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Our objective was to assess factors associated with health-related quality of life (HRQoL) among men who have sex with men (MSM) living with or those not living with HIV in Nigeria. A cross-sectional subset of adult MSM in the ongoing TRUST/RV368 HIV prevention and treatment study were recruited and completed the World Health Organization quality of life in HIV infection (WHOQOL-BREF) questionnaire. The tool comprises physical health, psychological health, social relationships and environmental health domains from which scores were extracted.

HIV drug resistance (HIVDR) surveillance is an important tool to monitor threats to progress towards epidemic control. The characterization of HIVDR in Nigeria at the national level is needed to inform both clinical decisions and population-level HIV policy strategies. This study uses data obtained from the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) to describe the prevalence and distribution of HIVDR in Nigeria.NAIIS was a cross-sectional, population-based survey of households throughout Nigeria in 2018. NAIIS was designed to provide estimates of HIV prevalence and related health indicators from a nationally representative sample. The study population included participants aged 15-64 years who tested positive for HIV, had a viral load at least 1000 copies/ml, and had available HIV drug resistance genotypes. HIV isolates were genotyped to detect drug resistance mutations. Individual characteristics of study participants associated with HIVDR were identified using a weighted multivariable logistic regression model.Of 1355 respondents with available HIV genotypes, 293 (19%) had evidence of drug-resistant mutations (DRMs) that conferred resistance to at least one antiretroviral drug. The majority of DRMs observed conferred resistance to NNRTIs (17.6%) and NRTIs (11.2%). HIVDR was associated with being ART-experienced, longer duration on ART, and lower CD4+ count but not sociodemographic characteristics.The population level DRM prevalence in Nigeria was consistent with what would be expected in a mature HIV treatment landscape. The continued roll out of dolutegravir-anchored regimens should mitigate the impact of NNRTI resistance on population viral load suppression and progress towards epidemic control.

BACKGROUND Nigeria has the fourth largest burden of HIV globally. Key populations (KP) including female sex workers (FSW), men who have sex with men (MSM), and people who inject drugs (PWID) often have poor social visibility and are more vulnerable to HIV than the general population due to stigma, discrimination, and criminalization of KP-defining behaviors. Reliable, empirical population size estimates (PSE) are needed to guide focused and appropriately scaled HIV epidemic response efforts for KP. We used novel approaches to sampling and analysis to calculate PSE in Nigeria. OBJECTIVE We sampled the population using three-source capture-recapture (3S-CRC) and analyzed results using Bayesian nonparametric latent-class models to generate median PSE with 80% highest density intervals. METHODS During October–December 2018, we used three-source capture-recapture (3S-CRC) to estimate the size of KP in seven United States President’s Emergency Plan for AIDS Relief (PEPFAR) priority states in Nigeria. Hotspots were mapped before 3S-CRC started. We sampled FSW, MSM, and PWID during three independent captures approximately one week apart. During encounters in KP hotspots, distributors offered inexpensive and memorable objects to KP, unique to each capture round and KP type. In subsequent rounds, participants were offered an object and asked to produce or identify objects received during previous rounds (if any); affirmative responses were tallied upon producing or identifying the correct object. Distributors recorded responses on tablets and uploaded to a secure server after each encounter. Data were aggregated by KP and state for analysis. Median PSE were derived using Bayesian nonparametric latent-class models with 80% highest density intervals for precision. RESULTS We sampled approximately 310,000 persons at 9,015 hotspots during three independent captures in all seven states. Overall, FSW PSE ranged from 14,500-64,300; MSM PSE, 3,200-41,400; and PWID PSE, 3,400-30,400. CONCLUSIONS This study represents the first implementation of these 3S-CRC sampling and novel analysis methods for large-scale population size estimation in Nigeria. Overall, our estimates were larger than previously documented for each KP in all states. The current Bayesian models account for factors (i.e., social visibility and stigma) that influence heterogeneous capture probabilities resulting in more reliable PSE. The larger estimates suggest a need for programmatic scale-up to reach these populations at highest risk for HIV.

Significance We provide evidence here that (i) a strain of mycoplasma promotes lymphomagenesis in an in vivo mouse model; (ii) a bacterial chaperone protein, DnaK, is likely implicated in the transformation process and resistance to anticancer drugs by interfering with important pathways related to both DNA-damage control/repair and cell-cycle/apoptosis; and (iii) a very low copy number of DNA sequences of mycoplasma DnaK were found in some tumors of the infected mice. Other tumor-associated bacteria carry a similar DnaK protein. Our data suggest a common mechanism whereby bacteria can be involved in cellular transformation and resistance to anticancer drugs by a hit-and-hide/run mechanism., We isolated a strain of human mycoplasma that promotes lymphomagenesis in SCID mice, pointing to a p53-dependent mechanism similar to lymphomagenesis in uninfected p53−/− SCID mice. Additionally, mycoplasma infection in vitro reduces p53 activity. Immunoprecipitation of p53 in mycoplasma-infected cells identified several mycoplasma proteins, including DnaK, a member of the Hsp70 chaperon family. We focused on DnaK because of its ability to interact with proteins. We demonstrate that mycoplasma DnaK interacts with and reduces the activities of human proteins involved in critical cellular pathways, including DNA-PK and PARP1, which are required for efficient DNA repair, and binds to USP10 (a key p53 regulator), impairing p53-dependent anticancer functions. This also reduced the efficacy of anticancer drugs that depend on p53 to exert their effect. mycoplasma was detected early in the infected mice, but only low copy numbers of mycoplasma DnaK DNA sequences were found in some primary and secondary tumors, pointing toward a hit-and-run/hide mechanism of transformation. Uninfected bystander cells took up exogenous DnaK, suggesting a possible paracrine function in promoting malignant transformation, over and above cells infected with the mycoplasma. Phylogenetic amino acid analysis shows that other bacteria associated with human cancers have similar DnaKs, consistent with a common mechanism of cellular transformation mediated through disruption of DNA-repair mechanisms, as well as p53 dysregulation, that also results in cancer-drug resistance. This suggests that the oncogenic properties of certain bacteria are DnaK-mediated.

BACKGROUND: Experimental evidence has shown that treatment of HIV infection with antiretroviral therapy (ART) prevents heterosexual transmission of HIV to an uninfected partner. However the "real-world" application of this strategy to key populations such as men who have sex with men (MSM) has been limited. We report findings on acceptability of a treatment as prevention (TasP) strategy among HIV-infected MSM at a Trusted Community Center providing comprehensive HIV prevention and treatment services to MSM in Abuja Nigeria. METHODS: Using respondent-driven sampling (RDS) MSM who were 16 years and older and have engaged in either receptive or insertive anal intercourse within the previous 12 months were recruited into a prospective combination HIV prevention and treatment study (TRUST). Two weeks after enrollment HIV testing and counseling was conducted. At each 3-month follow-up visits HIV-infected individuals underwent clinical and laboratory evaluation including CD4 count plasma HIV viral load immediate 3 weekly sessions of ART preparation and then ART initiation per TasP strategy irrespective of CD4 count. Reasons for not engaging in pre-TasP preparation and TasP were documented. Characteristics associated with TasP engagement and loss to follow-up (LTFU) were determined using logistic and Cox regression respectively. RESULTS: Of 186 HIV-positive MSM enrolled 58 (31.2%) were on ART at the time of recruitment whereas 128 (68.8%) were ART-naive and provided opportunity for engaging TasP. Of these 70 (54.7%) engaged in TasP. Compared with MSM who did not engage in TasP those who engaged had significantly lower mean CD4 count (P = 0.001) were more likely to be Christian (P = 0.01) and had disclosed being MSM to family (P = 0.02) or health care providers (P = 0.02). In multivariate models disclosure of being MSM to health care providers remained significantly associated with uptake of TasP. Among individuals engaged in TasP 10% were LTFU in care at 18 months since enrollment. Being engaged in TasP (relative hazards = 0.08 P < 0.001) and on ART (relative hazards = 0.17 P < 0.001) were associated with decreased risk of LTFU. CONCLUSIONS: Although there was high acceptance of HIV testing and low LTFU among individuals who were already on ART or engaged in TasP a higher than expected proportion did not engage in TasP suggesting the need for customized treatment preparation and an increase in enabling environments to support HIV treatment access with this key population.

STIs includingTRUST/RV368 is a cohort of MSM recruited using respondent-driven sampling at trusted community centres in Abuja and Lagos, Nigeria. MSM respondents (egos) provided STI risk factors and demographic information for up to five of their most recent sexual partners (alters) within their sexual networks. Egos were tested for HIV, NG and CT every 3 months. Log-binomial regression was used to assess associations between alter characteristics and incident NG and/or CT.Between March 2013 and October 2015, 492 MSM were longitudinally screened for STIs, of which 28.0% (n=138) were positive for incident rectal STI (61 NG only, 42 CT only and 35 NG and CT). Among egos, condom use was associated with STIs (half of the time vs never (adjusted risk ratio (aRR) 0.5; 95% CI 0.3 to 0.8), always/almost always vs never (aRR 0.7; 95% CI 0.5 to 1.0)). Incident STIs were associated with having a younger alter ≤19 versus 30 years (aRR 0.6; 95% CI 0.4 to 1.0), HIV infection (aRR 1.5; 95% CI 1.1 to 2.0) and engaging in sex under the influence of alcohol (aRR 1.4 95% CI 1.1 to 1.7) among regular alters and age ≤19 versus 30 years (aRR 0.3; 95% CI 0.2 to 0.6), HIV infection (aRR 1.4; 95% CI 1.1 to 1.8) and engaging in sex under the influence of alcohol (aRR 1.2 95% CI 1.0 to 1.4) among casual alters.Given the centrality of sexual partner characteristics as risks for incident STIs among Nigerian MSM, there is a need to move beyond individual interventions and syndromic surveillance and get 'out there' in the STI management.