scholarly journals Viral hauntology: Specters of AIDS in infrastructures of gay sexual sociability

2020 ◽  
Author(s):  
Kristian Møller ◽  
Chase Ledin
Keyword(s):  
Viral Load ◽  
Hiv Infection ◽  
Case Studies ◽  
Viral Transmission ◽  
Hiv Treatment ◽  
Social Lives ◽  
Medical Regimen ◽  
Somatic Condition ◽  
Exposure Prophylaxis ◽  
Hiv Negative

In recent years, HIV treatment has become so effective that a patients’ viral load can become so low that it is undetectable, which in turn reduces the risk of viral transmission to zero. At the same time for people who are HIV negative, the use of the medical regimen “pre-exposure prophylaxis”, or “PrEP”, reduces the risk of HIV infection by 92%-99%. In case studies of "the PrEP whore" and health disclosure on gay hookup apps, we think about HIV/AIDS not only as a somatic condition affecting a body, but also as a socio-technical matter. We argue that our concept of "viral hauntology" allows us to think deeply about how “old” technologies and their social lives fold over and into new ones, and how the folding process “drags” in order to imagine other, more inclusive, gay socio-sexual futures.

scholarly journals Southern African guidelines for the safe use of pre-exposure prophylaxis in men who have sex with men who are at risk for HIV infection

2012 ◽  
Vol 13 (2) ◽  
Author(s):  
Southern African HIV Clinicians Society Consensus Committee
Keyword(s):  
At Risk ◽  
Renal Function ◽  
Hiv Prevention ◽  
Hepatitis B ◽  
Hiv Infection ◽  
Creatinine Clearance ◽  
Fixed Dose ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
Hiv Negative

Background. The use of oral antiretrovirals to prevent HIV infection among HIV-negative men who have sex with men (MSM) has been shown to be safe and efficacious. A large, randomised, placebo-controlled trial showed a 44% reduction in the incidence of HIV infection among MSM receiving a daily oral fixed-dose combination of tenofovir disoproxil fumarate and emtricitabine (Truvada) in combination with an HIV prevention package. Improved protection was seen with higher levels of adherence. Aim. The purpose of this guideline is to: (i) explain what pre-exposure prophylaxis (PrEP) is; (ii) outline current indications for its use; (iii) outline steps for appropriate client selection; and (iv) provide guidance for monitoring and maintaining clients on PrEP. Method. PrEP is indicated for HIV-negative MSM who are assessed to be at high risk for HIV acquisition and who are willing and motivated to use PrEP as part of a package of HIV prevention services (including condoms, lubrication, sexually transmitted infection (STI) management and risk reduction counselling). Recommendations. HIV testing, estimation of creatinine clearance and STI and hepatitis B screening are recommended as baseline investigations. Daily oral Truvada, along with adherence support, can then be prescribed for eligible MSM. PrEP should not be given to MSM with abnormal renal function, nor to clients who are unmotivated to use PrEP as part of an HIV prevention package; nor should it be commenced during an acute viral illness. Three-monthly follow-up visits to assess tolerance, renal function, adherence and ongoing eligibility is recommended. Six-monthly STI screens and annual creatinine levels to estimate creatinine clearance are recommended. Hepatitis B vaccination should be provided to susceptible clients. Gastro-intestinal symptoms and weight loss are common side-effects, mostly experienced for the first 4 - 8 weeks after initiating PrEP. There is a risk of the development of antiretroviral resistance among those with undiagnosed acute HIV infection during PrEP initiation and among those with sub-optimal adherence who become HIV infected while on PrEP. Risk compensation (increasing sexual behaviours that can result in exposure to HIV) while on PrEP may become a concern, and clinicians should continue to support MSM clients to continue to use condoms, condom-compatible lubrication and practice safer sex. Research is ongoing to assess optimum dosing regimens, potential long-term effects and alternative PrEP medications. Recommendations for the use of PrEP among other at-risk individuals, and the components of these recommendations, will be informed by future evidence. S Afr J HIV Med 2012;13(2):40-55.

scholarly journals Pre-exposure prophylaxis for HIV-negative persons with partners living with HIV: uptake, use, and effectiveness in an open-label demonstration project in East Africa

2018 ◽  
Vol 1 ◽  
pp. 3 ◽  
Author(s):  
Renee Heffron ◽  
Kenneth Ngure ◽  
Josephine Odoyo ◽  
Nulu Bulya ◽  
Edna Tindimwebwa ◽  
...  
Keyword(s):  
Hiv Infections ◽  
Hiv Treatment ◽  
Demonstration Project ◽  
Hiv Incidence ◽  
Serodiscordant Couples ◽  
Treatment Services ◽  
Hiv Serodiscordant Couples ◽  
Exposure Prophylaxis ◽  
Living With Hiv ◽  
Hiv Negative

Background: Pre-exposure prophylaxis (PrEP) can provide high protection against HIV infection and is a recommended intervention for HIV-negative persons with substantial HIV risk.  Demonstration projects conducted in diverse settings worldwide illustrate practical examples of how PrEP can be delivered. This manuscript presents estimates of effectiveness and patterns of PrEP use within a two-year demonstration project of PrEP for HIV-negative members of heterosexual HIV serodiscordant couples in East Africa. Methods: The PrEP delivery model integrated PrEP into HIV treatment services, prioritizing PrEP use for HIV-negative partners within serodiscordant couples before and during the first 6 months after the partner living with HIV initiated antiretroviral therapy (ART).  We measured PrEP uptake through pharmacy records and adherence to PrEP through medication event monitoring system (MEMS) bottle caps and quantification of tenofovir in plasma among a random sample of participants. We estimated HIV infections prevented using a counterfactual cohort simulated from the placebo arm of a previous PrEP clinical trial. Results: We enrolled 1,010 HIV serodiscordant couples that were naïve to ART and PrEP.  Ninety-seven percent of HIV-negative partners initiated PrEP. Objective measures suggest high adherence: 71% of HIV-negative participants took ≥80% of expected doses, as recorded via MEMS, and 81% of plasma samples had tenofovir detected.  Four incident HIV infections were observed (incidence rate=0.24 per 100 person-years), a 95% reduction (95% CI 86-98%, p<0.0001) in HIV incidence, relative to estimated HIV incidence for the population in the absence of PrEP integrated into HIV treatment services.   Conclusions: PrEP uptake and adherence were high and incident HIV was rare in this PrEP demonstration project for African HIV-negative individuals whose partners were known to be living with HIV.  Delivery of PrEP to HIV-negative partners within HIV serodiscordant couples was feasible and should be prioritized for wide-scale implementation.

“Do I need to use condoms if I’m taking my meds?”

HIV ◽  
2020 ◽  
pp. 45-54
Author(s):  
Robert K. Bolan
Keyword(s):  
Viral Load ◽  
Sexual Transmission ◽  
Hiv Treatment ◽  
Load Testing ◽  
Hiv Replication ◽  
Viral Load Testing ◽  
Sexual Transmission Of Hiv ◽  
The Individual ◽  
Exposure Prophylaxis ◽  
Living With Hiv

It has been conclusively proven that sexual transmission of HIV does not occur if the individual living with HIV is adherent to antiretroviral therapy and HIV replication is consistently maintained below a plasma level of 200 copies/mL. What remains to be defined is the frequency of viral load testing to provide assurance that HIV is suppressed and how long must it remain so until suppression can be considered durable. This is required in order to provide guidance for HIV pre-exposure prophylaxis (PrEP) use by a sexual partner who is not living with HIV. Based on currently published studies and until more data are presented, it seems prudent to recommend that sexual partners of individuals living with HIV who are highly adherent to treatment use PrEP for 6 months to 1 year following initiation of HIV treatment and that viral load testing be performed quarterly for at least the first 2 years in the partner living with HIV.

Unsupervised PrEP in routine practice: a new challenge?

2019 ◽  
Vol 30 (7) ◽  
pp. 715-717
Author(s):  
Hélène Laroche ◽  
Caroline Lions ◽  
Olivia Zaegel-Faucher ◽  
Catherine Tamalet ◽  
Isabelle Poizot-Martin
Keyword(s):  
Viral Load ◽  
Hiv Infection ◽  
Western Blot ◽  
Plasma Viral Load ◽  
Routine Practice ◽  
Substantial Risk ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
Prevention Option ◽  
Prevention Of Hiv

Pre-exposure prophylaxis (PrEP) for the prevention of HIV infection with 300 mg daily tenofovir co-formulated with 200 mg emtricitabine is recommended as one prevention option for people who are at substantial risk of acquiring an HIV infection. We report the case of a 28-year-old man who has sex with men and who was referred to our unit for a primary HIV infection with positive p18, p24 and gp160 bands on Western blot analysis but with a low HIV plasma viral load. Although HIV misdiagnosis should always be considered in cases of atypical seroconversion pattern with a low viral burden, unsupervised PrEP should be systematically investigated.

Transmission of HIV infection by severe bites

2019 ◽  
Vol 30 (9) ◽  
pp. 927-929
Author(s):  
Mark G Thomas ◽  
Christopher J Hopkins ◽  
Christopher E Luey
Keyword(s):  
Viral Load ◽  
Hiv Infection ◽  
Post Exposure Prophylaxis ◽  
Hiv Viral Load ◽  
Post Exposure ◽  
Tissue Injuries ◽  
Exposure Prophylaxis ◽  
Severe Tissue

A 56-year-old man acquired HIV infection as the result of bites that caused severe tissue injuries. The features of the biting episode that led to transmission of infection were very similar to those in four other patients reported to have acquired HIV infection as the result of bites. Post-exposure prophylaxis should be recommended for people who have suffered bites that caused significant tissue injuries, inflicted by a person with known HIV infection, who had visible blood staining of their saliva at the time of biting, and an HIV viral load known or presumed to be greater than 3.0 log10 copies/ml.

Does qualitative viral load testing shorten the window period for diagnosing HIV in individuals attending for post-exposure prophylaxis?

2020 ◽  
Vol 31 (9) ◽  
pp. 816-819
Author(s):  
Gary Whitlock ◽  
Nneka Nwokolo ◽  
Keyword(s):  
Viral Load ◽  
Hiv Infection ◽  
Point Of Care ◽  
Fourth Generation ◽  
Post Exposure Prophylaxis ◽  
Hiv Incidence ◽  
Post Exposure ◽  
Window Period ◽  
Hiv Test ◽  
Exposure Prophylaxis

A fourth-generation HIV test is conventionally performed at baseline for individuals given HIV post-exposure prophylaxis (PEP). However, early HIV infection may be missed by fourth-generation tests especially in settings of high HIV incidence, meaning that recently infected individuals are potentially at risk of transmitting HIV. In 2013, HIV incidence in PEP recipients at the 56 Dean Street clinic was 7.6 per 100 person-years. We therefore wished to see if using a point-of-care PCR HIV test in such individuals would shorten the testing window period and pick up early infections that would be undiagnosed by conventional tests. We compared HIV detection in PEP recipients using the Cepheid GeneXpert® HIV-1 Qual viral load (Qual VL) assay with the standard HIV tests used in our clinical service. Between March 2017 and August 2018, a Qual VL assay was performed in addition to standard baseline HIV tests in consented PEP recipients. Of 494 consented PEP recipients, 476 had valid Qual VL assay results. Of these, 474 (99.6%) had a negative Qual VL result and were also negative on standard baseline HIV tests. Two (0.4%) tested positive for HIV on Qual VL. One of these patients was also HIV-positive on all baseline HIV tests. The other had discordant baseline point-of-care HIV test results. Although no additional HIV infections were diagnosed in PEP recipients using Qual VL, in one individual, it provided confirmation of new HIV infection more quickly than the standard HIV testing pathway.

scholarly journals Pre-exposure prophylaxis for HIV-negative persons with partners living with HIV: uptake, use, and effectiveness in an open-label demonstration project in East Africa

2017 ◽  
Vol 1 ◽  
pp. 3 ◽  
Author(s):  
Renee Heffron ◽  
Kenneth Ngure ◽  
Josephine Odoyo ◽  
Nulu Bulya ◽  
Edna Tindimwebwa ◽  
...  
Keyword(s):  
Hiv Infections ◽  
Hiv Treatment ◽  
Demonstration Project ◽  
Open Label ◽  
Serodiscordant Couples ◽  
Treatment Services ◽  
Hiv Serodiscordant Couples ◽  
Exposure Prophylaxis ◽  
Living With Hiv ◽  
Hiv Negative

Introduction: Pre-exposure prophylaxis (PrEP) can provide high protection against HIV infection and is a recommended intervention for HIV-negative persons with substantial HIV risk, such as individuals with a partner living with HIV.  Demonstration projects of PrEP have been conducted in diverse settings worldwide to illustrate practical examples of how PrEP can be delivered.  Methods: We evaluated delivery of PrEP for HIV-negative partners within heterosexual HIV serodiscordant couples in an open-label demonstration project in East Africa.  The delivery model integrated PrEP into HIV treatment services, prioritizing PrEP for HIV-negative partners within serodiscordant couples prior to and during the first 6 months after the partner living with HIV initiated antiretroviral therapy (ART).  We measured adherence to PrEP through medication event monitoring system (MEMS) bottle caps and quantification of tenofovir in plasma among a random sample of participants. We estimated HIV infections prevented using a counterfactual cohort simulated from the placebo arm of a previous PrEP clinical trial. Results: We enrolled 1,010 HIV serodiscordant couples that were naïve to ART and PrEP.  Ninety-seven percent (97%) of HIV-negative partners initiated PrEP, and when PrEP was dispensed, objective measures suggest high adherence: 71% of HIV-negative participants took ≥80% of expected doses, as recorded via MEMS, and 81% of plasma samples had tenofovir detected.  A total of 4 incident HIV infections were observed (incidence rate=0.24 per 100 person-years), a 95% reduction (95% CI 86-98%, p<0.0001) in HIV incidence, relative to estimated HIV incidence for the population in the absence of PrEP integrated into HIV treatment services.   Conclusions: PrEP uptake and adherence were high and incident HIV was rare in this PrEP demonstration project for African HIV-negative individuals whose partners were known to be living with HIV.  Delivery of PrEP to HIV-negative partners within HIV serodiscordant couples was feasible and should be prioritized for wide-scale implementation.

scholarly journals Maternal HIV Infection as a Risk Factor for Primary Epstein-Barr Virus Infection in Kenyan Infants

2022 ◽  
Vol 11 ◽  
Author(s):  
Gabriela Samayoa-Reyes ◽  
Sidney O. Ogolla ◽  
Ibrahim I. Daud ◽  
Conner Jackson ◽  
Katherine R. Sabourin ◽  
...  
Keyword(s):  
Risk Factor ◽  
Viral Load ◽  
Breast Milk ◽  
Hiv Infection ◽  
Post Partum ◽  
P Value ◽  
Hiv Status ◽  
Significant Difference ◽  
Maternal Hiv ◽  
Hiv Negative

Human immunodeficiency virus (HIV) infection is known to be associated with EBV shedding in saliva suggesting an increased risk of EBV transmission to infants born to mothers with HIV at an earlier age. In this study we investigated (i) whether maternal HIV status was a risk factor for EBV in blood at delivery or for shedding in saliva and breast milk of 6- and 10-weeks post-partum mothers, (ii) if there was a difference in EBV strains shed between HIV+ and HIV- mothers, and (iii) if maternal HIV status was a determinant of EBV viral load in their infants. Samples were collected as part of a prospective cohort study that followed HIV-positive (HIV+) and HIV-negative (HIV-) pregnant women in Western Kenya through delivery and post-partum period. EBV viral load in blood was found to be significantly higher in mothers with HIV (p-value = 0.04). Additionally, a statistically significant difference was observed between EBV viral load in saliva samples and HIV status where HIV+ mothers had a higher EBV viral load in saliva at 6-weeks post-partum compared to HIV- mothers (p-value &lt; 0.01). The difference in EBV shedding in breast milk was not found to be statistically significant. Furthermore, no difference in frequency of EBV strain was attributable to HIV- or HIV+ mothers. Interestingly, we found that infants born to HIV+ mothers had a higher EBV viral load at the time of their first EBV detection in blood than infants born to HIV- mothers and this was independent of age at detection. Overall, our study suggests that HIV infected mothers shed more virus in saliva than HIV-negative mothers and infants born to HIV+ mothers were at risk for loss of control of primary EBV infection as evidenced by higher EBV viral load following primary infection.

scholarly journals Modeling HIV disease progression and transmission at population-level: The potential impact of modifying disease progression in HIV treatment programs

2016 ◽  
Author(s):  
Jennifer M. Ross ◽  
Roger Ying ◽  
Connie L. Celum ◽  
Jared M. Baeten ◽  
Katherine K. Thomas ◽  
...  
Keyword(s):  
Viral Load ◽  
Hiv Infection ◽  
Disease Progression ◽  
Hiv Transmission ◽  
Acute Infection ◽  
Hiv Infections ◽  
Hiv Treatment ◽  
Hiv Viral Load ◽  
Potential Impact ◽  
The Impact

AbstractIntroductionMathematical models of HIV transmission that incorporate the dynamics of disease progression can estimate the potential impact of adjunctive strategies to antiretroviral therapy (ART) for HIV treatment and prevention. Suppressive treatment of HIV-positive persons co-infected with herpes simplex virus-2 (HSV-2) with valacyclovir, a medication directed against HSV-2, can lower HIV viral load, but the impact of valacyclovir on population HIV transmission has not been estimated.MethodsWe applied data on CD4 and viral load progression in ART-naïve persons studied in two HIV clinical trials to a novel, discrete-time Markov model. We validated our disease progression estimates using data from a trial of home-based HIV counseling and testing in KwaZulu-Natal, South Africa. Finally, we applied our disease progression estimates to a dynamic transmission model estimating the impact of providing valacyclovir to ART-naïve individuals to reduce onward transmission of HIV in three scenarios of different ART and valacyclovir population coverage. We assumed that valacyclovir reduced HIV viral load by 1.23 log copies/μL, and that persons treated with valacyclovir initiated ART more rapidly when their CD4 fell below 500 due to improved retention in pre-ART care.ResultsThe average duration of HIV infection following acute infection was 9.5 years. The duration of disease after acute infection and before reaching CD4 200 cells/μL was 2.53 years longer for females than males. Relative to a baseline of community HIV testing and counseling and ART initiation at CD4 <=500 cells/μL, valacyclovir with increased linkage to care resulted in 166,000 fewer HIV infections over ten years, with an incremental cost-effectiveness ratio (ICER) of $4,696 per HIV infection averted. The Test and Treat scenario with 70% ART coverage and no valacyclovir resulted in 202,000 fewer HIV infections at an ICER of $6,579.ConclusionEven when compared with initiation of valacyclovir, a safe drug that reduces HIV viral load, universal treatment for HIV is the optimal strategy for averting new infections and increasing public health benefit. Universal HIV treatment should be pursued by all countries to most effectively and efficiently reduce the HIV burden.

Specific features of pregnancy and delivery in HIV-infected women

2021 ◽  
Vol 70 (3) ◽  
pp. 103-113
Author(s):  
Olga L. Mozalyova ◽  
Anna V. Samarina
Keyword(s):  
Viral Load ◽  
Hiv Infection ◽  
Placental Abruption ◽  
Opportunistic Infections ◽  
High Viral Load ◽  
Chronic Viral Hepatitis ◽  
International Studies ◽  
Confounding Factors ◽  
Pregnancy And Delivery ◽  
Hiv Negative

HIV-infected women have a higher risk of complications during pregnancy and delivery (chronic placental insufficiency, anemia, placental abruption, preterm birth) compared with HIV-negative women, especially in case of opportunistic infections, immunodeficiency and a high viral load in the blood. The obstetrical pathologies are hard to study in these women because the above conditions are associated with a range of confounding factors that are not directly related to HIV infection but are often present, such as drug addiction, weight deficit, and chronic viral hepatitis coinfection. The literature review provides data from domestic and international studies on the correlation between HIV infection and the frequency of complications during pregnancy, delivery and the postpartum period, as well as the effect of the infection on the condition of newborns. The article cites current recommendations on the choice of delivery types for HIV-infected women.

Sign in / Sign up

Export Citation Format

Share Document