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HIV Infection
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The Journal of infectious diseases
This article lays out the research priorities for Mycoplasma genitalium research agreed upon by the participants in a 2016 National Institutes of Allergy and Infectious Diseases-funded Technical Consultation focused on this organism. The state of current knowledge concerning the microbiology, epidemiology, clinical manifestations of infection, treatment, and public health significance of M. genitalium reviewed at the meeting is described in detail in the individual articles included in this supplemental edition of the Journal of Infectious Diseases. Here we summarize the points made in these articles most relevant to the formulation of the research priorities listed in this article. The most important recommendation resulting from this Technical Consultation is the initiation of clinical trials designed to determine definitively whether screening for and treatment of M. genitalium infections in women and their sexual partners improve reproductive health in women and/or prevent human immunodeficiency virus transmission.
Infectious Diseases (3), Immune System Diseases (1), Women's Health (1)
HIV Infections (2), Allergy (2), Infections (2), more mentions
The Journal of infectious diseases
Minority variant human immunodeficiency virus type 1 (HIV-1) nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance mutations are associated with an increased risk of virological failure during treatment with NNRTI-containing regimens. To determine whether individuals to whom variants with isolated NNRTI-associated drug resistance were transmitted are at increased risk of virological failure during treatment with a non-NNRTI-containing regimen, we identified minority variant resistance mutations in 33 individuals with isolated NNRTI-associated transmitted drug resistance and 49 matched controls. We found similar proportions of overall and nucleoside reverse transcriptase inhibitor-associated minority variant resistance mutations in both groups, suggesting that isolated NNRTI-associated transmitted drug resistance may not be a risk factor for virological failure during treatment with a non-NNRTI-containing regimen.
Immune System Diseases (1)
HIV Infections (1), more mentions
The Journal of infectious diseases
Background: Systemic chemotherapies for various malignancies have been shown to significantly, yet transiently, decrease numbers of CD4+ T lymphocytes, a major reservoir for human immunodeficiency virus type 1 (HIV-1) infection. However, little is known about the impact of cytoreductive chemotherapy on HIV-1 reservoir dynamics, persistence, and immune responses. Methods: We investigated the changes in peripheral CD4+ T-cell-associated HIV-1 DNA and RNA levels, lymphocyte activation, viral population structure, and virus-specific immune responses in a longitudinal cohort of 15 HIV-1-infected individuals receiving systemic chemotherapy or subsequent autologous stem cell transplantation for treatment of hematological malignancies and solid tumors. Results: Despite a transient reduction in CD4+ T cells capable of harboring HIV-1, a 1.7- and 3.3-fold increase in mean CD4+ T-cell-associated HIV-1 RNA and DNA, respectively, were observed months following completion of chemotherapy in individuals on antiretroviral therapy. We also observed changes in CD4+ T-cell population diversity and clonal viral sequence expansion during CD4+ T-cell reconstitution following chemotherapy cessation. Finally, HIV-1 DNA was preferentially, and in some cases exclusively, detected in cytomegalovirus (CMV)- and Epstein-Barr virus (EBV)-responsive CD4+ T cells following chemotherapy. Conclusions: Expansion of HIV-infected CMV/EBV-specific CD4 + T cells may contribute to maintenance of the HIV DNA reservoir following chemotherapy.
Stem Cell Research (3), Immune System Diseases (2)
Cytomegalovirus Infections (2), Neoplasms (2), HIV Infections (1), more mentions
AIDS (London, England)
TITLE: Time from HIV infection to virological suppression: dramatic fall from 2007-2016. OBJECTIVES: We examined the time from HIV infection to virological suppression in men who have sex with men (MSM) who were first diagnosed at Melbourne Sexual Health Centre (MSHC) between 2007 and 2016. DESIGN: Retrospective cohort. METHODS: Date of infection was imputed from the testing history or serological evidence of recent infection (negative or indeterminate Western Blot) or baseline CD4 cell count. Date of virological suppression was determined using clinical viral load data. We analysed predictors of diagnosis with serological evidence of recent infection (logistic regression) and time from diagnosis to suppression and from infection to suppression (cox regression) using demographic, clinical and behavioural covariates. RESULTS: Between 2007 and 2016, the median time from HIV infection to diagnosis fell from 6.8 to 4.3 months (p = .001), from diagnosis to suppression fell from 22.7 to 3.2 months (p < .0001), and from infection to suppression fell from 49.0 to 9.6 months (p < .0001). Serological evidence of recent infection increased from 15.6% to 34.3% (p < .0001) of diagnoses. In the multivariate analyses, age, being recently arrived from a non-English speaking country, history of injecting drug use, other STIs and sexual risk were not associated with any of these measures. CONCLUSIONS: The duration of infectiousness in MSM diagnosed with HIV infection at MSHC in Victoria has fallen dramatically between 2007 and 2016 and the proportion diagnosed with serological evidence of recent infection has increased. This effect is observed across all population subgroups and marks a positive milestone for the treatment as prevention paradigm.
Infections (7), HIV Infections (5), more mentions
AIDS (London, England)
OBJECTIVE: To determine if the greater risk of ischemic stroke observed in women living with HIV infection (WLWH) compared with HIV-uninfected women persists after accounting for both traditional and sex-specific stroke risk factors. METHODS: We performed an observational cohort study of WLWH (n = 1,214) and demographics-matched HIV-uninfected women (n = 12,041) seen between 1996 and 2011 at two tertiary care hospitals in Boston. We used Cox proportional hazards regression analyses to model time to ischemic stroke, adjusting first for demographics and traditional stroke risk factors and then for sex-specific stroke risk factors, including menopause and estrogen use. We also constructed demographics-adjusted Cox models to identify HIV-related risk factors associated with ischemic stroke among WLWH. RESULTS: The incidence of ischemic stroke was higher among WLWH compared with HIV-uninfected women (incidence rate ratio 2.39, 95% CI 1.62-3.43). After adjusting for demographics and traditional stroke risk factors, HIV infection was associated with almost twice the risk of ischemic stroke (hazard ratio (HR) 1.93, 95% CI 1.31-2.85). The association of HIV with ischemic stroke persisted after inclusion of sex-specific stroke risk factors in the model (HR 1.89, 95% CI 1.28-2.81). Among WLWH, longer duration of antiretroviral therapy was associated with lower ischemic stroke risk (HR 0.86 per year, 95% CI 0.76-0.96). CONCLUSION: The increased risk of ischemic stroke among WLWH compared with HIV-uninfected women persisted after adjusting for both traditional and sex-specific stroke risk factors. Further investigation into the mechanisms of elevated stroke risk among WLWH, including immunologic factors, will be key for developing targeted preventive strategies for this at-risk population.
Cardiovascular Diseases (16), Women's Health (1)
HIV Infections (3), more mentions
Blood
Hematopoietic cell transplantation (HCT) has now been shown to be safe and effective for selected HIV-infected patients with hematological malignancies. Autologous HCT is now standard of care for patients with HIV-related lymphomas who otherwise meet standard transplant criteria. Limited data also supports use of allogeneic HCT (alloHCT) in selected HIV-infected patients who meet standard transplant criteria. We recommend enrolling patients on clinical trials that offer access to CCR5Δ32 homozygous donors, if available. HIV-infected patients requiring HCT may also be considered for participation in trials evaluating the activity of gene-modified hematopoietic stem cells in conferring resistance to HIV infection. To be considered for HCT, patients must have HIV infection that is responsive to combination anti-retroviral therapy (cART). Careful planning for the peri-HCT management of the cART can avoid risk of significant drug interactions and development of cART-resistant HIV. In general, we recommend against the use of boosted proteasome inhibitors and non-nucleotide reverse transcriptase inhibitors in the cART regimen, in favor of nucleoside reverse transcriptase inhibitors and integrase inhibitors (without cobicistat). Following HCT, patients must be closely monitored for development of opportunistic infections (OI), such as cytomegalovirus (CMV). Prevention of OI should include prophylactic and pre-emptive antimicrobials.
HIV Infections (2), Hematologic Neoplasms (2), Opportunistic Infections (1), more mentions
Sexually transmitted diseases
BACKGROUND: The rapid human immunodeficiency virus (HIV) self-test in the United States has expanded opportunities for HIV testing in nonclinical settings which may increase early diagnosis of HIV infection. However, broad application may be limited by the cost of the test and concerns that self-testers who test positive will not seek timely HIV care. METHODS: We used data from HIV partner services program to compare the sociodemographic characteristics, transmission risk, and clinical stage of persons diagnosed with HIV by report of rapid self-test. Among self-tested persons, we assessed timeliness of seeking definitive testing after self-test and linkage to care. RESULTS: From January 2013 to August 2016, 8032 HIV-positive persons were interviewed. Compared with the 7905 persons who did not self-test, self-tested persons were significantly (all P = <0.0001) male (96% vs 78%), white/non-Hispanic (46% vs 16%), men who have sex with men (92% vs 58%), college educated (67% vs 35%), and residing in medium-high income NYC neighborhoods (51% vs 44%). Higher proportions of self-tested (91%) than non-self-tested persons (81%) linked to care within three months of diagnosis. Significantly (P = <0.0001) more persons that self-tested positive (39/44, 89%) than persons that self-tested negative (14/36, 39%) sought laboratory-based HIV test within 1 month of last self-testing; and negative than positive self-tested persons were diagnosed with acute HIV infection (44% vs. 9%, P = <0.0001). CONCLUSIONS: Our findings suggest that men who have sex with men sought timely HIV confirmatory testing and linkage to care after self-test. However, the cost of self-test kit may be an important barrier to its wide adoption across sociodemographic groups.
Immune System Diseases (3)
HIV Infections (2), more mentions
AIDS (London, England)
No Abstract Available
Infectious Diseases (2), Immune System Diseases (2)
HIV Infections (2), Autoimmune Hepatitis (2), more mentions
American journal of public health
No Abstract Available
HIV Infections (2), more mentions
Neurology
No Abstract Available
HIV Infections (2), Motor Neuron Disease (2), more mentions
Sexually transmitted diseases
The proportion of persons living with human immunodeficiency virus (HIV) in New York City in stage 1 (CD4 ≥ 500 cells/mm) increased from 50.6% in 2011 to 59.6% in 2015. The revised Centers for Disease Control and Prevention staging system of HIV infection is a useful tool with which to classify persons living with HIV.
Immune System Diseases (2)
HIV Infections (1), more mentions
American journal of obstetrics and gynecology
BACKGROUND: There is limited information on the patterns and trends of contraceptive use among women living with HIV, compared with noninfected women in the United States. Further, little is known about whether antiretroviral therapy correlates with contraceptive use. Such information is needed to help identify potential gaps in care and to enhance unintended pregnancy prevention efforts. OBJECTIVE: We sought to compare contraceptive method use among HIV-infected and noninfected privately insured women in the United States, and to evaluate the association between antiretroviral therapy use and contraceptive method use. STUDY DESIGN: We used a large US nationwide health care claims database to identify girls and women ages 15-44 years with prescription drug coverage. We used diagnosis, procedure, and National Drug Codes to assess female sterilization and reversible prescription contraception use in 2008 and 2014 among women continuously enrolled in the database during 2003 through 2008 or 2009 through 2014, respectively. Women with no codes were classified as using no method; these may have included women using nonprescription methods, such as condoms. We calculated prevalence of contraceptive use by HIV infection status, and by use of antiretroviral therapy among those with HIV. We used multivariable polytomous logistic regression to calculate unadjusted and adjusted odds ratios and 95% confidence intervals for female sterilization, long-acting reversible contraception, and short-acting hormonal contraception compared to no method. RESULTS: While contraceptive use increased among HIV-infected and noninfected women from 2008 through 2014, in both years, a lower proportion of HIV-infected women used prescription contraceptive methods (2008: 17.5%; 2014: 28.9%, compared with noninfected women (2008: 28.8%; 2014: 39.8%, P < .001 for both). Controlling for demographics, chronic medical conditions, pregnancy history, and cohort year, HIV-infected women compared to HIV-noninfected women had lower odds of using long-acting reversible contraception (adjusted odds ratio, 0.67; 95% confidence interval, 0.52-0.86 compared to no method) or short-acting hormonal contraception method (adjusted odds ratio, 0.59; 95% confidence interval, 0.50-0.70 compared to no method). In 2014, HIV-infected women using antiretroviral therapy were significantly more likely to use no method (76.8% vs 64.1%), and significantly less likely to use short-acting hormonal contraception (11.0% vs 22.7%) compared to HIV-infected women not using antiretroviral therapy. Those receiving antiretroviral therapy had lower odds of using short-acting hormonal contraception compared to no method (adjusted odds ratio, 0.45; 95% confidence interval, 0.32-0.63). There was no significant difference in female sterilization by HIV status or antiretroviral therapy use. CONCLUSION: Despite the safety of reversible contraceptives for women with HIV, use of prescription contraception continues to be lower among privately insured HIV-infected women compared to noninfected women, particularly among those receiving antiretroviral therapy.
Women's Health (9)
HIV Infections (1), more mentions
Drug and alcohol dependence
BACKGROUND: and Aims Injecting illicit drugs in public settings has been linked to a higher risk of a range of drug-related harms, including overdose and HIV infection. However, the factors associated with public injecting among HIV-positive individuals have not been previously explored. We investigated the links between public drug injecting, drug-related harm, and HIV treatment measures among a cohort of HIV-positive persons who inject drugs (PWID) in a Canadian setting. METHODS: We used data from a prospective cohort of HIV-positive PWID recruited from community settings in Vancouver, Canada, linked to comprehensive clinical monitoring data in the context of an ongoing Treatment-as-Prevention (TasP) initiative to examine harms associated with public injecting. We used generalized linear mixed-effects analyses to identify longitudinal factors associated with self-reported public drug injection. RESULTS: Between 2005 and 2014, 626 HIV-seropositive PWID were recruited, of whom 213 (34%) reported public injection in the preceding 180days. In a longitudinal multivariable model, public injection was positively associated with daily heroin injection (Adjusted Odds Ratio [AOR]=2.63), incarceration (AOR=1.78), and detectable plasma HIV-1 RNA viral load (VL, AOR=1.42). CONCLUSIONS: Public injecting was linked to numerous drug-related harms among HIV-seropositive PWID in this setting. Given its link with detectable VL, an important marker of poor HIV treatment outcomes, our findings support prioritizing individuals engaged in public injecting with harm reduction strategies as well as clinical and social supports as a part of TasP-based efforts to prevent HIV-related morbidity and mortality, and HIV transmission.
HIV Infections (1), more mentions
AIDS (London, England)
OBJECTIVE: Lung cancer screening with low-dose computed tomography (LDCT) of high-risk groups in the general population is recommended by several authorities. This may not be feasible in people living with HIV (PLWHIV) due to higher prevalence of nodules. We therefore assessed the prevalence of positive computed tomography (CT) images and lung cancers in PLWHIV. DESIGN: The Copenhagen comorbidity in HIV infection (COCOMO) study is an observational, longitudinal cohort study. Single-round LDCT was performed with subsequent clinical follow-up (NCT02382822). METHOD: Outcomes included histology-proven lung cancer identified by LDCT and positive CT images (noncalcified nodules) in the entire cohort and in the high-risk group (>50 years of age and >30 pack-years). We also assessed the procedures and adverse events, and clinical factors associated with a positive CT image. RESULTS: LDCT was performed in 901 patients, including 113 at high risk for lung cancer. A positive image was found in 28 (3.1% of the entire cohort and 9.7% of the high-risk group). Nine patients (all in the high-risk group) had invasive procedures undertaken with no serious adverse events. Lung cancer (stages IA, IIA, and IIIA) was diagnosed in three patients from the high-risk group (2.7%). CD4 cell count less than 500 cells/μl and CD4 nadir less than 200 cells/μl were each independently associated with increased odds of a positive image odds ratio 2.32 [95% confidence interval: 1.01-5.13, P = 0.04] and odds ratio 2.63 [95% confidence interval: 1.13-6.66, P = 0.03]. CONCLUSION: Randomized LDCT screening trials in PLWHIV are nonexistent, but these findings are comparable with screening rounds from the general population in terms of prevalence of lung cancer and positive CT images.
Oncology (5)
Lung Neoplasms (5), HIV Infections (1), more mentions
AIDS (London, England)
OBJECTIVE: To evaluate the predictive value of Soluble Suppression of Tumorigenicity 2 (sST2), a decoy receptor of IL-33 involved in several inflammatory and immune diseases, for death in HIV infection. DESIGN: Patients enrolled in the ANRS CO3 Aquitaine Cohort, a prospective hospital-based cohort of HIV-1-infected patients, who had a plasma sample available in the bio-bank were systematically eligible. METHODS: sST2, sCD14 and IL6 were measured using Luminex® multiplex bead-based technology (R&D Systems) and a Bio-Plex 200 instrument (BioRad). Predictive capacities of sST2, sCD14, IL6 and of the Veteran Aging Cohort Study (VACS) clinical score at baseline on overall mortality were compared using multivariable Cox proportional hazards models. RESULTS: During a median follow-up of 7.2 years (IQR: 6.0; 7.9), 93 deaths from all causes (incidence rate 9.9 per 1000 patient-years; 95% confidence interval 7.9; 11.9) were reported in 1,414 patients. The median sST2 baseline concentration was 22.9 ng/mL (IQR: 17.7; 30.3) and was higher (30.8 ng/mL, IQR: 21.5; 42.1) in patients who died as compared to those who stayed alive (22.6 ng/mL; IQR: 17.5; 29.6) (p < 10). An increased risk of death of 21% for a concentration 10.0 ng/mL higher of sST2 remained after adjustment for sCD14, IL6 and VACS score (adjusted hazard ratio: 1.21; p < 10). The predictive capacity of sST2 was confirmed in a validation cohort (n = 386, 31 deaths) with an improved area c-index from 0.804 without sST2 to 0.811 with sST2. CONCLUSION: sST2 is a new valuable biomarker to evaluate the risk of all-cause mortality in HIV disease.
HIV Infections (1), Immune System Diseases (1), more mentions
The Journal of infectious diseases
Background: Human immunodeficiency virus (HIV)-infected individuals are at increased risk of chronic kidney disease (CKD). Human immunodeficiency virus infection, traditional CKD risk factors, and combination antiretroviral therapy (cART) may all contribute. Methods: We compared prevalence of renal impairment (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73m2), albuminuria (albumin/creatinine ratio ≥3 mg/mmol), and proximal renal tubular dysfunction (retinol-binding protein/creatinine ratio >2.93μg/mmol and/or fractional phosphate excretion >20% with plasma phosphate <0.8 mmol/L) in 596 HIV-infected and 544 HIV-uninfected AGEhIV Cohort Study participants. We also assessed whether being HIV-infected on cART, with follow-up censored when cART regimen was modified, was associated with greater eGFR decline or worsening albuminuria (increase ≥10%/year with change in albuminuria category). Results: Human immunodeficiency virus infection was independently associated with renal impairment (adjusted odds ratio [aOR] = 2.1; 95% confidence interval [CI] = 1.0-4.4), albuminuria (aOR = 5.8; 95% CI = 3.7-9.0), and proximal renal tubular dysfunction (aOR = 7.0; 95% CI = 4.9-10.2]). Among 479 HIV-infected and 377 HIV-uninfected individuals (median follow-up = 3.9/4.1 years, respectively) included in longitudinal analyses, being HIV-infected and remaining on unmodified cART was independently associated with greater eGFR decline (-0.56; 95% CI = -0.87 to -0.24 mL/min/1.73m2/year) and worsening albuminuria (aOR = 2.3; 95% CI = 1.3-4.0). Conclusions: In these middle-aged individuals, HIV infection was independently associated with renal impairment, albuminuria, and proximal renal tubular dysfunction. Human immunodeficiency virus-infected individuals on cART (predominantly containing tenofovir disoproxil fumarate) were also more likely to experience eGFR decline and worsening albuminuria compared with HIV-uninfected individuals.
Immune System Diseases (6), Kidney Disease (2)
Albuminuria (6), Fanconi Syndrome (2), Infections (2), more mentions
The Journal of antimicrobial chemotherapy
Objectives: To perform a systematic review and meta-analysis of the level of funding support and the sputum culture conversion rates in pulmonary Mycobacterium avium-intracellulare complex (P-MAC) disease in adult patients without cystic fibrosis or HIV infection, treated with recommended antibiotic regimens. Methods: We performed a literature search to identify clinical trials, prospective studies and registries that reported outcomes in P-MAC patients. Studies that reported P-MAC diagnosis and treatments based on established guidelines met the inclusion criteria and were examined for bias and quality. We modified existing quality scales and came up with a 10 star quality score. Outcomes meta-analysed were sputum conversion incidence ratios (IR) and their 95% CI, weighted for study quality. Results: Twenty-one studies that examined 28 regimens, including 2534 patients in intent-to-treat analyses and 1968 in per-protocol analyses, were identified. The study quality mean ± SD scores were 5.4 ± 2.2 out of 10 stars. Only two (9.5%) studies received public funding. There was significant heterogeneity of microbial effect among treatment regimens (I2 > 40%; P > 0.001). The pooled IR for sustained sputum conversion was 0.54 (95% CI 0.45-0.63) for macrolide-containing regimens versus 0.38 (0.25-0.52) with macrolide-free regimens. Prolonging therapy duration beyond 12 months was associated with an average decline in sputum conversion to 22% (95% CI 1%-44%). Conclusions: Researchers working on P-MAC therapy have received very little public funding support. As a result, the evidence base for treatment guidelines is based on studies of relatively small numbers of patients in low-quality studies. Nevertheless, these studies showed poor sputum conversion rates in patients receiving recommended treatment regimens.
Infectious Diseases (1)
Cystic Fibrosis (1), HIV Infections (1), more mentions
AIDS (London, England)
OBJECTIVE: To assess variation in genes that regulate cholesterol metabolism in relation to the natural history of HIV infection. DESIGN: Cross-sectional and longitudinal analysis of the Women's Interagency HIV Study (WIHS). METHODS: We examined 2,050 single nucleotide polymorphisms (SNPs) in 19 genes known to regulate cholesterol metabolism in relation to HIV viral load and CD4 T cell levels in a multiracial cohort of 1,066 antiretroviral therapy (ART) naïve women. RESULTS: Six SNPs were associated with both HIV viral load and CD4 T cell levels at a false discovery rate (FDR) of 0.01. Bioinformatics tools did not predict functional activity for five SNPs, located in introns of NCOR2, RXRA and TTC39B. Rs17111557 located in the 3' untranslated region (UTR) of PCSK9 putatively affects binding of hsa-miR-548t-5p and hsa-miR-4796-3p, which could regulate PCSK9 expression levels. Interrogation of rs17111557 revealed stronger associations in the subset of women with HIV/hepatitis C virus (HCV) co-infection (n = 408, 38% of women). Rs17111557 was also associated with low-density lipoprotein cholesterol (LDL-C) levels in HIV/HCV co-infected (β: -10.4; 95% CI: -17.9, -2.9; P = 0.007), but not in HIV monoinfected (β:1.2; 95% CI: -6.3, 8.6; P = 0.76) women in adjusted analysis. CONCLUSIONS: PCSK9 polymorphism may affect HIV pathogenesis, particularly in HIV/HCV co-infected women. A likely mechanism for this effect is PCSK9-mediated regulation of cholesterol metabolism. Replication in independent cohorts is needed to clarify the generalizability of the observed associations.
Infectious Diseases (2)
Hepatitis C (2), HIV Infections (1), Coinfections (1), more mentions
AIDS (London, England)
OBJECTIVES: Sexual stigma affecting men who have sex with men (MSM) in Nigeria may be an important driver of HIV and other sexually transmitted infections (STIs), but potential mechanisms through which this occurs are not well understood. This study assessed the contributions of suicidal ideation and sexual risk behaviors to causal pathways between stigma and HIV/STIs. DESIGN: Data were collected from the TRUST/RV368 Study, a prospective cohort of 1,480 MSM from Abuja and Lagos, Nigeria. METHODS: Participants enrolled from March 2013-February 2016 were classified into three stigma subgroups based on a latent class analysis of nine stigma indicators. Path analysis was used to test a model where disclosure led to stigma, then suicidal ideation, then condomless sex with casual sex partners, and finally incident HIV infection and/or newly diagnosed STIs, adjusting the model for age, education, having had female sex partners in the past 12 months, and sex position. Both direct and indirect (mediational) paths were tested for significance and analyses were clustered by city. RESULTS: As stigma increased in severity, the proportion of incident HIV/STI infections increased in a dose-response relationship (low: 10.6%, medium: 14.2%, high 19.0%, p-value = .008). All direct relationships in the model were significant and suicidal ideation and condomless sex partially mediated the association between stigma and incident HIV/STI infection. CONCLUSIONS: These findings highlight the importance of the meaningful integration of stigma-mitigation strategies in conjunction with mental health services as part of a broader strategy to reduce STI and HIV acquisitions among Nigerian MSM.
Infections (4), HIV Infections (1), more mentions
AIDS (London, England)
OBJECTIVES: In the general population, metabolic health (MH) often declines as body mass index (BMI) increases. However, some obese individuals maintain MH. HIV and antiretroviral therapy (ART) have been associated with metabolic disturbances. We hypothesized that HIV-infected (HIV+) men on suppressive ART experience less MH than HIV-uninfected (HIV-) men across all BMI categories. DESIGN/METHODS: In a cross-sectional analysis of 1018 HIV+ and 1092 HIV- men enrolled in the Multicenter AIDS Cohort Study, Poisson regression with robust variance determined associations between HIV serostatus and MH prevalence (defined as meeting 2 of 5 NCEP/ATP III metabolic syndrome criteria), adjusting for age, race, BMI category, smoking and hepatitis C virus infection status. RESULTS: HIV+ men were younger (54 vs 59 years) and had lower median BMI (25 vs 27 kg/m). Non-obese HIV+ men had lower MH prevalence than HIV- men (BMI ≤25 kg/m: 80% vs 94%, p<0.001; BMI 25-29 kg/m: 64% vs 71%, p = 0.05), but MH prevalence among obese men did not differ by HIV serostatus (BMI 30-34 kg/m: 35% vs 39%, p = 0.48; BMI ≥35 kg/m: 27% vs 25%, p = 0.79). In the adjusted model, non-obese HIV+ men were less likely to demonstrate MH than non-obese HIV- men. Among HIV+ men, per year darunavir, zidovudine and stavudine use were associated with lower MH likelihood. CONCLUSIONS: Metabolically healthy obesity prevalence does not differ by HIV serostatus. However, among non-obese men, HIV infection is associated with lower MH prevalence, with associations between lack of MH and darunavir and thymidine analog nucleoside reverse transcriptase inhibitor exposure observed.
Immune System Diseases (20), Anti-Obesity and Weight Loss (9), Infectious Diseases (1)
HIV Infections (1), Obesity (1), Infections (1), more mentions
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