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Abstract INTRODUCTION HIV incidence estimates are essential to monitor the progress of prevention and control interventions. METHODS Data collected by Brazilian surveillance systems were used to derive HIV incidence estimates by age group (15-24; 25+) and sex from 1986 to 2018. This study used a back-calculation method based on the first CD4 count among treatment-naïve cases. Incidence estimates for the population aged 15 years or over were compared to Global Burden of Disease Study (GBD) estimates from 2000 to 2018. RESULTS Among young men (15-24 years), HIV incidence increased from 6,400 (95% CI: 4,900-8,400), in 2000, to 12,800 (95% CI: 10,800-15,900), in 2015, reaching incidence rates higher than 70/100,000 inhabitants and an annual growth rate of 3.7%. Among young women, HIV incidence decreased from 5,000 (95% CI: 4,200-6,100) to 3,200 (95% CI: 3,000-3,700). Men aged ≥25 years and both female groups showed significant annual decreases in incidence rates from 2000 to 2018. In 2018, the estimated number of new infections was 48,500 (95% CI: 45300-57500), 34,800 (95% CI: 32800-41500) men, 13,600 (95% CI: 12,500-16,000) women. Improvements in the time from infection to diagnosis and in the proportion of cases receiving antiretroviral therapy immediately after diagnosis were found for all groups. Comparison with GBD estimates shows similar rates for men with overlapping confidence intervals. Among women, differences are higher mainly in more recent years. CONCLUSIONS The results indicate that efforts to control the HIV epidemic are having an impact. However, there is an urgent need to address the vulnerability of young men.
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Resumen OBJETIVO Determinar la incidencia de la infección por VIH en mujeres embarazadas atendidas en el Instituto Nacional Materno Perinatal de Lima, Perú (2007-2016). MATERIAL Y MÉTODOS Estudio observacional, descriptivo y retrospectivo. Revisión de los resultados de los exámenes diagnósticos de VIH de mujeres embarazadas efectuados según la normativa nacional vigente que incluye las pruebas de tamizaje (inmunocromatografía o ELISA). Los reportes positivos se corroboran con exámenes confirmatorios (inmunofluorescencia indirecta y western blot). Determinación de la incidencia de VIH de acuerdo con la tendencia anual; aplicación de la correlación de Pearson y prueba de χ2 para comparar las características del perfil de incidencia. RESULTADOS Se tamizaron 113,258 mujeres embarazadas y la incidencia obtenida fue de 2.9 por cada mil. La tendencia anual fue errática, excepto entre 2014 y 2016 años en los que se advirtió una tendencia a disminuir. Solo se tamizó a 22.7% de las parejas masculinas en quienes la seroconcordancia fue 10.3%, y la serodiscordancia 12.4%. La frecuencia de seroconcordancia se correlacionó directamente con el porcentaje de parejas tamizadas e inversamente con la frecuencia de VIH (p<0.05). La condición de convivencia o madre soltera se asoció con mayor frecuencia a la falta de tamizaje de la pareja (p<0.001). CONCLUSIONES La incidencia de VIH confirmado fue errática (2007-2016). Deben proponerse estrategias para incrementar el tamizaje en las parejas de las embarazadas infectadas, teniendo en cuenta la alta frecuencia de inestabilidad de ese tipo de unión.
Abstract OBJECTIVE To determine the incidence of HIV infection in pregnant women treated at the National Maternal and Perinatal Institute (Lima, Peru), between 2007-2016. MATERIAL AND METHODS Observational, descriptive and retrospective study. The results of the diagnostic tests of HIV in pregnant women were reviewed, carried out according to current national regulations, which includes the screening tests (immunochromatography and / or ELISA), which in case of being reactive were corroborated by confirmatory tests (indirect immunofluorescence and Western Blot). The incidence of HIV was measured according to the annual trend, and the Pearson correlation and χ2 test were applied to compare the characteristics of the incidence profile. RESULTS 113,258 pregnant women were screened, obtaining an incidence of 2.91 per thousand pregnant women, the annual trend was erratic, except between 2014 and 2016 where there was a tendency to decrease. Only 22.73% of the couples of the pregnant women were screened, the seroconcordance was 10.3%, and the serodiscordance was 12.42%. The frequency of seroconcordance correlated directly with the percentage of sifted couples and inversely with the frequency of HIV (p <0.05). The condition of coexistence or single mother was associated more frequently with the lack of screening of the couple (p <0.001). CONCLUSIONS The confirmed incidence of HIV was erratic (2007-2016). Strategies should be elaborated to increase the screening in the pairs of the infected pregnant women, taking into account the high frequency of the instability of said union.
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Background: For at-risk HIV-negative individuals, whether malarial morbidity increases the likelihood of HIV infection when exposed is unknown. Hence, we investigate the malaria-associated risk of postnatal HIV infection in 1804 breastfeeding infants of HIV-positive women from Dar es Salaam, Tanzania. Methods: Six-week-old HIV-negative infants were followed until breastfeeding cessation or postnatal HIV infection. HIV-1 status was determined by a DNA PCR test. Malarial morbidity was diagnosed by physicians using a combination of clinical symptoms and laboratory tests. For analytic purposes, malaria was distinguished by diagnostic specificity as: (1) clinical; (2) probable, where laboratory testing is requested for parasitemia; and (3) blood smear-confirmed. Hazard ratios (HR) and 95% confidence intervals (CI) for the risk of HIV infection were estimated from multivariate Cox regression models. Results: Mean follow-up duration was 6.2 months (standard deviation=2.4 months), during which 91 new HIV infections developed and clinical malaria was diagnosed in 594(32.3%) children, including 283 (15.5%) probable and 80(4.4%) confirmed malaria episodes. Infants ever diagnosed with clinical and probable malaria were at 73% (95%CI:1.11 - 2.69) and 100% (95%CI:1.17-3.42) higher risk of postnatal HIV infection, respectively. This risk increased by 39% (95%CI: 1.08-1.80) and 59% (95%CI: 1.00-2.32), respectively, per episode increment in clinical and probable malarial; however, confirmed malaria was not significantly associated with HIV incidence (HR=2.09; 95%CI: 0.74 - 5.91). Conclusion: We found positive associations between child malarial infection and postnatal HIV infection among breastfeeding HIV-negative children of HIV-positive women. These findings suggest that malaria prevention in such infants may decrease the risk of HIV mother-to-child-transmission. However, specific future studies using laboratory-confirmed malaria in HIV-negative but HIV at risk populations are needed to substantiate these findings.
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It has been estimated that by 2010, there might be more people living with HIV in Asia than in Africa. There is an urgent need for a safe, effective, accessible and affordable AIDS vaccine suitable for use in Asia. Factors that may hinder the development of AIDS vaccines in Asia include: 1) difficulty in recruiting adequate number of trial participants due to the low incidence of HIV infection in the general population and in defined population groups at high risk for HIV; 2) circulation of multiple HIV genetic subtypes and recombinant forms, and 3) unique geographical diversity of populations, cultures, social and political backgrounds. A proposed strategy to accelerate the development of an effective AIDS vaccine for Asia could be the constitution of a collaborative regional network in support of AIDS vaccine research and development. Collaborations would include 1) promoting the conduct of additional epidemiological studies and establishment of regional vaccine trial cohorts to reach adequate sample size for efficacy trials, 2) developinga regional platform for the conduct of clinical trials at multiple sites and harmonization of legal, regulatory and ethical frameworks to facilitate the review and approval processes, 3) strengthening the regional clinical research capacities and human resources for efficient development and testing of various vaccine candidates; and 4) promoting the development of regional capacities and infrastructures for vaccine production for the conduct of all phases of clinical trials, licensing and future public health use. A collaborative regional network in support of AIDS vaccine research and development will also require strong political commitment and leadership by all regional and international partners playing a significant role in the region.