International Journal of STD & AIDS最新文献

BackgroundHIV self-testing (HIVST) was endorsed by WHO in 2016 to expand access to HIV diagnosis, especially for young people. Kenyan youths, including university students, remain vulnerable to HIV, yet uptake of free HIVST kits is inconsistent. This study assessed determinants of HIVST utilization among health sciences undergraduates at the University of Nairobi.MethodsWe conducted a cross-sectional analytical study at the Chiromo and Faculty of Health Sciences campuses. Multi-stage cluster sampling yielded 412 students from Medicine, Pharmacy, Nursing, Dentistry and Medical Laboratory Science. Data on socio-demographics, sexual behaviour, stigma, and institutional access were collected via self-administered questionnaires and analysed in R. Associations were examined using χ²/Fisher's exact tests and Wilcoxon tests; variables with p < .05 entered a multivariable mixed-effects logistic regression model to account for clustering by course and year of study.ResultsOverall, 30.5% reported prior HIVST use. Uptake was higher among older students and those in advanced years. Being in a relationship and consistently using condoms were associated with lower HIVST uptake. Recency of the last HIV test strongly predicted use, with students tested within the preceding 3-6 months more likely to self-test. Residence and gender were not independent predictors after adjustment.ConclusionsHIVST uptake among Kenyan health sciences undergraduates is moderate but uneven. Age, academic seniority and recent HIV testing history increase uptake, whereas perceived low risk (e.g. condom use) reduces it. Universities and the Ministry of Health should pair easy kit access with messaging that encourages routine testing regardless of perceived risk to accelerate progress toward UNAIDS 95-95-95 targets.

Background/ObjectivesTransgender women in Mexico face a high HIV prevalence, yet they remain insufficiently engaged in pre-exposure prophylaxis (PrEP). This study aimed to evaluate willingness to use HIV pre-exposure prophylaxis (PrEP) and its connection to risk behaviors among transgender women in Mexico.MethodsIn 2021, a cross-sectional study was conducted among Mexican transgender women to assess HIV risk factors and willingness to use PrEP. We used Latent Class Analysis to cluster participants with similar HIV risk behaviors, and multivariable logistic regression to identify covariates of willingness to use PrEP.ResultsAmong 266 transgender women, 40% were aware of PrEP, yet 78% reported willingness to use it after a brief introduction. Only 25% of the participants perceived themselves at high HIV risk. Through Latent Class Analysis, three classes were identified: 1) transactional sex with lower risk (10%); 2) no transactional sex with higher risk (25%); and 3) transactional sex with higher risk (65%), with reported willingness to use PrEP at 61%, 66% and 85%, respectively. In the multivariable model, belonging to class 3 (vs class 1) was associated with higher willingness to use PrEP (aOR:3.3; CI:1.2-9.5).ConclusionsWillingness to use PrEP aligned with HIV risk in those with a higher risk (class 3) and lower risk (class 1), but not in those at higher risk despite not reporting transactional sex (class 2). Therefore, not all who could benefit from PrEP may want it. Strategies are needed to promote PrEP's awareness and willingness to use considering the needs of transgender women subgroups.

BackgroundCervical cancer (CC) is highly prevalent in Nigeria, with over 12,000 cases and 8000 deaths annually. Differences in diagnostic methods for human papillomavirus (HPV) genotypes have generated varied prevalence rates across populations.MethodsWe analyzed the prevalence and distribution of high-risk HPV (HR-HPV) genotypes among women with CC, comparing HIV-negative women and women living with HIV (WLWH), using data from a prospective Nigerian cohort study (2018-2022). High-throughput next-generation sequencing (NGS) of the HPV L-1 gene identified and classified genotypes.ResultsAmong 189 women tested for HR-HPV, 74.1% (140/189) were HIV-negative, and 25.9% (49/189) were WLWH. The median age was lower for WLWH at 48 years [IQR: 41-54] compared to HIV-negative women at 60 years [IQR: 49-69] (p < .001). The overall prevalence of HR-HPV was 64.6% (122/189; 95% CI: 57.4-71.1), with higher rates in WLWH (77.6%, 38/49) than HIV-negative women (60.0%, 84/140) (p < .001). Among HR-HPV-positive cases, HPV16 or HPV18 accounted for the highest proportion, representing 67.2% (95% CI: 58.3-75.0). The most prevalent HR-HPV types detected were HPV16 (46.7%), HPV18 (20.5%), HPV45 (9.8%), HPV35 (6.6%), and HPV52 (5.7%). Quadrivalent and nonavalent HPV vaccines would cover 67.2% (95% CI: 58.3-75.0) and 86.1% of HR-HPV infections, respectively.ConclusionOur NGS approach findings among women with CC identified HPV types not covered by the Gardasil-4 vaccine used in Nigeria. This highlights the need for broader vaccine coverage against most HR-HPV types, regardless of HIV status, in Nigeria.

ObjectiveThis narrative review examines the impact of the United States on the war against HIV/AIDS and thus the impact of political ideologies on the financing of the medical sector.DiscussionInitially marked by stigma, particularly in the early years of the epidemic, the US response was transformed with the launch of the Presidential Emergency Plan for AIDS Relief (PEPFAR) in 2003. PEPFAR has partnered with entities such as the Global Fund and the Joint United Nations Programme on HIV/AIDS (UNAIDS), retranslating global health governance. Despite this success, the global response remains dependent on the support of the United States. Political changes under the leadership of the conservatives have limited funding. Therefore, political polarization in the US is undermining long-term progress on HIV/AIDS prevention and treatment, particularly in low- and middle-income countries.ConclusionBy tracing historical developments and analysing current funding trends, the article highlights the urgent need for sustainable and depoliticized investments in global health systems. Without renewed bipartisan commitment and greater local ownership, the vision of eliminating AIDS as a public health threat by 2030 is seriously threatened.

We describe a case of human herpesvirus-8 (HHV8) associated extracavitary primary effusion lymphoma (PEL) in a 52-year-old man who initially presented with long-term nonproductive cough, fever, night sweats and loss of weight. Initial blood tests were positive for human immunodeficiency virus (HIV) with CD4 + T-lymphocytes count of 42/mm3. Respiratory opportunistic diseases were excluded. Additional investigation with bronchoscopy revealed a bronchial mass that was biopsied. Histology and immunohistochemical tests confirmed extracavitary PEL associated with HHV-8. Antiretroviral treatment and CHOP regimen chemotherapy was initiated with an effective response. Given its rarity and unusual presentation, this clinical case emphasizes the importance of considering PEL, along with other lymphoproliferative disorders, as a differential diagnosis in patients living with HIV with acquired immune deficiency syndrome (AIDS) with a bronchial mass.

BackgroundWe assessed the feasibility of point-of-care testing (POC) for Chlamydia trachomatis (CT) among Men who have Sex with Men (MSM) and Transgender Women (TGW) attending community-based clinics (CBOs) in Thailand.MethodsA secondary analysis using data from a study that enrolled participants aged ≥18 years who were at risk of HIV. They were tested for CT and Neisseria gonorrhoeae (NG) using Cepheid Xpert® POC tests. Behaviors were assessed using a questionnaire. Logistic regression was used to evaluate factors associated with CT infections.ResultsA total of 1885 participants were enrolled between 2019 and 2021, with 89.7% identifying as MSM. Of all participants, 15.9% were living with HIV (PLHIV), 20.6% initiated PrEP, 31.7% were already using it, and 31.8% had never used PrEP.Of all participants, 13.4% and 18.8% tested positive for NG and CT, respectively. CT prevalence was associated with age groups: 34.6% in 18-19 years (AOR 3.2), 24.1% in 20-24 years (AOR 1.7), compared to 14.5% in those ≥25 years. CT prevalence was higher in PLHIV (28.3%) compared to those who were HIV-negative and had never used PrEP (17.0%).ConclusionsAlmost one-fifth of Thai MSM and TGW had CT infection. POC testing is feasible and should be integrated into STI screening.

BackgroundSyphilis can cause significant clinical complications in adults and severe harm to fetuses and newborns through vertical transmission if it remains undiagnosed and untreated. With syphilis being on the rise in many countries, it causes a high and increasing burden of disease worldwide. Due to its high sensitivity and specificity, the TPPA (Treponema pallidum particle agglutination test) is considered the gold standard in serological syphilis diagnostic. However, the production of TPPA by the world's only manufacturer has stopped which has generated major gaps in diagnostic capabilities.MethodsFour polyvalent screening tests from Abbott, Roche, Diasorin and Euroimmun were evaluated on the base of negative, borderline and positive samples to develop an alternative diagnostic procedure of the highest possible quality. Additionally, alternative diagnostic threshold values of the test systems were evaluated for further optimization.ResultsA total of 1768 samples from different patient populations were analyzed. When performed according to the manufacturer's instructions, most tests achieved a high specificity. However, the sensitivity of the screening tests was not fully satisfactory, particularly in the early stages of infection, where sensitivity remained relatively low.ConclusionsBy lowering threshold values, the sensitivity could be significantly increased allowing for some of the evaluated assays to reach a test quality comparable to the TPPA, which is particularly relevant for samples from patients with higher risk of acquiring STIs. Moreover, the results of the polyvalent screening assays could also be used to monitor treatment success and detect possible re-infections.

BackgroundQuantitative HIV-1 DNA (qDNA) is a biomarker of the viral reservoir. We evaluated whether two-drug regimens (2DRs) maintain qDNA values comparable to those of three-drug therapies (3DRs).Materials and methodsWe collected data from people living with HIV (PLWH) undergoing qDNA testing. Total HIV-1 DNA was measured using the HIV-1 DNA Test PRO (Diatheva) on InGenius (ELITech) platform. Descriptive analyses and non-parametric tests were performed. Bivariate logistic regression was applied to identify predictors of qDNA levels ≥2.3 log copies/10⁶ in peripheral blood mononuclear cells (PBMC).Results263 PLWH receiving antiretroviral therapy (ART) were included; 118 (44.9%) had qDNA ≥2.3 log copies/10⁶ PBMC. Age (OR: 1.44 per 10-years increase, p = 0.008) and prior CDC C stage events (OR: 2.26, p = 0.025) were associated with qDNA >2.3 log copies/10⁶ PBMC. Years of treatment (OR: 0.71 per 5-years increase, p = 0.018) was associated to lower probability of qDNA >2.3 log copies/10⁶ PBMC. No association was found between ART type (2DR vs 3DR) and qDNA levels (p = 0.441).ConclusionThe impact of 2DRs on the viral reservoir assessed by mean of qDNA is not different from what observed with 3DRs and may be a viable option for PLWH at risk of disease progression.

Herpes simplex virus (HSV) resistance is rare, but incidence is rising. Managing resistant HSV phenotypes in individuals living with human immunodeficiency virus (HIV) poses an increasing challenge. Here, we present two (2) cases where a short course of oral amenamevir (helicase-primase Inhibitor) for the treatment of thymidine analogue-resistant herpes simplex lesions.Case presentationsCase 1: 55-year-old Liberian man living with HIV presented with an enlarging, hypertrophic lesion on his inner thigh. This had been diagnosed as HSV-2 by PCR. Despite treatment with acyclovir, the lesion persisted. It had also failed to respond to topical therapies and cidofovir. Further molecular diagnostics showed that it was thymidine analogue-resistant HSV. A novel oral, anti-viral agent, amenamevir was used with success.Case 2A 37-year-old Ghanaian woman living with HIV presented with recurrent painful confirmed HSV-2 genital ulceration. Despite escalating treatment from acyclovir to cidofovir, the HSV lesions failed to respond. A seven-day course of oral amenamevir provided excellent resolution of the lesions.ConclusionThese two cases highlight the challenges in managing aciclovir-resistant herpes simplex lesions and the swift resolution following treatment with a novel therapeutic agent, amenamevir. Early recognition of resistant HSV lesions allows for prompt outsourcing of alternative, novel anti-viral therapies such as amenamevir.