Primary giant congenital infantile fibrosarcoma of the left forearm

Infantile fibrosarcoma is a rare soft tissue tumor in the infant, and only a few cases have been reported as congenital. We report a case of congenital infantile fibrosarcoma of the left forearm at birth. An amputation was performed because the tumor was relapsed soon after surgical removal, and associated with anabrosis and bleeding.     

Human papillomavirus vaccination coverage among men who have sex with men—National HIV Behavioral Surveillance,United States, 2017

Men who have sex with men (MSM) are at high risk for infections and diseases caused by human papillomavirus (HPV), many of which are vaccine-preventable. In the United States, routine HPV vaccination has been recommended for adolescent males since 2011. This analysis evaluated self-reported receipt of ≥ 1 HPV vaccine dose by age group and HIV status among adult MSM using 2017 data from National HIV Behavioral Surveillance (NHBS) and compared the proportion vaccinated to prior years. Among 10,381 MSM aged ≥ 18 years, 17.9% of MSM overall and 28.4% of MSM living with HIV reported any HPV vaccination. Among 2,482 MSM aged 18–26 years, 32.8% overall and 51.3% living with HIV reported HPV vaccination. Since 2011, the proportion of MSM aged 18–26 years reporting HPV vaccination has increased over six-fold. As vaccinated adolescents age into young adults, coverage will continue to increase overall, including among MSM.     

Stigma towards people who use drugs: A case vignette study in methadone maintenance treatment clinics in China

BackgroundDrug use stigma among service providers has been recognized as a barrier to improving the accessibility and outcomes of addiction treatment. This study examined the stigmatizing attitudes towards people who use drugs (PWUD) among service providers in methadone maintenance treatment (MMT) clinics in China and its associated factors.MethodsThe cross-sectional study used the baseline data of a randomized intervention trial conducted in China, and the data were collected from January 2012 to August 2013. A total of 418 MMT service providers were included in the study. Stigma towards PWUD was measured via a 10-item scale embedded in two case vignettes (PWUD and non-PWUD). The Wilcoxon signed-rank test was performed to evaluate the vignette difference for each item of the scale. The linear mixed model was used to identify the adjusted association between drug use stigma and other interested variables including demographics, professional background, and MMT knowledge of the service providers.ResultsThe Wilcoxon signed-rank tests showed that the participants had a higher level of stigmatizing attitudes towards PWUD than non-PWUD (p-value<0.001 for all items of the stigma scale). The linear mixed model identified that the reception of national MMT training was associated with a lower degree of drug use stigma (estimate=−1.79; 95% CI: −3.13, −0.45; p-value = 0.009).ConclusionThe findings of the study provide evidence of the existence of drug use stigma among MMT providers in China. The expansion of national-level training and the development of stigma reduction interventions are needed to address this issue.     

Challenges in providing services in methadone maintenance therapy clinics in China: Service providers’ perceptions

BackgroundThe Methadone Maintenance Therapy (MMT) program has been initiated in China since 2004. As of the end of November, 2008, 558 MMT clinics had been established countrywide. The objective of this study was to elucidate the difficulties and challenges as perceived by service providers working in MMT clinics.MethodsOne service provider from each of the 28 MMT study clinics in Zhejiang and Jiangxi Provinces of China participated in a face-to-face in-depth interview for about 1–2 h to describe their perceptions of working in MMT clinics. Qualitative data were analysed using ATLAS.ti. The grounded theory was used to guide the data analysis.ResultsParticipants identified major problems in providing services in MMT clinics including lack of resources, professional training, and institutional support. Difficulties in pursuit of career, concern for personal safety, low income, heavy working load, and poor opinion of MMT by Chinese society often contributed to greater stress and burnout among the service providers.ConclusionThe MMT programs in China desperately need additional resource allocation and institutional support for the current and perhaps future expansion of the programs. The service providers are in urgent need of professional training to improve the quality of care they can offer MMT clients.     

The impact of an HIV prevention intervention for injecting drug users in Svetlogorsk,Belarus: model predictions

Background: From the mid-1990s there has been a rapid spread of HIV infection amongst injecting drug users (IDUs) in Svetlogorsk, Belarus. In 1997, when the IDU HIV prevalence had reached 74%, two needle and syringe exchange points (NEPs) were established in the town. These interventions have been operating since then, with some interruptions due to a lack of funding 1998. Methods: This article presents a deterministic epidemiological model ‘IDU 2.4’ that simulates the transmission of HIV among IDUs sharing injecting equipment, and between IDUs and their sexual partners. The model incorporates the impact of the interrupted distribution of clean syringes and condoms, is validated against data from Svetlogorsk, and is used to estimate the impact of the intervention on HIV transmission. Results: The model predicts that between 1997 and 2000 the intervention averted 414 HIV infections in Svetlogorsk (95% CI, 180–690) and caused a 6.5% decrease in IDU HIV prevalence compared to if there had been no intervention. The analysis also suggests that the gap in funding between 1998 and 1999 resulted in a 35% reduction in the number of HIV infections averted among IDUs during that period, and that the IDU HIV prevalence is 3% higher in 2000 (95% CI, 1.9–4.6%) than if there had been no gap in funding. Conclusions: Even though the HIV prevalence and incidence amongst the IDUs remained high, the findings suggest that the intervention had an important affect on HIV transmission in Svetlogorsk, Belarus. The findings reinforce the importance of strengthening existing projects and replicating similar projects in the region, and highlight the detrimental impact of gaps in intervention funding.     

Association of highly active antiretroviral treatment with incident tuberculosis in people living with HIV/AIDS

PurposeTo determine the short-term and long-term effects of highly active antiretroviral therapy (HAART) on incident tuberculosis (TB) in people living with HIV/AIDS (PLWHA).MethodsFrom 2000 to 2012, we identified adult PLWHA from Taiwan Centers for Disease Control HIV Surveillance System. All PLWHA were followed up until December 31, 2012, and observed for TB occurrence. Time-dependent Cox proportional hazards models were used to determine the short-term and long-term effects of HAART on incident TB.ResultsOf 20,072 PLWHA, 628 (3.13%) had incident TB, corresponding to an incident rate of 701/100,000 person-years. After adjusting for potential confounders, PLWHA receiving HAART were more likely to develop TB than those not receiving the drugs (adjusted hazard ratio [AHR] 1.56; 95% confidence interval [CI] 1.18–2.05). While the short-term and long-term effects of HAART on incident TB were considered, HAART was a risk factor for TB development within the first 90 days (AHR 6.06; 95% CI 4.58–8.01) and between 90 and 180 days of treatment (AHR 1.80; 95% CI 1.11–2.94) but was a protective factor after 180 days of HAART use (AHR 0.51; 95% CI 0.39–0.66).ConclusionsHAART is a risk factor for the development of TB in the short term but a protective factor in the long term.     

HIV incidence in the United States, 1978-1999

CONTEXT: HIV incidence measurements, which reflect recent or current transmission, are valuable for monitoring the epidemic and evaluating prevention programs. OBJECTIVES: To summarize HIV incidence patterns and trends in U.S. population groups. DATA SOURCES: Publications in English from 1980 through mid-2000. STUDY SELECTION AND STATISTICAL METHODS: We searched the literature for reports of HIV incidence in the United States. Locally weighted scatterplot smoothing was used to generate smooth curves to estimate trends in incidence. Spearman rank correlation was used to estimate the correlation coefficient between prevalence and incidence. DATA SYNTHESIS: In 74 eligible reports, HIV incidence varied widely (0.002-19.8 per 100 person-years [py]) depending on risk group. Among men who have sex with men (MSM), HIV incidence peaked in the early 1980s (5-20/100 py) and then declined but remained high during the 1990s (2-4/100 py). Among injection drug users (IDUs), incidence decreased since the mid-1980s but differed by geographic area; in the 1990s, incidence remained high in the East (1-3/100 py) but was lower in the West (<0.5/100 py). Throughout the late 1980s and 1990s, incidence was low and stable in broader populations (blood donors: <0.01/100 py; military personnel: 0.01-0.07/100 py). The correlation between HIV incidence and prevalence was strong in populations with a prevalence less than 1% (r = 0.94, p<.0001), moderate in populations with a prevalence from 1% to less than 10% (r = 0.57, p<.0001), and weak in populations with a prevalence at least 10% (r = 0.23, p=.09). CONCLUSIONS: HIV prevention in the United States should continue to focus on MSM and IDUs. HIV incidence measurements should be considered for monitoring HIV transmission in MSM, IDUs, and other populations in which seroprevalence is high.