International Journal of STD & AIDS最新文献

BackgroundHuman papillomavirus (HPV) is the most frequent sexually transmitted virus, with high importance due its oncogenic risk. Previous studies have reported an association between genital dysbiosis and HPV infection in women and also in men co-infected with HPV and HIV. However, it remains to be determined whether penile skin dysbiosis is associated with HPV infection in men who are HIV-negative. This study characterizes the penile skin microbiota (PSM) of HPV-positive and HPV-negative men, hypothesizing that HPV infection is linked to dysbiotic anaerobic-dominated communities.MethodsA cross-sectional study was conducted on 103 sexually active HIV-negative men (70 HPV-negative, 33 HPV-positive). Those who tested HPV-positive were genotyped. The PSM of all samples was analyzed using 16S rRNA sequencing of the V4 region. Alpha and beta diversity were compared. Community State Types (CSTs) were identified using hierarchical clustering. Associations between CSTs and HPV status were tested adjusting for sexual preference.ResultsHPV-positive men exhibited significantly higher microbial richness than HPV-negative men (Chao1 p = .02), particularly those with high-risk genotypes (Chao1 p = .03). Five CSTs were identified, with CST-5 (dominated by Finegoldia and other anaerobes) showing a three-fold higher likelihood of HPV positivity (OR = 3.11, 95% CI: 1.22-8.22) compared to other CSTs. CST-5 also displayed reduced abundance of commensals like Corynebacterium and Staphylococcus.ConclusionsSubclinical HPV infection in HIV-negative men was associated with a dysbiotic PSM, characterized by an increased abundance of anaerobic bacteria alongside with a reduced proportion of facultative anaerobic genera. These findings suggest that PSM composition may influence HPV susceptibility or persistence. Longitudinal studies are needed to explore causality.

BackgroundCondomless sexual behaviors and intimate interactions have increased co-infections of syphilis, Mpox, and HIV. The concurrent infections disrupt the natural course of syphilis, hindering timely diagnosis and the effective implementation of treatment strategies. This research investigates the clinical characteristics of individuals co-infected with Mpox, T. pallidum and HIV through case studies, aiming to enhance understanding and identify effective treatment strategies for syphilis to prevent disease progression.MethodsA retrospective study was conducted to assess the clinical characteristics and treatment strategies of two patients diagnosed with both syphilis and Mpox. Additionally, a thorough review of the existing literature was performed using the PubMed, Web of Science, and Medline databases.ResultsThe review identified 32 cases of syphilis co-infected with Mpox, with 75% of individuals also living with HIV and 25% newly diagnosed with HIV. Notably, 66% had a clearly defined stage of syphilis, and serological testing showed that 65% of patients had antibody titers of 1:16 or higher, while 35% had titers of 1:8 or lower.ConclusionsThis study emphasizes the importance of evaluating co-infections in individuals with anogenital ulcerative conditions. Timely identification and prompt intervention are crucial for effectively managing concurrent infections, especially when patients are facing multiple infections.

BackgroundNew HIV-1 infections continue to pose a major challenge to ending the HIV epidemic and may facilitate the transmission of drug-resistant strains. In this study, we aimed to determine the proportion of recent HIV-1 infections (RHI) among individuals initiating HIV care at a rural referral hospital in Tanzania and to assess the prevalence of pre-treatment HIV-1 drug resistance (PDR) and circulating subtypes among those with RHI.MethodsIn this cross-sectional analysis, RHI was identified using the Asante HIV-1 rapid recency assay on bio-banked samples from newly diagnosed adult people living with HIV (PLHIV) enrolled in the Kilombero and Ulanga Antiretroviral cohort between March 2019 and March 2022. Risk factors for recent HIV were evaluated using logistic regression analysis. Genotypic resistance testing (GRT) using Sanger sequencing was performed on samples from people with RHI.ResultsAmong 599 PLHIV, 24 (4%) were identified with RHI. No factors were found to be associated with RHI. Genotypic resistance testing was successful in 16 of the 24 (67%) participants, of whom 5 (31%) harbored HIV-1 drug resistance mutations: 4/16 (25%) for non-nucleoside reverse transcriptase inhibitors, 2/16 (13%) for nucleoside reverse transcriptase inhibitors, and 1/16 (6%) for protease inhibitors.ConclusionThe low prevalence of RHI in this hospital-based study suggests a high rate of late HIV diagnosis. Despite the limited sample size, the notable proportion of people with recent infection who had drug resistance highlights a serious public health concern.

BackgroundMen who have sex with men (MSM) are at increased risk for Human Papillomavirus (HPV) infection, yet data on genotype distribution in India remain limited. This study assessed HPV prevalence and genotype patterns at genital and extra-genital sites among MSM and evaluated the potential coverage of available vaccines.MethodsA cross-sectional study was conducted over 18 months at a tertiary care centre in New Delhi. One hundred MSM were enrolled after informed consent. Participants completed a brief questionnaire and HIV test. Pharyngeal, rectal, and urethral swabs were analysed for high-risk (HR) and low-risk (LR) HPV genotypes using real-time PCR. Statistical analyses included descriptive measures and chi-square tests.ResultsParticipants had a median age of 28 years (IQR: 23-28), with the highest proportion belonging to the 26-30 years age group (39%). Condom use was inconsistent among 95% of participants, and a history of paid sex was independently associated with HPV infection (OR 2.2). Regular geosocial networking (GSN) app use was significantly associated with urethral warts and inconsistent condom use. Overall, 43% were HPV-positive, with most infections detected in rectal samples (87%). The most common genotypes were HPV-6, HPV-11, HPV-16 and HPV-68. Genotypes targeted by bivalent, quadrivalent, and nonavalent vaccines were present in 0%, 56%, and 67% of cases, respectively.ConclusionHPV prevalence in our study was high, particularly at rectal sites. Despite genotype diversity, a majority of infections were covered by the nonavalent vaccine, supporting targeted HPV vaccination for MSM.

BackgroundThe Community Liver Health Checks Programme offers population-level screening to identify those with fibrosis or cirrhosis. In this study, we describe the population characteristics and results for our cohort to ascertain the clinical utility of routine FibroScan.MethodsProspective observational study of PLWH who had a FibroScan as part of the programme. All participants had risk factor(s) for liver fibrosis.ResultsA total of 382 people were included in the study. There were 291 males, with a median age of 48 years (range 26-75). Half (n = 191) were white British, and 31.4 % (n = 120) were Black African. Sixty-two percent (n = 237) were men who have sex with men (MSM). Median time since HIV diagnosis was 16 years, with a median CD4 of 642. Ninety-five percent were undetectable. The most common indication for FibroScan referral was BMI >30 in 47.4% (n = 181). Other common indications include NAFLD (31%, n = 118), Alcohol (27.1%, n = 103). 24.9% (n = 95) had more than two risk factors. Overall, 53.7% (n = 205) had evidence of steatosis (≥S1), 19.4% (n = 74) had evidence of fibrosis (≥F1), and 1% (n = 4) had evidence of cirrhosis. In bivariate analysis, BMI >30 and a known diagnosis of NAFLD were associated with steatosis (≥S1) (OR 3.1 and 1.8 respectively). Of those with multiple risk factors (≥2), 74.7% (n = 71) had evidence of steatosis, 20% (n = 19) had evidence of fibrosis, 2.1% (n = 2) had evidence of cirrhosis. Bivariate analysis shows a significant correlation between the presence of multiple risk factors and ≥F1 fibrosis (OR = 2.3) and ≥S1 steatosis (OR = 3.2).ConclusionsOur data shows a low prevalence of liver cirrhosis, increasing in the presence of multiple liver risk factors. We recommend FIB-4 score as an inexpensive primary screening tool for fibrosis/cirrhosis, and Fibroscan for those with multiple risk factors or high FIB-4 score.

BackgroundThis study aimed to identify people living with HIV (PLWH) with tuberculosis (TB) co-infection, explore their demographic and clinical characteristics, and determine predictors of early mortality within 6 months of TB diagnosis.MethodsA cross-sectional study was conducted in a tertiary referral center in Türkiye of PLWH diagnosed with TB between 2004 and 2023. Demographic, clinical, and laboratory data were reviewed, and statistical analyses were performed to identify early mortality predictors.ResultsAmong 1541 PLWH, 62 (4%) had TB, and 23 (37%) died within 6 months. TB presentations were pulmonary (44%), extrapulmonary (27%), and both (29%). Predictors significantly associated with early mortality included lymphopenia (p = 0.009), a CD4 + T lymphocyte count ≤50 cells/mm³ (p = 0.015), anemia (p = 0.009), and thrombocytopenia (p = 0.034), particularly platelet counts below 150,000/mm³ (p = 0.001). Clinical predictors also included symptoms such as fever (p = 0.017), anorexia (p = 0.012), weight loss (p = 0.012), and altered mental status (p = 0.043). Additionally, receiver operating characteristic (ROC) analysis demonstrated that CD4 + T lymphocyte count ≤50 cells/mm³ (AUC = 0.76, p = 0.039) and platelet count <150,000/mm³ (AUC = 0.71, p = 0.034) were significant predictive cutoffs for early mortality. TB culture positivity was high (84%), while PCR positivity was low (15%). Opportunistic infections were seen in 11% of cases.ConclusionsHigh early mortality among people living with HIV/TB co-infection is associated with advanced immunosuppression and hematological abnormalities. These results highlight the importance of early HIV detection and close clinical monitoring to reduce mortality.

BackgroundTo evaluate the outcomes of rapid antiretroviral therapy (ART) initiation following HIV diagnosis at 56 Dean Street in London, UK, following the implementation of the Rapid Initiation Option (RIO) in 2016.MethodsWe conducted a retrospective case-note review of all individuals newly diagnosed with HIV between 1 January 2017 and 31 December 2024. We analysed demographics, timing of ART initiation, and reasons for delayed treatment (>90 days). Differences between early (<2 days) and later ART initiators were assessed.ResultsOf 1081 individuals diagnosed, 1008 (93.2%) initiated ART at 56 Dean Street. Median time to ART initiation was 7 days (IQR 4-14), with 15.3% starting within 2 days. Median time to ART initiation remained stable from 2017 to 2024, despite disruptions due to the COVID-19 and mpox pandemics. Faster initiators were more likely to have recently acquired HIV, higher baseline viral loads, prior 56 Dean Street attendance, and prior PrEP use (all P < 0.05). Delayed initiation occurred in 2.2%, mainly due to poor attendance, personal choice, or being outside the UK. Demographic characteristics did not differ significantly between rapid and later initiators.ConclusionsRapid ART initiation has been sustained over 8 years through the RIO pathway. The model remained robust during healthcare disruptions. Familiarity with services and recent testing were associated with more rapid initiation, supporting the importance of patient-centred, adaptable care pathways.

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.