Construção e validação de instrumento para avaliação socioestrutural e comportamental associado à infecção pelo HIV em jovensa / Construcción y validación de un instrumento de evaluación sociológica y comportamental asociado con la infección por VIH en jóvenes / Construction and validity of an instrument for sociological and behavioral assessment associated with HIV infection in young peoplea

RESUMO Objetivo construir e validar conteúdo de instrumento para avaliação socioestrutural e comportamental associado à infecção pelo HIV em jovens. Método estudo metodológico, desenvolvido em duas etapas: elaboração do instrumento; e validação de conteúdo. Os itens que compuseram o instrumento foram selecionados através de revisão literária, tendo como referencial os domínios multiníveis do Modelo Social Ecológico Modificado, categorizados em componentes socioestruturais e comportamentais. O conteúdo foi avaliado por especialistas em duas rodadas conduzidas pela técnica Delphi, admitindo-se um índice de concordância de, no mínimo, 80%. Resultados a primeira versão do instrumento continha 52 itens, distribuídos em três domínios. Na primeira rodada, 19 itens (36,5%) obtiveram Índice de Validade de Conteúdo inferior a 0,80, dois itens foram excluídos e os demais foram reformulados. Na segunda rodada, 2 itens foram excluídos e 3 foram incorporados como subitem, totalizando 45 itens. O Índice de Validade de Conteúdo do Instrumento foi de 95%. Conclusão e implicações para a prática as recomendações dos especialistas contribuíram para a qualificação do instrumento Avaliação Socioestrutural e Comportamental-HIV, possibilitando a reorganização do conteúdo. O instrumento é válido para a identificação de fatores socioestruturais e comportamentais associados à infecção pelo HIV em jovens, com potencial para constituir planejamento de cuidados preventivos.

RESUMEN Objetivo construir y validar el contenido de un instrumento de evaluación socioestructural y conductual asociada a la infección por VIH en jóvenes. Método estudio metodológico, desarrollado en dos etapas: elaboración del instrumento; y validación de contenido. Los ítems que conformaron el instrumento fueron seleccionados a través de una revisión literaria, tomando como referencia los dominios multinivel del Modelo Ecológico Social Modificado, categorizados en componentes socioestructurales y conductuales. El contenido fue evaluado por expertos en dos rondas realizadas mediante la técnica Delphi, suponiendo una tasa de acuerdo de al menos el 80%. Resultados la primera versión del instrumento contuvo 52 ítems, distribuidos en tres dominios. En la primera ronda, 19 ítems (36,5%) tuvieron un Índice de Validez de Contenido inferior a 0,80, dos ítems fueron excluidos y el resto fueron reformulados. En la segunda ronda, se excluyeron 2 ítems y se incorporaron 3 como subítems, totalizando 45 ítems. El Índice de Validez de Contenido del Instrumento fue del 95%. Conclusión e implicaciones para la práctica las recomendaciones de los expertos contribuyeron para la calificación del instrumento Evaluación Socioestructural y del Comportamiento-VIH, permitiendo la reorganización del contenido. El instrumento es válido para identificar factores socioestructurales y conductuales asociados a la infección por VIH en jóvenes, con potencial para constituir una planificación de atención preventiva.

ABSTRACT Objective to construct and validate the content of an instrument for sociostructural and behavioral assessment associated with HIV infection in young people. Method a methodological study developed in two steps: instrument elaboration; and content validity. The items that made up the instrument were selected through a literary review using the Modified Social Ecological Model multilevel domains as a reference, categorized into sociostructural and behavioral components. Content was assessed by experts in two rounds conducted using the Delphi technique, assuming an agreement rate of at least 80%. Results the first version of the instrument contained 52 items, distributed across three domains. In the first round, 19 items (36.5%) had a Content Validity Index lower than 0.80, two items were excluded and the rest were reformulated. In the second round, 2 items were excluded and 3 were incorporated as subitems, totaling 45 items. The Instrument Content Validity Index was 95%. Conclusion and implications for practice experts' recommendations contributed qualifying the Sociostructural and Behavioral Assessment-HIV instrument, enabling content reorganization. The instrument is valid for identifying socio-structural and behavioral factors associated with HIV infection in young people, with the potential to constitute preventive care planning.

Analysis of combined prevention measures on HIV/AIDS incidence in Brazil (1980-2020) / Análise de medidas de prevenção combinadas sobre a incidência de HIV/AIDS no Brasil (1980­2020)

Introduction: The Human Immunodeficiency Virus (HIV) attacks the immune system, with acquired immunodeficiency syndrome (AIDS) being the most advanced clinical manifestation. Prevention strategies have evolved over time in response to scientific advancements. From an institutional perspective, the Unified Health System (SUS) provides tools for Combined Prevention to the entire Brazilian population, universally and free of charge. However, despite therapeutic advances, HIV/AIDS remains a significant public health problem. Objective: To analyze the impact of Combined Prevention measures on the incidence of HIV/AIDS in Brazil from 1980 to 2020. Methods: Quantitative, observational, longitudinal, and retrospective study. Descriptive and multivariate analyses were conducted, specifically employing linear regression techniques. The variables of interest included case incidence and the distribution of: tests for sexually transmitted infections (STIs), condoms, post-exposure prophylaxis for HIV (PEP), and pre-exposure prophylaxis for HIV (PrEP). Publicly available data were sourced from governmental repositories. Results: The country has accumulated 1,037,878 infection cases, with an average of 25,947 new cases per year. Regarding prophylaxis inputs, five out of six variables demonstrated a negative correlation with the incidence rate, with only the distribution of male condoms showing a positive correlation. The analysis of the effect of PrEP was not statistically significant. Conclusion:Brazil has reduced the incidence of the disease as Combined Prevention measures have advanced. More time is needed to assess the impact of PrEP on the incidence of new cases.

Introdução: O vírus da imunodeficiência humana (HIV) ataca o sistema imunológico. A síndrome da imunodeficiência adquirida (AIDS) é a manifestação clínica mais avançada. As estratégias de prevenção evoluíram ao longo do tempo conforme os avanços científicos. Do ponto de vista institucional, o Sistema Único de Saúde (SUS) disponibiliza ferramentas de prevenção combinada a toda a população brasileira de forma gratuita e universal. Contudo, apesar de todos os avanços terapêuticos, o HIV/AIDS continua sendo um grave problema de saúde pública. Objetivo: Analisar as medidas de prevenção combinada sobre a incidência de HIV/AIDS no Brasil no período entre 1980 e 2020. Métodos: Quantitativo, observacional, longitudinal e retrospectivo. Estatisticamente, foram realizadas análises descritiva e multivariada, mais especificamente a técnica de correção linear. As variáveis de interesse foram a incidência de caso e as distribuições de: testes para infecções sexualmente transmissíveis (IST), preservativos, profilaxia pós-exposição sexual ao HIV (PEP) e a profilaxia pré-exposição ao HIV (PrEP). Os dados utilizados são de caráter público e obtidos em repositórios governamentais. Resultados: O país acumula 1.037.878 casos de infecção, com média de 25.947 novos casos por ano. Quanto aos insumos de profilaxia, cinco das seis variáveis demonstraram correlação negativa com a taxa de incidência. Apenas a distribuição de preservativos masculinos teve correlação positiva. A análise do efeito da PrEP não foi estatisticamente significativa. Conclusão: O Brasil tem reduzido a incidência da doença à medida que avançam as medidas de prevenção combinada. É necessário mais tempo para analisar o impacto da PrEP na incidência de novos casos

HIV-1 Subtype Diversity and Factors Affecting Drug Resistance among Patients with Virologic Failure in Antiretroviral Therapy in Hainan Province, China, 2014-2020 / 生物医学与环境科学（英文）

OBJECTIVE@#This study aimed to determine the HIV-1 subtype distribution and HIV drug resistance (HIVDR) in patients with ART failure from 2014 to 2020 in Hainan, China.@*METHODS@#A 7-year cross-sectional study was conducted among HIV/AIDS patients with ART failure in Hainan. We used online subtyping tools and the maximum likelihood phylogenetic tree to confirm the HIV subtypes with pol sequences. Drug resistance mutations (DRMs) were analyzed using the Stanford University HIV Drug Resistance Database.@*RESULTS@#A total of 307 HIV-infected patients with ART failure were included, and 241 available pol sequences were obtained. Among 241 patients, CRF01_AE accounted for 68.88%, followed by CRF07_BC (17.00%) and eight other subtypes (14.12%). The overall prevalence of HIVDR was 61.41%, and the HIVDR against non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleotide reverse transcriptase inhibitors (NRTIs), and protease inhibitors (PIs) were 59.75%, 45.64%, and 2.49%, respectively. Unemployed patients, hypoimmunity or opportunistic infections in individuals, and samples from 2017 to 2020 increased the odd ratios of HIVDR. Also, HIVDR was less likely to affect female patients. The common DRMs to NNRTIs were K103N (21.99%) and Y181C (20.33%), and M184V (28.21%) and K65R (19.09%) were the main DRMs against NRTIs.@*CONCLUSION@#The present study highlights the HIV-1 subtype diversity in Hainan and the importance of HIVDR surveillance over a long period.

Psychosocial characteristics pattern correlated with HIV-related risky sexual behavior among HIV-negative men who have sex with men: a latent profile analysis

BACKGROUND@#Men who have sex with men (MSM) have become a high risk population of HIV infection due to their risky sexual behaviors. The latent pattern of psychosocial characteristics plays an important effect in HIV-related risky behaviors among HIV-negative MSM.@*METHOD@#Participants were recruited from Wuhan, Nanchang, and Changsha city from September 2017 to January 2018. Social support was assessed by the multidimensional scale of social support, Connor-Davidson Resilience scale-10 items for reliance, the assessment of Stigma towards Homosexuality for sexual minority stigma, the Likert subscale of nondisclosure for identity concealment, the ACE questionnaire-Kaiser-CDC for adverse childhood experience, the Centers for Epidemiological Studies Depression Scale for depression. Latent profile analysis (LPA) and multivariate regression were used to analyze the data.@*RESULTS@#Three psychosocial characteristic patterns were revealed by the LPA. "Social support and resilience group" (SR group), "Identity concealment group" (IC group) and "Adverse childhood experience" (ACE group) were identified, respectively. In comparison with "SR group", "IC group" have a higher likelihood of one-night male partners (AOR = 2.74, 95%CI = [1.54, 4.90]), both fixed and one-night male partners (AOR = 2.01, 95%CI = [1.34, 3.01]) and HIV-unsure male partner (AOR = 2.12, 95%CI = [1.44, 3.13]). Similarly, "ACE group" were more likely having inconsistent condom use (AOR = 2.58, 95%CI = [1.41, 4.73]), and having sex with HIV-positive male partner (AOR = 4.90, 95%CI = [1.95, 12.30]) with comparison of "SR group". In addition, we further revealed that "ACE group" had a higher ratio (90.0%) of inconsistent condom use among MSM whose male partners were HIV-positive.@*CONCLUSIONS@#Six important psychosocial factors were divided into three latent pattern classes. Compared with "SR group", "IC group" and "ACE group" were more likely to engage in HIV-related risky sexual behaviors. Further research may pay more attention to "IC group" and "ACE group" for targeted intervention.

Progress on diagnosis and treatment of latent tuberculosis infection / 浙江大学学报·医学版

One fourth of the global population has been infected with Mycobacterium tuberculosis, and about 5%-10% of the infected individuals with latent tuberculosis infection (LTBI) will convert to active tuberculosis (ATB). Correct diagnosis and treatment of LTBI are important in ending the tuberculosis epidemic. Current methods for diagnosing LTBI, such as tuberculin skin test (TST) and interferon-γ release assay (IGRA), have limitations. Some novel biomarkers, such as transcriptome derived host genes in peripheral blood cells, will help to distinguish LTBI from ATB. More emphasis should be placed on surveillance in high-risk groups, including patients with HIV infection, those using biological agents, organ transplant recipients and those in close contact with ATB patients. For those with LTBI, treatment should be based on the risk of progression to ATB and the potential benefit. Prophylactic LTBI regimens include isoniazid monotherapy for 6 or 9 months, rifampicin monotherapy for 4 months, weekly rifapentine plus isoniazid for 3 months (3HP regimen) and daily rifampicin plus isoniazid for 3 months (3HR regimen). The success of the one month rifapentine plus isoniazid daily regimen (1HP regimen) suggests the feasibility of an ultra-short treatment strategy although its efficacy needs further assessment. Prophylactic treatment of LTBI in close contact with MDR-TB patients is another challenge, and the regimens include new anti-tuberculosis drugs such as bedaquiline, delamanid, fluoroquinolone and their combinations, which should be carefully evaluated. This article summarizes the current status of diagnosis and treatment of LTBI and its future development direction.

Progress in research of strategies of expanding HIV testing in men who have sex with men / 中华流行病学杂志

In recent years, HIV infection prevalence in MSM has been in increase in China. HIV testing is the only way to identify HIV-infection, effectively curb the spread of HIV and reduce AIDS-related death risks. At present, the situation of HIV testing in MSM is not satisfactory, and expanding HIV testing is the one of the key measures for AIDS prevention and control in this population. This paper summarizes the role and strategies of expanding HIV testing in MSM in order to provide a reference for the improvement of HIV testing in this population.

Progress in research on HIV self-testing and associated factors among men who have sex with men in China / 中华流行病学杂志

HIV testing is the first step in HIV prevention and control, the rate of HIV infection is high and the rate of HIV testing is low among men who have sex with men (MSM) in China. HIV self-testing provides MSM with a new choice and plays a vital role in expanding the coverage of HIV testing in this population. This paper reviews HIV self-testing and associated factors among MSM in China and provides a reference for promoting HIV self-testing in this population.

Comportamiento epidemiológico del VIH-SIDA en Panamá / Epidemiological behavior of Hiv-Aids in Panama / Comportamento epidemiológico do vírus da aids no Panamá

La infección por el Virus de la Inmunodeficiencia Humana (VIH) es un problema de salud pública mundial; que tiene efectos a nivel individual, familiar y social; así como sobre los aspectos económicos, políticos y sociales de un país. Requiere la inversión de innumerables recursos, y de la acción conjunta de personas, gobiernos, ONG y sociedad civil, para lograr su control. Es un estudio descriptivo donde se analizaron datos secundarios proporcionados por el departamento de Epidemiología del Ministerio de Salud (MINSA) sobre el comportamiento de las infecciones por VIH para el periodo 1984-2019 en la República de Panamá. Se reportaron un total de 2042 casos de VIH en este intervalo y se observó un aumento de la prevalencia en el año 2018. En Panamá, la transmisión del VIH/SIDA ha ido aumentando desde la aparición del primer caso en Panamá en el año 1984. Y el sexo más afectado son los hombres.

Abstract The Human Immunodeficiency Virus (HIV) infection is a global public health problem that has effects at the individual, family, and social level, as well as on the economic, political and social aspects of a country. It requires the investment of countless resources and the joint action of people, governments, NGOs, and civil society to achieve its control. It is a descriptive study where secondary data on the behavior of HIV infections for the period 1984-2019 in the Republic of Panama, provided by the Department of Epidemiology of the Ministry of Health (MINSA), were analyzed. A total of 2042 HIV cases were reported in this interval, and an increase in prevalence in 2018 was observed. In Panama, the transmission of HIV/AIDS has been increasing since the first case appeared in Panama in 1984, and the sex most affected is men.

Resumo: A infecção pelo Vírus da Imunodeficiência Humana (HIV) é um problema global de saúde pública; que tem efeitos nos níveis individual, familiar e social; bem como sobre os aspectos econômicos, políticos e sociais de um país. Requer o investimento de inúmeros recursos, e a ação conjunta de indivíduos, governos, ONGs e sociedade civil, para alcançar seu controle. O presente trabalho é um estudo descritivo onde foram analisados dados secundários fornecidos pelo Departamento de Epidemiologia do Ministério da Saúde (MINSA) sobre o comportamento das infecções pelo HIV para o período 1984-2019 na República do Panamá. Foram notificados 2.042 casos de HIV nesse intervalo e observado aumento da prevalência em 2018. No Panamá, a transmissão do HIV/AIDS vem aumentando desde que o primeiro caso apareceu no Panamá em 1984. E o sexo mais afetado são os homens.

Caracterização das infecções que acometem o usuário no momento do diagnóstico para o Hiv/Aids / Characterization of infections that affect the user at the moment of diagnosis for Hiv/Aids / Caracterización de las infecciones que afectan a los usuarios en el momento del diagnóstico del Vih/Sida

: O estado do Pará, de 2009 a 2019, apresentou um aumento de 46,5% na taxa de detecção de aids. O que destaca a importância de estudos para a avaliação e acompanhamento deste público. Objetivo: Analisar as infecções que acometem os usuários de um centro de referência no momento de seu diagnóstico para a infecção pelo HIV. Métodos: Estudo descritivo, realizado em um centro de referência da cidade de Santarém, Pará. A amostra foi de 332 prontuários de pacientes diagnosticados para o HIV nos anos de 2016 e 2017. A coleta de dados buscou informações sociodemográficas, clínicas e imunológicas dos pacientes no momento do diagnóstico para a infecção pelo HIV. Os dados foram organizados e analisados por estatística descritiva e inferencial, adotando- se p<0,05. Resultados: Observou-se prevalência do sexo masculino (67%), faixa etária de 15-24 anos (32,2%), solteiros (59%), com vínculo empregatício (64,5%), contagem de linfócitos T CD4+ ≥200 céls/mm3 (54,8%) e carga viral detectável (75,3%). A Candidíase (25%) e a Tuberculose (25%) predominaram como infecções oportunistas (IO), e a Sífilis (67,5%) como outras infecções. Conclusão: Conforme método proposto e os dados já informados, conclui-se que o diagnóstico para a Sífilis se associou ao sexo masculino, bem como a situação de contagem de linfócitos T CD4+ <200 céls/mm3 se associou com a presença de alguma infecção oportunista, da instalação da Candidíase e da Tuberculose.

Introduction: The state of Pará, from 2009 to 2019, showed a 46.5% increase in the AIDS detection rate. What stands out the importance of studies for the evaluation and monitoring of this public. Objective: Analyze the infections that affect the users of a reference center at the moment of diagnosis for HIV infection. Methods: Descriptive study, carried out in a reference center in the city of Santarém, Pará. The sample consisted of 332 records of patients diagnosed with HIV in the years 2016 and 2017. The data collection sought sociodemographic, clinical and immunological information of the patients at the moment diagnosis for HIV infection. The data were organized and analyzed using descriptive and inferential statistics, adopting p <0.05. Results: There was a prevalence of males (67%), aged 15-24 years (32.2%), single (59%), with employment (64.5%), CD4 + T lymphocyte count ≥200 cells/mm3 (54.8%) and detectable viral load (75.3%). Candidiasis (25%) and Tuberculosis (25%) predominated as opportunistic infections (IO), and Syphilis (67.5%) as other infections. Conclusion: According to the proposed method and the data already reported, it is concluded that the diagnosis for Syphilis was associated with the male gender, as well as the situation of CD4 + T lymphocyte count <200 cells/mm3 was associated with the presence of some opportunistic infection, of the installation of Candidiasis and Tuberculosis.

Introducción: El estado de Pará, de 2009 a 2019, presentó un aumento del 46,5% en la tasa de detección del SIDA. Lo que pone de manifiesto la importancia de los estudios para la evaluación y el seguimiento de este público. Objetivo: Analizar las infecciones que sufren los usuarios de un centro de referencia en el momento de su diagnóstico de infección por VIH. Métodos: Estudo descritivo, realizado em um centro de referência da cidade de Santarém, Pará. La muestra fue de 332 historias clínicas de pacientes diagnosticados de VIH en los años 2016 y 2017. La recogida de datos buscaba información sociodemográfica, clínica e inmunológica de los pacientes en el momento del diagnóstico de la infección por VIH. Los datos se organizaron y analizaron mediante estadísticas descriptivas e inferenciales, adoptando p<0,05. Resultados: Se observó la prevalencia del sexo masculino (67%), el grupo de edad de 15 a 24 años (32,2%), la soltería (59%), el empleo (64,5%), el recuento de linfocitos T CD4+ ≥200 células/mm3 (54,8%) y la carga viral detectable (75,3%). La candidiasis (25%) y la tuberculosis (25%) predominaron como infecciones oportunistas (IO), y la sífilis (67,5%) como otras infecciones. Conclusión: De acuerdo con el método propuesto y los datos ya informados, se concluye que el diagnóstico de Sífilis se asocia al sexo masculino, así como la situación de contagio de linfocitos T CD4+ <200 células/mm3 se asocia a la presencia de alguna infección oportunista, a la instauración de la Candidiasis y a la Tuberculosis.

Impacto de la cuarentena por COVID-19 en el perfil metabólico de personas con infección por VIH en Argentina / Impact of COVID-19 related lockdown on the metabolic profile of people with HIV infection in Argentina

INTRODUCCIÓN: Para mitigar la propagación del SARS-CoV-2 se requirió de un confinamiento generalizado. Las autoridades argentinas impusieron aislamiento social preventivo durante 234 días (20 de marzo al 9 de noviembre de 2020), modificando el estilo de vida de la población. OBJETIVOS: Examinar la influencia de las medidas de bloqueo en el perfil metabólico de pacientes infectados por VIH en Argentina. PACIENTES Y MÉTODOS: Estudio de cohorte retrospectivo de 10.239 pacientes en seguimiento en una clínica de atención privada de personas con infección por VIH. Se incluyeron pacientes adultos con terapia antirretroviral (TARV) en curso que tuvieran una determinación de glucemia, colesterol total, colesterol HDL y trigliceridemia antes de la cuarentena (Pre-C: segundo semestre 2019) y una segunda determinación durante la misma (Intra-C: mayo 2020). Se excluyeron los pacientes con cambios en la TARV con impacto metabólico, los que iniciaron o suspendieron hipolipemiantes o hipoglucemiantes y mujeres embarazadas. Las variables categóricas se compararon mediante la prueba de la χ2 o la prueba exacta de Fisher y las continuas mediante la prueba t o la prueba de Mann-Whitney según correspondiera. Se consideró significativo un valor de p a dos colas < 0,05. RESULTADOS: Se incluyeron 540 individuos. La mediana de edad fue de 47 años y 74,6% fueron de sexo masculino. La mediana de índice de masa corporal fue 26,1 y 94,6% tenían bajo riesgo cardiovascular. Hubo un aumento significativo en el porcentaje de pacientes con hiperglucemia (Pre-C 5,2% vs Intra-C 8,5%, p 0,04), hipertrigliceridemia (Pre-C 33,9% vs Intra-C 40,7%, p 0,02) e hipercolesterolemia LDL (Pre-C 12,6% vs Intra-C 17,2%, p 0,04). CONCLUSIÓN: Nuestros resultados sugieren que la cuarentena, al menos en sus fases iniciales, puede tener un impacto negativo en el perfil metabólico de esta población.

BACKGROUND: The spread of SARS-CoV-2 required widespread lockdown to mitigate the pandemic. Argentine authorities imposed preventive social isolation for 234 days (March 20th to November 9th 2020). This measure led to major changes in the population's lifestyle. AIM: To examine the influence of COVID-19 lockdown measures on the metabolic profile of HIV-infected patients in Argentina. METHODS: Retrospective cohort study of 10,239 HIV-infected patients under follow up in a private clinic for HIV care. Adult patients with ongoing antiretroviral therapy (ART) and a baseline determination of blood glucose, total cholesterol, HDL-cholesterol and triglycerides done before lockdown (BL: second semester of 2019) and a second determination during lockdown (DL: May 2020) were included. Patients with recent changes in ART that may have metabolic impact, those starting lipid/glucose lowering agents and pregnant women were excluded. Categorical variables were compared using the χ2 test or Fisher's exact test, and continuous variables using the t-test or the Mann-Whitney test. A two-tailed value of p < 0.05 was considered significant. RESULTS: 540 individuals were included, median of age was 47 years and 74.6% were male. Median body mass index was 26.1 and 94.6% had low cardiovascular risk. There was a significant increase in the percentage of patients that met criteria for hyperglycemia (BL 4.8% and DL 8.5%, p < 0.001). We also observed significant (p < 0.001) increase in median (IQR) BL vs DL values in LDL-cholesterol [109 (90-128) vs 118 (97-139) mg/dL]; and triglycerides [120 (87-172) vs. 132 mg/dL (96-184)]. The proportion of patients with hyper-LDL cholesterolemia according to individual cardiovascular risk increased from 12.6 to 17.2% (p = 0.04). CONCLUSION: Our results suggest that quarantine, at least in its initial phases, may have a negative impact on the metabolic profile of this population.

La infección por vih en tiempos de pandemia: muchos retrocesos, innumerables desafíos / HIV infection in times of pandemic: many setbacks, countless challenges

Resumen Desde la llegada de la pandemia por COVID-19, se ha descrito un sinnúmero de consecuencias respecto a la infección por VIH en Chile, tanto en su diagnóstico como en su prevención, principalmente manifestadas en el descenso de la realización de exámenes serológicos, la interrupción de la atención, el retraso en el inicio de la terapia antirretroviral y la falta de acceso a métodos preventivos. A ello, se le suma el deterioro en algunas condiciones relacionadas con aspectos sociales y sobre salud mental. Todo esto implica, entre otras consecuencias, un probable empeoramiento en la situación epidemiológica de la infección por VIH en Chile. En el presente artículo, se revisarán algunos de los impactos señalados y se plantean algunos desafíos, para el enfrentamiento de esta problemática.

Abstract Since the arrival of the COVID-19 pandemic, countless consequences have been described regarding HIV infection in Chile, both in its diagnosis and prevention, mainly manifested in the decrease in serological tests, the interruption of care, the delay in starting antiretroviral therapy, and the lack of access to preventive methods. Added to this is the deterioration in some conditions related to social aspects and mental health. All this implies, among other consequences, a probable worsening in the epidemiological situation of HIV infection in Chile. Some of the designated impacts are reviewed in this article, and some challenges are raised to confront this problem.

Infección por SARS-CoV-2 en personas viviendo con VIH: tópicos del panorama mundial y en Chile / SARS-CoV-2 infection in people living with HIV: topics on the global panorama and in Chile

Resumen La enfermedad COVID-19 es una patología de origen infeccioso causada por el virus SARS-CoV-2 y fue declarada pandemia por la OMS el 11 de marzo 2020. A la fecha se registran más de 500 millones de personas infectadas y más de 6 millones de fallecidos en todo el mundo. Las personas que pertenecen a grupos de riesgo más vulnerables, particularmente aquellos que se encuentran en los extremos de la vida, con comorbilidades crónicas o inmunocomprometidas, son especialmente susceptibles a presentar un eventual mayor riesgo de infección, de gravedad y de mortalidad por esta enfermedad. Las personas que viven con VIH, especialmente aquellos en precarias condiciones inmunológicas o aquellas que aún no inician terapia antiretroviral, pueden ser un grupo especialmente susceptible de presentar complicaciones relacionadas a esta y otras enfermedades de origen infeccioso. Con esta revisión se pretende determinar la magnitud del impacto del virus SARS-CoV-2 en personas viviendo con VIH en Chile.

Abstract The COVID-19 disease is caused by the SARS-CoV-2 virus and was declared a pandemic by the WHO on March 11, 2020. To date, more than 500 million people have been infected and it has caused over 6 million deaths worldwide. People that belong to the most vulnerable risk groups, such as those at the extremes of life, patients with chronic comorbidities and those with severe immunosuppression, are especially susceptible to developing a severe form of COVID-19 infection and death. Subjects living with HIV, especially those in precarious immunological conditions or those in whom antiretroviral therapy is yet to be started, may be at risk of developing complications related to COVID-19, as observed with other infectious diseases. This review aims to determine the magnitude of the impact of the SARS-CoV-2 virus on people living with HIV in Chile.

Comportamiento sexual de pacientes con infección por VIH según grupos de edad / Sexual behavior among patients with HIV according to age groups

Nuestro objetivo fue determinar la prevalencia y conductas de riesgo por grupos de edad entre pacientes con infección por VIH. Se realizó un estudio observacional analítico transversal de pacientes que acuden al servicio de Enfermedades Infecciosas a recibir tratamiento antirretroviral. Resultados: De 117 personas que ingresaron al estudio, se observó que el grupo etario de los jóvenes varones con infección por VIH señalaron una orientación homosexual (HSH) en 64,5% y una mayor tasa de haber sufrido abuso sexual (29%) respecto al resto. En adultos el uso de métodos anticonceptivos es 71,4% y superior al resto de grupos de edad, la concurrencia a lugares de riesgo (visita a trabajadoras sexuales de la calle) se encuentra mayoritariamente en el rango de 45 a 90 años. El rol homosexual activo de los hombres con VIH representa 66,7%. Los hallazgos enfatizan la necesidad de realizar más estudios que profundicen el tema del abuso sexual en adolescentes y adultos jóvenes, debido a la alta prevalencia encontrada en este estudio(AU)

Our objective was to determine the prevalence and risk behaviors by age groups in patients with HIV infection. A cross-sectional analytical observational study of patients attending the Infectious Diseases service to receive antiretroviral treatment was carried out.Results: Out of 117 people who entered the study, it was observed that the age group of young men with HIV infection indicated a homosexual orientation (MSM) 64.5%; and a higher rate of having suffered sexual abuse (29%) in comparison to the others. In adults, the use of contraceptive methods is 71.4%, and higher than the rest of the age groups, attendance at places of risk (visits to street sex workers) is mostly in the range of 45 to 90 years. The active homosexual role of men with HIV represents 66.7%. The findings emphasize the need for more studies that delve into the issue of sexual abuse in adolescents and young adults, due to the high prevalence found in this study(AU)

Consideraciones en población transgénero respecto a la infección por VIH, terapia antiretroviral, profilaxis preexposición (PreP) e interacción con tratamiento de reafirmación de género / Considerations in the transgender population regarding HIV infection, antiretroviral therapy, pre-exposure prophylaxis (PreP) and interaction with gender reaffirmation treatment

Resumen La infección por VIH es una epidemia global (prevalencia de 0,8%). En Latinoamérica, Chile, Brasil y Uruguay son los países con mayores índices. Entre las más afectadas están la población transgénero (OR 48,8 respecto a la población general). Múltiples factores bio-psico-sociales explican estas cifras. Bajo uso del preservativo, la idea de reafirmación de género, el temor a ser reemplazadas(os) por personas cisgéneros, presencia de comercio sexual, entre otros, influyen en las mayores tasas de infección. Se han implementado medidas de prevención del VIH, pero pocas dirigidas en específico a personas transgénero. La profilaxis preexposición (PreP) parece ser una nueva alternativa de prevención en este grupo, y la integración de las unidades de apoyo en la reafirmación de género con las unidades que entregan PreP, podrían aumentar su adherencia y cobertura. En las personas transgénero con infección por VIH existe baja adherencia a terapia antirretroviral (TARV), en parte por priorización del tratamiento hormonal y miedo a que la TARV altere su proceso de hormonización. Los pocos datos existentes muestran que la hormonización no se afecta con la mayoría de la TARV, pero algunos tratamientos hormonales podrían disminuir las concentraciones plasmáticas y tisulares de ciertos antirretrovirales. Faltan estudios que evalúen la interacción entre antirretrovirales y tratamiento hormonal de reafirmación de género.

Abstract HIV infection is a global epidemic, with a prevalence of 0.8%. In Latin America, Chile, Brazil and Uruguay are the countries with the highest rates. The transgender population is the most affected (OR of 48.8 compared to the general population). Multiple bio-psycho-social factors explain these issues. The low use of condoms for pressure from the partner, the idea of reaffirmation of gender, the fear to be replaced by a cisgender person, the presence of commercial sex, among others, influence the highest rates of infection. HIV prevention measures have been implemented, but few specifically targeted at transgender people. Pre-exposure prophylaxis (PreP) seems to be a new prevention alternative in this group, and the integration of support units in gender reaffirmation with units that deliver PreP could increase their adherence and coverage. In HIV (+) transgender people there is low adherence to antiretroviral therapy (ART), in part due to the prioritization of hormonal treatment and the fear that ART will alter their hormonalization process. The few data that exist show that hormonalization is not affected by ART, but that some hormonal treatments could lower the levels of certain antiretrovirals. More studies must be done to evaluate the interaction between antiretrovirals and gender affirming hormone therapy.

Epidemiological data on HIV-infected patients and the importance of education regarding the infection rate. An analytical cross-sectional study

Abstract BACKGROUND: Sexually transmitted diseases (STIs) are an important public health problem in all countries. Knowledge of their relationship with the various socioeconomic levels is necessary for an understanding of their epidemiology and behavior in society. OBJECTIVE: To investigate the epidemiology of human immunodeficiency virus (HIV)-positive patients and to correlate education with history of sexually transmitted diseases, especially for syphilis. DESIGN AND SETTING: Analytical cross-sectional study carried out in the city of Juiz de Fora, Minas Gerais, Brazil. METHODS: The medical records of HIV/acquired immunodeficiency syndrome (AIDS) patients who started antiretroviral therapy (ART) between January 2010 and July 2018 were assessed. These patients were attended at the specialized assistance service for HIV/AIDS) of the Department of Sexually Transmitted Diseases (STD/AIDS) of the city of Juiz de Fora. In total, 335 patients were selected. RESULTS: In our sample, 73.13% were male; 57.36% were aged between 25 and 45 years and 24.23% were over 45 years of age. Regarding sexual orientation, 61.78% were homosexual. Regarding education, 52.88% had "unskilled education", while 47.12% had "qualified education". Analysis on the relationship between schooling and syphilis, a positive relationship between qualified schooling and syphilis was observed: odds ratio = 3.588; 95% confidence interval: 1.090-11.808. CONCLUSION: Homosexual male patients are most affected by HIV. Furthermore, this disease is not limited only to individuals with low education. Syphilis should be suspected in all individuals.

Analysis on migration of HIV/AIDS cases and related factors in Liangshan Yi Autonomous Prefecture in Sichuan province, 2020 / 中华流行病学杂志

Objective: To analyze the migration of the HIV/AIDS cases and related factors in Liangshan Yi autonomous prefecture (Liangshan). Methods: According to HIV/AIDS Comprehensive Response Information Management System of China Information System for Disease Control and Prevention, a total of 28 772 HIV/AIDS cases who had follow-up records in Liangshan in 2020 were included in the survey. The migration of the HIV/AIDS cases was described and the related factors were analyzed using multiple logistic regression models, and the migration destinations of the HIV/AIDS cases were mapped. Results: Among the 28 772 HIV/AIDS cases, 20.89% (6 010/28 772) had migration in 2020. Multivariate logistic regression analysis showed that among the HIV/AIDS cases, the migration related factors included being aged 15-24 years (compared with being aged 0-14 years, OR=2.74, 95%CI:2.04-3.69) and ethnic group (compared with Han ethnic group, OR=2.44, 95%CI:2.19-2.72), having education level of junior high school (compared with having education level of primary school or below, OR=1.25, 95%CI:1.14-1.38), being unmarried (compared with being married, OR=1.29, 95%CI:1.20-1.39), being engaged in business services (compared with being engaged in farming, OR=1.96, 95%CI:1.31-2.92), receiving antiviral treatment <1 year (compared with receiving antiviral treatment >3 years, OR=1.42, 95%CI:1.26-1.61), having recent CD4+T lymphocytes (CD4) counts >500 cells/μl (compared with having recent CD4 counts <200 cells/μl, OR=1.15, 95%CI:1.03-1.29). The geographical distribution maps showed that among all cities in Sichuan, Xichang (13.26%, 797/6 010) and Chengdu (10.12%,608/6 010) were the main migration destinations of the HIV/AIDS cases, and the provinces outside Sichuan where the HIV/AIDS cases would like to migrate to were mainly Guangdong (18.19%, 1 093/6 010) and Zhejiang provinces (7.67%, 461/6 010) in 2020. The HIV/AIDS cases who migrated where Liangshan, within Sichuan province, and to other provinces accounted for 27.67% (1 663/6 010), 15.34% (922/6 010) and 56.99% (3 425/6 010), respectively. Conclusions: More attention should be paid to the mobility characteristics and the classification management of HIV/AIDS cases according to their characteristics in Liangshan. Timely access to information on changes in the place of work and residence of HIV/AIDS cases should be warranted when they have migration. Good referrals and management for mobility of HIV/AIDS cases in different places should be made to reduce loss to follow-up and improving interventions.

Epidemiological characteristics of newly reported HIV-infected adolescents aged 15-17 years outside school in China, 2011-2019 / 中华流行病学杂志

Objective: To understand the epidemiological characteristics of HIV-infected adolescents outside school in China and provide reference to targeted prevention and control of HIV infection in this population. Methods: All the HIV-infected adolescents aged 15-17 years outside school reported during 2011-2019 were included this study. The information about their demographics, transmission routes and migration were collected from HIV/AIDS Comprehensive Response Information Management System. The χ2 test was done for comparison among groups. The Joinpoint 4.9.0 software was applied to the annual percent change (APC) for time trends analysis using the Joinpoint regression model. The Excel 2019 and SPSS 22.0 software were used for data cleaning and statistical analysis. Results: A total of 4 919 HIV-infected adolescents aged 15-17 years outside school were reported accumulatively in China between 2011 and 2019, accounting for 63.4% (4 919/7 757) of total reported HIV-infected cases in this age group. Analysis on trend revealed that the new HIV infection diagnosis rate has become stable since 2016 (APC=2.5%, P=0.173) after the increase between 2011 and 2015 (APC=36.4%, P<0.001). The migration across provinces was discovered in 13.9% (684/4 919) of the HIV-infected adolescents outside school. Males, workers, and those diagnosed in detention centers or transmitted by injecting drugs or homosexual contacts accounted for a larger proportion in migrated cases compared with non-migrated cases. The adolescents outside school mainly got HIV infected by sexual contacts route, in which 66.5% (280/421) of the males were infected by homosexual contacts, while 97.8% (182/186) of the females were infected by heterosexual contacts in 2019. Conclusions: HIV-infected adolescents aged 15-17 years outside school were mainly infected by sexual contacts. However, adolescents outside school have low awareness of sexual health and high mobility, to whom close attention should be paid to improve their awareness of sexual health and to provide them with appropriate HIV infection prevention and treatment service.

Analysis on psychoactive substances use in men who have sex with men in Tianjin / 中华流行病学杂志

Objective: To understand the use of psychoactive substances and its related factors in men who have sex with men (MSM) in Tianjin. Methods: A cross-sectional survey was conducted in MSM recruited in Tianjin by snowball sampling from September 2017 to December 2020, the information about their social demographic information, use of psychoactive substances and behavioral characteristics were collected, meanwhile the blood samples were taken from them for HIV/syphilis detections. Multivariate logistic regression was used to explore related factors about psychoactive substances use. Results: A total of 9 218 MSM were included in the study, in whom 43.5% (4 013/9 218) had ever used psychoactive substances, including 92.6% (3 718/4 013)who used Rush and 17.2% (692/4 013) who used multi substances. Multivariate analysis showed that, the OR of psychoactive substances use in MSM who were in Han ethnic group was 0.68 (95%CI:0.51-0.91) compared with those who were in minor ethnic group; the OR of psychoactive substances use in MSM who were married or cohabited, divorced or widowed were 0.65 (95%CI: 0.57-0.71), 0.80 (95%CI: 0.65-0.97) respectively compared with those who were unmarried; the OR of psychoactive substances use in MSM who had the first homosexual sex at age of ≥30 years was 0.57 (95%CI: 0.44-0.74) compared with those who had the first homosexual sex at age of <30 years; the OR of psychoactive substances use in local MSM in Tianjin was 1.12 (95%CI: 1.03-1.23) compared with those who were not local residents in Tianjin; the OR of psychoactive substances use in MSM with education level of college or above was 1.29 (95%CI: 1.12-1.49) compared with those with education level of junior middle school or below; the OR of psychoactive substances use in MSM who had anal sex in the past six months was 1.93 (95%CI: 1.34-2.77) compared with those who had no anal sex; the OR of psychoactive substances use in MSM who had >2 homosexual partners in the last week was 1.62 (95%CI: 1.41-1.87) compared with those who had ≤2 homosexual partners; the OR of psychoactive substances use in MSM who had homosexual commercial sex in the past six months was 1.99 (95%CI: 1.62-2.45) compared with those who had no homosexual commercial sex; the OR of psychoactive substances use in MSM who had sexually transmitted diseases in the last year was 2.39 (95%CI: 1.82-3.12) compared with those who had no sexually transmitted diseases and the OR of psychoactive substances use in MSM who received peer education services in the last year was 1.63 (95%CI: 1.50-1.78) compared with those who received no peer education services. Conclusion: The prevalence of psychoactive substances use is high in MSM in Tianjin, and there are many influencing factors. It is necessary to conduct targeted interventions according to the influencing factors.

Analysis of factors associated with the structure of the gut microbial community in HIV/AIDS patients in some areas of Henan province / 中华流行病学杂志

Objective: To investigate the related factors associated with the structure of the gut microbial community in HIV infection/AIDS cases (HIV/AIDS) in Henan province. Methods: The convenience sampling method was used to select 122 cases who were receiving Antiviral Treatment (ART) or ART-naive in Henan. Whole blood and stool specimens were collected. Genomic DNA of stool samples was extracted, and the V3-V4 hypervariable regions of the 16S rRNA gene were sequenced using Illumina NovaSeq 6000 high-throughput sequencing system. The analysis was performed mainly at the genus level, and the 30 genera with the highest abundance were selected as a measure of the gut microbial community structure. The correlation between community structure and related factors was analyzed using redundancy analysis and Envfit function. Results: 122 cases were finally completed sequencing and analysis, the average BMI was (23.62±2.78) kg/m2 and the average age was (47±13) years. Among them, male accounted for 66.39% (81/122), and heterosexual transmission route constituted the largest ratio, accounting for 51.64% (63/122). 36 cases were treatment naive (29.51%, 36/122). The top five dominant genera of the total population (122 cases) were Prevotella, Roseburia, Megamonas, Bacteroides and Faecalibacterium and the top five dominant genera of the ART population (86 cases) were Prevotella, Megamonas, Bacteroides, Roseburia and Faecalibacterium. The top five dominant genera of the ART-naive population (36 cases) appeared as Prevotella, Faecalibacterium, Roseburia, Bacteroides and Megamonas. In the total population, ART (P<0.001) was the most significant factors of community structure. Other significant factors were: duration of diagnosis (P=0.009), viral load (P=0.022) and anti-HCV (P=0.018). ART was positively correlated with Megamonas and negatively correlated with Prevotella, Roseburia and Faecalibacterium, while the other three factors of duration of diagnosis, viral load and anti-HCV were positively correlated with Prevotella, Roseburia and Faecalibacterium and negatively correlated with Megamonas. In the ART-naive population, duration of diagnosis (P=0.003) were the factors significantly associated with community structure. Duration of diagnosis was positively correlated with Roseburia, Faecalibacterium, Megamonas and Prevotella and negatively correlated with Bacteroides. Conclusion: ART and duration of diagnosis were factors significantly associated with gut microbial community structure and had a significant impact on multiple high-abundance genera.

HIV infection status and related factors in men who have sex with men in sentinel surveillance in Shanxi province, 2010, 2015 and 2020 / 中华流行病学杂志

Objective: To understand the infection status of HIV and related factors in men who have sex with men (MSM) in Shanxi province in 2010, 2015 and 2020. Methods: According to the sentinel surveillance protocol, continuous cross-sectional survey were conducted to collect the information about basic characteristics, general demographic characteristics, AIDS knowledge awareness, high-risk sexual behavior, sexually transmitted diseases, intervention services and HIV infection rate of the MSM in Shanxi in 2010, 2015 and 2020. Results: In 2010, 2015 and 2020, a total of 2 708 MSM were included in this study. There were significant differences in HIV infection rate among three years (χ2=23.76, P<0.001) with an increasing trend with year (trend χ2 =17.34, P<0.001). The rates of anal sex, commercial sex and heterosexual behavior in the past 6 months were 77.62% (2 102/2 708), 5.91% (160/2 708) and 28.14% (762/2 708) respectively, and the rates of consistent use of condom were 52.52% (1 104/2 102), 63.13% (101/160) and 23.49%(179/762) respectively, and the rate of consistent condom use was low. Results from multivariate logistic regression analysis showed that different cities, having educational level of junior high school or below, being recruited through internet, voluntary counseling and testing, suffering from sexually transmitted diseases, occasional condom use in anal sex in the past 6 months were the correlative factors of HIV infection of MSM. Conclusions: The HIV infection rate of MSM in Shanxi increased year by year from 2010, 2015 to 2020. The HIV/AIDS-related risk behavior persisted, and the proportion of condomuse adherence was low, and the HIV detection rate was low in the MSM, so targeted and effective measures should be taken to promote the condom use adherence and regular HIV testing in MSM.