International Journal of STD & AIDS最新文献

BackgroundHIV self-testing (HIVST) is a testing strategy to reach individuals not engaged in healthcare. We evaluated ICAP's Reaching Impact, Saturation and Epidemic Control (RISE) program's healthcare-worker-assisted HIVST on the number of persons testing HIV-positive (PTP) and HIV case finding rate (CFR) in "hard-to-reach" members of the general population in targeted provinces in Burundi.MethodsUsing routine data from October 2020 to September 2023, with October-December 2021 as the scale-up quarter, we used difference-in-difference analysis to assess changes in PTP and CFR after versus before scale-up-onset in "mature" versus "less mature" provinces. Provinces were chosen to approximate more and less exposed comparison units. We performed subgroup analyses by sex and age (10-24, ≥25 years).ResultsHIVST averaged 1.46% (mature) and 3.07% (less mature) of pre-scale-up testing, and 13.59% (mature) and 9.84% (less mature) of post-scale-up testing. PTP trends declined more in the mature versus less mature provinces post-scale-up (-34.25, 95% CI -84.87-16.37) although this was not significant. We found no difference in the CFR change between provinces post versus pre-scale-up (0.06%, 95% CI -0.29%-0.41%). Results were robust to subgroup and sensitivity analyses.ConclusionsWe found no changes in PTP and CFR after RISE's HIVST scale-up. After results were reported to implementers, they implemented strategies to better meet programmatic goals.

Intravesical Bacillus Calmette-Guérin (BCG) therapy is a mainstay for non-muscle invasive bladder cancer, but may rarely cause disseminated infection. We describe a 71-year-old man who developed fever, respiratory failure, and hepatomegaly 1 week after completing maintenance intravesical BCG instillations. Examination revealed multiple erythematous-violaceous papules on the glans penis. Biopsies of both skin and liver showed granulomatous inflammation with focal necrosis; Ziehl-Neelsen, PAS, and Grocott stains, culture, and PCR for Mycobacterium tuberculosis complex were negative. These findings supported a diagnosis of disseminated BCGitis with cutaneous penile involvement. Anti-tuberculous therapy with rifampicin, isoniazid, and ethambutol led to full systemic and cutaneous improvement. Penile involvement in BCGitis is exceedingly uncommon, and microbiologic confirmation is often lacking due to low sensitivity. Awareness of this entity is essential, as early recognition and prompt therapy can prevent severe systemic complications and improve outcomes in patients recently exposed to intravesical BCG.

BackgroundGenital dermatoses (GDs) significantly impact sexual health and psychosocial wellbeing, yet no specific patient-reported outcome measure (PROM) exists for this population. Our study aimed to appraise patient perspectives on GDs by composing a PROM to evaluate biopsychosocial concerns and compare outcomes between new and follow-up patients results.MethodsA literature review of applicable existing PROMs resulted in the selection of 14 pre-validated questions covering 3 domains: physical symptoms, quality-of-life and mental health. The response rate was 77.1% for the final PROM, with 48 responses for analysis following the exclusion of 6 incomplete responses.ResultsThe follow-up group showed a reduction in average scores compared to new patients, decreasing from 2.41 to 2.05 (p = 0.0002) with a lower score indicating better outcomes. All the questions showed a decrease in score from new to follow-up patients. Results revealed significant improvements in the average pain score among follow-up patients.ConclusionsOur findings demonstrate the necessity of PROMs in improving patient-centred care. Results indicated significant improvements in physical wellbeing in follow-up patients, affirming efficacy of existing treatments and suggested a necessity for greater psychological support to those suffering from genital dermatoses.

BackgroundTransgender (trans) people face a disproportionate global burden of gender-based violence (GBV). The socio-political context in China indicates that trans people there also face an elevated risk of experiencing GBV compared to cisgender people. Our scoping review examines GBV experienced by trans people in China to identify evidence gaps and inform future research, intervention, and policy.MethodsWe searched four English databases and three Chinese databases for peer-reviewed quantitative and qualitative articles on GBV experienced by trans people in China between 1/1/2015 and 1/7/2024.ResultsFourteen English-language papers were included. Twelve studies were quantitative, and two were qualitative. Studies focusing on transmasculine and/or non-binary individuals were scarce. Multiple forms of GBV (e.g., verbal, physical, sexual, emotional/psychological) towards trans people were identified. The most frequently studied GBV types were intimate partner violence and caregiver/family violence, with estimated prevalence ranging from 44.9% to 65.6% and 44.2% to 92.8%, respectively. GBV was found to be associated with poor mental and sexual health.ConclusionsWhilst prevalence estimates vary, GBV was found to be commonly reported by trans people in China and associated with significant adversities, demanding multilevel interventions. Future research should employ diverse methodologies with a broader demographic coverage to strengthen the evidence base.

BackgroundTo assess whether human papillomavirus (HPV) vaccination is associated with herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) infection among young women in the United States.MethodsWe analyzed data from the 2011-2016 National Health and Nutrition Examination Survey, including sexually active women aged 18-35 years with HSV-1 and HSV-2 serology and self-reported HPV vaccination status. Weighted prevalence estimates and logistic regression models were used to evaluate associations, adjusting for demographic and socioeconomic covariates. Propensity score-weighted analyses were conducted as sensitivity checks.ResultsAmong 1643 women, 30.1% reported HPV vaccination. Vaccinated women had lower unadjusted HSV-1 (41.9% vs 47.8%, p = 0.034) and HSV-2 prevalence (9.9% vs 15.2%, p = 0.007). In adjusted models, HPV vaccination was not significantly associated with HSV-1 (aOR = 1.26, 95% CI: 0.94-1.70) or HSV-2 infection (aOR = 0.86, 95% CI: 0.56-1.31). Sensitivity analyses confirmed these findings.ConclusionsHPV vaccination was not linked to increased risk of HSV-1 or HSV-2 infection, providing HSV-specific evidence against sexual risk compensation and supporting public health messaging promoting HPV immunization.

BackgroundHuman papillomavirus (HPV) dependent vulval intra-epithelial neoplasia (VIN) is a precursor to vulval squamous cell carcinoma (SCC) and an important global health concern. Immunosuppression increases the concurrence of VIN as well as multicentric HPV disease. A retrospective cohort study was designed to determine the burden of VIN in immunosuppressed women and extrapolate whether immunosuppression was a risk factor for poorer treatment outcomes.MethodAll biopsy proven women with VIN were reviewed over a 10-year period between 2013 and 2023. Patient and disease characteristics were collected and vulval lesions were mapped in quadrants using clinical photography. Treatment outcome including recurrence after first line treatment, progression to SCC or death due to disease were included.Results104 women were identified of whom 30% were immunosuppressed, with a higher burden of HPV disease including cervical (CIN) or anorectal (AIN) intraepithelial neoplasia and multifocal VIN. However, no difference in treatment outcome was found between the immunosuppressed and the control group. On multivariate analysis, having multifocal disease predicted worse treatment sequelae.ConclusionImmunosuppressed women need a multi-disciplinary group of specialists to manage their burden of HPV disease. Identifying multifocal and multicentric disease early is essential for improving treatment success.

BackgroundThis multicentre study evaluated the prevalence, distribution, and risk factors of cancer among people living with HIV (PLWH) in Turkey over two decades. Mortality rates and factors were also investigated.MethodsThis retrospective cohort study included 154 adults diagnosed with cancer and HIV between 2008 and 2024. Data were collected from the medical records. The demographics, clinical characteristics, cancer types, treatments, and outcomes were evaluated. The risk factors for ADCs and mortality were defined using multivariate logistic regression and Cox regression. The estimated survival time was determined using Kaplan-Meier analysis.ResultsAmong 8708 PLWH, cancer prevalence was 1.8% (95% CI:1.5-2). ADCs (66.9%) were twice as frequent as NADCs (33.1%). Most prevalent cancers were non-Hodgkin lymphoma (35.1%), Kaposi sarcoma (29.9%), and lung cancer (7.8%). Age ≤54 years, CD4 + T lymphocyte count ≤94/mm³, and HHV-8 co-infection were risk factors for ADCs. Mortality rate was 32%. Non-Hodgkin lymphoma and CD4 + T lymphocyte count ≤232/mm³ at treatment completion predicted mortality. The 3-years overall survival rate was 67.6%.ConclusionsThis study offers insights into cancer burden among PLWH in Turkey. High rates of ADCs and mortality highlight the importance of early HIV diagnosis and antiretroviral therapy access to reduce cancer burden in this population.

IntroductionAnal cancer, though rare in the general population, is increasing among men who have sex with men (MSM), particularly those living with HIV. In Algeria, no clinical data on anal HPV or precancerous lesions were available until now.ObjectiveTo determine the prevalence of anal HPV infection, identify circulating high-risk genotypes, and estimate the frequency of anal dysplasia among MSM with HIV in Setif, Algeria.MethodologyA cross-sectional study was conducted in 2024 among 57 MSM followed at the STI/HIV Reference Center in Setif. Anal HPV was detected by PCR (GeneXpert®), followed by high-resolution anoscopy with targeted biopsies. Histology was classified according to LAST (LSIL, HSIL).ResultsHPV infection was detected in 72% (41/57). HPV-16 and HPV-18 were the predominant genotypes, found in 42.1% and 35.1% of participants. Among the 41 biopsied patients, 85.4% had precancerous lesions, including 39% HSIL. Multiple HPV co-infections occurred in 24.3%. The main risk factors were condomless receptive anal intercourse, smoking, and chemsex.ConclusionThis first Algerian study reveals a high prevalence of anal HPV infection and precancerous lesions among MSM with HIV. Findings support the urgent need for targeted screening, HPV vaccination, and strengthened prevention.

BackgroundReal-world experience with low-level viremia (LLV) remains under reported, leading to limited knowledge about the clinical management and impact of persistent LLV on subsequent emergence of drug resistance and virologic failure (VF). The aim of this study was to assess the effect of bictegravir on the virologic outcomes in treatment-experienced people with HIV (PWHIV) with persistent LLV.Patients and MethodsAn observational, prospective study in which treatment-experienced PWHIV experiencing LLV were included after switch to BIC/TAF/FTC. Baseline demographic and clinical characteristics were collected from the participants' medical records. CD4 + T-cell counts, CD4/CD8 ratios, and HIV-RNA levels were evaluated 2, 6, 12, 18, and 24 months after initiation of BIC/TAF/FTC. Statistical analysis of the data was performed using IBM Statistical Package for Social Sciences (SPSS), version 19.0 (IBM Corp., Armonk, NY, USA).ResultsA total number of 31 PWHIV, 21 males, with a mean age of 47.08 ± 7.48 years, were included. The current ART regimen before switch was based on Integrase Strand Transfer Inhibitors (INSTIs) in 30 PWH (96.8%). The mean CD4 + T-cell count after bictegravir initiation (619.45 ± 181.71, p < 0.001) was significantly elevated compared to the baseline mean CD4 + T-cell count (485.85 ± 166.92). Two months after bictegravir initiation, viral suppression was achieved at 58.1% (n = 18), and at 90.3% (n = 28) at 12 months, which was maintained at 18 and 24 months. A significant gradual elevation of CD4/CD8 ratio was also observed (0.51 ± 0.30 before switch vs 0.69 ± 0.35 at 12 months, p < 0.001).ConclusionThe results of the present study indicate that BIC/TAF/FTC may improve the immunological response and reduce the proportion of PWHIV experiencing persistent LLV. Further studies in larger patient series are needed to determine the full beneficial role of bictegravir.

BackgroundSexual minority men (SMM) in China continue to face a disproportionately high burden of HIV. Yet, little is known about the differences in HIV prevention service utilization including HIV testing and pre-exposure prophylaxis (PrEP) by relationship status and sexual agreements among this population. The study aimed to explore the associations between relationship status and sexual agreements and HIV testing behaviors, PrEP willingness, and PrEP uptake among sexually active SMM in China.MethodsWe surveyed 1,379 sexually active SMM in China on a geosocial networking app and conducted multivariable regression to examine differences in HIV testing and PrEP-related outcomes.ResultsOver one-third of Chinese SMM (36%) were in a relationship (e.g., having a boyfriend or partner) and among these, 44% had a monogamous sexual agreement and 24.6% were having an open relationship agreement. In adjusted models, partnered Chinese SMM were more likely to have received a recent HIV test (AOR = 1.47, 95%CI: 1.14-1.91). Bisexual men were less likely to have tested for HIV (AOR = 0.71, 95% CI: 0.53-0.96) or ever used PrEP compared to gay men (AOR = 0.56, 95% CI: 0.30-0.98). Among partnered SMM, those with an open relationship agreement were less likely to have tested for HIV in the past 6 months (AOR = 0.51, 95% CI: 0.28-0.94) and more willing to use PrEP for HIV prevention (AOR = 1.96, 95% CI: 1.19-3.22), compared to SMM in monogamous relationships.ConclusionsThese findings provided quantitative evidence and insights into the differences in HIV prevention service utilizations among SMM in China and suggest the need for tailored interventions for targeted sub-groups to address the unique sexual health needs of Chinese SMM.