International Journal of STD & AIDS最新文献

BackgroundWe aimed to determine antiretroviral therapy (ART) initiation timing and outcomes in people living with HIV (PLHIV) receiving tuberculosis treatment in KwaZulu-Natal, South Africa.MethodsWe performed a retrospective cohort analysis of routinely collected de-identified data from 62 clinics including PLHIV not already receiving ART aged ≥16 years, starting tuberculosis treatment between October 2016-November 2019. Multivariable Poisson regression models with robust standard errors evaluated associations between timing of ART initiation (after starting tuberculosis treatment) and successful tuberculosis treatment, and 6-month HIV viral load (VL) < 50 copies/mL.ResultsAmong 5,548 PLHIV with tuberculosis, 29.8% initiated ART within 15 days ("early"), 36.2% in 16-56 days, 8.7% in 57-210 days, with 25.3% not initiating ART by 7 months. Proportions with successful tuberculosis treatment were similar comparing 16-56 and 57-210 days to early initiation, with a lower likelihood of successful tuberculosis outcome with no ART within 7 months (adjusted risk ratio [aRR] 0.81 [0.77-0.86], p < 0.001). In those with a known VL 6 months post-ART initiation (n = 2,658), initiation within 57-210 days had a lower likelihood of viral suppression (aRR 0.90 [0.82-0.99], p < 0.03).ConclusionAlthough <30% of PLHIV with tuberculosis initiated ART early, this was associated with better tuberculosis outcomes and VL suppression.

Sclerosing lymphangitis of the penis (SLP) is a rare, benign condition typically presenting as a cord-like swelling. We report an unusual case of SLP in a 75-year-old circumcised man with marked penile edema and deep ulcerations. STI screening was negative. After 2 weeks of sexual abstinence and local care, the ulcerations healed, revealing the characteristic SLP cord. The penile swelling resolved completely after 2 months. This presentation is unique due to the patient's age and the prominent edema and ulcerations, suggesting these features may indicate a severe clinical form of SLP that only manifests its typical appearance after the initial acute phase resolves.

We report a 49-year-old woman living with HIV who stopped her antiretroviral treatment for several weeks. One month after resuming treatment with dolutegravir and lamivudine (Dovato^®), she presented with myalgia, physical weakness and rhabdomyolysis. As we suspected a drug-related cause, Dovato^® was changed for tenofovir disoproxil fumarate, lamivudine and doravirine (Delstrigo^®) without improvement. Second line assessment led to a diagnosis of dermatomyositis, with presence of anti-Mi-2 antibodies, typical MRI findings and pathological analysis of muscle biopsy. The outcome was favorable after treatment with corticosteroids followed by methotrexate. Dovato^® was subsequently re-prescribed without recurrence of symptoms or rhabdomyolysis.

BackgroundSingle-tablet regimens (STRs) with integrase inhibitors, bictegravir (BIC) or dolutegravir (DTG), are favored in HIV treatment for their efficacy and convenience. This study compares persistence-time from initiation to discontinuation-between BIC/emtricitabine (FTC)/tenofovir alafenamide (TAF) and DTG-containing STRs at a Toronto HIV clinic.MethodsA retrospective cohort analysis was conducted on 1732 adults with HIV at Maple Leaf Medical Clinic who initiated or switched to BIC/FTC/TAF or DTG-containing STRs from 2016 to 2022. Persistence was measured in days until discontinuation. Kaplan-Meier curves and Cox models evaluated time-to-discontinuation and associated risks. Reasons for discontinuation were categorized into adverse events, patient preference, cost, compliance, physician preference, virologic failure, and others.ResultsAmong 1732 participants (median age 48 years, 88.7% cisgender men), 387 (22.3%) discontinued their STRs after a median of 402 days. BIC/FTC/TAF had a lower discontinuation rate (18.9%) compared to DTG-containing STRs (29.9%) (HR = 0.74, 95% CI: 0.60-0.92). Adverse events were the primary reason for discontinuation, with BIC having lower rates (9.6% vs. 12.5% for DTG).DiscussionBIC/FTC/TAF demonstrated higher persistence and fewer adverse events than DTG-containing STRs, aiding personalized HIV treatment decisions for better long-term outcomes.

Beard folliculitis is a frequent dermatologic complaint, but uncommon pathogens may challenge diagnosis and treatment. We report a case of persistent beard folliculitis in a 23-year-old man who has sex with men (MSM), unresponsive to conventional therapies. Culture of a pustule identified Klebsiella aerogenes, a Gram-negative enteric bacillus increasingly implicated in beard folliculitis in MSM. Combined oral and topical antibiotic therapy targeting K. aerogenes achieved full resolution. Differential diagnosis included tinea barbae caused by Trichophyton mentagrophytes ITS genotype VII, an emerging sexually transmitted dermatophyte with similar demographics and presentation. This case adds to a growing number of reports linking K. aerogenes to folliculitis in MSM, underlines the importance of bacterial culture in recalcitrant folliculitis, and raises awareness of K. aerogenes as a potential sexually transmissible pathogen. Prolonged therapy and avoidance of possible environmental reservoirs such as hot tubs may be necessary to prevent recurrence.

BackgroundHIV-PrEP is a key component of HIV combination prevention and has been routinely available through oral formulations (i.e. oral tablets) across sexual health services (SHSs) in the UK since 2020. We used data from a large, online community survey to assess the acceptability and preference of different HIV-PrEP modalities among gay, bisexual, and other men who have sex with men (GBMSM) and gender-diverse individuals living in the UK.MethodsUsing data collected from the 'Reducing inequalities in Sexual Health' (RiiSH) survey, an online community survey of 1106 GBMSM and gender-diverse individuals having sex with men (November/December 2023), we performed a secondary analysis examining HIV-PrEP modality acceptability and preference (e.g. oral, long acting injectable, gel, or patch) (%) by HIV-PrEP history (never, in lookback period of last 3-4 months since survey completion). Where ≥2 modalities were indicated, participants were asked to specify a single preferred modality. Single choice options were assumed to be the preferred HIV-PrEP modality.ResultsIrrespective of HIV-PrEP history, long acting injectables were highly acceptable (>70%) and the preferred modality (58% [222/386] by those never having used HIV-PrEP, 73% [75/103] in those without HIV-PrEP use in the lookback, 74% [314/424] in those with HIV-PrEP use in the lookback).ConclusionsWe found high acceptability of the use of injectables, with general preference over oral tablets. If injectable HIV-PrEP becomes available at SHSs in England, these modalities could have positive impacts on HIV-PrEP delivery, use, and access.

Verruciform xanthoma is a rare, benign mucocutaneous growth, usually seen in the oral cavity, but uncommonly also seen on genital skin. It presents as a flat or raised skin lesion, varying in colour with an irregular surface. These lesions can mimic stigmata of sexually transmitted infections such HPV-genital warts, condyloma latum or cause concern for inflammatory or malignant conditions, with histopathology being crucial for diagnosis and to avoid anxiety or invasive procedures. Underlying cause of these lesions remains uncertain, but no link to HPV has been identified. We present an 89 year old male referred to the sexual health service for concern of genital wart, despite low risk sexual history. Following removal and analysis to ensure non-malignant, the patient has been well since, with no recurrence.

BackgroundRates of sexually transmitted and blood borne infections (STBBI) are rapidly increasing. Despite the high diagnostic accuracy of self-testing, no fully remote STBBI testing programs are available in Canada. We aimed to evaluate the feasibility and acceptability of a fully-remote, web-based, at-home STBBI testing (self-collection) program in Calgary, Canada.MethodsParticipants who were Alberta residents aged ≥16 years self-enrolled into a web-based platform between February 2023 and March 2024 and completed consent and intake questionnaires consisting of demographic and sexual health data. Kits were mailed, and samples were self-collected including swabs, urine and dried blood spot cards. Results of processed kits were communicated securely to participants. Surveys to assess the feasibility and acceptability of the process were completed.ResultsOf the 156 participants (39.7% men, 37.3 ± 10.5 years) from diverse sex and gender backgrounds who completed the intake, 43% (n = 67) participants returned their testing kits. In the cohort, there was low reported condom use in more than 50%, and 40% had not had STBBI testing in the past 12 months. There were six participants (9.0%) with new positive tests for an STBBI and all were connected with appropriate treatment. Participants largely reported satisfaction with the web-based platform and testing process as well as ease with testing modalities with the except for dried blood spot testing which presented collection challenges.ConclusionsOur web-based comprehensive testing pilot was feasible and acceptable, demonstrating the value of such remote approaches to diminishing the threat of rising STBBI rates.

Background: Pre-exposure prophylaxis (PrEP) is a highly effective biomedical intervention for preventing HIV transmission. However, despite its proven efficacy, PrEP uptake in the Gulf Cooperation Council (GCC) countries remains suboptimal due to multiple systemic, legal, and sociocultural challenges.Purpose: This expert opinion review aims to present a strategic roadmap to enhance HIV prevention and support the integration and scale-up of PrEP adoption across the GCC region.Research Design: This narrative review synthesises insights from regional and international literature, expert panel discussions, and public health frameworks to develop practical recommendations for improving PrEP implementation in GCC countries.Study Sample: The review draws upon the perspectives of infectious disease specialists, public health policymakers, and HIV prevention advocates with expertise in the GCC region, alongside selected peer-reviewed and grey literature addressing HIV and PrEP in similar sociopolitical contexts.Data Collection and/or Analysis: Qualitative synthesis of the existing barriers and facilitators of PrEP adoption was conducted. The authors applied a framework-based approach to identify core pillars for effective policy, clinical, and public health interventions relevant to the GCC context.Results: Four strategic pillars were identified: (1) establishing a legal and regulatory framework with national PrEP guidelines; (2) improving risk identification and expanding access for individuals at heightened HIV risk; (3) enhancing healthcare provider education and capacity-building; and (4) conducting culturally sensitive public awareness campaigns. Financial accessibility and patient-provider communication were also highlighted as key to improving adherence and uptake.Conclusions: A coordinated, multi-sectoral approach is essential for advancing PrEP integration into national HIV prevention efforts across the GCC. By addressing structural and societal barriers, this roadmap provides actionable guidance to reduce new HIV infections and promote equitable access to PrEP for at-risk populations.