People diagnosed with HIV and in care in Italy in 2014: results from the second national survey

We conducted a second National survey in all Italian Infectious Disease clinics to assess the number of people diagnosed and linked to care and, among these, the number of people on antiretroviral therapy and viral load suppressed. In 2014, 100,049 (0.16 per 100 residents) people diagnosed and linked to care were estimated, corresponding to an increase of 6.3% compared to the survey conducted in 2012. Among people diagnosed and linked to care, 91.9% were on antiretroviral therapy (increase of 11.4% compared to 2012), and among these, 87.7% were viral load suppressed. Overall, the majority were males (72.1%), Italians (82.7%), aged 25–49 years (45.6%); the most common HIV mode of transmission was reported to be in heterosexual contact (37.9%) and men who had sex with men (31.3%); 8.8% had less than 350 CD4?cells/μL, 82.4% had VL <50 copies and 22.9% had a CDC stage C. In conclusion, the number of people diagnosed and linked to care was increasing. The vast majority of them was receiving ART but the percentage of people still with a detectable viral load was lower than the 90–90–90 WHO target.     

用HIV抗原/抗体联合试剂筛查吸毒者中窗口期HIV感染者

目的筛查窗口期艾滋病病毒(HIV)感染者,并验证HIV抗原/抗体联合试剂(第四代试剂)的检测性能。方法用HIV抗原/抗体联合试剂对经HIV抗体筛查呈阴性反应的吸毒者样本进行检测,并与HIV抗原检测及HIV-1 RNA检测的结果作比较,以证实其为窗口期感染样本。结果1 934份HIV抗体阴性样本中发现3例窗口期HIV感染者;所用第四代试剂检出窗口期样本的敏感性为100%,特异性为99.28%,假阳性率为0.77%。结论用第四代试剂检测虽然可以在某种程度上缩短检测窗口期,但该试剂有一定的假阳性结果,尤其是在S/CO值较低时其假阳性比率增高,故检测时应注意S/CO值的高低,如有条件可进一步做HIV-1 RNA检测。     

One-year follow-up on the safety and efficacy of isoprinosine for human immunodeficiency virus infection. Scandinavian Isoprinosine Study Group.

The safety and clinical impact of isoprinosine in HIV-infected individuals were assessed in a multicentre, randomized, double-blind, 24-week study phase, followed by an optional 24-week open treatment phase. The results of the double-blind phase have been reported. Of 866 HIV-seropositive patients randomized, 832 subjects were eligible for efficacy analysis. On completion of the double-blind phase, 596 patients started open treatment. All patients were evaluated with regard to progression to AIDS and/or death. Within 48 weeks, 10/412 (2.4%) patients assigned isoprinosine and 27/420 (6.4%) patients assigned placebo progressed to AIDS (P = 0.005). Intention-to-treat analysis showed identical results. Viewing the open treatment phase in isolation revealed no difference in progression rates between those treated and those not receiving the drug, perhaps reflecting the higher proportion of patients receiving zidovudine or PCP prophylaxis in the latter group. No severe adverse reactions or toxicities were observed. We conclude that HIV-seropositive patients without AIDS may be safely and effectively treated with isoprinosine.     

Heterosexual transmission of hepatitis C virus and the possible role of coexistent human immunodeficiency virus infection in the index case: A multicentre study of 423 pairings

Abstract. Objectives. To define the role that sexual transmission plays in the spread of hepatitis C virus (HCV) infection, and to examine the influence of coexistent human immunodeficiency virus (HIV) infection on this mode of transmission. Design. A multicentre, seroprevalence study of anti-HCV performed in the stable heterosexual partners (SHP) of index cases reactive for anti-HCV. Setting. Department of Internal Medicine and Section of Gastroenterology of three University Hospitals, Spain. Subjects. A total of 423 stable heterosexual partners of index cases reactive for anti-HCV. This included a group of 142 intravenous drug users (IVDU), 120 of whom were coinfected with HIV. Additionally, 2886 first-time voluntary blood donors selected at random were included to compare the prevalence of anti-HCV. Main outcome measures. Serum samples were screened for anti-HCV by a commercially available, second-generation enzyme-linked immunoassay. Tests repeatedly reactive for anti-HCV were analysed by a four-antigen, recombinant immunoblot assay. Anti-HIV was tested by enzyme immunoassay and Western blot was used for confirmation of positive cases. Results. The prevalence of anti-HCV, was 7.1% in SHP and 1.2% in random donors (P < 0.001). This prevalence was higher in SHP of index cases co-infected with HIV in comparison with that shown in the SHP of index cases only reactive for the anti-HCV (9.1 vs. 6.3%; P = 0.2), particularly when a younger and more homogeneous group such as the SHP of IVDU index cases was considered alone (9.2 vs. 0%; P = 0.1). However, the SHP of IVDU index cases coinfected with HIV were almost three times more likely to be infected with HIV than HCV (24.2 vs. 9.2%). Conclusions. These data suggest that HCV infection may be sexually transmitted but with low efficiency, and this could be increased in the presence of coexistent HIV infection in the index case.     

Unsafe Sexual Behavior Among HIV-Infected Patients in Croatia, 2006: Prevalence and Associated Factors

Self-reported measures of antiretroviral adherence vary greatly in recall time periods and response tasks. To determine which time frame is most accurate, we compared 3-, 7-day, and 1-month self-reports with data from medication event monitoring system (MEMS). To determine which response task is most accurate we compared three different 1-month self-report tasks (frequency, percent, and rating) to MEMS. We analyzed 643 study visits made by 156 participants. Over-reporting (self-report minus MEMS) was significantly less for the 1-month recall period (9%) than for the 3 (17%) or 7-day (14%) periods. Over-reporting was significantly less for the 1-month rating task (3%) than for the 1-month frequency and percent tasks (both 12%). We conclude that 1-month recall periods may be more accurate than 3- or 7-day periods, and that items that ask respondents to rate their adherence may be more accurate than those that ask about frequencies or percents.     

滤泡辅助T淋巴细胞与HIV感染

滤泡辅助T淋巴细胞(T follicular helper cells,Tfh)是宿主正常体液免疫应答中的重要组成部分,为抗原特异性B细胞提供了关键的辅助作用。近年的研究发现,HIV感染可导致Tfh细胞的数量和功能异常,并可能与慢性HIV感染中体液免疫的异常、中和性抗体的产生及疫苗的免疫效果相关。本文对近年来有关Tfh细胞的研究进展进行综述,以期更好地理解HIV感染的致病机制。     

云南省临沧市临翔区农村居民HIV检测服务利用和感染风险认知情况调查

目的了解云南临沧市临翔区农村居民对艾滋病病毒(HIV)检测的实际利用情况,以及对感染HIV风险的认知情况,为提高HIV检测服务利用提供基础信息。方法通过随机抽样方法,抽取大众人群进行面对面调查,对调查对象的一般人口统计学特征、HIV检测利用和自身感染风险等信息进行统计分析。结果 2007、2008、2009年,分别有1 153、909和899人参与。结果发现当地大众人群对HIV检测利用低于15%;超过60%的人愿意在医疗机构进行检测;超过50%的人没有意识到自身有感染HIV的风险,缺乏风险意识是影响他们不能主动进行检测的主要原因。结论当地农村居民对自身感染HIV的风险意识不足,影响了他们对HIV检测服务的利用,需对此制订干预措施来提高HIV检测率。     

Post-migration acquisition of HIV: Estimates from four European countries, 2007 to 2016

BackgroundThe assumption that migrants acquire human immunodeficiency virus (HIV) before migration, particularly those from high prevalence areas, is common.AimWe assessed the place of HIV acquisition of migrants diagnosed in four European countries using surveillance data.MethodsUsing CD4⁺ T-cell count trajectories modelled to account for seroconversion bias, we estimated infection year of newly HIV-diagnosed migrants residing in the United Kingdom (UK), Belgium, Sweden and Italy with a known arrival year and CD4⁺ T-cell count at diagnosis. Multivariate analyses identified predictors for post-migration acquisition.ResultsBetween 2007 and 2016, migrants constituted 56% of people newly diagnosed with HIV in the UK, 62% in Belgium, 72% in Sweden and 29% in Italy. Of 23,595 migrants included, 60% were born in Africa and 70% acquired HIV heterosexually. An estimated 9,400 migrants (40%; interquartile range (IQR): 34–59) probably acquired HIV post-migration. This proportion was similar by risk group, sex and region of birth. Time since migration was a strong predictor of post-migration HIV acquisition: 91% (IQR: 87–95) among those arriving 10 or more years prior to diagnosis; 30% (IQR: 21–37) among those 1–5 years prior. Younger age at arrival was a predictor: 15–18 years (81%; IQR: 74–86), 19–25 years (53%; IQR: 45–63), 26–35 years (37%; IQR: 30–46) and 36 years and older (25%; IQR: 21–33).ConclusionsMigrants, regardless of origin, sex and exposure to HIV are at risk of acquiring HIV post-migration to Europe. Alongside accessible HIV testing, prevention activities must target migrant communities.     

African-American Women and Self-Disclosure of HIV Infection: Rates, Predictors, and Relationship to Depressive Symptomatology

Unlike the prevalence rate of AIDS diagnoses for men, the prevalence rate for women has not reached a plateau. Moreover, the rate of AIDS diagnosis for African-American women is 17 times higher than for White women. In the context of considerable stress, these women must grapple with the question of to whom they can disclose their HIV diagnosis with minimal risk of negative consequences. This study examines patterns of disclosure to significant others, predictors of disclosure, and the relationship between disclosure and psychological functioning. Analyses indicated that women disclosed at varying rates to six different categories of others. Disclosure to mothers (66%) was most common, followed by disclosure to partners (56%). Rates of disclosure to children (28%) and fathers (25%) were lowest. Women's illness status predicted disclosure to father and friends. Only disclosure to partner was significantly related to women's psychological functioning: Fewer symptoms of depression were evident in women who had disclosed their HIV status to their partners compared to those who had not disclosed.Correspondence should be directed to Lisa Armistead, Ph.D., Department of Psychology, Georgia State University, University Plaza, Atlanta, Georgia 30303     

The risks of transfusion-transmitted infection: direct estimation and mathematical modelling

Direct measurement of the risk of transfusion-transmitted infection (TTI) is practical and accurate only if the level of risk is high. Historically, studies that established frozen repositories of transfusion recipient and/or blood donor samples were important in establishing the risk of many TTI agents, including the human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV). However, given the current very low risk of TTI, mathematical modelling is necessary to estimate the magnitude of such a risk. For agents for which routine blood donor screening is performed, most of this risk comes from transfusion of units collected in the window period between donor infection and a positive blood screening assay. The incidence/window period model has been used to estimate the magnitude of such risks (of the order of 1:100 000 to 1:1 000 000) and for predicting the extent of risk reduction that can be expected with implementation of new tests. Direct estimation and mathematical modelling approaches are both important tools for future assessment of potential, new or emerging TTI agents.     

Resilience,ageing, and quality of life in long-term diagnosed HIV-infected patients

Resilience is a predictor of emotional well-being and psychological adjustment in people living with HIV infection. We report the results of a cross-sectional study in which we evaluated resilience and its association with perception of ageing, coping strategies, quality of life, and emotional status in a group of long-term diagnosed HIV-infected patients. The analysis included 151 consecutive participants (57.6% men). Resilience was moderately high to high in 65 (43%) participants, moderately low to moderate in 57 (37.7%), and very low in 29 (19.2%). Univariate and multivariate analyses were performed. Two factors of perception of ageing (good cognitive self-concept and good subjective perception of social relationships), the use of positive reframing as a coping strategy and better emotional status remained associated with high resilience. Our findings suggest that successful ageing is possible in people living with HIV infection. Resilience seems to play a key role in the ageing process.     

Perceptions of school principals and experiences of disclosure of teachers living with HIV

The aim of this study was to explore the perceptions of school principals and the experiences of disclosure amongst teachers living with HIV. Due to HIV/AIDS-related stigma being prevalent in many societies today, many infected people would rather not disclose their status than deal with negative labelling and stereotyping. This study utilised narrative inquiry as a qualitative research design that is known to be a way of understanding experiences. Data was elicited via narrative interviews from a purposeful sample of ten principals and eight teachers living with HIV who were selected through network sampling from Gauteng public urban schools. The study found that stigma, fear of job loss and gossip deterred teachers from disclosing their HIV status. In some instances, they disclosed due to needing support, which principals provided in the form of counselling, and also to explain absenteeism. Although principals supported disclosure of teachers’ HIV status so that they could initiate care, confidentiality concerns showed that disclosure could further worsen stigma and the culture of discrimination and moral judgement that teachers living with HIV faced. The study recommends on-going development of caring relationships to deepen the understanding of the experiences of teachers living with HIV. Nondisclosure of HIV status stands in the way of building caring relationships between teachers and principals. There is still a need to create safe, supportive and empathetic environments in schools for teachers living with HIV.     

Assessing HIV infection in primary care practice

In routine office practice, primary care physicians see both individuals at risk for HIV infection and those who are already infected. They must be prepared to assess risks of HIV infection in all patients, counsel patients with histories of high-risk behavior about the reasons to be tested for infection, and explain the meanings of both positive and negative test results. The initial medical evaluation of an infected individual should include a history and physical examination to detect early manifestations of HIV infection, basic diagnostic tests, including CD4 counts and a purified protein derivative test, and immunization against potentially preventable infections. Received from the Division of General Medicine and Primary Care, The Department of Medicine, Beth Israel Hospital.     

High HIV seroprevalence among patients with pyomyositis in Northern Uganda

With the aim of correlating pyomyositis with HIV infection, we have carried out a case-control comparison of HIV seroprevalence among patients affected by pyomyositis and an age and sex-matched control group of healthy subjects. Over a one-year period, 35 patients with pyomyositis, 20 male and 15 female, mean age 28.31 years, were admitted to Dr Ambrosoli Memorial Hospital of Kalongo (Kitgum District, Northern Uganda). Among these patients, II were HIV-antibody-positive, with a seroprevalence of 31.42%. In the age and sex-matched control group of 35 healthy subjects, selected in the same period from volunteers admitted to the surgical ward for orthopaedic trauma, two were HIV-antibody-positive, with a seroprevalence of 5.71%. The matched analysis produced a Mantel-Haenszel matched odds ratio of 5.50 and a maximum likelihood estimate of OR (MLE) of 5.50 (exact 95% confidence limits for MLE=1.20P<0.0001). The authors conclude that pyomyositis is a bacterial infection very significantly associated with HIV infection, to be considered a strong sign of stage III–IV of HIV disease.     

山西省HIV感染者中流动人员现状调查分析

目的 了解HIV感染者中流动人员情况及其对传播HIV/AIDS的影响,为如何管理这部分人群提供科学依据.方法对全省HIV感染者进行个案追访.采用入户方法面对面询问调查.结果 在174例HIV感染者中,116例属流动人员,占66.67%.其中省间流动者54例,占45.56%,涉及全国15个省份;省内流动者62例,占53.44%,分布在全省11个地市40个县区.流动的HIV感染者,年龄在18～39岁有90例,占77.58%;未婚和离婚者54例,占46.55%;男女之比为8:1.对这些流动人员能进行流行病学和医学管理的只有17例,占14.56%.结论 流动的HIV感染者是传播HIV/AIDS的最危险因素,应采取有效措施加强管理.     

Problem drinking and medication adherence among persons with HIV infection

OBJECTIVE: To examine the relation between problem drinking and medication adherence among persons with HIV infection. DESIGN: Cross-sectional survey. SETTING/PARTICIPANTS: Two hundred twelve persons with HIV infection who visited 2 outpatient clinics between December 1997 and February 1998. MEASUREMENTS AND MAIN RESULTS: Nineteen percent of subjects reported problem drinking during the previous month, 14% missed at least 1 dose of medication within the previous 24 hours, and 30% did not take their medications as scheduled during the previous week. Problem drinkers were slightly more likely to report a missed dose (17% vs 12 %, P =.38) and significantly more likely to report taking medicines off schedule (45% vs 26%, P =.02). Among drinking subtypes, taking medications off schedule was significantly associated with both heavy drinking (high quantity/frequency) (adjusted odds ratio [OR], 4.70; 95% confidence interval [95% CI], 1.49 to 14.84; P <.05) and hazardous drinking (adjusted OR, 2.64; 95% CI, 1.07 to 6.53; P <.05). Problem drinkers were more likely to report missing medications because of forgetting (48% vs 35%, P =.10), running out of medications (15% vs 8%, P =.16), and consuming alcohol or drugs (26 % vs 3 %, P <.001). CONCLUSION: Problem drinking is associated with decreased medication adherence, particularly with taking medications off schedule during the previous week. Clinicians should assess for alcohol problems, link alcohol use severity to potential adherence problems, and monitor outcomes in both alcohol consumption and medication adherence.