Suchergebnisse

IntroductionTraditional screening system focus on classic risk factors "lost" a substantial proportion of HIV‐infected patients. Several organizations such as CDC or USPS Task Force favour universal screening for HIV infection for good cost‐effectiveness profile. In a previous study prevalence of HIV infection in patients attending our infectious diseases department was high (5.4%).ObjectiveTo determine prevalence of HIV infection in patients aged 20–55 years in primary care (PC).Material and MethodsA propsective observational study was undertaken between February and June 2013. We performed a screening of HIV infection type "Opt‐out" (offering voluntary rejection) in 4 PC centers (32 Physicians) in San Juan‐Alicante. Sample size (n=318) for a prevalence of 1% and a confidence level of 97% was calculated. Nevertheless, other PC physician not recruiting patients performed HIV testing according clinical risk factors.ResultsHIV testing was offered to 508 patients. Mean age 38.9±10 years (58.5% female). Overall, 430 (83.8%) agreed to participate. Finally, 368 patients (71.7% of total) were tested for HIV. No patient had a positive result (100% ELISA HIV negative). However, following clinical practice, 3 patients were diagnosed of HIV in the same period by non‐recruiting physicians. In 2 cases, serology was performed at the patient's request and in one case by constitutional syndrome. The 3 patients were MSM.Conclusions1) In our study, we detected no new cases of HIV infection through universal screening. 2) Our screened population could be lower‐risk because of high percentage of women included (58.5%). 3) Performing HIV opt‐in screening (clinical practice), we detected 3 cases in the same period, all having HIV risk factors (MSM). 4) These results suggest that opt‐out screening should be developed in high‐risk populations. It is still to be determined what is the best screening strategy in low‐risk populations such as ours.

Abstract

Gender differences in sexual behavior as a consequence of migration have been ignored in both the migration and the HIV literature in China. This study examines differences among temporary migrants in terms of sexual behavior and factors that make female migrants more vulnerable to the risk of acquiring HIV infection. Results suggest that the interplay of migration and gender renders female temporary migrants particularly vulnerable to engaging in casual and commercial sex. Although male temporary migrants do not differ from male nonmigrants in prevalence of casual and commercial sex, the prevalence rates of casual and commercial sex for female temporary migrants are found to be 14 and 80 times those for female nonmigrants, respectively. Female temporary migrants' higher unemployment rate and concentration in the service and entertainment sectors are keys to understanding differences in the prevalence of casual and commercial sex among temporary migrants according to sex. Policy measures to promote female temporary migrants' equal access to employment are urgently needed to improve their economic well‐being and to reduce their risky sexual behavior.

The completion of the second year of the Colorado Springs Study provided new insights into the location of HIV infection in a large urban social network. About 250 persons were interviewed by the end of the second year and provided information on over 3500 reported social relationships. Roughly 2000 persons were found to be part of a core connected region which included six individuals confirmed HIV positive. The density of social ties in this core region was about 0.01. The average number of steps (along shortest paths) between HIVinfected persons and others in connected core of this large urban social network was quite small (between 4 and 6). Some implications of the observations are discussed. When individuals are connected together to form large social networks, the concepts and methods of network analysis can lead to a better understanding of factors affecting the spread of infectious agents transmitted in the course of close or intimate personal contact. A better understanding of the factors involved, in turn, can lead to more effective disease control strategies (Klovdahl, 1985).

Rebecca Awiti and her partner live in Nairobi's Kibera slums. Both are HIV positive like many of their neighbours. Still, they dreamed of having a healthy child together. Before Rebecca conceived, her doctor referred her to the Prevention of Mother‐to‐Child Transmission (PMTCT) programme at Kenyatta National Hospital. Clinicians provided her with antiretroviral therapy, which can prevent babies contracting HIV from their parents 98% of the time. Today, the couple are proud parents of healthy, HIV‐negative four‐year‐old triplets. Rebecca now also works for a non‐profit organization called Women Fighting AIDS in Kenya (WOFAK).

IntroductionElevated IL‐6 levels have been linked to increased risk of cardiovascular disease (CVD), cancer and death. Compared to the general population, treated HIV+ persons have 50–100% higher IL‐6 levels, but few data on the determinants of IL‐6 levels during HIV infection currently exist.Material and MethodsParticipants in three international HIV trials (SMART, ESPRIT and SILCAAT) with IL‐6 plasma levels measured at baseline were included (N=9864). Factors independently associated with log2‐transformed IL‐6 level were identified by multivariate linear regression; exponentiated estimates corresponding to fold differences (FDs) in IL‐6 were calculated. Demographics (age, gender, race, BMI) and HIV‐specific variables (nadir and entry CD4 counts, HIV‐RNA, use of different ART regimens) were investigated in all three trials. In SMART (N=4498), smoking, comorbidities (CVD, diabetes, hepatitis B/C [HBV/HCV]), HDL‐cholesterol, renal function (eGFR) and educational level were also assessed.ResultsDemographics associated with higher IL‐6 were older age (FD [95% CI]: 1.09 [1.08–1.11] per 10 yr) and higher BMI (1.02 [1.01–1.04] per 5 kg/m2), whereas black race was associated with reduced IL‐6 (0.96 [0.93–0.99]). As for HIV variables, patients not receiving ART (1.36 [1.29–1.43]) and with higher HIV‐RNA (1.24 [1.01–1.52] for >100,000 vs. ≤500 copies/mL) had increased IL‐6. Participants taking protease inhibitors (PI) had higher IL‐6 (1.14[1.09–1.19]). Higher nadir CD4 count (0.98 [0.97–0.99]/100 cells/µL) was related to lower IL‐6. All evaluated comorbidities were related to higher IL‐6; FDs in IL‐6 were 1.08 [1.04–1.12] for smoking, 1.12 [1.02–1.24] for CVD, 1.07 [1.00–1.16] for diabetes and 1.12 [1.02–1.24] for HBV (1.15 [1.02–1.30]) and 1.53 [1.45–1.62] for HCV. IL‐6 increased with decreasing eGFR (0.98 [0.97–1.00]/10 mL/min) and HDL‐cholesterol (0.98 [0.96–0.99]/10 mg/mL). Lower education was related to higher IL‐6 (1.09 [1.03–1.15] for high school vs. bachelor's degree).ConclusionsHigher IL‐6 levels were associated with older age and non‐black race, higher BMI and lower HDL‐cholesterol, ongoing HIV replication, low nadir CD4 counts, comorbidities and decreased renal function. This suggests that there are multiple causes of inflammation in treated HIV infection. A possible contribution from PI use was also observed. Contribution from inflammation to explain variation in clinical outcomes for these factors should be investigated.