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HIV Seropositivity: HELP
Articles from US Dept of Health and Human Services
Based on 190 articles published since 2010

These are the 190 published articles about HIV Seropositivity that originated from US Dept of Health and Human Services during 2010-2020.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8
1 Editorial Systems Approaches to Improving Rates of Extragenital Chlamydia and Gonorrhea Screening Among Men Who Have Sex With Men Engaged in Human Immunodeficiency Virus Care. 2015

Bernstein, Kyle T. ·From the Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, GA. ·Sex Transm Dis · Pubmed #26366511.

ABSTRACT: -- No abstract --

2 Review Early versus Delayed Antiretroviral Therapy for HIV and Tuberculosis Co-Infected Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. 2015

Yan, Shipeng / Chen, Lizhang / Wu, Wenqiong / Fu, Zhongxi / Zhang, Heng / Li, Zhanzhan / Fu, Chenchao / Mou, Jingsong / Xue, Jing / Hu, Yingyun. ·The Affiliated cancer hospital of Xiangya Scholl of Medicine, Central South University, Changsha, 410013 China. · Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan Province, 410078 China. · Centers for Disease Control and Prevention of Hunan Province, Changsha, Hunan Province, 410005 China. · Centers for Disease Control and Prevention of Changsha City, Changsha, Hunan Province, 410013 China. · Xiangya Hospital, Central South University, Changsha, Hunan Province, 41008 China. · Changsha Medical University, Changsha, Hunan Province, 410000 China. ·PLoS One · Pubmed #26000446.

ABSTRACT: OBJECTIVE: To compare important clinical outcomes between early and delayed initiation of antiretroviral therapy (ART) in adults who had a co-infection of human immunodeficiency virus (HIV) and tuberculosis (TB). METHODS: We performed a systematic search for relevant publications on PubMed, EMBASE, and the International Clinical Trials Registry Platform. We included randomized controlled trials (RCTs) that compared early ART initiation (within four weeks after anti-TB treatment starting) and delayed ART initiation (after eight weeks but less than twelve weeks of anti-TB treatment starting) in the course of TB treatment. Pooled estimates with corresponding 95% confidence interval (95%CI) were calculated with random-effects model. Sensitivity analysis was performed to investigate the stability of pooled estimates. RESULTS: A meta-analysis was evaluated from six RCTs with 2272 participants. Compared to delayed ART initiation, early ART initiation significantly reduces all-cause mortality in HIV-positive patients with TB [incidence rate ratio (IRR) 0.75, 95%CI 0.59 to 0.95; I2 = 0.00%; p = 0.67], even though there is an increased risk for IRD [IRR 2.29, 95%CI 1.81 to 2.91; I22 = 0.00%; p = 0.56]. Additionally, early ART initiation was not associated with an increased risk for grade 3-4 drug-related adverse events [IRR 0.99, 95%CI 0.83 to 1.18; I2 = 0.00%; p = 0.56]. CONCLUSIONS: Although limited evidence, our results provide support for early ART initiation in the course of anti-TB treatment. However, more well-designed cohort or intervention studies are required to further confirm our findings.

3 Review Hispanics/Latinos and the HIV continuum of care in the Southern USA: a qualitative review of the literature, 2002-2013. 2014

Morales-Aleman, Mercedes M / Sutton, Madeline Y. ·a Division of HIV/AIDS Prevention , Centers for Disease Control and Prevention , Atlanta , GA , USA. ·AIDS Care · Pubmed #25027357.

ABSTRACT: Hispanics/Latinos are disproportionately affected by HIV infection, but access HIV care less often than non-Hispanic whites in the USA. The majority of new HIV diagnoses among Hispanics/Latinos occur in the southern USA; however, data are lacking regarding factors associated with HIV care access for Hispanics/Latinos in the South. We conducted a qualitative review of peer-reviewed articles using the HIV continuum of care framework to assess HIV care for Hispanics/Latinos in the US South. We identified 13 studies conducted in southern states that were informed by the continuum of care: testing and diagnosis of HIV infection (n = 9); linkage and retention in care (n = 2); and prescription of and adherence to ART (n = 2). Barriers to health care access included stigma, lack of Spanish-speaking health-care providers, and fear of deportation. Facilitators to health care access included provider endorsement of HIV tests and regular health care. Innovative solutions (e.g., patient navigators), tailored strategies (e.g., community outreach) and organizational-level interventions (e.g., increasing provider endorsement of HIV tests) can improve access for Hispanics/Latinos in the South.

4 Review Mental health of HIV-seropositive women during pregnancy and postpartum period: a comprehensive literature review. 2014

Kapetanovic, Suad / Dass-Brailsford, Priscilla / Nora, Diana / Talisman, Nicholas. ·National Institutes of Health, National Institute of Mental Health, Bethesda, MD, USA, suad.kapetanovic@nih.gov. ·AIDS Behav · Pubmed #24584458.

ABSTRACT: With growing numbers of HIV-seropositive (HIV+) women of child-bearing age and increased access to effective clinical protocols for preventing mother-to-child transmission (MTCT) of HIV, mental health-related factors have become increasingly relevant due to their potential to affect the women's quality of life, obstetric outcomes and risk of MTCT. This review synthesizes evidence from 53 peer-reviewed publications examining mental health-related variables in pregnant and postpartum HIV+ women. The presentation of results is organized by the level of socioeconomic resources in the countries where studies were conducted (i.e., high-, middle-, and low-income countries). It is concluded that psychiatric symptoms, particularly depression, and mental health vulnerabilities (e.g., inadequate coping skills) are widespread among pregnant HIV+ women globally and have a potential to affect psychological well-being, quality of life and salient clinical outcomes. The current body of evidence provides rationale for developing and evaluating clinical and structural interventions aimed at improving mental health outcomes and their clinical correlates in pregnant HIV+ women.

5 Review Interventions to improve retention in HIV primary care: a systematic review of U.S. studies. 2012

Higa, Darrel H / Marks, Gary / Crepaz, Nicole / Liau, Adrian / Lyles, Cynthia M. ·Prevention Research Branch, Division of HIV/AIDS Prevention, CDC, 1600 Clifton Road, NE, Mail Stop E-37, Atlanta, GA 30333, USA. dhiga@cdc.gov ·Curr HIV/AIDS Rep · Pubmed #22996171.

ABSTRACT: Retaining HIV-diagnosed persons in care is a national priority, but little is known on what intervention strategies are most effective for promoting retention in care. We conducted a systematic search and qualitatively reviewed 13 published studies and three recent conference presentations to identify evidence-informed retention strategies. We extracted information on study design, methods, and intervention characteristics. Strengths-based case management that encourages clients to recognize and use their own internal abilities to access resources and solve problems offered strong evidence for retention in care. Other evidence-informed strategies included peer navigation, reducing structural- and system-level barriers, including peers as part of a health care team, displaying posters and brochures in waiting rooms, having medical providers present brief messages to patients, and having clinics stay in closer contact with patients across time. Opportunities for additional intervention strategies include using community-based organizations as a setting for engaging HIV-infected persons about the importance of regular care and involving patients' significant others in retention in care interventions.

6 Review Reaping the prevention benefits of highly active antiretroviral treatment: policy implications of HIV Prevention Trials Network 052. 2012

Forsyth, Andrew D / Valdiserri, Ronald O. ·Office of HIV/AIDS Policy, U.S. Department of Health and Human Services, Washington DC, USA. andrew.forsyth@hhs.gov ·Curr Opin HIV AIDS · Pubmed #22227586.

ABSTRACT: PURPOSE OF REVIEW: This review explores the policy implications of findings from the HIV Prevention Trials Network (HPTN 052) treatment as prevention (TasP) study. RECENT FINDINGS: To date, the potential of antiretrovirals to prevent sexual transmission of HIV by infected persons has been grounded in observational cohort, ecological, mathematical modeling, and meta-analytic studies. HPTN 052 represents the first randomized controlled trial to test the secondary prevention benefit of HIV transmission using antiretroviral treatment in largely asymptomatic persons with high CD4 cell counts. SUMMARY: The US National HIV/AIDS Strategy has among its key goals the reduction of incident HIV infections, improved access to quality care and associated outcomes, and the reduction in HIV-associated health disparities and inequities. HPTN 052 demonstrates that providing TasP, in combination with other effective prevention strategies offers the promise of achieving these life-saving goals. But HPTN 052 also highlights the need for cautious optimism and underscores the importance of addressing current gaps in the HIV prevention, treatment, and care continuum in order for 'TasP' strategies to achieve their full potential. Among these are necessary improvements in the capacity to expand HIV testing, facilitate effective linkage and retention in care, and improve treatment initiation, maintenance, and virus suppression.

7 Review Preventing HIV transmission through antiretroviral treatment-mediated virologic suppression: aspects of an emerging scientific agenda. 2012

Dieffenbach, Carl W. ·Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA. Cdieffenba@NIAID.NIH.gov ·Curr Opin HIV AIDS · Pubmed #22227584.

ABSTRACT: PURPOSE OF REVIEW: This review describes important aspects of the research agenda that have emerged as a result of the recent findings of the HIV transmission study in sero-discordant couples conducted by the National Institute of Allergy and Infectious Disease (NIAID)-supported HIV Prevention Trials Network (HPTN) and referred to as HPTN 052. RECENT FINDINGS: The HPTN 052 study provided strong evidence that antiretroviral treatment (ART), given to HIV-infected partners with the purpose of achieving and maintaining full virologic suppression, could prevent linked HIV transmission in sero-discordant couples. These findings have implications in all future combination prevention strategies. SUMMARY: The HPTN 052 study demonstrated that sustained virus suppression, below detectable levels, can prevent HIV transmission in sero-discordant couples. As a result of this study, we have now identified ART as a key component for all combination prevention strategies. Additionally, this study demonstrates that HIV testing is the single door of entry for individualized HIV treatment and prevention. The challenge now is to create a robust, seamless linkage and retention system so that the vision of HIV treatment as prevention can be realized. Such a system will maximize both the treatment and the prevention benefits of ART. The research agenda outlined here describes the need to extend this finding to areas of implementation science, such as the development of simpler, easier to use point-of-care assays for virus load, and improved, better tolerated, more durable combinations and formulations of antiretroviral drugs.

8 Review Monoclonal antibody-based candidate therapeutics against HIV type 1. 2012

Chen, Weizao / Dimitrov, Dimiter S. ·Protein Interactions Group, Center for Cancer Research Nanobiology Program, National Cancer Institute (NCI)-Frederick, National Institutes of Health (NIH) , Frederick, MD 21702, USA. chenw3@mail.nih.gov ·AIDS Res Hum Retroviruses · Pubmed #21827278.

ABSTRACT: Treatment of HIV-1 infection has been highly successful with small molecule drugs. However, resistance still develops. In addition, long-term use can lead to toxicity with unpredictable effects on health. Finally, current drugs do not lead to HIV-1 eradication. The presence of the virus leads to chronic inflammation, which can result in increased morbidity and mortality after prolonged periods of infection. Monoclonal antibodies (mAbs) have been highly successful during the past two decades for therapy of many diseases, primarily cancers and immune disorders. They are relatively safe, especially human mAbs that have evolved in humans at high concentrations to fight diseases and long-term use may not lead to toxicities. Several broadly neutralizing mAbs (bnmAbs) against HIV-1 can protect animals but are not effective when used for therapy of an established infection. We have hypothesized that HIV-1 has evolved strategies to effectively escape neutralization by full-size antibodies in natural infections but not by smaller antibody fragments. Therefore, a promising direction of research is to discover and exploit antibody fragments as potential candidate therapeutics against HIV-1. Here we review several bnmAbs and engineered antibody domains (eAds), their in vitro and in vivo antiviral efficacy, mechanisms used by HIV-1 to escape them, and strategies that could be effective to develop more powerful mAb-based HIV-1 therapeutics.

9 Review Liver disease, HIV and aging. 2011

Falade-Nwulia, Oluwaseun / Thio, Chloe L. ·Johns Hopkins University, School of Medicine, Baltimore, MD 21231, USA. faladeoo@cc.nih.gov ·Sex Health · Pubmed #22127037.

ABSTRACT: The life expectancy of HIV-infected patients has increased due to the efficacy of highly active antiretroviral therapy (HAART) in controlling HIV replication; thus, the population living with HIV infection is steadily aging. Liver-related morbidity and mortality has emerged as a leading problem in HIV-infected patients. Since aging, HIV infection and HAART all affect the liver, understanding the impact of the combination of these factors on liver disease is crucial for optimisation of care in the aging HIV-infected population. This review will focus on the current understanding of liver disease in older (>50 years old) HIV-negative individuals and in HIV-infected individuals. Areas for future research in the area of HIV, liver disease and aging will also be discussed.

10 Clinical Trial Phase 2 Placebo-Controlled Trial of Two Vaccines to Prevent Ebola in Liberia. 2017

Kennedy, Stephen B / Bolay, Fatorma / Kieh, Mark / Grandits, Greg / Badio, Moses / Ballou, Ripley / Eckes, Risa / Feinberg, Mark / Follmann, Dean / Grund, Birgit / Gupta, Swati / Hensley, Lisa / Higgs, Elizabeth / Janosko, Krisztina / Johnson, Melvin / Kateh, Francis / Logue, James / Marchand, Jonathan / Monath, Thomas / Nason, Martha / Nyenswah, Tolbert / Roman, François / Stavale, Eric / Wolfson, Julian / Neaton, James D / Lane, H Clifford / Anonymous780923. ·From the Liberian Ministry of Health, Monrovia, Liberia (S.B.K., F.B., M.K., M.B., M.J., F.K., T.N.) · the University of Minnesota, Division of Biostatistics, Minneapolis (G.G., B.G., J.W., J.D.N.) · GlaxoSmithKline, Rockville (R.B.), and National Institutes of Health (R.E., D.F., L.H., E.H., M.N., H.C.L.) and AbViro (E.S.), Bethesda - all in Maryland · Merck, Kenilworth, NJ (M.F., S.G.) · Battelle Memorial Institute, Columbus, OH (K.J., J.L., J.M., E.S.) · International AIDS Vaccine Initiative, New York (M.F., S.G., T.M.) · and GlaxoSmithKline, Rixensart, Belgium (F.R.). ·N Engl J Med · Pubmed #29020589.

ABSTRACT: BACKGROUND: The safety and efficacy of vaccines to prevent Ebola virus disease (EVD) were unknown when the incidence of EVD was peaking in Liberia. METHODS: We initiated a randomized, placebo-controlled, phase 3 trial of the chimpanzee adenovirus 3 vaccine (ChAd3-EBO-Z) and the recombinant vesicular stomatitis virus vaccine (rVSV∆G-ZEBOV-GP) in Liberia. A phase 2 subtrial was embedded to evaluate safety and immunogenicity. Because the incidence of EVD declined in Liberia, the phase 2 component was expanded and the phase 3 component was eliminated. RESULTS: A total of 1500 adults underwent randomization and were followed for 12 months. The median age of the participants was 30 years; 36.6% of the participants were women. During the week after the administration of vaccine or placebo, adverse events occurred significantly more often with the active vaccines than with placebo; these events included injection-site reactions (in 28.5% of the patients in the ChAd3-EBO-Z group and 30.9% of those in the rVSV∆G-ZEBOV-GP group, as compared with 6.8% of those in the placebo group), headache (in 25.1% and 31.9%, vs. 16.9%), muscle pain (in 22.3% and 26.9%, vs. 13.3%), feverishness (in 23.9% and 30.5%, vs. 9.0%), and fatigue (in 14.0% and 15.4%, vs. 8.8%) (P<0.001 for all comparisons); these differences were not seen at 1 month. Serious adverse events within 12 months after injection were seen in 40 participants (8.0%) in the ChAd3-EBO-Z group, in 47 (9.4%) in the rVSV∆G-ZEBOV-GP group, and in 59 (11.8%) in the placebo group. By 1 month, an antibody response developed in 70.8% of the participants in the ChAd3-EBO-Z group and in 83.7% of those in the rVSV∆G-ZEBOV-GP group, as compared with 2.8% of those in the placebo group (P<0.001 for both comparisons). At 12 months, antibody responses in participants in the ChAd3-EBO-Z group (63.5%) and in those in the rVSV∆G-ZEBOV-GP group (79.5%) remained significantly greater than in those in the placebo group (6.8%, P<0.001 for both comparisons). CONCLUSIONS: A randomized, placebo-controlled phase 2 trial of two vaccines that was rapidly initiated and completed in Liberia showed the capability of conducting rigorous research during an outbreak. By 1 month after vaccination, the vaccines had elicited immune responses that were largely maintained through 12 months. (Funded by the National Institutes of Allergy and Infectious Diseases and the Liberian Ministry of Health; PREVAIL I ClinicalTrials.gov number, NCT02344407 .).

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 Probiotic supplementation promotes a reduction in T-cell activation, an increase in Th17 frequencies, and a recovery of intestinal epithelium integrity and mitochondrial morphology in ART-treated HIV-1-positive patients. 2017

d'Ettorre, Gabriella / Rossi, Giacomo / Scagnolari, Carolina / Andreotti, Mauro / Giustini, Noemi / Serafino, Sara / Schietroma, Ivan / Scheri, Giuseppe Corano / Fard, Saeid Najafi / Trinchieri, Vito / Mastromarino, Paola / Selvaggi, Carla / Scarpona, Silvia / Fanello, Gianfranco / Fiocca, Fausto / Ceccarelli, Giancarlo / Antonelli, Guido / Brenchley, Jason M / Vullo, Vincenzo. ·Department of Public Health and Infectious Diseases, Azienda Policlinico Umberto I of Rome, Rome, Italy. · School of Biosciences, Veterinary Medicine University of Camerino, Matelica, Italy. · Laboratory Affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy. · Department of Therapeutic Research and Medicines Evaluation, Italian Institute of Health, Rome, Italy. · Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy. · Section of Microbiology, Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy. · Department of Emergency Surgery-Emergency Endoscopic Unit, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy. · Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA. ·Immun Inflamm Dis · Pubmed #28474815.

ABSTRACT: INTRODUCTION: HIV infection is characterized by a persistent immune activation associated to a compromised gut barrier immunity and alterations in the profile of the fecal flora linked with the progression of inflammatory symptoms. The effects of high concentration multistrain probiotic (Vivomixx®, Viale del Policlinico 155, Rome, Italy in EU; Visbiome®, Dupont, Madison, Wisconsin in USA) on several aspects of intestinal immunity in ART-experienced HIV-1 patients was evaluated. METHODS: A sub-study of a longitudinal pilot study was performed in HIV-1 patients who received the probiotic supplement twice a day for 6 months (T6). T-cell activation and CD4+ and CD8+ T-cell subsets expressing IFNγ (Th1, Tc1) or IL-17A (Th17, Tc17) were stained by cytoflorimetric analysis. Histological and immunohistochemical analyses were performed on intestinal biopsies while enterocytes apoptosis index was determined by TUNEL assay. RESULTS: A reduction in the frequencies of CD4 CONCLUSIONS: These findings highlight the potential beneficial effects of probiotic supplementation for the reconstitution of physical and immunological integrity of the mucosal intestinal barrier in ART-treated HIV-1-positive patients.

13 Clinical Trial Brief Report: Impact of Early Antiretroviral Therapy on the Performance of HIV Rapid Tests and HIV Incidence Assays. 2017

Fogel, Jessica M / Piwowar-Manning, Estelle / Debevec, Barbara / Walsky, Tamara / Schlusser, Katherine / Laeyendecker, Oliver / Wilson, Ethan A / McCauley, Marybeth / Gamble, Theresa / Tegha, Gerald / Soko, Dean / Kumwenda, Johnstone / Hosseinipour, Mina C / Chen, Ying Q / Cohen, Myron S / Eshleman, Susan H. ·Departments of *Pathology; and †Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD; ‡Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, MD; §Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA; ‖Science Facilitation Department, FHI 360, Washington, DC; ¶Science Facilitation Department, FHI 360, Durham, NC; #UNC Project Laboratory, Tidziwe Centre, Kamuzu Central Hospital, Lilongwe, Malawi; **College of Medicine-Johns Hopkins Project, Blantyre, Malawi; ††Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC; ‡‡UNC Project-Malawi, Institute for Global Health and Infectious Diseases, Lilongwe, Malawi; §§Vaccine and Infectious Disease Division and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA; and ‖‖Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC. ·J Acquir Immune Defic Syndr · Pubmed #28471839.

ABSTRACT: BACKGROUND: Antiretroviral therapy (ART) can downregulate antibody responses to HIV infection. We evaluated the impact of early vs. delayed ART on the performance of HIV diagnostic and incidence assays. METHODS: Samples were obtained from 207 participants in the HPTN 052 trial, who were stably suppressed on ART for ≥4 years [Malawi sites; pre-ART CD4 cell count 350-550 cells/mm (early ART arm, N = 180) or <250 cells/mm or an AIDS-defining illness (delayed ART arm, N = 27)]. Samples were tested with 2 HIV rapid tests and 2 HIV incidence assays; selected samples were also tested with two fourth-generation immunoassays and a Western blot (WB) assay. A pre-ART sample was analyzed if the follow-up sample had a false-negative or weakly-reactive rapid test result, or had an incidence assay result indicative of recent infection (false-recent result). RESULTS: Ten (4.8%) samples had a nonreactive or weakly-reactive rapid test result (7/180 early ART arm, 3/27 delayed ART arm, P = 0.13); one sample had nonreactive fourth-generation assay results and 3 had indeterminate WBs. Forty (18.9%) samples had a false-recent incidence assay result; 16 (7.8%) had false-recent results with both incidence assays. Baseline samples had stronger rapid test and WB bands, higher fourth-generation assay signal-to-cutoff values, and fewer HIV incidence assay results indicative of recent infection. CONCLUSIONS: False-negative/weakly-reactive HIV rapid tests and false-recent HIV incidence assay results were observed in virally-suppressed individuals, regardless of pre-ART CD4 cell count. Downregulation of the antibody response to HIV infection in the setting of ART may impact population-level surveys of HIV prevalence and incidence.

14 Clinical Trial Sequential Immunization with gp140 Boosts Immune Responses Primed by Modified Vaccinia Ankara or DNA in HIV-Uninfected South African Participants. 2016

Churchyard, Gavin / Mlisana, Koleka / Karuna, Shelly / Williamson, Anna-Lise / Williamson, Carolyn / Morris, Lynn / Tomaras, Georgia D / De Rosa, Stephen C / Gilbert, Peter B / Gu, Niya / Yu, Chenchen / Mkhize, Nonhlanhla N / Hermanus, Tandile / Allen, Mary / Pensiero, Michael / Barnett, Susan W / Gray, Glenda / Bekker, Linda-Gail / Montefiori, David C / Kublin, James / Corey, Lawrence. ·Aurum Institute for Health Research, Klerksdorp, South Africa. · School of Public Health, University of Witwatersrand, Johannesburg, South Africa. · Advancing Care and Treatment for TB and HIV, Medical Research Council Collaborating Centre, Klerksdorp, South Africa. · University of Kwa-Zulu Natal, Durban, South Africa. · Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America. · Institute of Infectious Disease and Molecular Medicine, Division of Medical Virology, University of Cape Town, Cape Town, South Africa; National Health Laboratory Services, Observatory, Cape Town, South Africa. · National Institute for Communicable Diseases, National Health Laboratory Services, Sandringham, Johannesburg, South Africa. · Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC, United States of America. · Department of Laboratory Medicine, University of Washington, Seattle, WA, United States of America. · Vaccine Research Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America. · Novartis Vaccines and Diagnostics, Cambridge, MA, United States of America. · South African Medical Research Council, Cape Town, South Africa. · Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Braamfontein, Johannesburg, South Africa. · Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa. · Laboratory for AIDS Vaccine Research and Development, Duke University Medical Center, Durham, NC, United States of America. ·PLoS One · Pubmed #27583368.

ABSTRACT: BACKGROUND: The safety and immunogenicity of SAAVI DNA-C2 (4 mg IM), SAAVI MVA-C (2.9 x 109 pfu IM) and Novartis V2-deleted subtype C gp140 (100 mcg) with MF59 adjuvant in various vaccination regimens was evaluated in HIV-uninfected adults in South Africa. METHODS: Participants at three South African sites were randomized (1:1:1:1) to one of four vaccine regimens: MVA prime, sequential gp140 protein boost (M/M/P/P); concurrent MVA/gp140 (MP/MP); DNA prime, sequential MVA boost (D/D/M/M); DNA prime, concurrent MVA/gp140 boost (D/D/MP/MP) or placebo. Peak HIV specific humoral and cellular responses were measured. RESULTS: 184 participants were enrolled: 52% were female, all were Black/African, median age was 23 years (range, 18-42 years) and 79% completed all vaccinations. 159 participants reported at least one adverse event, 92.5% were mild or moderate. Five, unrelated, serious adverse events were reported. The M/M/P/P and D/D/MP/MP regimens induced the strongest peak neutralizing and binding antibody responses and the greatest CD4+ T-cell responses to Env. All peak neutralizing and binding antibody responses decayed with time. The MVA, but not DNA, prime contributed to the humoral and cellular immune responses. The D/D/M/M regimen was poorly immunogenic overall but did induce modest CD4+ T-cell responses to Gag and Pol. CD8+ T-cell responses to any antigen were low for all regimens. CONCLUSIONS: The SAAVI DNA-C2, SAAVI MVA-C and Novartis gp140 with MF59 adjuvant in various combinations were safe and induced neutralizing and binding antibodies and cellular immune responses. Sequential immunization with gp140 boosted immune responses primed by MVA or DNA. The best overall immune responses were seen with the M/M/P/P regimen. TRIAL REGISTRATION: ClinicalTrials.gov NCT01418235.

15 Clinical Trial Intimate Partner Violence and Adherence to HIV Pre-exposure Prophylaxis (PrEP) in African Women in HIV Serodiscordant Relationships: A Prospective Cohort Study. 2016

Roberts, Sarah T / Haberer, Jessica / Celum, Connie / Mugo, Nelly / Ware, Norma C / Cohen, Craig R / Tappero, Jordan W / Kiarie, James / Ronald, Allan / Mujugira, Andrew / Tumwesigye, Elioda / Were, Edwin / Irungu, Elizabeth / Baeten, Jared M / Anonymous17250869. ·*Department of Epidemiology, University of Washington, Seattle, WA; †Department of Medicine and Center for Global Health, Massachusetts General Hospital, Boston, MA; ‡Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; Departments of §Global Health; ‖Medicine, University of Washington, Seattle, WA; ¶Kenya Medical Research Institute, Nairobi, Kenya; #Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA; **Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA; ††Centers for Disease Control and Prevention, Atlanta, GA; ‡‡Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya; §§Department of Medicine, University of Manitoba, Winnipeg, Canada; ‖‖Kabwohe Clinical Research Center, Kabwohe, Uganda; ¶¶Department of Reproductive Health, Moi University, Eldoret, Kenya; and ##Kenyatta National Hospital, Nairobi, Kenya. ·J Acquir Immune Defic Syndr · Pubmed #27243900.

ABSTRACT: BACKGROUND: Intimate partner violence (IPV) is associated with higher HIV incidence, reduced condom use, and poor adherence to antiretroviral therapy and other medications. IPV may also affect adherence to pre-exposure prophylaxis (PrEP). METHODS: We analyzed data from 1785 HIV-uninfected women enrolled in a clinical trial of PrEP among African HIV serodiscordant couples. Experience of verbal, physical, or economic IPV was assessed at monthly visits by face-to-face interviews. Low PrEP adherence was defined as clinic-based pill count coverage <80% or plasma tenofovir levels <40 ng/mL. The association between IPV and low adherence was analyzed using generalized estimating equations, adjusting for potential confounders. In-depth interview transcripts were examined to explain how IPV could impact adherence. RESULTS: Sixteen percent of women reported IPV during a median of 34.8 months of follow-up (interquartile range 27.0-35.0). Overall, 7% of visits had pill count coverage <80%, and 32% had plasma tenofovir <40 ng/mL. Women reporting IPV in the past 3 months had increased risk of low adherence by pill count (adjusted risk ratio 1.49, 95% confidence interval: 1.17 to 1.89) and by plasma tenofovir (adjusted risk ratio 1.51, 95% confidence interval: 1.06 to 2.15). Verbal, economic, and physical IPV were all associated with low adherence. However, the impact of IPV diminished and was not statistically significant 3 months after the reported exposure. In qualitative interviews, women identified several ways in which IPV affected adherence, including stress and forgetting, leaving home without pills, and partners throwing pills away. CONCLUSIONS: Women who reported recent IPV in the Partners PrEP Study were at increased risk of low PrEP adherence. Strategies to mitigate PrEP nonadherence in the context of IPV should be evaluated.

16 Clinical Trial HIV Transmission Risk Behavior in a Cohort of HIV-Infected Treatment-Naïve Men and Women in the United States. 2016

Landovitz, Raphael J / Tran, Thuy Tien T / Cohn, Susan E / Ofotokun, Ighovwhera / Godfrey, Catherine / Kuritzkes, Daniel R / Lennox, Jeffrey L / Currier, Judith S / Ribaudo, Heather J. ·Division of Infectious Diseases, UCLA Center for Clinical AIDS Research and Education, University of California, Los Angeles, 11075 Santa Monica Blvd, Suite 100, Los Angeles, CA, 90025, USA. rlandovitz@mednet.ucla.edu. · Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA, USA. · Division of Infectious Diseases, Northwestern University School of Medicine, Chicago, IL, USA. · Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA. · Therapeutics Research Branch, Division of AIDS, National Institutes of Health, Bethesda, MD, USA. · Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA. · Division of Infectious Diseases, UCLA Center for Clinical AIDS Research and Education, University of California, Los Angeles, 11075 Santa Monica Blvd, Suite 100, Los Angeles, CA, 90025, USA. ·AIDS Behav · Pubmed #26979419.

ABSTRACT: Antiretroviral therapy (ART) can minimize HIV transmission. Prevention benefits may be compromised by barriers to virologic suppression, and by increased condomless sex among those initiating ART. We evaluated condomless sex in a cohort of HIVinfected US individuals poised to initiate ART in a clinical trial. We assessed partner and sex act type, condom use, and perception of infectiousness. Six percent of participants reported as not infectious; men who have sex with men were more likely to perceive high infectivity. Prevalence of condomless sex was 44 %; 74 % of those also reported homosexual acquisition of HIV. Predictors of increased risk of condomless sex included greater numbers of lifetime partners, recent stimulant drug use and an HIV-positive or unknown serostatus partner. In the context of serodifferent partners, lower perception of infectiousness was also associated with a higher risk of condomless sex. Results highlight opportunities for prevention education for HIV infected individuals at ART initiation.

17 Clinical Trial Chlamydia and Gonorrhea in HIV-Infected Pregnant Women and Infant HIV Transmission. 2015

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 / Anonymous5630842. ·From the *David Geffen UCLA School of Medicine, Los Angeles, CA; †Fielding School of Public Health, UCLA, Los Angeles, CA; ‡Westat, Rockville, MD; §Fundacao Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil; ¶Office of the Global AIDS Coordinator, US Department of State, Washington, DC; ∥Cepheid, Sunnyvale, CA; **Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD; ††Hospital Geral de Nova Iguaçu, Nova Iguaçu, RJ, Brazil; and ‡‡Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil. ·Sex Transm Dis · Pubmed #26372927.

ABSTRACT: BACKGROUND: 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. METHODOLOGY: 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. 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 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). CONCLUSIONS: 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.

18 Clinical Trial Low-intensity therapy in adults with Burkitt's lymphoma. 2013

Dunleavy, Kieron / Pittaluga, Stefania / Shovlin, Margaret / Steinberg, Seth M / Cole, Diane / Grant, Cliona / Widemann, Brigitte / Staudt, Louis M / Jaffe, Elaine S / Little, Richard F / Wilson, Wyndham H. ·From the Center for Cancer Research, National Cancer Institute, Bethesda, MD. ·N Engl J Med · Pubmed #24224624.

ABSTRACT: BACKGROUND: Burkitt's lymphoma is an aggressive B-cell lymphoma that occurs in children and adults and is largely curable with the use of intensive and toxic chemotherapy. Current treatments are less effective and have more severe side effects in adults and patients with immunodeficiency than in children. METHODS: We studied low-intensity treatment consisting of infused etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab (EPOCH-R) in patients with untreated Burkitt's lymphoma. Two EPOCH-R regimens were tested: a standard dose-adjusted combination in human immunodeficiency virus (HIV)-negative patients (DA-EPOCH-R group) and a lower-dose short-course combination with a double dose of rituximab in HIV-positive patients (SC-EPOCH-RR group). RESULTS: A total of 30 consecutive patients were treated; 19 patients were in the DA-EPOCH-R group, and 11 in the SC-EPOCH-RR group. The overall median age of the patients was 33 years, and 40% were 40 years of age or older; 73% of the patients had intermediate-risk disease, and 10% had high-risk disease. The principal toxic events, fever and neutropenia, were observed during 22% of the DA-EPOCH-R treatment cycles and 10% of the SC-EPOCH-RR treatment cycles. The tumor lysis syndrome developed in 1 patient; no treatment-related deaths occurred. The median cumulative doses of doxorubicin-etoposide and cyclophosphamide administered in the SC-EPOCH-RR group were 47% and 57% lower, respectively, than those administered in the DA-EPOCH-R group. With median follow-up times of 86 months in the DA-EPOCH-R group and 73 months in the SC-EPOCH-RR group, the rates of freedom from progression of disease and overall survival were, respectively, 95% and 100% with DA-EPOCH-R and 100% and 90% with SC-EPOCH-RR. None of the patients died from Burkitt's lymphoma. CONCLUSIONS: In this uncontrolled prospective study, low-intensity EPOCH-R-based treatment was highly effective in adults with sporadic or immunodeficiency-associated Burkitt's lymphoma. (Funded by the National Cancer Institute; ClinicalTrials.gov numbers, NCT00001337 and NCT00006436.).

19 Clinical Trial Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. 2012

Thigpen, Michael C / Kebaabetswe, Poloko M / Paxton, Lynn A / Smith, Dawn K / Rose, Charles E / Segolodi, Tebogo M / Henderson, Faith L / Pathak, Sonal R / Soud, Fatma A / Chillag, Kata L / Mutanhaurwa, Rodreck / Chirwa, Lovemore Ian / Kasonde, Michael / Abebe, Daniel / Buliva, Evans / Gvetadze, Roman J / Johnson, Sandra / Sukalac, Thom / Thomas, Vasavi T / Hart, Clyde / Johnson, Jeffrey A / Malotte, C Kevin / Hendrix, Craig W / Brooks, John T / Anonymous2090731. ·Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, USA. mthigpen@cdc.gov ·N Engl J Med · Pubmed #22784038.

ABSTRACT: BACKGROUND: Preexposure prophylaxis with antiretroviral agents has been shown to reduce the transmission of human immunodeficiency virus (HIV) among men who have sex with men; however, the efficacy among heterosexuals is uncertain. METHODS: We randomly assigned HIV-seronegative men and women to receive either tenofovir disoproxil fumarate and emtricitabine (TDF-FTC) or matching placebo once daily. Monthly study visits were scheduled, and participants received a comprehensive package of prevention services, including HIV testing, counseling on adherence to medication, management of sexually transmitted infections, monitoring for adverse events, and individualized counseling on risk reduction; bone mineral density testing was performed semiannually in a subgroup of participants. RESULTS: A total of 1219 men and women underwent randomization (45.7% women) and were followed for 1563 person-years (median, 1.1 years; maximum, 3.7 years). Because of low retention and logistic limitations, we concluded the study early and followed enrolled participants through an orderly study closure rather than expanding enrollment. The TDF-FTC group had higher rates of nausea (18.5% vs. 7.1%, P<0.001), vomiting (11.3% vs. 7.1%, P=0.008), and dizziness (15.1% vs. 11.0%, P=0.03) than the placebo group, but the rates of serious adverse events were similar (P=0.90). Participants who received TDF-FTC, as compared with those who received placebo, had a significant decline in bone mineral density. K65R, M184V, and A62V resistance mutations developed in 1 participant in the TDF-FTC group who had had an unrecognized acute HIV infection at enrollment. In a modified intention-to-treat analysis that included the 33 participants who became infected during the study (9 in the TDF-FTC group and 24 in the placebo group; 1.2 and 3.1 infections per 100 person-years, respectively), the efficacy of TDF-FTC was 62.2% (95% confidence interval, 21.5 to 83.4; P=0.03). CONCLUSIONS: Daily TDF-FTC prophylaxis prevented HIV infection in sexually active heterosexual adults. The long-term safety of daily TDF-FTC prophylaxis, including the effect on bone mineral density, remains unknown. (Funded by the Centers for Disease Control and Prevention and the National Institutes of Health; TDF2 ClinicalTrials.gov number, NCT00448669.).

20 Clinical Trial Decreased pre-existing Ad5 capsid and Ad35 neutralizing antibodies increase HIV-1 infection risk in the Step trial independent of vaccination. 2012

Cheng, Cheng / Wang, Lingshu / Gall, Jason G D / Nason, Martha / Schwartz, Richard M / McElrath, M Juliana / DeRosa, Steven C / Hural, John / Corey, Lawrence / Buchbinder, Susan P / Nabel, Gary J. ·Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Insititutes of Health, Bethesda, Maryland, United States of America. ·PLoS One · Pubmed #22496775.

ABSTRACT: BACKGROUND: The Step trial raised the possibility that uncircumcised men with pre-existing Ad5 neutralizing antibodies carried an increased risk of HIV infection after vaccination. Thus, understanding Ad seropositivity in humans is important to the development of an AIDS vaccine. Here, we analyze the impact of different Ad5-specific neutralizing antibodies on immune function and clinical outcome. METHODS AND FINDINGS: Ad seropositivity in the Step trial volunteers was analyzed using chimeric rAd5/35 vectors to characterize their specificity for Ad5 fiber and non-fiber external (capsid) proteins. Immune responses and HIV seropositivity were correlated with the specificity of Ad5-neutralizing antibodies. Neutralizing antibodies induced by the vaccine in Ad5 seronegative subjects were directed preferentially to Ad5 capsid proteins, although some fiber-neutralizing antibodies could be detected. Pre-vaccination Ad5 serostatus did not affect the capsid-directed response after three vaccinations. In contrast, anti-fiber antibody titers were significantly higher in volunteers who were Ad5 seropositive prior to vaccination. Those Ad5 seropositive subjects who generated anti-capsid responses showed a marked reduction in vaccine-induced CD8 responses. Unexpectedly, anti-vector immunity differed qualitatively in Ad5 seropositive participants who became HIV-1 infected compared to uninfected case controls; Ad5 seropositive participants who later acquired HIV had lower neutralizing antibodies to capsid. Moreover, Ad35 seropositivity was decreased in HIV-infected subjects compared with uninfected case controls, while seroprevalence for other serotypes including Ad14, Ad28 and Ad41 was similar in both groups. CONCLUSIONS: Together, these findings suggest that the case subjects were less immunologically responsive prior to infection. Subjects infected during the Step trial had qualitative differences in immunity that increased their risk of HIV-1 infection independent of vaccination.

21 Clinical Trial HIV-1 drug resistance emergence among breastfeeding infants born to HIV-infected mothers during a single-arm trial of triple-antiretroviral prophylaxis for prevention of mother-to-child transmission: a secondary analysis. 2011

Zeh, Clement / Weidle, Paul J / Nafisa, Lillian / Lwamba, Humphrey M / Okonji, Jully / Anyango, Emily / Bondo, Philip / Masaba, Rose / Fowler, Mary Glenn / Nkengasong, John N / Thigpen, Michael C / Thomas, Timothy. ·Division of HIV/AIDS Prevention, US Centers for Disease Control and Prevention, Kisumu, Kenya. czeh@ke.cdc.gov ·PLoS Med · Pubmed #21468304.

ABSTRACT: BACKGROUND: Nevirapine and lamivudine given to mothers are transmitted to infants via breastfeeding in quantities sufficient to have biologic effects on the virus; this may lead to an increased risk of a breastfed infant's development of resistance to maternal antiretrovirals. The Kisumu Breastfeeding Study (KiBS), a single-arm open-label prevention of mother-to-child HIV transmission (PMTCT) trial, assessed the safety and efficacy of zidovudine, lamivudine, and either nevirapine or nelfinavir given to HIV-infected women from 34 wk gestation through 6 mo of breastfeeding. Here, we present findings from a KiBS trial secondary analysis that evaluated the emergence of maternal ARV-associated resistance among 32 HIV-infected breastfed infants. METHODS AND FINDINGS: All infants in the cohort were tested for HIV infection using DNA PCR at multiple study visits during the 24 mo of the study, and plasma RNA viral load for all HIV-PCR-positive infants was evaluated retrospectively. Specimens from mothers and infants with viral load >1,000 copies/ml were tested for HIV drug resistance mutations. Overall, 32 infants were HIV infected by 24 mo of age, and of this group, 24 (75%) infants were HIV infected by 6 mo of age. Of the 24 infants infected by 6 mo, nine were born to mothers on a nelfinavir-based regimen, whereas the remaining 15 were born to mothers on a nevirapine-based regimen. All infants were also given single-dose nevirapine within 48 hours of birth. We detected genotypic resistance mutations in none of eight infants who were HIV-PCR positive by 2 wk of age (specimens from six infants were not amplifiable), for 30% (6/20) at 6 wk, 63% (14/22) positive at 14 wk, and 67% (16/24) at 6 mo post partum. Among the 16 infants with resistance mutations by 6 mo post partum, the common mutations were M184V and K103N, conferring resistance to lamivudine and nevirapine, respectively. Genotypic resistance was detected among 9/9 (100%) and 7/15 (47%) infected infants whose mothers were on nelfinavir and nevirapine, respectively. No mutations were detected among the eight infants infected after the breastfeeding period (age 6 mo). CONCLUSIONS: Emergence of HIV drug resistance mutations in HIV-infected infants occurred between 2 wk and 6 mo post partum, most likely because of exposure to maternal ARV drugs through breast milk. Our findings may impact the choice of regimen for ARV treatment of HIV-infected breastfeeding mothers and their infected infants.

22 Clinical Trial Acute HIV infections among men with genital ulcer disease in South Africa. 2010

Paz Bailey, G / Sternberg, M / Lewis, D A / Puren, A. ·Del Valle University of Guatemala and Centers for Disease Control and Prevention Collaboration, Guatemala City, Guatemala. gpaz@gt.cdc.gov ·J Infect Dis · Pubmed #20443734.

ABSTRACT: We investigated acute human immunodeficiency virus (HIV) infection among men enrolled in a genital ulcer treatment trial in South Africa. HIV-negative participants were tested at baseline by HIV RNA polymerase chain reaction and followed up after 1 month to measure HIV seroconversion. There were 228 HIV-negative men at baseline; 10 were positive for HIV RNA, and 8 seroconverted to HIV at day 28. The prevalence of acute HIV among HIV-negative men at baseline was 18 (7.9%) of 228 men (95% confidence interval [CI], 4.4-11.4) and 18 (2.9%) of 615 men (95% CI, 1.6-4.3) in the overall study population. These data highlight the importance of genital ulcer patients in HIV transmission. Trial Registration. ClinicalTrials.gov identifier: NCT00164424 .

23 Clinical Conference Management of needlestick injuries: a house officer who has a needlestick. 2012

Henderson, David K. ·National Institutes of Health Clinical Center, Bethesda, MD 20892-1888, USA. dkh@nih.gov ·JAMA · Pubmed #22146902.

ABSTRACT: Since its identification in 1985, human immunodeficiency virus (HIV) has challenged several aspects of health care delivery. Because HIV is a blood-borne infectious disease, from the early days of the epidemic, concern was raised about risks of occupational exposures and infections among health care workers. Despite the development of highly active antiretroviral therapy, which has effectively modulated HIV into a chronic disease in many settings, risks of occupational infection with 3 blood-borne pathogens remain in the health care workplace. Using the case of a house officer who has a needlestick during a resuscitation attempt, prevention of needlesticks including universal precautions and postexposure management of occupational HIV, hepatitis B, and hepatitis C exposures is discussed.

24 Article HIV and Hepatitis C Virus Infection Testing Among Commercially Insured Persons Who Inject Drugs, United States, 2010-2017. 2020

Bull-Otterson, Lara / Huang, Ya-Lin A / Zhu, Weiming / King, Hope / Edlin, Brian R / Hoover, Karen W. ·Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia. · Division of HIV/AIDS Prevention, NCHHSTP, CDC, Atlanta, Georgia. · Prosphere Tek, Inc., Alexandria, Virginia. · Division of Viral Hepatitis, NCHHSTP, CDC, Atlanta, Georgia. ·J Infect Dis · Pubmed #32002537.

ABSTRACT: BACKGROUND: We assessed prevalence of testing for HIV and hepatitis C virus (HCV) infection among persons who inject drugs (PWID). METHODS: Using a nationwide health insurance database for claims paid during 2010-2017, we identified PWID by using codes from the International Classification of Diseases, Current Procedural Terminology, and National Drug Codes directory. We then estimated the percentage of PWIDs tested for HIV or HCV within 1 year of an index encounter, and used multivariate logistic regression models to assess demographic and clinical factors associated with testing. RESULTS: Of 844 242 PWIDs, 71 938 (8.5%) were tested for HIV and 65 188 (7.7%) for HCV infections. Missed opportunities were independently associated with being male (ORs: HIV, 0.50 [95% CI, 0.49-0.50]; P < .001; HCV, 0.66 [95% CI, 0.65-0.72]; P < .001), rural residence (ORs: HIV, 0.67 [95% CI, 0.65-0.69]; P < .001; HCV, 0.75 [95% CI, 0.73-0.77]), and receiving services for skin infections or endocarditis (aORs: HIV, 0.91 [95% CI, 0.87-0.95]; P <.001; HCV, 0.90 [95% CI, 0.86-0.95]; P <.001). CONCLUSION: Approximately 90% of presumed PWIDs missed opportunities for HIV or HCV testing, especially male rural residents with claims for skin infections or endocarditis, commonly associated with injection drug use.

25 Article Risk factors for Burkitt lymphoma in East African children and minors: A case-control study in malaria-endemic regions in Uganda, Tanzania and Kenya. 2020

Peprah, Sally / Ogwang, Martin D / Kerchan, Patrick / Reynolds, Steven J / Tenge, Constance N / Were, Pamela A / Kuremu, Robert T / Wekesa, Walter N / Sumba, Peter O / Masalu, Nestory / Kawira, Esther / Magatti, Josiah / Kinyera, Tobias / Otim, Isaac / Legason, Ismail D / Nabalende, Hadijah / Dhudha, Herry / Ally, Hillary / Genga, Isaiah O / Mumia, Mediatrix / Ayers, Leona W / Pfeiffer, Ruth M / Biggar, Robert J / Bhatia, Kishor / Goedert, James J / Mbulaiteye, Sam M. ·Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD. · EMBLEM Study, St. Mary's Hospital Lacor, Gulu, Uganda. · African Field Epidemiology Network, Kampala, Uganda. · EMBLEM Study, Kuluva Hospital Kuluva, Arua, Uganda. · Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. · EMBLEM Study, Moi University College of Health Sciences, Eldoret, Kenya. · EMBLEM Study, Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya. · Kenya Medical Research Institute, Kisumu, Kenya. · EMBLEM Study, Bugando Medical Center, Mwanza, Tanzania. · EMBLEM Study, Shirati Health and Educational Foundation, Shirati, Tanzania. · Department of Pathology, The Ohio State University, Columbus, OH. ·Int J Cancer · Pubmed #31054214.

ABSTRACT: Endemic Burkitt lymphoma (eBL) is the most common childhood cancer in sub-Saharan African countries, however, few epidemiologic studies have been undertaken and none attempted enrolling cases from multiple countries. We therefore conducted a population-based case-control study of eBL in children aged 0-15 years old in six regions in Northern Uganda, Northern Tanzania and Western Kenya, enrolling 862 suspected cases and 2,934 population controls (response rates 98.5-100%), and processing ~40,000 vials of samples using standardized protocols. Risk factor questionnaires were administered, and malaria period prevalence was measured using rapid diagnostic tests (RDTs). A total of 80.9% of the recruited cases were diagnosed as eBL; 61.4% confirmed by histology. Associations with eBL risk were computed using logistic regression models adjusted for relevant confounders. Associations common in at least two countries were emphasized. eBL risk was decreased with higher maternal income and paternal education and elevated with history of inpatient malaria treatment >12 months before enrollment. Reporting malaria-attributed fever up to 6 months before enrollment and malaria-RDT positivity at enrollment were associated with decreased eBL risk. Conversely, reporting exposure to mass malaria suppression programs (e.g., indoor residual insecticide) was associated with elevated risk. HIV seropositivity was associated with elevated eBL risk, but the relative impact was small. The study shows that it is feasible to conduct networked, multisite population-based studies of eBL in Africa. eBL was inversely associated with socioeconomic status, positively associated with inpatient malaria treatment 12 months ago and with living in areas targeted for malaria suppression, which support a role of malaria in eBL.