HIV and Hepatitis in an Urban Penetrating Trauma Population: Unrecognized and Untreated

Human immunodeficiency virus (HIV) infection through transfusion has been an imperative challenge for blood safety. Despite the implementation of screening strategies, there was still the residual risk of transfusion-transmitted HIV. Considering that the prevalence of HIV infection in blood donors is significant for evaluating blood safety and potential risks to the population, meta-analysis was applied to investigate the HIV prevalence among voluntary blood donors during the past 27 years to characterize the epidemiology and related risk factors of HIV in blood donors. The literature concerning the HIV screening reactive rate and prevalence in Chinese voluntary blood donors was collected through the systematic searching of four electronic databases. After integrating data, following the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses guidelines, data manipulation and statistical analyses were conducted by Stata 12.0. The results indicated that overall HIV prevalence was 0.0178% (95% confidence interval [CI], 0.0169%-0.0187%) with a remarkable rise, which varied from 2000 (0.0034%) to 2015 (0.027%). The HIV window period infection rate was 0.0475‱ (95%CI, 0.0304‱-0.0646‱). Importantly, subgroup analysis revealed the heterogeneity in gender, occupations, education and donation frequency. With the effective control of HIV transmission through blood, HIV prevalence declined in China to some extent in recent years, and the characteristics of HIV epidemic in some provinces have drastically changed. However, remaining relatively high HIV prevalence and overall increased trend of HIV prevalence since the 21th century demonstrates the potential residual risk of blood transfusion, and the whole society is supposed to pay close attention to HIV infection.

This was a retrospective study to evaluate the prevalence and impact of hepatitis G virus (HGV) infection in hepatitis C virus (HCV)-positive drug addicts, according to the serological status of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection. Two hundred and thirty-five randomly selected intravenous drug addicted patients (147 French, 88 Italian) were studied. All patients were positive for antibodies to HCV (anti-HCV). HGV RNA positivity was measured by reverse transcriptase-polymerase chain reaction (RT-PCR). Comparisons of HCV RNA positivity rate, and biological and histopathological variables, were made between HGV RNA-positive and negative patients, according to their HBV and HIV status. HGV prevalence was around 30% in both French and Italian groups. No clear association between HGV infection and a particular HCV genotype was observed. The rate of HCV RNA positivity did not differ between HGV-positive and HGV-negative patients after stratification for hepatitis B surface antigen (HBsAg) and HIV positivity. Histological severity of the underlying chronic hepatitis did not differ according to the HGV status; however, in HIV-positive HBsAg-negative patients, the hepatitis activity was moderately increased in HGV-positive patients. A striking negative influence of HBsAg positivity on HCV replication was observed in HIV-negative patients; an HCV RNA-positive rate of 25% was found in HBsAg-positive patients vs 86% in HBsAg-negative patients; similar significant results were observed in HIV-positive patients, although to a lesser extent. The underlying chronic hepatitis was significantly more severe in HBsAg-positive than in HBsAg-negative HIV-negative patients. Hence, HGV infection is highly prevalent in anti-HCV positive drug addicts but the co-infection with HCV does not seem to influence HCV replication nor to worsen the underlying chronic hepatitis, in HIV-negative patients at least. Reciprocal influence between HBV, HCV and HIV appears rather complex, HBsAg carriage seeming to exert per se a negative effect on HCV replication, particularly in HIV-negative patients, suggesting that interactions between hepatitis viruses should always be analysed in the light of HIV status.

To assess the rate and determinants of sharp injuries during the previous 6 months among health care workers at first-level care facilities in two districts of Pakistan. Cross-sectional survey at public, general practitioners and non-licensed private practitioners selected through stratified random sampling. At each facility, we interviewed a prescriber and a dispenser/injection provider about knowledge of bloodborne pathogens transmission and preventive practices, risk perception, and use of precautions and sharp injuries received during the previous 6 months. Multivariable Poisson regression was used to assess the factors associated with the number of sharp injuries. Fifty-four percentage of the 233 workers had at least one injury during the previous 6 months. The overall rate of sharp injuries per person per year was 3.7; among non-physician prescribers (9%), it was 4.3; among dispensers (69%), it was 3.7, and among physicians (18%), it was 2.1. In the multivariable model, work experience, risk perception and type of health care worker were significantly associated with receiving sharp injuries during the previous 6 months. In the model including dispensers only, a higher knowledge score was associated with fewer sharp injuries, while perceived severity of disease and lack of professional qualification were associated with more. Sharp injuries are common in Pakistan. Better knowledge about modes of bloodborne pathogen transmission and professional qualification may reduce their incidence.

Human immunodeficiency virus (HIV) prevalence and incidence rates have expeditiously increased among Chongqing men who have sex with men (MSM) over the past decade. This study investigated the trends of HIV, syphilis, and hepatitis C virus (HCV) infections and behavioral attributes of Chongqing MSM. Chongqing MSM who were 18 years or older were recruited annually from 2011 to 2018. Interviewer-administered paper-pencil interviews were used to collect demographics, behavioral information, and sexually transmitted diseases history. Blood samples were collected for the tests of HIV, syphilis, and HCV. A stepwise regression model was conducted to assess the associations of demographics, behaviors, and syphilis and HCV infections with HIV infection. A total of 4900 MSM participated in the study. The average HIV, syphilis, and HCV prevalence over 8 years were 15.4%, 4.0%, and 0.3%, respectively. The HIV prevalence ranged from 13.5% to 16.4%. Syphilis and HCV were generally low and stable across years. An increased proportion of participants received HIV counseling, testing, and condoms. Multivariable regression indicated that HIV-positive MSM were more likely to be older, married, and less educated, and they were more likely to perform unprotected anal intercourse with male partners in the past 6 months, have syphilis, and less likely to receive HIV counseling, testing, condoms, and peer education in the past year. The HIV counseling, testing, and peer education programs showed a negative association with HIV-positive status among Chongqing MSM. The HIV prevalence is still high. More programs must be implemented to effectively curb the HIV epidemic.

Mexico's evolving HIV epidemic.

A human immunodeficiency virus (HIV) outbreak was identified among people who inject drugs (PWID) in Glasgow in 2015, with >150 diagnoses by the end of 2019. The outbreak response involved scaling up HIV testing and improving HIV treatment initiation and retention. We parameterized and calibrated a dynamic, deterministic model of HIV transmission among PWID in Glasgow to epidemiological data. We use this model to evaluate HIV testing and treatment interventions. We present results in terms of relative changes in HIV prevalence, incidence, and cases averted. If the improvements in both testing and treatment had not occurred, we predict that HIV prevalence would have reached 17.8% (95% credible interval [CrI], 14.1%-22.6%) by the beginning of 2020, compared to 5.9% (95% CrI, 4.7%-7.4%) with the improvements. If the improvements had been made on detection of the outbreak in 2015, we predict that peak incidence would have been 26.2% (95% CrI, 8.8%-49.3%) lower and 62.7% (95% CrI, 43.6%-76.6%) of the outbreak cases could have been averted. The outbreak could have been avoided if the improvements had already been in place. Our modeling suggests that the HIV testing and treatment interventions successfully brought the HIV outbreak in Glasgow under control by the beginning of 2020.

BackgroundBotswana has the second-highest human immunodeficiency virus (HIV) infection rate in the world, with one in three adults infected. However, there is significant geographic variation at the district level and HIV prevalence is heterogeneous with the highest prevalence recorded in Selebi-Phikwe and North East. There is a lack of age-and location-adjusted prevalence maps that could be used for targeting HIV educational programs and efficient allocation of resources to higher risk groups.MethodsWe used a nationally representative household survey to investigate and explain district level inequalities in HIV rates. A Bayesian geoadditive mixed model based on Markov Chain Monte Carlo techniques was applied to map the geographic distribution of HIV prevalence in the 26 districts, accounting simultaneously for individual, household, and area factors using the 2008 Botswana HIV Impact Survey.ResultsOverall, HIV prevalence was 17.6%, which was higher among females (20.4%) than males (14.3%). HIV prevalence was higher in cities and towns (20.3%) than in urban villages and rural areas (16.6% and 16.9%, respectively). We also observed an inverse U-shape association between age and prevalence of HIV, which had a different pattern in males and females. HIV prevalence was lowest among those aged 24 years or less and HIV affected over a third of those aged 25–35 years, before reaching a peak among the 36–49-year age group, after which the rate of HIV infection decreased by more than half among those aged 50 years and over. In a multivariate analysis, there was a statistically significant higher likelihood of HIV among females compared with males, and in clerical workers compared with professionals. The district-specific net spatial effects of HIV indicated a significantly higher HIV rate of 66% (posterior odds ratio of 1.66) in the northeast districts (Selebi-Phikwe, Sowa, and Francistown) and a reduced rate of 27% (posterior odds ratio of 0.73) in Kgalagadi North and Kweneng West districts.ConclusionThis study showed a clear geographic distribution of the HIV epidemic, with the highest prevalence in the east-central districts. This study provides age- and location-adjusted prevalence maps that could be used for the targeting of HIV educational programs and efficient allocation of resources to higher risk groups. There is need for further research to determine the social, cultural, economic, behavioral, and other distal factors that might explain the high infection rates in some of the high-risk areas in Botswana.

Background:People who inject drugs are vastly over-represented, often accounting for 50% of prison inmates, so, the transmission of human immunodeficiency virus (HIV), hepatitis C virus (HCV) and tuberculosis (TB) is a serious problem in many prison systems. The prevalence of HCV infection is so disproportionately high in the correctional population that one in four detainees worldwide is living with HCV and the story is similar for HIV.Objective:The objective of the study is to find the prevalence of HIV, HCV and dual HIV-HCV infection in the prison inmates.Materials and Methods:A sample of 1569 jail inmates was assessed, after obtaining formal approval from the ethical committee for assessment of the medical record of subjects, to know sero-positivity for HIV and HCV. The data generated is then analysed.Results:The results show a very high point prevalence of HIV (10.0%) and HCV (31.6%) in the jail inmates, which is 40 and 30 times higher, respectively, as compared to the national average. A staggering 8.5% of the inmates were found to be positive for both viruses. The sero-prevalence for mono-infection for HCV (23.1%) is found to be significantly higher compared to HIV (1.5%). The infection rate of HCV was found to be three times higher compared to HIV.Conclusions:Substantially high prevalence of HIV, HCV and dual HIV-HCV infection exists in the prison inmates. Data suggests high virulence for HCV compared to HIV, as both viruses have common routes of transmission. There is an urgent need to keep a constant check on the intravenous drug usage (IDU) in the prisons that is linked to the common transmission of both these blood-borne viruses.

Human immunodeficiency virus (HIV) and hepatitis infections are among viral infectionstransmissible among inmates of orphanage and motherless babies' homes.Records are scanty on the prevalence of HIV and hepatitis infections in children resident in orphanage homes in Anambra State, Nigeria.This study investigated the prevalence of HIV and Hepatitis infections in children resident in eight orphanages in Anambra State.A total of 300 subjects consisting of 172 orphans, 100 children from community setting serving as controls, 14 female consented care givers in the orphanages and 14 females in community setting served as controls.All the subjects and control groups were investigated for HIV using rapid test and molecular technique.ELISA assay and liver enzyme estimation were used for Hepatitis investigation.The prevalence of 0.6%, 0.0%, 0.6%, and 9.9% were observed in HIV, hepatitis A, B and C respectively.Liver enzymes (serum alanine and aspartate amino transferases) did not show significant increase.The viral load and CD4+ count of the HIV positive child were 373 copies/ml and 28% respectively.Three (21.4%) of the care givers in the orphanages tested positive to HCV infection while none of the females in the community tested positive to the virus.HCV infections were most common in ages 0-5 years.The infection may be at dormant phase in the homes.Thus, continuous monitoring for progression into active hepatitis C infection is necessary for disease management in the orphanage homes.

To determine whether South African youths living in communities that had either of two youth human immunodeficiency virus (HIV) prevention interventions [(a) loveLife Youth Centre or (b) loveLife National Adolescent Friendly Clinic Initiative] would have a lower prevalence of HIV, sexually transmitted infections (STIs), and high risk sexual behaviours than communities without either of these interventions. In 2002 the baseline survey of a quasi-experimental, community-based study was conducted in South Africa. In total 33 communities were included in three study arms (11 communities per study arm). The final sample included 8735 youths aged 15-24 years. All participants took part in a behavioural interview and were tested for HIV, gonorrhoea (Neisseria gonorrhoeae) and Chlamydia (Chlamydia trachomatis). HIV prevalence was 20.0% among females and 7.5% among males (OR 3.93 95% CI 2.51-6.15). There were no significant differences between study arms for HIV, NG or CT prevalence at baseline. In multiple regression analyses, HIV was significantly associated with NG infection (OR 1.96 95% CI 1.24-3.12) but not with CT infection. Youths who reported >1 lifetime partner were also significantly more likely to be infected with HIV (OR 1.98 95% CI 1.55-2.52), as were those who reported ever having engaged in transactional sex (OR 1.86 P = 0.02) or having had genital ulcers in the past 12 months (OR 1.71 P < or = 0.001). HIV prevention programmes must ensure that gender inequities that place young women at greater risk for HIV infection are urgently addressed and they must continue to emphasize the importance of reducing the number of sexual partners and STI treatment.

Tuberculosis (TB) and infection with human immuno-deficiency virus (HIV) are leading infectious causes of morbidity particularly in sub-Saharan Africa, which is disproportionately affected by the two epidemics. Kenya is one of the 30 countries with the highest HIV and TB burden in the world. Kenya’s HIV prevalence was estimated to be 4,900 per 100,000 in 2019 while TB prevalence was 558 per 100,000 population in a 2016 survey. Estimates of mortality from TB and HIV were based on modeling of civil registration and vital statistics (CRVS) which may not be accurate in low- and middle-income countries due to under-reporting, poor documentation of causes of death and lack of verification of causes of death. In this thesis, we provide updated estimates of TB and HIV mortality using a variety of data sources including routine surveillance, post mortem surveillance for HIV infection and minimally invasive tissue sampling (MITS). We also evaluated two mortality preventive interventions. Our mortality studies documented a higher-than-expected HIV prevalence (28.5%) among 846 decedents received by high-volume mortuaries in western Kenya; 17% of deaths were attributable to HIV-infection. Half of HIV-infected decedents had viral load of ≥1,000 copies/milliliter. Among 456 decedents whose causes of death were determined by an expert panel, HIV/AIDS was the leading underlying cause of death (HIV cause-specific mortality rate: 251/100,000 population); TB was ranked 12th among immediate causes of death. Among 176 decedents aged under-five years, malnutrition, malaria, and HIV were the top three underlying causes of death. HIV prevalence among 176 decedents aged under-five years (14%) twenty-fold higher than the estimated prevalence among children in the population (0.7%); 96% of HIV-infected decedents were virally non-suppressed. While Mycobacterium tuberculosis was not detected among under-five decedents, five decedents (four HIV-infected) had been on TB treatment antemortem. Epidemiological analysis of national TB surveillance data showed that 28% of children aged &lt;14 years and 35% of adults on TB treatment were co-infected with HIV. The case fatality ratio during TB treatment was 4% in children and 6% in adults. The risk of death was five-fold higher among HIV-infected children who were not on ART compared to HIV-uninfected children; 42% of deaths during TB treatment were attributed to HIV-infection. In a retrospective analysis of data from an integrated TB/HIV active case-finding intervention conducted in Kisumu County, the odds of new HIV diagnoses among TB-symptomatic adults attending private not-for-profit facilities were thrice as high as those attending government facilities. An evaluation of the isoniazid preventive therapy (IPT) cascade among 856 HIV-infected children newly enrolled on HIV care over a four-year period revealed high coverage of screening for IPT eligibility (98%), but suboptimal initiation (68%) and completion (78%). Our mortality studies demonstrate that TB and HIV remain leading causes of death in Kenya despite the availability of effective interventions. Preventing mortality from these diseases would substantially contribute to a reduction in overall mortality in the population. Existing interventions against the two diseases should be evaluated to identify gaps that continue to contribute to excess mortality from TB and HIV.

Studies have documented high human immunodeficiency virus (HIV) prevalence among transwomen in the United States; however, to our knowledge, no studies have documented trends in HIV prevalence in this population. We used respondent-driven sampling to sample transwomen in San Francisco for 3 HIV prevalence and behavioral surveys in 2010, 2013, and 2016. Our analysis of point estimates and trends were weighted for the sampling method. Human immunodeficiency virus prevalence by serological testing in the survey was 38.8% (95% confidence interval [CI], 32.4-45.2), 33.7% (95% CI, 25.9-41.5), and 31.6% (95% CI, 12.2-38.1) in 2010, 2013, and 2016, respectively. Disparities in higher HIV prevalence by black, Latino, and Asian race/ethnicity and lower education level persisted through 2016. Based on a statistical test for trend, HIV prevalence among transwomen has remained high and stable from 2010 to 2016. Human immunodeficiency virus infection is still highest at 31.6% compared to any other group in San Francisco. We also observed that older transwomen had significantly higher odds of living with HIV than younger women over the last 2 waves of data collection. Taken together, these trends suggest that there is declining incidence of new HIV infections among low-income transwomen in San Francisco. Moreover, among transwomen, HIV disproportionately affects transwomen of color.

Background Using cross-sectional data from recent Demographic and Health Surveys (DHS) in 29 low- and middle-income countries, this study examined how youth and young adults (15-24 years) differ from older adults in human immunodeficiency virus (HIV) prevalence, knowledge and attitudes, risk taking, and economic vulnerability to the epidemic. Methods Using individual DHS data from 403,000 adults, logistic regression modeling was used to examine prevalence, knowledge, attitudes, and risky behaviors in 27 sub-Saharan African and two Caribbean countries. As DHS lacks a cohort design, we used inverse probability weighting (IPW) rather than the DHS sampling weights to adjust sample weights for selection bias, which reflects the fact that wealthier persons tend to live longer with HIV, making it appear that higher wealth is a risk factor for HIV prevalence. Results As in older adults, HIV prevalence among younger adults varies enormously across countries. Prevalence in adults ages 15-24 varies from lows of &lt; 0.3% (Niger, Ethiopia, Senegal, Burundi, The Gambia, Burkina Faso) to over 20 times higher in countries such as Zambia, Mozambique, and Lesotho. Multivariate results show that prevalence among youth and young adults is largely due to: (1) the high prevalence among young women, and (2) for both genders, the influence of family poverty in regions of high wealth inequality. We confirm previous studies showing that all women, including women 15-24 have far higher risk of HIV infection than comparable males. They develop faster physically, and our study data show that they are sexually active earlier, and that young women engage in more risky behaviors than young men. Conclusions Though one might imagine that HIV infections of young adults is due to more risky behaviors, our findings do not support this. Controlling for demographics and economic status, younger adults show better risk behavior than older adults for all three risky behaviors we study here. One important risk factor for the youth and young adults, both male and female, is being poor and living in regions with high wealth inequality, suggesting the need for continued targeting programs to reduce HIV risk for young men and young women separately, and concentrating those programs geographically in high wealth inequality areas.

This venue-based, cross-sectional study reports on human immunodeficiency virus (HIV) prevalence and behaviour of 649 men who have sex with men (MSM) in Antwerp and Ghent, Flanders, Belgium, from October 2009 to March 2010. Using time-location sampling, we found that HIV prevalence in MSM who attended different types of venue ranged from a high of 14.5% (95% CI: 8.9–20.1; n=22 in cruising venues to 4.9% (95% CI: 1.9–7.9; n=10) in more general gay venues to 1.4% (95% CI: 0.0–3.6; n=3) at younger MSM venues. Of those who tested HIV positive (n=35, five were unaware of their HIV status or self-reported as being HIV negative. One in five respondents were of non-Belgian nationality. The results showed relatively high rates of testing for HIV (52.2%; 95 % CI: 47.8–56.2; n=288) and other sexually transmitted infections (STIs) (57.4%; 95% CI: 52.6–62.0; n=248) in the last 12 months. A majority of the men (n=233) used condoms consistently during their last anal sexual contact with a casual partner; however, HIV-positive men who were aware of their serostatus (n=30) reported less condom use with casual partners. This is the first such study in Belgium and the results constitute the evidence base for local, targeted interventions. Furthermore, our findings underscore the need for European cross-border cooperation to prevent HIV infection and other STIs among MSM.

Background: About half of human immunodeficiency virus (HIV) infected children in Africa die before their second birthday if not treated. Majority of the HIV infected children who die have never been diagnosed as HIV infected or present too late to the health care facility, with advanced disease. To avert this, interventions to ensure early diagnosis of HIV infection in children will need to be expanded. Aims and Objectives: The present study was aimed at high lightening the usefulness of provider initiated testing and counseling of HIV in determining the prevalence of HIV exposure/infection among children (aged 0 -18 years) who attended the children out -patient clinic of Federal Medical Center Abakaliki (now Federal Teaching Hospital Abakaliki,). Materials and Methods: It is a retrospective study involved all the children that presented at the children out -patient clinic from March 2010 to February 2013, regardless of their presenting complaints and were referred for HIV antibody testing using the opt -out (provider initiated HIV testing and counseling [PITC]) model. The rapid tests were used to test for HIV. Results: A total of 13,652 children were tested within the 3 -year period, out of which 279 (2%) tested positive for HIV. Among those who tested positive to rapid test, 147 (52.7%) were males and 132 (47.3%) were females. Children 18 months (infected) had a prevalence rate 0.6% (86). There was statistically significant association between age and prevalence of HIV in the children ( P Conclusion: Findings from this research suggested that PITC could be used to identify many previously undiagnosed HIV infected children, many of whom maybe asymptomatic and are at high risk of mortality.