International Journal of STD & AIDS最新文献

Objectives: Oral HIV pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV, but its efficacy depends on adequate absorption of drug, which may decrease following gastrointestinal surgery.

Methods: Clinicians across eight Genito-urinary Medicine clinics in the United Kingdom submitted data on PrEP users with history of gastrointestinal surgery who were referred to a national complex PrEP multi-disciplinary team between June 2021 and April 2023. Anonymised data were submitted on demographics, surgical history, PrEP regimen, and results of therapeutic drug monitoring (TDM) and HIV screening tests. Descriptive analyses were performed in SPSS version 29.

Results: Nine cases described cis-gender men-who-have-sex-with-men (MSM) with median age of 47.4 years (IQR = 43 - 56.5) taking tenofovir disoproxil (TDF)/emtricitabine (FTC) daily (n = 8) or event-based (n = 1) as PrEP. Median time between PrEP initiation and TDM was 53 days (IQR = 8.5-1705). The mean (±SD) trough concentration of tenofovir (TFV) and FTC were 90.2 ± 27.7 ng/mL and 76.0 ± 45.9 ng/mL, respectively. All patients had a negative HIV test at follow-up.

Conclusions: Plasma trough concentrations of TFV observed in our cohort taking TDF/FTC were above the expected concentrations associated with PrEP efficacy as previously described in the literature, suggesting that PrEP can be safely given in this population, with TDM used for reassurance.

Background: Data on the impact of coronavirus disease 2019 (COVID-19) on hospitalization and outcomes among people living with HIV (PLHIV) are limited.

Methods: A retrospective cohort study was conducted among PLHIV hospitalized during the pre-COVID-19, COVID-19, and post-COVID-19 periods.

Results: Of the 310 PLHIV included, 117, 125 and 68 were admitted during the three periods, respectively and 115 (37%) were newly diagnosed with HIV. Median CD4 cell counts and proportions of those with antiretroviral therapy (ART) adherence rates ≥95% at admission were different between the three periods [(206, 97 and 138 cells/mm³ (p = .02) and 97%, 89% and 100% (p = .06), respectively]. Of the 310 PLHIV, admission diagnoses were non-AIDS-related (62%) and AIDS-related (38%). Most of the non-AIDS-related diagnoses were infections other than opportunistic infections (OIs) (40%) while OIs were the most common for AIDS-related diagnoses (88%). The types of admission diagnoses were comparable between the three periods. Hospital mortality rates were 10%, 13% and 16% during pre-COVID-19, COVID-19 and post-COVID-19 periods, respectively (p = .80). By multivariable analysis, intensive care unit admission, underlying malignancy, monthly income less than $USD 400, and admission CD4 less than 50 cells/mm³ were independently associated with hospital mortality.

Conclusions: Although admission during COVID-19 pandemic period was not associated with increased mortality, we observed the impact of the pandemic on the lower CD4 cell count and ART adherence at admission among hospitalized PLHIV. Interventions to improve early care engagement, ART adherence, and close monitoring for those with identified mortality risks are needed for better HIV care, especially during pandemics.

Syphilis, known for its capacity to mimic various diseases, has seen rising incidence, particularly in adolescents, men who have sex with men (MSM), and individuals with HIV. Palmoplantar keratoderma (PPK), a rare manifestation of secondary syphilis, poses diagnostic challenges due to its resemblance to other conditions. We report the case of a 42-year-old man living with HIV presenting with acquired PPK, characterized by hyperkeratotic plaques on the palms and soles, alongside syphilitic roseola. Histopathology confirmed psoriasiform dermatitis with spirochetes. The patient received weekly intramuscular benzathine penicillin G, leading to significant clinical improvement without relapse. This case underscores the importance of recognizing atypical infectious presentations in individuals living with HIV and highlights the need for careful differential diagnosis in acquired PPK cases.

Objective: This systematic review aimed to explore any demographic, biological and behavioural characteristics of men who have sex with men (MSM) with diarrhoeagenic E.coli.

Design/methods: We searched MEDLINE, EMBASE, and CINAHL for manuscripts published to March 2024. One author screened manuscript abstracts; two authors independently conducted a full text review. We only included primary data on gastrointestinal E.coli in MSM. Risk of bias was assessed independently by two authors using the Joanna Briggs Institute tools. This review was registered on PROSPERO(CRD42023455321).

Results: Eleven manuscripts (cross-sectional studies (n = 8), case-series (n = 1), case-control study (n = 1), longitudinal study (n = 1)) from Europe (n = 7) Australia (n = 2), USA (n = 2) including 983 MSM with gastrointestinal E.coli published between 2014-2023 were included in this review. Demographic factors (living with HIV, using HIV-PrEP, using dating apps and working as airline crew, group sex, non-regular (casual) sexual partners); behavioural factors (non-regular sexual partners, non-condom use, oro-anal sex, penile-anal sex, use of sex toys, insertive and receptive fisting, scat play); and infection factors (co-infection with Chlamydia trachomatis including LGV, Neisseria gonorrhoeae, Treponema pallidum, hepatitis C, other enteric pathogens [Shigella spp. Giardia duodenalis, Entamoeba histolytica, hepatitis A and intestinal spirochaetosis]) were observed in MSM with E. coli. Antimicrobial resistance (extended spectrum beta-lactamase and quinolone resistance) was described in MSM with E.coli.

Conclusion: We have highlighted demographic, behavioral and infection factors observed in MSM with E.coli suggesting sexual transmissibility. These data provide insight for future clinical guidelines, public health control strategies and research.

Background: Given the therapeutic challenge of wart treatment and the need for an ideal treatment that is effective, noninvasive, cost-effective, and has minimal side effects, this study aims to compare the local impact of a 5% potassium hydroxide (KOH) solution with cryotherapy, the current standard treatment for genital warts.

Methods: Two groups, each consisting of 49 patients: the first group was treated with a daily topical application of 5% KOH solution using a swab, while the second group underwent cryotherapy in two 5-20 s freeze-thaw cycles. Before treatment, patient demographic data and number of lesions were recorded. Follow-up visits were conducted at four-week intervals for 12 weeks, during which the number of lesions, time to complete recovery, and skin-related side effects were examined and recorded, ensuring comprehensive data collection.

Results: A total of 98 patients (average age: 28.40 ± 7.34 years), 55 cases (55.1%) being female and 43 cases (43.9%) being male. Importantly, there was no significant difference in terms of gender (p = .684), education (p = .533), and marital status (p = .703) between the two study groups. Further, no significant difference in previous infection history (p = .493) and partner infection (p = .098) was identified. There was no significant difference in terms of treatment response (p = .510) and relapse (p < .999) between the two KOH and cryotherapy study groups.

Conclusion: The study found no significant differences in treatment response, relapse rates, or side effects between using 5% potassium hydroxide solution and cryotherapy for genital wart treatment. These findings suggest that both modalities offer comparable efficacy and safety profiles, providing clinicians with valuable options in tailoring treatment approaches for patients with genital warts.

Objectives: Mental health (MH) care for people living with HIV (PLWH) emerges as an important unmet need, yet there are no integrated HIV-MH clinics in Turkey. Our aim is to determine MH service use and its associated factors in PLWH followed up in the HIV/AIDS outpatient clinics in Istanbul/Turkey.

Methods: A cross-sectional study was conducted at the HIV/AIDS outpatient clinics of the Infectious Diseases (ID) departments in hospitals affiliated with the ACTHIV-IST Study Group. Structured interviews were performed using questionnaires that covered psychiatric state, medical history, and help-seeking behavior.

Results: Out of 172 outpatients, 121 (70.3%) reported MH complaints after infection, and 65.6% felt a need to see MH professionals. Among those, 59% shared their MH distress with the ID team. However, only 20.7% applied to an MH service, and 16.5% received psychiatric treatment. Previous MH diagnoses (AOR = 4.11; 95%CI = 1.26-13.39), sharing the disease with the ID team (AOR = 4.18; 95%CI = 1.24-14.11), and being hospitalized due to HIV (AOR = 6.54; 95%CI = 1.21-35.39) emerged as the predictors of MH service use among those who would like to see an MH professional in logistic regression.

Conclusions: Closer contact with the healthcare system may increase the chances of PLWH receiving MH care. Thus, integrating MH services in HIV/AIDS care would help reach more PLWH who are distressed.

Background: Despite the availability of PrEP, 2023 data have demonstrated an increase in new HIV diagnoses. LGBTQ + individuals are disproportionately affected by HIV. PrEP access is crucial but limited due to high demand on sexual health services. Additional modalities of PrEP access may help to address this unmet need. LVNDR Health, a digital solution for LGBTQ + care, sought to evaluate its PrEP pathway.

Methods: We conducted a retrospective cross-sectional service evaluation of users accessing the LVNDR digital PrEP pathway between December 2022-April 2023. Operational data (e.g., appointment attendance) were derived from the clinical dashboard. Service-user feedback (e.g., service experience) was sought using a bespoke questionnaire. Descriptive statistics are reported for socio-demographic information. Non-parametric between-group analyses are reported.

Results: In total, 90 users completed the end-to-end pathway and received PrEP. Average time for pathway completion was 2.7 weeks. A survey response rate of 71.0% was achieved. Users reported significantly higher service satisfaction, inclusivity, and accessibility, compared to their most recent experience accessing PrEP (p < .01). Up to 89% of users strongly agreed they would switch to a digital PrEP service if made available.

Conclusion: Digital PrEP shows acceptability among LGBTQ + populations. More research is needed to assess scalability, digital equity, and cost-effectiveness.

Background: Vertical transmission of HIV is a major global public health issue, particularly due to maternal HIV acquisition during pregnancy, challenges in enrolling pregnant women living with HIV into antiretroviral therapy programmes, and loss to follow-up. The factors influencing HIV retesting in pregnant women with an initial HIV-negative results are understudied. The study examined health service delivery factors affecting HIV retesting among pregnant women.

Methods: A cross-sectional study was conducted in six health facilities in the Saboba District in 2023. Pregnant women who initially tested HIV-negative and were attending antenatal clinics at 34 weeks gestation or later were randomly selected. Data was analyzed using Stata version 15.0. Logistic regression was used to examined the health service factors affecting HIV retesting at a 0.05 significant level.

Results: Out of 445 pregnant women initially HIV-negative, only 21.1% were retested at 34 weeks gestation. Pregnant women receiving antenatal care at health centers were less likely to be retested [aOR = 0.34; CI: 0.14-0.84], while those who spent less time during ANC were more likely to retest [aOR = 2.58; CI: 1.33-5.01].

Conclusions: Improvement in HIV retesting requires reproductive health units to develop strategies to enhance coverage and reduce waiting times at health centers could encourage more pregnant women to retest for HIV.

Objectives: Delays in HIV antiretroviral therapy (ART) have been associated with HIV disease progression and forward transmission. We evaluated the effectiveness of an accelerated ART virtual protocol (VP) for active duty (AD) members with incident HIV diagnosis.

Methods: Under the traditional protocol (TP), service members stationed worldwide were evaluated in-person at Brooke Army Medical Center (BAMC) and received comprehensive HIV care. In February 2020, a VP was adopted to initiate HIV care at the local base. Chart reviews were conducted to obtain patient demographics and clinical data. Continuous variables were compared using 2-tailed t tests, categorical variables were evaluated with Fisher's exact or Chi squared tests.

Results: Time from HIV notification to ART initiation was significantly shorter with the VP compared to the TP (15 days vs 25 days; p = <0.05). The VP had a shorter time to viral suppression compared to the TP (96 days [SD ± 86] compared to 269 days [SD ± 300], p = <0.05).

Conclusions: The VP was associated with a shorter time to HIV specialty evaluation, ART initiation, and viral suppression. The use of virtual health protocols for other time sensitive medical interventions and/or for access to limited specialties should be considered as these may improve quality of care.