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High-risk human papillomavirus anal infections are common in human immunodeficiency virus-infected women. We conducted a cross-over study in 30 women seen in a California human immunodeficiency virus clinic, to test the feasibility of self-performed anal Pap smears. Women found the tests acceptable and feasible. Compared with physician-collected specimens, results were highly concordant for anal cytology (κ = 0.53) and high-risk human papillomavirus typing (κ = 0.59 inclusive of equivocal results, or κ = 0.81 excluding equivocal results).

Background: Technology-enabled approaches may reach suburban and rural men who have sex with men (MSM) who lack physical venues, where they live for sexually transmitted disease (STD)/HIV prevention efforts. We evaluated using Grindr, an all-male social networking platform, for STD/HIV prevention services to MSM by a suburban Public Health department., Methods: Phase 1 (October 2012-March 2013) focused on acceptability of prevention messages by MSM on Grindr and phase 2 (October 2013-March 2014) Grindr use for implementing testing and linkage-to-care. We compared the number of Public Health encounters with MSM before and after initiation of Grindr use and the proportion of users who remained engaged with Public Health staff after being told they were interacting with a health educator., Results: For a 6-month period before Grindr outreach, Public Health had 60 contacts with MSM. Contacts increased to 305 MSM in phase 1, of which 168/213 (79%) remained engaged. In phase 2, among 903 MSM contacts, 69% remained engaged. Asian and Hispanic MSM were more likely to remain engaged with outreach staff; white men were more likely to be not engaged. No significant difference in age between engaged and nonengaged MSM was seen., Conclusions: Grindr outreach by Public Health in a suburban county seems acceptable to MSM and leads to a 14-fold increase in MSM reached for counseling and education compared with a traditional outreach period. Further evaluation of technology-enabled approaches for STD/HIV prevention in suburban and rural MSM is warranted.

Objectives: Late HIV testing leads to preventable, severe clinical and public health outcomes. California, lacking a mature HIV surveillance system, has been excluded from documented analyses of late HIV testers in the United States. We identified factors associated with late HIV testing in the California AIDS surveillance data to inform programs of HIV testing and access to treatment., Methods: We analyzed data from California AIDS cases diagnosed between 2000 and 2006 and reported through November 1, 2007. Late testers were people diagnosed with HIV within 12 months before their AIDS diagnosis. We identified factors significantly associated with late HIV testing using multivariable logistic regression., Results: Among 28,382 AIDS cases, 61.2% were late HIV testers. Late testing was significantly associated with those > or = 35 years of age, heterosexual contact or unknown/other reported transmission risk, and being born outside of the U.S. When further classified by country of birth, people born in Mexico were most likely to be HIV late testers who progressed to AIDS., Conclusions: Our findings support wider implementation of opt-out HIV testing and HIV testing based in emergency departments. Services for HIV testing and treatment should be inclusive of all populations, but especially targeted to populations that may have more limited access.

To describe the determinants of delayed HIV presentation in one Northern California County, the authors identify persons with an opportunistic infection (OI) at HIV diagnosis. From 2000-2002, a sample of HIV patients attending a public AIDS program (n=391) were identified. Immigrants composed 24% of our sample; 78.7% of immigrants were Hispanic. Immigrants, compared to U.S.-born patients, presented with lower initial CD4+ counts at diagnosis than U.S.-born patients (287 cells/mm(3) vs. 333 cells/mm(3), p=0.143), were more likely to have an OI at HIV diagnosis (29.8% vs. 17.2%, p=0.009), and were more likely to be hospitalized at HIV diagnosis (20.2% vs. 12.5%, p=0.064). We found only immigrant status was significantly and independently associated with delayed presentation. Interviews with 20 newly HIV diagnosed Hispanic patients suggest lack of knowledge regarding HIV risk, social stigma, secrecy and symptom driven health seeking behavior all contribute to delayed clinical presentation. The main precipitants of HIV testing for immigrants were HIV/AIDS related symptoms and sexually transmitted infection (STI)/HIV diagnosis in a sexual partner. These results support augmentation of STI/HIV voluntary clinical testing and partner notification services along the Mexico-California migrant corridor.

Coinfections with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are common globally. HIV infection modifies the course of HBV infection by increasing rates of chronicity, prolonging HBV viremia, and increasing liver-related morbidity. To minimize the emergence of HIV and/or HBV resistance, as well as the emergence of liver enzyme flares, the treatment of both infections should be coordinated. Lamivudine or emtricitabine monotherapy readily selects resistant strains in the YMDD motif of the polymerase gene. Adefovir and tenofovir are fully active in the presence of YMDD mutations [corrected] If HBV treatment can be deferred until combination antiretroviral therapy for HIV infection is needed, the combination of tenofovir plus lamivudine or emtricitabine provides potent HBV therapy and a solid backbone for HIV combination antiretroviral therapy, and it likely decreases the emergence of HBV resistance.

Objectives/goal: We compared risk behaviors and HIV testing between recent (in the U.S. <5 years) and established (in the U.S. >5 years) Hispanic immigrant men (N = 410)., Study: This study was a population-based, cross-sectional survey of HIV/sexually transmitted disease markers and risk behaviors in men age 18 to 35 years residing in low-income census block groups in 3 northern California counties., Results: Recent immigrants were less likely to currently have a main sexual partner (45.3% vs. 67.2%, P <0.01) and more likely to have ever used commercial sex workers (40.0% vs. 27.6%, P <0.01). Recent immigrants were less likely to receive medical care in the last 6 months (21.2% vs. 31.3%, P = 0.04) or had ever been HIV tested (26.0% vs. 43.3%, P <0.01). Established immigrants more likely reported unprotected sex, hallucinogen or ecstasy use., Conclusions: Recent Hispanic immigrants have less stable sexual partnerships and less health-seeking behavior, including HIV testing. Established immigrants report HIV test rates comparable to the national average.

BackgroundDaily preexposure prophylaxis (PrEP) with oral emtricitabine and tenofovir disoproxil fumarate (FTC/TDF) decreases the risk of human immunodeficiency virus (HIV) acquisition. Initiation of TDF decreases bone mineral density (BMD) in HIV-infected people. We report the effect of FTC/TDF on BMD in HIV-seronegative men who have sex with men and in transgender women.MethodsDual-energy X-ray absorptiometry was performed at baseline and 24-week intervals in a substudy of iPrEx, a randomized, double-blind, placebo-controlled trial of FTC/TDF PrEP. Plasma and intracellular tenofovir concentrations were measured in participants randomized to FTC/TDF.ResultsIn 498 participants (247 FTC/TDF, 251 placebo), BMD in those randomized to FTC/TDF decreased modestly but statistically significantly by 24 weeks in the spine (net difference, -0.91% [95% confidence interval {CI}, -1.44% to -.38%]; P = .001) and hip (-0.61% [95% CI, -.96% to -.27%], P = .001). Changes within each subsequent 24-week interval were not statistically significant. Changes in BMD by week 24 correlated inversely with intracellular tenofovir diphosphate (TFV-DP), which was detected in 53% of those randomized to FTC/TDF. Net BMD loss by week 24 in participants with TFV-DP levels indicative of consistent dosing averaged -1.42% ± 29% and -0.85% ± 19% in the spine and hip, respectively (P < .001 vs placebo). Spine BMD tended to rebound following discontinuation of FTC/TDF. There were no differences in fractures (P = .62) or incidence of low BMD.ConclusionsIn HIV-uninfected persons, FTC/TDF PrEP was associated with small but statistically significant decreases in BMD by week 24 that inversely correlated with TFV-DP, with more stable BMD thereafter.Clinical trials registrationNCT00458393.

In Peru, men who have sex with men (MSM) should be added to the groups at risk for hepatitis B (HBV) infection which include persons from endemic areas, health care workers and commercial sex workers. Given the shared sexual risk factors for transmission, co-infection with HBV and HIV is common in MSM and high risk heterosexuals. The treatment of chronic HBV infection needs to be carefully coordinated with HIV management in HBV-HIV co-infected patients. The main treatment goals for HBV infection are to suppress HBV replication, improve liver function, and minimize the emergence of HBV and HIV drug resistance. In this article, we review the epidemiology of HBV in Peru, the natural history of HBV-HIV co-infection, and describe current treatment options in the Peruvian context. [ABSTRACT FROM AUTHOR]

An abstract of the article "HIV-1 Evolution and Drug Resistance Among Patients Receiving Antiretroviral Therapy in San Mateo county, California, 1997-2006," by Sudeb Dalai, Jonathan Dyal, Keyan Salari, Seble Kassaye, Vivian Levy, Dennis Israelski and David Katzenstein is presented.