Our study has shown that in addition to being in an HIV discordant relationship, there are other important riskfactors for HIV transmission among HIV discordant couples that need to be urgently targeted. The high HIV incidence and moderate participant retention observed in this study suggest that HIV- uninfected partners in discordant couples may be a suitable population for phase IIb/III preventive HIV vaccine trials in our setting. However, recent findings confirming that ART signifi- cantly reduces HIV transmission from an infected partner to an uninfected spouse may make it unfeasible to conduct future HIV prevention trials in this population.
Methods: This was an un-matched case-control study conducted between June 2015 and June 2016 in Kisumu County Referral Hospital, Kenya. The study enrolled 257 patients with HCC cases and 257 controls. A multivariable logistic regression analysis was used to assess the riskfactors for HIV and controlling for exploratory variables.
Independent t-test was used to compare means. Exposure variable with values < 0.05 were considered to be statistically significant.
ABSTRACT HIV and sexually-transmitted diseases (STDs) represent a sig-
nificant public health problem worldwide. We analyzed the seroprevalence and riskfactors for HIV, hepatitis B and syphilis in populations with high-risk behaviors in Croatia. During a three-year period, a total of 443 men who have sex with men (MSM) / bisexual persons, sex workers (SW) / clients of SW, persons with multiple sexual partners, and persons with a history of STD were tested for the presence of HIV, hepatitis B virus (HBV), and Treponema pallidum (syphilis) antibodies within the framework of second generation HIV surveillance. Participants were recruited from 11 Croatian counties, the vast majority among clients of voluntary counselling and testing centers. The overall prevalence of HIV, HBsAg, anti-HBc, and syphilis was 1.4%, 2.6%, 12.1%, and 3.4%, respectively. HBV and syphilis seroprevalence differed sig- nificantly between, genders with higher prevalence among men (anti-HBc 13.8% vs. 5.7%, P=0.043; syphilis 4.4% vs. 0%; P=0.049), as well as between age groups, with a steady increase according to age. Participants with a histo- ry of STD were more often seropositive than participants who did not report STD (HBsAg 8.2% vs. 1.0%, P=0.002; anti-HBc 32.4% vs. 6.4%, P<0.001; syphilis 12.0% vs. 1.7%, P<0.001). Syphilis seroprevalence was higher in homo / bi- sexual persons (12.2%) compared with heterosexual persons (1.2%, P<0.001). logistic regression showed that history of STD was a significant risk factor for hepatitis B (HBsAg AOR=6.229, 95% CI=1.491-26.022; anti-HBc AOR=5.872, 95% CI=2.899-11.896) and syphilis seropositivity (AOR=5.572, 95% CI=1.751- 17.726), while homo / bisexual behavior was associated with syphilis seropos- itivity (AOR=12.820, 95% CI=3.688-44.557). Our results highlight the impor- tance of continuing STDs screening and prevention in at-risk populations.
Significance of the study. Currently, there are no studies that specifically examine the association between CSA and HIV-related riskfactors for HIV positive women living in Haiti. When discussing HIV infection, risk reduction and prevention efforts in Haiti, it is imperative to address the riskfactors that may have an impact on sexual risk behaviors. Understanding the psychological impact CSA has had on victims and how their coping strategies translate into their current risk behaviors, attitudes, and relationships is essential to truly making a positive impact on the overall health of Haitians. By analyzing childhood sexual abuse among HIV-positive alcohol using Haitian women, the doors open to not only discussions surrounding the development of interventions that may be helpful to the study population, but may also translate into discussions on prevention efforts for the rest of the population that is at risk for HIV infection.
Methods Study population
We conducted a cross-sectional study of individuals do- nating blood from January 1st 2018 and December 31st 2018 to the blood bank of Gabriel Toure University teaching hospital in Bamako, Mali. We aimed to esti- mate HIV, HBV, HCV and syphilis infection prevalence and riskfactors of blood donors during this time. The current study included all blood donations during 2018 ( n = 8207) and respecting blood donation criteria: age
Background. Tuberculosis (TB) notification in South Africa has increased six-fold over the past two decades, mainly because of the HIV epidemic.
Objectives. To describe the sociodemographic and outcome characteristics of TB patients, and to identify riskfactors associated with TB treatment outcomes stratified by HIV status.
Methods. A cross-sectional study was used to analyse data from the Cape Town Metro East geographical service area (GSA) electronic TB register (ETR.Net), including adult patients aged ≥15 years who initiated TB treatment between 1 July 2011 and 30 June 2012.
In the present study, incidence of HIV in persons admitted to Pediatric ward was 1.21 % and for those who had one or more riskfactors or predictors was 6.56%.
Agrawal et al observed this in 0.83% of all patients admitted to hospital and 15.1 % those having riskfactors and predictors. 12 In their study, high incidence of HIV can be explained on the basis that their hospital was located near large commercial sex area, where nearly half of the workers were infected and this hospital was catering to this population. Adrien et al at Haiti found 11.8% seropositivity in children having one or more riskfactors. 13 Since in their study 71 % of children were less than one year of age and PCR test was not done, so the presence of maternal antibodies could not be ruled out, and this reflected high incidence of HIV in their study.
symptom severity assessed at multiple time points is a stronger predictor of subclinical CVD than depressive symptom severity assessed at one time point. 20 However, because depressive episodes are likely to recur in those with a MDD diagnosis, a baseline measure of MDD diagnosis should capture those at risk for chronic exposure to the unhealthy impact of depression. 72, 73 Lastly, our findings that depression treatment is associated with a reduced risk of HF among HIV infected veterans with MDD, while novel and intriguing, should be interpreted with caution. As this is an observational study and not a randomized control trial, we cannot eliminate confounding due to indication associated with the treatment of depression. Moreover, improved HF outcomes may be attributed to more frequent visits with a provider and better management of CVD riskfactors and other medical conditions in addition to MDD treatment. Additionally, only 10% of participants with an MDD diagnosis did not have a prescription for an antidepressant during the baseline period. The high prevalence of treatment is likely a reflection of the fact that MDD in our study was determined by clinical diagnostic codes and not by a formal depression screening instrument administered to all participants. It is likely that some participants with unrecognized depression existed in our no MDD group. This possible misclassification, however, would lead us to underestimate the strength of the MDD-HF relationship, as veterans with unrecognized depression would be included in our referent group.
Professor H. Virginia McCoy Major Professor
Adolescents engage in a range of risk behaviors during their transition from childhood to adulthood. Identifying and understanding interpersonal and socio-
environmental factors that may influence risk-taking is imperative in order to meet the Healthy People 2020 goals of reducing the incidence of unintended pregnancies, HIV, and other sexually transmitted infections among youth. The purpose of this study was to investigate gender differences in the predictors of HIVrisk behaviors among South Florida youth. More specifically, this study examined how protective factors, riskfactors, and health risk behaviors, derived from a guiding framework using the Theory of
BMI was determined. Relevant investigations were performed. Potential riskfactors of BMI were analyzed at different BMI categories. Association of variables with BMI and the strength of va- riables to predict BMI, underweight and obesity were determined. Results: The mean BMI of the HIV subjects was 26.2 ± 5.4 kg/m 2 . Underweight was present in 24 (6.1%), overweight in 150 (38.4%) and obesity in 84 (21.5%) of the HIV subjects. High spot urine creatinine (SUCr), high 24-hour urine osmolality (24HUOsm), high serum cholesterol and high hemoglobin predicted BMI in HIV subjects. Low 24HUOsm predicted under weight, whereas low 24-hour urine protein (24 HUP) and high 24HUOsm predicted obesity in HIV subjects. Conclusion: The prevalence of under- weight was low (6.1%), overweight high (38.4%) and obesity high (21.5%) in HIV subjects. High SUCr, high 24HUOsm, high serum cholesterol and high hemoglobin were predictors of BMI in HIV subjects. Low 24HUOsm was a predictor of underweight, while low 24HUP and high 24HUOsm were predictors of obesity in HIV subjects. Abnormalities of serum lipids, renal function, and ane- mia were common in HIV subjects who were underweight and in those obese. Underweight HIV subjects should be evaluated at the early stages for dyslipidemia, renal damage and anemia.
The association between chronic inﬂammatory conditions and low BMD is well documented and receptor activator of NFkB ligand (RANKL), the key mediator of osteoclast activity, is produced by activated T cells. In HIV infection, the virus can infect both activated T cells and macrophages. HIV-infected activated T cells and osteoblasts produce RANKL, which fur- ther stimulates osteoclast activity. Speciﬁcally, HIV proteins increase osteoclastic activity and decrease bone formation by promoting osteoblast apoptosis. 14 Thus, many studies showed association between low BMD and higher levels of HIV viremia in HAART naive patients. 15,16 In our study, viral load level was statistically higher in patients with osteopenia/osteoporosis in line with other studies. However, Cazanave et al. 7 showed that low HIV viral load and low CD4+ lymphocyte nadir were independent riskfactors for low BMD, suggesting an effect of therapy rather than the disease itself. On the other hand, Collins 17 had not found an association between abnormal BMD and CD4+ cell count nadir. In our study, there was no correlation between either CD4+ cell count nadir or CD4+ cell count before BMD measurement and osteopenia/osteoporosis.
Our study had some limitations. Our population was predominantly male, and the sample size was small;
more independent riskfactors may have been identified with a larger study population. As our data were col- lected at a single public hospital for only outpatients, it may not reflect all HIV-infected patients. We may have underestimated prior hospitalizations, as data collection for this study did not account for admission to other hospitals. Data collection was also limited for some riskfactors previously associated with MRSA colonization in HIV infected patients such as prior incarceration and high risk sexual behaviors [35,36]. Many healthcare related factors assessed by the questionnaire in this study may be subjected to recall and reporting bias.
5 Department of Sciences for Health Promotion and Mother-Child Care "G D'Alessandro", University of Palermo, Italy
Multifactorial riskfactors such as HIV/HCV co-infection and antiretroviral therapy (ARV) have been associated with osteoporosis in HIV+ women. We retrospectively analysed which known riskfactors were associated with the diagnosis of osteoporosis, according to the WHO definition, in HIV positive women who were followed-up at the AIDS Centre of the University of Palermo, Italy between January 2011 and December 2014.
Abstract: In order to eliminate infant HIV infection from mother to child, evidence based implementation strategies are needed to address the riskfactors that are associated with this infection using limited resources and applicable to all stakeholders especially the parents of the infants. This study assessed the infant, maternal and paternal riskfactors associated with HIV infection among infants below 24 months born to HIV positive mothers in care. An unmatched nested case control study was conducted at the HIV/ART clinic, Mildmay Uganda in 2012. 370 HIV positive mothers with their biological infants below 24 months who had had a DNA-PCR test done in the last 6 months were enrolled in the study (cases: DNA-PCR positive infants, controls: DNA-PCR negative infants). Data was collected using a structured questionnaire. Descriptive, bivariate and multivariate analyses were done. The riskfactors that showed a significant relationship with HIV infection of infants below 24 months born to HIV positive mothers were: Infant factors: Infant and young child feeding option used in the first 8 weeks of life (p <0.001) ART status (p<0.001), Immunization status (p=0.031) and duration of receiving Nevirapine syrup of the infant (p=0.002) significantly increased the risk of infection. Maternal factors: High baseline viral load during pregnancy (p=0.046), Body Mass Index > 30kg/m2 (p=0.008), receipt of ART during pregnancy (p<0.001), receipt of nutrition counseling (p=0.002) and non-disclosure of HIV status to spouse of the mother during pregnancy (p<0.001). Paternal factors: Acceptance to test for HIV (p<0.001), non-disclosure of HIV status to spouse (p<0.001) and receipt of ART (p<0.001). Multivariate analysis showed a significant relationship with HIV infection of infants who were mixed fed the infant (OR: 4.971, 95%CI: 1.71 - 14.48, p=0.003), receipt of ART (NVP) of the infant (OR: 0.0062, 95%CI:0.002 - 0.019, p<0.001), mother not disclosing of HIV status to spouse (OR:2.736, 95%CI:1.074 - 6.971, p=0.035) and Father not disclosing of HIV status to spouse (OR:4.38, 95%CI:1.764 - 11.235, p=0.002). The results show that mixed feeding of infants and parental non- disclosure of HIV status are key drivers that significantly increase the risk of infant infection while infant prophylactic Niverapine reduces the risk of infection. It is recommended that exclusively breastfeed of infants born to HIV positive women, HIV testing and spousal disclosure of HIV status be promoted among PLHIV.
In conclusion, HIV-positive MSM patients are more likely than HIV-negative patients to have riskfactors for syphilis, such as anonymous contacts, CAS, and chemsex. These factors facilitate syphilis acquisition and and have been found to contribute to the syphilis epidemic in Western countries. HIV-positive patients practicing receptive anal sex and seropositioning may cause them to have anal chan- cres more often than HIV-negative patients. HIV could in- fluence the natural course of syphilis as secondary syphilis has been found to be more common in HIV-positive pa- tients. These findings are an updated report on syphilis in Barcelona and provide important information to be consid- ered for public health interventions, including STI screen- ing and, access to health services and risk-reduction programs targeting high-risk groups.
aminotransferase (AST)-to-platelet ratio index (APRI).
Methods: We conducted a cross-sectional study among HIV-infected patients negative for hepatitis B surface antigen and hepatitis C antibody in the Penn Center for AIDS Research Adult/Adolescent Database. Clinical and laboratory data were collected from the database at enrollment. Hypothesized determinants of significant fibrosis were modifiable riskfactors associated with liver disease progression, hepatic fibrosis, or hepatotoxicity, including immune dysfunction (i.e., CD4 T lymphocyte count <200 cells/mm 3 , HIV viremia), diseases associated with hepatic steatosis (e.g., obesity, diabetes mellitus), and use of antiretroviral therapy. The primary outcome was an APRI score >1.5, which suggests significant hepatic fibrosis. Multivariable logistic regression identified independent riskfactors for significant fibrosis by APRI.
African and Asian origin, low CD4 cell count at HIV
diagnosis, lack of HAART and heterosexual and IDU route of HIV transmission were riskfactors for being diagnosed with TB. To our knowledge this study is the first to present a comprehensive, nationwide analysis of incidence, riskfactors of TB and prognosis of TB in HIV infected individuals. Further, the study design allowed long and nearly complete follow-up with the inclusion of only patients diagnosed with HIV in the study period after arrival to Denmark. Of importance our study population was incident concerning HIV and TB diagnosis.
This study investigated the long-term TB incidence and riskfactors among PLWHA in Germany. A specific fea- ture of the study is that it is not restricted to patients re- ceiving cART, but determines TB IDR and TB riskfactors also for patients who never started cART. The ClinSurv HIV Cohort used in this study is characterized by a long duration of follow-up and broad enrollment criteria of PLWHA irrespective of their age, disease stage or ART-status. Therefore, this instrument allowed us to calculate long-term TB incidence rate and to determine associated riskfactors with high precision and to update existing estimates . This enhances the generalizability of the study results to other coun- tries with low TB and HIV incidence.
Dear Dr. Kop,
Please find our enclosed manuscript, titled “Metabolic RiskFactors as Differential Predictors of Profiles of Neurocognitive Impairment Among Older HIV+ and HIV- Adults”, which we would like to submit for publication as an original article in Psychosomatic Medicine. In this study, latent class analysis was used to identify profiles of neurocognitive impairment (NCI) among older persons living with HIV (PLWH) and HIV-uninfected adults. Furthermore, metabolic riskfactors were examined as predictors of these profiles of NCI. We identified three patterns of NCI and PLWH were more likely to be classified as having extensive global NCI. Additionally, among PLWH, those with metabolic riskfactors (dyslipidemia, central obesity, and hypertension) had greater odds of classification in this class characterized by extensive NCI. Lastly, regardless of HIV status, individuals with diabetes were also more likely to have extensive NCI.
The Korea HIV/AIDS Cohort Study is a multicenter prospec- tive cohort study with ongoing enrollment of HIV-infected pa- tients from 19 hospitals in South Korea. At the time of registra- tion, the enrolled participants are interviewed by a trained clinical researcher and baseline information on clinical and epidemiological data is collected using a standardized proto- col . Information on medical history, physical findings, and laboratory findings, including immunological and virological status, is collected every 6 months. This was a cross-sectional point prevalence study. We performed a case–control study with 1,218 HIV-infected patients older than 18 years who were enrolled from December 2006 to July 2013. To evaluate the prevalence and riskfactors of renal insufficiency, we investi- gated baseline data at the time of registration in the Korea HIV/AIDS Cohort Study.