HIV and Sexually Transmitted Infections Among Persons with Monkeypox - Eight U.S. Jurisdictions, May 17-July 22, 2022.

High prevalences of HIV and other sexually transmitted infections (STIs) have been reported in the current global monkeypox outbreak, which has affected primarily gay, bisexual, and other men who have sex with men (MSM) (1-5). In previous monkeypox outbreaks in Nigeria, concurrent HIV infection was associated with poor monkeypox clinical outcomes (6,7). Monkeypox, HIV, and STI surveillance data from eight U.S. jurisdictions* were matched and analyzed to examine HIV and STI diagnoses among persons with monkeypox and assess differences in monkeypox clinical features according to HIV infection status. Among 1,969 persons with monkeypox during May 17-July 22, 2022, HIV prevalence was 38%, and 41% had received a diagnosis of one or more other reportable STIs in the preceding year. Among persons with monkeypox and diagnosed HIV infection, 94% had received HIV care in the preceding year, and 82% had an HIV viral load of <200 copies/mL, indicating HIV viral suppression. Compared with persons without HIV infection, a higher proportion of persons with HIV infection were hospitalized (8% versus 3%). Persons with HIV infection or STIs are disproportionately represented among persons with monkeypox. It is important that public health officials leverage systems for delivering HIV and STI care and prevention to reduce monkeypox incidence in this population. Consideration should be given to prioritizing persons with HIV infection and STIs for vaccination against monkeypox. HIV and STI screening and other recommended preventive care should be routinely offered to persons evaluated for monkeypox, with linkage to HIV care or HIV preexposure prophylaxis (PrEP) as appropriate.

Correction: Estimated hepatitis C prevalence and key population sizes in San Francisco: A foundation for elimination.

[This corrects the article DOI: 10.1371/journal.pone.0195575.].

Estimated hepatitis C prevalence and key population sizes in San Francisco: A foundation for elimination.

BACKGROUND: Initiated in 2016, End Hep C SF is a comprehensive initiative to eliminate hepatitis C (HCV) infection in San Francisco. The introduction of direct-acting antivirals to treat and cure HCV provides an opportunity for elimination. To properly measure progress, an estimate of baseline HCV prevalence, and of the number of people in various subpopulations with active HCV infection, is required to target and measure the impact of interventions. Our analysis was designed to incorporate multiple relevant data sources and estimate HCV burden for the San Francisco population as a whole, including specific key populations at higher risk of infection. METHODS: Our estimates are based on triangulation of data found in case registries, medical records, observational studies, and published literature from 2010 through 2017. We examined subpopulations based on sex, age and/or HCV risk group. When multiple sources of data were available for subpopulation estimates, we calculated a weighted average using inverse variance weighting. Credible ranges (CRs) were derived from 95% confidence intervals of population size and prevalence estimates. RESULTS: We estimate that 21,758 residents of San Francisco are HCV seropositive (CR: 10,274-42,067), representing an overall seroprevalence of 2.5% (CR: 1.2%- 4.9%). Of these, 16,408 are estimated to be viremic (CR: 6,505-37,407), though this estimate includes treated cases; up to 12,257 of these (CR: 2,354-33,256) are people who are untreated and infectious. People who injected drugs in the last year represent 67.9% of viremic HCV infections. CONCLUSIONS: We estimated approximately 7,400 (51%) more HCV seropositive cases than are included in San Francisco's HCV surveillance case registry. Our estimate provides a useful baseline against which the impact of End Hep C SF can be measured.

Epidemiology of the viral hepatitis-HIV syndemic in San Francisco: a collaborative surveillance approach.

OBJECTIVES: To describe the epidemiology of people coinfected with hepatitis B virus (HBV) or hepatitis C virus (HCV) and HIV in San Francisco, the San Francisco Department of Public Health's Communicable Disease Control and Prevention Section and the HIV Epidemiology Section collaborated to link their registries. METHODS: In San Francisco, hepatitis reporting is primarily through passive laboratory-based surveillance, and HIV/AIDS reporting is primarily through laboratory-initiated active surveillance. We conducted the registry linkage in 2010 using a sequential algorithm. RESULTS: The registry match included 31,997 HBV-infected people who were reported starting in 1984; 10,121 HCV-infected people who were reported starting in 2001; and 34,551 HIV/AIDS cases reported beginning in 1981. Of the HBV and HCV cases, 6.3% and 12.6% were coinfected with HIV, respectively. The majority of cases were white males; however, black people were disproportionately affected. For more than 90% of the HBV/HIV cases, male-to-male sexual contact (men who have sex with men [MSM]) was the risk factor for HIV infection. Injection drug use was the most frequent risk factor for HIV infection among the HCV/HIV cases; however, 35.6% of the HCV/HIV coinfected males were MSM but not injection drug users. CONCLUSIONS: By linking the two registries, we found new ways to foster collaborative work and expand our programmatic flexibility. This analysis identified particular populations at risk for coinfection, which can be used by viral hepatitis and HIV screening, prevention, and treatment programs to integrate, enhance, target, and prioritize prevention services and clinical care within the community to maximize health outcomes.

The effect of migration on HIV high-risk behaviors among Mexican migrants.

BACKGROUND: Previous studies have shown an association between Mexican migration to the United States and an increased frequency of HIV high-risk behaviors among male Mexican migrants. However, the individual level change in these behaviors after migration has not been quantified. OBJECTIVE: To estimate the change in HIV high-risk behaviors among Mexican migrants after migration to the United States. METHODS: A case-crossover study was embedded in the California-Mexico Epidemiological Surveillance Pilot, a targeted, venue-based, sampling survey. We implemented the study from July to November 2005, studying 458 Mexican migrants at sites in rural and urban areas in Fresno County and San Diego County and directly comparing individual HIV high-risk behaviors before and after migration. RESULTS: After migration, there were increases in the odds of male migrants engaging in sex with a sex worker [odds ratio (OR) = 2.64, P < 0.0001], sex while under the influence of drugs or alcohol (OR = 5.00, P < 0.0001), performing sex work (OR = 6.00, P = 0.070), and sex with a male partner (OR = 13.00, P = 0.001). Those male Mexican migrant subgroups at particularly elevated risk were those in the United States for more than 5 years, those from the youngest age cohort (18-29 years old), or those frequenting high-risk behavior venues and male work venues. CONCLUSIONS: Our results show that Mexican migrant men were significantly more likely to engage in several HIV high-risk behaviors after migration to the United States. However, a smaller proportion of men reported low condom use after migration, indicating increased adoption of some prevention methods. Our results also identified subgroups of Mexican migrants at elevated risk who should be targeted for HIV prevention interventions.

Methamphetamine and cocaine use among Mexican migrants in California: the California-Mexico Epidemiological Surveillance Pilot.

Methamphetamine and cocaine use have been associated with a vulnerability to HIV infection among men who have sex with men and among men who have sex with women but not specifically among Mexican migrants in the United States. The California-Mexico Epidemiological Surveillance Pilot was a venue-based targeted survey of male and female Mexican migrants living in rural and urban areas in California. Among men (n = 985), the percentage of methamphetamine/cocaine use in the past year was 21% overall, 20% in male work venues, 19% in community venues, and 25% in high-risk behavior venues. Among women, 17% reported methamphetamine/cocaine use in high-risk behavior venues. Among men, methamphetamine/cocaine use was significantly associated with age less than 35 years, having multiple sex partners, depressive symptoms, alcohol use, sexually transmitted infections (including HIV), and higher acculturation. Prevention interventions in this population should be targeted to specific migrant sites and should address alcohol, methamphetamine, and cocaine use in the context of underlying psychosocial and environmental factors.

The epidemiology of HIV among Mexican migrants and recent immigrants in California and Mexico.

For Mexican migrants and recent immigrants, the impact of migration from Mexico to California has the potential to lead to an increased risk for HIV infection. Until recently, the prevalence of HIV in Mexico and among Mexican migrants in California appeared to be stable and relatively low. Recent studies have raised new concerns, however, that the HIV epidemic may expand more aggressively among this population in the coming years. Unfortunately, the insufficient amount of data available within recent years makes it difficult to fully assess the potential for rapid spread of the HIV epidemic among this population. Consequently, there is a critical need for an ongoing binational surveillance system to assess prevalence and trends in HIV/STD/TB disease and related risk behaviors among this population both in Calfornia and within this population's states of origin in Mexico. This enhanced epidemiologic surveillance system should provide improved data on the subpopulations at the highest risk for HIV/STD/TB, such as men who have sex with men, and should provide the opportunity to evaluate the impact of migration on the transmission dynamics, risk behaviors, and determinants of behavior on each side of the border. It is essential that this potential threat be assessed and that intervention programs are developed and implemented to combat this possible escalation in the HIV epidemic.

Prevalence of Bartonella infection among human immunodeficiency virus-infected patients with fever.

Bartonella infection can be difficult to diagnose, especially when it manifests as bacteremia, which is usually accompanied by nonspecific symptoms, such as fever. Therefore, we hypothesized that Bartonella infection represents an underrecognized cause of febrile illness. To determine the prevalence of Bartonella infection among patients presenting with fever, we evaluated 382 patients in San Francisco. Overall, 68 patients (18%) had evidence of Bartonella infection detected by culture, indirect fluorescent antibody testing, or polymerase chain reaction (PCR). Twelve patients (3%) had either Bartonella henselae or Bartonella quintana isolated from specimens of blood, tissue, or both or had DNA detected in tissue; all 12 had concomitant human immunodeficiency virus (HIV) infection. Bartonella antibodies were detected in 17% of febrile patients, including 75% of culture-positive or PCR-positive patients. In a nested, matched case-control study aimed at identifying clinical features of febrile illness associated with Bartonella infection, only bacillary angiomatosis and elevated alkaline phosphatase levels were associated with Bartonella infection (P< or =.03 for both). The prevalence of Bartonella infection among patients with late-stage HIV infection and unexplained fever is much greater than has previously been documented.

Molecular epidemiology of Bartonella henselae infection in human immunodeficiency virus-infected patients and their cat contacts, using pulsed-field gel electrophoresis and genotyping.

Bartonella henselae causes severe disease in immunocompromised individuals. B. henselae was isolated from 12 human immunodeficiency virus (HIV)-infected individuals with bacillary angiomatosis and/or peliosis hepatis and from their 15 cat contacts. Specific associations between the 2 B. henselae genotypes, individual pulsed-field gel electrophoresis (PFGE) patterns, and different clinical syndromes and pathogenicity were investigated. The role of cat contacts as the source of human infection was also examined. Three of the 4 patients with B. henselae genotype I infection, but none of the 8 patients with genotype II infection, had hepatosplenic vascular proliferative lesions (P=.018). Four of 5 human-cat pairs had closely-related PFGE patterns and concordant results by 16S rDNA typing, which strongly suggests that human infection was caused by the cat contact. These results corroborate the major role of cats in the transmission of B. henselae to humans and suggest that B. henselae genotypes may induce different pathological features in HIV-infected patients.