Effect of HIV diagnosis disclosure on psychosocial outcomes in Thai children with perinatal HIV infection

Abstract Background The prevalence of Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) is much higher at extragenital anatomic sites among men who have sex with men (MSM) with HIV infection. National guidelines recommend that all MSM with HIV infection undergo screening for extragenital sexually transmitted infections (EG-STIs), however uptake is low in many primary care settings. We evaluated EG-STI screening by primary care providers (PCPs) for US Air Force (USAF) members with incident HIV infection. Methods All USAF members newly diagnosed with HIV infection who received initial HIV specialty care with Infectious Disease (ID) providers at Brooke Army Medical Center from 2016-2018 (n=98) were included. A retrospective chart review was conducted to evaluate STI screening performed by PCPs within 1 week of HIV diagnosis compared to screening at entry into ID care. Demographic, clinical, laboratory and behavioral risk data were collected. STI screening included GC/CT EG-STIs, urethral GC/CT, syphilis, and hepatitis B and C. Results Patients were predominantly male (97.9%) with a median age of 26 (IQR 23, 32) years at HIV diagnosis (Table 1). A previous history of STIs was reported in 53 (54.1%) patients and the majority of males self-identified as MSM (66.3%) or bisexual (22.5%). The median time from HIV diagnosis to ID evaluation was 26 days (IQR 9, 33). PCPs performed any STI screening in 61 (62.2%) patients (Table 2). EG-STI screening was conducted in 3 (3.1%) patients overall and in (3.4%) MSM/bisexuals. A total of 31 (31.6%) patients had missed STIs; the majority due to EG-STIs of the rectum (71%) and pharynx (21.9%). All EG-STIs would have been missed by urethral GC/CT screening alone. Table 1 Table 2 Conclusion EG-STI screening uptake was low among PCPs evaluating USAF members with incident HIV infection. Underutilization of EG-STI screening can result in missed infections and forward transmission of GC/CT. Barriers to low uptake need to be explored. Continued education and training of PCPs may be necessary to improve uptake of EG-STI screening. Disclosures All Authors: No reported disclosures

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Epidemiological factors associated with recent HIV infection among newly-diagnosed cases in Singapore, 2013–2017

BMC Public Health ◽

10.1186/s12889-021-10478-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Li Wei Ang ◽

Carmen Low ◽

Chen Seong Wong ◽

Irving Charles Boudville ◽

Matthias Paul Han Sim Toh ◽

...

Keyword(s):

Early Diagnosis ◽

Hiv Infection ◽

Hiv Transmission ◽

Risk Groups ◽

Newly Diagnosed ◽

Hiv Diagnosis ◽

Factors Associated ◽

Epidemiological Factors ◽

Voluntary Testing ◽

Recent Hiv Infection

AbstractBackgroundEarly diagnosis is crucial in securing optimal outcomes in the HIV care cascade. Recent HIV infection (RHI) serves as an indicator of early detection in the course of HIV infection. Surveillance of RHI is important in uncovering at-risk groups in which HIV transmission is ongoing. The study objectives are to estimate the proportion of RHI among persons newly-diagnosed in 2013–2017, and to elucidate epidemiological factors associated with RHI in Singapore.MethodsAs part of the National HIV Molecular Surveillance Programme, residual plasma samples of treatment-naïve HIV-1 positive individuals were tested using the biotinylated peptide-capture enzyme immunoassay with a cutoff of normalized optical density ≤ 0.8 for evidence of RHI. A recent infection testing algorithm was applied for the classification of RHI. We identified risk factors associated with RHI using logistic regression analyses.ResultsA total of 701 newly-diagnosed HIV-infected persons were included in the study. The median age at HIV diagnosis was 38 years (interquartile range, 28–51). The majority were men (94.2%), and sexual route was the predominant mode of HIV transmission (98.3%). Overall, 133/701 (19.0, 95% confidence interval [CI] 16.2–22.0%) were classified as RHI. The proportions of RHI in 2015 (31.1%) and 2017 (31.0%) were significantly higher than in 2014 (11.2%). A significantly higher proportion of men having sex with men (23.4, 95% CI 19.6–27.6%) had RHI compared with heterosexual men (11.1, 95% CI 7.6–15.9%). Independent factors associated with RHI were: age 15–24 years (adjusted odds ratio [aOR] 4.18, 95% CI 1.69–10.31) compared with ≥55 years; HIV diagnosis in 2015 (aOR 2.36, 95% CI 1.25–4.46) and 2017 (aOR 2.52, 95% CI 1.32–4.80) compared with 2013–2014; detection via voluntary testing (aOR 1.91, 95% CI 1.07–3.43) compared with medical care; and self-reported history of HIV test(s) prior to diagnosis (aOR 1.72, 95% CI 1.06–2.81).ConclusionAlthough there appears to be an increasing trend towards early diagnosis, persons with RHI remain a minority in Singapore. The strong associations observed between modifiable behaviors (voluntary testing and HIV testing history) and RHI highlight the importance of increasing the accessibility to HIV testing for at-risk groups.

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Perinatal Human Immunodeficiency Virus (HIV) Testing

PEDIATRICS ◽

10.1542/peds.89.4.791 ◽

1992 ◽

Vol 89 (4) ◽

pp. 791-794

Author(s):

Keyword(s):

Human Immunodeficiency Virus ◽

Hiv Infection ◽

Vertical Transmission ◽

Task Force ◽

Perinatal Transmission ◽

Pediatric Hiv ◽

Number Of Children ◽

Perinatal Hiv ◽

Seroprevalence Data ◽

Immunodeficiency Virus

PERINATAL INFECTIONS The primary route of human immunodeficiency virus (HIV) infection in infants is vertical transmission from HIV-infected mothers. This is of particular concern as the number of infected women and the number of children infected by perinatal transmission continue to increase rapidly. The number of perinatally acquired acquired immunodeficiency syndrome (AIDS) cases increased 17% in 1989 and 21% in 1990. Similarly, the number of heterosexually acquired AIDS cases increased 27% in 1989 and 40% in 1990. There is evidence that vertical transmission of HIV can occur in utero (congenital/transplacental, similar to rubella),1,2 in the postpartum period (breast-feeding), and perhaps in the intrapartum period (similar to hepatitis B).3 The relative frequency and efficiency of transmission during each of these periods remains uncertain. The best estimates of vertical transmission from an HIV-seropositive mother to the fetus range from 12.9% to 39%4-6 Although the risk of transmission appears to be increased in women who are symptomatic, this point is still unclear.5 Preliminary information suggests that the presence of high levels of high-affinity/avidity antibodies to specific epitopes of the gp 120 of HIV may be protective and may decrease or prevent vertical transmission,7-10 although others have not been able to confirm this finding.11 More detailed information on perinatal HIV infection,12 and infection control13 in pediatric HIV infection is available in previously published statements from the AAP Task Force on Pediatric AIDS. SEROPREVALENCE Anonymous seroprevalence data from newborn specimens are being collected in 44 states, Puerto Rico, and the District of Columbia. In some states, seroprevalence data are available by metropolitan area and/or by hospital of birth.

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Characteristics, mortality and outcomes at transition for adolescents with perinatal HIV infection in Asia

AIDS ◽

10.1097/qad.0000000000001883 ◽

2018 ◽

Vol 32 (12) ◽

pp. 1689-1697 ◽

Cited By ~ 4

Author(s):

Adam W. Bartlett ◽

Khan Huu Truong ◽

Wipaporn Natalie Songtaweesin ◽

Kulkanya Chokephaibulkit ◽

Rawiwan Hansudewechakul ◽

...

Keyword(s):

Hiv Infection ◽

Perinatal Hiv

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Antiretroviral Resistance and Pregnancy Characteristics of Women with Perinatal and Nonperinatal HIV Infection

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2016/4897501 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Gweneth B. Lazenby ◽

Okeoma Mmeje ◽

Barbra M. Fisher ◽

Adriana Weinberg ◽

Erika K. Aaron ◽

...

Keyword(s):

Drug Resistance ◽

Hiv Infection ◽

Univariate Analysis ◽

Categorical Variables ◽

Continuous Variables ◽

Resistance Mutations ◽

Hiv Drug Resistance ◽

Fourfold Increase ◽

Perinatal Hiv ◽

Adverse Pregnancy

Objective. To compare HIV drug resistance in pregnant women with perinatal HIV (PHIV) and those with nonperinatal HIV (NPHIV) infection.Methods. We conducted a multisite cohort study of PHIV and NPHIV women from 2000 to 2014. Sample size was calculated to identify a fourfold increase in antiretroviral (ARV) drug resistance in PHIV women. Continuous variables were compared using Student’st-test and Wilcoxon rank-sum tests. Categorical variables were compared usingχ2and Fisher’s exact tests. Univariate analysis was used to determine factors associated with antiretroviral drug resistance.Results. Forty-one PHIV and 41 NPHIV participants were included. Women with PHIV were more likely to have drug resistance than those with NPHIV ((55% versus 17%,p=0.03), OR 6.0 (95% CI 1.0–34.8),p=0.05), including multiclass resistance (15% versus 0,p=0.03), and they were more likely to receive nonstandard ARVs during pregnancy (27% versus 5%,p=0.01). PHIV and NPHIV women had similar rates of preterm birth (11% versus 28%,p=0.08) and cesarean delivery (47% versus 46%,p=0.9). Two infants born to a single NPHIV woman acquired HIV infection.Conclusions. PHIV women have a high frequency of HIV drug resistance mutations, leading to nonstandard ARVs use during pregnancy. Despite nonstandard ARV use during pregnancy, PHIV women did not experience increased rates of adverse pregnancy outcomes.

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Difficulties in primary diagnosis of HIV infection at the stages of health care settings

Epidemiology and Infectious Diseases (Russian Journal) ◽

10.17816/eid35187 ◽

2020 ◽

Vol 25 (1) ◽

pp. 11-17

Author(s):

Elena V. Esaulenko ◽

Kseniya E. Novak ◽

Thierry Ingabire ◽

Sof’ya A. Semenova ◽

Aleksandra O. Nikiforova

Keyword(s):

Infectious Diseases ◽

Hiv Infection ◽

Primary Care Physicians ◽

Sexual Transmission ◽

Laboratory Data ◽

Primary Diagnosis ◽

Newly Diagnosed ◽

Hiv Diagnosis ◽

Rapid Tests ◽

First Time

Aim: to demonstrate the difficulties and timeliness of HIV diagnosis by primary care physicians, to carry out a clinical and epidemiological analysis of newly diagnosed cases of HIV infection. Materials and methods: The study evaluated the routing of diagnosis and analyzed the epidemiological and clinical and laboratory data of 85 patients with a newly diagnosed HIV infection hospitalized in the St. Petersburg Clinical Infectious Diseases Hospital named after S. P. Botkin during the period from November 2018 to October 2019. To confirm positive results, ELISA and western blot were used. Results: Among the observed patients, 71.3% were women and 28.7% were men. The average age was 39.3 2 years. Upon admission to the infectious diseases hospital with an established diagnosis of HIV infection, 49.5% were hospitalized in specialized departments (n = 42). Of them, nine (9) were referred by the polyclinic with an established diagnosis, in 20 patients the diagnosis was established in somatic hospitals, and emergency room doctors newly diagnosed HIV infection in 13 more patients. The remaining 50.5% (n = 43) were hospitalized in various departments with other diagnoses. Clinical and laboratory analysis of these patients showed that for the first time in life, an established diagnosis of HIV infection corresponded to both early (15.3%) and late (84.7%) stages of the disease with dominance of sexual transmission of the virus (43.6%). Conclusion: HIV infection at both early and late stages can manifest under the guise of various other diseases, which makes it necessary to expand testing of patients for HIV infection, including using rapid tests.

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