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Objectives Recently developed genotyping tools allow better understanding of Trichomonas vaginalis population genetics and epidemiology. These tools have yet to be applied to T vaginalis collected from HIV + populations, where understanding the interaction between the pathogens is of great importance due to the correlation between T vaginalis infection and HIV transmission. The objectives of the study were twofold: first, to compare the genetic diversity and population structure of T vaginalis collected from HIV + women with parasites from reference populations; second, to use the genetic markers to perform a case study demonstrating the usefulness of these techniques in investigating the mechanisms of repeat infections. Methods Repository T vaginalis samples from a previously described treatment trial were genotyped at 11 microsatellite loci. Estimates of genetic diversity and population structure were determined using standard techniques and compared with previously reported estimates of global populations. Genotyping data were used in conjunction with behavioural data to evaluate mechanisms of repeat infections. Results T vaginalis from HIV + women maintain many of the population genetic characteristics of parasites from global reference populations. Although there is evidence of reduced diversity and bias towards type 1 parasites in the HIV + population, the populations share a two-type population structure and parasite haplotypes. Genotyping/behavioural data suggest that 36% (12/33) of repeat infections in HIV + women can be attributed to treatment failure. Conclusions T vaginalis infecting HIV + women is not genetically distinct from T vaginalis infecting reference populations. Information from genotyping can be valuable for understanding mechanisms of repeat infections.

Previous studies have indicated a potential association between trauma, such as physical violence, emotional violence and sexual violence, and high-risk sexual behavior. Female sex workers (FSWs) were interviewed to elicit history of traumatic events and sexual behaviors. Among 187 participants, 79 (42.2 %) inconsistently used condoms with clients in the past 30 days. Experiencing community violence (OR: 0.4; 95 % CI: 0.2, 0.8) was found to be significantly protective for inconsistent condom use. In this study, experiencing community violence was found to be protective for inconsistent condom use among FSWs, but none of the other trauma subgroups had significant associations with inconsistent condom use. Reasons for unprotected sex among FSW may be more related to economic or other contextual factors.

Objective To discuss the epidemiology of Trichomonas vaginalis (TV) and HIV co-infections, the role of TV in acquisition and transmission of HIV, special treatment considerations for TV among women with HIV and the prevention of TV among HIV-infected persons. Design Systematic review. Data source Review of literature of EMBASE and PubMed databases from January 1990 to February 2013. Search keywords included TV , HIV co-infections, HIV acquisition, HIV transmission, HIV shedding, TV treatment, HIV and couples studies. Review method We included studies of any design that contained the selected search words and were published during the specified time frame. We then searched the reference lists of included papers for additional papers and included these when relevant. Results There is strong evidence that TV increases both transmission and acquisition of HIV among women, and that successful treatment for TV can reduce HIV genital shedding. Single dose metronidazole (MTZ) should no longer be used for HIV+ women with TV given the high rates of asymptomatic bacterial vaginosis co-infections and other factors that may render MTZ less effective in HIV+ women. Prevention of TV among HIV+ persons is similar to among HIV, including promotion of condoms as well as regular screening and prompt treatment. There may be a role for expedited partner treatment for the prevention of repeat infections, but most repeat infections are clinical treatment failures. Diligence in screening and treating TV among both HIV- susceptible and HIV+ persons is an important public health strategy.

Summary We aimed to examine whether out-of-pocket (OOP) costs associated with chlamydia (CT) and gonorrhoea (GC) screening tests is a barrier to receiving CT/GC re-screening and follow-up annual screening. A major health insurance claims database 2006–2010 was used for analysis. The date of first CT/GC diagnosis was used as the index date, and OOP costs at index date for screening tests were retrieved. A re-screening test and an annual screening were defined as tests that occurred within 90–180 days and 181–395 days of the index date, respectively. Re-screening rates were 11.7% and 10.9% and annual screening rates were 24.7% and 23.7% for CT and GC cases, respectively. Compared with the CT patients without OOP expenses, those with OOP expenses of $30 or higher had significantly reduced likelihood of receiving re-screening and annual screening. Similar results were found for GC patients. We concluded that OOP costs serve as a significant barrier to re-screening and annual screening.

Background Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are the most commonly reported notifiable diseases in the United States, with annual reported cases exceeding 1.2 million and estimated costs exceeding $1.2 billion. Reported Emergency Department (ED) prevalence rates for CT and GC for adolescents and young adults range from 0.9% to 8.1%. Objective Our aim was to evaluate the burden of CT/GC infection in ED patients, assess the extent of associated under- and overtreatment, and investigate mechanisms whereby ED screening can be feasible. Methods We performed a systematic review of the time period from 1995 to 2010. Discussion Positivity rates for ED patients are comparable with other high-risk populations, and sufficient for selected screening to be cost-effective. Unfortunately, ED patient follow-up is notoriously difficult, and clinicians frequently must choose to either delay treatment until laboratory confirmation or presumptively treat based on presenting symptoms and clinical diagnosis. This results in high rates of both undertreatment (i.e., not treating those infected) and overtreatment (i.e., treating those who are infection-free). Incorrect on-the-spot treatment decisions can result in potentially infected future partners and lack of follow-up treatment, or unnecessary treatment and personal stress associated with improper diagnosis. Conclusions ED clinician activities are frequently symptom-driven, and screening nonsymptomatic patients presents a major barrier. Educating ED clinicians on the topics of CT/GC epidemiology, sample collection, and analysis will enable them to address the risks in their presenting populations. Collaboration with health department partners for sample analysis, cost-sharing, and patient follow-up can make routine screening feasible and enable EDs to become more important partners in intervention programs.

A previous case report of West Nile virus (WNV) illness during pregnancy suggested that WNV could be a cause of congenital defects. We performed a prospective, longitudinal cohort study of pregnant women with WNV illness to increase our knowledge of the effects of WNV illness during pregnancy.Participants were enrolled in 2005 to 2008 from pregnant women with serologically confirmed WNV illness reported to the Centers for Disease Control and Prevention. Comparison was made to WNV-uninfected women, matched on maternal age and enrollment month. Pregnancy and newborn data were collected; cord blood WNV serology was obtained. Pediatric exams and the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) were performed.Twenty-eight WNV-infected mothers and 25 WNV-uninfected mothers participated. Maternal demographics were similar except for a higher rate of planned pregnancies, education, and household income in the WNV-uninfected mothers. There were no differences in pregnancy and delivery characteristics except that infected mothers had a higher incidence of febrile illnesses and used more medications. Birth weight, length, head circumference, and rate of congenital malformations were similar in babies born to WNV-infected and -uninfected mothers. Follow-up physical exams were generally normal. The Bayley-III assessments, available for 17 children born to mothers with WNV illness, showed performance at or above age level across domains.The risk for adverse pregnancy and newborn outcomes in women experiencing WNV illness in pregnancy appears to be low, but future studies with larger numbers are needed to rule out a small risk. Birth Defects Research (Part A) 106:716-723, 2016. © 2016 Wiley Periodicals, Inc.

Multiple sexual partnerships (MSP), both concurrent and serial short gap, are thought to increase the risk of HIV and sexually transmitted infection (STI) acquisition and transmission. In this study we evaluate potential individual and environmental risk factors for engaging in MSP in a cohort of newly arrived Latino migrant men (LMM) in New Orleans, LA, USA. Participants were surveyed at three time points over a nine-month period to examine factors associated with MSP. Of the 113 men, 32.5 % reported ever MSP. In 290 observations, 19.5 % of men had concurrent, and 15.0 % had serial short gap partnerships in at least one interviews. Substance was associated with MSP, OR (95 % CI) 2.00 (1.16, 3.45) whereas belonging to a community organization was found to be protective, OR 0.32 (0.17, 0.59). Interventions to reduce substance use and promote social connection are needed to prevent a potential HIV/STI epidemic in this population.

This study examines factors associated with the acceptability of receiving sexually transmitted disease (STD) laboratory results by text message and e-mail among clinic attendees.An anonymous self-administered survey was conducted with a convenience sample of STD clinic attendees in South Carolina and Mississippi in 2009-2010. In total, 2,719 individuals with a median age of 26 years (interquartile range, 21-32 years) completed the survey.More than 70% had Internet access at home, and 80% reported using text messaging daily. Participants preferred receiving laboratory results by text message compared with e-mail (50.2% versus 42.3%; p0.001). Acceptability of receiving laboratory results by text message was higher with younger age (adjusted odds ratio [aOR] 1.13; 95% confidence interval [CI] 1.10-1.26), daily use of text messaging (aOR 1.30; 95% CI 1.14-1.49), and reporting cell phone and text message as the preferred choice of regular communication with the clinic (aOR 2.31; 95% CI 1.50-3.58) and was significantly lower in female subjects (aOR 0.89; 95% CI 0.81-0.98) and those with college-level education (aOR 0.88; 95% CI 0.77-0.99).A majority of STD clinic attendees have access to cell phones and Internet. The acceptability of receiving STD laboratory results electronically may facilitate test result delivery to patients and expedite treatment of infected individuals.

There is growing interest in the application of propensity scores (PS) in epidemiologic studies, especially within the field of reproductive epidemiology. This retrospective cohort study assesses the impact of a short interpregnancy interval (IPI) on preterm birth and compares the results of the conventional logistic regression analysis with analyses utilizing a PS. The study included 96,378 singleton infants from Louisiana birth certificate data (1995-2007). Five regression models designed for methods comparison are presented. Ten percent (10.17 %) of all births were preterm; 26.83 % of births were from a short IPI. The PS-adjusted model produced a more conservative estimate of the exposure variable compared to the conventional logistic regression method (β-coefficient: 0.21 vs. 0.43), as well as a smaller standard error (0.024 vs. 0.028), odds ratio and 95 % confidence intervals [1.15 (1.09, 1.20) vs. 1.23 (1.17, 1.30)]. The inclusion of more covariate and interaction terms in the PS did not change the estimates of the exposure variable. This analysis indicates that PS-adjusted regression may be appropriate for validation of conventional methods in a large dataset with a fairly common outcome. PS's may be beneficial in producing more precise estimates, especially for models with many confounders and effect modifiers and where conventional adjustment with logistic regression is unsatisfactory. Short intervals between pregnancies are associated with preterm birth in this population, according to either technique. Birth spacing is an issue that women have some control over. Educational interventions, including birth control, should be applied during prenatal visits and following delivery.

High rates of sex and drug risk behaviors have been documented among Latino migrant men in the US. Whether these behaviors were established in the migrants’ home countries or were adopted in the US has not been described and has implications for prevention strategies. Quarterly surveys were conducted to gather information on selected sex and drug risk practices of Latino migrant men who arrived in New Orleans after Hurricane Katrina seeking work. Both kappa scores and McNemar’s tests were performed to determine if practice of these behaviors in home country was similar to practice post-emigration to the US. Female sex worker (FSW) patronage, same sex encounters (MSM), and crack cocaine use was more likely to occur post- rather than pre-emigration. Of those who ever engaged in these selected behaviors, most adopted the behavior in the US (i.e., 75.8 % of FSW patrons, 72.7 % of MSM participants, and 85.7 % of crack cocaine users), with the exception of binge drinking (26.8 %). Men who were living with a family member were less likely to adopt FSW patronage OR = 0.27, CI = 0.10–0.76, whereas men who earned >$465 per week were more likely to adopt crack cocaine use OR = 6.29 CI = 1.29, 30.57. Interventions that facilitate the maintenance of family cohesion and provide strategies for financial management may be useful for reducing sex and drug risk among newly arrived migrants.

To date, seven randomized trials have evaluated the efficacy of expedited partner treatment (EPT). These trials have included heterosexual men and women and examine EPT for Chlamydia trachomatis, Neisseria gonorrhoea, and Trichomonas vaginalis. These studies demonstrated either superiority for percentage of partners being treated, for a reduction in repeat infections, or cost benefit for EPT compared to the standard partner referral method and reported no adverse events. In the United States, although the number of states where EPT is legal continues to grow, adoption of EPT remains low. Provider concerns about liability and payment issues continue to be a barrier to implementation of EPT. More translational research is needed to improve adoption by the players involved: index patients, partners, providers, and payers.

1 Microbiology, Immunology, and Parasitology and 2 Medicine, Louisiana State University Health Sciences Center, 3 Clinical Background. Identification of factors associated with the presence of human immunodeficiency virus (HIV) in female genital secretions is critical for intervention strategies targeting transmission and eliminating replication of genital virus. We sought to monitor the prevalence of genital HIV shedding in antiretroviral therapy-adherent women over time and to assess changes in the genital microenvironment. Methods. Levels of cell-free HIV (HIV RNA) and HIV-infected cells (HIV DNA) were monitored in peripheral blood samples and cervical and vaginal fluid samples at monthly intervals in 11 women for 1 year. Genital tract infections and fluctuations in cervical and vaginal white blood cell counts were also evaluated at each study visit. Results. Plasma HIV was undetectable at the majority of study visits; when detected, it was only at low levels. Throughout the study, genital HIV RNA and DNA were detected in each person. Combined genital HIV (RNA and DNA) was detected at 49.2% of study visits and was associated with an elevated concentration of cervical white blood cell infiltrate (odds ratio, 2.52 (95% confidence interval, 1.01-6.22); ). Infiltrate was not P p .04 associated with a clinical disorder or patient-reported symptoms. Conclusions. Despite antiretroviral therapy adherence and clinically suppressed plasma viremia, HIV was in- termittently detected in genital secretions and was associated with subclinical inflammation and cells trafficking to the cervical mucosa. The presence of human immunodeficiency virus (HIV) in female genital secretions presents a risk for sexual transmission and mother-to-infant transmission during parturition (1-5). HIV replication in the genital tract may also increase the risk of pathogenesis because of compartmentalized replication and evolution of virus

Background The reliance on Latino migrant day labor in the U.S. is increasing. Prospective data on day laborers' work and health experience in non-agriculture settings are lacking and outcomes are generally restricted to injury rates. Methods An ambidirectional study was conducted to quantify the number of job and job task changes held over 12 months in a cohort of 73 migrant day laborers and assessed the relation between work type, health symptoms, and blood lead level. Results On average, participants worked 2.4 different jobs over the past year averaging 41.5 hr per week. Construction work was associated with a twofold increase in sino-nasal and respiratory symptoms in both adjusted and unadjusted models and was associated with increased blood lead levels. Conclusions Despite day labor status, workers had relatively stable employment. Respiratory symptoms were common and often improved when away from work suggesting that workplace irritant exposure is likely. Migrant day laborers working construction are vulnerable to adverse health effects associated with irritant and lead exposure. Am. J. Ind. Med. 54:366–374, 2011. © 2010 Wiley-Liss, Inc.

Trichomonas vaginalis (TV) is a common parasitic sexually transmitted infection found among human immunodeficiency virus (HIV)-infected women with prevalence rates ranging from 6% to 44% in this population.1–6 TV in women is associated with vaginitis, cervicitis, urethritis, and pelvic inflammatory disease.7 Among HIV-infected women, the presence of TV infection may amplify HIV transmission through increased shedding of HIV in vaginal fluids8,9 implicating TV infection as a source of sexual and perinatal transmission of HIV.10–12 Two studies have shown that treatment for TV can result in a reduction of HIV vaginal shedding.13,14 Therefore, prevention of TV infections, including repeat infections, among HIV-infected women can provide not only a clinical, but also a public health benefit.15 The rates of repeat TV infections among HIV-infected women range from 18% to 36%,4,16,17 which is much higher than the 8% repeat infection rate for non-HIV infected women.18 Repeat TV infections can result from nonadherence to treatment by the index patient, reinfection by an untreated sexual partner, infection by a new sexual partner, or treatment failure.16,19 Expedited partner therapy (EPT) is the practice of treating the sex partners of persons with curable sexually transmitted infections without requiring the partners to first obtain a medical evaluation.20 EPT generally consists of a practice called patient-delivered partner therapy or treatment (PDPT), where the patient is given a medication or prescription to deliver to their sex partner(s). PDPT has been recommended for the prevention of recurrent infections with Chlamydia trachomatis and Neisseria gonorrhoeae among women and heterosexual men. However, the Centers for Disease Control and Prevention has declared that there is insufficient evidence to support recommending PDPT for partner management among patients with TV.21 We found some evidence that PDPT may be helpful among HIV-infected women. In our prior cohort of HIVinfected women with TV who were given PDPT, we found that most repeat infections (55%) were attributed to treatment failure16 suggesting that PDPT does prevent reinfection. The purpose of the current study was to evaluate in more depth adherence to PDPT, and possible causes of repeat TV infection in a different cohort of HIV-infected women to determine whether our prior findings are reproducible.

Substance abuse counselors have shown limited success in adopting evidence-based practices (EBPs). The purpose of this paper is to identify the barriers and facilitators of adopting an EBP called motivational enhancement therapy (MET). One hundred thirty-six predominantly female (60%) African American (68%) addiction counselors representing over 40 agencies completed surveys before and after participating in a 2-day MET training. Based on stepwise regressions, 10 variables predicted gains in MET knowledge, attitudes, and/or skills: high consistency of MET with organization’s philosophy, being Caucasian, being younger, low self-efficacy, high practitioner self-perceived cultural competency, low adherence to the 12-step treatment philosophy, viewing MET as challenging to learn, high workload, fewer colleagues in same MET training, and working in a smaller organization. Implications for social work practice are discussed.

Post-traumatic stress disorder (PTSD) is a common psychological outcome of any disaster. The purpose of this study was to examine the effects of PTSD on disease progression among HIV-infected persons in metropolitan New Orleans post-hurricane Katrina. One-year post-storm, a convenience sample of 145 HIV-infected patients who returned to care at the HIV Outpatient Program clinic in New Orleans were interviewed. Clinical factors pre and one and two years post-disaster were abstracted from medical records and compared by PTSD status. Of the 145 participants, 37.2% had PTSD. Those with PTSD were more likely than those without PTSD to have detectable plasma viral loads at both follow-up time points post-disaster and more likely to have CD4 cell counts200/mm(3) two years post-disaster. They were also more likely to have had medication interruptions immediately post-disaster. Our findings corroborate the findings of others that PTSD accelerates HIV disease progression. Disaster planners should consider the special counseling and medication safeguards needs of HIV-infected persons.

The study tested the model of adaptation after trauma by Benight and Bandura (2004) indicating that posttraumatic recovery may be predicted directly by coping self-efficacy (CSE) and indirectly by social support. These relations were investigated in the context of posttraumatic growth (PTG) among Hurricane Katrina survivors living with HIV. Additionally, it was hypothesized that among individuals with more intensive Posttraumatic Stress Disorder (PTSD) symptoms, those with strong CSE would experience the strongest PTG. Cross-sectional data were collected among 90 patients with HIV who reinitiated care at the HIV outpatient clinic. Questionnaires were administered approximately 14 months after the hurricane. Higher CSE was related to higher PTG among the survivors who suffered from more intensive PTSD symptoms. Received social support was directly related to only one index of PTG, relating to others. Furthermore, although there was a significant relationship between social support and CSE, the indirect conditional effect of received social support on PTG was not confirmed. Similar results were obtained across the indices of PTG, controlling for the level of exposure to hurricane-related trauma. Cross-sectional design and convenience character of the sample warrants replications.

Trauma exposure, loss of resources, and stressful life events are usually listed among key predictors of posttraumatic adaptation. Our studies investigated if self-efficacy (i.e. beliefs about ability to deal with posttraumatic adversities) mediates the relationships between these peri- and post-traumatic risk factors and mental health. Study 1 investigated these relationships among 50 Hurricane Katrina survivors infected with HIV. Specifically, it was hypothesised that the effects of exposure and loss of resources (measured 1 year after the disaster) on posttraumatic symptoms and general distress (measured 2 years after disaster) would be mediated by self-efficacy (assessed 1 year after trauma). Study 2, enrolling 70 survivors of motor vehicle accidents, tested the mediating effect of self-efficacy in the relationship between stressful life events (reported at approximately 7 days after the trauma) and PTSD symptom severity and number (measured 90 days later). Results of both studies confirmed the mediating effects of beliefs about the ability to deal with posttraumatic adversities, whereas the direct effects of trauma exposure, number of stressors, and losses on mental health were negligible. Our findings indicate that although self-efficacy beliefs are affected by trauma and stressful life events (in particular, balance of negative and positive events), they should facilitate posttraumatic adaptation.

The purpose of this study was to examine the association between alcohol consumption and HIV-1 vaginal shedding.HIV-1 infected women attending a large urban HIV primary care clinic in New Orleans, LA, between June 2002 and October 2004 who underwent a gynecological exam, were 18 years of age or older, and provided informed consent were included. Subjects underwent exams and were interviewed using a computer-assisted survey at baseline, 1 month, and 3 months.Most of the women were black (86.4%), with a median age of 38 (range: 19-61 years). Most (56.7%) also were on antiretroviral therapy (ART; with 89.6% self-reported adherence) and had a median CD4 of 404 copies/ml and a plasma viral load of 13,400 copies/ml at baseline. The overall period prevalence of vaginal shedding (50 copies/swab) was 24.5%, with a baseline prevalence of 27.3%. At baseline, 30% reported any alcohol consumption, 32.6% were weekly drinkers, 25.5% were heavy episodic drinkers, and 10.0% had recent moderate to heavy alcohol consumption (two or more drinks the day before the interview). Recent moderate to heavy alcohol consumption and heavy episodic drinking were both strongly and positively associated with vaginal shedding but only among women on ART. After adjusting for plasma viral load, immunosuppression, and ART adherence, recent moderate to heavy alcohol consumption was significantly associated with vaginal shedding (adjusted prevalence odds ratio=2.29, 95% confidence interval: 1.18-14.43). No association was observed for plasma viral load and alcohol consumption.Recent alcohol consumption was associated with expression of HIV-1 RNA in vaginal fluids of women on ART. Future research is needed to support this observation and to determine the mechanisms behind it.

Objective: The Hurricane Katrina disaster caused rapid displacement of over a million persons in metropolitan New Orleans. The purpose of this study was to describe changes in sexual behavior and access to reproductive care pre- and postrapid displacement among a cohort of young women receiving family planning services before displacement. Methods: Women 16 to 24 years old, who were attending 2 public family planning clinics and enrolled in a vaginal douching prevention study, were located 5 to 6 months after Katrina and interviewed by telephone to elicit information about sexual behavior and access to reproductive care. Results: Women who were located were interviewed (N = 55). Of these, 96% were black, 62% were employed before the disaster, and the mean age was 22.1 (SD 2.1). In the 5 to 6 months after disaster, 86% lived in 3 or more places, 31% had returned to New Orleans, 17% needed health care but could not access it, 40% had not used birth control, and 2 (4%) experienced an unintended pregnancy as a result of lack of access to care. When compared with baseline, after the hurricane, women were less likely to have attended family planning services, to have used birth control, to have >1 sex partner, to have a vaginal odor or discharge. Conclusion: Relief efforts for disasters causing rapid displacement of impoverished women should include reproductive care such as provision of contraception, condoms, and STI services, as well as linking women back into care.

Author(s): Beilke, Mark A; Traina-Dorge, Vicki L; Sirois, Maria; Bhuiyan, Azad; Murphy, Edward L; Walls, Jane M; Fagan, Ryan; Winsor, Elsa L; Kissinger, Patricia J | Abstract: BACKGROUND: Human T lymphotropic virus types 1 (HTLV-1) and 2 (HTLV-2) are frequent copathogens among individuals infected with human immunodeficiency virus type 1 (HIV-1). The long-term effects of coinfection are unknown, and little information exists regarding how levels of HTLV-1/2 viral burden are affected by antiretroviral medications. METHODS: Factors associated with HTLV-1/2 viral burden were examined in patients with HIV-HTLV-1/2 coinfection. A total of 72 subjects were evaluated. The variables analyzed included HTLV-1/2 proviral load, HTLV-1/2 tax/rex mRNA expression, HIV load, HTLV-1/2 viral antigen detection in peripheral blood mononuclear cell (PBMC) cultures, T cell subsets, demographic variables (age, race, sex, and reported use of injection drugs), and administration of highly active antiretroviral therapy. RESULTS: An HTLV-1/2 proviral DNA copy number g20,000 copies/10(6) PBMCs was significantly associated with the following variables: (1) a positive HTLV-1 Western blot test result, (2) a positive HTLV-1/2 PBMC culture result, (3) a positive tax/rex mRNA result, (4) an HIV load l10,000 copies/mL, and (5) higher CD4 cell counts among subjects with HIV-HTLV-1 coinfection. There was no correlation between HTLV-1/2 proviral copy number or HTLV-1/2 tax/rex mRNA detection and administration of antiretroviral therapy. CONCLUSIONS: HTLV-1/2 proviral burden was significantly higher among patients with HIV-HTLV-1 coinfection than among patients with HIV-HTLV-2 coinfection. Highly active antiretroviral therapy may be of limited value in controlling virus expression of HTLV-1/2 in patients with HIV-HTLV-1/2 coinfection.

Trichomonas vaginalis (TV) is likely the most common non-viral sexually transmitted infection (STI) in the world. It is as an important source of reproductive morbidity, a facilitator of HIV transmission and acquisition, and thus it is an important public health problem. Despite its importance in human reproductive health and HIV transmission, it is not a reportable disease and surveillance is not generally done. This is problematic since most persons infected with TV are asymptomatic. Metronidazole (MTZ) has been the treatment of choice for women for decades, and single dose has been considered the first line of therapy. However, high rates of retest positive are found among TV infected persons after single dose MTZ treatment. This has not been explained by drug resistance since in vitro resistance is only 2–5 %. Treatment failure can range from 7–10 % and even higher among HIV+ women. Treatment efficacy may be influenced by vaginal ecology. The origins of repeat positives need further explanation and better treatment options are needed.

Trichomonas vaginalis is the most common nonviral sexually transmitted infection (STI) in the world. It was once thought to be a nuisance STI, but it is now being recognized as an important source of reproductive morbidity and a facilitator of HIV transmission and acquisition, and thus it is an important public health problem. The prevalence of T. vaginalis varies greatly by geography and risk group, but is more common among persons of African descent and appears to increase with age, though this may be a screening phenomenon. Wet mount and culture are simple diagnostics, but have lower sensitivity than nucleic acid amplification techniques presently approved for women only. Single dose (2 g) metronidazole (MTZ) for both the index patient and their sexual partners is the preferred treatment. High rates of retest positivity are found after single-dose treatment which are likely due to clinical resistance rather than re-infection and/or drug resistance.

Trichomonas vaginalis is the most prevalent nonviral sexually transmitted infection, affecting an estimated 3.7 million women and men in the United States. Health disparities are prominent in the epidemiology of this infection, which affects 11% of women aged ≥40 years and a disproportionately high percentage of black women. Particularly high prevalences have been identified among sexually transmitted disease (STD) clinic patients and incarcerated individuals. This article reviews and updates scientific evidence in key topic areas used for the development of the 2015 STD Treatment Guidelines published by the Centers for Disease Control and Prevention. Current evidence is presented regarding conditions associated with Trichomonas vaginalis infection, including human immunodeficiency virus (HIV) and pregnancy complications such as preterm birth. Nucleic acid amplification tests and point-of-care tests are newly available diagnostic methods that can be conducted on a variety of specimens, potentially allowing highly sensitive testing and screening of both women and men at risk for infection. Usually, trichomoniasis can be cured with single-dose therapy of an appropriate nitroimidazole antibiotic, but women who are also infected with HIV should receive therapy for 7 days. Antimicrobial resistance is an emerging concern.

To examine correlates of HIV disclosure, a convenience sample of 273 HIV-infected persons throughout rural Louisiana were interviewed. Disclosure to sexual partners at time of initial HIV-positive diagnosis and the time of the study interview was ascertained (an average of 5.76 years later). The prevalence of disclosure to past and current sex partners was 57.2% and 80.7% respectively. Those who reinitiated sex with their partner since testing positive for HIV and those who received partner notification were more likely to disclose to past partners. Non-African Americans and those with only one partner were more likely to disclose to present sex partners. Much like urban settings, disclosure is not universal, and interventions such as disclosure skills building and/or ongoing partner notification services may be needed to facilitate disclosure.

We examine the role of alcohol consumption on sexual risk behavior among a cohort of 187 sexually active HIV-infected women (aged 18-61) in care at an urban ambulatory clinic in New Orleans, Louisiana, U.S. Sexual risk behavior among women on and off antiretroviral therapy (ART) and the relationship between alcohol use, ART, and behavior was also explored. One-fourth of respondents were classified as binge drinkers and the average number of drinking occasions per week ranged from none to 10-12. Approximately 60% were prescribed ART and self-reported adherence was 90%. One-third of the women reported no condom use at last vaginal sex, 62% reported inconsistent condom use for vaginal sex, and 7% had multiple male sex partners in the last month. Binge alcohol users and women on ART were significantly more likely to participate in each sexual risk outcome examined. Partner refusal of condom use was also significantly associated with binge drinking patterns. Results lend strength to the equivocal literature on the relationship between both alcohol and prescription of ART and sexual behavior. Enhanced detection of alcohol abuse, coupled with risk reduction counseling especially among women prescribed ART are important clinical practices in treating women with HIV.

Objectives: Cervicovaginal lavage (CVL) is often used for research and may be easier and more accurate than vaginal swabs as a specimen collection method. Goal: The goal of this study was to compare (CVL) with vaginal swabs for the detection of bacterial vaginosis (BV) and Trichomonas vaginalis (TV). Study: CVL and vaginal swabs were collected from 216 HIV-infected women. Clinical assessments were made using wet mount for TV and Amsel's criteria for BV through CVL and swab collection methods. Laboratory gold standards used were Nugent's criteria for BV and InPouch (Biomed Diagnostics, San Jose, CA) culture for TV collected by swab. Results: The prevalence by gold standards for BV was 49.3% and for TV was 25.2%. Sensitivities for direct microscopy versus culture for TV were 72.2 for CVL and 52.8 for vaginal swab (P

The goal of this study was to determine the period prevalence of mother-child separation (i. e., living apart from mother) and factors associated with separation between women infected with HIV type 1 and their children (17 years old or younger). A retrospective cohort study was conducted, based on routinely collected data by the Family Advocacy, Care and Education Services (FACES) of Children's Hospital (New Orleans, Louisiana) on children (n 586) of 231 HIV-infected mothers followed from July 1, 2001 to March 20, 2003. The 3-month period prevalence of separation from mother ranged between 12.7% and 21.2% over the course of follow-up. At baseline, 14% of children were separated from their mothers. Over the course of follow-up, older children (6 to 17 years), those with mothers who used illegal drugs and/or alcohol and who suffered from mental health problem(s), those whose mothers did not live at a permanent residence, and children with mothers who had a CD4 cell count below 200 cells per microliter were more likely to be separated from their mother. No significant differences in substance use, mental health, CD4 count, or other sociodemographics were identified between women lost to follow-up and those who remained in care. Substance use and mental health problems played a role in maternal-child separation among the HIV-positive women in this sample, even after clinical status and socioeconomic factors were taken into account. Providing additional resources for substance use and mental health treatment may help to prevent or reduce maternal-child separation among similar populations.

The goal of this study was to investigate clinical outcomes and survival probabilities among persons coinfected with human immunodeficiency virus (HIV) and human T lymphotropic viruses types 1 and 2 (HTLV-I/II). A nonconcurrent cohort study of 1033 HIV-infected individuals was also conducted. Sixty-two patients were coinfected with HTLV-I, and 141 patients were coinfected with HTLV-II. HTLV-I/II coinfection was highly associated with African-American race/ethnicity, age of >36 years, higher CD4(+) T cell count at baseline and over time, and history of injection drug use. Coinfected patients were more likely to have neurologic complications, thrombocytopenia, respiratory and urinary tract infections, and hepatitis C. Despite having higher CD4(+) T cell counts over time, there was no difference in the incidence of opportunistic infections. Progression to both acquired immunodeficiency syndrome (AIDS; adjusted hazard ratio [aHR], 0.50; 95% confidence interval [CI], 0.25-0.98) and death (aHR, 0.57, 95% CI, 0.37-0.89) were slower among HTLV-II-coinfected patients, compared with time-entry- and CD4(+) T cell count-matched control subjects. In conclusion, HIV-HTLV-I/II coinfection may result in improved survival and delayed progression to AIDS, but this happens at the expense of an increased frequency of other of clinical complications.

The prevalence of human papillomavirus type 16 E6 variant lineages was characterized in a cross-sectional study of 24 human immunodeficiency virus type 1 (HIV)-positive and 33 HIV-negative women in New Orleans. The European prototype was the predominant variant in the HIV-negative women (39·4 %), while in the HIV-positive women the European 350G variant was predominant (29·1 %). In exact logistic regression models, HIV-positive women were significantly more likely to harbour any variant with a nucleotide G-350 mutation compared with HIV-negative women [58·3 % vs 21·1 %; adjusted odds ratio (AOR)=6·28, 95 % confidence interval (CI)=1·19–46·54]. Models also revealed a trend towards increased prevalence of Asian–American lineage in HIV-positive women compared with HIV-negative women (25·0 % vs 6·0 %; AOR=6·35, 95 % CI=0·77–84·97). No association was observed between any variant and cytology or CD4 cell counts or HIV-1 viral loads. These observations reflect a difference in the distribution of HPV-16 variants among HIV-positive and -negative women, indicating that HIV-positive status may lead to increased prevalence of a subset of variants.

Prevalence of 27 human papillomavirus (HPV) genotypes was assessed in 1,331 women in three clinical settings: Family planning clinic (low-risk HIV-, n = 202, 21.3% HPV+), colposcopy clinic (high-risk HIV-, n = 854, 34.3% HPV+), and HIV outpatient clinic (HIV+, n = 275, 48.7% HPV+). Compared to women from both family planning and colposcopy clinics, HIV+ women revealed significantly higher prevalence of infection with oncogenic, non-oncogenic, and multiple HPV types. HPV types 52 and 51 were most prevalent in the low-risk HIV- women, whereas in the high-risk HIV- women, HPV types 16, 52, 58, and 35 were most prevalent. Interestingly, in the HIV+ women, less characterized types 83, 53, and 54 were most prevalent. The distinct profiles of genotype prevalence persisted after stratification by Pap smear status. After adjustment for concurrent infections with other types, HPV type 51 in the low-risk HIV- women, and types 16, 35, 39, 45, 52, and 58 in the high-risk HIV- women were significantly associated with cytologic abnormalities (exact P < 0.05). In HIV+ women across CD4 cell count strata, HPV types 42, 16, and 82 revealed significant decreasing trends with increasing CD4 counts (exact P for trend < 0.05). These data suggest distinct genotypic prevalence profiles in women at diverse risk for cervical cancer. The association of several genotypes with cytologic abnormalities underscores the need for vaccines targeting a wide range of HPV types.

Objectives To describe the patterns and correlates of discontinuation of the initial highly active antiretroviral therapy (HAART) regimen in an urban, outpatient cohort of antiretroviral-naive patients. Design Retrospective cohort of 345 randomly selected antiretroviral-naive patients who initiated HAART on 6 selected regimens between January 1997 and May 2001 in New Orleans, LA. Methods An investigator reviewed medical records to collect information on concurrent medications, symptoms/diagnoses, staging indicators, and reasons for HAART discontinuation. Proportional hazards regression methods were used to identify predictors of discontinuation. Results After a median follow-up of 8.1 months, 61% of patients changed or discontinued their initial HAART regimen; 24% did so because of an adverse event. The events most commonly cited as the cause for discontinuation were nausea, vomiting, and diarrhea. A detectable viral load was associated with discontinuation at any time, while reporting nausea/vomiting or dizziness at the previous visit were associated with discontinuation during the first 3 months on HAART. Nausea/vomiting and not having AIDS at the time of HAART initiation were associated with discontinuation due to an adverse event at any time, while a high viral load, and dizziness or anorexia/weight loss at the previous visit were associated with discontinuation due to an adverse event in the first 3 months on HAART. Conclusions Gastrointestinal adverse events of HAART are the most frequently cited reason for discontinuation of HAART. An effort should be made to educate patients about these events and to encourage continued adherence. Additionally, appropriate prophylaxes for these events are warranted.

Trichomonas vaginalis (Tv) is a common sexually transmitted disease (STD) among HIV-infected populations. The relationship between Tv and immune status and HIV viral load as affected by protease inhibitor (PI) use has not been well examined.The goals were to evaluate the association between Tv and both immune status and PI use among HIV-infected women, and to characterize factors associated with Tv among HIV-infected women.We used a retrospective cohort study conducted between 1990 and 2000.Of 1578 women, the majority was under 35 years, black (AA), and infected heterosexually or with unidentified risk. Thirty percent (30.2%) had Tv at least once, and 36.9% had at least one subsequent positive test; Tv was more common than chlamydia, gonorrhea, genital warts, or syphilis. After adjusting for follow-up time, young age, AA race, substance use, and other sexually transmitted diseases (STDs) were associated with initial Tv infection, but pregnancy, immune status, and PI use were not associated. After adjusting for follow-up time, having other STDs was associated with and pregnancy was protective of subsequent Tv positivity, but immune status and PI use were not associated; neither were age, race, or substance use.Tv is a common STD among HIV-infected women and does not appear to be associated with immune status or PI use. Aggressive screening might represent a means of reducing the incidence and prevalence of Tv.

Background and objective A study of HIV-positive individuals in New Orleans, Louisiana, found that the majority of patients disclosed to their main partners and family members, but less than one fourth disclosed to any casual sex partner. Older age and lower CD4 cell counts were associated with disclosure. Goal The goal was to describe patterns of HIV serostatus disclosure among a diverse sample of patients at an HIV outpatient clinic in New Orleans, Louisiana. Study design A convenience sample of HIV-seropositive patients provided information about disclosure of seropositivity, demographics, date of HIV diagnosis, CD4 cell count, mode of HIV acquisition, and sexual activity since HIV diagnosis. Results The 269 persons disclosed their HIV status to people in the following categories: main sex partner (74.2%), casual sex partner (24.8%), immediate family member (69.8%), other relative (27.0%), or friend (26.4%). Adolescents were less likely than adults to disclose to a main partner, immediate family member, or a friend. Immunosuppressed persons were more likely than nonimmunosuppressed persons to disclose to a main partner, immediate family member, or another relative. Conclusion Many HIV-infected individuals delay disclosure until their disease has progressed. Interventions such as partner notification and skill-building to facilitate appropriate HIV disclosure are needed.

Repeated infection with C trachomatis increases the risk for serious sequelae: pelvic inflammatory disease, ectopic pregnancy, infertility, and chronic pelvic pain. A substantial proportion of women treated for C trachomatis infection are reinfected by an untreated male sex partner in the first several months after treatment. Effective strategies to ensure partner treatment are needed.The goal of the study was to determine whether repeated infections with C trachomatis can be reduced by giving women doses of azithromycin to deliver to male sex partners.A multicenter randomized controlled trial was conducted among 1,787 women aged 14 to 34 years with uncomplicated C trachomatis genital infection diagnosed at family planning, adolescent, sexually transmitted disease, and primary care clinics or emergency or other hospital departments in five US cities. Women treated for infection were randomized to one of two groups: patient-delivered partner treatment (in which they were given a dose of azithromycin to deliver to each sex partner) or self-referral (in which they were asked to refer their sex partners for treatment). The main outcome measure was C trachomatis DNA detected by urine ligase chain reaction (LCR) or polymerase chain reaction (PCR) by 4 months after treatment.The characteristics of study participants enrolled in each arm were similar except for a small difference in the age distribution. Risk of reinfection was 20% lower among women in the patient-delivered partner treatment arm (87/728; 12%) than among those in the self-referral arm (106/726; 15%); however, this difference was not statistically significant (odds ratio, 0.80; 95% confidence interval, 0.62-1.05; = 0.102). Women in the patient-delivered partner treatment arm reported high compliance with the intervention (82%).Patient-delivered partner treatment for prevention of repeated infection among women is comparable to self-referral and may be an appropriate option for some patients.

The purpose of this study was to measure the accuracy of HIV-infected persons' knowledge of their sexual partners' HIV infection status. HIV-infected persons at two public health clinics reported their knowledge of the HIV infection status of their sexual partners. Actual HIV test results for sexual partners were then linked to survey responses. The association between reported knowledge and actual infection status of partners was estimated by kappa scores and percent agreement. Sixty-four percent (14/22) of partners thought to be infected were actually uninfected, and 42% (8/19) of partners thought to be uninfected were actually infected. The overall percent agreement was 46% (kappa = -0.06), less than that expected by random chance alone. Individuals in committed partnerships were less likely to have accurate knowledge than those in casual partnerships. In conclusion, HIV-infected individuals have poor knowledge regarding their partners' infection status. This may influence sexual behaviors that result in increased transmission.

The objective of this meta-analysis was to determine the effect of behavioral interventions in reducing risky sexual behavior and incident sexually transmitted infections (STI) among Latina women living in the United States. Studies were found by systematically searching the MEDLINE, EMBASE, and PsychInfo databases without language restriction. Two independent reviewers screened abstracts and full texts of articles to find randomized control trials testing the effects of behavioral interventions aimed at changing risky sexual behavior among Latinas. Articles were selected using prespecified inclusion criteria. Two independent reviewers extracted data from the included trials in duplicate using a standardized data extraction form. Six randomized control trials met the inclusion criteria for a total of 2,909 participants. Using random effects models with inverse variance weighting, we found a protective effect of the behavioral intervention on reported risky sexual behavior (odds ratio = 0.52; 95% confidence interval = 0.42, 0.64) and on incident nonviral STI (odds ratio = 0.65; 95% confidence interval = 0.46, 0.93). Behavioral interventions targeted toward Latina populations are effective in reducing risky sexual behaviors and incident STI and should be considered by policymakers as a potential tool for HIV/STI prevention in this population.

Background and Objectives: The presence of sexually transmitted infections (STIs) may facilitate transmission of HIV to uninfected partners. Goal: To describe the incidence of reinfection with Trichomonas vaginalis in HIV-infected women and to assess predictors of reinfection. Study Design: A retrospective cohort study using data abstracted from medical records of HIV-infected women with at least one diagnosis of trichomoniasis. Results: Approximately one third (36%) of the study population was reinfected with T vaginalis during the follow-up period, with an incidence of 16.4 reinfections per 100 person years. Significant predictors of reinfection included history of another STI (hazard ratio, 1.52; 95% CI, 1.08-2.14) and becoming pregnant during the follow-up period (hazard ratio, 0.59; 95% CI, 0.39-0.87). Conclusions: There is a high rate of reinfection with T vaginalis in HIV-infected women. Further research that includes information on sexual partners should be conducted to better describe the reinfection patterns of trichomoniasis.

Chlamydia trachomatis (CT) and neisseria gonorrhoeae (GC) are the 2 most common sexually transmitted infections in the United States.1 Among women, repeated infections with CT and GC are associated with serious reproductive outcomes such as pelvic inflammatory disease, ectopic pregnancy, chronic pelvic pain, and infertility.2-6 Because men often spontaneously clear infection7,8 and do not have the same adverse outcomes as women, less attention has been paid to repeated infections among men. However, the burden of repeat infections among men is high. The average repeat infection rates of CT and GC among men (11% and 7%)9 are close to those reported among women (10.7% and 3.6%).10 Repeatedly infected men are reservoirs of infection for women,11,12 thus preventing repeat infections among men is an important public health measure. Understanding whether these repeat infections result from reexposure to a baseline partner, infection from a new partner, or treatment failure is important in understanding the most effective interventions. Centers for Disease Control and Prevention (CDC) suggests expedited partner treatment (EPT) or the provision of medication or prescriptions for index persons to deliver to their sex partners if there is concern that their partner will not seek care.13 The basic assumption of this approach is that most repeat infections are due to reexposure and treating the source of exposure will reduce the repeat infection. Although the efficacy of EPT for preventing repeat infections among men has been demonstrated in several studies, repeat infection rates among men given EPT remain high (10%–14%).14,15 This suggests that, among men, some of the repeat infections may be due to factors other than reexposure and that rescreening in addition to the provision of EPT may be needed. As an additional prevention measure among women, the CDC strongly encourages rescreening of women 3 months posttreatment. Suggestions for men are more nebulous. The CDC states that there is a lack of evidence to support rescreening among men.16 The purpose of this article is to examine the possible origin of infection among heterosexual men who rescreen positive for CT and/or GC.

Objective: To determine the seroprevalence of and risk factors for human papillomavirus (HPV) type 16 capsid antibodies in a large cohort of pregnant women. Methods: Antibodies against in vitro produced HPV-16 capsids were measured in stored sera from 2597 pregnant women enrolled from 1984 through 1989 in the Vaginal Infection and Prematurity Study, New Orleans site. Results: Women in this study were primarily black (83.4%) with a mean age of 23.4 years (standard deviation [SD], 5.1), mean number of sexual partners in lifetime was 3.3 (SD, 6.6), and the mean age at sexual debut was 16.7 years (SD, 2.2). Overall, 28.0% (n = 727) of these women were positive for HPV-16 capsid antibodies. In bivariate analysis, the presence of antibodies against HPV-16 was correlated with numerous demographic characteristics as well as history of various sexually transmitted diseases. However, neither current cervical or vaginal infection nor adverse obstetric outcome was associated with increased detection of HPV-16 antibodies. In multivariate logistic regression analysis, factors predictive of HPV-16 seropositivity were: more than five lifetime sexual partners (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.28, 2.52), 6 or more years of sexual activity (OR, 1.84; 95% CI, 1.22, 2.78), level of education (OR, 1.26; 95% CI, 1.03, 1.55), and history of Neisseria gonorrhoeae infection (OR, 1.53; 95% CI, 1.20, 1.96). Conclusion: HPV-16 seropositivity correlates with measures of sexual activity, confirming its role as a sexually transmitted disease, and its prevalence is similar to that in nonpregnant populations. HPV-16 seropositivity does not predict an adverse obstetric outcome.

Collection of sensitive data with the use of video-enhanced, computer-assisted, self-administered interviews (V-CASI) has the potential to reduce interview bias and improve the validity of the study. The purpose of this study was to compare responses to sensitive questions elicited by V-CASI and by face-to-face interview (FTFI) methods. Women attending a New Orleans, Louisiana, public family planning or sexually transmitted disease clinic from July 1995 to July 1996, diagnosed with a Chlamydia trachomatis infection responded to eight close-ended behavioral questions (four socially undesirable, two socially desirable, and two neutral behaviors) using both FTFI and V-CASI techniques in a randomized crossover design. Of the 280 women included, the mean age was 23 years, 95 percent were African American, and 71 percent felt comfortable using computers. While kappa scores indicated good-to-excellent agreement between interview techniques, women tended to admit to socially undesirable behaviors more often on V-CASI compared with FTFI. Thirty percent of the women gave a discrepant response between V-CASI and FTFI toward social desirability. Women who reported a socially undesirable behavior in V-CASI (i.e., more than two sex partners and infrequent condom usage) were more likely to have a discrepant response. Utilization of the same logistic regression model to predict condom use yielded different results when data from V-CASI were used compared with data from FTFI. The V-CASI technique can reduce social desirability bias and improve validity in research requiring information on sensitive sexual behaviors.Bias needs to be minimized when conducting survey-based research in order to produce more valid results. Reporting biases are more likely to occur when sensitive behaviors are being investigated. Research suggests that computer-assisted, self-administered interviews (CASIs) may produce more valid reports of sensitive behaviors than will the more traditional survey techniques such as face-to-face interviews (FTFIs). Findings are reported from a study conducted to compare responses to sensitive questions administered through video-enhanced CASIs (V-CASIs) and FTFIs. 280 women of mean age 23 years attending a New Orleans, Louisiana, public family planning or STD clinic from July 1995 to July 1996, diagnosed with Chlamydia trachomatis infection responded to 8 close-ended sexual behavioral questions using both survey techniques in a randomized crossover design. 95% of the women were Black and 71% felt at ease using computers. Although kappa scores indicated good-to-excellent agreement between interview techniques, the women tended to admit to socially undesirable behaviors more often upon V-CASIs than upon FTFIs. 30% of the women gave a discrepant response between V-CASI and FTFI toward social desirability. Women who reported a socially undesirable behavior in V-CASIs were more likely to have a discrepant response. Use of the same logistic regression model to predict condom use yielded different results when data from V-CASIs were used compared with data from FTFIs. Findings suggest that the V-CASI technique can reduce social desirability bias and improve validity in research requiring data on sensitive sexual behaviors.

Background and objectives Differences in sociodemographic attributes and healthcare access may explain differences in regional sexually transmitted disease rates but don't fully explain why syphilis persists disproportionately in certain populations. Goal of this study To understand the behavioral epidemiology of syphilis, we conducted a social network analysis of persons with syphilis and their contacts and developed and applied a definition of core transmitters. Study design We interviewed 10 index persons with primary or secondary untreated syphilis and 80 of their named sexual and social contacts. Results Fourteen (16%) of 90 interviewed persons met the definition of core transmitters, 9 of whom had past or current syphilis. The other interviewed persons had only moderately risky behaviors. Seventy-eight (42%) of the network sexual contacts were connected directly or indirectly to a core transmitter. Conclusion This analysis suggests that syphilis transmission is maintained by a community with a small percentage of high-risk persons centrally placed amidst a larger group with moderately risky behavior.

Objective To determine louisiana pharmacy managers' attitudes and practices regarding needle and syringe sales to suspected injection drug users (IDUs) without prescriptions, and to assess which factors affect their decisions to sell nonprescription needles and syringes. Design Cross-sectional mail survey. Setting The six most populous cities of Louisiana. Participants Pharmacy managers with active permits not affiliated with large hospitals or institutions. Main Outcome Measures Selling nonprescription needles to suspected IDUs, willingness to sell nonprescription needles to suspected IDUs, and reasons for not selling nonprescription needles to suspected IDUs. Results Approximately one-fourth of the respondents reported that they had sold needles and syringes to suspected IDUs without a prescription. The most frequently cited reason for not selling was fear of increasing drug use; however, many of these pharmacists reported that they would conduct a sale if the customer had a referral from an agency or clinic. Conclusion Pharmacists can assist in the prevention of HIV transmission through nonprescription needle sales to IDUs. This role can be promoted through education of pharmacists and development of referral systems for IDUs.

THE QUESTION OF WHETHER systemic hormonal therapies can effect genital tract HIV-1 RNA shedding is plausible since selected cytokine production in the genital tract, which can be influenced by the hormonal milieu, may modulate the replication of HIV-1.1 The observation that genital tract HIV-1 RNA s

The purpose of this study was to describe the clinical profile of end-stage AIDS in patients 12 months before death. A cross-sectional examination of HIV-infected patients who attended a public HIV outpatient clinic between 1990 and 1996 and who died was conducted. The prevalence and first-time acquisition of AIDS-defining conditions 12 months before death were evaluated. The AIDS-defining conditions with the highest percentages of first-time acquisition in the last 12 months of life were progressive multifocal leukoencephalopathy (100%), lymphoma (96%), dementia (78.6%), Mycobacterium avium complex (MAC) infection (74.0%), toxoplasmosis (72.6%), and cytomegalovirus (CMV) infection (69.6%). Of the concomitant conditions studied, those with the highest percentages of first-time acquisition in the last 12 months of life were CMV with MAC (99%) and CMV with wasting (88%). Patients who acquire these AIDS-defining conditions may be eligible to receive information about end-stage options, such as hospice care. However, administration of aggressive antiretroviral treatments, such as the protease inhibitors, may affect this profile in the future, as the majority of the patients in this study were receiving the standard antiretroviral treatments of the time, primarily zidovudine.

The objective of this study is to describe the characteristics associated with a history of sexual abuse among HIV-infected women enrolled in a public inner-city HIV outpatient clinic. A retrospective chart review of 238 women of childbearing age enrolled in the HIV outpatient clinic between 1987 and 1995 was performed. Characteristics of the study population were 83% African American, 69% single, and 53% finished high school or were still in school. The mean age was 25.7 years. Of the 238 women, 32% had a history of sexual abuse. Factors associated with sexual abuse history after controlling for age included living in a nonpermanent situation (OR=4.8), history of non-intravenous drug use (OR=4.65), and having dropped out of school (OR=2.2). HIV-infected women should be screened for a history of sexual abuse and carefully counselled regarding their reproductive choices and drug treatment.

The purpose of the study was to determine the seroprevalence of human T-lymphotropic virus types I and II (HTLV-I and HTLV-II) infections in an outpatient clinic population of human immunodeficiency virus (HIV)-1 infected persons as well as to identify the demographic and clinical characteristics and laboratory results associated with HTLV-I/II infections. During 1993-1995, 854 patients were tested for HTLV-I/II infection on entry into the clinic, of whom 25 were infected with HTLV-I and 35 with HTLV-II. Multivariate analysis revealed that patients with coinfections were more likely to be black, aged over 35 years, and have a history of injection drug use. HIV-1/HTLV-I coinfections were associated with higher median CD8 counts on entry (p < 0.05), and HIV-1/HTLV-II coinfections were associated with higher median percent CD4 counts (p < 0.05) compared with patients infected with HIV only. Coinfection was not associated with an increased diagnosis of AIDS. These findings indicate that HIV-1/HTLV-I/II coinfections are frequently diagnosed and are associated with unique immune phenotypes. Given the lack of information regarding the influence of dual infection on clinical status, differentiation of HTLV-I from HTLV-II infections may be important in understanding the clinical significance of retroviral coinfections.