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Objectives. We examined risk factors for syphilis infection among injection drug users in 3 Russian Federation cities, focusing particular attention on the potential roles of gender and sex work. Methods. We conducted a cross-sectional survey of injection drug users in Moscow, Volgograd, and Barnaul, collecting behavioral data and testing for antibodies to Treponema pallidum. Associations between presence of antibodies to T pallidum and covariates were explored. Results. Overall, the prevalence of antibodies to T pallidum was 11% (95% confidence interval=9.7%, 13.1%). Syphilis was associated with involvement in sex work and with gender in Moscow and Barnaul but not in Volgograd. Female injection drug users not involved in sex work were more likely than men to be younger and to have recently begun to inject; female injection drug users involved in sex work were more likely than those not involved in sex work to inject daily. Conclusions. Syphilis transmission dynamics varied by region. Sex work can increase syphilis risk among injection drug users, potentially feeding the momentum of sexually transmitted HIV and syphilis among noninjectors. Targeted interventions are needed to reduce both sexual and injection risk behaviors among injection drug users. doi:10.2105/AJPH.2005.069732

The molecular diversity and demographic characteristics of HIV-1-positive heterosexuals, attending sexually transmitted infection (STI) clinics, participating in a serosurvey, in England and Wales, between 1997 and 2000 were investigated. The results are presented on the genetic diversity of the heterosexual HIV epidemic in England and Wales.

About 27% of HIV infections in England and Wales are non-B subtypes and are spread almost entirely through heterosexual intercourse. This subtype may have been brought to the UK by immigrants from countries where non-B subtypes are common.

Abstract Background Little is known about the prevalence of HIV or HCV in injecting drug users (IDUs) in Serbia and Montenegro. We measured prevalence of antibodies to HIV (anti-HIV) and hepatitis C virus (anti-HCV), and risk factors for anti-HCV, in community-recruited IDUs in Belgrade and Podgorica, and determined the performance of a parallel rapid HIV testing algorithm. Methods Respondent driven sampling and audio-computer assisted survey interviewing (ACASI) methods were employed. Dried blood spots were collected for unlinked anonymous antibody testing. Belgrade IDUs were offered voluntary confidential rapid HIV testing using a parallel testing algorithm, the performance of which was compared with standard laboratory tests. Predictors of anti-HCV positivity and the diagnostic accuracy of the rapid HIV test algorithm were calculated. Results Overall population prevalence of anti-HIV and anti-HCV in IDUs were 3% and 63% respectively in Belgrade (n = 433) and 0% and 22% in Podgorica (n = 328). Around a quarter of IDUs in each city had injected with used needles and syringes in the last four weeks. In both cities anti-HCV positivity was associated with increasing number of years injecting (eg Belgrade adjusted odds ratio (AOR) 5.6 (95% CI 3.2–9.7) and Podgorica AOR 2.5 (1.3–5.1) for ≥ 10 years v 0–4 years), daily injecting (Belgrade AOR 1.6 (1.0–2.7), Podgorica AOR 2.1 (1.3–5.1)), and having ever shared used needles/syringes (Belgrade AOR 2.3 (1.0–5.4), Podgorica AOR 1.9 (1.4–2.6)). Half (47%) of Belgrade participants accepted rapid HIV testing, and there was complete concordance between rapid test results and subsequent confirmatory laboratory tests (sensitivity 100% (95%CI 59%–100%), specificity 100% (95%CI 98%–100%)). Conclusion The combination of community recruitment, ACASI, rapid testing and a linked diagnostic accuracy study provide enhanced methods for conducting blood borne virus sero-prevalence studies in IDUs. The relatively high uptake of rapid testing suggests that introducing this method in community settings could increase the number of people tested in high risk populations. The high prevalence of HCV and relatively high prevalence of injecting risk behaviour indicate that further HIV transmission is likely in IDUs in both cities. Urgent scale up of HIV prevention interventions is needed.

Seven out of 35,000 blood donors began to have antibodies to the AIDS virus in their blood after previously being free of antibodies. Samples given by these seven donors before antibodies were detected were analyzed for antibodies to the virus. In five of these seven donors, antigens to the AIDS virus were found to have appeared prior to or simultaneously with one type of antibody. The antigens disappeared and the amount of AIDS virus in the blood decreased as the antibody response increased. Although new and more sensitive tests for antibodies have reduced the period between AIDS infection and detection, the presence of antigens and the virus itself were the only markers of infection for several days in two donors. These results show that the AIDS virus and its antigens can be present several days before antibodies to the virus., ABSTRACT: During a 1-year period of study at two plasma collection centers, 7 of 35 000 plasma donors seroconverted to the human immunodeficiency virus (HIV) and had stored plasma samples that predated or antedated the seroconversion period. From each donor, three to eight plasma samples that had been collected at 2- to 7-day intervals were tested for IgG and IgM antibodies to HIV with enzyme immunoassays, Western blot testing, and radioimmunoprecipitation assays. The presence of an HIV viremic phase was demonstrated by the infectivity of plasma on normal, phytohemagglutinin-stimulated peripheral blood mononuclear cells and by the detection of HIV antigen. In 5 of these donors, HIV antigen was detected prior to or simultaneously with IgG to HIV; these HIV-antigen-positive samples overlapped an IgM immune response. The disappearance of detectable HIV antigen, and to a lesser extent plasma infectivity, was concurrent with the development of an IgG immune response. Although the improved sensitivity of a recombinant DNA-derived anti-HIV screening assay shortened the "window period" between initial HIV infection and antibody detection, HIV antigen and plasma HIV viremia were the only markers of HIV infection for several days in 2 donors. These results demonstrate that HIV plasma viremia and antigenemia occur prior to seroconversion in healthy plasma donors.