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Background: The Korean government is implementing policy to reduce medical costs and improve treatment related for human immunodeficiency virus (HIV) patients. The level of cost reduction and the benefits provided vary depending on how individuals with HIV utilize the system. This study aims to determine exact HIV prevalence by analyzing healthcare utilization patterns and examining differences in healthcare usage based on how individuals pay for their medical expenses. Materials and Methods: We analyzed National Health Insurance Service (NHIS) claims data from 2002 to 2021. From a total of 106,675 individuals with at least one HIV-related claim, 22,779 participants were selected for this study. Results: Data from Korea Disease Control and Prevention Agency annual reports indicated that 93% of HIV patients were male, while NHIS data showed 84%. In the analysis of those exempted from registration, it was found that the registration rate for female patients is notably low, with adults between the ages of 20 and 40 making up 80% of the total. The registration rate in Gangwon State was lower than Seoul. The treatment experience rate was much higher in the registered group (93.0%) than the unregistered group (4.9%). Also, there was a big difference in treatment continuity rates: 76.2% for registered individuals and 2.8% for non-registered individuals. Conclusion: The exempt calculation system for health insurance improves HIV care. However, those diagnosed anonymously or with reduced medical costs may be less likely to continue HIV treatment, so a new policy is needed to ensure anonymity and treatment continuity. [ABSTRACT FROM AUTHOR]

Neutralizing monoclonal antibodies hold great potential for prevention of human immunodeficiency virus (HIV) acquisition. IgG is the most abundant antibody in human serum, has a long half-life, and potent effector functions, making it a prime candidate for an HIV prevention therapeutic. We combined Positron Emission Tomography imaging and fluorescent microscopy of 64Cu-labeled, photoactivatable-green fluorescent protein HIV (PA-GFP-BaL) and fluorescently labeled HGN194 IgG1 to determine whether intravenously instilled IgG influences viral interaction with mucosal barriers and viral penetration in colorectal tissue 2 h after rectal viral challenge. Our results show that IgG1 did not alter the number of virions found throughout the colon or viral penetration into the epithelium of the rectum or descending colon. A minor increase in virions was observed in the transverse colon of IgG1 treated animals. Overall, the number of viral particles found in the mesenteric lymph nodes was low. However, IgG1 administration resulted in a significant reduction of virions found in mesenteric lymph nodes. Taken together, our results show that HGN194 IgG1 does not prevent virions from penetrating into the colorectal mucosa but may perturb HIV virion access to the lymphatic system. [ABSTRACT FROM AUTHOR]

In the current study, we present a mathematical model for human immunodeficiency virus type-1 (HIV -1) transmission, incorporating Cytotoxic T-Lymphocyte immune impairment within a seasonal environment. The model divides the infected cell compartment into two sub-compartments: latently infected cells and productively infected cells. Additionally, we consider three possible routes of infection, allowing HIV to spread among susceptible cells via direct contact with the virus, latently infected cells, or productively infected cells. The system is analyzed, and the basic reproduction number is derived using an integral operator. We demonstrate that the HIV -free periodic trajectory is globally asymptotically stable if R 0 < 1 , while HIV persists when R 0 > 1. Several numerical simulations are provided to validate the theoretical results. [ABSTRACT FROM AUTHOR]

In the current study, we present a mathematical model for human immunodeficiency virus type-1 (HIV-1) transmission, incorporating Cytotoxic T-Lymphocyte immune impairment within a seasonal environment. The model divides the infected cell compartment into two sub-compartments: latently infected cells and productively infected cells. Additionally, we consider three possible routes of infection, allowing HIV to spread among susceptible cells via direct contact with the virus, latently infected cells, or productively infected cells. The system is analyzed, and the basic reproduction number is derived using an integral operator. We demonstrate that the HIV-free periodic trajectory is globally asymptotically stable if $ \mathcal{R}_0 < 1 $, while HIV persists when $ \mathcal{R}_0 > 1 $. Several numerical simulations are provided to validate the theoretical results.

Late human immunodeficiency virus (HIV) diagnosis has been associated with missed opportunities for earlier diagnosis. We conducted a retrospective, longitudinal, single-centre cohort study evaluating these missed opportunities and their clinical repercussions in adults with a new HIV diagnosis or who were drug-naïve, who attended our Infectious Diseases Department between 2018 and 2023. We assessed missed opportunities in the two years prior to diagnosis or after the last negative HIV test. We compared clinical and laboratorial data from individuals with and without missed opportunities. The primary outcome considered was AIDS-defining conditions at diagnosis. Among the 436 included individuals, 27.1% experienced at least one missed opportunity. Those with missed opportunities were more likely to be female (p = 0.007), older at their first consultation (p < 0.001), born in Africa (p < 0.001) and in countries with a high HIV prevalence (p < 0.001), and have heterosexual transmission (p < 0.001). The adjusted analysis showed that missed opportunities were significantly associated with AIDS-defining conditions at diagnosis (OR 3.23, CI 95% [1.62–6.46], p < 0.001). These findings highlight the impact of missed opportunities on HIV severity, underscoring the need for more targeted interventions to reduce them. [ABSTRACT FROM AUTHOR]

With the advancement of artificial intelligence(AI), platforms like ChatGPT have gained traction in different fields, including Medicine. This study aims to evaluate the potential of ChatGPT in addressing questions related to HIV prevention and to assess its accuracy, completeness, and inclusivity. A team consisting of 15 physicians, six members from HIV communities, and three experts in gender and queer studies designed an assessment of ChatGPT. Queries were categorized into five thematic groups: general HIV information, behaviors increasing HIV acquisition risk, HIV and pregnancy, HIV testing, and the prophylaxis use. A team of medical doctors was in charge of developing questions to be submitted to ChatGPT. The other members critically assessed the generated responses regarding level of expertise, accuracy, completeness, and inclusivity. The median accuracy score was 5.5 out of 6, with 88.4% of responses achieving a score ≥ 5. Completeness had a median of 3 out of 3, while the median for inclusivity was 2 out of 3. Some thematic groups, like behaviors associated with HIV transmission and prophylaxis, exhibited higher accuracy, indicating variable performance across different topics. Issues of inclusivity were identified, notably the use of outdated terms and a lack of representation for some communities. ChatGPT demonstrates significant potential in providing accurate information on HIV-related topics. However, while responses were often scientifically accurate, they sometimes lacked the socio-political context and inclusivity essential for effective health communication. This underlines the importance of aligning AI-driven platforms with contemporary health communication strategies and ensuring the balance of accuracy and inclusivity. [ABSTRACT FROM AUTHOR]

Summary: Within the penile microbiome, bacteria associated with seroconversion, immunology, and cells (BASIC species) enhance HIV susceptibility in heterosexual uncircumcised men by inducing foreskin inflammation and HIV target cell recruitment. This phase 1/2 clinical trial randomizes HIV-uninfected Ugandan men (n = 125) to either oral tinidazole, topical metronidazole, topical clindamycin, or topical hydrogen peroxide to define impact on ex vivo foreskin HIV susceptibility, penile immunology, and BASIC species density. Antimicrobials are well tolerated, and 116 (93%) participants complete the protocol. Topical metronidazole and oral tinidazole reduce the inner foreskin tissue density of HIV-susceptible CD4+ T cells (predefined primary endpoint). Antimicrobials also have varying but substantial effects on reducing prepuce inflammation and BASIC species density, reducing density of foreskin T cell subsets, and increasing foreskin epithelial integrity. Immune alterations correlate strongly with changes in the abundance of BASIC species. Clinical interventions targeting the penile microbiota, particularly topical metronidazole, may reduce HIV susceptibility in uncircumcised men.

Thirty-eight years into the HIV and AIDS pandemic, the world is still striving to reduce global HIV infections towards zero new infections and AIDS-related deaths by 2030. Sub-Saharan Africa continues to carry the burden of global HIV infections as governmental and nongovernmental agencies try out different prevention strategies (UNAIDS, 2024b). Several scholars have argued that comprehensive sexuality education (CSE) is the best preventive strategy to reach youth and key populations with factual information regarding HIV and AIDS. This paper draws from the project, Mentoring as a Method to Promote Women's Health in the Context of HIV-Prevention and Unequal Gender Relations, which employed memory work, photo-voice, drama, drawings, and focus group discussions with third-year student teachers in a life orientation module. Focussing on the data generated through drama, I present an arts-based activity that was used to teach about HIV transmission to student teachers in a bid to equip them with alternative ways of teaching school-learners about HIV and AIDS. The findings highlight student teachers' lived experiences and how they have shaped their perceptions of HIV infections and living with AIDS. I argue from the findings, that arts-based pedagogies allow for enhanced understanding of complex phenomena due to their participatory and in-built intervention nature. Thus, I posit that pedagogies that employ participatory, arts-based, and visual methodologies should be extensively employed in teacher-education towards reducing new HIV infections among the youth. [ABSTRACT FROM AUTHOR]

Late human immunodeficiency virus (HIV) diagnosis has been associated with missed opportunities for earlier diagnosis. We conducted a retrospective, longitudinal, single-centre cohort study evaluating these missed opportunities and their clinical repercussions in adults with a new HIV diagnosis or who were drug-naïve, who attended our Infectious Diseases Department between 2018 and 2023. We assessed missed opportunities in the two years prior to diagnosis or after the last negative HIV test. We compared clinical and laboratorial data from individuals with and without missed opportunities. The primary outcome considered was AIDS-defining conditions at diagnosis. Among the 436 included individuals, 27.1% experienced at least one missed opportunity. Those with missed opportunities were more likely to be female (p = 0.007), older at their first consultation (p < 0.001), born in Africa (p < 0.001) and in countries with a high HIV prevalence (p < 0.001), and have heterosexual transmission (p < 0.001). The adjusted analysis showed that missed opportunities were significantly associated with AIDS-defining conditions at diagnosis (OR 3.23, CI 95% [1.62–6.46], p < 0.001). These findings highlight the impact of missed opportunities on HIV severity, underscoring the need for more targeted interventions to reduce them.

BackgroundViral load (VL) testing is key in monitoring adherence to antiretroviral therapy (ART) and documenting HIV treatment response. As per HIV treatment guidelines in Uganda, the first VL test is recommended 6 months after initiation of ART. Undetectable VL (uVL) at ART initiation may be helpful in detecting elite controllers in the absence of previous ART use. We investigated viral suppression at ART initiation among a cohort of HIV-positive pregnant women enrolled in the Friends for Life Circles (FLC) for Option B+ randomized controlled trial (RCT).MethodsPregnant women ≥ 18 years of age testing positive for HIV at their first antenatal care visit and starting on ART Option B+ as per the National PMTCT Program guidelines were enrolled into the FLC for Option B+ RCT in urban Kampala and rural Mityana districts of Uganda. Each participant had whole blood samples collected at enrolment to assess baseline VL. Plasma HIV-1 RNA was quantified using COBAS Ampliprep /COBAS Taqman. Baseline VL below 400 RNA copies/ml was considered as viral suppression while baseline VL below 20 RNA copies/ml was considered uVL.ResultsThe mean duration from the date of ART initiation to time of sample collection for baseline VL assessment was 4.4 days (SD 3.6). Of the 532 HIV-positive pregnant women enrolled in the FLC for Option B+ study and newly starting Option B+ without a self-reported history of prior ART use, 29 (5.5%) had uVL and 113 (21.4%) had suppressed VL at baseline. There was no association between participants' age, gravidity, marital status, mean monthly income, educational level, disclosure of HIV status to partner, and uVL or viral suppression at baseline. However, non-disclosure of HIV status to any other person was associated with decreased odds of viral suppression at baseline (OR 0.640; 0.416-0.982).ConclusionTwenty-one percent of HIV-positive Ugandan pregnant women initiating ART (Option B+) showed virological suppression at baseline and were presumed to be "elite controllers" or to have misreported being ART-naive. Further studies are needed to better understand the biologic mechanisms of elite controllers among pregnant women as well as to differentiate elite controllers from concealed ART use. Trial Registration The trial was registered as NCT02515370 (04/08/2015) on Clinicaltrials.gov.

Men who have sex with men (MSM) living with HIV have been studied extensively for stigmatization and inequitable factors affecting well-being. Although intersecting factors are acknowledged in some studies, they are rarely discussed in the context of health implications among multiple minority identities. This leaves psychosocial research outputs to focus their efforts among less stigmatized MSM groups, white men, while disregarding specific issues among historically marginalized MSM-related identities (e.g., racialized, Indigenous, and aging populations). As per the 95-95-95 goals set by the Joint United Nations Programme on HIV and AIDS, this systematic review covers psychosocial protective and risk factors experienced by HIV-positive MSM while also considering other intersecting identities. Following a standardized search inquiry, 2,139 records were identified and narrowed down to 24 peer-reviewed articles which were systematically reviewed. Psychological and social protective factors are contextually described. Some risk factors such as co-occurring stigmas, psychological distress, exposure to violence, and trauma among diverse MSM can potentiate greater risk-taking behaviours associated with HIV transmission among HIV-positive men. These findings highlight factors that contribute to resilient pathways among racialized minorities and other intersections among MSM while also examining specific psychological stressors. Tailored interventions and care for minorities with intersecting identities, with a focus on co-occurring stigmas, are crucial to ensure the well-being of diverse HIV-positive MSM and reduce HIV transmission. We propose an adaptation to the minority stress model to refine available tools and provide future studies with more accurate depictions of the lived experiences among diverse MSM. [ABSTRACT FROM AUTHOR]

Objective: To examine trends in time spent viremic and initiation into antiretroviral treatment (ART) among persons newly diagnosed with HIV in San Francisco. Methods: Using HIV surveillance data, we included persons diagnosed with HIV during 2012-2020, a San Francisco resident at HIV diagnosis, alive 12 months after HIV diagnosis, and had $2 viral load tests within 12 months after diagnosis. Percent person-time spent (pPT) .200, pPT .1500, and pPT .10,000 copies per milliliter was calculated during the 12 months after HIV diagnosis. Multivariate regression models assessed the year of diagnosis and time spent above each viral threshold and year of diagnosis and ART initiation within 0-7 days (rapid), 8-365 days (delayed), or no ART initiation. Results: Of 2471 new HIV diagnoses in San Francisco from 2012 to 2020, 1921 (72%) were included. Newly diagnosed persons spent a mean of 40.4% pPT .200, 32.4% pPT .1,500%, and 23.4% pPT .10,000 copies per milliliter; 33.8% had rapid ART initiation, 57.3% delayed, and 9% had no ART initiation. After adjustment, persons diagnosed in years 2014-2015, 2016-2017, 2018-2019, and 2020 were associated with less time spent above all viral thresholds and lower risk of delayed or no ART initiation compared with those diagnosed in 2012-2013. Greater time above thresholds correlated with injection drug use, ages 25-29 and 30-39 years, and homelessness. Conclusions: Percent time spent above each viremic level decreased significantly, whereas rapid ART initiation increased among newly diagnosed persons from 2014 through 2020 compared with 2012-2013. Population differences in time spent unsuppressed highlight the need for targeted interventions to reduce new HIV infections and improve health. [ABSTRACT FROM AUTHOR]

We analyzed 1,397 HIV-1 pol sequences of antiretroviral therapy-naive patients in a total of 7 university hospitals in Bonn, Cologne, Frankfurt, Hamburg, Hannover, and Munich, Germany. Phylogenetic and network analysis elucidated numerous cases of shared drug resistance mutations among genetically linked patients; K103N was the most frequently shared mutation.

Introduction: Inflammation and injury within reproductive organs, including artificial vagina, can facilitate human immunodeficiency virus (HIV) transmission. However, HIV infection in a patient with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome has been rarely described. Both MRKH and HIV diagnoses are linked to psychological distress in patients. Case description: We report on a case of a 34-year-old HIV-infected woman with MRKH syndrome. The presented report is the second described case of HIV infection in a woman with MRKH syndrome, the previous one dating back to 1992. Entry of infection were squamous cells, covering the wall of artificial vagina. Acquired immunodeficiency syndrome (AIDS) diagnosis was delayed because symptoms, such as thrombocytopenia, subfebrile illness, cachexia, malaise, and persistent diarrhea were misdiagnosed by physicians. Conclusions: HIV infection is rarely described in women with MRKH syndrome; however, the procedure of artificial vagina can favor sexually transmitted diseases (STD) transmission, including HIV. In any case, a patient with unexplained symptoms or illnesses that may have any connection with HIV infection should be tested for HIV, even in the absence of risk factors. Moreover, these two diagnoses combined can be considered as huge psychological burden for the patient. Receiving information about incurable infertility due to MRKH during young adolescence might cause severe psychological complications. Despite many sources of HIV infection, ways of transmission, and risk factors, HIV patient still can face stigma associated with the infection. Psychological circumstances of HIV infection can include depressive symptoms, feeling of guilt, fear of consequences, and escape from reality. [ABSTRACT FROM AUTHOR]

BackgroundGeographical allocation of interventions focusing on hotspots of human immunodeficiency virus (HIV) transmission has the potential to improve efficiency. We used phylogeographic analyses to identify hotspots of the HIV transmission in Cologne-Bonn, Germany.MethodsWe included 714 HIV-1 infected individuals, followed up at the University Hospitals Cologne and Bonn. Distance-based molecular network analyses were performed to infer putative relationships. Characteristics of genetically linked individuals and assortativity (shared characteristics) were analyzed. Geospatial diffusion (ie, viral gene flow) was evaluated using a Slatkin-Maddison approach. Geospatial dispersal was determined by calculating the average distance between the residences of linked individuals (centroids of 3-digit zip code).ResultsIn sum, 217/714 (30.4%) sequences had a putative genetic linkage, forming 77 clusters (size range: 2-8). Linked individuals were more likely to live in areas surrounding the city center (P = .043),

: In 2015, only 53 infants born in the United States acquired HIV - the lowest recorded number of perinatal HIV infections. Recognizing this significant achievement, we must acknowledge that the United States has not yet reached the goal of eliminating perinatal HIV transmission. This analysis describes different approaches to perinatal HIV preventive services among five states and the District of Columbia as case studies. Continuous focus on improving identification, surveillance and prevention of HIV infection in pregnant women and their infants is necessary to reach the goal of eliminating perinatal HIV transmission in the United States.

Background: The bidirectional relationship between human immunodeficiency virus (HIV) and psychiatric illnesses is well documented. Misinformation about HIV transmission and prevention is associated with high rates of HIV-related risky behaviours, and therefore, HIV infection risk. Aim: To assess basic HIV transmission knowledge in psychiatric patients. Setting: Outpatient psychiatric clinic at Tara Psychiatric Hospital, Johannesburg, South Africa. Methods: A cross-sectional, quantitative study was conducted employing a self-administered HIV knowledge questionnaire, the 18- item HIV knowledge questionnaire (HIV-KQ18). Consent, demographic, and clinical profile information were obtained from participants meeting the selection criteria. Results: This study indicated a mean knowledge score of 12.6 (69.7%) out of 18, and therefore good knowledge. The highest HIV-KQ18 mean scores were found in patients with personality disorders (78.9%), anxiety disorders (75.6%) and bipolar and related disorders (71.1%). Participants with schizophrenia, depressive disorders and substance use disorders had scores ranging between 66.1% and 69.4%. Statistically significant differences in knowledge were evident based on age, marital status, level of education and employment status. Interestingly, participants who used substances had higher average basic HIV transmission knowledge scores compared to those who did not use substances. Conclusion: Good overall HIV transmission knowledge was found in this population, albeit lower than in the general population. Statistically, correlates were found between psychiatric diagnosis, substance use, age, marital status, level of education, and employment status and basic level of HIV knowledge. Contribution: HIV knowledge remains lower in psychiatric patients than in the general population, with correlates between demographic and clinical factors, calling for psychoeducation efforts to take all these into consideration.

Background Adolescent girls and young women aged 15‒24 years in sub-Saharan Africa are at disproportionate risk of human immunodeficiency virus (HIV) infection. Given the known association between vaginal microbial dysbiosis and HIV susceptibility, we performed an age-stratified analysis of the vaginal microbiome in South African women and compared this to their risk of HIV acquisition. Methods Vaginal microbiome data were generated by mass spectrometry–based proteomic analysis of cervicovaginal lavages collected from participants (n = 688) in the Centre for the AIDS Programme of Research in South Africa (CAPRISA) 004 trial. Participants were grouped by age (18–19 years, n = 93; 20–24 years, n = 326; 25–41 years, n = 269). Results Four microbiome types were identified based on predominant taxa, including Lactobacillus crispatus (CST-LC, 12.2%), Lactobacillus iners (CST-LI, 43.6%), Gardnerella vaginalis (CST-GV, 26.6%), or polymicrobial (CST-PM, 15.1%). Women aged 18–19 and 20–24 years had increased CST-PM and a non- Lactobacillus -dominant microbiome compared to those 25–41 years (odds ratio [OR], 3.14 [95% confidence interval {CI}, 1.12–7.87], P =.017; OR, 2.81 [95% CI, 1.07–7.09], P =.038, respectively; and OR, 1.65 [95% CI, 1.02–2.65], P =.028; OR, 1.40 [95% CI, 1.01–1.95], P =.030, respectively). The HIV incidence rate of women with CST-PM microbiome was 7.19-fold higher compared to women with CST-LC (hazard ratio [HR], 7.19 [95% CI, 2.11–24.5], P =.00162), which was also consistent in women aged 20–24 years (HR, 4.90 [95% CI, 1.10–21.9], P =.0375). Conclusions Younger women were more likely to have a higher-risk polymicrobial microbiome suggesting that vaginal microbiota are contributing to increased HIV-1 susceptibility in this group. Clinical Trials Registration NCT00441298. [ABSTRACT FROM AUTHOR]

Background: Long-distance truck drivers (LDTDs) have a higher rate of HIV infection compared to the general population. This is due to their living and working conditions which predispose them to riskier sexual behaviours. Inadequate knowledge of HIV and AIDS, coupled with risky sexual behaviours such as unprotected sex with commercial sex workers (CSWs), predisposes LDTDs to contract and propagate HIV. This study aims to determine the factors associated with buying sex and the knowledge that condoms prevent HIV transmission among long-distance truck drivers at Kazungula weighbridge terminal in the Chobe District of Botswana. Methods: A cross-sectional descriptive survey was employed and 399 LDTDs participated. A questionnaire was used to collect sociodemographic data and information on knowledge of HIV and AIDS and the sexual behaviours of the LDTDs. Results: The results reveal that more than half of the LDTDs (56.9%; n = 227) had paid for sex with CSWs at some point in their travels, and 27.1% (n = 108) reported having had unprotected sex with CSWs. The LDTDs who preferred to have sex with CSWs without a condom had about five times the odds of buying sex with CSWs than those who preferred to use a condom (AOR 4.9; 95% CI 2.85–8.46). Disliking condom use was a factor contributing to less knowledge of condom use preventing HIV among the LDTDs (AOR 0.4; CI 0.17–0.97). Conclusion: It can be concluded from the results of this study that the LDTDs engage in considerable risky sexual behaviours, and associated factors were found to be multidimensional. This population remains of concern in HIV acquisition and transmission. Therefore, there is a need for a robust public health response to deal with the problem of both new infection and re-infection with HIV in this population. [ABSTRACT FROM AUTHOR]

Syphilis and HIV infections form a dangerous combination. In this paper, we propose an epidemic model of HIV-syphilis coinfection. The model always has a unique disease-free equilibrium, which is stable when both reproduction numbers of syphilis and HIV are less than 1. If the reproduction number of syphilis (HIV) is greater than 1, there exists a unique boundary equilibrium of syphilis (HIV), which is locally stable if the invasion number of HIV (syphilis) is less than 1. Coexistence equilibrium exists and is stable when all reproduction numbers and invasion numbers are greater than 1. Using data of syphilis cases and HIV cases from the US, we estimated that both reproduction numbers for syphilis and HIV are slightly greater than 1, and the boundary equilibrium of syphilis is stable. In addition, we observed competition between the two diseases. Treatment for primary syphilis is more important in mitigating the transmission of syphilis. However, it might lead to increase of HIV cases. The results derived here could be adapted to other multi-disease scenarios in other regions. [ABSTRACT FROM AUTHOR]

Using the incidence of bacterial sexually transmitted infection (STI) as a surrogate for condomless sexual behavior, we assessed the association between STI and uncontrolled HIV replication among in-care persons with HIV (PWH) enrolled in a longitudinal HIV cohort study in the District of Columbia (the DC Cohort). Although STI occurrence initially correlated with higher HIV viral load (VL), this difference became more attenuated over time (2012–2016). This was true overall and among those with the greatest number of STIs [age 18–34, men who have sex with men (MSM)]. This likely reflects gains in population-wide virologic control through improved antiretroviral therapy and access to care, which helps mitigate the risk of HIV transmission. [ABSTRACT FROM AUTHOR]

BackgroundNorth Tijuana, Mexico is home to many individuals at high risk for transmitting and acquiring human immunodeficiency virus (HIV). Recently, policy shifts by local government impacted how these individuals were handled by authorities. Here we examined how this affected regional HIV transmission dynamics.MethodsHIV pol sequences and associated demographic information were collected from 8 research studies enrolling persons in Tijuana and were used to infer viral transmission patterns. To evaluate the impact of recent policy changes on HIV transmission dynamics, qualitative interviews were performed on a subset of recently infected individuals.ResultsBetween 2004 and 2016, 288 unique HIV pol sequences were obtained from individuals in Tijuana, including 46.4% from men who have sex with men, 42.1% from individuals reporting transactional sex, and 27.8% from persons who inject drugs (some individuals had >1 risk factor). Forty-two percent of sequences linked to at least 1 other sequence, forming 37 transmission clusters. Thirty-two individuals seroconverted during the observation period, including 8 between April and July 2016. Three of these individuals were putatively linked together. Qualitative interviews suggested changes in policing led individuals to shift locations of residence and injection drug use, leading to increased risk taking (eg, sharing needles).ConclusionsNear real-time molecular epidemiologic analyses identified a cluster of linked transmissions temporally associated with policy shifts. Interviews suggested these shifts may have led to increased risk taking among individuals at high risk for HIV acquisition. With all public policy shifts, downstream impacts need to be carefully considered, as even well-intentioned policies can have major public health consequences.

In this paper, we examine a prominent interpretation of HIV risk in a rural South African setting experiencing a severe HIV epidemic well into older ages: the discourse of caregiving HIV transmission. By caregiving transmission, we refer to HIV infection resulting from caring for family members who are living with HIV and may be sick with AIDS-related illnesses. We draw on individual life history and community focus group interviews with men and women aged 40–80+, as well as interviews with health workers providing HIV counselling and testing services at local health facilities in their communities. We illustrate the social and strategic role caregiving HIV transmission discourses play in re-signifying HIV as a sexless infection for older women, thereby promoting HIV testing as well as blameless acceptance of an HIV diagnosis. We further highlight the role of rural health workers who serve as medical epistemic bricoleurs, vernacularising global HIV counselling and prevention messages by blending ideas of gender, generation, and local lived experiences and practices so that they resonate with community norms, values and understandings. Our study highlights the gendered and generational complexities and challenges experienced by rural South Africans aging in a community over-burdened by an HIV epidemic and AIDS-related mortality. [ABSTRACT FROM AUTHOR]

During male-to-female transmission, HIV-1 must cross the mucosal epithelium of the female reproductive tract to gain access to underlying target cells. Previously, we demonstrated that HIV-1 can penetrate intact columnar and squamous genital epithelia in both ex vivo and in vivo systems. We found that the virus enters the squamous epithelium via a diffusion-based mechanism, but the mechanism of entry in columnar epithelium remained elusive. Using a similar set of approaches, we now demonstrate that HIV enters the endocervical simple columnar epithelium via endocytosis. By exposing human endocervical explant tissue to small molecule endocytosis inhibitors prior to virus exposure, we show that virus penetration into the simple columnar barrier is impeded. These data suggest a transcytosis-based mechanism for HIV-1 penetration into the endocervical columnar barrier.

Background: The prevention of new infections in high-risk groups is a major thrust in National AIDS Control Program. There is enough evidence that many epidemiological and behavioral determinants which make High Risk Group vulnerable to HIV transmission. The most effective means of controlling the spread of HIV is through the implementation of Targeted Interventions (TIs) efforts by which services are catered to them. Furthermore, stigma and marginalization are often linked to this population, which may lead to difficulties while accessing social and health services (SHS) due to behavioral, cultural and language barriers or lack of knowledge of the system. So, finding the sociodemographic & behavioral profile can give a breakthrough in improving the quality of life of HIV high risk groups. Material and Methods: A cross sectional study was conducted during September to December 2019 in two districts (i.e., Raipur & Durg) among HRGs of Chhattisgarh. Training cum sensitization of survey team e.g., peer educators, outreach workers, counselors, project managers prior to the survey was done for data collection. Results: A Total of 3963 HRGs were registered with TI NGOs, 3418 (86.2%) were screened. The mean age of study participants was 27.69 ± 6.1. Compliance of participation was 86.2%. HRGs were observed to have malnutrition (BMI 25.0). 7 cases of Pulmonary TB were found among IDUs. Prevalence of diabetes and Hypertension was 1.2% and 1.1% respectively. Substance abuse (i.e., for Alcohol and Tobacco) was significantly higher among IDUs and FSWs. Conclusion: This study reinforces the fact that for accessing High Risk Groups and retrieval of relevant information can best be obtained by their care givers i.e., TI NGOs personnel. Also understanding the sociodemographic and behavioral profiles are central to designing targeted HIV prevention interventions for them.

Young men who have sex with men (YMSM) represent a particularly high-risk group for HIV acquisition in the US, despite similarly reported rates of sexual activity as older, adult MSM (AMSM). Increased rates of HIV infection among YMSM compared to AMSM could be partially attributable to differences within the rectal mucosal (RM) immune environment associated with earlier sexual debut and less lifetime exposure to receptive anal intercourse. Using an ex vivo explant HIV challenge model, we found that rectal tissues from YMSM supported higher levels of p24 at peak viral replication timepoints compared to AMSM. Among YMSM, the RM was characterized by increased CD4+ T cell proliferation, as well as lower frequencies of tissue resident CD8+ T cells and pro-inflammatory cytokine producing CD4+ and CD8+ T cells. In addition, the microbiome composition of YMSM was enriched for anaerobic taxa that have previously been associated with HIV acquisition risk, including Prevotella, Peptostreptococcus, and Peptoniphilus. These distinct immunologic and microbiome characteristics were found to be associated with higher HIV replication following ex vivo challenge of rectal explants, suggesting the RM microenvironment of YMSM may be uniquely conducive to HIV infection. [ABSTRACT FROM AUTHOR]

The efficacy of HIV pre-exposure prophylaxis (PrEP) is high in men who have sex with men, but much more variable in women, in a manner largely attributed to low adherence. This reduced efficacy, however, could also reflect biological factors. Transmission to women is typically via the female reproductive tract (FRT), and vaginal dysbiosis, genital inflammation, and other factors specific to the FRT mucosa can all increase transmission risk. We have demonstrated that mucosal fibroblasts from the lower and upper FRT can markedly enhance HIV infection of CD4+ T cells. Given the current testing of tenofovir disoproxil fumarate, cabotegravir, and dapivirine regimens as candidate PrEP agents for women, we set out to determine using in vitro assays whether endometrial stromal fibroblasts (eSF) isolated from the FRT can affect the anti-HIV activity of these PrEP drugs. We found that PrEP drugs exhibit significantly reduced antiviral efficacy in the presence of eSFs, not because of decreased PrEP drug availability, but rather of eSF-mediated enhancement of HIV infection. These findings suggest that drug combinations that target both the virus and infection-promoting factors in the FRT—such as mucosal fibroblasts—may be more effective than PrEP alone at preventing sexual transmission of HIV to women. [ABSTRACT FROM AUTHOR]

Objectives: Sex work sites have been hypothesised to be at the root of the observed heterogeneity in HIV prevalence in sub‐Saharan Africa. We determined if proximity to sex work sites is associated with HIV prevalence among the general population in Zimbabwe, a country with one of the highest HIV prevalence in the world. Methods: In this cross‐sectional study we use a unique combination of nationally representative geolocated individual‐level data from 16,121 adults (age 15–49 years) from 400 sample locations and the locations of 55 sex work sites throughout Zimbabwe; covering an estimated 95% of all female sex workers (FSWs). We calculated the shortest distance by road from each survey sample location to the nearest sex work site, for all sites and by type of sex work site, and conducted univariate and multivariate multilevel logistic regressions to determine the association between distance to sex work sites and HIV seropositivity, controlling for age, sex, male circumcision status, number of lifetime sex partners, being a FSW client or being a stable partner of an FSW client. Results: We found no significant association between HIV seroprevalence and proximity to the nearest sex work site among the general population in Zimbabwe, regardless of which type of site is closest (city site adjusted odds ratio [aOR] 1.010 [95% confidence interval {CI} 0.992–1.028]; economic growth point site aOR 0.982 [95% CI 0.962–1.002]; international site aOR 0.995 [95% CI 0.979–1.012]; seasonal site aOR 0.987 [95% CI 0.968–1.006] and transport site aOR 1.007 [95% CI 0.987–1.028]). Individual‐level indicators of sex work were significantly associated with HIV seropositivity: being an FSW client (aOR 1.445 [95% CI 1.188–1.745]); nine or more partners versus having one to three lifetime partners (aOR 2.072 [95% CI 1.654–2.596]). Conclusions: Sex work sites do not seem to directly affect HIV prevalence among the general population in surrounding areas. Prevention and control interventions for HIV at these locations should primarily focus on sex workers and their clients, with special emphasis on including and retaining mobile sex workers and clients into services. [ABSTRACT FROM AUTHOR]

Abstract Background Viral load (VL) testing is key in monitoring adherence to antiretroviral therapy (ART) and documenting HIV treatment response. As per HIV treatment guidelines in Uganda, the first VL test is recommended 6 months after initiation of ART. Undetectable VL (uVL) at ART initiation may be helpful in detecting elite controllers in the absence of previous ART use. We investigated viral suppression at ART initiation among a cohort of HIV-positive pregnant women enrolled in the Friends for Life Circles (FLC) for Option B+ randomized controlled trial (RCT). Methods Pregnant women ≥ 18 years of age testing positive for HIV at their first antenatal care visit and starting on ART Option B+ as per the National PMTCT Program guidelines were enrolled into the FLC for Option B+ RCT in urban Kampala and rural Mityana districts of Uganda. Each participant had whole blood samples collected at enrolment to assess baseline VL. Plasma HIV-1 RNA was quantified using COBAS Ampliprep /COBAS Taqman. Baseline VL below 400 RNA copies/ml was considered as viral suppression while baseline VL below 20 RNA copies/ml was considered uVL. Results The mean duration from the date of ART initiation to time of sample collection for baseline VL assessment was 4.4 days (SD 3.6). Of the 532 HIV-positive pregnant women enrolled in the FLC for Option B+ study and newly starting Option B+ without a self-reported history of prior ART use, 29 (5.5%) had uVL and 113 (21.4%) had suppressed VL at baseline. There was no association between participants’ age, gravidity, marital status, mean monthly income, educational level, disclosure of HIV status to partner, and uVL or viral suppression at baseline. However, non-disclosure of HIV status to any other person was associated with decreased odds of viral suppression at baseline (OR 0.640; 0.416–0.982). Conclusion Twenty-one percent of HIV-positive Ugandan pregnant women initiating ART (Option B+) showed virological suppression at baseline and were presumed to be “elite controllers” or to have misreported being ART-naive. Further studies are needed to better understand the biologic mechanisms of elite controllers among pregnant women as well as to differentiate elite controllers from concealed ART use. Trial Registration The trial was registered as NCT02515370 (04/08/2015) on Clinicaltrials.gov.

Abstract Background HIV incidence can be estimated with cross-sectional studies using clinical, serological, and molecular data. Worldwide, HIV incidence data in only men who have sex with men (MSM) are scarce and principally focus on those with healthcare or under treatment. However, better estimates can be obtained through studies with national representativeness. The objective was to estimate the prevalence, incidence, and factors associated with acquiring HIV in a national sample of MSM who attend meeting places, considering geographical regions. Methods A nationally representative survey of MSM attending meeting places was performed in Mexico. Participants answered a questionnaire, and a dried blood spot (DBS) was collected. Samples were classified as recent infections using an algorithm with HIV status, antiretroviral therapy, and the result of BED-EIA assay. Parameters were analysed considering regions and demographic and sexual behaviour characteristics. Results The national HIV prevalence was 17.4% with regional differences; the highest prevalence (20.7%) was found in Mexico City, and the lowest prevalence was found in the West region (11.5%). The incidence was 9.4 per 100 p/y, with regional values from 6.2 to 13.2 for the Northeast and the Centre regions, respectively. Age, age at sexual debut, low wealth index, and rewarded sex were associated with HIV prevalence. Centre region, use of private clinics as health services, and having sex exclusively with men were associated with recent HIV infections. Conclusions The incidence and prevalence showed regional differences, suggesting a difference in the dynamics of HIV transmission; some regions have a greater case accumulation, and others have a greater rate of new infections. Understanding this dynamic will allow developing health programs focused on HIV prevention or treating people already living with HIV.

Commensal organisms appear to play significant roles in normal homeostasis as well as in the pathogenesis of HIV infection in a number of different organ systems. On November 17th and 18th, 2016, leading researchers from around the world met to discuss their insights on advances in our understanding of HIV and the microbiome at the National Institutes of Health (NIH) in Bethesda. Dr. Elhanan Borenstein of the University of Washington gave a keynote address where he discussed new developments in systems biology which hold the promise of illuminating the pathways by which these organisms interact with human physiology. He suggested that we need to get past correlations in microbiome research by using models and informatics which incorporate metagenomics to predict functional changes in the microbiome.

We examined concurrency among sexual partners reported by men who have sex with men (MSM) with recent (acute or early) HIV infection in San Diego, California (2002-2015). Partners overlapping in time in the past 3 months were considered concurrent. Logistic generalized linear mixed models were used to identify factors associated with concurrency at the partner-level. 56% (388/699) of partners were concurrent to ≥1 other partner. The odds of concurrency were higher among partners >10 years younger than the participant (vs. within 10 years of age) [adjusted odds ratio (AOR) = 2.22, 95% confidence interval (CI) 1.09-4.52], longer term partners (AOR per month = 1.02, 95% CI 1.01-1.03), and partners met online (AOR = 1.56, 95% CI 0.98-2.48). Concurrency is common among partners of recently HIV-infected MSM. Tailored HIV prevention strategies for MSM with older partners, longer term partners, and partners met online may help minimize the potential impact of concurrency on HIV transmission.

ObjectiveEvaluate the incidence and predictors of HIV acquisition from outside partners in serodiscordant couples.MethodsDemographic, behavioral, and clinical exposures were measured quarterly in a cohort of serodiscordant cohabiting couples in Zambia from 1995 to 2012 (n = 3049). Genetic analysis classified incident infections as those acquired from the study partner (linked) or acquired from an outside partner (unlinked). Factors associated with time to unlinked HIV infection were evaluated using multivariable Cox proportional hazards regression stratified by sex.ResultsThere were 100 unlinked infections in couples followed for a median of 806 days. Forty-five infections occurred in women [1.85/100 couple-years; 95% confidence interval (CI): 1.35 to 2.47]. Risk of female unlinked infection (vs. nonseroconverting females) was associated with reporting being drunk weekly/daily vs. moderate/nondrinkers at baseline [adjusted hazard ratio (aHR) = 5.44; 95% CI: 1.03 to 28.73], genital ulcers (aHR = 6.09; 95% CI: 2.72 to 13.64), or genital inflammation (aHR = 11.92; 95% CI: 5.60 to 25.37) during follow-up adjusting for age, years cohabiting, income, contraceptive use, previous pregnancies, history of sexually transmitted infections, and condomless sex with study partner. Fifty-five infections occurred in men (1.82/100 couple-years; 95% CI: 1.37 to 2.37). Risk of male unlinked infection was associated with genital inflammation (aHR = 8.52; 95% CI: 3.82 to 19.03) or genital ulceration (aHR = 2.31; 95% CI: 2.05 to 8.89), reporting ≥1 outside sexual partner (aHR = 3.86; 95% CI: 0.98 to 15.17) during follow-up, and reporting being drunk weekly/daily vs. moderate/nondrinkers at baseline (aHR = 3.84; 95% CI: 1.28 to 11.55), controlling for age, income, circumcision status, and history of sexually transmitted infection.ConclusionsPredictors of unlinked infection in serodiscordant relationships were alcohol use, genital inflammation, and ulceration. Causes of genital inflammation and ulceration should be screened for and treated in HIV-negative individuals. Counseling on risk of alcohol use and sex with outside partners should be discussed with couples where 1 or both are HIV-negative, including in counseling on use of pre-exposure prophylaxis to prevent HIV acquisition in the HIV-negative partner (when feasible and affordable).

Risk of HIV acquisition varies, and some individuals are highly HIV-1-exposed, yet, persistently seronegative (HESN). The immunologic mechanisms contributing to this phenomenon are an area of intense interest. As immune activation and inflammation facilitate disease progression in HIV-1-infected persons and gastrointestinal-associated lymphoid tissue is a highly susceptible site for transmission, we hypothesized that reduced gut mucosal immune reactivity may contribute to reduced HIV-1 susceptibility in HESN men with a history of numerous rectal sexual exposures. To test this, we used ex vivo mucosal explants from freshly acquired colorectal biopsies from healthy control and HESN subjects who were stimulated with specific innate immune ligands and inactivated whole pathogens. Immune reactivity was then assessed via cytokine arrays and proteomic analysis. Mucosal immune cell compositions were quantified via immunohistochemistry. We found that explants from HESN subjects produced less proinflammatory cytokines compared with controls following innate immune stimulation; while noninflammatory cytokines were similar between groups. Proteomic analysis identified several immune response proteins to be differentially expressed between HIV-1-stimulated HESN and control explants. Immunohistochemical examination of colorectal mucosa showed similar amounts of T cells, macrophages, and dendritic cells between groups. The results of this pilot study suggest that mucosal innate immune reactivity is dampened in HESN versus control groups, despite presence of similar densities of immune cells in the colorectal mucosa. This observed modulation of the rectal mucosal immune response may contribute to lower risk of mucosal HIV-1 transmission in these individuals.

In this paper we evaluate the effects of heavy alcohol consumption on sexual behavior, HIV acquisition, and antiretroviral treatment (ART) initiation in a longitudinal open cohort of 1929 serodiscordant couples in Lusaka, Zambia from 2002 to 2012. We evaluated factors associated with baseline heavy alcohol consumption and its association with condomless sex with the study partner, sex outside of the partnership, and ART initiation using multivariable logistic regression. We estimated the effect of alcohol consumption on HIV acquisition using multivariable Cox models. Baseline factors significantly associated with women's heavy drinking (drunk weekly or more in 12-months before enrollment) included woman's older age (adjusted prevalence odds ratio [aPOR] = 1.04), partner heavy drinking (aPOR = 3.93), and being HIV-infected (aPOR = 2.03). Heavy drinking among men was associated with less age disparity with partner (aPOR per year disparity = 0.97) and partner heavy drinking (aPOR = 1.63). Men's being drunk daily (aOR = 1.18), women's being drunk less than monthly (aOR = 1.39) vs. never drunk and being in a male HIV-negative and female HIV-positive union (aOR = 1.45) were associated with condomless sex. Heavy alcohol use was associated with having 1 or more outside sex partners among men (aOR drunk daily = 1.91, drunk weekly = 1.32, drunk monthly = 2.03 vs. never), and women (aOR drunk monthly = 2.75 vs. never). Being drunk weekly or more increased men's risk of HIV acquisition (adjusted hazard ratio [aHR] = 1.72). Men and women being drunk weekly or more was associated (p

Young men who have sex with men (YMSM) represent a particularly high-risk group for HIV acquisition in the US, despite similarly reported rates of sexual activity as older, adult MSM (AMSM). Increased rates of HIV infection among YMSM compared to AMSM could be partially attributable to differences within the rectal mucosal (RM) immune environment associated with earlier sexual debut and less lifetime exposure to receptive anal intercourse. Using an ex vivo explant HIV challenge model, we found that rectal tissues from YMSM supported higher levels of p24 at peak viral replication timepoints compared to AMSM. Among YMSM, the RM was characterized by increased CD4+ T cell proliferation, as well as lower frequencies of tissue resident CD8+ T cells and pro-inflammatory cytokine producing CD4+ and CD8+ T cells. In addition, the microbiome composition of YMSM was enriched for anaerobic taxa that have previously been associated with HIV acquisition risk, including Prevotella, Peptostreptococcus, and Peptoniphilus. These distinct immunologic and microbiome characteristics were found to be associated with higher HIV replication following ex vivo challenge of rectal explants, suggesting the RM microenvironment of YMSM may be uniquely conducive to HIV infection.

Background To assess the prevalence and evolution of transmitted drug resistance (TDR) in Belgium, a total of 3708 baseline human immunodeficiency virus (HIV)-1 polymerase sequences from patients diagnosed between 2013 and 2019 were analyzed. Methods Protease and reverse-transcriptase HIV-1 sequences were collected from the 7 national Aids Reference Laboratories. Subtype determination and drug resistance scoring were performed using the Stanford HIV Drug Resistance Database. Trends over time were assessed using linear regression, and the maximum likelihood approach was used for phylogenetic analysis. Results A total of 17.9% of the patients showed evidence of TDR resulting in at least low-level resistance to 1 drug (Stanford score  ≥15). If only the high-level mutations (Stanford score ≥60) were considered, TDR prevalence dropped to 6.3%. The majority of observed resistance mutations impacted the sensitivity for nonnucleoside reverse-transcriptase inhibitors (NNRTIs) (11.4%), followed by nucleoside reverse-transcriptase inhibitors (6.2%) and protease inhibitors (2.4%). Multiclass resistance was observed in 2.4%. Clustered onward transmission was evidenced for 257 of 635 patients (40.5%), spread over 25 phylogenetic clusters. Conclusions The TDR prevalence remained stable between 2013 and 2019 and is comparable to the prevalence in other Western European countries. The high frequency of NNRTI mutations requires special attention and follow-up. Phylogenetic analysis provided evidence for local clustered onward transmission of some frequently detected mutations. [ABSTRACT FROM AUTHOR]

Background: Liangshan is one of the areas severely affected by both HIV and poverty in China. We investigated associations between perceptions of social norms related to casual sex and the occurrence of casual sex in lifetime among Yi minority people. Participants were Yi minority people aged 15–49 years old living in Liangshan. Of the participants, 11.8% were confirmed to be HIV-positive. About half of the participants (46.6%) had engaged in casual sex in their lifetime. All six perceptions of social norms were significantly associated with the presence of casual sex in lifetime. They were acceptable of belife: (1) casual sex in general (OR: 15.03), (2) not to use condom during casual sex (OR: 1.58), (3) a Yi woman to have more than one sex partner(OR: 4.54), (4) a Yi man to have more than one sex partner(OR: 4.51), (5) premarital sex with casual sex partner (OR: 4.29), and (6) extra-marital sex with casual sex partner (OR: 3.23). Casual sex may play an important role in facilitating HIV transmission among Yi minority people. Future interventions should consider making use of the Yi clan system to change perceptions of social norms related to casual sex. [ABSTRACT FROM AUTHOR]

Background: The prevention of new infections in high-risk groups is a major thrust in National AIDS Control Program. There is enough evidence that many epidemiological and behavioral determinants which make High Risk Group vulnerable to HIV transmission. The most effective means of controlling the spread of HIV is through the implementation of Targeted Interventions (TIs) efforts by which services are catered to them. Furthermore, stigma and marginalization are often linked to this population, which may lead to difficulties while accessing social and health services (SHS) due to behavioral, cultural and language barriers or lack of knowledge of the system. So, finding the sociodemographic & behavioral profile can give a breakthrough in improving the quality of life of HIV high risk groups. Material and Methods: A cross sectional study was conducted during September to December 2019 in two districts (i.e., Raipur & Durg) among HRGs of Chhattisgarh. Training cum sensitization of survey team e.g., peer educators, outreach workers, counselors, project managers prior to the survey was done for data collection. Results: A Total of 3963 HRGs were registered with TI NGOs, 3418 (86.2%) were screened. The mean age of study participants was 27.69 ± 6.1. Compliance of participation was 86.2%. HRGs were observed to have malnutrition (BMI <18.5 &> 25.0). 7 cases of Pulmonary TB were found among IDUs. Prevalence of diabetes and Hypertension was 1.2% and 1.1% respectively. Substance abuse (i.e., for Alcohol and Tobacco) was significantly higher among IDUs and FSWs. Conclusion: This study reinforces the fact that for accessing High Risk Groups and retrieval of relevant information can best be obtained by their care givers i.e., TI NGOs personnel. Also understanding the sociodemographic and behavioral profiles are central to designing targeted HIV prevention interventions for them. [ABSTRACT FROM AUTHOR]

Fufa Hunduma, Ewenat Gebrehanna, Fanna Adugna Debela Department of Public Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, EthiopiaCorrespondence: Fufa HundumaDepartment of Public Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, EthiopiaTel +251 922956730Email fhunduma@gmail.comBackground: Mother-to-child transmission (MTCT) of human immune deficiency virus (HIV) is the infection of baby by HIV that originated from an HIV-positive mother during pregnancy and breast feeding. Without intervention, the transmission rate of HIV ranges from 15– 45%, which can be reduced to below 5% with effective intervention. In Ethiopia, the final mother-to-child transmission rate was 15% in 2016, which was much higher than the target of the country to reduce transmission to lower than 5% by 2020. The study aims to identify determinants of transmission of HIV from mother to child in the West Shewa Zone.Methods: An unmatched case–control study, among children less than 5 years who tested HIV positive and negative, at the end of PMTC follow-up, N=96 (24 cases, 72 controls) was conducted during June to August 2019, focusing on PCR done during the last 2 years (June 2017 to July 2019), in public hospitals. Data were collected using a structured questionnaire and data abstraction forms from mothers of exposed infants, medical records of mothers and children.Results: The majority of cases (17, 70.8%) were not included in the option B+ program, but only 11.1% of controls were not included. Home delivery (adjusted odds ratio (AOR)=6.047, confidence interval (CI)=1.549– 29.230), non-inclusion into option B+ (AOR=18.0, 95% CI=5.0– 68.1), and partner non-involvement to HIV care (AOR=7.3, 95% CI=1.14– 37.459) had higher odds of transmitting HIV, while a mother-to-mother support program decreases the chance of transmission by 86.5% (AOR=0.135, 95% CI=0.11– 0.396) when compared to their counterparts.Conclusion: Mother-to-mother support programs have a protective effect, while non-inclusion to option B+, partner non-involvement in HIV care, home delivery, and poor antenatal care (ANC) practices were determinant factors of HIV transmission from mother to child.Keywords: mother-to-child transmission of HIV, Ethiopia, West Shewa, HIV transmission, prevention of MTCT

BackgroundTransmitted/founder viruses isolated at the early stage of infection are indicators of the variants that are spreading within a population. The French reporting system for new HIV diagnoses is linked to a virological surveillance using dried serum spots.MethodsWe combined an immunoassay for very recent infection (less than 31 days) to a phylogenetic analysis of transmitted/founder viruses and sociodemographic information to analyze the dynamics of the HIV-1 epidemic during a 3-year period. Bayesian coalescent-based methods were used to explore the temporal and spatial dynamics of the identified clusters.ResultsOf 17 010 dried serum spots collected, 549 very recent infections were identified for which both env sequences and sociodemographic data were available. Non-B transmitted/founder viruses were found in 196 cases (35.7%), belonging to six subtypes and seven circulating recombinant forms. Forty-three dyads/clusters were identified (range 2-11 cases), including 107 individuals (19.5%), mainly MSM. The largest cluster involved MSM infected by a CRF02_AG variant. Reconstruction of viral migrations across time suggests that Paris was the major hub of dissemination.ConclusionThe study shows the feasibility of the surveillance of the HIV epidemic using this methodology. The observation of actively growing spatiotemporal clusters allows identification of specific networks that may be targets for intervention.

BackgroundTo examine the yield of HIV partner services provided to persons newly diagnosed with acute and early HIV infection (AEH) in San Diego, United States.DesignObservational cohort study.MethodsThe study investigated the yield (i.e. number of new HIV and AEH diagnoses, genetically linked partnerships and high-risk uninfected partners) of partner services (confidential contact tracing) for individuals with AEH enrolled in the San Diego Primary Infection Resource Consortium 1996-2014.ResultsA total of 107 of 574 persons with AEH (19%; i.e. index cases) provided sufficient information to recruit 119 sex partners. Fifty-seven percent of the 119 recruited partners were HIV infected, and 33% of the 119 were newly HIV diagnosed. Among those newly HIV diagnosed, 36% were diagnosed during AEH. There were no significant demographic or behavioral risk differences between HIV-infected and HIV-uninfected recruited partners. Genetic sequences were available for both index cases and partners in 62 partnerships, of which 61% were genetically linked. Partnerships in which both index case and partner enrolled within 30 days were more likely to yield a new HIV diagnosis (P = 0.01) and to be genetically linked (P

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.