Adolescents and Young Adults: The Pediatrician’s Role in HIV Testing and Pre- and Postexposure HIV Prophylaxis

Most sexually active youth in the United States do not believe that they are at risk for contracting HIV and have never been tested. Creating safe environments that promote confidentiality and respect, obtaining an accurate sexual and reproductive health assessment, and providing nonstigmatizing risk counseling are key components of any youth encounters. Pediatricians can play a key role in preventing and controlling HIV infection by promoting risk-reduction counseling and offering routine HIV testing and prophylaxis to adolescent and young adult (youth) patients. In light of persistently high numbers of people living with HIV in the United States and documented missed opportunities for HIV testing, the Centers for Disease Control and Prevention and the US Preventive Services Task Force recommend universal and routine HIV screening among US populations, including youth. Recent advances in HIV diagnostics, treatment, and prevention help support this recommendation. This clinical report reviews epidemiological data and recommends that routine HIV screening be offered to all youth 15 years or older, at least once, in health care settings. After initial screening, youth at increased risk, including those who are sexually active, should be rescreened at least annually, and potentially as frequently as every 3 to 6 months if at high risk (male youth reporting male sexual contact, active injection drug users, transgender youth; youth having sexual partners who are HIV-infected, of both genders, or injection drug users; youth exchanging sex for drugs or money; or youth who have had a diagnosis of or have requested testing for other sexually transmitted infections). Youth at substantial risk for HIV acquisition should be routinely offered HIV preexposure prophylaxis, and HIV postexposure prophylaxis is also indicated after high-risk exposures. This clinical report also addresses consent, confidentiality, and coverage issues that pediatricians face in promoting routine HIV testing and HIV prophylaxis for their patients.

206. Clinical and Molecular Characteristics of Community-associated Staphylococcus aureus Bacteremia in Injection and Non-injection Drug Users at a New York City Medical Center

Background The opioid epidemic has resulted in a dramatic resurgence of bacterial infections, most notably those due to Staphylococcus aureus (SA). We compared the demographic, clinical, and molecular factors of injection drug users (IDUs) and non-IDUs with SA bacteremia. Methods Patients with SA bacteremia were identified through a query of the electronic medical record EMR from January 2018 to December 2019 at a New York City medical center. All cases of community-associated (CA) SA bacteremia among adults with a history of active injection drug use were evaluated. Patients with positive SA blood cultures ≤ 72 hours of admission were considered CA. IDUs were identified with keyword searches and were deemed active if they had a history of use in the 12 months prior to admission. A randomly selected group of non-IDUs with CA SA bacteremia was used for comparison at a 4:1 ratio. Available SA isolates underwent Illumina whole genome sequencing (WGS). Using SRST2 multilocus sequence types (MLST), antimicrobial resistance genes and putative virulence factors were extracted. Results From January 2018 to December 2019, 669 patients with SA bacteremia were identified. 29 patients were active IDUs. Compared to 112 randomly selected non-IDUs, IDUs were significantly younger and more likely to be unstably housed (Table 1). Rates of MRSA were similar in IDUs (31%) and non-IDUs (32.1%). Endocarditis (44.8% vs 11.6%) and abscesses (27.6% vs 8.9%) were diagnosed more frequently in IDUs than non-IDUs. A positive hepatitis C antibody was strongly associated with SA bacteremia in IDUs (62.1% vs 6.3%, p< 0.001). WGS demonstrated comparable proportions of sequence types across IDUs and non-IDUs. ST8 accounted for the majority of infections in both groups (Table 2). MRSA bacteremia due to ST8 occurred in a higher proportion of IDUs (7/29, 24.1%) than non-IDUs (14/112, 12.5%). Conclusion IDUs with CA SA bacteremia have unique demographic and clinical features that differentiate them from non-IDUs. Endocarditis rates in IDUs are of particular concern. Use of these risk factors could allow hospitals to rapidly identify IDUs and offer them necessary medical and social services. WGS revealed a majority of MRSA bacteremia was due to one sequence type in IDUs (ST8). Further analysis of virulence genes in this cohort are ongoing. Disclosures Franklin D. Lowy, MD, GlaxoSmithKline (Advisor or Review Panel member)UpToDate (Other Financial or Material Support, Topic Writer and Editor) Anne-Catrin Uhlemann, MD, PhD, Merck (Grant/Research Support)

Features of using qualitative interviews with injection drug users

This article is dedicated to some features of using qualitative interviews when interviewing injection drug users. The main purpose of this article is to give young researchers and all social scientists some important hints and guidelines that would help them when using qualitative interviews for studying injection drug users. In the first part of the article authors make a literature review concerning specifics and advantages of using qualitative methods for studying specific groups or categories in sociology. However, there are many qualitative methods besides interview, that can be used for studying these groups (focus-groups, observation, content analysis, etc.), authors focus their attention on qualitative interviews as one of the most universal ones, considering its wide-spread use and advantages. In the second part of the article authors reveal and stress some major points on every stage of qualitative interview: preparation, literature review, methodology development, respondent recruiting, interviewing and analysis. Some of the major points are the understanding of the social and cultural context in which the studied group lives, always paying attention to the senses and meanings that respondent give to concepts that are important to the research, the importance of trust for the injection drug users due to the illegality of their actions that is crucial on both recruitment and interviewing stage, ethical issues concerning confidentiality and anonymity, etc. Also researches in this area include such components as practical recommendations and the ways or steps that could be taken to solve problems related to research problematic. Despite concentrating on the use of one particular method for studying people who use injection drugs, hints and guidelines given in this article can be applied to a wider list of specific respondent’s categories and can even be useful when choosing similar methods.

HBV, HCV, HIV & TB Prevalence in Injection Drug Users in Major Cities of Punjab, Pakistan- a Survey-Based Research Report

Hepatitis-B,C,HIV and TB among intravenous drug users continues to be a serious explanation for disease and death, this study was conducted to survey the prevalence of Hepatitis-B,C,HIV and TB in rehabilitation center of Punjab, Pakistan. A telephonic and visited survey of 78 rehabilitation centers in Punjab Pakistan to assess their treatment. An analysis of 21 responded that returned useable data revealed that only 7.2% patients of responded rehabilitation centers are positive for HEP-B. 33.23% patients are positive for HEP-C, 8.74% patients are positive for HIV and 0.87% patients are positive for TB. Majority of the respondent of whom doctors, psychologists believe that the patient, partner of the patient and their children should be offered for HEP-B,C,HIV and TB screening regularly.

Using Molecular Transmission Networks to Reveal the Epidemic of Pretreatment HIV-1 Drug Resistance in Guangxi, China

IntroductionPretreatment drug resistance (PDR) is becoming an obstacle to the success of ART. This study investigated the prevalence of PDR and the transmission clusters (TCs) of drug resistance mutations (DRMs) in two cities where drug abuse used to be high to describe the local HIV-1 transmission dynamics.MethodsPlasma samples were obtained from 1,027 ART-naïve patients in Guangxi. Viral subtypes and DRMs were identified. Transmission network and related factors were also determined.ResultsA total of 1,025 eligible sequences were obtained from Qinzhou (65.8%) and Baise (34.2%) cities. The predominant HIV-1 genotype was CRF08_BC (45.0%), followed by CRF01_AE (40.9%). The overall prevalence of PDR was 8.3%, and resistance to NNRTI was the most common. Putative links with at least one other sequence were found in 543/1,025 (53.0%) sequences, forming 111 clusters (2–143 individuals). The most prevalent shared DRMs included V106I (45.35%), V179D (15.1%), and V179E (15.1%). Clusters related to shared DRMs were more frequent and larger in CRF08_BC. The prevalence of shared DRMs increased with time, while the proportion of PDR gradually decreased. Age > 50 years was associated with clustering. Subtype CRF08_BC was more likely to have DRMs, PDR propagation, and DRM sharing.ConclusionPDR prevalence is moderate in this region. The association between PDR and subtype CRF08_BC suggested that DRMs spreading from injection drug users (IDUs) to heterosexuals (HETs) might be the major source of PDR in this region. Our findings highlight the significance of continuous surveillance of PDR.

Hepatitis C Virus Subtypes Novel 6g-Related Subtype and 6w Could Be Indigenous in Southern Taiwan with Characteristic Geographic Distribution

Hepatitis C virus (HCV) genotype (GT) 6 is the most genetically diverse GT and mainly distributed in Southeast Asia and south China but not Taiwan. Earlier studies showed the major HCV GTs in Taiwan were GT 1b and 2 with very rare GT 6 except in injection drug users (IDUs), and subtype 6a is the main GT 6 subtype among IDUs. Recently, we reported a much higher prevalence (18.3%) of GT 6 in Tainan City, southern Taiwan. This study was designed to clarify the subtypes of GT 6 in this endemic area. A total of 3022 (1343 men and 1679 women) HCV viremic patients were enrolled. Subtypes of GT 6 were determined by sequencing of core/E1 and nonstructural protein 5B in 322 of 518 GT 6 patients. The overall GT 6 prevalence rate was 17.1% (518/3022), with higher prevalence districts (>25%) located in northern Tainan. A novel 6g-related subtype is the most prevalent subtype (81.0%), followed by 6w (10.8%), 6a (7.5%), and 6n (0.7%). The high GT 6 prevalence in Tainan was mainly due to a novel 6g-related subtype and 6w. These two subtypes could be indigenous in Tainan with characteristic geographic distribution.

A Review of Hepatitis C Virus: Prevalence, Genotype, Risk Factors in Pakistan Last Quarter of Century

Hepatitis C virus has infected over 200 million people worldwide and is the most common blood-borne disease. Pakistan has the HCV prevalence rate of over 8%. A literature search has been performed using different keywords in different databases i.e. PubMed, Google Scholar, and NCBI. 6.2% prevalence rate was found in the general population, 4.13% in healthcare workers and a higher prevalence rate was observed in injection drug users and multi transfusion population. Use of injection was very frequent among the Pakistani population, reuse and sharing of syringes have an association with HCV infections. In Pakistan most prevalent genotype of HIV was 3a. Knowledge about HCV and its risk factors also varies with the educational background. Blood donors should be screened for HCV, awareness campaigns about different risk factors should be initiated at the government level, and strict regulation on healthcare waste should be implemented, these might help in preventing its spread to healthy individuals.