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.

Introduction: Rates for HIV are disproportionately higher for Black men who have sex with men (MSM) compared to other MSM in the U.S. While there is evidence that low perceived risk of HIV infection may increase HIV vulnerability, few studies have examined this relationship among Black MSM in the Southern U.S. where the HIV rates are the highest in the country. This study examined the association between perceived HIV risk and PrEP adoption among Black MSM in a medium-size city in Mississippi.

Methods: Data were drawn from a subsample of the "ACCELERATE!" intervention, an innovative and sustainable community-driven project to improve health outcomes among Black MSM. The outcome of interest was PrEP uptake, a binary variable derived from responses to the question "Have you taken PrEP in the last year?". The perceived risk of HIV, an independent variable, is measured by self-report of an individual's assessment of their vulnerability of contracting HIV defined as low versus high risk. Covariates included age and socio-environmental factors (health insurance, incarceration and discrimination) Sample characteristics were provided using means and standard deviations for continuous variables and proportions for categorical variables. Exact logistic regression was used to assess the association between perceived HIV risk and PrEP adoption, adjusting for covariates.

Results: A total of 84 HIV negative Black men with a median age of 30 (min = 18, max = 69) years were available for analyses. Approximately 16% of participants reported experiencing incarceration and 57% reported experiencing discrimination. Seven out of ten respondents reported having low perceived risk, and 28.6% (24/84) reported having high perceived risk for HIV. There were 73 participants (86.9%) who reported PrEP use in the last year. We observed a higher proportion of participants with high perceived risk that reported lower uptake of PrEP. After adjusting for age, socioeconomic variables, and risky sexual behaviors, higher levels of perceived risk of HIV were associated with decreased odds of PrEP uptake (OR = 0.20, 95% CI: 0.04-0.94, p = 0.040).

Conclusion: The role of HIV risk perception on PrEP adoption is complex among Black MSM in Mississippi. Higher levels of perceived risk of HIV were associated with lower odds of PrEP adoption among Black MSM. This inverse relationship between HIV risk perception and PrEP adoption suggests social- and structural- factors play a critical role in decision-making on PrEP initiation among Black MSM in Jackson. In addition, further longitudinal studies are needed to understand the complex interactions between perceived risk and PrEP use.

Background: We sought to clarify the current incidence, risk factors and symptoms of disseminated Mycobacterium avium complex (dMAC) infection in admitted people living with HIV in a hospital in the Southeast of Spain.

Methods: 5-years observational, retrospective and single-centre study. Demographic, clinical and analytical variables, along with microbiological, treatment and follow-up were collected.

Results: Five cases of dMAC infection in severely immunocompromised people living with HIV people living were found. dMAC was diagnosed in 22.7% of patients under 100 CD4. All patients presented with fever and clinical manifestations of pneumonia, lymphadenopathy, or gastrointestinal symptoms. Despite low CD4 levels and high viral loads in some cases, primary prophylaxis had not been previously administered.

Conclusions: Until 2018, U.S. American guidelines recommended antimycobacterial prophylaxis for patients with low CD4 cell counts, a practice not adopted in Europe. Untreated dMAC infection is associated with high morbidity and mortality rates. dMAC infection represents a prevalent disease in severely immunosuppressed people living with HIV. dMAC requires a high index of suspicion in this population, in order to perform mycobacterial cultures from different samples.

Background: In the context of People Living with HIV (PLWH), poor health literacy (HL) seems to be linked to poorer health outcomes and reduced engagement in care. Additionally, the level of HL can affect HIV knowledge and may impact adherence to antiretroviral therapy (ART). This research explored the connection between ART adherence, HL, and engagement in care in a cohort of 250 PLWH receiving ART in Italy.

Methods: A questionnaire was given to PLWH at Policlinico Gemelli in Rome to assess their health literacy and adherence to therapy. The Brief Health Literacy Screening (BHLS) and the Newest Vital Sign (NVS) were used to evaluate subjective and objective HL. Adherence levels were self-reported as poor, good, or excellent, and the assessment included the Patient Health Engagement Scale (PHE-S).

Results: Notably, the majority of the sample comprised male individuals (67.9%), with 69.2% reporting a 10-years or longer duration between their HIV diagnosis and their initiation of ART. It was found that PLWH with poor adherence had low schooling, had been living with HIV for 1-5 years, were HCV co-infected, had a viremia >50 copies/mL, poor health status, poor engagement in care, and poor HL (p = <0.001). They exhibited lower mean scores on the subjective HL scale and lower CD4 T-cell counts and nadir CD4 T-cell counts (p < .001).

Conclusion: Our study demonstrated a positive correlation between higher HL levels and improved disease management, treatment adherence, and overall physical and mental well-being. Enhanced HL capabilities are paramount in bolstering health management and treatment adherence.

Introduction: In line with the NHS net zero initiative, University Hospitals Sussex (UHS) committed to a Green Plan which included the introduction of reusable instruments. Following positive responses from a staff and patient survey in 2021, the sexual health and contraception (SHAC) department began a pilot scheme of 100 medium size reusable stainless steel vaginal specula (RMS) as an alternative to disposable acrylic models. The aim was to determine outcomes regarding sustainability goals and clinician experiences.

Methods: Estimated carbon footprint and cost was calculated for actual use during study period, and expected use if RMS were to be exclusively used in the future. A staff questionnaire was distributed to ascertain attitudes towards RMS, including obstacles to their use and how these might be overcome.

Results: Monthly medium size plastic specula use decreased during the pilot, resulting in a 22.4% reduction in carbon footprint. Exclusively using RMS for all examinations could reduce carbon emissions by 85.6%. Clinicians had an overall positive attitude towards RMS. Key obstacles to use were poorly stocked rooms and insufficient variety of size.

Discussion: The success of this pilot scheme is being built upon by investing in a greater variety of sizes of RMS for use in SHAC aiming for a 100% reusable system.

Introduction: Simulation-based education (SBE) provides enactive experiences for learners. This project explores the utility of SBE in GUM training.

Methods: Phase 1 was a qualitative survey of GUM trainees across the UK exploring their views on SBE. Phase 2 involved roll-out of SBE to new GUM trainees. Feedback was subsequently obtained.

Results: Twenty-three participants were surveyed in phase 1. When asked to rate the relevance of SBE to curriculum competencies on a scale of 1 to 5 (1 = not relevant, 5 = highly relevant), the highest ratings (score ≥4) were for proctoscopy (4.1), IUD insertion (4.1), SDI removal (4.1), SDI insertion (4.0), and punch biopsy (4.0). All curriculum items scored ≥3. Eighty-three percent (n = 19) felt SBE will improve clinician confidence and competence. Following introduction of SBE, participants fed back on the relevance of the session. All 5 respondents rated the session ≥4 for addressing their clinical and curriculum goals. All respondents rated the session ≥4 for improving clinician confidence and competence. The session received an overall rating of 5, and respondents similarly rated 5 for more sessions.

Conclusion: Trainees recognise the value of simulated learning experiences and its role in improving procedural competence and addressing bespoke human factor skills relevant to GUM.

Background: Cervical cancer, primarily from HPV, is prevalent in countries like Mozambique, with HIV individuals at higher risk. The Visual Inspection with Acetic Acid (VIA) screening method can be influenced by STIs like Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). This study examines CT and NG prevalence in HIV-positive and negative women using VIA in Mozambique's DREAM program.

Methods: In this cross-sectional research conducted at a DREAM program facility in Maputo from 01/07/2021 to 31/05/2022, cervical specimens were taken from VIA-positive patients. CT/NG testing was performed using the Cobas® 4800 DNA CT/NG test. Statistical analyses focused on associations and prevalence rates, considering demographic, clinical, and exposure data.

Results: Among 117 women, we observed a CT prevalence of 6.8% (8/117) and an NG prevalence of 2.6%(3/117). No significant associations between CT/NG infection rates and factors such as age, HIV status, VIA results, or high-risk HPV (hrHPV) was observed. We found a 47% prevalence of hrHPV infections among participants with cervical lesions; no significant association between hrHPV and CT/NG infections was observed.

Conclusion: This study highlights the prevalence of CT and NG in VIA-positive women in Mozambique, emphasizing the STI burden and suggesting integration of STI screening in cervical cancer prevention strategies.

Background: Molluscum contagiosum (MC) is a poxvirus that manifests as firm, smooth, dome-shaped, umbilicated, flesh-colored papules. In adults, MC is commonly spread by sexual contact, and is self-limited in patients with intact immune systems but more widely distributed and difficult to treat in immunocompromised persons. We analyzed cases of adult MC for associations with immunosuppression, lifestyle risk factors, and sexually transmitted infections (STIs).

Methods: Using the All of Us Research Program database, adults with MC were identified and matched with controls 1:10 based on demographic factors. Comorbidities, lifestyle risk factors, and medication exposures were analyzed. Odds ratios were calculated using logistic regression.

Results: Our analysis included 146 cases of adults with MC and 1460 demographic-matched controls. Patients with MC were 48 years old on average, 59% female, and majority White (82.5%). Controls were similar for all demographic features. Adults with MC were more likely to have syphilis (odds ratio (OR) 16; 95% confidence interval (CI) 2.57-99.5), human immunodeficiency virus (HIV) (OR 9.54; 95% CI 3.95-23.0), chlamydia (OR 6.24; 95% CI 2.38-16.4), condyloma acuminata (OR 13.9; 95% CI 7.36-26.2), genital herpes (OR 4.13; 95% CI 1.87-9.15), or atopic dermatitis (AD) (OR 2.85; 95% CI 1.5-5.4) (all p < .01). There were no differences in prevalence of other comorbidities, lifestyle risk factors, nor medication exposures (all p > .05).

Conclusions: We showed that adult MC is associated with AD and STIs, including HIV, chlamydia, condyloma acuminata, genital herpes, and syphilis. Sexually active adolescents and adults and those diagnosed with AD may be screened for MC and counseled on their potentially increased risk.

Background: Injection of opioids has contributed to growing HIV epidemics in Tajikistan and Afghanistan. This qualitative study explored determinants of access to primary prevention and screening for HIV among people who inject drugs (PWID) residing in border communities of Gorno-Badakhshan, Tajikistan and Badakhshan, Afghanistan.

Methods: Semi-structured interviews were conducted with PWID, community leaders, and healthcare workers. The social-ecological model was used to inform a thematic analysis of determinants of access.

Results: There were no preventive or screening services for HIV in the border districts of Afghanistan. Barriers to accessing HIV-related services in Tajikistan, and to accessing general health services in Afghanistan, included: lack of knowledge about HIV, inaccessible communities with poor infrastructure, discrimination and violence against women, and stigmatization of PWID and people living with HIV. Access to HIV-related and other health services by PWID was facilitated by community leader support, family support, outreach services, and linkage of harm reduction services with HIV testing and care.

Conclusion: Urgent interventions are needed to stem the escalating HIV epidemic in Afghanistan and enhance existing services in Tajik border communities. This qualitative study offers insights into barriers and facilitators for accessing HIV prevention and screening services among PWID, suggesting potential interventions.

Introduction: Giant condylomata acuminata (GCA) is a rare presentation of anogenital wart (AGW), invasive locally but does not metastasize. Combination therapy for GCA is suggested based on modalities and experiences. The combination of TCA and podophyllin has showed good efficacy, followed by electrocautery to eradicate warts. Case: A 24-year-old male had a chief complaint of large warts on the base of the penis that had started to bleed for 4 weeks. The initial lesion appeared 8 months prior as a small varucose papule. The patient is unmarried and has history of sexual contact with sex workers. Physical examination showed multiple verrucous papules, flesh-coloured, cauliflower-like shaped, 5 × 2 × 1 cm in size. The patient tested negative for HIV infection. Histopathological examination showed acanthosis, exophytic growth, parakeratosis, and koilocytosis with no signs of malignancy. This patient received a combination of TCA 90% and podophyllin 25% to initially reduce the tumor size, followed by electrocautery to eradicate the remaining lesions. The tumor showed complete clearance. Discussion: There is no definitive evidence that one therapy is superior to completely eliminating warts. Combination therapy of TCA and podophyllin leads to complete wart clearance, followed by electrocautery to destroy smaller warts.