Human Immunodeficiency Virus-infected men who have sex with men with syphilis: A 5-year multicentre study in Malaysia

@#Objectives: High rates of syphilis have been reported worldwide among men who have sex with men (MSM). This study aims to describe the clinical pattern and treatment response of syphilis among human immunodeficiency virus (HIV)-infected MSM in Malaysia. Methods: This is a retrospective study on all HIV-infected MSM with syphilis between 2011 and 2015. Data was collected from case notes in five centres namely Hospital Kuala Lumpur, Hospital Sultanah Bahiyah, Hospital Umum Sarawak, University of Malaya Medical Centre and Hospital Sungai Buloh. Results: A total of 294 HIV seropositive MSM with the median age of 29 years (range 16-66) were confirmed to have syphilis. Nearly half (47.6%) were in the age group of 20-29 years. About a quarter (24.1%) was previously infected with syphilis. Eighty-three patients (28.2%) had other concomitant sexually transmitted infection with genital warts being the most frequently reported (17%). The number of patients with early and late syphilis in our cohort were almost equal. The median pre-treatment non-treponemal antibody titre (VDRL or RPR) for early syphilis (1:64) was significantly higher than for late syphilis (1:8) (p<0.0001). The median CD4 count and the number of patients with CD4 <200/μl in early syphilis were comparable to late syphilis. Nearly four-fifth (78.9%) received benzathine-penicillin only, 5.8% doxycycline, 1.4% Cpenicillin, 1% procaine penicillin, and 12.4% a combination of the above medications. About 44% received treatment and were lost to follow-up. Among those who completed 1 -year follow-up after treatment, 72.3% responded to treatment (serological non-reactive – 18.2%, four-fold drop in titre – 10.9%; serofast – 43.6%), 8.5% failed treatment and 17% had re-infection. Excluding those who were re-infected, lost to follow-up and died, the rates of treatment failure were 12.1% and 8.8% for early and late syphilis respectively (p=0.582) Conclusion: The most common stage of syphilis among MSM with HIV was latent syphilis. Overall, about 8.5% failed treatment at 1-year follow-up.

Situaciones que incrementan la vulnerabilidad a la infección por el virus de inmunodeficiencia humana / Situations increasing vulnerability to Human Immunodeficiency Virus infection

RESUMEN Introducción: el comportamiento de la epidemia del virus de inmunodeficiencia humana en Cuba, desde su inicio y hasta la actualidad, afecta mayoritariamente a personas y grupos cuyas prácticas e identidades sexuales son discriminadas. Objetivo: describir las situaciones que incrementan la vulnerabilidad a la infección por el virus de inmunodeficiencia humana, en hombres que tienen sexo con hombres y mujeres transgénero. Materiales y métodos: se realizó un estudio descriptivo, en hombres que tienen sexo con hombres y mujeres transgénero, que acudieron a espacios de encuentro sexual, distribuidos en ocho municipios de los 45 más afectados por la epidemia de virus de inmunodeficiencia humana en Cuba, entre octubre de 2013 y febrero de 2017. Se estudiaron las variables: ocupación, comportamientos sexuales, toma de decisiones, valoración social, roles de género, discriminación y violencia. Para medir la magnitud de la diferencia se utilizó el indicador "porcentaje de diferencia". Resultados: el 28.9% de los participantes refirió que las tareas domésticas eran realizadas generalmente por el hombre "pasivo"; en cambio, los "activos" toman las decisiones en la pareja (24.0% vs. 6.3%), resultan ser más valorados por la sociedad (23.1% vs. 8.2%) y generalmente se ubican en el rol de proveedores económicos (17.1% vs. 8.8%). El 64.9% percibió haber sido excluido o discriminado a causa de la orientación sexual o identidad de género y el 32.0% se sintió discriminado en instituciones de salud. El 44.8% refirió haber sido víctima de violencia económica, seguida de la sexual (44.3%). La violencia física fue referida por el 32.2%. Conclusiones: las desigualdades y discriminaciones percibidas, sustentan la diversidad de realidades y retos específicos a los que se enfrentan estas personas, que pueden hacerlos vulnerables a adquirir el virus de inmunodeficiencia humana (AU).

SUMMARY Introduction: the behavior of the Human Immunodeficiency Virus epidemics in Cuba, from the beginning and up today, mainly affects persons and groups whose sexual practices and identities are discriminated. Objective: to describe the situations increasing the vulnerability to Human Immunodeficiency Virus infection in men having sex with other men and transgender women. Materials and Methods: a descriptive study was carried out in men who have sex with other men and transgender women who assisted to places of sexual encounters located in eight municipalities of the 45 most affected ones by the epidemics of Human Immunodeficiency Virus in Cuba, from October 2013 to October 2017. The studied variables were: job, sexual behavior, social assessment, gender roles, discrimination and violence. The indicator "difference percentage" was used to assess the magnitude of the difference. Results: 28.9 % of the participants referred that housework was done in general by the ¨bottom¨ man; meanwhile, the ¨active¨ ones take the decisions in the couple (24.0 % versus 6.3 %) and are more appreciated by the society (23.1 % versus 8.2 %), usually playing the role of economic providers (17.1 % versus. 8.8 %). 64.9 % perceived to be excluded or discriminated because of their sexual orientation or genre identity, and 32.0 % felt being discriminated in health institutions. 44.8 % referred being victim of economical violence, followed by sexual violence (44.3 %). Physical violence was referred by 32.2 %. Conclusions: perceived inequalities and discriminations sustain the diversity of realities and specific challenges affronted by these persons, and they could make them vulnerable to acquire the Human Immunodeficiency Virus (AU).

Sexually transmitted infections: Need for extragenital screening

Extragenital infections can occur concurrently with simultaneous urogenital infections. Extragenital sites are believed to serve as hidden reservoirs and play a critical role in their transmission. The etiological relationship of the most widespread Sexually transmitted diseases (STD) pathogen to reproductive tract has long been established, but the distribution to extragenital sites appears to be infrequent and its correlation with the sexual practice still requires to be investigated. Optimal-screening strategies for extragenital infections are largely unknown. However, there is a lack of data on clinical outcomes and optimal treatment regimens for rectal and pharyngeal extragenital infections. Further studies are needed in settings other than reproductive health and STD clinics, especially in primary care clinics and resource-limited settings.

Molecular epidemiology related to human immunodeficiency virus type 1 infection in men having sex with men in Xi'an / 中华流行病学杂志

Objective To investigate the subtype distribution of HIV-1 infection among men having sex with men (MSM) in Xi' an city.Methods 5 ml anti-coagulating blood samples were collected from MSM who had been reported during 2010-2012 in Xi'an.Both gag and env genes were amplified by nested RT-PCR from the extracted RNA and then sequenced.The acquired sequences were compared with international subtype references,and then the genetic distances were calculated and phylogenetic trees were constructed by Mega 5.2.Epidemiological information including sexual behavior characteristics,history of drug use,blood donation,etc.were gathered.Results 168 samples were successfully amplified and sequenced.Results from Phylogenic analysis showed that the gag and env sequences of 165 samples shared the same subtypes,of which 79 (47.0％) were CRF01_AE,74 (44.0％) were CRF07_BC and 12 (7.1％) belonged to subtype B.There were 3 samples with gag and env sequences classified into different subtypes,of which 2 (1.2％) were CRF01_AE/A1,and the other 1 was CRF07_BC/CRF01_AE.Conclusion At least three HIV-1 subtypes including CRF01_AE,CRF07_BC were identified among MSM population in Xi'an city.

Performance of audio-assisted confidential voting interview for assessment of sexual behavior among young adults in Chandigarh Union Territory.

A cross-sectional study was conducted in Chandigarh Union Territory to evaluate the performance of an audio-assisted confidential voting interview (AVI), for assessing the sexual behavior among young adults aged 20 - 34 years. Using systematic random sampling 625 males and 630 females were interviewed alternately, either by AVI or by face-to-face interview (FFI). More men revealed having sex with men in AVI (2.6%) than FFI (0.6%) (P 0.06). Women reported having sex with non-regular partners more often in AVI (4.8%) compared to FFI (0.3%) (P < 0.001). AVI performed better than FFI for eliciting sensitive sexual behaviors.