International Journal of STD & AIDS最新文献

Third-degree atrioventricular (AV) block is characterised by complete dissociation between atrial and ventricular activity. It is commonly caused by degenerative conduction disease, ischaemia, medications, or in this case - an infective process. We report a rare case of third-degree AV block caused by disseminated gonococcal infection (DGI). Rates of Neisseria gonorrhoeae are increasing, and DGI remains an important but often under-recognised complication. While DGI typically presents with tenosynovitis, polyarthralgia, and skin lesions - cardiac involvement is uncommon. A 36-year-old cis-male who has sex with men presented with polyarthralgia, tenosynovitis, maculopapular rash, and exertional dyspnoea. Electrocardiogram (ECG) demonstrated third-degree AV block. Mucosal swabs were positive for N. gonorrhoeae at both rectal and pharyngeal sites, though blood cultures were likely negative due to prior antibiotic usage before obtaining cultures. Cardiac imaging showed no structural abnormality or evidence of endocarditis. In the absence of an alternative cause, a diagnosis of presumptive DGI was made. After treatment with intravenous ceftriaxone for seven days, cardiac conduction normalised. Follow-up ECG and cardiac magnetic resonance imaging (MRI) at later time points confirmed complete recovery. This case highlights a novel cardiac manifestation of DGI and reinforces the importance of recognising systemic complications of gonorrhoea.

BackgroundCondoms remain among the most effective methods for preventing HIV and other sexually transmitted infections (STIs). However, consistent use among youth remains suboptimal worldwide. This study aimed to evaluate the psychometric properties and cross-cultural measurement invariance of the Multidimensional Condom Attitude Scale (MCAS) among young adults from 11 countries.MethodsA total of 5656 participants aged 18-26 years from ten Spanish-speaking countries and the United States completed the MCAS online. Confirmatory factor analyses and multigroup invariance testing were performed using the Weighted Least Squares Mean and Variance Adjusted estimator. Reliability was examined with Cronbach's α for the total sample and by biological sex and sexual experience.ResultsThe five-factor structure of the MCAS showed good model fit across all countries, exceeding recommended thresholds (CFI > .95, RMSEA < 0.05; observed CFI > 0.97, RMSEA < 0.04). Strong, though not strict, measurement invariance was established across cultural contexts and sexes. Reliability coefficients were acceptable to high (α = 0.66-0.94). Cross-country differences in attitudes were small, whereas sex-based differences, particularly in stigma, shame, and pleasure, were more pronounced.ConclusionsFindings confirm the MCAS as a valid and reliable tool for assessing condom-related attitudes across diverse cultural settings. The demonstrated invariance supports its use in global research, sexuality education, and HIV prevention initiatives extending beyond Western, Educated, Industrialized, Rich, and Democratic contexts (WEIRD) contexts.

BackgroundTuberculosis (TB) is the leading cause of death among people living with HIV (PLHIV). Globally in 2023, an estimated 161,000 PLHIV died of TB. TB preventive treatment (TPT) can reduce TB mortality yet scale up remains a challenge. We documented Zimbabwe's experience in scaling TPT among PLHIV.MethodologyWe analyzed routine aggregate data from the President Emergency Plan for AIDS Relief (PEPEFAR) database, Data for Accountability Transparency and Impact Monitoring (DATIM). We conducted a desk review of national guidelines, reports, training manuals, policy and strategic plans. Program reports were reviewed to understand scale up best practices, successes and challenges.ResultsTPT coverage (cumulative number completed TPT divided by PLHIV on ART) increased from <1% (144/950,235) in 2018 to 101% (1,040,460/1,029,583) in 2024, in PEPFAR supported health facilities. Adults had a higher TPT coverage of 102% (1,006,544/990,818) than children 87% (33,916/38,765). TPT completion (number started TPT divided number completing TPT) was significantly higher among adults, 99.2% compared to children, 97.9%, difference 1.2 percentage points (CI 0.98-1.50, p < 0.01). Key interventions resulting in improved TPT coverage and completion, included removal of the 3-months waiting period for PLHIV to initiate TPT, introduction of shorter regimens, pharmacovigilance, implementation monitoring, stakeholder engagement, and communication of updated policies.ConclusionWe report a significant increase in TPT coverage and completion rates. We observed lower TPT coverage and completion among children compared to adults. TPT scale-up lessons from Zimbabwe can inform TPT expansion in countries of similar context.

BackgroundAsymptomatic shedding of herpes simplex virus type 2 (HSV-2) and cytomegalovirus (CMV) could be detrimental among people living with HIV (PLWH) hospitalized with acute illness, and clinical trials of suppressive antivirals may be warranted if so. However, the acceptability of serial viral shedding assessments in this setting is unclear.MethodsWe assessed the feasibility of quantifying subclinical HSV-2 and CMV reactivations in a pilot cohort study among PLWH hospitalized with acute illness. Consenting participants provided up to six serial oral, genital and anal mucosal swabs for HSV-2 detection by polymerase chain reaction (PCR) and blood for HSV-2 and CMV PCR.ResultsOf 81 persons approached, 45 (56%) consented. Most were cisgender men (89%) and were seropositive for HSV-2 (64%), CMV (89%), or both (62%). Median age was 47 (41-52) years and CD4 count was 146 (40-338) cells/mm³. Over a median (interquartile range) of 2 (1-3) assessments each, 42% of participants with HSV-2 experienced mucosal HSV-2 shedding, 16% had detectable HSV-2 viremia at least once and 33% of CMV seropositive participants had CMV viremia at least once.ConclusionsSerial collection of mucosal swabs and blood for HSV-2/CMV shedding appeared feasible among people living with HIV hospitalized with acute illness. The relationship between asymptomatic shedding and clinical outcomes warrants further study in this setting, to inform trial design.

IntroductionDetectable plasma HIV viral loads remain a major public health concern due to its association with increased HIV transmission and disease progression. The aim of this study is to assess the factors associated with a detectable HIV viral load in People Living with HIV (PLHIV) aged between 15 and 60 at the Cité des Palmiers District Hospital in Cameroon.MethodologyThis is a cross-sectional study conducted between July 2023 and January 2024 using a non-probability convenience sampling method. Data were collected using a semi-structured questionnaire administered to PLHIV aged between 15 and 65 years (n = 309). Analyses were performed using logistic regression, with a p-value <0.05.ResultsOut of 511 patients recruited, 309 consented to participate, representing a participation rate of 60%. Among the participants, 17% had a detectable viral load. Analyses revealed that living in a rural area [aOR = 4.40, p-value = 0.040], having a primary education as the highest level attained [aOR = 4.82, p-value = 0.025], frequently forgetting to take medication [aOR = 5.67, p-value = 0.002], eating only one meal a day [aOR = 13.02, p-value = 0.007], and fearing that therapy would no longer be effective in the future [aOR = 4.45, p-value = 0.009] significantly increased the probability of having a detectable HIV viral load.ConclusionThese result provide insight into targeting adherence support for PLWH in Cameroon to reduce the community HIV viral load. By improving access to care and providing psychosocial support, it may be possible to reduce community viral load, and reducing HIV transmission.

Transient detection of hepatitis B surface antigen (HBsAg) following hepatitis B vaccination is a rare but recognized phenomenon that may be misinterpreted as acute hepatitis B virus (HBV) infection. We report a case illustrating this diagnostic challenge in an HIV pre-exposure prophylaxis (PrEP) user. A 36-year-old man presented in October 2025 for PrEP initiation. He reported condomless sex with multiple male partners and occasional on-demand use of tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) obtained from a partner. Screening for sexually transmitted infections in August 2025 showed negative viral hepatitis serologies. Two days prior to the PrEP consultation, he received a combined hepatitis A/B vaccine in preparation for travel to Thailand.Routine baseline testing revealed isolated HBsAg positivity. The patient was asymptomatic and recalled for further evaluation. Repeat testing eight days later showed HBsAg negativity, newly positive anti-HBs antibodies, undetectable HBV DNA, negative hepatitis D serology, and normal liver enzymes. Follow-up serology fourteen days later confirmed sustained HBsAg negativity with isolated anti-HBs positivity. The rapid resolution of HBsAg in close temporal proximity to vaccination, together with the absence of hepatitis B core antibodies and undetectable HBV DNA, supported transient post-vaccination antigenemia rather than acute HBV infection.Transient HBsAg positivity after vaccination has previously been described, particularly among hemodialysis patients. Retrospective studies indicate that circulating recombinant HBsAg may be detected shortly after immunization, most commonly within five days but occasionally up to twenty days. To our knowledge, this is the first reported case of transient HBsAg positivity in a PrEP user. This is clinically relevant given the anti-HBV activity of TDF and evidence suggesting that TDF-based PrEP reduces HBV acquisition. As incident HBV infection during PrEP use is uncommon, isolated HBsAg positivity shortly after vaccination may create diagnostic uncertainty. Awareness of this phenomenon is essential to avoid misdiagnosis, unnecessary anxiety, and inappropriate interruption of PrEP.

This case report describes the first documented use of lenacapavir in the setting of Y188L NNRTI resistance mutation during pregnancy, resulting in successful maternal viral suppression and prevention of vertical transmission of HIV. A 24-year-old woman with prior poor adherence, socioeconomic instability, and NNRTI resistance (Y188 L mutation) presented with uncontrolled viremia during her second pregnancy. After consultation with perinatal HIV experts, she initiated a long-acting injectable regimen combining lenacapavir (927 mg subcutaneous every 6 months) and cabotegravir/rilpivirine (600/900 mg intramuscular every 2 months). Rapid viral load reduction was achieved, declining from 147,351 to 67 copies/mL within weeks. Despite transient hepatotoxicity, the patient delivered an HIV-negative infant at term. Maternal HIV RNA remained <50 copies/mL postpartum and became undetectable by January 2025. The infant remained HIV-negative at 18-months follow-up. This case demonstrates the potential role of long-acting antiretroviral therapy (ART) in achieving sustained virologic control among pregnant patients with adherence challenges and drug resistance. While lenacapavir shows promise as a biannual agent addressing barriers to adherence, its pharmacokinetics and safety during pregnancy remain uncharacterized. These findings underscore the urgent need for systematic studies and pregnancy registries evaluating long-acting ART agents in maternal populations to optimize outcomes and eliminate vertical transmission in hard-to-treat cases.