Reaching homosexual men for HIV surveillance through a gay magazine.

HIV surveillance in homosexual men is poor in most countries, as this risk group is difficult to sample. The aim of this study is to test the feasibility of reaching homosexual men for national HIV surveillance using gay community media. In 1989, a questionnaire on general gay issues, with a section on AIDS, was included in a widely sold gay magazine in the Netherlands. Among 17,700 sold copies, 1134 responses were obtained from males (6%). Of these, 669 men (59%) gave their address, of which in turn 84% responded to a questionnaire on risk behaviour in 1990. In 1991/1992, the 669 men were asked to participate in an HIV serosurvey, in which eventually 308 participated with a blood test (46%) and 147 without (total 68%). Participation in the serosurvey with blood test was associated with reporting multiple partners in 1989. Twenty participants were infected (6.5%). In logistic regression analysis, risk factors for infection were recent unprotected receptive anal intercourse with multiple partners (odds ratio (OR): 10.7; 95% confidence interval (CI): (2.18-52.2); one partner 1.17 (0.31-4.48); none 1) and living in Amsterdam (OR: 3.92; 95% CI: (0.99-15.5); urbanised western Netherlands 2.15 (0.57-8.03); elsewhere 1), while a high educational level was protective (OR: 0.29 (0.08-0.96); middle 0.41 (0.11-1.54); low 1). Among those who participated in 1991/1992, risk behaviour increased between 1989 and 1991/1992 (reporting multiple casual partners rose from 55% to 64%; reporting inconsistent condom use with receptive anal sex from 58% to 71%). Using a predictive model which included self-reported serostatus in 1989, the HIV prevalence rate in 1991/1992 among all male responders to the 1989 questionnaire was estimated to be 5.3% (95% CI: 3.1 7.7%). In conclusion, unless initial response is improved, recruitment through a gay magazine may not allow reliable estimates of HIV prevalence in homosexual men. However, it can be useful at the national level for monitoring changes in prevalence and risk behaviour over time, geographical differences and risk factors for infection.

Human immunodeficiency virus (HIV) antibodies detected by new assays that are enhanced for HIV-1 subtype O.

BACKGROUND: Human immunodeficiency virus type 1 (HIV-1) subtype O infections are not reliably detected by commonly used anti-HIV-1/2 screening assays. Therefore, anti-HIV-1/2 assays have been modified to increase their sensitivity in detecting antibodies to HIV-1 subtype O. STUDY DESIGN AND METHODS: Two new anti-HIV-1/2 enzyme-linked immunosorbent assays (ELISAs) (Abbott Plus and Ortho Enhanced) were compared with a currently used anti-HIV-1/2 ELISA (Abbott Recombinant) in various serum panels: 91 Western blot-confirmed anti-HIV-1-positive samples, 20 samples from Western blot-confirmed HIV-1-infected patients in log3 serial dilutions, and 1463 samples from consecutive, volunteer, nonremunerated blood donors. RESULTS: Among 91 anti-HIV-1 Western blot-positive samples, 2 (2.2%) were missed by the Abbott Recombinant ELISA, but all 91 were detected by the Abbott Plus and Ortho Enhanced ELISAs. In contrast, two discrepant samples were found to react in viral lysate-based assays. In serial dilutions, Ortho Enhanced ELISA was significantly less sensitive than the Abbott Recombinant and Abbott Plus ELISAs, with the latter two being of comparable sensitivity. The specificities of Abbott Recombinant, Abbott Plus, and Ortho Enhanced ELISAs in 1463 blood donors were 100, 99.93, and 99.86 percent, respectively. Routine testing of 29,102 donations with the enhanced Abbott Plus ELISA revealed a specificity of 99.93 percent. CONCLUSION: Two Western blot-confirmed anti-HIV-1-positive samples were missed by the Abbott Recombinant ELISA but detected by the Abbott Plus and Ortho Enhanced ELISAs. The analytic sensitivity of the Ortho Enhanced ELISA was inferior to that of both Abbott ELISAs. The specificities of the Abbott Recombinant, Abbott Plus, and Ortho Enhanced ELISAs were comparable.

Sexual risk of HIV infection among expatriates posted in AIDS endemic areas.

OBJECTIVE: To assess the prevalence of HIV infection and related risk factors among Dutch expatriates returning from assignment in sub-Saharan Africa, Latin America, and South and South-east Asia. METHODS: From July 1994 to January 1996, a questionnaire on the risks of sexual exposure was completed by 864 respondents, and blood samples were taken. RESULTS: Of the 634 men, 41% reported having sex with casual or steady local partners and 11% with casual or steady expatriate partners, during an average stay of 26 months in the previous 3 years. Of the 230 women, these figures were 31 and 24%, respectively. Of the men with local casual partners (29%), 59% paid for sex at least once. For men as well as women, having sexual contacts abroad was associated with younger age, positive intention prior to departure to have sex abroad, being single at departure, and, only for the men, working for a commercial organization, and feelings of loneliness and boredom. Among men, consistent condom use with casual local partners was 69%, and with casual expatriate partners 63%. Among women, these figures were 64 and 48%, respectively. Consistent condom use with steady local or expatriate partners was much lower. Among men, non-consistent condom use with casual partners was more prevalent if they had been abroad for a longer time, condoms were not taken along from The Netherlands, the country where they were posted was Asian, and the estimated HIV prevalence among the local population was lower. Among the women, non-consistent condom use was more prevalent if condoms were not taken along, and if they did not have the intention before departure to have sex abroad. Of the persons from whom blood could be obtained, one man was HIV-positive. Another man who refused to participate in the study indicated that he was HIV-positive. CONCLUSIONS: Although 23% of the expatriates had unprotected sex with partners from endemic areas, very few HIV infections were found. In comparison with a previous study among this population carried out in 1987-1989, which found five out of 1968 expatriates to be HIV-infected, consistent condom use with casual local partners did increase considerably (from 21 to 67%). However, health education is needed to reduce the risk of HIV infection, which should emphasize the sociocultural differences in sexual practices.

PIP: A survey conducted among 864 Dutch expatriates returning home from assignment in AIDS-endemic areas in sub-Saharan Africa, Latin America, and South and South East Asia revealed a low rate of HIV infection, despite widespread high-risk sexual practices. During an average stay out of the country of 26 months in 1991-96, 41% of the 634 male respondents reported sex with casual or steady local partners and 11% with casual or steady expatriate partners. Among the 230 female expatriates, these rates were 31% and 24%, respectively. 58% of men with casual local partners paid for sex at least once. Among men, consistent condom use was practiced in 69% of encounters with casual local partners and 63% of the time with casual expatriate partners. Among women, these rates were 64% and 48%, respectively. The prevalence of consistent condom use with casual local partners in this study was three times greater than that identified in a study conducted among Dutch expatriates in 1987-89. Condom use with regular local or expatriate partners was substantially lower (16.1-27.8%), however. Inconsistent condom use with casual partners was significantly associated, among men, with being abroad for a longer period of time, failure to bring condoms with them from the Netherlands, posting in an Asian country, and a relatively low estimated HIV prevalence in the local population. Among women, these risk factors were failure to take condoms to their destination and lack of intention at departure to have sex abroad. Only one case of HIV infection was detected in the 847 respondents who underwent serologic testing. Since expatriates function as a bridge between areas with high and low HIV prevalence, educational campaigns that prepare departing workers for differences between the sexual culture at home and abroad and encourage them to take a supply of condoms are recommended.

Detection of HIV antibodies in saliva as a tool for epidemiological studies.

OBJECTIVE: To evaluate the use of saliva specimens for the detection of HIV antibodies among high-risk groups in epidemiological studies. DESIGN: Testing of saliva specimens collected by different methods from individuals with known HIV status. The most reliable method was examined for its usefulness in a field study among a high-risk group. METHODS: Saliva samples were obtained either by using a cotton-wool roll ('Salivette') or as 'whole saliva'. HIV antibodies were determined using commercial enzyme-linked immunosorbent assays (ELISA). Confirmation was performed using a line immunoassay or an immunoblot assay. RESULTS: In 'Salivette' samples, HIV antibodies were detected by ELISA in seven out of 22 seropositive individuals. In contrast, testing of 'whole saliva' samples from 79 HIV-seropositive and 115 HIV-seronegative individuals resulted in a 100% correlation with HIV serum status. The positive reaction of 20 'whole saliva' specimens was confirmed in a line immunoassay, whereas in an immunoblot assay only seven specimens were positive, one negative, and 12 indeterminate. In an HIV prevalence study among drug users, 395 'whole saliva' samples were tested in two different ELISA. Both assays showed complete agreement in detecting 58 positive and 337 negative samples. All positive samples were confirmed by the line immunoassay. CONCLUSION: Our study demonstrates that 'whole saliva' specimens are a good alternative to blood samples in epidemiological studies of HIV prevalence in high-risk groups.

Sero-diagnosis of tuberculosis with A60 antigen enzyme-linked immunosorbent assay: failure in HIV-infected individuals in Ghana.

In order to assess the diagnostic usefulness of the A60 (ANDA Biological, Strassbourg, France) sero-diagnostic enzyme-linked immunosorbent assay (ELISA) kit for tuberculosis in Africa, sera of 53 pulmonary smear-positive tuberculosis (TB) patients, 30 apparently healthy control subjects and 6 AIDS suspects were sampled in Agogo Hospital in the forest area of Ghana. These sera were analyzed for antibodies to HIV-1 and HIV-2, and IgG-antibodies to the A60 BCG-antigen, while the non-HIV individuals were tested for total IgG levels. One healthy control subject, all of 6 AIDS suspects and 7 of the TB patients has HIV infections. In the non-HIV TB group, the sensitivity and specifity of the A60 ELISA was 78% and 86%, respectively, which was much poorer than expected from published reports about the A60 test. The A60 test failed, completely however, to discriminate between TB and non-TB in the HIV-positive group. In the non-HIV groups, total IgG levels were significantly higher in TB patients than in controls. It seems that the usefulness of the A60 ELISA test to diagnose tuberculosis is very limited in this high-incidence area, and that it seems to be of no value in patients infected with HIV.

Sero-diagnosis of tuberculosis with A60 antigen enzyme-linked immunosorbent assay: failure in HIV-infected individuals in Ghana

In order to assess the diagnostic usefulness of the A60 (ANDA Biological; Strassbourg; France) sero-diagnostic enzyme-linked immunosorbent assay (ELISA) kit for tuberculosis in Africa; sera of 53 pulmonary smear-positive tuberculosis (TB) patients; 30 apparently healthy control subjects and 6 AIDS suspects were sampled in Agogo Hospital in the forest area of Ghana. These sera were analyzed for antibodies to HIV-1 and HIV-2; and IgG-antibodies to the A60 BCG-antigen; while the non-HIV individuals were tested for total IgG levels. One healthy control subject; all of 6 AIDS suspects and 7 of the TB patients has HIV infections. In the non-HIV TB group; the sensitivity and specifity of the A60 ELISA was 78 per cent and 86 per cent; respectively; which was much poorer than expected from published reports about the A60 test. The A60 test failed; completely however; to discriminate between TB and non-TB in the HIV-positive group. In the non-HIV groups; total IgG levels were significantly higher in TB patients than in controls. It seems that the usefulness of the A60 ELISA test to diagnose tuberculosis is very limited in this high-incidence area; and that it seems to be of no value in patients infected with HIV

Sero-Diagnosis of tuberculosis with A-60 Antigen ELISA: Failure in HIV-Infected individuals in Ghana

It is concluded that the A60 ELISA test to diagnose fails in patients infected with HIV

[HIV-2 in The Netherlands]. / HIV-2 in Nederland.

By comparing data from the HIV confirmation laboratories it could be established that in the period prior to February 1991 a HIV-2 infection was demonstrated in at least 18 persons in the Netherlands. Consequently, use of combined HIV-1/2 tests is urgently recommended for screening in diagnostic and blood bank laboratories in the Netherlands. A suspicion of presence of HIV-2 antibodies may arise in the interpretation of a combined HIV-1/2-ELISA, a specific HIV-1-ELISA and the pattern of HIV-1 western immunoblot. Confirmation of the presence of HIV-2 antibodies should be obtained by means of western blots of viral lysates of both HIV-1 and HIV-2 and peptide tests from the transmembranous region. Most persons with a HIV-2 infection originated from Africa south of the Sahara or the Cape Verdean Islands or had had a sexual relationship with a person from these areas. The vast majority was heterosexual and 13 of the 18 infected persons were women. This differs greatly from the epidemiological pattern of HIV-1 infections in the Netherlands. The possibility of further spread of HIV-2 in the Netherlands via heterosexual contacts should be seriously taken into account.

Low number of functionally active B lymphocytes in the peripheral blood of HIV-1-seropositive individuals with low p24-specific serum antibody titers.

The in vitro synthesis of HIV-1, p24-, reverse transcriptase (RT)- and gp120-specific immunoglobulin (Ig) G by unstimulated peripheral blood mononuclear cells (PBMC) from 38 asymptomatic and 10 symptomatic HIV-1-seropositive individuals was analysed. In the majority of these individuals, spontaneous production of HIV-1- and gp120-specific IgG from PBMC cultures was demonstrated. In addition, in the majority of the PBMC cultures from individuals with high serum antibody titers to p24, spontaneous production of p24-specific IgG was shown. In contrast, no p24-specific IgG production was detected in PBMC cultures from seropositive individuals with low or no serum antibody titers to p24. A similar relationship between low or absent RT-specific serum antibody titers and the absence of in vitro RT-specific IgG synthesis was not demonstrated. Furthermore, it was shown that the number of p24-specific B lymphocytes in circulation, as calculated by a spot enzyme-linked immunosorbent assay, were significantly lower in individuals with low serum antibody titers to p24. These results suggest that the decline in p24-specific serum antibodies observed during progression towards AIDS is not merely a reflection of the clearance via immune complexes, but may also be attributable, at least in part, to a reduction of p24-specific antibody-producing active B lymphocytes.

Prevalence of HIV-1 antibody among groups of patients and healthy subjects from a rural and urban population in the Mwanza region, Tanzania.

In April 1987, antibody to HIV-1 was determined in sera from 764 subjects from the Mwanza region in the north of Tanzania. Patients with a clinical suspicion of AIDS were HIV-1 antibody-positive in 65.4% (34 out of 52) and patients admitted for pulmonary tuberculosis in 25% (9 out of 36). In patients attending general outpatient departments (OPD), HIV antibody was found in 12.5% of 48 patients with a history of sexually transmitted disease (STD) and in 10.6% of 141 patients without such a history. In healthy subjects, HIV-1 antibody was present in 6% of 332 pregnant women and in 4.5% of 155 blood donors. Of the blood donors, pregnant women and OPD patients without a history of STD (628 subjects in all), 465 belonged to the rural population of the region and the majority were peasants. In this subgroup, the HIV-1 antibody prevalence was 4.8% in blood donors, 4.9% in pregnant women and 10.3% in OPD patients. This indicates a spread of HIV-1 among the population in this part of Tanzania. Further studies are needed to determine what proportion of the population is affected.

Blood donors with indeterminate anti-p24gag reactivity in HIV-1 western blot: absence of infectivity to transfused patients and in virus culture.

During a follow-up period of 23-40 months, 7 regular blood donors had persistently, and 4 had intermittently indeterminate anti-p24gag reactivity in human immunodeficiency virus (HIV)-1 Western Blot. Serological testing and viral cultures revealed that these donors had no signs of infection for HIV-1, HIV-2, human T-cell lymphotropic virus (HTLV)-4, and HTLV-1. Extensive interviewing and physical examination of these donors revealed neither risk factors, nor signs of HIV infection in the tested donors. Ten recipients, who were transfused with blood products from 6 of these 11 anti-p24gag-positive donors, were traced back. Six months after transfusion, no serological or clinical signs of HIV-1, HIV-2, or HTLV-1 infection were observed in these patients. It is concluded that blood donors with persistent or intermittent anti-p24gag reactivity in HIV-1 Western Blot, without development of antibodies to other HIV-encoded proteins in later blood samples, do not transmit the described retroviruses to transfused patients.