International Journal of STD & AIDS最新文献

BackgroundPre-exposure prophylaxis (PrEP) for Human Immunodeficiency Virus (HIV) is safe and effective, but its implementation is suboptimal with the US South having disproportionately high numbers of new HIV infections and low PrEP use.MethodsParkland Health in Dallas, Texas has implemented interventions to improve PrEP uptake. A retrospective review was conducted of targeted PrEP offers in 2022 to eligible patients aged >=16 years to compare differences between those who accepted versus declined PrEP.ResultsOf 2,219 patients offered PrEP, 287 were excluded. Of the remaining 1,932, 195 (10%) accepted a PrEP offer. Those who accepted were more likely to be from a younger age group (16-25 vs > 55 years, p-value <0.01), men who have sex with men (p-value <0.01), and transgender females with male partners (p-value <0.01). Other positive predictors of PrEP acceptance included being insured (p-value 0.01), sero-discordant partner (p-value <0.01), and pregnancy (p-value <0.01). Patients who accepted were more likely to have received multiple interventions (145/195 (74.36%) vs 580/1737 (33.39%), p-value <0.01).ConclusionsA multipronged approach to increasing PrEP uptake in a health system in the South reached a variety of eligible patients. Future efforts should focus on improving PrEP engagement for Black, uninsured, heterosexual, and older individuals.

BackgroundSexually transmitted infections (STIs) are increasing globally. To improve understanding of the epidemiology of STIs in key populations, we analysed sentinel surveillance data on STI test positivity among individuals tested using subsidised tests at anonymous walk-in clinics in North Rhine-Westphalia (NRW), Germany.MethodsThis was a cross-sectional analysis of sentinel surveillance data from all 53 local health authority anonymous walk-in clinics in NRW during 2021. Test positivity for HIV, syphilis, chlamydia, and gonorrhoea was analysed by key population group. We used univariable and multivariable logistic regression to examine factors associated with each infection.ResultsAmong 11,560 consultations, overall STI test positivity was 6.6%. Chlamydia was the most frequently detected (6.4%), followed by gonorrhoea (2.7%), syphilis (0.9%), and HIV (0.6%). We observed disparities in STI test positivity among key population groups. Men-who-have-sex-with-men (MSM) (aOR 1.93; 95%CI 1.38-2.68), sex work (aOR 2.77; 95%CI 1.9-3.96), and having an STI-positive partner (aOR 1.71; 95%CI 1.30-2.22) were associated with increased STI risk. Coinfections were rare (0.4%) and predominantly occurred among MSM.ConclusionsAnonymous walk-in clinics reach diverse high-risk populations with substantial STI burdens. Findings support targeted prevention strategies for key populations and highlight the importance of comprehensive STI screening in anonymous settings for surveillance and case detection.

BackgroundDrug-sparing antiretroviral treatment (ART) regimens are gaining interest in the treatment of HIV-1. Dolutegravir (DTG), a second-generation integrase inhibitor, has been pivotal in this development, allowing treatment with fewer drugs while maintaining virologic control. This study aimed to analyze and compare treatment persistence in people with HIV (PWH) on DTG-based two-drug regimens (2DRs) and three-drug regimens (3DRs) at an HIV center in Munich, Germany.MethodsRetrospective, observational, longitudinal analysis using electronic patient records at MVZ München am Goetheplatz. All people with HIV-1 receiving DTG-containing ART regimens-combined with rilpivirine (RPV) or lamivudine (3TC) for 2DRs, or with tenofovir (TAF or TDF) and emtricitabine (FTC), or abacavir (ABC) and FTC for 3DRs-were included. Exclusion criteria included HIV-2 infection or concomitant use of other antiretroviral drugs. The primary endpoint was the comparison of time-to-discontinuation between 2DRs and 3DRs. Secondary endpoints included an analysis of reasons for discontinuation. Kaplan-Meier estimates, log-rank tests, and accelerated failure time (AFT) models were used for statistical analysis.ResultsOverall, 854 individuals were included in the study, with 462 (54.1%) on a 2DR. For the primary endpoint, 141 events occurred. In the unadjusted analysis, treatment persistence was significantly longer in the 2DR group compared to the 3DR group (p = .005, log-rank test). Median persistence was not reached in either group. In AFT models, being on a 2DR was associated with a 74.9% (23.0%-126.8%), 85.7% (30.5%-140.8%), and 98.0% (36.7%-159.0%) longer time-to-discontinuation in the unadjusted, partially adjusted (sex, age, route of transmission), and fully adjusted models (additionally adjusted for CD4 nadir and baseline resistance) after multiple imputation, respectively. For the secondary endpoint, 196 events occurred. Persistence on 2DRs and 3DRs was found to be comparable (p = .190). Reasons for discontinuation included cardiovascular risk, unspecified side effects, gastrointestinal side effects, impaired kidney function, weight gain, convenience (switch to a single-tablet regimen), and other factors. Weight gain (p = .018), impaired renal function (p = .008), cardiovascular risk (p = .004), unspecified side effects (p = .003), gastrointestinal side effects (p = .003), and switching to a single-tablet regimen (p < .001) remained significant after adjusting for multiple testing.ConclusionsThis study found significant associations between the type of antiretroviral treatment regimen (2DR or 3DR) and time-to-discontinuation. DTG-based 2DRs were associated with significantly longer treatment persistence compared to 3DRs, as confirmed in parametric and non-parametric time-to-event analyses and after adjusting for baseline differences. Virologic efficacy was comparable between the two regimens, aligning with previo

BackgroundApproximately 50% of pregnant individuals treated for syphilis do not achieve a decline in non-treponemal titers by delivery. The serological response in pregnant persons is significantly slower compared to non-pregnant individuals, with unclear pathogenesis and clinical significance. This study aimed to determine the association between the host immune response and serological outcome in pregnant individuals with syphilis.MethodsTwenty-four females with early syphilis, including 14 pregnant individuals, were included. Pro-inflammatory and regulatory cytokines (IFN-γ, TNF-α, IL-4, IL-1β, IL-10, TGF-β) were measured before treatment and 6 months after penicillin injection.ResultsThe median time to serological cure was 5 months for pregnant individuals and 2 months for non-pregnant females. Pregnant individuals had significantly higher serum levels of IL-10 and TGF-β at baseline and at 6 months post-treatment compared to non-pregnant individuals (p < .05).ConclusionsA robust regulatory immune response to syphilis may be associated with a slower serological response to therapy during pregnancy.

BackgroundChlamydia trachomatis (CT) infections are prevalent and often asymptomatic. Point-of-Care (PoC) tests offer a diagnostic option. We described the incidence and predictors of CT infection using secondary data collected from men who have sex with men (MSM) and transgender women (TGW) attending Community-Based Organizations (CBOs) clinics in Thailand.MethodsMSM and TGW aged ≥18 and had HIV risks were enrolled and followed for 12 months with visits every 3 months. Behavioral risks and Sexually Transmitted Infection testing were assessed at every visits. Specimens were collected via pharyngeal swab, urine sample, rectal swab, and neovaginal swab for TGW. These specimens were tested for CT using PoC test. The incidence was calculated using survival analysis, and the Cox regression model for multiple failures.ResultsFrom 2019-2021, 1886 participants were enrolled. Of these, 89.7% were MSM; 10.3% were TGW: 20.7% were lost to follow-up. Of the remaining participants, 18.2% had CT at baseline, with 36.4% experiencing repeat infections. The incidence rate of CT was 42.9 infections per 100 person-years. Predictors of CT infections included enrollment year, age 18-24 years, HIV status, pre-exposure prophylaxis and condom use.ConclusionRepeat CT infections were common. CBOs should incorporate POC STI testing into services, and the provision of STI prevention strategies.

This guideline offers recommendations on the diagnosis, treatment and health promotion principles needed for the effective management of gonorrhoea. It is an update of the 2018 guideline.

BackgroundThis study aimed to assess HIV prevalence and associated sexual behaviors among immigrant men who have sex with men (MSM) in Brazil and Portugal, recognizing the elevated vulnerability of this population due to sociocultural and structural barriers.MethodsA cross-sectional online survey was conducted between January 2020 and May 2021 with 2033 immigrant MSM. Participants were recruited using snowball sampling through dating applications. Data were self-reported and analyzed to identify associations between sexual behaviors and HIV status.ResultsThe overall HIV prevalence was 11.7%. Higher-risk sexual practices were frequent, including receptive anal intercourse and having multiple sexual partners. Conversely, low adoption of preventive behaviors such as sexual abstinence and non-penetrative sex was observed. Condomless sex was commonly justified by trust in partners or recent negative HIV test results. Factors independently associated with unprotected sex included being versatile or receptive in anal sex and not disclosing HIV status on dating apps. Gaps in HIV prevention knowledge and engagement were also identified.ConclusionsImmigrant MSM in Brazil and Portugal experience a high burden of HIV and engage in behaviors that increase their risk of infection. Cultural and structural barriers-such as language difficulties, limited healthcare access, and stigma-contribute to inadequate prevention practices. These findings highlight the urgent need for targeted, culturally competent public health interventions to expand access to HIV prevention strategies and reduce transmission risk in this underserved population.

BackgroundWe analyzed the prevalence of complementary/alternative medicines (CAM) in people living with HIV (PLWH) and effects on immunovirological response, treatment adherence, and quality of life (QoL).MethodsA multicentre cross-sectional observational study involving PLWH who were stably on combination antiretroviral therapy (cART) between 2018 and 2019. Participants completed a modified International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q). CAM use was analyzed using descriptive statistics and multivariable logistic regression models were implemented to study factors associated.ResultsCAM use (predominantly vitamins and dietary supplements: 64.2%) was reported by 38.5% of the 548 participants. Higher CAM use was noted in men who have sex with men, Caucasians, people with hepatitis C virus, and those with higher level of education. 76.3% used CAM for a better well-being, energy restoration, and aesthetic purposes. Multivariable analysis identified ethnicity, HIV acquisition route, HCV status, level of education, plasma undetectability and cardiovascular diseases as significant factors influencing CAM use. Immunovirological response, treatment adherence, and QoL were not significantly different between CAM users and non-users.ConclusionsThe study highlighted a high prevalence of CAM use in PLWH, revealing no adverse effects on treatment efficacy or clinical outcomes. Demographic factors influence CAM use, underscoring the need for healthcare providers to explore CAM use, promoting information and safe care.

Circinate balanitis is a characteristic mucocutaneous lesion commonly associated with reactive arthritis (ReA), previously described as Reiter's disease. It typically presents alongside other ReA symptoms, including urethritis, conjunctivitis, and arthritis, but can occasionally occur as an isolated finding. We report two cases of circinate balanitis occurring in patients with HLA B27-positive spondyloarthritis, without the classical triad of reactive arthritis. A 32-year-old male presented with recurrent erosions on the glans penis for 2 years, with a history of HLA B27-positive spondyloarthritis. He was on treatment with tofacitinib, deflazacort, and sulfasalazine. A skin biopsy from the scrotum confirmed the diagnosis of psoriasis. MRI spine and sacrum showed anterior syndesmophyte formation and right-sided sacroillitis. The final diagnosis was circinate balanitis in association with HLA B27-positive psoriatic spondyloarthritis. A 41-year-old male presented with recurrent erosions on the glans penis for 4 years with history of HLA B27 positivity, and ankylosing spondyloarthritis. The biopsy from the glans penis showed squamous hyperplasia. MRI spine and pelvis was suggestive of inflammatory spondyloarthropathy of the cervical, dorsal and lumbar spine with bilateral sacroilitis. The final diagnosis was circinate balanitis with primary ankylosing spondylitis. Both cases highlight the diagnostic challenge of distinguishing between different forms of spondyloarthritis in the presence ofcircinate balanitis.

In this case, we describe a 52-year-old man who was switched to long-acting cabotegravir/rilpivirine (CAB/RPV LA) injectable antiretroviral therapy (ART) on a background of well-controlled HIV. He subsequently developed a painful and swollen area on his right ventrogluteal region 10 days after his first CAB/RPV LA injections when he injected alternatively sourced testosterone in the same region. Examination findings showed a firm and defined lump with ecchymosis noted on the skin overlying. His initial blood results did not show any gross abnormalities and an ultrasound of the area was equivocal. After being reviewed in ambulatory care, the emergency department and an outpatient plastic surgery clinic settings over the course of 3 weeks, the swelling and skin changes gradually resolved. He was then switched back to oral ART on subsequent review.