HIV preexposure prophylaxis: An essential,safe and effective prevention tool for sexual health

Preexposure prophylaxis of HIV with antiretroviral drugs is a prevention tool available in France since 2016, combined with the prevention methods already used (condoms, post-exposure treatment, rapid treatment of diagnosed HIV infections, etc.). It is targeted at populations at high risk of HIV infection, especially men who have sex with men, for whom traditional prevention methods are insufficient. We collected clinical research data, which resulted in the launch of preexposure prophylaxis in the United States and then elsewhere in the world, safety, tolerability and cost data, as well as ongoing research data (new molecules/methods of administration). We also provided an update of its use in France.     

Immunogenicity of a meningococcal serogroup C conjugate vaccine in HIV-infected children, adolescents, and young adults

Children and adolescents infected with HIV typically have a lower response to immunization than do those in the general population. In most developed countries, meningococcal serogroup C conjugate vaccine is one of the recommended vaccines for such individuals. However, there have been no studies evaluating the antibody response to this vaccine in HIV-infected children, adolescents or young adults. In this study, we evaluated that response using serum bactericidal antibody (SBA) and enzyme-linked immunosorbent assay, comparing HIV-infected with non-HIV-infected patients, as well as analysing the occurrence of side effects. In non-responders, we assessed the antibody response to revaccination. This clinical trial involved 92 patients between 10 and 20 years of age: 43 HIV-infected patients (HIV+ group) and 49 non-HIV-infected patients (HIV- group). After one dose of the vaccine, 72.1% of the HIV+ group patients and 100% of the HIV- group patients were considered protected. Of the HIV+ group patients who received a second dose of the vaccine, only 40% acquired protection. Overall, 81.4% of the HIV+ group patients acquired protection (after one or two doses of the vaccine). Side effects occurred in 16.3% and 44% of the HIV+ group and HIV- group patients, respectively. Therefore, the meningococcal serogroup C conjugate vaccine proved to be safe and effective for use in HIV-infected children, adolescents, and young adults, although their antibody response was weaker than that shown by non-HIV-infected patients. This indicates the need to discuss changes to the immunization schedule for children, adolescents, and young adults infected with HIV, in order to ensure more effective protection against meningococcal disease.     

Dyslipidaemia and insulin resistance in vertically HIV-infected children and adolescents

This cross-sectional study determined the influence of antiretroviral therapy (ART) on the lipid profile and insulin sensitivity of 119 perinatally HIV-infected Brazilian patients aged 6-19 years. Inadequate high-density lipoprotein cholesterol (HDL-c) concentrations were observed in 81.4% of patients. High concentrations of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c) and triglycerides (TG) were found in 33.9%, 9.7% and 35.6% of patients, respectively. There were statistically significant differences in mean concentrations of TC (P = 0.004), HDL-c (P = 0.015) and LDL-c (P = 0.028) among children (<10 years), early adolescents (10-14 years) and late adolescents (15-19 years). Children presented the highest mean concentrations of TC and LDL-c, and patients in late adolescence presented the lowest concentrations of HDL-c. Insulin sensitivity, assessed by the Homeostasis Model Assessment (HOMA) index, was diagnosed in 16.7% of patients, with a statistically higher proportion (P = 0.034) of insulin-resistant children (33.3%) compared with adolescents (12.5%). There was a statistically significant association between TG concentrations and use of ART regimens containing protease inhibitors (PI) (P = 0.0003). Children presented a higher prevalence of insulin resistance and dyslipidaemia compared with adolescents, suggesting that ART, especially PIs, may lead to metabolic complications.     

Performance of Xpert® MTB/RIF and Determine™ TB-LAM Ag in HIV-infected adults in peri-urban sites in Zambia

Setting:Peri-urban health facilities providing HIV and TB care in Zambia.Objective:To evaluate 1) the impact of Xpert^® MTB/RIF on time-to-diagnosis, treatment initiation, and outcomes among adult people living with HIV (PLHIV) on antiretroviral therapy (ART); and 2) the diagnostic performance of Xpert and Determine™ TB-LAM Ag assays.Design:Quasi-experimental study design with the first cohort evaluated per standard-of-care (SOC; first sputum tested using smear microscopy) and the second cohort per an algorithm using Xpert as initial test (intervention phase; IP). Xpert testing was provided onsite in Chongwe District, while samples were transported 5–10 km in Kafue District. TB was confirmed using mycobacterial culture.Results:Among 1350 PLHIV enrolled, 156 (15.4%) had confirmed TB. Time from TB evaluation to diagnosis (P = 0.018), and from evaluation to treatment initiation (P = 0.03) was significantly shorter for IP than for SOC. There was no difference in all-cause mortality (7.0% vs. 8.6%). TB-LAM Ag showed higher sensitivity with lower CD4 cell count: 81.8% at CD4 < 50 cells/mm³ vs. 31.7% overall.Conclusion:Xpert improved time to diagnosis and treatment initiation, but there was no difference in all-cause mortality. High sensitivity of Determine TB-LAM Ag at lower CD4 count supports increased use in settings providing care to PLHIV, particularly with advanced HIV disease.     

Outcomes of isoniazid prophylaxis among HIV-infected children attending routine HIV care in Kenya

Setting:

Three human immunodeficiency virus (HIV) care clinics in Eastern Province, Kenya.

Objectives:

To establish rates of treatment completion, loss to follow-up, adverse drug reactions, tuberculosis (TB) disease and mortality among 606 HIV-infected children during 6 months of isoniazid preventive therapy (IPT).

Design:

Retrospective record review.

Results:

Of 606 HIV-infected children started on IPT, 556 (91.7%) successfully completed treatment, while 20 (3.3%) completed with interruptions. Cumulatively, 30 children (4.9%) did not complete IPT: 4 (0.7%) were lost to follow-up, 4 (0.7%) discontinued because of treatment interruptions, 2 (0.3%) developed adverse drug reactions, 1 developed a chronic cough, 1 was transferred to a non-IPT facility and 18 (3%) developed TB, including 2 who eventually died. TB disease was diagnosed in a median of 3 weeks (interquartile range [IQR] 2–16) post-IPT initiation. The median CD4 cell count for those aged 1–4 years who developed TB disease was 1023 cells/mm³ (IQR 375–1432), while for those aged 5–14 years it was 149 cells/mm³ (IQR 16–332). Isoniazid resistance was not detected in the four culture-confirmed TB cases.

Conclusion:

The high treatment completion, low loss to follow-up rate and few adverse drug reactions affirm the feasibility of IPT provision to children in HIV care clinics.     

Safety,immunogenicity and shedding of LAIV4 in HIV-infected and uninfected children

ObjectivesHIV-infected children have poor responses to inactivated influenza vaccines. Live vaccines (LAIVs) are highly efficacious in children, but they are not used in HIV-infected children du e to limited information. We investigated the safety, immunogenicity and viral shedding of LAIV4 in HIV-infected compared with uninfected children.DesignForty-six HIV-infected and 56 uninfected children 2 to 25 years old, who had been previously vaccinated against influenza, consented to receive a single dose of LAIV4. All grade adverse events (AEs) were recorded in the first month post-vaccination and serious AEs (SAEs) throughout the influenza season. Nasopharyngeal swabs for influenza PCR and IgA ELISA and blood for hemagglutination inhibition antibody (HAI) measurements were collected at entry, 2–5, 7–10 and 21–28 days post-vaccination.ResultsThe HIV-infected subjects had median CD4+ cells of 649 cells/μL and plasma HIV RNA of 20 copies/mL. AEs were similar in the two groups. There were no vaccine-related SAEs. Shedding of ≥1 vaccine virus was detected in 67% HIV-infected and 50% uninfected participants (p = 0.14). HAI titers did not appreciably change, but mucosal IgA antibodies significantly increased post-vaccination in both groups. High baseline HAI and IgA antibody concentrations were associated with decreased viral shedding in controls, but not in HIV-infected subjects. Similar proportions of HIV-infected vaccinees and controls reported influenza-like illnesses (12% and 6%) throughout the season.ConclusionsLAIV4 was equally safe and immunogenic and caused similar viral shedding in HIV-infected and uninfected children. A correlate of protection against vaccine viral shedding was not identified in HIV-infected participants, although both circulating and mucosal antibodies correlated with protection in controls.     

The PEDVAC trial: preliminary data from the first therapeutic DNA vaccination in HIV-infected children

The PEDVAC study is the first trial designed to analyze safety and immunogenicity of a therapeutic vaccination with a multiclade multigene HIV DNA vaccine (HIVIS) in infected children. Twenty HIV-1 vertically infected children (6-16 years of age), on stable antiretroviral treatment for at least 6 months with HIV-1 RNA < 50 copies/ml and stable CD4 counts (>400 cells/mm³ or 25%) over 12 months of follow-up, were recruited into the study. Enrolled patients have been randomized into two arms: a control group of 10 children who continued previous antiretroviral treatment (HAART) (arm A) and a group of 10 children immunized intramuscularly with the HIVIS DNA vaccine in addition to previous HAART (arm B). Immunizations took place at week 0, 4, 12 and the boosting dose is planned at week 36. The 10 children in the vaccine group have received the first 3 priming doses of the HIVIS vaccine. Safety data showed good tolerance to the vaccination schedule. Mild cutaneous self-limeted reactions consisted of local irritation, usually itching or erythema +/− swelling at the injection site, were reported. No severe systemic adverse events have been observed. No vaccinated children had a decrease of CD4 T-cell counts from baseline. None experienced virological failure.Analysis of cellular immune responses was scheduled at week 0, 4, 12, 16, 20, 40, 60, 72 and 96 by standard lymphoproliferation assay, intracellular cytokine staining and cell-ELISA, a miniaturized assay to measure antigen-induced IFNγ secretion. Evaluation of these results is in progress and will provide key information on the status and changes of antigen specific immunity during HIV DNA immunization.     

北京市男男性行为者HIV新发感染率与高危行为及接受暴露前后预防用药服务情况调查

目的 了解北京市MSM的HIV新发感染率与高危行为及接受暴露前后预防（PrEP/PEP）用药服务情况。方法 采用Epi Info7.0软件计算参加横断面调查和队列调查样本量分别为1 227人和207人年。采用方便抽样法通过手机微信公众号招募MSM参加自填式网络问卷调查,收集其社会人口学、高危行为及接受PrEP/PEP用药服务利用情况,MSM自行采集干血斑样本邮寄到指定实验室进行HIV核酸检测。建立HIV核酸阴性受检者开放式队列,随访观察至研究终点。采用非条件logistic回归分析MSM最近1个月无保护肛交行为、最近1个月同性多性伴的影响因素。结果 共招募MSM 1 147人,其中HIV核酸阴性者956人观察236人年。HIV新发感染率为1.3/100人年（3/236）。最近1个月肛交和口交每次都使用安全套者分别占50.7%（238/469）和4.9%（23/469）。最近1个月与HIV感染者发生性行为的比例为5.9%（43/723）。分别有9.8%（103/1 049）和8.7%（91/1 049）的研究对象曾接受PrEP/PEP用药服务。PrEP/PEP用药期间发生性行为每次使用安全套的比例分别为34.3%（24/70）和72.2%（39/54）。多因素logistic回归分析结果显示,接受PrEP/PEP用药服务者的最近1个月发生无保护肛交行为和有同性多性伴的可能性均较高（aOR=3.16,95%CI：1.45~7.18;aOR=2.64,95%CI：1.19~6.30）;最近1个月使用毒品或Rush Popper者的最近1个月发生无保护肛交行为和有同性多性伴的可能性均较高（aOR=2.34,95%CI：1.67~3.30;aOR=2.42,95%CI：1.76~3.33）。结论 应在MSM中倡导坚持使用安全套及开展常见滥用药物危害的健康教育。在PrEP/PEP用药服务咨询中,需提示MSM坚持使用安全套的重要性。     

我国14岁及以下HIV感染儿童生存分析

目的 探究我国≤14岁HIV感染儿童全阶段生存情况及相关影响因素。方法 选取我国艾滋病病例报告数据库及抗病毒治疗数据库内的HIV感染儿童,采取回顾性队列研究方法探究HIV感染儿童生存情况,采取Cox比例风险回归模型对影响生存时间的因素进行筛选。结果 HIV感染儿童8 029例,中位生存时间179.75个月,确诊阳性后1、2、5、10年的累积生存概率分别为99.13%、97.95%、90.11%、78.63%。多因素Cox比例风险回归分析发现,未接受抗病毒治疗儿童的死亡风险是接受抗病毒治疗儿童的12.81倍（95% CI：11.40～14.27）;男童的死亡风险是女童的1.20倍（95% CI：1.10～1.32）;确诊阳性年龄在3～5岁HIV感染的儿童死亡风险是确诊阳性年龄在<2岁儿童的0.67倍（95% CI：0.60～0.76）。西北地区儿童的死亡风险是东北地区儿童的0.52倍（95% CI：0.29～0.95）,本地治疗儿童的死亡风险是异地治疗儿童的1.96倍（95% CI：1.48～2.61）,未获得关怀服务儿童死亡风险是获得关怀服务儿童的2.07倍（95% CI：1.88～2.29）。结论 我国≤14岁HIV感染儿童中位生存时间179.75个月。接受抗病毒治疗、女童、异地治疗、西北地区,获得关怀服务和确诊时年龄较大是HIV感染儿童生存时间的保护因素。     

Serological response to trivalent inactive influenza vaccine in HIV-infected children with different immunologic status

Influenza vaccination is usually recommended for HIV-infected children. One hundred and twenty seven HIV-infected and twenty-one HIV-uninfected children aged ≥6 months to <18 years, all of whom were naïve to influenza vaccine, were enrolled to receive an influenza Trivalent Inactivated Vaccine (TIV). In the HIV group, the post-vaccination immune response (geometric mean titer, seroconversion and seroprotection rates) correlated with their immunological status before vaccination. The HIV-infected children with no immunosuppression had comparable serological response to HIV-uninfected children. For moderately and severely immunosuppressed HIV groups, two doses of TIV resulted in greater serological responses and should be recommended in these groups.     

广西壮族自治区2004-2019年初始抗病毒治疗儿童HIV感染者死亡和脱失情况分析

目的 了解初始抗病毒治疗（ART）儿童HIV感染者死亡和脱失情况及其影响因素。方法 采用回顾性队列研究方法,从我国艾滋病综合防治信息系统ART信息系统下载广西壮族自治区（广西）2004-2019年初始ART儿童HIV感染者数据库,采用Cox比例风险回归模型分析其死亡和脱失情况。结果 共计943例儿童HIV感染者进入队列,总体病死率和脱失率分别为1.00/100人年和0.77/100人年。初始治疗后第1年病死率和脱失率分别为3.90/100人年和1.67/100人年。初始ART后第1、2、5、10年的累计生存率分别为96.14%、95.80%、93.68%、91.54%。多因素Cox比例风险回归分析显示：女性（aHR=2.00,95%CI：1.17~3.40）、基线CD4⁺T淋巴细胞（CD4）计数<200个/μl（aHR=2.79,95%CI：1.54~5.06）、基线年龄别体重Z评分<-2（aHR=2.38,95%CI：1.32~4.26）、基线血红蛋白<80 g/L（aHR=2.47,95%CI：1.24~4.92）和初始ART方案含LPV/r（aHR=5.05,95%CI：1.15~22.12）是儿童HIV感染者死亡的关联性因素;女性（aHR=2.23,95%CI：1.22~4.07）和初始ART方案含LPV/r（aHR=2.02,95%CI：1.07~3.79）是儿童HIV感染者脱失的关联性因素。结论 广西儿童HIV感染者ART效果较好,但初始ART后第1年病死率和脱失率较高。需针对死亡和脱失的影响因素,加强医护人员培训和儿童HIV感染者及其父母的宣传教育以提高ART效果。     

Sensitivity and specificity of BCG scar reading among HIV-infected children

BCG scar has been used as an indicator of vaccination with BCG in the past, but the validity of scar among HIV-positive children is still unknown. The validity of BCG scar reading among such children was estimated, using three different gold standards. The sensitivity ranged from 81.3% (95%-CI: 78.0–84.2) to 91.6% (95%-CI: 88.4–94.0), when the gold standards were, respectively, information from the adult responsible for the child and the vaccination card. The specificity ranged from 90.5% (95% CI: 81.6–95.5) to 94.1% (95% CI: 87.7–97.4), when the gold standards were, respectively, the vaccination card and information from the adult responsible for the child. Reading of BCG scar was shown to be a good indicator for vaccination in the past, among HIV-infected children.     

Serum-free purified Vero rabies vaccine is safe and immunogenic in children: Results of a randomized phase II pre-exposure prophylaxis regimen study

BackgroundA serum-free, highly purified Vero rabies vaccine (PVRV-NG) has been developed with no animal or human components and low residual DNA content. A phase II randomized clinical study aimed to demonstrate the non-inferiority of the immune response and assess the safety profile of PVRV-NG versus a licensed human diploid cell culture rabies vaccine (HDCV) in a pre-exposure regimen in healthy children and adolescents in the Philippines.MethodologyChildren aged 2–11 years and adolescents aged 12–17 years were randomized (2:1) to receive three injections of either PVRV-NG or HDCV (on day [D] 0, D7 and D28). Rabies virus-neutralizing antibodies (RVNA) were measured at D0, D42 and 6 months after the first injection (month [M] 6). Safety was assessed during the vaccination period and up to 28 days after the last vaccination. Serious adverse events were followed until 6 months after last vaccination.Principal findings342 healthy participants (171 children and 171 adolescents) were randomized and followed for 6 months after the last dose. All participants in both groups had an RVNA titer ≥ 0.5 IU/ml at D42, demonstrating non-inferiority in seroconversion rate for PVRV-NG versus HDCV. Over 90% of participants had RVNA titer ≥ 0.5 IU/ml at M6. PVRV-NG was well tolerated after each vaccination and up to 6 months following the last dose. There were no major safety concerns during the study, and the type and severity of solicited adverse events was similar for both treatment groups.ConclusionsThis study demonstrated the non-inferior immune profile of PVRV-NG compared with HDCV in a pre-exposure setting within a pediatric population. PVRV-NG was well tolerated with no safety concerns. This study is registered at ClinicalTrials.gov (NCT01930357) and EU Clinical Trials Register (2015–003203-30).     

Circumstances and motivations for fostering children in Zambia

Abstract

This short report explores motivations and circumstances of fostering children at six sites in Zambia. Cross-sectional community household surveys using multistage random sampling (totalling 1503 households, reporting on 5009 children) and participatory qualitative research (focus groups and in-depth interviews) with adult and youth community members were conducted as part of baseline research for the US-funded RAPIDS (Reaching HIV/AIDS Affected People with Integrated Development and Support) programme. Interviews and discussions with community members revealed the complexity of fostering patterns and decision-making, considered from the dual perspectives of fostering household and fostered child. Programme implementers need to recognize the complexity of fostering in intervention design, including the possibility of introducing perverse incentives.     

Influenza surveillance in a cohort of HIV-infected children and adolescents immunized against seasonal influenza

During the 2006–2007 season, 19 HIV-uninfected and 33 HIV-infected children and adolescents with full immunovirologic response to HAART were immunized against influenza and subsequently followed up. One month post-immunization all subjects had protective antibodies titres which persisted for the whole influenza season. Seven vaccinees (four HIV-infected and three HIV-uninfected) were found to be infected by influenza viruses during the epidemic, but disease was lab-confirmed only in two HIV-infected subjects. Both presented a benign clinical course and were infected by an A/Brisbane/10/07-H3N2-like virus. These data indicate that HIV-infected subjects benefit from routine seasonal influenza vaccination.     

Educational outcomes of family-based HIV-infected and affected children from Maharashtra,India

India is home to 0.14 million children, living with HIV. Little is known about their educational needs. The present analysis estimated educational outcomes of family-based children affected by HIV/AIDS (CABA) and impact of their HIV status on educational outcomes. A situation analysis was undertaken in four districts from Maharashtra, India. A total of 510 parents/guardians of family-based CABA were interviewed. Data of single child per household, aged 6–16 years, were analyzed. Child not infected/not tested for HIV and having one/both parents infected with HIV was defined as HIV affected. Logistic regression analysis was used to understand determinants of ‘currently out of school’ and ‘lag behind age appropriate standard’. Of the total 472 CABA, 237 and 235 were HIV infected and affected respectively, 43% were girls, 70% were below 13 years of age, 51% resided in rural area, 83% belonged to lower economic strata and 61% had lost one/both parents. Higher proportion of HIV-infected children had history of hospitalization in the past year (26%) compared with HIV affected (7%). Majority of HIV-infected children (84%) were taking ART. A total of 23 (4.87%) children were currently out of school and 43 (9.23%) lagged behind age appropriate standard. Compared to HIV-affected, HIV-infected children were more likely to be out of school (aOR = 7.16, 95% CI = 1.79–42.47) and lagged behind age appropriate standard (aOR = 2.82, 95% CI = 1.17–6.81). Children 14–16 years old had higher risk of being out of school (aOR = 11.55, 95% CI = 3.46–50.65) and lag (aOR = 3.85, 95% CI = 1.79–8.29), compared to 6–13 years old children. Having lost mother and caregiver being illiterate independently predicted the lag. Among HIV-infected children, the most common reason for discontinuation of school was child’s illness. The analysis highlights greater educational disadvantages of HIV-infected children and its possible linkage with ill health of these children.     

山东省男男性行为人群HIV暴露前后预防用药情况及相关因素分析

目的 了解山东省MSM的HIV暴露前后预防（PrEP/PEP）用药情况并分析相关因素,为PrEP/PEP工作的推广提供参考依据。方法 2022年4-7月在山东省7个城市监测哨点招募MSM进行问卷调查,每个城市样本量为400人。收集MSM社会人口学、性行为、PrEP/PEP用药等信息,并采集血标本做HIV和梅毒抗体检测。结果 研究对象MSM共2 815人,以≤30岁（55.7%,1 569/2 815）、未婚（68.6%,1 931/2 815）、大专及以上文化程度（56.5%,1 590/2 815）为主。PrEP用药者占9.2%（258/2 815）;PEP用药者占10.8%（305/2 815）。多因素logistic回归分析结果显示,MSM中PrEP用药的可能性较高的相关因素包括年龄≤30岁（aOR=4.04,95%CI：1.25~13.01）、自我认知HIV感染风险较低（aOR=1.76,95%CI：1.16~2.68）、最近6个月发生群交行为（aOR=1.51,95%CI：1.10~2.09）、最近6个月发生同性商业性行为（aOR=1.69,95%CI：1.16~2.47）、使用新型毒品（aOR=1.53,95%CI：1.11~2.11）、接受同伴教育（aOR=1.56,95%CI：1.03~2.37）、知晓别人PrEP用药（aOR=3.29,95%CI：2.48~4.36）、HIV抗体阴性（aOR=8.40,95%CI：1.12~63.12）;MSM中PrEP用药的可能性较低的相关因素为主要性伴为临时性伴（aOR=0.67,95%CI：0.49~0.90）。MSM中PEP用药的可能性较高的相关因素包括年龄<50岁（≤30岁：aOR=2.41,95%CI：1.02~5.69;31~49岁：aOR=3.33,95%CI：1.42~7.85）、自我认知无HIV感染风险（aOR=1.87,95%CI：1.12~3.11）、最近6个月发生群交行为（aOR=1.68,95%CI：1.23~2.29）、使用新型毒品（aOR=3.86,95%CI：2.94~5.07）以及未接受同伴教育（aOR=1.54,95%CI：1.12~2.12）。结论 山东省MSM的PrEP/PEP用药比例较高。应加强同伴教育和自我认知HIV风险教育,提高MSM中PrEP/PEP用药的使用率。     

Safety and immune response after two-dose meningococcal C conjugate immunization in HIV-infected children and adolescents in Rio de Janeiro,Brazil

We aimed to evaluate immunogenicity and adverse events (AEs) after a booster dose of Meningococcal C conjugated (MCC) vaccine in HIV-infected children and adolescents, who had a previous low seroconversion rate after priming with MCC, at a reference HIV-care center in Rio de Janeiro.Methods2–18 years old HIV-infected subjects with CD4+ T-lymphocyte cell (CD4) ≥15%, without active infection or antibiotic use, were enrolled to receive 2 doses of conjugated meningococcal C oligosaccharide-CRM197 12–18 months apart. All patients were evaluated before and 1–2 months after immunization for seroprotection [defined as human serum bactericidal activity (hSBA) titer ≥1:4]. AEs were assessed at 20 min, 3 and 7 days after each dose. Factors independently associated with seroprotection were studied.Results156 subjects were enrolled and 137 received a booster MCC dose. 55% were female, and median age was 12 years. Eight-nine percent were receiving combined antiretroviral therapy (cART) at the booster visit (median duration of 7.7 years), 59.9% had undetectable viral load (VL) at baseline, and 56.2% at the booster visit. Seroprotection was achieved in 78.8% (108/137) subjects, with a significantly higher GMT than after the priming dose (p < 0.01). Mild AEs were experienced after a second MCC dose (38%). In logistic regression, undetectable viral load at entry [odds ratio (OR) = 7.1, 95% confidence interval (95%CI): 2.14–23.37], and probably higher CD4 percent at the booster immunization visit (OR): 1.1, 95%CI: 1.01–1.17 were associated with seroprotection after a booster dose of MCC.ConclusionA booster dose of MCC was safe and induced high seroprotection rate even 12–18 months after priming. MCC should be administered after maximum virologic suppression has been achieved. These results support the recommendation of 2-dose of MCC for primary immunization in HIV-infected children and adolescents with restored immune function.     

2014—2020年广州市HIV职业暴露变化趋势及暴露后预防相关因素分析

目的 分析广州市HIV职业暴露情况,为加强HIV职业暴露防护工作提供依据。方法 收集并分析2014—2020年广州市报告的HIV职业暴露个案,内容包括暴露者的基本情况、暴露方式、暴露等级与暴露源感染情况、暴露后紧急处理方式、暴露后预防用药时间及暴露者HIV抗体检测等信息。结果 2014—2020年,广州市累计报告HIV职业暴露个案455例,医务人员占86.8%（395/455）,锐器损伤占54.3%（247/455）,II级暴露占63.3%（288/455）,规范化暴露后处理占93.8%（427/455）,暴露后2 h内预防用药占35.4%（161/455）;医务人员暴露后2 h内预防用药比例高于警务人员（P<0.01）;男性、锐器损伤、皮肤/黏膜接触暴露、I级暴露、暴露源为轻度、强化用药方案、2 h内及2~24 h内预防用药的构成比均呈上升趋势（P<0.05或P<0.01）;传染病专科医院、II级暴露、超过24 h预防用药的比例呈下降趋势（均P<0.01）;传染病专科医疗机构暴露个案更倾向于及早预防用药（OR=0.305）,暴露源不明的暴露个案预防用药时间更晚（OR=2.713）。结论 应重点提高医护人员和一线警务人员防护意识及技能,增加暴露后预防用药的便利性;同时加强暴露源检测,减少对预防用药及时性的影响。