Heterosexual HIV transmission and STD prevalence: predictions of a theoretical model

BACKGROUND: Previous studies suggest that concurrent sexually transmitted infection may enhance HIV transmission. This paper explores some theoretical consequences of this using a mathematical model of transmission of HIV and other STD pathogens. OBJECTIVES: To develop a deterministic mathematical model to describe the heterosexual transmission dynamics of both HIV and a bacterial STD. STUDY DESIGN: We used survey derived estimates of sexual behaviour in a young heterosexual London population in our deterministic mathematical model to estimate the effects on an HIV epidemic of different levels of STD prevalence in such a population. RESULTS: We show that the predictions of the model are plausible and suggest that, even under conditions both of low STD prevalence and of low HIV transmission enhancement, a substantial proportion of HIV transmission events may be attributable to concurrent STD. CONCLUSIONS: It is likely that epidemics of heterosexually transmitted HIV infection in industrialised countries have been limited in size by the relative success of efforts to control STD. None the less, a significant proportion of heterosexual transmission events which do occur may be attributable to concurrent STD. In developing countries, cheap and simple STD care is likely to be a highly cost effective strategy to prevent HIV transmission.     

Heterosexual transmission of the human immunodeficiency virus: a seroepidemiological study

Summary The transmission of the buman immunodeficiency virus (HIV) was studied in 647 subjects who presented no apparent risk factors for the infection other than having had promiscuous heterosexual relations, heterosexual relations with people with an elevated risk of infection, or heterosexual relations with people infected by human immunodeficiency virus. Thirty subjects were found to be seropositive for anti-human immunodeficiency virus antibodies. The elevated risk factors included being the habitual partner of a person at risk of infection or of a person who was infected by human immunodeficiency virus, or being the partner of a patient with acquired immunodeficiency syndrome. The transmission of the virus was verified in 13 of 284 subjects (4.57%) who had had heterosexual intercourse three or more times with persons at risk and in 16 of 101 subjects (15.84%) who had had heterosexual intercourse three or more times with persons who were seropositive for human immunodeficiency virus antibodies. No significant correlation between human immunodeficiency virus infection and a history of sexually transmitted infections, nor between human immunodeficiency virus infection and female subjects was found. These data suggest that the epidemic of acquired immunodeficiency syndrome can also spread through heterosexual relations, even if the possibility of becoming infected in this way seems at the moment limited to particular risk behaviors.     

The association between HIV infection and alcohol use: a systematic review and meta-analysis of African studies

To summarize the association between alcohol use and human immunodeficiency virus (HIV) infection based on studies conducted in Africa, EMBASE and PubMed were searched for African studies that related alcohol use to HIV infection. Meta-analyses were conducted to obtain pooled univariate and multivariate relative risk estimates. Subgroup analyses were performed for studies having different sample types: males or females and population-based or high-risk, and ones that differentiated between problem and asymptomatic drinkers. Alcohol drinkers were more apt to be HIV+ than nondrinkers. The pooled unadjusted odds ratio (OR) from 20 studies was 1.70 (95% confidence interval, CI = 1.45-1.99). Results from 11 studies that adjusted for other risk factors produced a pooled risk estimate of 1.57 (95% CI = 1.42-1.72). Males and females had similar risk estimates, while studies involving high-risk samples tended to report larger pooled odds ratios than studies of the general population. When compared with nondrinkers, the pooled estimates of HIV risk were 1.57 (95% CI = 1.33-1.86) for non-problem drinkers versus 2.04 (95% CI = 1.61-2.58) for problem drinkers, a statistically significant difference (z = 2.08, P <0.04). Alcohol use was associated with HIV infection in Africa and alcohol-related interventions might help reduce further expansion of the epidemic.     

China's syphilis epidemic: a systematic review of seroprevalence studies

OBJECTIVE: The objective of this study was to investigate syphilis prevalence among low- and high-risk groups in China. GOAL: The goal of this study was to explore the magnitude of China's syphilis epidemic. STUDY DESIGN: A systematic literature review of syphilis seroprevalence studies in China was performed searching PubMed and the Chinese Periodicals Database (CPD). RESULTS: Five and 169 studies were retrieved from PubMed and the CPD, respectively. From 2000 to 2005, select low-risk groups had the following median syphilis prevalence: antenatal women (0.45%), premarital individuals (0.66%), and food and service employees (0.3%). Select high-risk groups had the following median prevalence: incarcerated female sex workers (12.49%), drug users (6.81%), and men who have sex with men (14.56%). In the last decade, prevalence has increased in all groups with the steepest rises seen among high-risk groups. CONCLUSIONS: Syphilis infection is increasing among low- and high-risk groups in China, suggesting unsafe sexual behavior that may accelerate HIV transmission and challenge current syphilis prevention and control efforts.     

Psoriasis and adverse pregnancy outcomes: a systematic review of observational studies

Psoriasis is a chronic inflammatory disorder with significant physical and psychological sequelae. The majority of individuals experience disease onset in early adult life – for women this often occurs during their reproductive years. While some autoimmune diseases have been shown to affect pregnancy outcomes adversely, such a relationship has not been well studied in psoriasis. We searched PubMed, Embase and the Cochrane database for published articles examining psoriasis and adverse pregnancy outcomes, and included observational studies and clinical trials evaluating direct measures of maternal and fetal morbidity and mortality. Four of the nine included articles reported a statistically significant increase in the risk of at least one outcome, including spontaneous abortion, caesarean delivery, low birth weight, macrosomia, large‐for‐gestational age, and a composite outcome consisting of both prematurity and low birth weight. However, these associations were not always consistent across studies. Overall, there was no clear evidence of increased adverse outcomes in pregnant women with psoriasis.     

Quality of life in patients with vitiligo: an analysis of the dermatology life quality index outcome over the past two decades

Vitiligo is one of the most important skin disorders that does not cause much physical impairment, but due to its disfiguring appearance, patients have disturbances in mental health and quality of life (QoL). The dermatology life quality index (DLQI), as one of the most specific QoL instruments, is now used widely for patients with vitiligo. The main objective of this review is to collect and present detailed information about issues and disturbances related to the QoL of patients with vitiligo by reviewing the DLQI studies worldwide in the past 20 years. The impact of vitiligo assessed by the DLQI varies according to the clinical and demographic characteristics of patients. In the majority of our reviewed studies, women showed more QoL impairment than men did, as did young patients compared to elderly ones, married women with vitiligo than singles, and patients with involvement on exposed sites than those on unexposed sites. Dark‐skinned people showed more life quality effects than white people did. Dermatologists should pay particular attention to such patients who experience insufficient QoL, as they require more effort to cure their disease.     

系统评价中国大陆地区有关淋球菌头孢曲松耐药监测的研究

目的 收集近期国内外发表的有关中国大陆淋球菌头孢曲松耐药监测文献,分析文献的质量及淋球菌的耐药趋势.方法 检索中国期刊全文数据库、PubMed、Cochrane数据库,筛选合格文献进行系统评价.结果 入选46篇文献,共报道10 163株淋球菌头孢曲松药敏情况.23篇文献主要来自华南(50%);26篇提供的标准菌株为WHO淋球菌分离株(56.52%);32篇文献药敏试验方法为WHO推荐的琼脂糖稀释法(69.57%);淋球菌的头孢曲松耐药率仍较低,但有增加趋势.结论 应该进一步提高淋球菌耐药监测研究的质量,使之能更好地反映淋球菌耐药状况.     

环孢素维持治疗银屑病随机对照研究的文献分析

检索MEDLINE、Embase、Cochrane图书馆、SinoMed、CNKI和万方数据库中1974年1月1日至2018年7月1日环孢素维持治疗银屑病的随机对照临床研究,评价不同环孢素给药方案治疗银屑病的疗效和安全性。共纳入9篇随机临床对照试验文献,均报道环孢素治疗银屑病有效,其中2篇文献研究发现连续治疗方案在长达24周的维持治疗期内是安全有效的,2篇发现间断治疗比连续治疗更安全有效。     

Risk of HIV transmission within marriage in rural China: implications for HIV prevention at the family level

BACKGROUND: Little is known about HIV transmission at the family level in China. GOAL:: We examined the risks for HIV transmission between husbands and wives and from parents to children in a rural area where HIV spread among former commercial blood donors. STUDY: A cross-sectional study was conducted among 605 (302 couples) marriage license applicants. RESULTS: More males (64.6%) than females (52.1%) reported having had premarital sex and multiple sex partners (12.6% and 6.9%, respectively). Among those having had multiple sex partners, 8.5% reported often or always using condoms. Only 36.8% of the couples agreed that they would not plan to have a baby after knowing the status of HIV infection. Approximately 43% of the couples agreed that they would use condoms consistently if 1 of them were HIV-positive. CONCLUSIONS: There is an urgent need for national programs to prevent HIV infection within couples in rural areas.     

Methotrexate and liver fibrosis in people with psoriasis: a systematic review of observational studies

Methotrexate (MTX) is an effective treatment for psoriasis but concerns regarding the development of liver fibrosis prevent optimal use. The primary objective of this systematic review was to assess whether MTX use increases the risk of developing fibrosis in people with psoriasis. Searches were performed on Medline, Embase, the Cochrane Database and Clinical Trials Register from inception until September 2013 for studies including at least two liver biopsies in people with psoriasis. Double extraction using predefined data fields was performed. Randomized controlled trials and observational studies were considered. Statistical analysis was performed using Review Manager 5. Quality of observational studies was assessed using a study quality bias checklist. Eight observational studies met the inclusion criteria (n = 429 patients). The pooled risk difference (RD) of developing significant liver fibrosis was 0·09 [95% confidence interval (CI) ?0·03 to 0·20]. The RD for developing ‘any fibrosis’ was 0·22 (95% CI 0·04–0·41). The RD for cirrhosis was 0·04 (95% CI 0·02–0·07). There was no clear association between cumulative dose of MTX and fibrosis. Obesity, diabetes and alcohol use were under‐reported. The quality of the included studies was weak and the degree of selection bias means the results are not generalizable to all patients with psoriasis taking MTX. High‐quality, population‐based studies that consider potential confounders common in psoriasis population are justified for better prediction of the subset of patients at risk of liver fibrosis. In this highly selected review population, MTX use appears to contribute to the development of ‘any’ fibrosis without clear evidence of risk stratifiers.