Acute HIV infection syndrome mimicking COVID-19 vaccination side effects: a case report

Background Symptoms of primary HIV infection, including fever, rash, and headache, are nonspecific and are often described as flu-like. COVID-19 vaccination side effects, such as fever, which occur in up to 10% of people following COVID-19 vaccination, can make the diagnosis of acute HIV infection even more challenging. Case presentation A 26-year-old man presented with fever and headache following COVID-19 vaccination. The symptoms were initially thought to be vaccine side effects. A diagnostic workup was conducted due to persisting fever and headache > 72 h following vaccination, and he was diagnosed with Fiebig stage II acute HIV infection, 3 weeks after having unprotected anal intercourse with another man. Conclusion Thorough anamnesis is key to estimating the individual risk of primary HIV infection, in patients presenting with flu-like symptoms. Early diagnosis and initiation of antiretroviral therapy is associated with better prognosis and limits transmission of the disease.

Acute HIV infection syndrome mimicking COVID-19 vaccination side effects : A case report

BackgroundSymptoms of primary HIV infection, including fever, rash, and headache, are nonspecific and are often described as flu-like. COVID-19 vaccination side effects, such as fever, which occur in up to 10% of people following COVID-19 vaccination, can make the diagnosis of acute HIV infection even more challenging.Case PresentationA 26-year-old man presented with fever and headache following COVID-19 vaccination. The symptoms were initially thought to be vaccine side effects. A diagnostic workup was conducted due to persisting fever and headache > 72 hours following vaccination, and he was diagnosed with Fiebig stage II acute HIV infection, 3 weeks after having unprotected anal intercourse with another man.ConclusionThorough anamnesis is key to estimating the individual risk of primary HIV infection, in patients presenting with flu-like symptoms. Early diagnosis and initiation of antiretroviral therapy is associated with better prognosis and limits transmission of the disease.

The effects of intimate relationship characteristics on unprotected anal intercourse among same-sex male couples in China: a dyadic analysis using the actor-partner interdependence model

Background Unprotected anal intercourse (UAI) within the context of concurrent sexual relationship are prevalent among men who have sex with men (MSM) who have regular male sex partners and it aggravates the risk of HIV infection among this community. The aim of this study was to assess the effect of intimate relationship characteristics on UAI among MSM couples at the dyadic level. Methods Two hundred four MSM couples were recruited from a HIV testing clinic from April 2017 to April 2018 in Guangzhou, China. The actor-partner interdependence model (APIM) was applied for dyadic analysis. Each MSM couple was divided into the insertive role and the receptive role according to their regular anal sex role. In this context, actor effect is the impact of an MSM’s intimate relationship characteristics on his own UAI, and partner effect is the impact of his partner’s intimate relationship characteristics on his UAI. Results Of the 408 participants, 58.82% had UAI with regular male sex partner (UAI-RP) and 8.09% had concurrent UAI. Intimate relationship characteristics were associated with concurrent UAI, but not associated with UAI-RP. For the receptive role, his relationship investment exerted significant actor and partner effects on concurrent UAI (AORactor = 1.31, P < 0.001; AORpartner = 1.17, P < 0.001). Meanwhile, receptive role’s violence experience within relationship exerted significant actor effects on his own concurrent UAI (AORactor = 6.43, P = 0.044). Conclusions Relationship investment and violence experience influenced concurrent UAI among MSM couples and it varied in different sex roles. Additional assistance on empowerment, relationship therapy and sexual agreement is urgently needed to reduce their high possibility on engagement of HIV-related risk behaviors.

Structural, Personal and Socioenvironmental Determinants of HIV Transmission among Transgender Women in Indonesia

Transgender populations are considered as a highly vulnerable group to HIV infection. This study aimed to understand structural, personal and socioenvironmental factors and the mechanisms through which these factors facilitate HIV transmission among transgender women (waria) in Yogyakarta, Indonesia. A qualitative inquiry using one-on-one in-depth interviews was employed to collect data from participants (n = 29). Thematic analysis was used to guide data analysis. Findings showed that poverty in families, a sense of responsibility to support family necessities, limited employment options and low education attainment were the structural factors driving participants’ engagement in sex work practices and unprotected anal intercourse, which facilitated HIV transmission among them. Personal need fulfilment and the desire for savings were personal factors driving their engagement in these high-risk practices that supported HIV transmission. Social relationships, social influence and the participants’ living environment were socioenvironmental factors that also supported sex work practices and HIV transmission among the participants. The findings indicate the need for capacity building in terms of knowledge and skills for waria populations to prepare and enable them to gain meaningful employment to prevent the vicious cycle of HIV transmission among them. As structural factors seemed to be the main drivers predisposing waria to HIV acquisition, further studies to explore effective HIV/AIDS interventions that address economic aspects of waria in Yogyakarta and other similar settings in Indonesia are recommended.

Impact of victimization during youth on adult high-risk sexual behaviour among gay and bisexual men

Based on the minority stress model, this study examines the impact of general and gay-specific childhood teasing on adult high-risk sexual behaviour among gay and bisexual men, mediated by depression and social anxiety. High-risk sexual behaviour was operationalized as the number of acts of unprotected anal intercourse with a partner of opposite or unknown HIV status, and also as the number of partners of opposite or unknown HIV status with whom an individual engaged in unprotected anal intercourse. Depression, social anxiety, and retrospective self-report of childhood teasing were measured at baseline, and sexual behaviour was measured at 6-month follow-up. Results indicate that gay-specific teasing, but not general teasing, was indirectly associated with number of high-risk sex acts via depression. Additionally, both types of teasing were directly associated with number of high-risk sex partners after accounting for depression and social anxiety.

Impact of victimization during youth on adult high-risk sexual behaviour among gay and bisexual men

Based on the minority stress model, this study examines the impact of general and gay-specific childhood teasing on adult high-risk sexual behaviour among gay and bisexual men, mediated by depression and social anxiety. High-risk sexual behaviour was operationalized as the number of acts of unprotected anal intercourse with a partner of opposite or unknown HIV status, and also as the number of partners of opposite or unknown HIV status with whom an individual engaged in unprotected anal intercourse. Depression, social anxiety, and retrospective self-report of childhood teasing were measured at baseline, and sexual behaviour was measured at 6-month follow-up. Results indicate that gay-specific teasing, but not general teasing, was indirectly associated with number of high-risk sex acts via depression. Additionally, both types of teasing were directly associated with number of high-risk sex partners after accounting for depression and social anxiety.

Infectious Proctitis in Ulcerative Colitis: The Importance of an Accurate Differential Diagnosis

The authors present the case of a 62-year-old male presenting with a relapse of ulcerative colitis. He had unprotected anal intercourse with other men and his medical record was remarkable for HIV infection. He was admitted to the emergency department with bloody diarrhea, tenesmus, urgency, and recent weight loss. Laboratory workup revealed de novo mild anemia and mild elevation of inflammation parameters. Endoscopic evaluation displayed loss of normal vascular pattern, edema, erythema, exudation, and superficial ulceration in the distal rectum. Biopsies showed chronic proctitis with mild to moderate activity. The patient was treated with intravenous glucocorticoids, but symptoms persisted. Extensive microbial study allowed the identification of multiple infectious agents with potential for infectious proctitis: cytomegalovirus, <i>Chlamydia trachomatis</i>, and <i>Blastocystis hominis</i>. This case highlights the importance of careful microbial investigation, supporting a detailed clinical history, in patients presenting with symptoms of inflammatory bowel disease flare, particularly in risk groups such as that with sexual risk.

The effective recruitment for high-risk MSM in the mobile HIV testing through social networking platforms (Preprint)

BACKGROUND Social networking platforms could be the direct path to recruit high-risk men who have sex with men (MSM) and promote the delivery of voluntary counselling and testing (VCT) as mobile HIV testing (MHT). The structured client recruitment and availability of MHT through social networking platforms need to further evaluate its effectiveness. OBJECTIVE This research aimed to compare the effects of targeting high-risk MSM and HIV case finding between two MHT recruitment and approaches through the website and social networking platforms. METHODS Comparative study design and propensity score matching (PSM) was applied. Traditional VCT model, the control group, recruited MSM on a website and provided a walk-in testing station at a gay zone on Friday and Saturday nights. Social networking VCT mode, the experimental group, recruited MSM from social networking platforms applying the reloading into and online discussion function in dating applications (apps) and Facebook, and referrals to social networks by the mobile phone app, and provided a test at a designated time and place during weekdays. RESULTS A total of 857 MSM were recruited over six months; the completion rate was 8.56% (616/7200) in the traditional VCT model and 20.8% (215/1033) in the social networking VCT mode. After PSM, there were 215 MSM in each group with a mean age of 29.97 (SD=7.609). The social networking model was more likely to reach MSM with HIV risk behaviours: those seeking sex through social media, having multiple sexual partners and unprotected anal intercourse, an experience of recreational drug use, and never having or not regularly having an HIV test than the traditional model. HIV positive rates (IRR=3.395, 95% CI=1.089-10.584, p=0.026) and clinic referred rates (IRR=0.028, 95% CI=0.001-0.585, p=0.006) were significantly higher among those in the social networking VCT model than the traditional VCT model. CONCLUSIONS Through effective recruitment strategies on social networking platforms, the social networking VCT mode can be smoothly promoted compared to traditional VCT model to target high-risk MSM and promote testing outcomes.

Recommendations for Intervention Content to Enhance HIV Pre-Exposure Prophylaxis Uptake among Men Who have Sex with Men Receiving Care at Sexually Transmitted Disease Clinics

Background and objective Pre-exposure prophylaxis (PrEP) uptake has been suboptimal. Sexually transmitted disease (STD) clinics provide important opportunities to scale PrEP uptake. Material and methods To inform the development of a brief intervention to enhance PrEP uptake in STD clinics, we conducted 32 qualitative interviews to explore barriers and facilitators of PrEP uptake among PrEP eligible, PrEP naïve, and men who have sex with men (MSM) presenting for STD screening services. We also solicited input for intervention components to enhance PrEP uptake at STD clinics. Results Most participants’ self-perceived HIV risks were low despite reporting unprotected anal intercourse. Many were reluctant to take any medications, expressed apprehension about perceived side effects of PrEP, and were unaware of how to obtain PrEP. Participants recommended that interventions focusing on enhancing PrEP uptake in STD clinics should include: culturally tailored educational materials about PrEP, informational graphics indicating PrEP’s relative efficacy in reducing HIV transmission risks, and comprehensive PrEP navigation. Most participants did not feel strongly about gender, race or ethnicity of providers; however, nearly all preferred gay affirming providers. Brief interventions to enhance PrEP uptake among MSM in STD clinics should include efforts to raise self-awareness of HIV risk, provide information about PrEP’s efficacy relative to other interventions, underscore PrEP’s relatively few side effects, and provide culturally tailored messaging.