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ObjectivesWe examined data collected as part of the fifth round of integrated biological and behavioural surveillance to determine the prevalence and factors associated with HIV infection among female sex workers (FSWs) in Pakistan.MethodsFSWs were defined as ‘all females, age 13 years and above, who receive money or goods in exchange for sexual services, regardless of the site of operation’. Data were collected between October 2016 and January 2017 in 18 cities using multistage sampling techniques to randomly select FSWs from spots facilitated by peers. Behavioural data were collected by interviewers using structured questionnaires, which was followed by obtaining finger prick blood samples tested for HIV using two rapid tests. Multivariate logistic regression analysis was done to assess independent associations of potential correlates using HIV status as dependent variable.ResultsWe invited 5728 FSWs to participate, of which 68 refused to participate (refusal rate=1.2%). Of the 5660 FSWs who participated, 121 were HIV seropositive (weighted HIV prevalence 2.3%; 95% CI 1.9% to 2.7%) mostly concentrated within cities in Sindh. Multivariate analysis showed being uneducated/illiterate (adjusted OR (aOR) 2.1; 95% CI 1.4 to 3.4), directly dealing with clients without a pimp (aOR 1.8; 95% CI 1.1 to 2.8), non-use of condom with clients (aOR 1.8; 95% CI 1.1 to 2.8), having sexual contact with people who inject drugs (PWID) (aOR 2.2; 95% CI 1.3 to 3.7) and non-participation in HIV programmes (aOR 1.7; 95% CI 1.0 to 3.1) as factors independently associated with HIV seropositivity.ConclusionsWe found a weighted national HIV prevalence of 2.3% and identified factors independently associated with HIV in FSWs. The country needs to scale up HIV prevention programmes to improve coverage, prioritising FSWs who are illiterate, work independently and have PWID as sex partners. Emphasis should be laid on strategies to improve condom use with both regular and non-regular partners.

Non-tuberculous mycobacteria (NTM) such as Mycobacterium avium intracellulare are commonly encountered by HIV physicians and management strategies are well established. Experience of other NTM is, however, limited. As HIV epidemiology in the United Kingdom changes, we may expect the emergence of these lesser known mycobacterial infections. We present the first UK report of an AIDS patient who has survived infection with disseminated Mycobacterium simiae despite cerebrospinal fluid involvement, an extremely high level of baseline HIV viraemia and treatment complicated by severe immune reconstitution inflammatory syndrome.

Background We measured the prevalence of hearing sensitivity among HIV+ and HIV- men and women and identified associated risks co-factors. Methods Audiometric testing was conducted among 262 men [median age 54.7 years; 117 (44.7% HIV+; median (25th, 75th): nadir CD4+: 296 (191, 400); viral load (VL): 40 (40.40))] from the Baltimore-DC site of the Multicenter AIDS Cohort Study and 134 women [median age 45.2 years; 105 (78.4% HIV+; median (25th, 75th): nadir CD4+: 249 (92, 367); VL: 80 (48,1270))] from the DC site of the Women’s Interagency HIV Study. Pure-tone hearing thresholds were obtained at 500, 1000, 2000, and 4000 Hz and HL was defined as a pure tone average (PTA) ≥ 20 dB hearing level in either ear. A linear mixed model with a random-subjects effect was used to account for two repeated measurements (one per ear) adjusted for age, gender, race, HIV status, and noise exposure. The HIV+ model included nadir CD4+, peak CD8+, VL, ever having AIDS, ever monotherapy (MT), ever combination therapy (CT) and ever HAART use. Results 84 (95.2% men, 4.8% women) HIV- and 90 (65.6% men, 34.4% women) HIV+ participants had HL in the poorer ear. Age was a statistically significant risk factor of HL, however HIV status and noise exposure were not. In the HIV+ model, nadir CD4+, peak CD8+, VL, ever having AIDS, and MT were not statistically significantly associated with HL. Although there was a higher PTA and a lower PTA with ever CT and HAART use neither was significantly associated with HL. Conclusions We found no impact of HIV status or treatment variables on HL. HIV-infected individuals who used HAART had a lower PTA, an indicator of better hearing sensitivity. However, due to cross-sectional design of this study, it is not known whether HAART use protects hearing sensitivity.

Background In the menopausal transition, the occurrence of insomnia, genito-urinary, psychological and.vasomotor symptoms may occur and this may be aggravated by the diagnosis of HIV infection. Methods Cross-sectional study including 273 HIV-infected and 264 HIV uninfected Brazilian women. They were submitted to an interview to assess climacteric symptoms, socio-demographic characteristics and weight and height measurement. Results The average age was 47.7 ± 5.8 years in HIV seropositive women and 49.8 ± 5.3 years in seronegative (p Conclusions HIV infection in these groups was not associated with vasomotor symptoms, genito-urinary, psychological, and insomnia.

To examine the seroprevalence and correlates of antibodies to herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2), and to assess patients' knowledge and attitude towards genital herpes infection and its serotesting, before and after counselling.A cross sectional study among genitourinary medicine (GUM) clinic attenders in Coventry, a UK metropolitan city. Participants were asked to complete a self administered questionnaire before and after counselling. Patients were counselled before testing and after receiving the result. A commercially available enzyme immunoassay (EIA) was used to identify HSV-1 and HSV-2 antibodies (Gull/Meridian EIA).223 patients participated in the study (97% of eligible patients). Overall, prevalence of HSV-2 antibody was 43/216 (20%) (19/103, 18% for males and 24/113 (21%) for females, p=0.61) while prevalence of HSV-1 antibody was 129/215 (60%) (60% for both sexes, p=0.91). In the multivariate analysis HSV-2 seropositivity was higher among black people and those with a history of genital herpes. HSV-1 seropositivity was independently associated with less education, increased years of sexual activity (between 14-25 years), and history of cold sores. The majority of patients wanted this serotesting to be available in the clinic (204/222 (92%) before and 216/218 (99%) after counselling, p=0.0003) and 97% accepted the test when offered. Only three patients regretted having the test and four patients contacted the department within 6 months of receiving the results for more counselling.The vast majority of the study population not only wanted to be tested, but accepted the test when offered. HSV-2 infection is common and largely unrecognised among our study population. The psychological impact of introducing type specific HSV serological testing in a clinical setting seems to be minimal. Counselling could improve patients' awareness of the infection and the acceptability of the test and its results.

Editor,—The patients attending the STD clinics are at risk of having concurrent HIV infection. The trends of HIV infection in these patients may reflect the trends of HIV epidemic in the community. We have analysed the HIV status of 981 patients (824 males, 157 females) who attended our STD clinic from January 1993 to July 1999 (about 6½ years). The screening for HIV was done by ELISA. Those who were found positive were tested by repeat ELISA utilising another blood sample and considered HIV seropositive only, if both samples were found positive. The STDs were diagnosed by appropriate laboratory tests. The majority of the attenders had STDs; …