gestation at presentation was 28 weeks. The median baseline CD4 count and viral load were 134 cells/µl and 28 282 copies/ml. Two hundred and sixty-five women (72%) commenced ART before giving birth, 73 women (20%) were referred for prevention of mother-to-child transmission therapy (PMTCT), and 29 (8%) received no intervention. Among ART-eligible women, 13% were lost to follow-up. Of those starting ART, median duration of therapy prior to birth was 7.6 weeks (interquartile range (IQR) 4 – 11.9). The HIV transmission rate was 5.1% (95% confidence interval (CI) 2.8 – 9.0%). Factors associated with transmission were advanced maternal WHO disease stage (odds ratio (OR) 9.57, p=0.02), and follow-up viral load above 50 copies/ml (OR 3.64, p=0.03). Each additional week on ART reduced transmission by 20% (p=0.05). There was no HIV transmission among women who received more than 8 weeks’ therapy. Conclusions The rate of HIV transmission in this study was higher than reported in high-income countries. Prevention of vertical transmission with ART was hindered by women presenting late in pregnancy and with advanced stage of HIV disease. Interventions that facilitate earlier ART commencement and improve programmatic retention of pregnant women are required. PMID:21414276

Body fat distribution in perinatally HIV-infected and HIV-exposed but uninfected children in the era of highly active antiretroviral therapy: outcomes from the Pediatric HIV/AIDS Cohort Study1234

PubMed Central

Jacobson, Denise L; Patel, Kunjal; Siberry, George K; Van Dyke, Russell B; DiMeglio, Linda A; Geffner, Mitchell E; Chen, Janet S; McFarland, Elizabeth J; Borkowsky, William; Silio, Margarita; Fielding, Roger A; Siminski, Suzanne; Miller, Tracie L

2011-01-01

Background: Associations between abnormal body fat distribution and clinical variables are poorly understood in pediatric HIV disease. Objective: Our objective was to compare total body fat and its distribution in perinatally HIV-infected and HIV-exposed but uninfected (HEU) children and to evaluate associations with clinical variables. Design: In a cross-sectional analysis, children aged 7–16 y in the Pediatric HIV/AIDS Cohort Study underwent regionalized measurements of body fat via anthropometric methods and dual-energy X-ray absorptiometry. Multiple linear regression was used to evaluate body fat by HIV, with adjustment for age, Tanner stage, race, sex, and correlates of body fat in HIV-infected children. Percentage total body fat was compared with NHANES data. Results: Males accounted for 47% of the 369 HIV-infected and 51% of the 176 HEU children. Compared with HEU children, HIV-infected children were older, were more frequently non-Hispanic black, more frequently had Tanner stage ≥3, and had lower mean height (−0.32 compared with 0.29), weight (0.13 compared with 0.70), and BMI (0.33 compared with 0.63) z scores. On average, HIV-infected children had a 5% lower percentage total body fat (TotF), a 2.8% lower percentage extremity fat (EF), a 1.4% higher percentage trunk fat (TF), and a 10% higher trunk-to-extremity fat ratio (TEFR) than did the HEU children and a lower TotF compared with NHANES data. Stavudine use was associated with lower EF and higher TF and TEFR. Non-nucleotide reverse transcriptase inhibitor use was associated with higher TotF and EF and lower TEFR. Conclusion: Although BMI and total body fat were significantly lower in the HIV-infected children than in the HEU children, body fat distribution in the HIV-infected children followed a pattern associated with cardiovascular disease risk and possibly related to specific antiretroviral drugs. PMID:22049166

Integrating Prevention of Mother-to-Child HIV Transmission Programs to Improve Uptake: A Systematic Review

PubMed Central

Tudor Car, Lorainne; Van Velthoven, Michelle H. M. M. T.; Brusamento, Serena; Elmoniry, Hoda; Car, Josip; Majeed, Azeem; Tugwell, Peter; Welch, Vivian; Marusic, Ana; Atun, Rifat

2012-01-01

Background We performed a systematic review to assess the effect of integrated perinatal prevention of mother-to-child transmission of HIV interventions compared to non- or partially integrated services on the uptake in low- and middle-income countries. Methods We searched for experimental, quasi-experimental and controlled observational studies in any language from 21 databases and grey literature sources. Results Out of 28 654 citations retrieved, five studies met our inclusion criteria. A cluster randomized controlled trial reported higher probability of nevirapine uptake at the labor wards implementing HIV testing and structured nevirapine adherence assessment (RRR 1.37, bootstrapped 95% CI, 1.04–1.77). A stepped wedge design study showed marked improvement in antiretroviral therapy (ART) enrolment (44.4% versus 25.3%, p<0.001) and initiation (32.9% versus 14.4%, p<0.001) in integrated care, but the median gestational age of ART initiation (27.1 versus 27.7 weeks, p = 0.4), ART duration (10.8 versus 10.0 weeks, p = 0.3) or 90 days ART retention (87.8% versus 91.3%, p = 0.3) did not differ significantly. A cohort study reported no significant difference either in the ART coverage (55% versus 48% versus 47%, p = 0.29) or eight weeks of ART duration before the delivery (50% versus 42% versus 52%; p = 0.96) between integrated, proximal and distal partially integrated care. Two before and after studies assessed the impact of integration on HIV testing uptake in antenatal care. The first study reported that significantly more women received information on PMTCT (92% versus 77%, p<0.001), were tested (76% versus 62%, p<0.001) and learned their HIV status (66% versus 55%, p<0.001) after integration. The second study also reported significant increase in HIV testing uptake after integration (98.8% versus 52.6%, p<0.001). Conclusion Limited, non-generalizable evidence supports the effectiveness of integrated PMTCT programs. More research measuring

Monitoring Prevention Impact of Mother-to-Child Transmission of HIV in Concentrated Epidemics With Program and Survey Data

PubMed Central

Sabin, Keith; Ho, Thi Quynh Trang; Le, Ai Kim Anh; Hayashi, Chika; Kato, Masaya

2017-01-01

Background The prevention of mother-to-child transmission (PMTCT) of HIV program was introduced in Vietnam in 2005. Despite the scaling up of PMTCT programs, the rate of mother-to-child HIV transmission in Vietnam was estimated as high as 20% in 2013. Objective The objective of this study was to assess the outcomes of PMTCT and identified factors associated with mother-to-child transmission and infant survival using survey and program data in a high HIV burden province in Vietnam. Methods This community-based retrospective cohort study observed pregnant women diagnosed with HIV infection in Thai Nguyen province from October 2008 to December 2012. Data were collected through interviews using a structured questionnaire and through reviews of log books and medical charts in antenatal care and HIV clinics. Logistic regression and survival analysis were used to analyze data using Stata (StataCorp). Results A total of 172 pregnant women living with HIV were identified between 2008 and 2012. Most of these women had acquired the HIV infection from their husband (77/119, 64.7%). Significant improvement in the PMTCT program was documented, including reduction in late diagnosis of HIV for pregnant women from 62.5% in 2008 to 30% in 2012. Access to antiretrovirals (ARVs) improved, increasing from a rate of 18.2% (2008) to 70.0% (2011) for mothers and from 36.4% (2008) to 93.3% (2012) for infants. For infants, early diagnosis within 2 months of birth reached 66.7% in 2012 compared with 16.7% in 2009. Transmission rate reduced from 27.3% in 2008 to 6.7% in 2012. Late diagnosis was associated with increased risk for HIV transmission (odds ratio [OR] 14.7, 95% CI 1.8-121.4, P=.01), whereas ARV therapy for mother and infant in combination with infant formula feeding were associated with reduced risk for HIV transmission (OR 0.01, 95% CI 0.001-0.1; P<.001). Overall survival rate for HIV-exposed infants at 12 months was 97.7%. Conclusions A combination of program and survey data

Network Structure and the Risk for HIV Transmission Among Rural Drug Users

PubMed Central

Young, A. M.; Jonas, A. B.; Mullins, U. L.; Halgin, D. S.

2012-01-01

Research suggests that structural properties of drug users’ social networks can have substantial effects on HIV risk. The purpose of this study was to investigate if the structural properties of Appalachian drug users’ risk networks could lend insight into the potential for HIV transmission in this population. Data from 503 drug users recruited through respondent-driven sampling were used to construct a sociometric risk network. Network ties represented relationships in which partners had engaged in unprotected sex and/or shared injection equipment. Compared to 1,000 randomly generated networks, the observed network was found to have a larger main component and exhibit more cohesiveness and centralization than would be expected at random. Thus, the risk network structure in this sample has many structural characteristics shown to be facilitative of HIV transmission. This underscores the importance of primary prevention in this population and prompts further investigation into the epidemiology of HIV in the region. PMID:23184464

Rate of HIV transmission and associated factors among HIV-exposed infants in selected health facilities of East and West Gojjam Zones, Northwest Ethiopia; retrospective cohort study.

PubMed

Moges, Nurilign Abebe; Kassa, Getachew Mullu; Boneya, Dube Jara

2017-07-06

In 2014, there were 170,000 new HIV-infected children globally. The rate of HIV transmission from mother to child in Ethiopia was 18%. Though there are a number of HIV-related studies conducted in Ethiopia, there is a scarcity of evidence on the rate of mother to child transmission. So, the aim of this study was to determine the rate of HIV transmission and associated factors among HIV-exposed infants in selected health facilities in East and West Gojjam Zones, Northwest Ethiopia. Retrospective cohort study design was conducted. A total of 305 exposed infant- and mother pairs were included in this study. Data were collected from seven selected health facilities in East and West Gojjam Zone, Northwest Ethiopia. The study included a four-year duration PMTCT data, registered from July/2011 to July/2015. Data was collected using a prepared checklist. Data was entered using EpiData and analyzed using SPSS software. Descriptive, bivariate and multiple variable logistic regression analysis were conducted. A p-value less than 0.05 were used to declare statistical significant association. Three hundred five infants and their mothers were included in this study. The mean age of mothers was 27.4 with a standard deviation of 4.3 years. The majority, 96.4% of infants were on exclusive breastfeeding before six months. The rate of HIV transmission at the end of 24 months were 5.9% (95% CI: 3.9%-7.9%). The number of positive children was reduced from 14 (10.29%) to 4(2.37%) due to the program shift from option A to option B+. Factors which were associated with transmission of HIV from mother to child were; children who were born from older mothers (AOR = 5.4, 95% CI = 1.15, 25.70), and infants whose mother couldn't get PMTCT intervention (AOR = 15.95, 95% CI = 3.35, 75), and mothers who became pregnant after they knew they were HIV positive (AOR = 0.22, 95%CI = 0.049,096). There is significant progress on the reduction of the rate of HIV transmission from mother to

Knowledge and beliefs of international travellers about the transmission and prevention of HIV infection.

PubMed Central

Allard, R; Lambert, G

1992-01-01

OBJECTIVES: To measure the perceived risk of acquired immunodeficiency syndrome (AIDS) among international travellers, to measure their knowledge of the transmission and prevention of HIV infection abroad and to identify some of the determinants of this knowledge. DESIGN: Survey. SETTING: Travellers' immunization clinic providing mostly primary preventive care to international travellers. PARTICIPANTS: All clients aged 18 to 50 years seen at the clinic between Oct. 2 and Dec. 21, 1989, before their departure. MAIN OUTCOME MEASURES: Sixteen statements measured knowledge of transmission and prevention of HIV infection. Standardized scales measured health beliefs. RESULTS: The response rate was 81% (331/409). Compared with other diseases AIDS was perceived to be associated with a low risk except by those travelling to countries with a high prevalence of AIDS. Most of the clients were found to have a good knowledge of HIV transmission to travellers, although some myths remained popular and some real routes of transmission, especially blood, remained underrated. In all, 70% of the subjects believed in the efficacy of condoms when used with local people, as compared with 79% when used with other tourists; this difference was greatest among travellers who perceived AIDS as being particularly severe but difficult to prevent. The determinants of the knowledge of HIV transmission and prevention were a high level of education, a mother tongue other than French, unmarried status, a high prevalence of AIDS at the destination, the duration of the trip and a high perceived risk of HIV infection. CONCLUSIONS: Counselling should teach travellers (a) not to underestimate their risk of HIV infection during their trip, (b) to decrease the risk of requiring health care in developing countries and (c) to rely on their own prudent sexual behaviour rather than on their assessment of the level of risk posed by the environment. PMID:1544046

Knowledge and beliefs of international travellers about the transmission and prevention of HIV infection.

PubMed

Allard, R; Lambert, G

1992-02-01

To measure the perceived risk of acquired immunodeficiency syndrome (AIDS) among international travellers, to measure their knowledge of the transmission and prevention of HIV infection abroad and to identify some of the determinants of this knowledge. Survey. Travellers' immunization clinic providing mostly primary preventive care to international travellers. All clients aged 18 to 50 years seen at the clinic between Oct. 2 and Dec. 21, 1989, before their departure. Sixteen statements measured knowledge of transmission and prevention of HIV infection. Standardized scales measured health beliefs. The response rate was 81% (331/409). Compared with other diseases AIDS was perceived to be associated with a low risk except by those travelling to countries with a high prevalence of AIDS. Most of the clients were found to have a good knowledge of HIV transmission to travellers, although some myths remained popular and some real routes of transmission, especially blood, remained underrated. In all, 70% of the subjects believed in the efficacy of condoms when used with local people, as compared with 79% when used with other tourists; this difference was greatest among travellers who perceived AIDS as being particularly severe but difficult to prevent. The determinants of the knowledge of HIV transmission and prevention were a high level of education, a mother tongue other than French, unmarried status, a high prevalence of AIDS at the destination, the duration of the trip and a high perceived risk of HIV infection. Counselling should teach travellers (a) not to underestimate their risk of HIV infection during their trip, (b) to decrease the risk of requiring health care in developing countries and (c) to rely on their own prudent sexual behaviour rather than on their assessment of the level of risk posed by the environment.

Selection bias at the heterosexual HIV-1 transmission bottleneck

PubMed Central

Carlson, Jonathan M.; Schaefer, Malinda; Monaco, Daniela C.; Batorsky, Rebecca; Claiborne, Daniel T.; Prince, Jessica; Deymier, Martin J.; Ende, Zachary S.; Klatt, Nichole R.; DeZiel, Charles E.; Lin, Tien-Ho; Peng, Jian; Seese, Aaron M.; Shapiro, Roger; Frater, John; Ndung’u, Thumbi; Tang, Jianming; Goepfert, Paul; Gilmour, Jill; Price, Matt A.; Kilembe, William; Heckerman, David; Goulder, Philip J.R.; Allen, Todd M.; Allen, Susan; Hunter, Eric

2014-01-01

SUMMARY Introduction Heterosexual HIV-1 transmission is an inefficient process with rates reported at <1% per unprotected sexual exposure. When transmission occurs, systemic infection is typically established by a single genetic variant, taken from the swarm of genetically distinct viruses circulating in the donor. Whether that founder virus represents a chance event or was systematically favored is unclear. Our work has tested a central hypothesis that founder virus selection is biased toward certain genetic characteristics. Rationale If HIV-1 transmission involves selection for viruses with certain favorable characteristics, then such advantages should emerge as statistical biases when viewed across many viral loci in many transmitting partners. We therefore identified 137 Zambian heterosexual transmission pairs, for whom plasma samples were available for both the donor and recipient partner soon after transmission, and compared the viral sequences obtained from each partner to identify features that predicted whether the majority amino acid observed at any particular position in the donor was transmitted. We focused attention on two features: viral genetic characteristics that correlate with viral fitness, and clinical factors that influence transmission. Statistical modeling indicates that the former will be favored for transmission, while the latter will nullify this relative advantage. Results We observed a highly significant selection bias that favors the transmission of amino acids associated with increased fitness. These features included the frequency of the amino acid in the study cohort, the relative advantage of the amino acid with respect to the stability of the protein, and features related to immune escape and compensation. This selection bias was reduced in couples with high risk of transmission. In particular, significantly less selection bias was observed in women and in men with genital inflammation, compared to healthy men, suggesting a more

Characteristics of HIV-infected U.S. Army soldiers linked in molecular transmission clusters, 2001-2012

PubMed Central

Jagodzinski, Linda L.; Liu, Ying; Pham, Peter T.; Kijak, Gustavo H.; Tovanabutra, Sodsai; McCutchan, Francine E.; Scoville, Stephanie L.; Cersovsky, Steven B.; Michael, Nelson L.; Scott, Paul T.; Peel, Sheila A.

2017-01-01

Objective Recent surveillance data suggests the United States (U.S.) Army HIV epidemic is concentrated among men who have sex with men. To identify potential targets for HIV prevention strategies, the relationship between demographic and clinical factors and membership within transmission clusters based on baseline pol sequences of HIV-infected Soldiers from 2001 through 2012 were analyzed. Methods We conducted a retrospective analysis of baseline partial pol sequences, demographic and clinical characteristics available for all Soldiers in active service and newly-diagnosed with HIV-1 infection from January 1, 2001 through December 31, 2012. HIV-1 subtype designations and transmission clusters were identified from phylogenetic analysis of sequences. Univariate and multivariate logistic regression models were used to evaluate and adjust for the association between characteristics and cluster membership. Results Among 518 of 995 HIV-infected Soldiers with available partial pol sequences, 29% were members of a transmission cluster. Assignment to a southern U.S. region at diagnosis and year of diagnosis were independently associated with cluster membership after adjustment for other significant characteristics (p<0.10) of age, race, year of diagnosis, region of duty assignment, sexually transmitted infections, last negative HIV test, antiretroviral therapy, and transmitted drug resistance. Subtyping of the pol fragment indicated HIV-1 subtype B infection predominated (94%) among HIV-infected Soldiers. Conclusion These findings identify areas to explore as HIV prevention targets in the U.S. Army. An increased frequency of current force testing may be justified, especially among Soldiers assigned to duty in installations with high local HIV prevalence such as southern U.S. states. PMID:28759645

Prevention of mother-to-child HIV transmission cascade in China: a systematic review and meta-analysis.

PubMed

Zeng, Huan; Chow, Eric P F; Zhao, Yong; Wang, Yang; Tang, Maozhi; Li, Leyu; Tang, Xue; Liu, Xi; Zhong, Yi; Wang, Ailing; Lo, Ying-Ru; Zhang, Lei

2016-03-01

The Chinese government has invested US$140 million annually on prevention of mother-to-child transmission (PMTCT) of HIV. This study evaluates the programme by examining the improvements in programme coverage HIV testing and provision of antiviral drugs along the PMTCT cascade. Data for PMTCT cascade indicators were collected through a comprehensive systematic review of published peer-reviewed English and Chinese literature during 2003-2011. Meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This study included 113 publications. HIV prevalence among pregnant women in China who accessed antenatal care (ANC) remained below 0.1% during the past decade. HIV testing coverage in pregnant women attending ANC and in HIV-exposed infants at 18 months significantly increased from 62.4% (95% CI 4.7% to 98.2%) and 22.1% (16.3% to 32.3%) in 2003 to 90.3% (88.4% to 91.8%) and 82.8% (66.9% to 99.5%) in 2011 respectively, whereas antiretroviral (ARV) prophylaxis uptake increased from 35.2% (12.2% to 47.3%) and 26.9% (24.3% to 28.9%) to 86.2% (53.2% to 97.2%) and 90.3% (85.5% to 93.7%). HIV vertical transmission rate substantially decreased from 31.8% (25.7% to 38.6%) prior to the programme to 2.3% (1.4% to 3.8%) in 2011. During 2003-2011, among 25,312 (23,995-26,644) infants born to HIV-positive mothers who received ARV prophylaxis, 975 (564-1395) were diagnosed with HIV, corresponding to an average transmission rate of 3.9% (3.2% to 4.6%). However, while including transmissions among HIV-positive pregnant women who were lost along the cascade, the average transmission rate during 2003-2011 was 17.4% (15.8% to 19.0%). PMTCT programmes have reduced HIV mother-to-child transmission in China. Further improvements in the continuum of care remain essential in realising the full potential of the programme. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence

Comparison of cluster-based and source-attribution methods for estimating transmission risk using large HIV sequence databases.

PubMed

Le Vu, Stéphane; Ratmann, Oliver; Delpech, Valerie; Brown, Alison E; Gill, O Noel; Tostevin, Anna; Fraser, Christophe; Volz, Erik M

2018-06-01

Phylogenetic clustering of HIV sequences from a random sample of patients can reveal epidemiological transmission patterns, but interpretation is hampered by limited theoretical support and statistical properties of clustering analysis remain poorly understood. Alternatively, source attribution methods allow fitting of HIV transmission models and thereby quantify aspects of disease transmission. A simulation study was conducted to assess error rates of clustering methods for detecting transmission risk factors. We modeled HIV epidemics among men having sex with men and generated phylogenies comparable to those that can be obtained from HIV surveillance data in the UK. Clustering and source attribution approaches were applied to evaluate their ability to identify patient attributes as transmission risk factors. We find that commonly used methods show a misleading association between cluster size or odds of clustering and covariates that are correlated with time since infection, regardless of their influence on transmission. Clustering methods usually have higher error rates and lower sensitivity than source attribution method for identifying transmission risk factors. But neither methods provide robust estimates of transmission risk ratios. Source attribution method can alleviate drawbacks from phylogenetic clustering but formal population genetic modeling may be required to estimate quantitative transmission risk factors. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

'You're HIV positive': perinatally infected young people's accounts of the critical moment of finding out their diagnosis.

PubMed

Dorrell, Judith; Katz, Jeanne

2014-04-01

This paper presents the recollections of 28 young people (15-24 years old) of formally learning that they had acquired HIV perinatally. Prior to the naming of their illness, many participants had experienced repeated biographical disruption through ill health and other major life events. However, the critical moment in their HIV trajectory was when they were told their diagnosis. How information about their diagnosis was managed previously, often disguised, combined with the ways in which the disclosure process was handled communicated to young people the inherent dangers and stigma associated with revealing their HIV status to others. The formal disclosure occasion also signalled to most participants the route of their HIV infection as well as previously hidden health information about family members. Although some young people discovered their diagnosis in an unplanned way, most described the disclosure of their HIV status as a structured event, usually a formal telling with those in authority naming the condition. This even applied to those for whom the discovery that they were HIV positive was a process that happened over time. This paper describes their memories of the disclosure event which for half took place over the age of 12. They received messages conveying the imperative to keep this information a secret to avoid being stigmatised and to protect themselves and their families. They described subsequent feelings of isolation and distress. Policy-makers and clinicians need to consider the WHO disclosure recommendations whilst taking into account individual circumstances.

Multiple introductions and onward transmission of HIV-1 subtype B strains in Shanghai, China.

PubMed

Li, Xiaoshan; Zhu, Kexin; Xue, Yile; Wei, Feiran; Gao, Rong; Duerr, Ralf; Fang, Kun; Li, Wei; Song, Yue; Du, Guoping; Yan, Wenjuan; Musa, Taha Hussein; Ge, You; Ji, Yu; Zhong, Ping; Wei, Pingmin

2017-08-01

To investigate the viral genetic evolution, spatial origins and patterns of transmission of HIV-1 subtype B in Shanghai, China. A total of 242 Shanghai subtype B and 1519 reference pol sequences were subjected to phylogenetic inference and genetic transmission network analyses. Phylogenetic analysis revealed that subtype B strains circulating in Shanghai were genetically diverse and closely associated with viral sequence lineages in Beijing (76 of 242 [31.4%]), Central China (Henan/Hebei/Hunan/Hubei) (43 of 242 [17.8%]), Chinese Taiwan (20 of 242 [8.3%]), Japan (6 of 242 [2.5%]), and Korea (7 of 242 [2.9%]), suggesting multiple introductions into Shanghai from mainland China and Taiwan, Japan, and Korea. Interestingly, a monophyletic Shanghai lineage (SH-L) (36 of 242 [14.9%]) of HIV-1 subtype B most likely originated from an Argentine strain, transferred through Liaoning infected individuals. In-depth analyses of 195 Shanghai subtype B sequences revealed that a total of 37.9% (n = 74) sequences contributed to 35 transmission networks, whereof 33.8% (n = 25) of the sequences associated with infected individuals from other provinces. Our new findings reflect the evolution complexity and transmission dynamics of HIV-1 subtype B in Shanghai, which would provide critical information for the design of effective prevention measures against HIV transmission. Copyright © 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Randomized trial of vitamin supplements in relation to transmission of HIV-1 through breastfeeding and early child mortality.

PubMed

Fawzi, Wafaie W; Msamanga, Gernard I; Hunter, David; Renjifo, Boris; Antelman, Gretchen; Bang, Heejung; Manji, Karim; Kapiga, Saidi; Mwakagile, Davis; Essex, Max; Spiegelman, Donna

2002-09-27

HIV-1 transmission through breastfeeding is a global problem and has been associated with poor maternal micronutrient status. A total of 1078 HIV-infected pregnant women from Tanzania were randomly assigned to vitamin A or multivitamins excluding A from approximately 20 weeks' gestation and throughout lactation. Multivitamins excluding A had no effect on the total risk of HIV-1 transmission (RR 1.04, 95% CI 0.82-1.32, P= 0.76). Vitamin A increased the risk of transmission (RR 1.38, 95% CI 1.09-1.76, P = 0.009). Multivitamins were associated with non-statistically significant reductions in transmission through breastfeeding, and mortality by 24 months among those alive and not infected at 6 weeks. Multivitamins significantly reduced breastfeeding transmission in infants of mothers with low baseline lymphocyte counts (RR 0.37; 95% CI 0.16-0.85, P = 0.02) compared with infants of mothers with higher counts (RR 0.99, 95% CI 0.68-1.45, P = 0.97; -for-interaction 0.03). Multivitamins also protected against transmission among mothers with a high erythrocyte sedimentation rate (P-for-interaction 0.06), low hemoglobin (P-for-interaction 0.06), and low birthweight babies (P-for-interaction 0.04). Multivitamins reduced death and prolonged HIV-free survival significantly among children born to women with low maternal immunological or nutritional status. Vitamin A alone increased breastfeeding transmission but had no effect on mortality by 24 months. Vitamin A increased the risk of HIV-1 transmission. Multivitamin (B, C, and E) supplementation of breastfeeding mothers reduced child mortality and HIV-1 transmission through breastfeeding among immunologically and nutritionally compromised women. The provision of these supplements to HIV-infected lactating women should be considered.

HIV sexual transmission risks in the context of clinical care: a prospective study of behavioural correlates of HIV suppression in a community sample, Atlanta, GA, USA.

PubMed

Kalichman, Seth C; Cherry, Chauncey; Kalichman, Moira O; Washington, Christopher; Grebler, Tamar; Merely, Cindy; Welles, Brandi; Pellowski, Jennifer; Kegler, Christopher

2015-01-01

Antiretroviral therapy (ART) improves the health of people living with HIV and has the potential to reduce HIV infectiousness, thereby preventing HIV transmission. However, the success of ART for HIV prevention hinges on sustained ART adherence and avoiding sexually transmitted infections (STI). To determine the sexual behaviours and HIV transmission risks of individuals with suppressed and unsuppressed HIV replication (i.e., viral load). Assessed HIV sexual transmission risks among individuals with clinically determined suppressed and unsuppressed HIV. Participants were 760 men and 280 women living with HIV in Atlanta, GA, USA, who completed behavioural assessments, 28-daily prospective sexual behaviour diaries, one-month prospective unannounced pill counts for ART adherence, urine screening for illicit drug use and medical record chart abstraction for HIV viral load. Individuals with unsuppressed HIV demonstrated a constellation of behavioural risks for transmitting HIV to uninfected sex partners that included symptoms of STI and substance use. In addition, 15% of participants with suppressed HIV had recent STI symptoms/diagnoses, indicating significant risks for sexual infectiousness despite their HIV suppression in blood plasma. Overall, 38% of participants were at risk for elevated sexual infectiousness and just as many engaged in unprotected sexual intercourse with non-HIV-infected partners. Implementation strategies for using HIV treatments as HIV prevention requires enhanced behavioural interventions that extend beyond ART to address substance use and sexual health that will otherwise undermine the potential preventive impact of early ART.

Prevention of mother-to-child transmission of HIV: challenges for the current decade.

PubMed Central

Newell, M. L.

2001-01-01