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The author discusses the care continuum among HIV-infected men who have sex with men (MSM) in the U.S. He relates the article "Updated data on linkage to HIV care and antiretroviral treatment among men who have sex with men - 20 cities, United States," by B. E. Hoots and colleagues. He discusses the prevalence of linkage to care and antiretroviral therapy (ART) coverage among HIV-infected persons in the country.

The article focuses on a study conducted by the authors related to the Use of Pharmacokinetic Data in Novel Analyses to Determine the Effect of topical Microbicides as Preexposure Prophylaxis Against HIV Infection. Tocpis disucssed include the VOICE trial failing to indicate the affectivity of topical tenofovir, oral tenofovir to protect women against HIV, high incidence of HIV infection among sub-Saharan African regions, and other studies to demonstrate product efficacy and effectiveness.

Background. Unsafe practices during illegal plasma donation in the late 1980s and early 1990s spread blood-borne infections in central China. Methods. A cross-sectional survey of a random sample of 538 adult residents of 12 villages in rural Shanxi Province, where there had been an illegal commercial plasma-collection center, was conducted in 2003. Structured questionnaires were administered, and blood samples were tested for hepatitis C virus (HCV) antibodies. Results. HCV seroprevalence rates were 8.2% in all subjects, 27.7% in former commercial plasma/blood donors, and 2.6% in nondonors. Selling blood or plasma was the strongest independent predictor of HCV seropositivity (odds ratio [OR], 14.4 [95% confidence interval {CI}, 7.1-31.6]). A history of blood transfusion was also independently associated with HCV seropositivity (OR, 8.3 [95% CI, 2.1-32.0]). Plasma donors had a higher risk of being HCV seropositive than did whole-blood donors (OR, 7.6 [95% CI, 2.9-20.9]), and female donors had a lower risk than did male donors (OR, 0.32 [95% CI, 0.12-0.80]). The strength of the association between selling blood and HCV seropositivity was weaker when plasma donors were excluded (OR, 8.0 vs. 14.4). Conclusions. Unsafe practices during illegal plasma donation led to a high risk of HCV seropositivity for donors during the 1980s and 1990s. Failure to screen for HCV increased the risk of seropositivity for transfusion recipients during this same period. China has taken steps to halt illegal plasma collection and to improve blood-banking methods. However, there will be an ongoing challenge to care for patients with HCV infection, even as its incidence decreases. [ABSTRACT FROM AUTHOR]

The human gene for CC chemokine receptor 5, a coreceptor for human immunodeficiency virus type 1 (HIV-1), affects susceptibility to infection. Most studies of predominantly male cohorts found that individuals carrying a homozygous deleted form of the gene, Delta 32, were protected against transmission, but protection did not extend to Delta 32 heterozygotes. The role played by this mutation in HIV-1 transmission to women was studied in 2605 participants in the Women's Interagency HIV Study. The Delta 32 gene frequency was 0.026 for HIV-1-seropositive women and 0.040 for HIV-1-seronegative women, and statistical analyses showed that Delta 32 heterozygotes were significantly less likely to be infected (odds ratio, 0.63 [95% confidence interval, 0.44-0.90]). The CCR5 Delta 32 heterozygous genotype may confer partial protection against HIV-1 infection in women. Because Delta 32 is rare in Africans and Asians, it seems plausible that differential genetic susceptibility, in addition to social and behavioral factors, may contribute to the rapid heterosexual spread of HIV-1 in Africa and Asia. [ABSTRACT FROM AUTHOR]

Seventeen women who were persistently uninfected by human immunodeficiency virus type 1 (HIV-1), despite repeated sexual exposure, and 12 of their HIV-positive male partners were studied for antiviral correlates of non-transmission. Thirteen women had > or = 1 immune response in the form of CD8 cell noncytotoxic HIV-1 suppressive activity, proliferative CD4 cell response to HIV antigens, CD8 cell production of macrophage inflammatory protein-1 beta, or ELISPOT assay for HIV-1-specific interferon-gamma secretion. The male HIV-positive partners without AIDS had extremely high CD8 cell counts. All 8 male partners evaluated showed CD8 cell-related cytotoxic HIV suppressive activity. Reduced CD4 cell susceptibility to infection, neutralizing antibody, single-cell cytokine production, and local antibody in the women played no apparent protective role. These observations suggest that the primary protective factor is CD8 cell activity in both the HIV-positive donor and the HIV-negative partner. These findings have substantial implications for vaccine development. [ABSTRACT FROM AUTHOR]

Presents a study which examined human immunodeficiency virus infection associated with ectopy among adolescent girls. Background on ectopy; Characteristics of subjects; Methods; Results.

Studies the impact of sexually transmitted viruses on the cytokine profile in genital tract secretions from female adolescents. Cytokine concentration distribution by category; Prediction model and influence of coinfection on cytokine concentration; Prediction of interleukin-10 concentrations with an ordinal logistic regression model.

To determine risk factors for squamous intraepitheliallesions (SIL) on Pap smear, 253 women at risk for human immunodeficiency virus (HIV) infection had Pap smear, HIV antibody testing, CD4+ cell measurements, and human papillomavirus (HPV) genome detection by Southern blot hybridization. Associated with SIL (P < .05) on univariate analysis were genital HPV (SIL prevalence in HPV-positive subjects, 36.3%; odds ratio [OR], 9.3; 95% confidence interval [CI], 4.2–20.3) and HIV infection (SIL prevalence in seropositive subjects, 21.9%; OR, 2.5; 95% Cl, 1.2–5.1). No demographic or behavioral variables were associated with risk for SIL. Multivariate analyses identified genital HPV infection (OR, 6.78; 95% Cl, 2.9–15.7), detection of known high-risk HPV types (OR, 11.8; 95% CI, 4.1–34.1), strong HPV Southern blot signal strength (OR, 10.8; 95% CI, 3.5–33.7), and severe HIV-related immunosuppression (OR, 3.1; 95% CI, 1.04–9.5) as independent risk factors associated with SIL. Thus, severe immunosuppression due to HIV infection increases the risk for SIL mediated by HPV infection. [ABSTRACT FROM PUBLISHER]

Incidence rates of AIDS illnesses are described among patients with ⩽100 CD4 cells/mm3 grouped by use of antiretrovirals and chemoprophylaxis. Data were obtained from 2646 homosexual men infected with human immunodeficiency virus type 1. Participants were in the Multicenter AIDS Cohort Study during 1985–1993. The incidence rates per 100 person-years for Pneumocystis carinii pneumonia were 47.4 without treatment, 21.5 with antiretrovirals alone, and 12.8 with antiretrovirals combined with chemoprophylaxis. For Kaposi's sarcoma these rates were 23.2, 11.3, and 15.1, respectively. The incidence of some opportunistic infections, including Mycobacterium avium complex, nonretinitis cytomegalovirus disease, and cytomegalovirus retinitis, increased among persons receiving P. carinii pneumonia prophylaxis, because of reduction of this pneumonia and extension of life span. The incidence pattern of AIDS-defining illnesses in patients receiving treatment points to the changing AIDS epidemic and the need for new therapies. The data are particularly relevant to the development and planning of clinical trials and to health care providers. [ABSTRACT FROM PUBLISHER]

A cross-sectional study was undertaken to determine the prevalence of Mycoplasma fermentans infection in patients with human immunodeficiency virus (HIV) infection using polymerase chain reaction methodology. Targeted M. fermentans DNA sequences could be amplified from the DNA extracted from the blood of 6 (11%) of 55 HIV-seropositive patients but from none of 26 HIV-seronegative subjects at low risk for HIV infection (P = .17). There was no correlation between M. fermentans infection and HIV clinical stage. There was a nonsignificant trend toward an association between M. fermentans infection and a history of syphilis. Infection with M. fermentans may occur more commonly in HIV-infected patients; however, a role as a copathogen or opportunistic infection was not established in this study. [ABSTRACT FROM PUBLISHER]

Over the last 10 years the appreciation of the full breadth of the spectrum of human immunodeficiency virus (HIV) infection has gradually increased; it is now known that AIDS represents merely the end stage of this progressive infectious process. The surrogate marker that most closely correlates with the stage of HIV infection is the CD4+, or T helper, cell count. Because this count is relied on in making important therapeutic decisions, it is of paramount importance that clinicians be cognizant of and fully understand the multiple factors that can influence this parameter: the variability of the count from day to day and from morning to night, the influence of intercurrent viral infections, the influence of drugs. In this AIDS Commentary, Sten H. Vermund and his colleagues at the National Institutes of Health discuss these issues and put the CD4+ cell count into a lucid and practical clinical perspective. Merle A. Sande [ABSTRACT FROM PUBLISHER]

The article reflects on the benefits of antiretroviral therapy (ART) in Africa. Topics of discussion included were transformational public health efforts in modern history with the U.S. President's Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria and effort to prevent human immunodeficiency virus (HIV) infection with ART-based care to infected persons. It also discusses the role of the South African government in HIV-related morbidity and mortality.

Presents a study which developed a molecular viability assay for human form of Pneumocystis carinii that is applicable to both clinical specimens and environmental samples. Materials and methods; Results; Significance of the assay.

Among 2099 uninfected subjects in phase I and II trials of candidate AIDS vaccines, 23 were diagnosed with intercurrent human immunodeficiency virus type 1 (HIV-1) infection. High-risk sexual exposures accounted for 17 infections, and intravenous drug use accounted for 6. Four subjects received placebo, 13 received a complete immunization schedule (⩾3 injections), and 6 were partially immunized (⩽2 injections). There was no significant difference between vaccine recipients and control groups in incidence of HIV-1 infection, virus load, CD4 lymphocyte count, or V3 loop amino acid sequence. In summary, 19 vaccinated subjects acquired HIV-1 infection during phase I and II trials, indicating that immunization with the products described is <100% effective in preventing or rapidly clearing infection. Laboratory analysis suggested that vaccineinduced immune responses did not significantly affect the genotypic or phenotypic characteristics of transmitted virus or the early clinical course of HIV-1 infection. [ABSTRACT FROM PUBLISHER]