Anne Buve

Risk factors for HCV acquisition among HIV positive MSM in Belgium

Objective:To better understand risk factors for the sexual transmission of hepatitis C viral (HCV) infection among men who have sex with men (MSM). Design:Case–control study among HIV-infected MSM, attending AIDS Reference Centers in Belgium. Methods:Cases were HIV-infected MSM who were diagnosed with HCV between January 2010 and December 2013. For each case, 2 controls were randomly selected among the HIV-positive MSM who tested negative for HCV around the same time as the cases were identified. Consenting participants were interviewed with a questionnaire on risk factors. Medical records were abstracted to document past episodes of sexually transmitted infections (STIs). Associations between HCV infection and risk factors were explored using bivariate analysis followed by multiple logistic regression analysis. Results:A total of 52 cases and 90 controls were recruited. In multivariate analysis, douching before anal intercourse [adjusted odds ratio (AOR) = 9.84, 95% CI: 2.26 to 42.78], fisting (AOR = 3.54, 95% CI: 1.31 to 9.57), having intercourse with HIV-positive men (AOR = 5.51, 95% CI: 1.87 to 16.20), and a documented gonorrhoea or chlamydial infection in the year before inclusion in the study (AOR = 4.50, 95% CI: 1.11 to 18.31) were independently associated with incident HCV infection. Conclusions:Our study confirmed fisting and suffering from other STIs as risk factors for HCV and suggested an increased risk of HCV associated with serosorting. Furthermore, we identified anal douching as being associated with HCV infection. The role that douching plays in the acquisition of HCV infection and other STIs requires further research, as well as the effect of serosorting on STI transmission.

Partner-concurrency associated with herpes simplex virus 2 infection in young South Africans.

This study was undertaken in two locations in Trinidad Sea Lots and Point Fortin between November and December 2007. Participants were women aged 16-24. The study uses the PEER (participatory ethnographic evaluation and research) method to generate in-depth narrative data and provide an authentic insider view of the realities of the target group. The FoQus on Segmentation strategy was used to gain programmer input into the study design identify potential determinants of condom use and explore factors that will be used to develop a concept for promoting condom use with outside partners. PSI/Caribbean will use the results to develop interpersonal communication activities and a media campaign directed at the target group. Initially the study set out to understand transactional cross-generational relationships identified as a major risk factor among the target group. The data revealed that within the target population sexual relationships and financial benefits are intimately linked within all relationships. Despite the differences in economic context between Sea Lots and Point Fortin in all interview narratives sex and money are inextricable. An over-riding feature of the interviews is that sex is commoditised as part of the norm of relationships. Sex without financial gain is perceived within the target group as aberrant and certainly not normative. The data made clear that defining some relationships as transactional and some as not is not meaningful in the context of the target group. The study has therefore focussed on understanding how patterns of concurrent relationships are managed and maintained.Whilst much is known about the individual-level risk factors for herpes simplex virus 2 (HSV-2) infection, little is known about why only some populations develop generalized HSV-2 epidemics. This study aims to assess the extent to which partner-concurrency (a factor which operates at both the partnership- and network-level) may be responsible. We utilized multivariate logistic regression to analyse the relationship between HSV-2 seropositivity and potential risk factors in data from a representative cross-sectional survey of 14–24 year olds from a township in South Africa conducted in 1999. The overall prevalence of HSV-2 was 53.3% amongst women and 17% amongst men. For men, four factors remained significantly associated with HSV-2 infection in the multivariate regression analysis: total number of sex acts, being a migrant labourer, Zulu ethnicity and being human immunodeficiency virus (HIV) positive. For women, eight factors were associated with HSV-2 infection: increasing age, partner-concurrency (having a partner who had other partners), an older partner, total number of sex acts, using hormonal contraception, Xhosa ethnicity, syphilis seropositivity and being HIV positive. We conclude that partner-concurrency is associated with increased HSV-2 seropositivity in women.

Control of viral replication after cessation of HAART

We describe two patients who did not experience a viral rebound after cessation of HAART which was initiated for progressive disease. CD4 T-cell count remained stable in one patient and progressively declined in the other, despite apparent viral control. We failed to identify any immune activation or genetic markers that could offer an explanation for this unusual secondary controller status. But their viruses are clearly less fit compared to viruses from rebounders.

HIV-Related Risk Behaviors Among Labor Migrants, Their Wives and the General Population in Nepal

Nepalese labor migrants and their wives are considered as at-risk populations for HIV infection. There may be a risk of HIV transmission from the labor migrant and their wives to the general population due to HIV-related risk behaviors, but so far empirical evidence to support this hypothesis is scarce. Therefore, this study was conducted to compare HIV-related risk behaviors between labor migrants, their wives, and males and females from the general population in the far-western region of Nepal. This was a cross-sectional study, in which structured face-to-face interviews were conducted with 261 male labor migrants, 262 wives of labor migrants, 123 males and 122 females from the general population. We found that the proportion of the labor migrants and their wives reporting having had extramarital sex in the previous year did not differ significantly with the males (11.9 vs. 13.4u2009%, p value 0.752) and females (2.0 vs. 1.7u2009%, p value 0.127) from the general population. However, the labor migrants compared with the males from the general population were 1.51 times and the wives of labor migrants compared with the females from the general population were 2.37 times more likely to have been tested for HIV. Both the males from the general population and the labor migrants are equally engaged in unprotected extramarital sex. Therefore, it is recommended that the prevention programs, including access to condoms and HIV testing, should be scaled up targeting a broader range of individuals in the far-western region of Nepal.

Development and validation of the HCV-MOSAIC risk score to assist testing for acute hepatitis C virus (HCV) infection in HIV-infected men who have sex with men (MSM)

Current guidelines recommend hepatitis C virus (HCV) testing for HIV-infected men who have sex with men (MSM) with ongoing risk behaviour, without specifying the type of risk behaviour. We developed and validated the HCV-MOSAIC risk score to assist HCV testing in HIV-infected MSM. The risk score consisted of six self-reported risk factors identified using multivariable logistic regression using data from the Dutch MOSAIC study (nu2009=u2009213, 2009–2013). Area under the ROC curve (AUC), sensitivity, specificity, post-test-probability-of-disease and diagnostic gain were calculated. The risk score was validated in case–control studies from Belgium (nu2009=u2009142, 2010–2013) and the United Kingdom (nu2009=u2009190, 2003–2005) and in cross-sectional surveys at a Dutch sexually transmitted infections clinic (nu2009=u2009284, 2007–2009). The AUC was 0.82; sensitivity 78.0% and specificity 78.6%. In the validation studies sensitivity ranged from 73.1% to 100% and specificity from 56.2% to 65.6%. The post-test-probability-of-disease ranged from 5.9% to 20.0% given acute HCV prevalence of 1.7% to 6.4%, yielding a diagnostic gain of 4.2% to 13.6%. The HCV-MOSAIC risk score can successfully identify HIV-infected MSM at risk for acute HCV infection. It could be a promising tool to improve HCV testing strategies in various settings.

Association of Sexual Debut in Adolescents With Microbiota and Inflammatory Markers.

OBJECTIVE: To investigate the association of sexual debut and vaginal, anorectal, and oral microbiota and vaginal inflammatory markers in female adolescents. METHODS: We conducted a school-based study in adolescents in Antwerp, Belgium. During three visits over 8 months, participants answered questionnaires and self-collected vaginal, anorectal, and oral swabs. Five Lactobacillus species, Lactobacillus genus, Gardnerella vaginalis, and Atopobium vaginae were quantified; and seven inflammatory markers were measured in the vaginal specimens. In the oral and anorectal specimens, Lactobacillus genus, G vaginalis, and A vaginae were ascertained. RESULTS: Of the 93 adolescents (mean age 16.2 years) at the first visit, 41 (44.1%) had passed sexual debut (penile–vaginal intercourse) and five (5.4%) had sexual experience without passing sexual debut. Having sexual experience at the first visit was not found to be associated with species presence or concentrations (acknowledging an underpowered study because the required sample size was not attained). Modeling the longitudinal data on all girls showed that sexual debut was associated with increased odds of vaginal and anorectal G vaginalis (P=.021; P=.030) and A vaginae (P=.041; P=.012) with increments of interleukins (interleukin [IL]-1&agr; P<.001, IL-1&bgr; P=.046, IL-8 P=.033) and chemokines (regulated on activation, normal T cell expressed and secreted P<.001; macrophage inflammatory protein-1&bgr; P=.040), whereas no difference was seen when modeling (before–after) the girls initiating and girls staying without sexual intercourse. The association of sexual intercourse with IL-1&agr; (P<.001), IL-1&bgr; (P=.030), and IL-8 (P=.002) at the first visit was (greater than 70%) mediated by vaginal G vaginalis and A vaginae concentrations. CONCLUSION: Sexual debut in adolescents is associated with an inflammatory vaginal reaction and with the presence of bacterial vaginosis–related species. Strategies preventing the colonization of bacterial vaginosis–related organisms during early sexual debut are urgently needed and may prevent acquisition of sexually transmitted infections including human immunodeficiency virus in early life.

Mothers' willingness to pay for daughters' HPV vaccine in northern Vietnam

ABSTRACT HPV vaccine is effective in preventing human papillomavirus, the main cause of cervical cancer. In Vietnam, at first, it was subsidized at

Theorizing the complexity of HIV disclosure in vulnerable populations: a grounded theory study

5 a dose and reached the coverage of 96% in two pilot provinces, indicating potentially high acceptance. Currently, it is provided at

Building a Conceptual Framework to Study the Effect of HIV Stigma-Reduction Intervention Strategies on HIV Test Uptake: A Scoping Review

120–195 for three doses. This is a cross-sectional study, conducted in two northern rural districts of Vietnam. Researchers present findings to show 53.1% of mothers stated their willingness to pay (WTP) for HPV vaccine for their daughters. Perceptions on cost and condom use were associated with WTP. Mothers affordability ranged from under

Factors associated with condom use for HIV prevention among Nepalese labor migrant couples

23 to