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HIV Seropositivity: HELP
Articles from Ontario
Based on 82 articles published since 2008
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These are the 82 published articles about HIV Seropositivity that originated from Ontario during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Editorial Disclosure of positive HIV status: a public health issue? 2013

Remis, Robert. ·University of Toronto. editor@cpha.ca. ·Can J Public Health · Pubmed #24183174.

ABSTRACT: -- No abstract --

2 Review Contraceptive options for HIV-positive women: making evidence-based, patient-centred decisions. 2015

Sharma, M / Walmsley, S L. ·Division of Infectious Diseases, University of Toronto, Toronto, Canada. · Division of Experimental Therapeutics - Infection and Immunity, Toronto General Research Institute, Toronto, Canada. ·HIV Med · Pubmed #25689044.

ABSTRACT: OBJECTIVES: Women of reproductive age represent a large proportion of the global population living with HIV/AIDS. With improvements in morbidity and mortality since the advent of combination antiretroviral therapy, contraception and pregnancy planning are an increasingly important issue for women living with HIV. This review aims to outline the key considerations when choosing contraceptive methods in HIV-positive women and provides a review of the literature to inform decision-making. METHODS: Pubmed was searched using the terms 'HIV', 'contraception', 'HIV progression', 'HIV acquisition', 'HIV transmission' and the combination of 'antiretroviral' and 'contraception'. Abstracts were reviewed and relevant articles were retrieved. Reference lists were also reviewed for pertinent citations. RESULTS: HIV and contraceptive methods can interact in several clinically meaningful ways. Concomitant use may result in altered contraceptive efficacy, drug-drug interactions, or increased toxicity. Hormonal contraceptives have not been shown to affect HIV progression. Notably, the impact of hormonal contraceptives on HIV transmission and acquisition remains unclear, particularly for injectable forms. Data are lacking on several newer methods of contraception including contraceptive rings, patches and intrauterine systems. CONCLUSIONS: Effective, reliable contraception is important for HIV-positive women. Efficacy, toxicity, drug interactions, and potential impacts on HIV disease progression, transmission, and acquisition must be assessed when making clinical decisions.

3 Review Probability of a false-negative HIV antibody test result during the window period: a tool for pre- and post-test counselling. 2015

Taylor, Darlene / Durigon, Monica / Davis, Heather / Archibald, Chris / Konrad, Bernhard / Coombs, Daniel / Gilbert, Mark / Cook, Darrel / Krajden, Mel / Wong, Tom / Ogilvie, Gina. ·British Columbia Centre for Disease Control, Vancouver, BC, Canada School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada Darlene.taylor@bccd.ca. · British Columbia Centre for Disease Control, Vancouver, BC, Canada. · Alberta Health Services, Edmonton, AB, Canada. · Public Health Agency of Canada, Ottawa, ON, Canada. · School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. · British Columbia Centre for Disease Control, Vancouver, BC, Canada School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. · British Columbia Centre for Disease Control, Vancouver, BC, Canada BCCDC Public Health Microbiology and Reference Laboratory, Vancouver, BC, Canada. · British Columbia Centre for Disease Control, Vancouver, BC, Canada BCCDC Public Health Microbiology and Reference Laboratory, Vancouver, BC, Canada Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada. · British Columbia Centre for Disease Control, Vancouver, BC, Canada Family Practice, University of British Columiba, Vancouver, BC, Canada. ·Int J STD AIDS · Pubmed #25033879.

ABSTRACT: Failure to understand the risk of false-negative HIV test results during the window period results in anxiety. Patients typically want accurate test results as soon as possible while clinicians prefer to wait until the probability of a false-negative is virtually nil. This review summarizes the median window periods for third-generation antibody and fourth-generation HIV tests and provides the probability of a false-negative result for various days post-exposure. Data were extracted from published seroconversion panels. A 10-day eclipse period was used to estimate days from infection to first detection of HIV RNA. Median (interquartile range) days to seroconversion were calculated and probabilities of a false-negative result at various time periods post-exposure are reported. The median (interquartile range) window period for third-generation tests was 22 days (19-25) and 18 days (16-24) for fourth-generation tests. The probability of a false-negative result is 0.01 at 80 days' post-exposure for third-generation tests and at 42 days for fourth-generation tests. The table of probabilities of falsely-negative HIV test results may be useful during pre- and post-test HIV counselling to inform co-decision making regarding the ideal time to test for HIV.

4 Review Drug interactions between antiretrovirals and hormonal contraceptives. 2013

Tseng, Alice / Hills-Nieminen, Cara. ·University of Toronto, Toronto General Hospital, Faculty of Pharmacy, Toronto, ON, Canada. alice.tseng@uhn.ca ·Expert Opin Drug Metab Toxicol · Pubmed #23425052.

ABSTRACT: INTRODUCTION: Significant advances in antiretroviral therapy have transformed HIV into a chronic manageable disease, and millions of women living with HIV now have the opportunity to reconsider their reproductive choices, be it contraception or pregnancy planning. Hormonal contraceptives are metabolized by cytochrome P450 isoenzymes and sulfate and glucuronide conjugation in the liver. Many antiretrovirals have inducing or inhibiting effects on the cytochrome P450 system. As such, the pharmacokinetics of hormonal contraceptives can be affected by antiretroviral therapy with potential for significant clinical impact. AREAS COVERED: This article presents the pharmacology and metabolism of selected antiretrovirals and hormonal contraceptives, and highlights the potential interactions between these two classes of drugs. Furthermore, the authors present the pharmacokinetic evidence of interactions from available clinical trials, product monographs, and international conference abstracts. EXPERT OPINION: Drugs most likely to interact with combined oral contraceptives, transdermal and implant contraceptives include protease inhibitors, the NNRTIs efavirenz and nevirapine, and cobicistat-boosted elvitegravir. There do not appear to be significant pharmacokinetic interactions with depo-medroxyprogesterone or intrauterine systems and antiretrovirals, although further study is needed. Clinicians working with HIV-positive women need to know the significance of these interactions in order to properly counsel patients and prevent unplanned pregnancies.

5 Review Systematic review of HIV transmission between heterosexual serodiscordant couples where the HIV-positive partner is fully suppressed on antiretroviral therapy. 2013

Loutfy, Mona R / Wu, Wei / Letchumanan, Michelle / Bondy, Lise / Antoniou, Tony / Margolese, Shari / Zhang, Yimeng / Rueda, Sergio / McGee, Frank / Peck, Ryan / Binder, Louise / Allard, Patricia / Rourke, Sean B / Rochon, Paula A. ·Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada. mona.loutfy@wchospital.ca ·PLoS One · Pubmed #23418455.

ABSTRACT: BACKGROUND: The risk of sexual HIV transmission in serodiscordant couples when the HIV-positive partner has full virologic suppression on combination antiretroviral therapy (cART) is debated. This study aims to systematically review observational studies and randomized controlled trials (RCTs), evaluating rates of sexual HIV transmission between heterosexual serodiscordant couples when the HIV-positive partner has full suppression on cART. METHODS AND FINDINGS: We searched major bibliographic databases to November 2012 for relevant observational studies and RCTs without language restrictions. Conference proceedings, key journals and bibliographies were also searched. Studies reporting HIV transmission rates, cART histories and viral loads of the HIV-positive partners were included. Two reviewers extracted methodologic characteristics and outcomes. Of 20,252 citations, 3 studies met all eligibility criteria with confirmed full virologic suppression in the HIV-positive partner. We included 3 additional studies (2 cohort studies, 1 RCT) that did not confirm viral suppression in the HIV-positive partner at transmission in a secondary meta-analysis. Methodologic quality was reasonable. The rate of transmission in the 3 studies confirming virologic suppression was 0 per 100 person-years (95% CI = 0-0.05), with low heterogeneity (I(2) = 0%). When we included the 3 studies that did not confirm virologic suppression, the rate of transmission was 0.14 per 100 person-years (95%CI = 0.04-0.31) (I(2) = 0%). In a sensitivity analysis including all 6 studies, the rate of transmission was 0 per 100 person-years (95%CI = 0-0.01) after omitting all transmissions with known detectable or unconfirmed viral loads, as full suppression in these cases was unlikely. Limitations included lack of data on same-sex couples, type of sexual intercourse (vaginal vs. anal), direction of HIV transmission, exact viral load at the time of transmission, sexually transmitted infections (STI) rates, and extent of condom use. CONCLUSIONS: Our findings suggest minimal risk of sexual HIV transmission for heterosexual serodiscordant couples when the HIV-positive partner has full viral suppression on cART with caveats regarding information on sexual intercourse type, STIs, and condom use. These findings have implications when counseling heterosexual serodiscordant couples on sexual and reproductive health. More research is needed to explore HIV transmission risk between same-sex couples.

6 Review A review of reproductive health research, guidelines and related gaps for women living with HIV. 2013

Loutfy, Mona R / Sonnenberg-Schwan, Ulrike / Margolese, Shari / Sherr, Lorraine / Anonymous1701005. ·Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada. mona.loutfy@wchospital.ca ·AIDS Care · Pubmed #23088551.

ABSTRACT: The study of pregnancy and motherhood in women living with HIV (WLWH) has concentrated on the health of the unborn baby and the prevention of mother-to-child transmission, whereas consideration of the broader aspects of women's reproductive health has been largely overlooked. The rights of WLWH with respect to their reproductive health should be exactly the same as non-HIV-positive women, however, inequalities exist due to discrimination and also because the treatment guidelines used in the care of women are often based on insufficient evidence. The purpose of this article is to review the available literature on reproductive health issues for WLWH and to identify gaps requiring further investigation. Our review indicates that further research is warranted into a number of aspects of reproductive health among WLWH. Currently, access to the relevant reproductive health resources and services, such as advice on contraception and fertility services, for WLWH is far from optimal in many developed countries and most developing countries. More data are needed on the most appropriate family planning options with the consideration of drug interactions between contraceptives and antiretroviral therapy and the risk of HIV transmission. Also, more research is needed to improve understanding of the maternal health challenges facing WLWH. Similarly, our understanding of the impact of HIV on the physical and emotional health of pregnant women and new mothers is far from complete. Answering these questions and countering these inequalities will help to ensure the reproductive health and child-bearing intentions of WLWH become an integral part of HIV medicine.

7 Review Male sex and the risk of mortality among individuals enrolled in antiretroviral therapy programs in Africa: a systematic review and meta-analysis. 2013

Druyts, Eric / Dybul, Mark / Kanters, Steve / Nachega, Jean / Birungi, Josephine / Ford, Nathan / Thorlund, Kristian / Negin, Joel / Lester, Richard / Yaya, Sanni / Mills, Edward J. ·Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada. ·AIDS · Pubmed #22948271.

ABSTRACT: BACKGROUND: HIV/AIDS has historically had a sex and gender-focused approach to prevention and care. Some evidence suggests that HIV-positive men have worse treatment outcomes than their women counterparts in Africa. METHODS: We conducted a systematic review and meta-analysis of the effect of sex on the risk of death among participants enrolled in antiretroviral therapy (ART) programs in Africa since the rapid scale-up of ART. We included all cohort studies evaluating the effect of sex (male, female) on the risk of death among participants enrolled in regional and national ART programs in Africa. We identified these studies by searching MedLine, EMBASE, and Cochrane CENTRAL. We used a DerSimonian-Laird random-effects method to pool the proportions of men receiving ART and the hazard ratios for death by sex. RESULTS: Twenty-three cohort studies, including 216 008 participants (79 892 men) contributed to our analysis. The pooled proportion of men receiving ART was 35% [95% confidence interval (CI): 33-38%]. The pooled hazard ratio estimate indicated a significant increase in the risk of death for men when compared to women [hazard ratio: 1.37 (95% CI: 1.28-1.47)]. This was consistent across sensitivity analyses. INTERPRETATION: The proportion of men enrolled in ART programs in Africa is lower than women. Additionally, there is an increased risk of death for men enrolled in ART programs. Solutions that aid in reducing these sex inequities are needed.

8 Review A systematic review and meta-analysis of risk factors for sexual transmission of HIV in India. 2012

Arora, Paul / Nagelkerke, Nico J D / Jha, Prabhat. ·Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. paul.arora@mail.utoronto.ca ·PLoS One · Pubmed #22937158.

ABSTRACT: BACKGROUND: Approximately 2.4 million people are living with HIV in India. This large disease burden, and potential for epidemic spread in some areas, demands a full understanding of transmission in that country. We wished to quantify the effects of key sexual risk factors for HIV infection for each gender and among high- and low-HIV risk populations in India. METHODOLOGY: We conducted a systematic review of sexual risk factors for HIV infection from 35 published studies. Risk factors analyzed were: male circumcision/religion, Herpes Simplex Virus 2, syphilis, gonorrhoea, genital ulcer, multiple sexual partners and commercial sex. Studies were included if they met predetermined criteria. Data were extracted and checked by two researchers and random-effects meta analysis of effects was conducted. Heterogeneity in effect estimates was examined by I(2) statistic. Publication bias was tested by Begg's test and funnel plots. Meta regression was used to assess effect modification by various study attributes. RESULTS: All risk factors were significantly associated with HIV status. The factor most strongly associated with HIV for both sexes was HSV-2 infection (OR(men): 5.87; 95%CI: 2.46-14.03; OR(women): 6.44; 95%CI: 3.22-12.86). The effect of multiple sexual partners was similar among men (OR = 2.46; 95%CI: 1.91-3.17,) and women (OR = 2.02; 95%CI: 1.43-2.87) and when further stratified by HIV-risk group. The association between HSV-2 and HIV prevalence was consistently stronger than other STIs or self-reported genital ulcer. If the strong associations between HSV-2 and HIV were interpreted causally, these results implied that approximately half of the HIV infections observed in our study population were attributable to HSV-2 infection. CONCLUSIONS: The risk factors examined in our analysis should remain targets of HIV prevention programs. Our results confirm that sexual risk factors for HIV infection continue to be an important part of Indian HIV epidemic 26 years after it began.

9 Review The association of hospital, clinic and provider volume with HIV/AIDS care and mortality: systematic review and meta-analysis. 2012

Handford, Curtis D / Rackal, Julia M / Tynan, Anne-Marie / Rzeznikiewiz, Damian / Glazier, Richard H. ·Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada. handfordc@smh.ca ·AIDS Care · Pubmed #22007914.

ABSTRACT: The objective of this systematic review and meta-analysis is to examine the association between hospital, clinic and provider patient volumes on HIV/AIDS patient outcomes including mortality, antiretroviral (ARV) use and proportion of patients on indicated opportunistic infection (OI) prophylaxis. We searched MEDLINE and nine other electronic databases from 1 January 1980 through 29 May 2009. Experimental and controlled observational studies of persons with HIV/AIDS were included. Studies examined the volume or concentration of patients with HIV/AIDS in hospitals, clinics or individual providers. Outcomes included mortality, ARV use and proportion of patients on indicated OI prophylaxis. We reviewed 22,692 titles and/or abstracts. Patient characteristics, study design, volume measures, medical outcomes and study confounders were abstracted. Data were extracted independently by two reviewers. Twenty-two studies were included in the final review. High volume hospital care was associated with lower in-hospital mortality (pooled odds ratio (OR) 0.71, 95% confidence interval [CI] 0.57-0.90 p = 0.004) and lower mortality 30 days from admission (pooled OR 0.62, 95% CI 0.47-0.81 p = 0.0004). Higher volume provider care was associated with significantly higher ARV use (pooled OR 4.41, 95% CI 2.70-7.18 p<0.00001). Differences in volume definitions and controlling for confounding variables did not appreciably alter the results. Higher volume hospitals, clinics and providers were associated with significantly decreased mortality for people living with HIV/AIDS and higher volume providers and clinics had higher ARV use. Heterogeneity of volume thresholds and absence of studies from resource-limited settings are major limitations.

10 Review Failures in interpersonal psychotherapy (IPT): factors related to treatment resistances. 2011

Ravitz, Paula / McBride, Carolina / Maunder, Robert. ·University of Toronto, Joseph and Wolf Lebovic Health Complex, Mt. Sinai Hospital, Department of Psychiatry, 600 University Avenue, room 930, Toronto, Canada. pravitz@mtsinai.on.ca ·J Clin Psychol · Pubmed #21968699.

ABSTRACT: Interpersonal psychotherapy (IPT) is an effective treatment for depression across the lifespan and across cultures. However, even when delivered with fidelity, some patients drop out and others do not improve sufficiently. Attention to IPT treatment attrition, dropout, nonresponse, or failure can elucidate its limitations and the opportunities to improve its effectiveness. Studies of factors known to moderate and negatively predict IPT depression treatment response are reviewed along with recommended modifications to improve outcomes. Although the risk of treatment failure always exists, it is possible to enhance treatment effectiveness by attending to the therapeutic alliance, strategically addressing depression, and adapting IPT to patient characteristics. These include adding pharmacotherapy, extending the course of treatment, and targeting specific symptoms or interpersonal vulnerabilities. Case examples illustrate several of these points.

11 Clinical Trial Penile Anaerobic Dysbiosis as a Risk Factor for HIV Infection. 2017

Liu, Cindy M / Prodger, Jessica L / Tobian, Aaron A R / Abraham, Alison G / Kigozi, Godfrey / Hungate, Bruce A / Aziz, Maliha / Nalugoda, Fred / Sariya, Sanjeev / Serwadda, David / Kaul, Rupert / Gray, Ronald H / Price, Lance B. ·Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA cindyliu@gwu.edu. · Center for Microbiomics and Human Health, Division of Pathogen Genomics, Translational Genomics Research Institute, Flagstaff, Arizona, USA. · National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA. · Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. · Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. · Rakai Health Sciences Program, Entebbe, Uganda. · Department of Ophthalmology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. · Department of Biological Sciences, Center for Ecosystem Science and Society, Northern Arizona University, Flagstaff, Arizona, USA. · Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. · Department of Medicine, University of Toronto, Toronto, Canada. ·MBio · Pubmed #28743816.

ABSTRACT: Sexual transmission of HIV requires exposure to the virus and infection of activated mucosal immune cells, specifically CD4

12 Clinical Trial A Pilot Trial of a Sexual Health Counseling Intervention for HIV-Positive Gay and Bisexual Men Who Report Anal Sex without Condoms. 2016

Hart, Trevor A / Stratton, Natalie / Coleman, Todd A / Wilson, Holly A / Simpson, Scott H / Julien, Rick E / Hoe, David / Leahy, Bob / Maxwell, John / Adam, Barry D. ·Department of Psychology, Ryerson University, Toronto, Ontario, Canada. · Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. · AIDS Committee of Toronto, Toronto, Ontario, Canada. · Poz Prevention Working Group, Gay Men's Sexual Health Alliance, Toronto, Ontario, Canada. · Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, Ontario, Canada. · Ontario HIV Treatment Network, Toronto, Ontario, Canada. ·PLoS One · Pubmed #27054341.

ABSTRACT: BACKGROUND: Even in the presence of promising biomedical treatment as prevention, HIV incidence among men who have sex with men has not always decreased. Counseling interventions, therefore, continue to play an important role in reducing HIV sexual transmission behaviors among gay and bisexual men and other men who have sex with men. The present study evaluated effects of a small-group counseling intervention on psychosocial outcomes and HIV sexual risk behavior. METHOD: HIV-positive (HIV+) peer counselors administered seven 2-hour counseling sessions to groups of 5 to 8 HIV+ gay and bisexual men. The intervention employed information provision, motivational interviewing, and behavioral skills building to reduce sexual transmission risk behaviors. RESULTS: There was a significant reduction in condomless anal sex (CAS) with HIV-negative and unknown HIV-status partners, from 50.0% at baseline to 28.9% of the sample at 3-month follow-up. Findings were robust even when controlling for whether the participant had an undetectable viral load at baseline. Significant reductions were also found in the two secondary psychosocial outcomes, loneliness and sexual compulsivity. CONCLUSIONS: The findings provide preliminary evidence that this intervention may offer an efficient way of concurrently reducing CAS and mental health problems, such as sexual compulsivity and loneliness, for HIV+ gay and bisexual men. TRIAL REGISTRATION: ClinicalTrials.gov NCT02546271.

13 Clinical Trial Safety and tolerability of varenicline tartrate (Champix(®)/Chantix(®)) for smoking cessation in HIV-infected subjects: a pilot open-label study. 2012

Cui, Qu / Robinson, Linda / Elston, Dawn / Smaill, Fiona / Cohen, Jeffrey / Quan, Corinna / McFarland, Nancy / Thabane, Lehana / McIvor, Andrew / Zeidler, Johannes / Smieja, Marek. ·Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. cuiq2@mcmaster.ca ·AIDS Patient Care STDS · Pubmed #22007690.

ABSTRACT: The prevalence of smoking in HIV-infected subjects is high. As a smoking cessation aid, varenicline (Champix(®), Pfizer, Saint-Laurent, QC, Canada or Chantix(®), Pfizer, Mission, KS) has not been previously evaluated in HIV-infected smokers. In this multicenter pilot open label study, varenicline 1.0 mg was used twice daily for 12 weeks with dose titration in the first week. Adverse events (AEs) during the treatment period were recorded. Changes from baseline in laboratory tests, vital signs, daily cigarette consumption, nicotine dependence, and withdrawal were measured through week 24. Self-reported abstinence was validated by serum cotinine at week 12. We enrolled 36 subjects with a mean of 29 pack-years of smoking and a minimum of 4 cigarettes per day. All but 1 were male, 33 (92%) were white. The most frequently reported AEs were nausea (33%), abnormal dreams (31%), affect lability (19%), and insomnia (19%). Six (17%) subjects discontinued varenicline due to AEs. No grade 3/4 laboratory abnormalities or serious AEs occurred during the study. There was no significant change in HIV viral load. CD4 counts increased by 69 cells/mm3 (p = 0.001) at week 24. Serum cotinine-verified 4-week continuous abstinence rate through weeks 9-12 was 42% (95% confidence interval [CI]: 26-58%). AEs and abstinence rates were comparable to those in published randomized controlled trials conducted in generally healthy HIV-negative smokers. Varenicline was safe and appears effective among HIV-infected smokers in this exploratory study, although AEs were common. The most common AE was nausea, with no adverse effect on HIV treatment outcome. Close monitoring of liver enzymes and blood pressure is recommended for HIV-positive smokers taking varenicline.

14 Clinical Trial Allogeneic hematopoietic cell transplantation in human immunodeficiency virus-positive patients with hematologic disorders: a report from the center for international blood and marrow transplant research. 2009

Gupta, Vikas / Tomblyn, Marcie / Pedersen, Tanya L / Atkins, Harry L / Battiwalla, Minoo / Gress, Ronald E / Pollack, Marilyn S / Storek, Jan / Thompson, Jill C / Tiberghien, Pierre / Young, Jo-Anne H / Ribaud, Patricia / Horowitz, Mary M / Keating, Armand. ·Division of Haematology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada. vikas.gupta@uhn.on.ca ·Biol Blood Marrow Transplant · Pubmed #19539219.

ABSTRACT: The role of allogeneic hematopoietic cell transplantation (alloHCT) in human immunodeficiency virus (HIV)-positive patients is not known. Using the Center for International Blood and Marrow Transplant Research database, we retrospectively evaluated 23 HIV-positive patients undergoing matched sibling donor (n = 19) or unrelated donor (n = 4) alloHCT between 1987 and 2003. The median age at alloHCT was 32 years. Indications for alloHCT were diverse and included malignant (n = 21) and nonmalignant (n = 2) hematologic disorders. Nine patients (39%) underwent transplantation after 1996, the approximate year that highly active antiretroviral therapy became standard treatment. The median time to neutrophil engraftment was 16 days (range, 7 to 30 days), and the cumulative incidences of grade II-IV acute graft-versus-host disease (aGVHD) at 100 days, chronic GVHD (cGVHD), and survival at 2 years were 30% (95% confidence interval [CI] = 14% to 50%), 28% (95% CI = 12% to 48%), and 30% (95% CI = 14% to 50%), respectively. At a median follow-up of 59 months, 6 patients were alive. Survival appears to be better in the patients undergoing alloHCT after 1996; 4 of these 9 patients survived, compared with only 2 of 14 those undergoing transplantation before 1996. These data suggest that alloHCT is feasible for selected HIV-positive patients with malignant and nonmalignant disorders. Prospective studies are needed to evaluate the safety and efficacy of this modality in specific diseases in these patients.

15 Article A longitudinal analysis of cannabis use and mental health symptoms among gay, bisexual, and other men who have sex with men in Vancouver, Canada. 2019

Chou, Frank Y / Armstrong, Heather L / Wang, Lu / Bacani, Nicanor / Lachowsky, Nathan J / Patterson, Thomas L / Walsh, Zach / Olarewaju, Gbolahan / Card, Kiffer G / Roth, Eric A / Hogg, Robert S / Moore, David M. ·BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Queen's University, Kingston, Ontario, Canada. · BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. Electronic address: harmstrong@cfenet.ubc.ca. · BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. · BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; University of Victoria, Victoria, BC, Canada. · University of California, San Diego, San Diego, CA, United States. · Department of Psychology, University of British Columbia, Kelowna, BC, Canada. · University of Victoria, Victoria, BC, Canada. · BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Simon Fraser University, Burnaby, BC, Canada. · BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. ·J Affect Disord · Pubmed #30665075.

ABSTRACT: BACKGROUND: Cannabis use, anxiety, and depression are common among gay, bisexual, and other men who have sex with men (gbMSM) and some report using cannabis to manage mental health symptoms. METHODS: Sexually-active gbMSM aged ≥16 years were recruited into a longitudinal cohort through respondent-driven sampling and completed study visits every six months. Data on demographics, drug use, and anxiety and depression symptoms were collected via a self-administered computer-based survey. A study nurse determined previous mental health diagnoses and treatment. Using multivariable generalized linear mixed models, we examined factors associated with regular cannabis use (≥weekly in the previous 3 months) and, among individuals who reported anxiety or depression/bipolar diagnoses, factors associated with moderate/severe anxiety or depression symptoms. RESULTS: Of 774 participants (551 HIV-negative, 223 HIV-seropositive), 250 (32.3%) reported regular cannabis use, 200 (26.4%) reported ever being diagnosed with anxiety, and 299 (39.3%) reported ever being diagnosed with depression or bipolar disorder at baseline. Regular cannabis use was positively associated with HIV-seropositivity (aOR = 2.23, 95%CI:1.40-3.54) and previous mental health diagnosis (aOR = 1.52, 95%CI: 1.00-2.31, p = 0.05). Among those previously diagnosed with anxiety or depression/bipolar disorder, regular cannabis use was not associated with moderate/severe anxiety (aOR = 1.16, 95%CI:0.69-1.94) or depression symptoms (aOR = 0.96, 95%CI:0.59-1.58), respectively. LIMITATIONS: Because of observational study design, we are unable to determine absolute effect. CONCLUSIONS: Regular cannabis use was more likely among HIV-positive gbMSM and those previously diagnosed with a mental health disorder. No association was found between regular cannabis use and severity of anxious or depressive symptoms among those diagnosed with these conditions.

16 Article Antiretroviral resistance testing in HIV-positive people. 2018

Aves, Theresa / Tambe, Joshua / Siemieniuk, Reed Ac / Mbuagbaw, Lawrence. ·Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario, Canada, L8S 4L8. ·Cochrane Database Syst Rev · Pubmed #30411789.

ABSTRACT: BACKGROUND: Resistance to antiretroviral therapy (ART) among people living with human immunodeficiency virus (HIV) compromises treatment effectiveness, often leading to virological failure and mortality. Antiretroviral drug resistance tests may be used at the time of initiation of therapy, or when treatment failure occurs, to inform the choice of ART regimen. Resistance tests (genotypic or phenotypic) are widely used in high-income countries, but not in resource-limited settings. This systematic review summarizes the relative merits of resistance testing in treatment-naive and treatment-exposed people living with HIV. OBJECTIVES: To evaluate the effectiveness of antiretroviral resistance testing (genotypic or phenotypic) in reducing mortality and morbidity in HIV-positive people. SEARCH METHODS: We attempted to identify all relevant studies, regardless of language or publication status, through searches of electronic databases and conference proceedings up to 26 January 2018. We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov to 26 January 2018. We searched Latin American and Caribbean Health Sciences Literature (LILACS) and the Web of Science for publications from 1996 to 26 January 2018. SELECTION CRITERIA: We included all randomized controlled trials (RCTs) and observational studies that compared resistance testing to no resistance testing in people with HIV irrespective of their exposure to ART.Primary outcomes of interest were mortality and virological failure. Secondary outcomes were change in mean CD4-T-lymphocyte count, clinical progression to AIDS, development of a second or new opportunistic infection, change in viral load, and quality of life. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed each reference for prespecified inclusion criteria. Two review authors then independently extracted data from each included study using a standardized data extraction form. We analysed data on an intention-to-treat basis using a random-effects model. We performed subgroup analyses for the type of resistance test used (phenotypic or genotypic), use of expert advice to interpret resistance tests, and age (children and adolescents versus adults). We followed standard Cochrane methodological procedures. MAIN RESULTS: Eleven RCTs (published between 1999 and 2006), which included 2531 participants, met our inclusion criteria. All of these trials exclusively enrolled patients who had previous exposure to ART. We found no observational studies. Length of follow-up time, study settings, and types of resistance testing varied greatly. Follow-up ranged from 12 to 150 weeks. All studies were conducted in Europe, USA, or South America. Seven studies used genotypic testing, two used phenotypic testing, and two used both phenotypic and genotypic testing. Only one study was funded by a manufacturer of resistance tests.Resistance testing made little or no difference in mortality (odds ratio (OR) 0.89, 95% confidence interval (CI) 0.36 to 2.22; 5 trials, 1140 participants; moderate-certainty evidence), and may have slightly reduced the number of people with virological failure (OR 0.70, 95% CI 0.56 to 0.87; 10 trials, 1728 participants; low-certainty evidence); and probably made little or no difference in change in CD4 cell count (mean difference (MD) -1.00 cells/mm³, 95% CI -12.49 to 10.50; 7 trials, 1349 participants; moderate-certainty evidence) or progression to AIDS (OR 0.64, 95% CI 0.31 to 1.29; 3 trials, 809 participants; moderate-certainty evidence). Resistance testing made little or no difference in adverse events (OR 0.89, 95% CI 0.51 to 1.55; 4 trials, 808 participants; low-certainty evidence) and probably reduced viral load (MD -0.23, 95% CI -0.35 to -0.11; 10 trials, 1837 participants; moderate-certainty evidence). No studies reported on development of new opportunistic infections or quality of life. We found no statistically significant heterogeneity for any outcomes, and the I² statistic value ranged from 0 to 25%. We found no subgroup effects for types of resistance testing (genotypic versus phenotypic), the addition of expert advice to interpretation of resistance tests, or age. Results for mortality were consistent when we compared studies at high or unclear risk of bias versus studies at low risk of bias. AUTHORS' CONCLUSIONS: Resistance testing probably improved virological outcomes in people who have had virological failure in trials conducted 12 or more years ago. We found no evidence in treatment-naive people. Resistance testing did not demonstrate important patient benefits in terms of risk of death or progression to AIDS. The trials included very few participants from low- and middle-income countries.

17 Article Antifungal Combinations for Treatment of Cryptococcal Meningitis in Africa. 2018

Molloy, Síle F / Kanyama, Cecilia / Heyderman, Robert S / Loyse, Angela / Kouanfack, Charles / Chanda, Duncan / Mfinanga, Sayoki / Temfack, Elvis / Lakhi, Shabir / Lesikari, Sokoine / Chan, Adrienne K / Stone, Neil / Kalata, Newton / Karunaharan, Natasha / Gaskell, Kate / Peirse, Mary / Ellis, Jayne / Chawinga, Chimwemwe / Lontsi, Sandrine / Ndong, Jean-Gilbert / Bright, Philip / Lupiya, Duncan / Chen, Tao / Bradley, John / Adams, Jack / van der Horst, Charles / van Oosterhout, Joep J / Sini, Victor / Mapoure, Yacouba N / Mwaba, Peter / Bicanic, Tihana / Lalloo, David G / Wang, Duolao / Hosseinipour, Mina C / Lortholary, Olivier / Jaffar, Shabbar / Harrison, Thomas S / Anonymous1461061. ·From the Centre for Global Health, Institute for Infection and Immunity, St. George's University of London (S.F.M., A.L., N.S., N. Karunaharan, J.A., T.B., T.S.H.), University College London (R.S.H.), and the MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine (J.B.), London, and Liverpool School of Tropical Medicine, Liverpool (T.C., D.G.L., D.W., S.J.) - all in the United Kingdom · the University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe (C. Kanyama, C.C., C.H., M.C.H.), Malawi-Liverpool-Wellcome Trust Clinical Research Programme (R.S.H., N. Kalata, K.G., M.P., J.E.) and the College of Medicine, University of Malawi (R.S.H., N. Kalata, K.G., M.P., J.E., J.J.O.), Blantyre, and Dignitas International, Zomba Central Hospital, Zomba (A.K.C., P.B., D.L., J.J.O.) - all in Malawi · University of Dschang, Dschang (C. Kouanfack), Hôpital Central Yaoundé/Site Agence Nationale de Recherche sur le Sida (ANRS) Cameroun, Yaoundé (C. Kouanfack, S. Lontsi, J.-G.N., V.S.), and Douala General Hospital (E.T., Y.N.M.) and University of Douala (Y.N.M.), Douala - all in Cameroon · the Institute for Medical Research and Training (D.C., N.S., N. Karunaharan, P.B.), University Teaching Hospital (D.C., S. Lakhi, N.S., N. Karunaharan, P.B.), and the Department of Internal Medicine and Directorate of Research and Postgraduate Studies, Lusaka Apex Medical University (P.M.), Lusaka, Zambia · the National Institute for Medical Research, Muhimbili Medical Research Centre, Dar Es Salaam, Tanzania (S.M., S. Lesikari) · Institut Pasteur, Molecular Mycology Unit (E.T., O.L.), and Paris Descartes University, Necker Pasteur Center for Infectious Diseases and Tropical Medicine, IHU Imagine, Assistance Publique-Hôpitaux de Paris (O.L.), Paris · the Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto (A.K.C.) · and the University of North Carolina, Chapel Hill (C.H., M.C.H.). ·N Engl J Med · Pubmed #29539274.

ABSTRACT: BACKGROUND: Cryptococcal meningitis accounts for more than 100,000 human immunodeficiency virus (HIV)-related deaths per year. We tested two treatment strategies that could be more sustainable in Africa than the standard of 2 weeks of amphotericin B plus flucytosine and more effective than the widely used fluconazole monotherapy. METHODS: We randomly assigned HIV-infected adults with cryptococcal meningitis to receive an oral regimen (fluconazole [1200 mg per day] plus flucytosine [100 mg per kilogram of body weight per day] for 2 weeks), 1 week of amphotericin B (1 mg per kilogram per day), or 2 weeks of amphotericin B (1 mg per kilogram per day). Each patient assigned to receive amphotericin B was also randomly assigned to receive fluconazole or flucytosine as a partner drug. After induction treatment, all the patients received fluconazole consolidation therapy and were followed to 10 weeks. RESULTS: A total of 721 patients underwent randomization. Mortality in the oral-regimen, 1-week amphotericin B, and 2-week amphotericin B groups was 18.2% (41 of 225), 21.9% (49 of 224), and 21.4% (49 of 229), respectively, at 2 weeks and was 35.1% (79 of 225), 36.2% (81 of 224), and 39.7% (91 of 229), respectively, at 10 weeks. The upper limit of the one-sided 97.5% confidence interval for the difference in 2-week mortality was 4.2 percentage points for the oral-regimen group versus the 2-week amphotericin B groups and 8.1 percentage points for the 1-week amphotericin B groups versus the 2-week amphotericin B groups, both of which were below the predefined 10-percentage-point noninferiority margin. As a partner drug with amphotericin B, flucytosine was superior to fluconazole (71 deaths [31.1%] vs. 101 deaths [45.0%]; hazard ratio for death at 10 weeks, 0.62; 95% confidence interval [CI], 0.45 to 0.84; P=0.002). One week of amphotericin B plus flucytosine was associated with the lowest 10-week mortality (24.2%; 95% CI, 16.2 to 32.1). Side effects, such as severe anemia, were more frequent with 2 weeks than with 1 week of amphotericin B or with the oral regimen. CONCLUSIONS: One week of amphotericin B plus flucytosine and 2 weeks of fluconazole plus flucytosine were effective as induction therapy for cryptococcal meningitis in resource-limited settings. (ACTA Current Controlled Trials number, ISRCTN45035509 .).

18 Article Higher sequence diversity in the vaginal tract than in blood at early HIV-1 infection. 2018

Klein, Katja / Nickel, Gabrielle / Nankya, Immaculate / Kyeyune, Fred / Demers, Korey / Ndashimye, Emmanuel / Kwok, Cynthia / Chen, Pai-Lien / Rwambuya, Sandra / Poon, Art / Munjoma, Marshall / Chipato, Tsungai / Byamugisha, Josaphat / Mugyenyi, Peter / Salata, Robert A / Morrison, Charles S / Arts, Eric J. ·Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada. · Department of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America. · Joint Clinical Research Centre, Kampala, Uganda. · FHI 360, Durham, North Carolina, United States of America. · Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada. · Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe. · Faculty of Medicine, Makerere University, Kampala, Uganda. ·PLoS Pathog · Pubmed #29346424.

ABSTRACT: In the majority of cases, human immunodeficiency virus type 1 (HIV-1) infection is transmitted through sexual intercourse. A single founder virus in the blood of the newly infected donor emerges from a genetic bottleneck, while in rarer instances multiple viruses are responsible for systemic infection. We sought to characterize the sequence diversity at early infection, between two distinct anatomical sites; the female reproductive tract vs. systemic compartment. We recruited 72 women from Uganda and Zimbabwe within seven months of HIV-1 infection. Using next generation deep sequencing, we analyzed the total genetic diversity within the C2-V3-C3 envelope region of HIV-1 isolated from the female genital tract at early infection and compared this to the diversity of HIV-1 in plasma. We then compared intra-patient viral diversity in matched cervical and blood samples with three or seven months post infection. Genetic analysis of the C2-V3-C3 region of HIV-1 env revealed that early HIV-1 isolates within blood displayed a more homogeneous genotype (mean 1.67 clones, range 1-5 clones) than clones in the female genital tract (mean 5.7 clones, range 3-10 clones) (p<0.0001). The higher env diversity observed within the genital tract compared to plasma was independent of HIV-1 subtype (A, C and D). Our analysis of early mucosal infections in women revealed high HIV-1 diversity in the vaginal tract but few transmitted clones in the blood. These novel in vivo finding suggest a possible mucosal sieve effect, leading to the establishment of a homogenous systemic infection.

19 Article Gender differences in health-related quality of life at the time of a positive HIV test - a cross-sectional study in a resource-poor, high prevalence setting in Nairobi, Kenya. 2018

van der Kop, Mia L / Muhula, Samuel / Patel, Anik / Thabane, Lehana / Awiti, Patricia / Kyomuhangi, Lennie / Abunah, Bonface / Nagide, Patrick I / Smillie, Kirsten / Ojakaa, David I / Kimani, Joshua / Ekström, Anna Mia / Lester, Richard T. ·a Department of Public Health Sciences/Global Health (IHCAR) , Karolinska Institutet , Stockholm , Sweden. · b Department of Medicine , University of British Columbia , Vancouver , Canada. · c Amref Health Africa , Nairobi , Kenya. · d Department of Clinical Epidemiology and Biostatistics , McMaster University , Hamilton , Canada. · e Brim Ltd , Nairobi , Kenya. · f Department of Medical Microbiology , University of Manitoba , Winnipeg , Canada. · g Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden. ·AIDS Care · Pubmed #29258342.

ABSTRACT: Few studies have examined gender differences in sub-Saharan Africa, where HIV disproportionately affects women. Objectives of this cross-sectional study were to determine gender differences in HRQoL at the time of a positive HIV test, and whether factors associated with HRQoL differed between men and women. Adults testing HIV-positive were recruited from two clinics located in informal settlements. HRQoL was measured with the SF-12. Multiple linear regression was used to test whether there were gender differences in physical (PCS) and mental composite summary (MCS) scores. Separate models were built for men and women to examine factors associated with HRQoL. Between April 2013 and June 2015, 775 individuals from were recruited. The mean PCS score was higher in women (adjusted mean difference 2.49, 95% CI 0.54 to 4.44, p = 0.012). There was no significant gender difference in MCS scores. Similar factors were associated with better physical HRQoL in men and women: secondary education, younger age, higher CD4, and employment. Employment was the only factor associated with MCS in men, while less social support and low CD4 were associated with poorer MCS scores in women. Gender differences in factors related to HRQoL should be considered in broader policy and interventions to improve the HRQoL in those diagnosed with HIV.

20 Article Condomless Sex Among Virally Suppressed Women With HIV With Regular HIV-Serodiscordant Sexual Partners in the Era of Treatment as Prevention. 2017

Patterson, Sophie / Carter, Allison / Nicholson, Valerie / Webster, Kath / Ding, Erin / Kestler, Mary / Ogilvie, Gina / de Pokomandy, Alexandra / Loutfy, Mona / Kaida, Angela. ·*Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada;†Department of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada;‡Oak Tree Clinic, British Columbia Women's Hospital and Healthcare Centre, Vancouver, British Columbia, Canada;§Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada;‖Chronic Viral Illness Service, McGill University Health Centre, Montreal, Québec, Canada;¶Department of Family Medicine, McGill University, Montreal, Québec, Canada;#Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; and**Department of Medicine, University of Toronto, Toronto, Ontario, Canada. ·J Acquir Immune Defic Syndr · Pubmed #29077673.

ABSTRACT: BACKGROUND: Sexual HIV transmission does not occur with sustained undetectable viral load (VL) on antiretroviral therapy (ART). Awareness of ART prevention benefits and its influence on condom use among women with HIV (WWH) remain unexplored. We estimated prevalence and correlates of condomless sex with regular HIV-serodiscordant partners among WWH with undetectable VL on ART. METHODS: We used baseline questionnaire data from the community-based longitudinal Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). We included WWH self-reporting vaginal/anal sex with ≥1 HIV-negative/unknown status regular partner within 6 months, and undetectable VL (<50 copies/mL) on ART. We excluded participants exclusively reporting female partners or missing condom-use data. Condomless sex was defined as <100% condom use within 6 months. The primary explanatory variable was awareness of ART prevention benefits. Logistic regression identified factors independently associated with condomless sex. RESULTS: Of 271 participants (19% of the CHIWOS cohort), median age was 41 (interquartile range: 34-47), 51% were in a relationship, 55% reported condomless sex, and 75% were aware of ART prevention benefits. Among women aware, 63% reported condomless sex compared with 32% of women not aware (P < 0.001). Factors independently associated with condomless sex included being aware of ART prevention benefits (adjusted odds ratio: 4.08; 95% confidence interval: 2.04 to 8.16), white ethnicity, ≥high-school education, residing in British Columbia, and being in a relationship. CONCLUSIONS: Virally suppressed women aware of ART prevention benefits had 4-fold greater odds of condomless sex. Advancing safer sex discussions beyond condoms is critical to support women in regular serodiscordant partnerships to realize options for safe and satisfying sexuality in the Treatment-as-Prevention era.

21 Article Consistent Condom Use with Paying and Nonpaying Partners among Female Sex Workers in Iran: Findings of a National Biobehavioral Survey. 2017

Karamouzian, Mohammad / Sadeghirad, Behnam / Sharifi, Hamid / Sedaghat, Abbas / Haghdoost, Ali Akbar / Mirzazadeh, Ali. ·1 HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. · 2 School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. · 3 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. · 4 Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran. · 5 Center for Disease Control (CDC), Ministry of Health and Medical Education, Tehran, Iran. · 6 Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. · 7 Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA. ·J Int Assoc Provid AIDS Care · Pubmed #28974161.

ABSTRACT: OBJECTIVES: Little is known about the dynamics of condom use among female sex workers (FSWs) in Iran. We investigated the correlates of consistent condom use (CCU) among FSWs, using data from a national biobehavioral surveillance survey in 2010. METHODS: A total of 872 FSWs were recruited using a facility-based sampling strategy from 21 sites in 13 cities in Iran. Data were collected through face-to-face interviews using a standardized questionnaire. RESULTS: Overall, 33.6% and 17.3% of FSWs reported CCU with paying and nonpaying sex partners, respectively. Consistent condom use with paying partners was significantly associated with temporary marriage, accessing family planning services and history of working in brothels. Conversely, temporary marriage or married status, condom rupture/slippage, and HIV seropositivity remained independently significantly associated with CCU with nonpaying sex partners. CONCLUSION: Our findings indicated the urgent need for scaling up condom promotion interventions catered toward FSWs and their sex partners to practice safe sex consistently.

22 Article Pregnancy incidence and intention after HIV diagnosis among women living with HIV in Canada. 2017

Salters, Kate / Loutfy, Mona / de Pokomandy, Alexandra / Money, Deborah / Pick, Neora / Wang, Lu / Jabbari, Shahab / Carter, Allison / Webster, Kath / Conway, Tracey / Dubuc, Daniele / O'Brien, Nadia / Proulx-Boucher, Karene / Kaida, Angela / Anonymous2351016. ·Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada. · British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada. · Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada. · Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada. · Department of Family Medicine, McGill University, Montreal, Quebec, Canada. · Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, Canada. · Faculty of Medicine, University of British Columbia, Vancouver, Canada. ·PLoS One · Pubmed #28727731.

ABSTRACT: BACKGROUND: Pregnancy incidence rates among women living with HIV (WLWH) have increased over time due to longer life expectancy, improved health status, and improved access to and HIV prevention benefits of combination antiretroviral therapy (cART). However, it is unclear whether intended or unintended pregnancies are contributing to observed increases. METHODS: We analyzed retrospective data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS). Kaplan-Meier methods and GEE Poisson models were used to measure cumulative incidence and incidence rate of pregnancy after HIV diagnosis overall, and by pregnancy intention. We used multivariable logistic regression models to examine independent correlates of unintended pregnancy among the most recent/current pregnancy. RESULTS: Of 1,165 WLWH included in this analysis, 278 (23.9%) women reported 492 pregnancies after HIV diagnosis, 60.8% of which were unintended. Unintended pregnancy incidence (24.6 per 1,000 Women-Years (WYs); 95% CI: 21.0, 28.7) was higher than intended pregnancy incidence (16.6 per 1,000 WYs; 95% CI: 13.8, 20.1) (Rate Ratio: 1.5, 95% CI: 1.2-1.8). Pregnancy incidence among WLWH who initiated cART before or during pregnancy (29.1 per 1000 WYs with 95% CI: 25.1, 33.8) was higher than among WLWH not on cART during pregnancy (11.9 per 1000 WYs; 95% CI: 9.5, 14.9) (Rate Ratio: 2.4, 95% CI: 2.0-3.0). Women with current or recent unintended pregnancy (vs. intended pregnancy) had higher adjusted odds of being single (AOR: 1.94; 95% CI: 1.10, 3.42), younger at time of conception (AOR: 0.95 per year increase, 95% CI: 0.90, 0.99), and being born in Canada (AOR: 2.76, 95% CI: 1.55, 4.92). CONCLUSION: Nearly one-quarter of women reported pregnancy after HIV diagnosis, with 61% of all pregnancies reported as unintended. Integrated HIV and reproductive health care programming is required to better support WLWH to optimize pregnancy planning and outcomes and to prevent unintended pregnancy.

23 Article Access to fertility services in Canada for HIV-positive individuals and couples: a comparison between 2007 and 2014. 2017

Lo, Carson K / Kennedy, V Logan / Yudin, Mark H / Shapiro, Heather M / Loutfy, Mona. ·a Department of Medicine , University of Toronto , Toronto , Ontario , Canada. · b Women's College Research Institute , Women's College Hospital , Toronto , Ontario , Canada. · c Department of Obstetrics and Gynaecology , St. Michael's Hospital , Toronto , Ontario , Canada. · d Department of Obstetrics and Gynecology , University of Toronto , Toronto , Ontario , Canada. · e Department of Obstetrics and Gynaecology , Mount Sinai Hospital , Toronto , Ontario , Canada. ·AIDS Care · Pubmed #28553759.

ABSTRACT: In the modern era of HIV care, a multitude of clinical needs have emerged; one such need is the growing sub-specialty of HIV and reproductive health. In 2007, a study surveying Canadian fertility clinics found limited access to fertility services for HIV-positive patients. Given the extensive efforts made to address this lack of services, a follow-up assessment was warranted. This study aimed to compare the access to Canadian fertility clinics and services for HIV-positive individuals and couples in 2014 and 2007. Surveys were sent to medical or laboratory directors of assisted reproductive technology (ART) clinics in 2014 and results were compared to those sent in 2007. Main outcome measures included: the proportion of fertility clinics willing to provide ART to people with HIV, the specific services offered, and whether the 2012 Canadian HIV Pregnancy Planning Guidelines were implemented to inform practice. Across Canadian provinces, 20/34 (59%) clinics completed the survey. Ninety-five percent (19/20) of clinics accepted HIV-positive patients for consultation. Only 50% (10/20) of clinics in four provinces offered a full range of ART (defined as including in vitro fertilization [IVF]). Ten clinics (50%) in five provinces were aware that guidelines exist; half (n = 5) having read them and four reporting implementation of all the guidelines' recommendations in their practice. Compared to 2007, more clinics had implemented separate facilities (p = 0.028) to treat HIV-positive individuals, offered IVF (p = 0.013) for HIV-positive female partners, sperm washing (p = 0.033) for HIV-positive male partners, and risk reduction techniques to couples with HIV-positive men and women (p = 0.006). Access to fertility clinics for people with HIV has improved over time but is still regionally dependent and access to full ART remains limited. These findings suggest the need for advocacy targeted towards geographical-specific areas and optimizing access to comprehensive services.

24 Article Risk of End-Stage Renal Disease in HIV-Positive Potential Live Kidney Donors. 2017

Muzaale, A D / Althoff, K N / Sperati, C J / Abraham, A G / Kucirka, L M / Massie, A B / Kitahata, M M / Horberg, M A / Justice, A C / Fischer, M J / Silverberg, M J / Butt, A A / Boswell, S L / Rachlis, A R / Mayor, A M / Gill, M J / Eron, J J / Napravnik, S / Drozd, D R / Martin, J N / Bosch, R J / Durand, C M / Locke, J E / Moore, R D / Lucas, G M / Segev, D L. ·Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. · Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD. · Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. · University of Washington Center for AIDS Research, Seattle, WA. · Mid-Atlantic Permanente Institute, Rockville, MD. · Veterans Affairs Connecticut Healthcare System, West Haven, CT. · Jesse Brown VA Medical Center and Hines VA Hospital, Chicago, IL. · Kaiser Permanente Division of Research, Oakland, CA. · Hamad Healthcare Quality Institute, Hamad Medical Corporation, Doha, Qatar. · Weill Cornell Medical College, Doha, Qatar. · Weill Cornell Medical College, New York, NY. · Fenway Health HIV Cohort, Boston, MA. · Infectious Diseases Division, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. · Universidad Central del Caribe, Bayamón, PR. · Southern Alberta HIV Clinic, Sheldon M. Chumir Health Centre, Calgary, Alberta, Canada. · University of North Carolina, HIV Clinic Cohort, Chapel Hill, NC. · The Polyclinic Madison Center, Seattle, WA. · Department of Epidemiology and Biostatistics, University of California, San Francisco, CA. · Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA. · Department of Surgery, University of Alabama, Birmingham, AL. ·Am J Transplant · Pubmed #28497525.

ABSTRACT: New federal regulations allow HIV-positive individuals to be live kidney donors; however, potential candidacy for donation is poorly understood given the increased risk of end-stage renal disease (ESRD) associated with HIV infection. To better understand this risk, we compared the incidence of ESRD among 41 968 HIV-positive participants of North America AIDS Cohort Collaboration on Research and Design followed for a median of 5 years with the incidence of ESRD among comparable HIV-negative participants of National Health and Nutrition Examination III followed for a median of 14 years. We used risk associations from multivariable Cox proportional hazards regression to derive cumulative incidence estimates for selected HIV-positive scenarios (no history of diabetes, hypertension, AIDS, or hepatitis C virus coinfection) and compared these estimates with those from similarly selected HIV-negative scenarios. For 40-year-old HIV-positive individuals with health characteristics that were similar to those of age-matched kidney donors, viral load <400 copies/mL, and CD4

25 Article Acute and Painless Monocular Vision Loss in a Human Immunodeficiency Virus-Positive Man. 2017

Kansal, Vinay / Dollin, Michael. ·Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. · University of Ottawa Eye Institute, Ottawa, Ontario, Canada. ·JAMA Ophthalmol · Pubmed #28418505.

ABSTRACT: -- No abstract --

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