Epidemic crack cocaine use linked with epidemics of genital ulcer disease and heterosexual HIV infection in the Bahamas: evidence of impact of prevention and control measures

BACKGROUND: Epidemic freebase/crack cocaine use began in the Bahamas in 1982, closely followed by epidemics of genital ulcer disease (GUD) and HIV infection. Numbers of new clients receiving ambulatory treatment for cocaine use in Nassau peaked in 1984. GOAL: To assess interrelations among epidemics of crack use, GUD, and HIV infection. STUDY DESIGN: The study was designed for review and comparison of temporal trends in ambulatory and inpatient treatment of cocaine users and in numbers of cases of sexually transmitted disease (STD) and HIV infection in the Bahamas. A retrospective case-control study of cocaine use and STDs was performed at the Comprehensive Dermatovenereology Clinic in Nassau. RESULTS: Ambulatory visits and inpatient admissions for cocaine use peaked in 1984 and 1987, respectively. GUD cases increased 12-fold in the Bahamas from 1983 to the period of 1985-1987 and then declined. At the Comprehensive Dermatovenereology Clinic, gonorrhea cases outnumbered bacterial GUD cases approximately 10:1 in 1982 and 1983, but the latter increased to outnumber gonorrhea cases in 1985 and 1987-1988. Annual HIV seroprevalences at new-problem visits rose from less than 0.3% in 1986 to 12.9% by 1994 and then leveled off. Cocaine use among patients seen with STD from 1985 through 1990 was significantly associated with GUD (odds ratio [OR], 3.3; 95% CI, 2.1-5.1), secondary syphilis (OR 5.5; 95% CI, 2.4-12.6), and HIV infection (OR, 8.1; 95% CI, 4.3-15.2). CONCLUSIONS: In temporally linked successive epidemics of cocaine use, GUD, and HIV infection, case-control analyses confirmed the association of cocaine use with GUD and with HIV infection. Declining GUD and HIV seroprevalence stabilization followed declines in cocaine use and implementation of syndromic management of GUD, as well as intensified partner-notification efforts.     

Lymphogranuloma venereum of the rectum in a homosexual man. Case report.

A male homosexual presented initially with bloody diarrhoea and a swelling in the left groin, which was unsuccessfully treated with erythromycin. Examination in hospital showed a rectal mass and an abscess in the left groin. Histological examination of the rectal mass and a positive lymphogranuloma complement fixation test result confirmed the diagnosis of lymphogranuloma venereum. This disease, although rare, should not be forgotten in the differential diagnosis of rectal problems in male homosexuals.     

Lymphogranuloma venereum - a rare cause of genital ulcers in central Europe

Lymphogranuloma inguinale, caused by Chlamydia trachomatis serovar L1-L3 is rare in patients from western countries but needs yet to be considered in the differential diagnosis of genital ulcers. We report a case of a young male patient without any eventful travel history who presented with a genital ulcer at the sulcus coronarius and painfully enlarged lymph nodes in the right inguinal area. The typical clinical picture and serum IgM and IgG antibody titers of 1:16 and 1:512, respectively, against C. trachomatis were suggestive of infection with C. trachomatis serovar L1-L3. The diagnosis was confirmed by isolation of the organisms from the ulcer ground and subsequent sequence analysis of the omp1 gene which led to identification of C. trachomatis genotype L2 with 99% homology to a reference strain of C. trachomatis serovar L2. The lesion healed rapidly under treatment with doxycycline for 3 weeks, and the lymph nodes did not ulcerate. Thus, clinical suspicion was confirmed by genotyping of the isolated strain allowing timely diagnosis and treatment of lymphogranuloma inguinale.     

Lymphogranuloma venereum proctitis in men who have sex with men is associated with anal enema use and high-risk behavior

OBJECTIVES: In the industrialized world, lymphogranuloma venereum proctitis (LGVP) has been reported only in men who have sex with men. Factors responsible for the outbreak remain to be elucidated. GOAL: The goal of the present work was to elucidate risk factors associated with LGVP. STUDY DESIGN: The study design comprised a cross-sectional study including 32 men with LGVP and 93 men without LGVP (22 with gonorrheal proctitis, 30 with a non-LGV chlamydial proctitis, and 41 with proctitis of unknown etiology). Factors associated with LGVP were analyzed by (multinomial) logistic regression. RESULTS: Comparing men with LGVP with men without LGVP, factors significantly associated with higher risk of LGVP in multivariate analyses were as follows: anal enema use [odds ratio (OR): 7.8, 95% confidence interval (CI): 2.6-23.2], having sex on sex parties (OR: 5.7, 95% CI: 1.5-21.8), and having sex with human immunodeficiency virus-positive partners (OR: 3.2, 95% CI: 1.1-9.3). Evaluating the 4 proctitis groups separately in a multinomial logistic regression model, similar associations between anal enema use and LGVP were found. Men with non-LGV chlamydial proctitis showed less risk behavior than men with LGVP. No substantial difference in risk behavior was found, except for attending sex parties, between men with LGVP, and gonorrheal proctitis or proctitis of unknown etiology. CONCLUSIONS: Apart from men with LGVP, men with gonorrheal proctitis or proctitis of unknown etiology exhibit high risk behavior. Enema use seems to play a key role in transmission of LGVP, and needs further investigation.     

The use of serological titres of IgA and IgG in (early) discrimination between rectal infection with non-lymphogranuloma venereum and lymphogranuloma venereum serovars of Chlamydia trachomatis

OBJECTIVES: To investigate whether serological titres of species-specific IgA and IgG antibodies in patients with rectal chlamydial infection could discriminate between infection with serovar L2 lymphogranuloma venereum (LGV) and infection with non-LGV serovars. METHODS: A total of 39 male patients with chlamydial infection of the rectum were tested for titres of IgA and IgG antibodies within 14 days after detection of the infection and 6 and 12 months after adequate treatment. Data were collected regarding demographics, sexual orientation, HIV serostatus, history of chlamydial infection, concomitant sexually transmitted infection (STI) or HIV infection, hepatitis C virus antibodies and new STIs during follow-up. RESULTS: Between May 2003 and November 2005, 24 men with confirmed L2 proctitis and 15 men with non-LGV rectal chlamydial infection were recruited. In multivariable analyses, both high titre of IgA within 14 days after detection of the infection and older age of the individual were found significantly associated with L2 proctitis (p<0.001 and p = 0.001, respectively). A total sum score of seven times IgA titre and individual's age >or=50 years resulted in an overall sensitivity of 92% and specificity of 100%. This total sum score was highly accurate for detection of LGV proctitis, with an area under the curve in a receiver operating characteristic curve of 0.989. CONCLUSIONS: An increased IgA antibody response and the age of the infected individual are of possible diagnostic value for (early) detection of LGV proctitis.     

Criteria for detecting and understanding changes in the risk of HIV infection at a national level in generalised epidemics

Identification of causes of changes in prevalence and incidence of HIV at a national level is important for planning future prevention and intervention needs. However, the slow progression to disease and the sensitive and stigmatising nature of the associated behaviours can make this difficult. Changing rates of incidence are to be expected as an epidemic progresses, but separating background changes from those brought about by changes in behaviour and interventions requires careful analysis. This paper discusses the criteria required to determine whether observed changes in HIV prevalence are the result of changes in behaviour.     

Health issues associated with increasing use of "crack" cocaine among female sex workers in London

OBJECTIVES: To document changes in "crack" cocaine use in the sex industry in London, and to assess health risks associated with the drug. DESIGN: Two serial cross sectional surveys. SUBJECTS: Sex workers interviewed in 1989-9 and 1995-6. MAIN OUTCOME MEASURES: Self reported use of crack cocaine; clinical history of sexually transmitted infection and pregnancy, clinical outcomes. RESULTS: The proportion of women reporting crack use increased significantly from 22/193 (11%) in 1989-91 to 48/143 (34%) in 1995-6. Women in all the main prostitution sectors reported crack use. Crack users had been working in prostitution for longer, were more likely to have worked on the streets, to inject drugs, and to have a partner who injected. Crack use was associated with termination of pregnancy and with hepatitis C infection. The association with hepatitis C was partially explained by confounding with injecting drug use. CONCLUSIONS: Crack use is more common and less problematic than clinical presentation suggests. Use has increased over the past decade, and is associated with hepatitis C infection and termination of pregnancy. It is possible that crack use facilitates hepatitis C transmission due to oral lesions from smoking. Crack use can be difficult to identify because of the stigma of being labelled a "crack whore," therefore information on crack might usefully be integrated into general health promotion material on drugs and safer sex.     

The profile and context of the epidemics of sexually transmitted infections including HIV in Zimbabwe

Zimbabwe has widespread and widely disseminated epidemics of most major sexually transmitted infections (STI) including HIV. This epidemiological situation is examined from a broad historical perspective, exploring the interactions between the population incidence of STI and the social profile of the country. The results suggest opportunities for upstream prevention efforts. Examples of these include: integration of prevention with care and social support; increasing general communication and openness about sexuality; economic support initiatives including income generating and micro-credit programmes, offering living accommodations for families in cities, mines, and military camps; and programmes focusing on adolescents before they become sexually active.     

Modelling HIV epidemics in the antiretroviral era: the UNAIDS Estimation and Projection package 2009

OBJECTIVE: The UNAIDS Estimation and Projection Package (EPP) is a tool for country-level estimation and short-term projection of HIV/AIDS epidemics based on fitting observed HIV surveillance data on prevalence. This paper describes the adaptations made in EPP 2009, the latest version of this tool, as new issues have arisen in the global response, in particular the global expansion of antiretroviral therapy (ART). RESULTS: By December 2008 over 4 million people globally were receiving ART, substantially improving their survival. EPP 2009 required modifications to correctly adjust for the effects of ART on incidence and the resulting increases in HIV prevalence in populations with high ART coverage. Because changing incidence is a better indicator of program impact, the 2009 series of UNAIDS tools also focuses on calculating incidence alongside prevalence. Other changes made in EPP 2009 include: an improved procedure, incremental mixture importance sampling, for efficiently generating more accurate uncertainty estimates; provisions to vary the urban/rural population ratios in generalised epidemics over time; introduction of a modified epidemic model that accommodates behaviour change in low incidence settings; and improved procedures for calibrating models. This paper describes these changes in detail, and discusses anticipated future changes in the next version of EPP.     

Fingertip and nasal tip thermal burn in crack cocaine user

Crack cocaine addiction is a public health problem in Brazil. It is an endemicdisease that affects rural and urban areas. The Ministry of Health has launchedemergency programs for the treatment of dependents and to combat drug trafficking.Recognition of dermatological signs of this disease is important because through themthe diagnosis can be suspected and early treatment of patients with crack cocaineaddiction be provided.     

石家庄市2004年HIV/AIDS疫情分析

目的分析石家庄市HIV/AIDS的流行特征及趋势,为预防与控制HIV/AIDS提供科学依据。方法对石家庄市2004年HIV/AIDS确认报告和流行病学个案调查表进行统计分析。结果2004年共检出HIV/AIDS35例,比去年同期增长150%;感染人群以青壮年为主;女性检出首次超过男性;传播途径以经血传播为主,已出现了母婴传播病例。结论石家庄市HIV/AIDS流行速度明显加快,经性传播将成为下一阶段的主要传播途径,应采取措施预防HIV/AIDS从高危人群向一般人群的传播。     

HIV中和抗体在抗HIV感染中的作用

HIV的中和抗体可以与HIV病毒特异结合并且阻断病毒侵入细胞的抗体.HIV中和抗体的靶位是病毒的膜蛋白上那些与细胞受体结合和膜融合有关的区域,抗体的结合与相关蛋白的构象紧密相关,目前的相关研究为抗HIV药物和杀微生物剂的研制提供了理论基础.HIV具有逃逸中和抗体的能力.因此,为设计有效的疫苗,需要对抗原进行理性设计,以便更有效的诱导广谱中和抗体.概述HIV的侵入机制,中和抗体与侵入关键蛋白、靶点以及抗HIV疫苗研究的关系和进展.

Abstract：

Neutralizing antibodies specific for HIV can bind to the virus and inhibit HIV entry into host cells.The targets of HIV-specific neutralizing antibodies are the sites associated with receptor binding or membrane fusion on the envelop proteins of HIV.Relevant studies have provided theoretical basis for developing anti-HIV medicines and microbicides.The neutralization is sensitive to the conformation of related proteins.On the other hand, HIV has a latent ability to escape from antibodies neutralization.Therefore, the rational design of antigen to induce broad-spectrum neutralizing antibodies is necessary for the development of successful vaccines.This paper introduces HIV invasion mechanism as well as the relationship of HIV neutralizing antibodies with entry-related crucial proteins,targets and anti-HIV vaccines.     

CRF01-AE基因亚型毒株在HIV传播及流行中的作用

目的研究HIV-1CRF01-AE亚型毒株与HIV传播及流行的关系,为预防控制艾滋病提供科学依据。方法分三个时段检测贵州省多地区190份HIV-1毒株样本,用套式PCR扩增其Env基因和测序分析,将实验结果与贵州省艾滋病流行现状进行相关分析。结果检出B,B',E,C亚型及CRF07-BC,CRF08-BC和CRF01-AE三种新的流行性重组亚型毒株,流行性重组亚型毒株是造成贵州省艾滋病流行的因素之一,其中CRF01-AE毒株与性传播、16～50岁年龄段高度相关。结论 CRF01-AE亚型毒株是贵州省艾滋病传播与流行的主要亚型毒株;16～50岁年龄段是CRF01-AE亚型毒株通过性传播艾滋病的主体人群;CRF01-AE亚型毒株引起的艾滋病流行,具有传播范围广、流行时间长、控制难度大等特点。