HTLV-1/2 among high-risk groups in Argentina: molecular diagnosis and prevalence of different sexual transmitted infections

The objectives of this study were to estimate the prevalence and characterize the epidemiologic patterns of HTLV-1/2 infections and co-infections with HIV, HBV (hepatitis B), HCV (hepatitis C), and Treponema Pallidum in five different high-risk groups, including injecting drug users (IDUs), female sex workers (FSWs), men who have sex with men (MSM), patients with tuberculosis (TB), and patients attending clinics for sexually transmitted infections (STIs) in Buenos Aires, Argentina. The HTLV-1/2 prevalence was 19.1% (33/173) for IDUs, 2.0% (10/613) for FSWs, 2.1% (4/187) for TB, 1.0% (4/400) for STIs and 0.4% (3/282) for MSM, respectively. Among all groups, the higher percentages of co-infection were HTLV-1/HBV (63%, 17/27) and HTLV-1/HCV (52%, 14/27). Among IDUs, there was a high percentage of co-infection of HTLV-2 with HCV (96.3%, 26/27), HIV (92.6%, 25/27), and HBV (77.8%, 21/27), respectively. In summary, HTLV-1/2 infections appear to be widely distributed among high-risk groups in a nonendemic area of Argentina being the co-infection with HBV and HCV more frequent among IDUs.     

The impact of sex partners' HIV status on HIV seroconversion in a prospective cohort of injection drug users

OBJECTIVE AND DESIGN: The identification of individuals at highest risk of HIV infection is critical for targeting prevention strategies. We evaluated the HIV status of the sex partners of injection drug users (IDUs) and rates of subsequent HIV seroconversion among a prospective cohort study of IDUs. METHODS: We performed an analysis of the time to HIV infection among baseline HIV-negative IDUs enrolled in the Vancouver Injection Drug Users Study. IDUs were stratified based on whether or not they reported having an HIV-positive sex partner. Kaplan-Meier methods were used to estimate cumulative HIV incidence rates, and Cox regression was used to determine adjusted relative hazards (RHs) for HIV seroconversion. RESULTS: Of 1013 initially HIV-negative IDUs, 4.8% had an HIV-positive partner at baseline. After 18 months, the cumulative HIV incidence rate was significantly elevated among those who reported having an HIV-positive sex partner (23.4% vs. 8.1%; log-rank P < 0.001). In a Cox regression model adjusting for all variables that were associated with the time to HIV infection in univariate analyses, including drug use characteristics, having an HIV-positive sex partner (RH = 2.42 [95% confidence interval: 1.30 to 4.60]; P = 0.005) remained independently associated with time to HIV seroconversion. CONCLUSIONS: Having an HIV-positive sex partner was strongly and independently associated with seroconversion after adjustment for risk factors related to drug use. Our findings may aid public health workers in their efforts to identify IDUs who should be targeted with education and prevention efforts and indicate the need for ongoing development of prevention interventions for IDU sex partners who are HIV discordant.     

Risk factors for HIV infection in injection drug users and evidence for onward transmission of HIV to their sexual partners in Chennai, India

OBJECTIVES: Determining HIV prevalence in injection drug users (IDUs) and their regular sex partners in Chennai, India. METHODS: A total of 226 IDUs and their regular sex partners were enrolled during April-July 2003. After informed consent was obtained, a semistructured questionnaire was administered and serum was tested for HIV antibody. RESULTS: The HIV seroprevalence was 30% (68/226) in IDUs and 5% in their regular sex partners (11/226). While in 25% of couples only the male partner was HIV positive, 5% of the couples were concordant for HIV infection and 70% were HIV negative. Fifty-seven percent of the HIV-positive IDUs and 45% of the HIV-infected women thought that they had "no chance" or "very little chance" of getting HIV, reflecting low HIV risk perception. More than 20% IDUs reported borrowing or lending of injection equipment. In univariate analyses "sex" and "condom use" with sex workers had no bearing but "more than twice a day injecting frequency," "history of incarceration," "tattoos," "recruitment from northern part of the city," and ever-injecting drugs in drug-selling places had significant association with HIV infection in IDUs. In an adjusted model, the odds of HIV infection were 2 times higher among IDUs who had ever injected drugs in drug-selling places and 6 times higher in those who were recruited from the northern part of central Chennai. CONCLUSION: Reducing sharing of injection equipment and unsafe tattooing through targeted and environmental interventions, increasing HIV risk perception, and promoting safer sex practices among IDUs and their sex partners are urgent program needs.     

Prevalences, genotypes, and risk factors for HIV transmission in South America

HIV cross-sectional studies were conducted among high-risk populations in 9 countries of South America. Enzyme-linked immunosorbent assay screening and Western blot confirmatory testing were performed, and env heteroduplex mobility assay genotyping and DNA sequencing were performed on a subset of HIV-positive subjects. HIV prevalences were highest among men who have sex with men (MSM; 2.0%-27.8%) and were found to be associated with multiple partners, noninjection drug use (non-IDU), and sexually transmitted infections (STIs). By comparison, much lower prevalences were noted among female commercial sex workers (FCSWs; 0%-6.3%) and were associated mainly with a prior IDU and STI history. Env subtype B predominated among MSM throughout the region (more than 90% of strains), whereas env subtype F predominated among FCSWs in Argentina and male commercial sex workers in Uruguay (more than 50% of strains). A renewed effort in controlling STIs, especially among MSM groups, could significantly lessen the impact of the HIV epidemic in South America.     

HIV prevalence and risks among injection and noninjection drug users in northern Thailand: need for comprehensive HIV prevention programs

The authors sought to determine sociodemographic and sexual and drug use risk factors for HIV infection among drug users in northern Thailand adjacent to the Golden Triangle. The authors enrolled patients admitted for inpatient drug detoxification at one treatment center in northern Thailand and studied HIV risks and prevalence using an interviewer-administered questionnaire and serum collection with HIV pretest and posttest counseling. Between February 1, 1999 and January 31, 2000, 1865 patients admitted for opiate and methamphetamine dependence completed study procedures. Overall HIV prevalence was 10.3%: 30.0% among 513 injection drug users (IDUs) and 2.8% among non-IDUs (OR = 14.8, 95% CI: 10.2, 21.6). HIV seroprevalence was 2.4% among exclusive methamphetamine users (98% of whom are non-IDUs) and 3.4% among opium smokers. Injection drug use was the dominant risk factor in multivariate models. Although Thailand is widely recognized as having a successful national response to the heterosexual HIV epidemic, seroprevalence in IDUs remains high. Despite a sharp increase of non-IDUs admitted to the drug treatment center, HIV infection and risks remained high among IDUs in northern Thailand. HIV prevention campaigns need to focus on IDUs and to implement harm reduction strategies to reduce transmission to IDUs and further contain the HIV epidemic in Thailand.     

HIV in Vietnam: the evolving epidemic and the prevention response, 1996 through 1999

OBJECTIVES: To describe epidemiologic patterns and trends in HIV infection in Vietnam from 1996 through 1999, and to summarize the national response to the epidemic. METHODS: We reviewed nationwide HIV case reports, and we analyzed annual seroprevalence among different sentinel populations in 21 provinces, using the chi2 test for linear trend to assess trends in HIV prevalence. HIV prevention efforts were also reviewed. RESULTS: Through 1999, 17,046 HIV infections, including 2947 AIDS cases and 1523 deaths had been reported in Vietnam. The cumulative incidence rate for the country was 22.5 per 100,000 population. Injection drug users (IDUs) represented 89.0% of all those for whom risk was reported before 1997 and 88.0% in the period 1997 to 1999. In 1999, HIV prevalence rates among IDUs ranged by province from 0% to 89.4%. Significantly increasing HIV trends among IDUs (p <.05) were found in 14 of the 21 sentinel provinces during 1996 to 1999. HIV prevalence among commercial sex workers (CSWs) ranged from 0% to 13.2%, increased significantly in 6 of 21 provinces. In 1999, prevalence among pregnant women, blood donors, and military recruits were 0.12%, 0. 20% and 0.61%, respectively. Major prevention activities include mass information; peer education and outreach among groups at increased risk; availability of low-cost syringes and condoms through pharmacies; needle exchange pilot projects; widely available treatment for sexually transmitted diseases; antibody screening of blood for transfusion; and free medical treatment at government hospitals. DISCUSSION: The HIV epidemic continues to evolve rapidly, intensifying among IDUs and increasing among CSWs. Serosurveillance indicators of HIV in the population at large continue to indicate the relatively slow extension beyond those at highest risk. Immediate, intensive preventions in high-risk groups may decelerate expansion to the broader population.     

Prevalence and correlates of HIV infection among young injection drug users in San Francisco

OBJECTIVE: We assessed the prevalence of HIV infection and associated risk behaviors among street-recruited young injection drug users (IDUs) in San Francisco. METHODS: In a cross-sectional study, 304 young (age <30 years) IDUs with a history of injecting in the previous 30 days were interviewed and tested for antibodies to HIV. Analyses assessing independent associations with HIV infection were limited to males only, due to the low number of infections in women. RESULTS: The prevalence of HIV infection was 5.3% overall but was highly stratified by gender and sexual preference (15.6% among homosexual/bisexual men vs. heterosexual men) and recruitment neighborhood (18% in the Polk Street area). Of 16 HIV infections, 14 (88%) were in males. Factors independently associated with HIV infection in males included sexual preference (homosexual/bisexual vs. heterosexual: adjusted odds ratio [AOR], 7.5; 95% confidence interval [CI], 1.5-36.6), recruitment neighborhood (Polk Street neighborhood vs. other neighborhoods: AOR, 4.8; 95% CI, 1.4-16.7), and duration of residence in San Francisco (>or=1 year vs. <1 year: AOR, 11.8; 95% CI, 1.4-95.8). CONCLUSIONS: The prevalence of HIV infection was highest among male IDUs who have sex with men. The strong associations between HIV infection and sexual orientation and HIV infection and recruitment locale suggest that risk may be attributable largely to sexual risk. In addition to successful prevention efforts aimed at reducing needle-associated risk, current intervention models aimed at young IDUs should target high-risk neighborhoods and emphasize sexual risk reduction measures, in particular among men who have sex with men.     

High HIV sexual risk behaviors and sexually transmitted disease prevalence among injection drug users in Northern Vietnam: implications for a generalized HIV epidemic

BACKGROUND: HIV prevalence in Vietnam is currently concentrated among injection drug users (IDUs). The extent to which this core risk group represents a potential for broader HIV transmission to the general population is currently unknown. METHODS: A community-based cross-sectional study among IDUs in Vietnam assessed sexually transmitted disease (STD) prevalence and behavioral risk factors. Qualitative interview data enhanced quantitative findings. RESULTS: The prevalence of any STDs among 272 IDUs was 30% (chlamydia, 9%; herpes simplex virus type 2 [HSV-2], 22%; gonorrhea, 0%; and syphilis, 1%). Part-time work or unemployment (odds ratio [OR] = 2.74, 95% confidence interval [CI]: 1.1 to 6.9), sex with > or =2 sex workers in the past year (OR = 4.9, 95% CI: 1.91 to 12.6), having ever smoked heroin (OR = 4.5, 95% CI: 1.1 to 18.3), and injecting less frequently than daily (OR = 3.9, 95% CI: 1.43 to 10.6) were independently associated with chlamydial infection. Urban residency (OR = 4.0, 95% CI: 1.4 to 11.0) and daily injecting (OR = 2.2, 95% CI: 1.1 to 4.4) were independently associated with HSV-2. Odds of HSV-2 among older (> or =28 years of age) IDUs who had sex with <2 sex workers in the past year was higher than among younger IDUs who had sex with more sex workers (OR = 6.4, 95% CI: 2.1 to 18.4). CONCLUSIONS: High STD prevalence and high-risk sexual and parenteral behaviors among IDUs indicate the potential for HIV/STD transmission to the general Vietnamese population.     

Antigenic and genetic variability of human respiratory syncytial viruses (group A) isolated in Uruguay and Argentina: 1993-2001

The antigenic and genetic diversity of G glycoprotein from 25 human respiratory viruses (group A) isolated during nine consecutive epidemics (1993-2001) in Montevideo, Uruguay, and 7 strains isolated in Buenos Aires, Argentina, in the same period were analyzed. Genetic variability was evaluated by partial sequence of the G protein gene. Phylogenetic analysis indicated that most Uruguayan and Argentinean group A isolates clustered into three genotypes: GA5, GA2, and GA1. Some strains clustered into the GA3 genotype characterized previously. The antigenic analysis was carried out with a panel of anti-G monoclonal antibodies that recognized conserved and strain-specific epitopes. A close correlation between the antigenic and genetic relatedness of the strains analyzed was observed.     

Predictors of self-reported HIV infection among drug injectors in Ukraine

OBJECTIVE: To identify characteristics, including current high-risk drug and sex behaviors, associated with self-reported HIV infection among injection drug users (IDUs) in Ukraine. DESIGN: Targeted sampling of IDUs from Kiev, Odessa, and Makeevka/Donetsk, Ukraine. METHODS: From June through August 2002, 100 IDUs from each site were recruited through street outreach, including 212 who had previously been tested for HIV and knew their serostatus. Subjects were administered a standardized computer-assisted interview assessing HIV-related drug and sex risk behaviors and history of HIV testing. RESULTS: Twenty six percent of the 212 participants reported they were HIV-positive. Univariate followed by multiple logistic regression analyses were used to identify factors associated with HIV infection. In the 30-day period before their interview, HIV-infected IDUs were significantly more likely to have injected with a needle previously used by another injector without disinfecting, frontloaded and/or backloaded, and shared the drug solution from a common container. In addition, they had higher prevalence rates for hepatitis B virus and hepatitis C virus than those not infected with HIV. On the other hand, they were more likely to have reported no sex partners and, if sexually active, more likely to have used a condom. CONCLUSION: The high HIV seroprevalence among IDUs in Ukraine, combined with their continued engagement in needle-related risk behaviors, assures the continuance of the epidemic in this region, a region that is the epicenter of HIV in Europe.     

Progress in HIV reduction and prevention among injection and noninjection drug users

Substantial progress has been made in reducing HIV among injection drug users (IDUs) in the United States, despite political and social resistance that reduced resources and restricted access to services. The record for HIV prevention among noninjecting drug users is less developed, although they are more numerous than IDUs. Newer treatments for opiate and alcohol abuse can now be integrated into primary HIV care; treatment for stimulant abuse is less developed. All drug users present challenges for newer HIV prevention strategies (eg, "test and treat," nonoccupational postexposure prophylaxis and preexposure prophylaxis, contingency management, and conditional cash transfer). A comprehensive HIV prevention program that includes multicomponent multilevel approaches (ie, individual, network, structural) has been effective in HIV prevention among IDUs. Expanding these approaches to noninjecting drug users, especially those at highest risk (eg, minority men who have sex with men) and incorporating these newer approaches is a public health priority.     

Does name-based HIV reporting deter high-risk persons from HIV testing? Results from San Francisco

OBJECTIVE: Name-based HIV reporting has been recommended as a method to track the HIV epidemic but may deter or delay at-risk persons from HIV testing. Previous studies of a deterrent effect of HIV reporting were not conducted in areas with high HIV infection rates and politically active populations. METHODS: In a cross-sectional survey, men who have sex with men (MSM) recruited from gay bars, heterosexuals recruited from the sexually transmitted disease clinic, and injection drug users (IDUs) recruited from street venues were administered a face-to-face anonymous questionnaire. RESULTS: Ninety-four percent of the 118 MSM, 76% of the 99 heterosexuals, and 97% of 105 IDUs surveyed were tested. Six percent of MSM, 9% of heterosexuals, and none of the IDUs correctly identified California's HIV reporting regulations. Of the 75 (25%) participants who thought California had a name-based HIV reporting system, 2 were never tested and 23 had not been tested in the past 12 months. None of those who had never been tested and 2 of those who had not been tested in the past 12 months cited fear of being reported as a reason for not testing recently. CONCLUSION: Fear of reporting is an infrequently cited reason for deterring or delaying testing.     

Trends in HIV seroprevalence and risk among gay and bisexual men who inject drugs in San Francisco, 1988 to 2000.

OBJECTIVES: To determine trends in HIV infection and risk behaviors among street-recruited self-identified gay and bisexual male injection drug users (IDUs) in San Francisco. METHODS: Trends in HIV infection and risk behaviors were calculated for gay/bisexual ( n = 1594 interviews) IDUs in 26 semiannual cross sections from 1988 to 2000. RESULTS: HIV seroprevalence among gay/bisexual IDUs decreased from the range of 35% to 45% in 1988/1989 to 25% in 1996 and then began to increase, reaching 42% in 2000. In contrast, HIV prevalence among heterosexual male IDUs remained stable during the study period. For gay/bisexual IDUs, injection and sex-related HIV risk behaviors declined modestly throughout the study period. As of the last cross section (July 2000), however, over a third of respondents reported recent syringe sharing or unprotected anal sex. CONCLUSIONS: Gay/bisexual men who inject drugs continue to be at elevated risk for HIV, suggesting that interventions such as amphetamine drug treatment and sexual risk reduction programs targeted at this population are needed.     

清远市高危人群HIV感染状况及艾滋病相关知识知晓情况调查

目的了解清远市高危人群HIV感染流行趋势和艾滋病相关知识知晓情况,为采取有针对性的行为干预措施和开展宣传教育工作提供准确的信息。方法于2005-2008年采用横断面调查的方法对强制戒毒者、暗娼和性病门诊就诊者等高危人群进行监测,并调查吸毒者和暗娼的艾滋病相关知识知晓情况。结果吸毒人群HIV抗体阳性率介于2.58%～4.15%之间;吸毒者中注射吸毒的比例为82.05%,其中共用注射器吸毒的比例为57.26%;吸毒者中42.39%有商业性行为,而且从未使用安全套的比例为52.53%。在227名暗娼中未发现HIV抗体阳性者,暗娼中最近1个月与客人发生性行为时坚持每次使用安全套的比例为39.43%。性病门诊就诊者HIV抗体阳性率介于0.20%～0.42%之间;34.56%的性病门诊就诊者最近3个月有非婚性伴,而且从未使用安全套的比例为16.25%。调查人群的艾滋病相关知识总体知晓率为57.17%,其中吸毒者和暗娼艾滋病相关知识总知晓率分别为53.05%、61.73%。结论清远市高危人群中以吸毒者HIV抗体阳性率较高,注射吸毒及共用注射器的比例较高,性乱人群中HIV流行水平较低,但存在不安全性行为;高危人群中艾滋病相关知识知晓率低,需采取有效的行为干预措施,加大宣传力度和覆盖面。     

Correlates of HIV, HBV, and HCV infections in a prison inmate population: results from a multicentre study in Italy

A cross-sectional study was undertaken on the correlates of infection for the human immunodeficiency virus (HIV) and hepatitis viruses B and C (HBV and HCV) in a sample of inmates from eight Italian prisons. A total of 973 inmates were enrolled [87.0% males, median age of 36 years, 30.4% intravenous drug users (IDUs), 0.6% men who have sex with men (MSWM)]. In this sample, high seroprevalence rates were found (HIV: 7.5%; HCV: 38.0%; anti-HBc: 52.7%; HBsAg: 6.7%). HIV and HCV seropositivity were associated strongly with intravenous drug use (OR: 5.9 for HIV; 10.5 for HCV); after excluding IDUs and male homosexuals, the HIV prevalence remained nonetheless relatively high (2.6%). HIV prevalence was higher for persons from Northern Italy and Sardinia. The age effect was U-shaped for HIV and HCV infections; HBV prevalence increased with age. Tattoos were associated with HCV positivity (OR: 2.9). The number of imprisonments was associated with HIV infection, whereas the duration of imprisonment was only associated with anti-HBc. The probability of being HIV-seropositive was higher for HCV-seropositive individuals, especially if IDUs. In conclusion, a high prevalence of HIV, HCV, and HBV infections among inmates was observed: these high rates are in part attributable to the high proportion of IDUs. Frequency of imprisonment and tattoos were associated, respectively, with HIV and HCV positivity. Although it is possible that the study population is not representative of Italy's prison inmate population, the results stress the need to improve infection control measures users was prisons.     

HIV/AIDS surveillance in Japan, 1984-2000

The HIV/AIDS surveillance system in Japan, which began collecting data on the number of AIDS patients in 1984 and the number of HIV-infected persons in 1987, has played an important role in monitoring the trend and magnitude of Japan's HIV/AIDS epidemic and its distribution across various population subgroups. However, the system lacks any personal identifiers, making it impossible to eliminate duplication or to track cases for disease progression. It also does not permit the identification of the residence of HIV-infected persons because the residence of only the reporting physician is documented under the New Infectious Diseases Control Law, effective since April 1, 1999. The number of people with HIV/AIDS in Japan continues to grow. Among youth, sexually transmitted diseases, induced abortion, and sexual activities have shown a marked increase since the mid-1990s. Behavioral risk of infection for both injection drug users (IDUs) and men who have sex with men (MSM) remains alarmingly high. Accurate monitoring of infection rates is critical to the planning and evaluation of treatment, care and prevention programs. Japan should restructure its HIV/AIDS surveillance system to more accurately monitor the HIV/AIDS epidemic and related risk behaviors.     

Gender differences in sex risk behaviors among Ukraine injection drug users

OBJECTIVE: To assess gender differences in drug and sex risk behaviors and evaluate predictors of HIV-related sex risk behaviors among heterosexual injection drug users (IDUs) in Ukraine. DESIGN: Street-recruited IDUs from Kiev, Odessa, and Makeevka/Donesk, Ukraine. METHODS: From June 2004 through November 2006, outreach workers recruited 1557 IDUs, including 526 from Kiev, 494 from Odessa, and 537 from Makeevka/Donesk. Participants were administered a standardized computer-assisted interview assessing HIV-related drug and sex risk behaviors, self-efficacy for practicing safe sex, and HIV knowledge. RESULTS: Overall, 80% of the participants were sexually active in the 30-day period before their interview. They also engaged in high-risk sex behaviors during this brief 30-day window: 53% reported anal or vaginal sex without a condom, 27% had sex with more than 1 partner, 41% had an IDU sex partner, and 37% had an HIV-positive sex partner or a partner whose HIV status they did not know. Overall, women were at higher risk than men and were more likely to have been told they were HIV-positive. CONCLUSION: The extremely high HIV prevalence rate in Ukraine and in this cohort, combined with their recent high-risk sex behaviors, forecasts not only a continuance of the epidemic in the region but an escalation.     

HIV voluntary counseling and testing and HIV incidence in male injecting drug users in northern Thailand: evidence of an urgent need for HIV prevention

HIV voluntary counseling and testing (VCT), an important strategy for HIV prevention and care, has been available in all government hospitals in Thailand since 1992. We assessed factors associated with HIV testing, its uptake, and estimates of HIV incidence after HIV testing among male northern Thai injecting drug users (IDUs) admitted for inpatient drug treatment. Participants were interviewed about risk behaviors and HIV testing history before VCT was provided as part of the study. Of 825 IDUs who participated, 36% reported a prior HIV test. Factors associated with prior HIV testing in multiple logistic regression analysis included higher education and having >1 lifetime sex partner. Needle sharing was not associated with prior HIV testing. Of the 298 men with a prior test, 80% reported a negative result on their last prior HIV test, of whom 28% tested positive in our study, leading to an estimated incidence rate of 10.2 per 100 person-years. Fifty-nine percent of the IDUs who reported a prior HIV test stated that they did not receive pre- and/or posttest counseling. HIV incidence among IDUs remains high despite having VCT. Extending HIV prevention and harm reduction programs is urgently needed for IDUs in the region.     

Failure to return for HIV test results among persons at high risk for HIV infection: results from a multistate interview project

BACKGROUND: Voluntary counseling and testing is an important strategy for HIV prevention. For optimal impact, however, clients must return for HIV test results and counseling. The goal of this study was to document the frequency of self-reported failure to return for HIV test results (FTR) and associated reasons among persons at high risk for HIV infection. METHODS: Respondents were recruited at gay bars (men who have sex with men [MSM]), by street intercept (injection drug users [IDUs]), or at sexually transmitted disease clinics (high-risk heterosexuals [HRHs]) in 7 US states in 2000. Self-reported history of and reasons for FTR were evaluated. RESULTS: FTR was commonly reported among 2241 respondents: 10% of MSM, 20% of HRHs, and 27% of IDUs reported FTR at least once. FTR was significantly (P < 0.05) more common among those with higher perceived risk of HIV infection and significantly less common among HRHs who had completed more than high school (vs. high school or General Education Development certificate) or were employed part time (vs. unemployed). About one fourth of respondents cited fear of getting test results as an important reason for FTR. CONCLUSION: Self-reported occurrences of FTR in our venue-recruited sample were similar to proportions of FTR previously reported from publicly funded venues. Increased pretest counseling on fear of learning HIV status and on the availability of rapid testing may help to reduce FTR.