Heterosexual transmission of HIV in Africa: an empiric estimate

For more than a decade, most experts have assumed that more than 90% of HIV in African adults results from heterosexual transmission. In this exercise, we show how data from studies of risk factors for HIV can be used to estimate the proportion from sexual transmission, and we present our estimates. Calculating two ways from available data, our two point estimates — we do not estimate confidence intervals — are that 25-29% of HIV incidence in African women and 30-35% in men is attributable to sexual transmission; these estimates assume 10% annual epidemic growth. These findings call for reconceptualization of research to more accurately assess routes of HIV transmission.

Download Full-text

HIV infections in sub-Saharan Africa not explained by sexual or vertical transmission

International Journal of STD & AIDS ◽

10.1258/095646202760326390 ◽

2002 ◽

Vol 13 (10) ◽

pp. 657-666 ◽

Cited By ~ 61

Author(s):

David Gisselquist ◽

Richard Rothenberg ◽

John Potterat ◽

Ernest Drucker

Keyword(s):

Hiv Transmission ◽

Sexual Transmission ◽

Hiv Infections ◽

Developed Countries ◽

Sub Saharan Africa ◽

African Women ◽

Heterosexual Transmission ◽

Direction Of Causation ◽

Sub Saharan ◽

Hiv Negative

An expanding body of evidence challenges the conventional hypothesis that sexual transmission is responsible for more than 90% of adult HIV infections in Africa. Differences in epidemic trajectories across Africa do not correspond to differences in sexual behaviour. Studies among African couples find low rates of heterosexual transmission, as in developed countries. Many studies report HIV infections in African adults with no sexual exposure to HIV and in children with HIV-negative mothers. Unexplained high rates of HIV incidence have been observed in African women during antenatal and postpartum periods. Many studies show 20%–40% of HIV infections in African adults associated with injections (though direction of causation is unknown). These and other findings that challenge the conventional hypothesis point to the possibility that HIV transmission through unsafe medical care may be an important factor in Africa's HIV epidemic. More research is warranted to clarify risks for HIV transmission through health care.

Download Full-text

Epidemiological Features and Risk Factors for Acquiring Hepatitis B, Hepatitis C, and Syphilis in HIV-Infected Patients in Shaanxi Province, Northwest China

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17061990 ◽

2020 ◽

Vol 17 (6) ◽

pp. 1990

Author(s):

Chao Zhang ◽

Qiang Ren ◽

Wenhui Chang

Keyword(s):

Risk Factors ◽

Hepatitis C ◽

Hepatitis B ◽

Hiv Transmission ◽

Treponema Pallidum ◽

Northwest China ◽

High Rate ◽

Shaanxi Province ◽

Heterosexual Transmission ◽

Hiv Positive

Human immunodeficiency virus (HIV)-infected patients are at a higher risk for co-infection with Hepatitis B virus (HBV), Hepatitis C virus (HCV), and Treponema pallidum (TP; the agent causing syphilis) than the general population. The prevalence of HBV, HCV, and syphilis has geographic differences and varies from region to region among HIV-positive individuals. A retrospective study was carried out on HIV-positive individuals between June 2011 and June 2016 in Shaanxi Province. Univariate and multivariate logistic regression analyses using stepwise regression analysis regarding risk factors for HIV–HBV, HIV–HCV, and HIV–syphilis co-infection. HBV–HCV, HCV–syphilis, HBV–syphilis, and HBV–HCV–syphilis co-infection rates were 1.7%, 2.2%, 2.6%, and 0.1%, respectively. The rate of ineffective hepatitis B vaccine immunization was as high as 30.2% among HIV-positive individuals. Ethnicity (OR = 31.030, 95% CI: 11.643–82.694) and HIV transmission routes (OR = 134.024, 95% CI: 14.328–1253.653) were the risk factors for HCV infection in HIV-positive individuals. Among the HIV-positive individuals with the antibodies of TP, the rate of homosexual transmission was also higher, but heterosexual transmission was lower (OR = 0.549 95% CI: 0.382–0.789) The HIV-infected patients in Shaanxi Province had the characteristics of low active detection rate and late diagnosis. The high rate of ineffective vaccination against HBV suggests a need for improved vaccination services.

Download Full-text

Sexually transmitted infections may assume an increasingly important role in the evolution of HIV transmission in Europe

Weekly releases (1997–2007) ◽

10.2807/esw.06.29.01923-en ◽

2002 ◽

Vol 6 (29) ◽

Author(s):

C M Lowndes

Keyword(s):

Sexually Transmitted Infections ◽

Drug Users ◽

Hiv Transmission ◽

Sexual Transmission ◽

Sexual Partners ◽

Heterosexual Transmission ◽

Sexually Transmitted ◽

The United Kingdom ◽

Sex With Men ◽

Sexual Transmission Of Hiv

Findings presented at the XIV International AIDS conference in Barcelona last week (7-12 July 2002) indicate that sexual transmission of HIV is assuming increasing importance in the western European context, in terms both of increased rates of reported new cases of heterosexual transmission, and of continuing transmission between men who have sex with men (MSM) (1). In some countries, such as the United Kingdom, Belgium and Denmark, relatively high and increasing proportions of new cases of heterosexual HIV transmission occur in migrants from countries with generalised HIV epidemics, where prevalence of sexually transmitted infections (STIs) may also be high (2-4). In other countries, particularly those of southern Europe, there is evidence of significant ongoing heterosexual transmission from injecting drug users (IDUs) (predominantly male) to their sexual partners (5).

Download Full-text

Man-to-woman sexual transmission of the human immunodeficiency virus. Risk factors related to sexual behavior, man's infectiousness, and woman's susceptibility. Italian Study Group on HIV Heterosexual Transmission

Archives of Internal Medicine ◽

10.1001/archinte.151.12.2411 ◽

1991 ◽

Vol 151 (12) ◽

pp. 2411-2416 ◽

Cited By ~ 34

Author(s):

A. Lazzarin

Keyword(s):

Risk Factors ◽

Human Immunodeficiency Virus ◽

Sexual Behavior ◽

Sexual Transmission ◽

Heterosexual Transmission ◽

Study Group ◽

Human Immunodeficiency Virus Risk ◽

Italian Study ◽

Immunodeficiency Virus

Download Full-text

Prevalence of different HIV-1 subtypes in sexual transmission in China: a systematic review and meta-analysis

Epidemiology and Infection ◽

10.1017/s0950268816000212 ◽

2016 ◽

Vol 144 (10) ◽

pp. 2144-2153 ◽

Cited By ~ 16

Author(s):

R. YUAN ◽

H. CHENG ◽

L.-S. CHEN ◽

X. ZHANG ◽

B. WANG

Keyword(s):

Hiv Transmission ◽

Meta Analysis ◽

Sexual Transmission ◽

Heterosexual Transmission ◽

Subtype C ◽

Comprehensive Overview ◽

Subtype B ◽

Pooled Prevalence ◽

Hiv 1 ◽

Subtype Distribution

SUMMARYSexual transmission has become the primary route of HIV transmission in China. Therefore, a comprehensive overview of HIV-1 subtype distribution is necessary for the prevention and control of the HIV epidemic. The present study aimed to provide a comprehensive prevalence estimate of different HIV-1 subtypes in sexual transmission in China. We conducted a systematic literature review for studies of HIV-1 subtypes in English and Chinese through several databases. Eligible articles were screened and selected by two authors independently. Random-effects model were applied to calculate the pooled prevalence of different HIV-1 subtypes, and subgroup analyses examined prevalence estimates across time, locations, and populations. A total of 130 eligible studies were identified, including 18 752 successfully genotyped samples. The pooled prevalence of CRF01_AE, subtype B, CRF07_BC, CRF08_BC, and subtype C were 44·54% (95% CI 40·81–48·30), 18·31% (95% CI 14·71–22·17), 16·45% (95% CI 13·82–19·25), 2·55% (95% CI 1·56–3·73), 0·37% (95% CI 0·11–0·72), respectively. The prevalence of subtype B in sexual transmission decreased, while the prevalence of CRF01_AE and CRF07_BC in sexual transmission, and CRF08_BC in heterosexual transmission increased. There is significant variation in HIV-1 subtype distribution between regions. The distribution of HIV-1 subtypes and circulating recombinant forms have changed significantly. The high genetic variability of HIV-1 poses a significant challenge for disease control and surveillance in China.

Download Full-text

THU0442 GOUT AND HEART FAILURE IN THE US: A NATIONAL PERSPECTIVE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3905 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 458.2-458

Author(s):

G. Singh ◽

M. Sehgal ◽

A. Mithal

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Confidence Intervals ◽

Burden Of Illness ◽

Average Length ◽

Private Insurance ◽

Significant Risk ◽

Case Fatality ◽

The United States ◽

The Us

Background:Heart failure (HF) is the eighth leading cause of death in the US, with a 38% increase in the number of deaths due to HF from 2011 to 2017 (1). Gout and hyperuricemia have previously been recognized as significant risk factors for heart failure (2), but there is little nationwide data on the clinical and economic consequences of these comorbidities.Objectives:To study heart failure hospitalizations in patients with gout in the United States (US) and estimate their clinical and economic impact.Methods:The Nationwide Inpatient Sample (NIS) is a stratified random sample of all US community hospitals. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. We examined all inpatient hospitalizations in the NIS in 2017, the most recent year of available data, with a primary or secondary diagnosis of gout and heart failure. Over 69,800 ICD 10 diagnoses were collapsed into a smaller number of clinically meaningful categories, consistent with the CDC Clinical Classification Software.Results:There were 35.8 million all-cause hospitalizations in patients in the US in 2017. Of these, 351,735 hospitalizations occurred for acute and/or chronic heart failure in patients with gout. These patients had a mean age of 73.3 years (95% confidence intervals 73.1 – 73.5 years) and were more likely to be male (63.4%). The average length of hospitalization was 6.1 days (95% confidence intervals 6.0 to 6.2 days) with a case fatality rate of 3.5% (95% confidence intervals 3.4% – 3.7%). The average cost of each hospitalization was $63,992 (95% confidence intervals $61,908 - $66,075), with a total annual national cost estimate of $22.8 billion (95% confidence intervals $21.7 billion - $24.0 billion).Conclusion:While gout and hyperuricemia have long been recognized as potential risk factors for heart failure, the aging of the US population is projected to significantly increase the burden of illness and costs of care of these comorbidities (1). This calls for an increased awareness and management of serious co-morbid conditions in patients with gout.References:[1]Sidney, S., Go, A. S., Jaffe, M. G., Solomon, M. D., Ambrosy, A. P., & Rana, J. S. (2019). Association Between Aging of the US Population and Heart Disease Mortality From 2011 to 2017. JAMA Cardiology. doi:10.1001/jamacardio.2019.4187[2]Krishnan E. Gout and the risk for incident heart failure and systolic dysfunction. BMJ Open 2012;2:e000282.doi:10.1136/bmjopen-2011-000282Disclosure of Interests: :Gurkirpal Singh Grant/research support from: Horizon Therapeutics, Maanek Sehgal: None declared, Alka Mithal: None declared

Download Full-text

Human anogenital monocyte-derived dendritic cells and langerin+cDC2 are major HIV target cells

Nature Communications ◽

10.1038/s41467-021-22375-x ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Jake W. Rhodes ◽

Rachel A. Botting ◽

Kirstie M. Bertram ◽

Erica E. Vine ◽

Hafsa Rana ◽

...

Keyword(s):

T Cells ◽

Dendritic Cells ◽

Cd4 T Cells ◽

Pathogen Detection ◽

Hiv Transmission ◽

Sexual Transmission ◽

Mononuclear Phagocytes ◽

Target Cells ◽

Epithelial Surface ◽

Transmission Studies

AbstractTissue mononuclear phagocytes (MNP) are specialised in pathogen detection and antigen presentation. As such they deliver HIV to its primary target cells; CD4 T cells. Most MNP HIV transmission studies have focused on epithelial MNPs. However, as mucosal trauma and inflammation are now known to be strongly associated with HIV transmission, here we examine the role of sub-epithelial MNPs which are present in a diverse array of subsets. We show that HIV can penetrate the epithelial surface to interact with sub-epithelial resident MNPs in anogenital explants and define the full array of subsets that are present in the human anogenital and colorectal tissues that HIV may encounter during sexual transmission. In doing so we identify two subsets that preferentially take up HIV, become infected and transmit the virus to CD4 T cells; CD14+CD1c+ monocyte-derived dendritic cells and langerin-expressing conventional dendritic cells 2 (cDC2).

Download Full-text

Confound it: latent lessons from the Mwanza trial of STD treatment to reduce HIV transmission

International Journal of STD & AIDS ◽

10.1258/095646203762869188 ◽

2003 ◽

Vol 14 (3) ◽

pp. 179-184 ◽

Cited By ~ 9

Author(s):

David Gisselquist ◽

John J Potterat

Keyword(s):

Sexually Transmitted Disease ◽

Hiv Transmission ◽

Additional Data ◽

Transmitted Disease ◽

Published Data ◽

Hiv Incidence ◽

Syndromic Management ◽

Sexually Transmitted ◽

Safe Injection ◽

Injection Safety

In 1995, an international team reported that improved syndromic management of sexually transmitted disease (STD) in Mwanza, Tanzania, had reduced HIV incidence by 38% in intervention compared to control communities. However, the team has not addressed confound: project interventions might have reduced HIV transmission during health care through provision of syringes and benzathine (replacing short acting) penicillin and through interactions with a coeval safe injection initiative. Mwanza's success in lowering HIV incidence is a puzzle, since it was achieved with only minor reductions in observed STD prevalence. Despite incomplete analyses, reports from Mwanza have encouraged expansion of STD treatment. However, should success be attributed to injection safety rather than to decreased STD prevalence — an hypothesis that fits published data — expanded STD treatment without attention to injection safety could, ironically, increase rather than decrease HIV incidence. To control for confound, additional data and analyses from the Mwanza study are warranted.

Download Full-text