Search

Our study aimed to provide a comprehensive overview of the current status and dynamic trends of the human immunodeficiency virus (HIV) prevalence in Sichuan, the second most heavily affected province in China, and to explore future interventions. The epidemiological, behavioral, and population census data from multiple sources were analyzed to extract inputs for an acquired immunodeficiency syndrome (AIDS) epidemic model (AEM). Baseline curves, derived from historical trends in HIV prevalence, were used, and the AEM was employed to examine future intervention scenarios. In 2015, the modeled data suggested an adult HIV prevalence of 0.191% in Sichuan, with an estimated 128,766 people living with HIV/AIDS and 16,983 individuals with newly diagnosed infections. Considering current high-risk behaviors, the model predicts an increase in the adult prevalence to 0.306% by 2025, projecting an estimated 212,168 people living with HIV/AIDS and 16,555 individuals with newly diagnosed infections. Heterosexual transmission will likely emerge as the primary mode of AIDS transmission in Sichuan. Furthermore, we anticipate a stabilization in the incidence of AIDS with a concurrent increase in prevalence. Implementing comprehensive intervention measures aimed at high-risk groups could effectively alleviate the spread of AIDS in Sichuan. [ABSTRACT FROM AUTHOR]

To better understand the transmission of human immunodeficiency virus type 1 (HIV-1), the genetic characteristics of blood and genital viruses from males were compared to those of the imputed founding virus population in their female partners. Initially serodiscordant heterosexual African couples with sequence-confirmed male-to-female HIV-1 transmission and blood and genital specimens collected near the time of transmission were studied. Single viral templates from blood plasma and genital tract RNA and DNA were sequenced across HIV-1 env gp160. Eight of 29 couples examined yielded viral sequences from both tissues. Analysis of these couples' sequences demonstrated, with one exception, that the women's founding viral populations arose from a single viral variant and were CCR5 tropic, even though CXCR4 variants were detected within four males. The median genetic distance of the imputed most recent common ancestor of the women's founder viruses showed that they were closer to the semen viruses than to the blood viruses of their transmitting male partner, but this finding was biased by detection of a greater number of viral clades in the blood. Using multiple assays, the blood and genital viruses were consistently found to be compartmentalized in only two of eight men. No distinct amino acid signatures in the men's viruses were found to link to the women's founders, nor did the women's env sequences have shorter variable loops or fewer N-linked glycosylation sites. The lack of selective factors, except for coreceptor tropism, is consistent with others' findings in male-to-female and high-risk transmissions. The infrequent compartmentalization between the transmitters' blood and semen viruses suggests that cell-free blood virus likely includes HIV-1 sequences representative of those of viruses in semen.IMPORTANCE Mucosal transmissions account for the majority of HIV-1 infections. Identification of the viral characteristics associated with transmission would facilitate vaccine design. This study of HIV strains from transmitting males and their seroconverting female partners found that the males' genital tract viruses were rarely distinct from the blood variants. The imputed founder viruses in women were genetically similar to both the blood and genital tract variants of their male partners, indicating a lack of evidence for genital tract-specific lineages. These findings suggest that targeting vaccine responses to variants found in blood are likely to also protect from genital tract variants.

Studies have shown that sexual transmission, both heterosexually and homosexually, is one of the main ways of HBV infection. Based on this fact, we propose a mathematical model to study the sexual transmission of HBV among adults by classifying adults into men and women and considering both same-sex and opposite-sex transmissions of HBV in adults. Firstly, we calculate the basic reproduction number $ R_{0} $ and the disease-free equilibrium point $ E_{0} $ . Secondly, by analysing the sensitivity of $ R_{0} $ in terms of model parameters, we find that the infection rate among people who have same-sex partners, the frequency of homosexual contact and the immunity rate of adults play important roles in the transmission of HBV. Moreover, we use our model to fit the reported data in China and forecast the trend of hepatitis B. Our results demonstrate that popularizing the basic knowledge of HBV among residents, advocating healthy and reasonable sexual life style, reducing the number of adult carriers, and increasing the immunization rate of adults are effective measures to prevent and control hepatitis B.

Abstract Background Understanding the demographic characteristics of people living with HIV/AIDS (PLWHA) infected through commercial heterosexual contact (CHC) or nonmarital noncommercial heterosexual contact (NMNCHC) is important for HIV/AIDS prevention and control. Methods Cases reported through the Chinese HIV/AIDS Case Reporting System (CRS) from 2015 to 2018 were analyzed. A descriptive and preliminary inferential analysis were performed for those demographic characteristics deemed of interest. Results Overall, 523,121 identified PLWHA between 2015 and 2018 in the CRS were analyzed. The constituent ratio of heterosexual transmission increased from 66.25% in 2015 to 71.48% in 2018. The proportion of CHC heterosexual transmission decreased from 40.18% in 2015 to 37.99% in 2018, while that of NMNCHC increased from 46.33% in 2015 to 49.02% in 2018. PLWHA infected through NMNCHC were significantly younger than those who were infected through CHC (Student’s t test, P

ObjectiveHIV epidemiology in South-Central China is rarely reported. This study aims to characterize epidemiological and clinical features of HIV-infected patients in Hunan Province, located in South-Central China, for better management of HIV infections.MethodsThis retrospective study retrieved multi-center records of laboratory-confirmed HIV-infected patients in Hunan province. Information on HIV-associated mortality and antiretroviral therapies was also collected.ResultsAmong 34,297 patients diagnosed with HIV infections from 2003 to 2018, 73.9% were males, 41.3% were older adults (≥50 years), and 71.2% were infected by heterosexual transmission. Despite a slow growth of new HIV infections in the overall population, annual percentages of HIV infections increased in older males (85.3% through heterosexual transmission) and young patients

Studies have shown that sexual transmission, both heterosexually and homosexually, is one of the main ways of HBV infection. Based on this fact, we propose a mathematical model to study the sexual transmission of HBV among adults by classifying adults into men and women and considering both same-sex and opposite-sex transmissions of HBV in adults. Firstly, we calculate the basic reproduction number R 0 and the disease-free equilibrium point E 0 . Secondly, by analysing the sensitivity of R 0 in terms of model parameters, we find that the infection rate among people who have same-sex partners, the frequency of homosexual contact and the immunity rate of adults play important roles in the transmission of HBV. Moreover, we use our model to fit the reported data in China and forecast the trend of hepatitis B. Our results demonstrate that popularizing the basic knowledge of HBV among residents, advocating healthy and reasonable sexual life style, reducing the number of adult carriers, and increasing the immunization rate of adults are effective measures to prevent and control hepatitis B. [ABSTRACT FROM AUTHOR]

Abstract Background Heterosexual transmission has contributed greatly to the current HIV-1 epidemic in China. However, the HIV-1 genetic characteristics in the heterosexually transmitted population in Jiangsu province remained unclear. Methods A molecular epidemiological investigation on heterosexual transmission of HIV-1 was conducted across Jiangsu province. 301 HIV-1 patients infected through heterosexual transmission were involved in this study. The epidemiological information was investigated by trained staff via face-to-face interviews. Blood samples were taken from each patient, HIV-1 RNA was extracted from the plasma, and used for amplifying the gag and env genes followed by further products sequencing. The genotypes of HIV-1 were determined using phylogenetic tree analyses in the neighbor-joining method. Results A total of 262 samples were successfully taken for genotyping. The main subtypes which accounted for 90.5% of all HIV-1 strains are CRF01_AE (45.4%), CRF07_BC (21.4%), subtype B (12.6%), CRF08_BC (11.1%). Minor subtypes were also detected, such as CRF68_01B, subtype C, CRF55_01B, CRF02_AG and subtype A. Time trend analysis suggested the prevalence of subtype B and CRF08_BC decreased gradually, but the prevalence of CRF01_AE increased over time. A relatively higher prevalence of CRF07_BC in Central Jiangsu and subtype B were detected in South Jiangsu, while a relatively lower prevalence of subtype B and CRF08_BC were detected in Central Jiangsu. Conclusion Complex and unbalanced HIV distribution characteristics suggest that heterosexual transmission of HIV needs to be taken seriously. It is necessary to implement more effective and comprehensive intervention strategies for further control of HIV-1 dissemination.

BackgroundBecause many human papillomavirus (HPV) infections are transient, rates of transmission may be miscalculated if the interval between testing spans several months. We examined rates of concordance and transmission in heterosexual couples over short intervals.Methods Twenty-five adult couples were enrolled and sampled for HPV DNA from the genitals, hand, and mouth 5 times over a 6-week period, including 24 hours after sexual intercourse and after 48 hours of abstinence. Concordance and transmission patterns were described.ResultsConcordance between the couple's genital sites ranged from 64% to 95% for at least 1 HPV type. The highest rates of concordance were observed 24 hours after sexual intercourse. A similar peak in concordance was not seen between genital and nongenital anatomic sites. Transmission rates for female genital to male genital ranged from 26.8 to 187.5 per 100 person-months and for male genital to female genital from 14.5 to 100 per 100 person-months.ConclusionsHigh rates of concordance shortly after intercourse suggest that some DNA detections in the genital area are contaminants from a partner and not established HPV infections. Female-to-male transmission appeared more common than male-to-female transmission.

Background: Understanding the demographic characteristics of people living with HIV/AIDS (PLWHA) infected through commercial heterosexual contact (CHC) or nonmarital noncommercial heterosexual contact (NMNCHC) is important for HIV/AIDS prevention and control.Methods: Cases reported through the Chinese HIV/AIDS Case Reporting System (CRS) from 2015 to 2018 were analyzed. A descriptive and preliminary inferential analysis were performed for those demographic characteristics deemed of interest.Results: Overall, 523,121 identified PLWHA between 2015 and 2018 in the CRS were analyzed. The constituent ratio of heterosexual transmission increased from 66.25% in 2015 to 71.48% in 2018. The proportion of CHC heterosexual transmission decreased from 40.18% in 2015 to 37.99% in 2018, while that of NMNCHC increased from 46.33% in 2015 to 49.02% in 2018. PLWHA infected through NMNCHC were significantly younger than those who were infected through CHC (Student's t test, P < 0.0001), with an average age gap ranging from 5.63 (2015) to 7.46 (2018) years, and the average age of both groups increased annually. The frequency of newly identified PLWHA who were infected through CHC had a remarkable increase among the ages of 65 and above. Gender distribution was significantly different between CHC and NMNCHC (χ2 = 8909.00(2015), 9941.90(2016), 11,004.00 (2017), 12,836.00(2018), all P < 0.0001), and the ratio of men to women in the NMCHC group was 1.50:1 (2015), 1.51:1 (2016), 1.54:1 (2017), and 1.52:1 (2018), while in the commercial heterosexual contact (CHC) group, these ratios were 11.45:1 (2015), 12.08:1 (2016), 12.53:1 (2017), and 13.28:1 (2018). Marital status was significantly different between CHC and NMNCHC (χ2 = 94.67 (2015), 109.88(2016), 58.18(2017), 152.38(2018), all P < 0.0001). As the educational level improved, the proportion of NMNCHC also increased (Cochran - Armitage test, P < 0.0001).Conclusions: We found that heterosexual transmission was the primary mode of HIV transmission in China from 2015 to 2018. PLWHA infected through CHC and NMNCHC had different characteristics in age, gender, marital status, and educational level. The frequency of PLWHA infected through CHC increased substantially in the age group of 65 and above. This study provides useful baseline data for future studies on the heterosexual transmission of HIV in China. [ABSTRACT FROM AUTHOR]

Objectives: To study the clinico-epidemiologic attributes of persons living with HIV/AIDS on highly active antiretroviral therapy (HAART). Methods: Clinico-epidemiological details, CD4 counts, previous illness and mucocutaneous diseases were studied in 515 persons living with HIV/AIDS on HAART. Results: The study comprised 250 (48.5%) males and 265 (51.5%) females aged between 10 and 79 (mean 38.9) years. The 196 (38%) males were drivers, staying-alone laborers/self-employed, and 253 (49.1%) females were homemakers. All were on HAART for one month to 9 years. Heterosexual transmission was noted in 478 (92.8%) individuals. The 274 (53.5%) individuals had 200–350 CD4 cells/mm3 counts, whereas it was

Three deterministic Kermack-McKendrick-type models for studying the transmission dynamics of an infection in a two-sex closed population are analyzed here. In each model it is assumed that infection can be transmitted through heterosexual contacts, and that there is a higher probability of transmission from one sex to the other than vice versa. The study is focused on understanding whether and how this bias in transmission reflects in sex differences in final attack ratios (i.e. the fraction of individuals of each sex that eventually gets infected). In the first model, where the other two transmission modes are not considered, the attack ratios (fractions of the population of each sex that will eventually be infected) can be obtained as solutions of a system of two nonlinear equations, that has a unique solution if the net reproduction number exceeds unity. It is also shown that the ratio of attack ratios depends solely on the ratio of gender-specific susceptibilities and on the basic reproductive number of the epidemic $ \mathcal{R}_0 $, and that the gender-specific final attack-ratio is biased in the same direction as the gender-specific susceptibilities. The second model allows also for infection transmission through direct, non-sexual, contacts. In this case too, an analytical expression is derived from which the attack ratios can be obtained. The qualitative results are similar to those obtained for the previous model, but another important parameter for determining the value of the ratio between the attack ratios in the two sexes is obtained, the relative weight of direct vs. heterosexual transmission (namely, ρ). Quantitatively, the ratio of final attack ratios generally will not exceed 1.5, if non-sexual transmission accounts for most transmission events (ρ ≥ 0.6) and the ratio of gender-specific susceptibilities is not too large (say, 5 at most).The third model considers vector-borne, instead of direct transmission. In this case, we were not able to find an analytical expression for the final attack ratios, but used instead numerical simulations. The results on final attack ratios are actually quite similar to those obtained with the second model. It is interesting to note that transient patterns can differ from final attack ratios, as new cases will tend to occur more often in the more susceptible sex, while later depletion of susceptibles may bias the ratio in the opposite direction.The analysis of these simple models, despite their lack of realism, can help in providing insight into, and assessment of, the potential role of gender-specific transmission in infections with multiple modes of transmission, such as Zika virus (ZIKV), by gauging what can be expected to be seen from epidemiological reports of new cases, disease incidence and seroprevalence surveys.

Changes over time in HIV-1 subtype diversity within a population reflect changes in factors influencing the development of local epidemics. Here we report on the genetic diversity of 2364 reverse transcriptase sequences from people living with HIV-1 in New South Wales (NSW) notified between 2004 and 2018. These data represent >70% of all new HIV-1 notifications in the state over this period. Phylogenetic analysis was performed to identify subtype-specific transmission clusters. Subtype B and non-B infections differed across all demographics analysed (p < 0.001). We found a strong positive association for infections among females, individuals not born in Australia or reporting heterosexual transmission being of non-B origin. Further, we found an overall increase in non-B infections among men who have sex with men from 50 to 79% in the last 10 years. However, we also found differences between non-B subtypes; heterosexual transmission was positively associated with subtype C only. In addition, the majority of subtype B infections were associated with clusters, while the majority of non-B infections were singletons. However, we found seven non-B clusters (≥5 sequences) indicative of local ongoing transmission. In conclusion, we present how the HIV-1 epidemic has changed over time in NSW, becoming more heterogeneous with distinct subtype-specific demographic associations.

Introduction: Post-Soviet countries of Eastern Europe and Central Asia have witnessed a recent growth of HIV infection through heterosexual transmission. Women’s low levels of knowledge about HIV prevention and transmission methods have been found to account for the higher female-to-male ratio among cases infected through the heterosexual route. This cross national comparison study assessed comprehensive HIV/AIDS knowledge and its key determinants among women of seven post-Soviet countries and identified which countries face the highest levels of risk due to the low levels of HIV/AIDS awareness. Methods: Study data were obtained from the third wave of the Multiple Indicator Cluster Surveys (MICS3) (conducted in 2005 and 2006), nationally representative samples of women aged 15-49 years. Data on HIV/AIDS knowledge were analyzed for women in Kazakhstan (N=14,310), Kyrgyzstan (N=6,493), Tajikistan (N=4,676), Uzbekistan (N=13,376), Belarus (N=5,884), Ukraine (N=6,066), and Georgia (N=7,727) using descriptive statistics and ordinary least squares (OLS) regressions. Results: We found that the percentage of women who could correctly identify all five modes of HIV/AIDS transmission and prevention was highest in Eastern European countries of Belarus (34.98%) and Ukraine (31.67%). Across all countries, the strongest predictors of comprehensive HIV/AIDS knowledge were age, education, and region of residence. Marital status, area of residence (urban vs. rural), and household wealth were significant predictors for several countries. Conclusion: High rates of comprehensive HIV/AIDS knowledge were found among women of Belarus and Ukraine. To reduce the spread of HIV in the region, programs promoting comprehensive HIV/AIDS knowledge for women of younger ages and with lower education are recommended.

Introduction: Post-Soviet countries of Eastern Europe and Central Asia have witnessed a recent growth of HIV infection through heterosexual transmission. Women's low levels of knowledge about HIV prevention and transmission methods have been found to account for the higher female-to-male ratio among cases infected through the heterosexual route. This cross national comparison study assessed comprehensive HIV/AIDS knowledge and its key determinants among women of seven post-Soviet countries and identified which countries face the highest levels of risk due to the low levels of HIV/AIDS awareness. Methods: Study data were obtained from the third wave of the Multiple Indicator Cluster Surveys (MICS3) (conducted in 2005 and 2006), nationally representative samples of women aged 15-49 years. Data on HIV/AIDS knowledge were analyzed for women in Kazakhstan (N=14,310), Kyrgyzstan (N=6,493), Tajikistan (N=4,676), Uzbekistan (N=13,376), Belarus (N=5,884), Ukraine (N=6,066), and Georgia (N=7,727) using descriptive statistics and ordinary least squares (OLS) regressions. Results: We found that the percentage of women who could correctly identify all five modes of HIV/AIDS transmission and prevention was highest in Eastern European countries of Belarus (34.98%) and Ukraine (31.67%). Across all countries, the strongest predictors of comprehensive HIV/AIDS knowledge were age, education, and region of residence. Marital status, area of residence (urban vs. rural), and household wealth were significant predictors for several countries. Conclusion: High rates of comprehensive HIV/AIDS knowledge were found among women of Belarus and Ukraine. To reduce the spread of HIV in the region, programs promoting comprehensive HIV/AIDS knowledge for women of younger ages and with lower education are recommended. [ABSTRACT FROM AUTHOR]

The viral genotype has been shown to play an important role in HIV pathogenesis following transmission. However, the viral phenotypic properties that contribute to disease progression remain unclear. Most studies have been limited to the evaluation of Gag function in the context of a recombinant virus backbone. Using this approach, important biological information may be lost, making the evaluation of viruses obtained during acute infection, representing the transmitted virus, a more biologically relevant model. Here, we evaluate the roles of viral infectivity and the replication capacity of viruses from acute infection in disease progression in women who seroconverted in the CAPRISA 004 tenofovir microbicide trial. We show that viral replication capacity, but not viral infectivity, correlates with the set point viral load (Spearman r = 0.346; P = 0.045) and that replication capacity (hazard ratio [HR] = 4.52; P = 0.01) can predict CD4 decline independently of the viral load (HR = 2.9; P = 0.004) or protective HLA alleles (HR = 0.61; P = 0.36). We further demonstrate that Gag-Pro is not the main driver of this association, suggesting that additional properties of the transmitted virus play a role in disease progression. Finally, we find that although viruses from the tenofovir arm were 2-fold less infectious, they replicated at rates similar to those of viruses from the placebo arm. This indicates that the use of tenofovir gel did not select for viral variants with higher replication capacity. Overall, this study supports a strong influence of the replication capacity in acute infection on disease progression, potentially driven by interaction of multiple genes rather than a dominant role of the major structural gene gag. [ABSTRACT FROM AUTHOR]

Desde os primeiros anos da epidemia de Aids, grandes diferenças geográficas na prevalência de infecção pelo HIV foram registradas entre países vizinhos e regiões vizinhas dentro de um mesmo país na África subsaariana. Tais diferenças não podiam ser completamente explicadas por fatores como o comportamento sexual e o uso de preservativos. Um acúmulo de dados epidemiológicos vem mostrando que a circuncisão masculina desempenha um efeito protetor contra a aquisição heterossexual do HIV pelo homem na África subsaariana e provavelmente contribui para as acentuadas diferenças de prevalência de HIV. Assim, realizou-se uma atualização dos estudos conduzidos em solo africano sobre a associação entre circuncisão masculina e infecção pelo HIV, as origens da prática da circuncisão entre as populações humanas, os mecanismos pelos quais a presença do prepúcio aumentaria a susceptibilidade de aquisição heterossexual do HIV pelo homem, sua associação com outras doenças infecciosas e também neoplásicas, o debate sobre a conveniência da adoção de práticas de circuncisão como estratégia de controle da epidemia de HIV na África, a escassa literatura brasileira sobre circuncisão masculina e as perspectivas de investigações futuras.Since the early years of the AIDS epidemic significant geographic differences in HIV prevalence were reported within neighboring countries and neighboring regions within the same country in sub-Saharan Africa. These differences could not be fully explained by factors such as sexual behavior and condom use. Mounting epidemiological data have demonstrated that male circumcision is a major protective factor against male heterosexual HIV infection in sub-Saharan Africa and probably contributes to these significant differences in HIV prevalence. This is a review of African studies on the association between male circumcision and HIV infection, the origin of circumcision practices in human societies, potential prepuce mechanisms for increasing male vulnerability to heterosexual HIV infection, its association with other infectious and neoplastic diseases, controversies on the convenience of male circumcision as an HIV control strategy in Africa, the scarce Brazilian literature on male circumcision and perspectives of future research.

Background: In 2009, 27% of the 48,100 estimated new cases of HIV were attributed to heterosexual contact with an infected or at-risk person. Sexually active adults are less likely to use condoms in relationships with main partners than with non-regular partners, despite general knowledge that condom use reduces HIV transmission. Methods: The purpose of this secondary qualitative analysis was to explore and contextualize perceptions of main partnerships, HIV risk, and attitudes toward condom use within main partner relationships among a subsample of intervention-arm cocaine- and/or heroin-using patients enrolled in a negative trial of brief motivational intervention to reduce the incidence of sexually transmitted disease and unsafe sexual behaviors. The open-ended portion of these interview audiotapes consisted of questions about perceptions of risk and attitudes about condom use with main partners. Enrollees were aged 18-54, English or Spanish speaking, and included in this analysis only if they reported having a main partner. We identified codes and elaborated important themes through a standard inductive three step coding process, using HyperRESEARCH™ software. Results: Among 48 interviewees, 65% were male, half were non-Hispanic white, over 60% were 20-39 years of age, 58% had intravenous drug use (IDU), and 8% were HIV-positive. Participants defined respect, support, trust, and shared child-rearing responsibility as the most valued components of main partner relationships. Condom use was viewed occasionally as a positive means of showing respect with main partners but more often as a sign of disrespect and a barrier to intimacy and affection. Enrollees appraised their partners' HIV risk in terms of perceptions of physical health, cleanliness, and sexual and HIV testing history. They based decisions regarding condom use mainly on perceived faithfulness, length of involvement, availability of condoms, and pregnancy desirability. Conclusions: Risk appraisal was commonly based on appearance and subjective factors, and condom use with main sexual partners was described most often as a demonstration of lack of trust and intimacy. [ABSTRACT FROM AUTHOR]

Identifying cohorts of US women with HIV infection rates sufficient for inclusion in vaccine efficacy trials has been challenging. Using geography and sexual network characteristics to inform recruitment strategies, HVTN 906 determined the feasibility of recruiting a cohort of women at high risk for HIV acquisition.HIV uninfected women who reported unprotected sex in the prior 6 months, resided or engaged in risk behavior in local geographical high-risk pockets and/or had a male partner who had been incarcerated, injected drugs, or had concurrent partners were eligible. Behavioral risk assessment, HIV counseling and testing, and pregnancy testing were done at baseline, 6, 12, and 18 months.Among 799 women, 71% were from local high-risk pockets and had high-risk male partners. Median age was 37 years; 79% were Black; and 15% Latina. Over half (55%) reported a new partner in the prior 6 months, 57% reported a male partner who had concurrent female sexual partners, and 37% reported a male partner who had been incarcerated. Retention at 18 months was 79.5%. Annual pregnancy incidence was 12%. Annual HIV incidence was 0.31% (95% confidence interval: 0.06% to 0.91%). Risk behaviors decreased between screening and 6 months with smaller changes thereafter.This cohort of women recruited using new strategies based on geography and sexual network characteristics did not have an HIV incidence high enough for HIV vaccine efficacy trials, despite high baseline levels of risk and a high pregnancy rate. New strategies to identify cohorts of US women for efficacy trials are needed. [ABSTRACT FROM AUTHOR]

This article reviews the antiretroviral therapy (ART) initiation criteria from national treatment guidelines for 70 countries and determines the extent of consistency with the current World Health Organization (WHO) recommendations.Published ART guidelines were collected from the Internet, databases, and WHO staff. ART eligibility criteria for asymptomatic people, pregnant women, people with HIV-associated tuberculosis, serodiscordant couples, injecting drug users, men who have sex with men, and sex workers were abstracted from them. Multiple regression analysis was used to determine the relation between ART eligibility criteria, ART coverage, and various population characteristics and policy interventions.Of the 70 countries, 42 (60%) follow WHO’s ART guidelines for asymptomatic people and 31 (44%) for pregnant women, recommending ART at CD4 count of 350 cells/mm3. Twenty-three (33%) countries recommend ART for people with HIV-associated tuberculosis irrespective of CD4 count. Nineteen countries are also recommending or considering earlier ART above CD4 count 350 cell/mm3 for asymptomatic people, pregnant women, and/or serodiscordant couples. Multiple linear regression analysis shows that HIV prevalence, year of publication of guidelines, and HIV expenditure are significantly associated with published ART eligibility criteria. On average, the ART coverage is similar irrespective of published guidelines being consistent with the WHO recommendation (P < 0.53).Published guidelines from a significant number of countries are not following WHO recommendations. Although published guidelines may not reflect practice, it is important to adapt recommendations and services quickly to reflect the emerging science on the health and prevention benefits of earlier access to ART. [ABSTRACT FROM AUTHOR]

Human Immunodeficiency Virus-type 1 (HIV- 1) binds to CD4 and CCR5 receptors on target cells in the human female reproductive tract. We sought to determine whether reducing levels of messenger RNA (mRNA) transcripts that encode these receptors in female reproductive tract cells could protect mucosal tissue explants from HIV- 1 infection. Explants prepared from the endometrium, endocervix, and ectocervix of hysterectomy tissues from HIV-1 sero-negative women were exposed to nanoparticles containing CD4- and CCR5-specific short-interfering RNA (siRNA) sequences. Explants were then exposed two days later to HIV-1, and HIV-1 reverse transcripts were measured five days post-infection. Explants treated with nanoparticles containing CD4- and CCR5-specific siRNA showed reduced levels of CD4 and CCR5 transcripts, and significantly lower levels of HIV-1 reverse transcripts compared to those treated with an irrelevant siRNA. In female reproductive tract explants and in peripheral blood cell cultures, siRNA transfection induced the secretion of IFN-alpha (IFN-α), a potent antiviral cytokine. In female mice, murine-specific Cd4-siRNA nanoparticles instilled within the uterus significantly reduced murine Cd4 transcripts by day 3. Our findings demonstrate that siRNA nanoparticles reduce expression of HIV-1 infectivity receptors in human female reproductive tract tissues and also inhibit HIV-1 infection. Murine studies demonstrate that nanoparticles can penetrate the reproductive tract tissues in vivo and silence gene expression. The induction of IFN-α after siRNA transfection can potentially contribute to the antiviral effect. These findings support the therapeutic development of nanoparticles to deliver siRNA molecules to silence host cell receptors in the female reproductive tract as a novel microbicide to inhibit mucosal HIV-1 transmission. [ABSTRACT FROM AUTHOR]

The article discusses a study which examines the relationships between bacterial vaginosis, vaginal yeast, vaginal practices, mucosal inflammation and HIV acquisition in women in Zimbabwe and Uganda. Bacterial vaginosis was measured by Gram stain Nugent scoring, vaginal yeast by wet mount, and mucosal inflammation by white blood cells on Gram stain. According to the study, bacterial vaginosis and yeast may contribute more to the HIV epidemic than previously thought.

Abstract: We present a sex-structured model for heterosexual transmission of HIV/AIDS with explicit incubation period for modelling the effect of male circumcision as a preventive strategy for HIV/AIDS. The model is formulated using integro-differential equations, which are shown to be equivalent to delay differential equations with delay due to incubation period. The threshold and equilibria for the model are determined and stabilities are examined. We extend the model to incorporate the effects of condom use as another preventive strategy for controlling HIV/AIDS. Basic reproductive numbers for these models are computed and compared to assess the effectiveness of male circumcision and condom use in a community. The models are numerically analysed to assess the effects of the two preventive strategies on the transmission dynamics of HIV/AIDS. We conclude from the study that in the continuing absence of a preventive vaccine or cure for HIV/AIDS, male circumcision is a potential effective preventive strategy of HIV/AIDS to help communities slow the development of the HIV/AIDS epidemic and that it is even more effective if implemented jointly with condom use. The study provides insights into the possible community benefits that male circumcision and condom use as preventive strategies provide in slowing or curtailing the HIV/AIDS epidemic. [Copyright &y& Elsevier]

The article describes a dynamic mathematical epidemic model for heterosexual HIV transmission and disease progression. The epidemic model was developed to stimulate the impact of various partially effective preventive HIV vaccination scenarios in a population at high risk for heterosexually transmitted HIV in Soweto, South Africa. The model defines six compartments, with each representing a particular health state to stimulate the process of HIV transmission and disease progression.

The article focuses on the health risk assessment of the factors behind the heterosexual transmission of HIV infection among African Americans in North Carolina. Significantly, a population-based case-control study has been made regarding the diagnosis of heterosexually transmitted HIV infection. Finally, though such infections are associated with established high-risk characteristics, poverty is considered as an underlying determinant and a contributor to infection risk.

Studies the importance of sexual contact with sex workers in driving the HIV epidemic among men in rural Zimbabwe. Establishment of the importance of commercial sex in addressing the HIV epidemic in the general population; Determination of risk factors for HIV infection among male mine and farm workers having sexual contact with sex workers; Prevalence of HIV infections attributable to sexual contact with sex workers.

Assesses the efficacy of highly active antiretroviral therapy (HAART) in reducing plasma levels of heterosexual couples affected with HIV. Variation of HIV transmission risks in unprotected sexual relationships; Link between zidovudine use and a decrease in the rate of HIV transmission from infected men to their partners; Persistence of HIV in genital secretions of patients with HAART.

Investigates the molecular diversity and demographic characteristics of HIV-positive heterosexuals who participated in a prevalence serosurvey in England and Wales from 1997-2000. Assignment of subtypes by heteroduplex mobility assay; Result of the logistic regression analyses; Indication of a high evel of genetic diversity among HIV-infected heterosexuals.

Objective: To examine the relationship between socioeconomic status (SES), risk factors for HIV infection and HIV status in an urban population with high prevalence of HIV infection in sub-Saharan Africa.Methods: Cross-sectional population survey of adults from the city of Kisumu, Kenya, in 1996. Around 1000 men and 1000 women aged 15-49 years were interviewed using a structured questionnaire, and most gave a venous blood sample for HIV testing. SES was represented by a composite variable of educational status, occupation and household utilities. Multiple regression was used to examine whether SES was associated with HIV infection or with risk factors for HIV infection.Results: Human immunodeficiency virus prevalence was 19.8% in males and 30.2% in females. Higher SES was associated with a more mobile lifestyle, later sexual debut and marriage among both sexes, and with circumcision among men aged 25-49 and condom use among women aged 25-49. Higher levels of alcohol consumption were associated with an increased risk of HIV infection and were more common amongst those of higher SES. HSV-2 infection was strongly associated with an increased risk of HIV infection and was more common among those of lower SES. HIV was associated with a lower SES among females aged 15-24 whereas in males aged 15-24 and females aged 25-49 there was some indication that it was associated with higher SES. Among males aged 25-49 there was no association between HIV infection and SES.Conclusions: Risk of infection was high among groups of all SES. Risk profiles suggested men and women of lower SES maybe at greater risk of newly acquired HIV infection. New infections may now be occurring fastest among young women of the lowest SES. [ABSTRACT FROM AUTHOR]

Objectives: To study the clinico-epidemiologic attributes of persons living with HIV/AIDS on highly active antiretroviral therapy (HAART). Methods: Clinico-epidemiological details, CD4 counts, previous illness and mucocutaneous diseases were studied in 515 persons living with HIV/AIDS on HAART. Results: The study comprised 250 (48.5%) males and 265 (51.5%) females aged between 10 and 79 (mean 38.9) years. The 196 (38%) males were drivers, staying-alone laborers/self-employed, and 253 (49.1%) females were homemakers. All were on HAART for one month to 9 years. Heterosexual transmission was noted in 478 (92.8%) individuals. The 274 (53.5%) individuals had 200–350 CD4 cells/mm3 counts, whereas it was <200 cells/mm3 in 88 (17.2%) individuals. Candidiasis (in 48), dermatophytoses (n = 23), herpes labialis (n = 13), herpes zoster (n = 12), seborrheic dermatitis (n = 29), generalized pruritus (n = 22), and xerosis in 20 individuals were the most common dermatoses. Most dermatoses occurred with 200–350 CD4 cells/mm3. Adverse drug reactions from antiretroviral therapy (ART) and concurrent therapies also occurred. Conclusions: Although most of our patients had mild HIV-associated dermatoses while on HAART, adverse drug reactions from HAART or concurrent therapies themselves remain a potential risk. Nevertheless, knowledge of these aspects will help planning for comprehensive health care envisaged in the National AIDS Control Program phase IV. [ABSTRACT FROM AUTHOR]

At che end of 1994, there will be reponed approximarely 60 000 AIDS cases in Brazil and Brazil Ministry of Health estimares between 600 000 co one million cases of HIV-infected individuais mainly concentrared in São Paulo and Rio de Janeiro. The Gaffrée and Guinle University Hospital, Nacional AlDS Referrai Center, Rio de Janeiro, Brazil, is a leading and pioneering AIDS Research Center in South America, which has accumulated more than five thousand HlVpositive individuals since 1983. Sexual transmission is che main category of cransmission in Brazil. Hecerosexual transmission has been expanded si nce 1985. 34.1% of these cases among women and 7.2% among men. Hecerosexual concactconstitute the only risk cacegory of AIDS cases in which the number of female cases exceeds the number of male cases. Since early in the epidemie more men than women have been infected and therefore can infect their femaJe parmers. These differences can reflect more efficient maleco- female rransmission compared with female-tomale as well diversicy of sexual practices among hecerosexual partners in latin american culture more widespread than generally observed. Group sex, heterosexual anoreccal intercourse, bisexuality, lack of fidelity female low self-esteem, risk-averse facet, complete submission to mal e desire, multiple sexual parmers, unprotected sexual concacts are the main componencs of the male-to-female ratio 6 to 1 in Brazil. Hecerosexual cransmission of HIV may reflect latin american sexual praccices and culture. lt is of imporcance to acknowledge real human sexuality to design adequate educacional program that could impact on the epidemie. Healch care provi ders should be alen co the diverse behavior of borh women and men which can be AIDS hot spocs.