Birth conditions of children of women living with HIV

The objective was to identify the conditions of birth of children of women living with HIV in the period between 2009 and 2019, at the Regional Maternal and Child Hospital of Imperatriz (MA). Cross-sectional, quantitative, documentary study, with descriptive analysis of the data and carried out in a reference maternity hospital between August 2020 and July 2021. Information from the medical records of HIV-positive pregnant women and their newborn children was included. The results collected 314 medical records, of which 195 were eligible. Regarding the birth conditions of the newborns, in 56.41% the rapid test was negative; 72.82% used post-birth prophylaxis; 75.38% did not receive breast milk; 68.2% received vaccines at birth; 40.51% did not use any medication. 20.51% of the mothers were between 36 and 40 years old; 59.48% did not live in the municipality surveyed; 23.6% were housewives; 65.64 were multipara women; 46.15% were diagnosed with HIV during pregnancy; 67.17% had no coinfections; 82.05% underwent prenatal care; 60.51% used intrapartum prophylaxis; and 77.43% underwent cesarean section. The prenatal and childbirth follow-up of most of these women living with HIV reflected positively on the conditions of birth of their children, being an important strategy, aiming at the non-vertical transmission and prevention of the disease in children (AU).

Objetivou-se identificar as condições de nascimento de filhos de mulheres vivendo com HIV no período compreendido entre 2009 e 2019, no Hospital Regional Materno Infantil de Imperatriz (MA). Estudo transversal, quantitativo, documental, com análise descritiva dos dados e realizado em maternidade de referência entre os meses de agosto de 2020 e julho de 2021. Incluíram-se informações dos prontuários das gestantes soropositivas para HIV e de seus filhos recém-nascidos. Os resultados levantaram 314 prontuários, destes, 195 eram elegíveis. Sobre as condições de nascimento dos recém-nascidos, em 56,41% o teste rápido foi negativo; 72,82% usaram profilaxia pós-nascimento; 75,38% não receberam leite materno; 68,2% receberam vacinas logo ao nascer; 40,51% não faziam uso de nenhuma medicação; 20,51% das mães tinham entre 36 a 40 anos; 59,48% não residiam no município pesquisado; 23,6% eram donas de casa; 65,64 eram multigestas; 46,15% receberam o diagnóstico de HIV na gestação; 67,17% não tinham coinfecções; 82,05% realizaram o pré-natal; 60,51% fizeram uso da profilaxia intraparto; e 77,43% fizeram cesariana. O acompanhamento no pré-natal e parto da maioria dessas mulheres vivendo com HIV refletiu positivamente nas condições de nascimento de seus filhos, sendo uma importante estratégia, visando a não transmissão vertical e prevenção da doença nas crianças (AU).

Meningitis aséptica por varicela zóster sin rash vesicular previo en paciente VIH positivo. Presentación de caso / Varicella Zoster aseptic meningitis without previous vesicular rash in VIH positive patient. Case report

Resumen Un cuadro de meningitis aséptica, en el contexto de un paciente inmunosuprimido con diagnóstico de infección por Virus de Inmunodeficiencia Humana (VIH), debe llevar a pensar en múltiples diagnósticos diferenciales. Entre estos, se incluye el virus varicela zóster (VVZ) como uno de los principales agentes causales de meningitis a líquido cefalorraquídeo claro. Su reactivación da lugar a múltiples manifestaciones neurológicas potencialmente mortales en las que se consideraba al rash vesicular, o exantema pápulo/vesículo/ costroso como un signo fundamental para su diagnóstico. No obstante, las lesiones cutáneas están ausentes en más de un tercio de los pacientes con compromiso del sistema nervioso central. A continuación, se presenta el caso de un paciente con infección por VIH que presenta cefalea más fiebre, con hallazgos en líquido cefalorraquídeo de pleocitosis neutrofílica y una prueba molecular confirmatoria para virus varicela zóster, en ausencia de rash vesicular previo que guiara hacia este diagnóstico. MÉD.UIS.2021;34(1): 91-9.

Abstract The clinical presentation of aseptic meningitis in the context of an immunosuppressed patient with a diagnosis of Human Immunodeficiency Virus (HIV) infection, should lead us to consider multiple differential diagnoses. Among these, the Varicella Zoster Virus (VZV) has been found as one of the main causative agents of clear cerebrospinal fluid meningitis. Its reactivation gives rise to multiple life-threatening neurological manifestations in which vesicular rash, or papule / vesicular / crusted rash was considered a fundamental sign for its diagnosis. However, skin lesions are absent in more than a third of patients with central nervous system involvement. Herein, we report a case of an HIV-infected patient with headache, fever and neutrophilic pleocytosis with FilmArray that confirms Varicella Zoster virus infection in an immunocompromised patient in the absence of vesicular rash. MÉD.UIS.2021;34(1): 91-9.

Evaluation of an HIV recent infection testing algorithm with serological assays among men who have sex with men in Mexico.

BACKGROUND: Human immunodeficiency virus (HIV) incidence should be calculated in cross-sectional studies using recent infection testing algorithms (RITA) that consider clinical variables and serological test results such as enzyme-linked immunosorbent assay (ELISA) and dried blood spot (DBS) analysis. METHODS: The correlation between serum samples and DBS was evaluated using two commercial ELISA kits: SediaTM BED HIV-1 Incidence EIA (BED-Sedia) and Maxim HIV-1 Limiting Antigen Avidity (LAg-Avidity). Eight different RITAs were developed; all of them included serological assays. A combination of the variables viral load, antiretroviral therapy (ART) and CD4 count was used to build the RITAs. The sensitivity, specificity, Youden index, predictive positive value, predictive negative value, false recent rate (FRR) and false long-term rate were evaluated. RESULTS: The correlations between serum samples and DBS were 0.990 and 0.867 for BED-Sedia and LAg-avidity, respectively. Using only serological assays, the Youden index was higher for LAg-avidity than BED-Sedia (82.1-83.0% versus 69.2-69.6%). The best RITA was ART-serology, which showed a Youden index of 91.2-93.9% and FRR of 1.8-2.2%. CONCLUSIONS: Using DBS samples to determine HIV incidence is a good tool for epidemiological surveillance. The RITA that included ART and serological tests (BED-Sedia or LAg-avidity) showed the highest sensitivity and specificity and a low FRR.

Perceived risk and decisional balance to HIV testing in men who have sex with men from Monterrey, Mexico. / Riesgo percibido y balance decisional hacia la prueba del VIH en hombres que tienen sexo con hombres de Monterrey, México.

The perceived risk to HIV and the decisional balance (pros and cons) towards HIV testing are fundamental aspects for understanding the motivation of men who have sex with men to engage in behaviours that reduce or increase the risk of infection with the virus. OBJECTIVES: To describe the perceived risk of HIV and the decisional balance towards HIV testing and determine the association between perceived risk and the decisional balance towards HIV testing of men who have sex with men. METHOD: Descriptive correlational design, we used respondent-driven sampling, with which we recruited 202 men who have sex with men. RESULTS: Mean age of 27.79 (SD=8.13), 66.3% reported low perceived risk to HIV. The most significant pros were: "If I had HIV I would not want to infect anyone else" (95%) and "I would like to be sure I did not have HIV to tell my sexual partner" (90.6%). The most significant cons were: "I am afraid of the needle used for the HIV test" (53%), "people could reject me if they had HIV" (78.7%). Finally, there was a correlation between the perceived risk and the decisional balance towards HIV testing (rs=.759, p<.001). CONCLUSIONS: Given such data, in future interventions it is important to consider information about the importance of HIV testing on a regular basis, as well as actions to increase the perception of vulnerability to HIV in this population.

Centro de testagem e aconselhamento: características dos usuários e prevalência de infecção pelo HIV / Testing and counseling center: characteristics of users and HIV infection prevalence

A política brasileira de diagnóstico precoce e prevenção da infecção pelo HIV fortaleceu-se a partir dos Centros de Testagem e Aconselhamento (CTA). O objetivo deste estudo foi analisar as características de residentes do município de Rolândia que procuraram pelo diagnóstico de HIV no próprio município e no município de referência, assim como a prevalência de soropositividade. Trata-se de uma pesquisa descritiva, cujos dados foram levantados do Sistema de Informação (SI) do CTA referentes ao período de 2006 a 2010. Os dados foram tabulados e analisados por meio de frequências simples e relativas. Em Rolândia, foram 5.502 pacientes, sendo 79,5% mulheres, 64,8% apresentavam união estável, e 40,8% procuraram o CTA alegando prevenção. Dos 37 pacientes que estiveram no CTA de Londrina, 62,1% eram solteiros ou separados, 27,0% compareceram devido à exposição a situação de risco, e 19% apresentavam sintomas da aids. Dentre todos os pacientes que realizaram o exame anti-HIV, o índice de positividade foi de 0,60%. Esta pesquisa reiterou a importância de conhecer os usuários que demandam os CTA e a soroprevalência, constituindo informações relevantes para elaboração de políticas públicas, implantação de estratégias de prevenção e ações de assistência e promoção à saúde da população.

The Brazilian policy on early diagnosis and prevention of HIV infection was consolidated through the establishment of Testing and Counseling Centers (TCCs). The aim of this study was to analyze the characteristics of residents of the municipality of Rolândia who sought HIV diagnosis in their own municipality and in the municipality of reference, as well as seropositivity prevalence. This is a descriptive research whose data was collected from the TCC's Information System (IS) referring to the period from 2006 to 2010. The data was tabulated and analyzed through simple and relative frequencies. In Rolândia, there were 5,502 patients, of whom 79.5% were women, 64.8% were in a stable relationship and 40.8% sought the TCC for prevention. Among the 37 patients of Londrina's TCC, 62.1% of them were single or divorced; 27.0% went to the TCC due to exposure to risk situation, and19% presented AIDS symptoms. Among all patients tested for HIV, the positivity index stood at 0.60%. This research reiterated the importance of knowing the users who need the TCC, in addition to seroprevalence, comprising relevant information for the implementation of public policies, prevention strategies and actions aimed at promoting the population's healthcare.

Revelação do diagnóstico da infecção pelo HIV no contexto do aconselhamento: a versão do usuário / Disclosure of the HIV infection diagnosis in the context of counseling from the user's perspective: la versión del usuario / La revelación del diagnóstico de la infección por el VIH en el contexto del asesoramiento

A partir de uma investigação realizada em dois Centros de Testagem e Aconselhamento em DST/Aids de São Paulo, objetiva-se descrever processos de revelação do diagnóstico da infecção pelo HIV no contexto do aconselhamento sorológico. O estudo envolveu 14 sujeitos entrevistados após a revelação do resultado do teste. Conceitos da teoria psicanalítica de D. W. Winnicott foram utilizados para analisar e compreender os processos de aconselhamento investigados. Os resultados mostraram que o enfrentamento do diagnóstico da infecção pelo HIV e o desejo de cuidar da saúde a partir da revelação do resultado reagente têm efeitos variados nos sujeitos, dependendo do modo como o aconselhamento é feito. De um lado, pode-se ter a oportunidade de confronto consigo mesmo, com os próprios problemas, com a angústia gerada pela revelação do resultado, observando-se maior ou menor integridade psíquica dos sujeitos. Em contraste, isso não foi observado nos casos em que os sujeitos não se sentiram acolhidos e apoiados no aconselhamento. É importante que seja estabelecida uma relação intersubjetiva de ajuda no momento da revelação do diagnóstico da infecção pelo HIV para que o aconselhamento possa cumprir sua função estratégica de focar no problema específico e nos recursos mais saudáveis do indivíduo.

The present study emerged from a research done in two Testing and Couseling Centers for STD/AIDS in São Paulo. It aims at describing the reagent HIV test disclosure processes within the context of the serological counseling. The study involved 14 subjects interviewed after they were disclosed their test results. In the analysis and understanding of the counseling processes investigated, concepts from D. W. Winnicott's psychoanalytical theory were applied. The results showed that facing the HIV infection diagnosis and being willing to take care of one's health after the reagent result disclosure have different effects on the subjects, depending on how the counseling takes place. From one side, they can have the opportunity to confront themselves, their own problems and the anguish generated by the result disclosure, observing more or less psychic integrity from the subjects. On the other hand, this was not observed in cases where the subjects did not feel welcome and supported during counseling. It is important that an intersubjective relationship of support be established on the moment of the reagent HIV result disclosure so that the counseling can fulfill its strategic function to focus on the specific problem and the healthiest resources from the individual.

El estudio surge de una investigación que se produjo en dos Centros de Pruebas y Asesoramiento en DST/Sida en São Paulo, con el objetivo de describir procesos de revelación del resultado de la infección por el VIH en el contexto del asesoramiento serológico. El estudio involucró a 14 sujetos a quienes se les hizo una entrevista tras la revelación del resultado del examen. El análisis y la comprensión se hicieron aplicando conceptos de la teoría psicoanalítica de D. W. Winnicott. Los resultados demostraron que hacer frente al diagnóstico de la infección por el VIH y el deseo de cuidar la salud tras la revelación del resultado reactivo tiene efectos distintos en los sujetos, y dependen del modo con el que se hace el asesoramiento. Por un lado, es posible que haya oportunidad del confronto consigo mismo, con los propios problemas, con la angustia generada por la revelación del resultado, observándose más o menos la integridad psíquica de los sujetos. Por otro lado, esto no se observó en los casos en que los sujetos no se sintieron acogidos y apoyados en el asesoramiento. Es importante que se establezca una relación intersubjetiva de ayuda en el momento de la revelación de la infección por el VIH para que el asesoramiento cumpla su función estratégica de enfocar en el problema específico y en los recursos más sanos del indivíduo.

Niñez afectada con VIH/SIDA: calidad de vida, funcionalidad familiar y apoyo social en cinco ciudades colombianas / Children affected with HIV/AIDS: quality of life, family function and social support in five Colombian cities

Objetivo: Describir calidad de vida, funcionalidad familiar y apoyo social en menores de 18 años afectados con VIH/sida y cuidadores residentes en Cali, Buenaventura, Barranquilla, Santa Marta y Cartagena. Materiales y métodos: 286 encuestas personales realizadas a 11 menores que conocían su diagnóstico de seropositivos para VIH y 275, a cuidadores de menores que aún no conocían situación de afectación para VIH; se aplicaron en instituciones de salud tanto del sector estatal como del privado, empleándose los instrumentos EuroQol (EQ-5D), APGAR familiar y apoyo social MOS. Se realizó análisis descriptivo de los datos y tabulación en SPSS, versión 15, en español. Resultados: Las razones para retrasar la entrega del diagnóstico que reportaron profesionales de salud y cuidadores de los menores afectados [96.2% (n=275)] se relacionan con evitar daño psicológico o estrés emocional al menor; temor a causar situaciones de estigmatización ante la revelación involuntaria a otros, y falta de capacitación respecto al procedimiento y edad para entregar esta información. Las dimensiones de calidad de vida indicaron que los menores presentan dolor/malestar y angustia/depresión entre modera- do/severo [15.4% (n=44); 9.8% (n=28)], respectivamente. Se encontró normofuncionalidad familiar [73.8% (n=211)] y percepción de apoyo social máximo [74.1% (n=212)] en los participantes. Conclusiones: La baja tasa de divulgación del estado serológico para VIH/sida en población infantil encontrada en el estudio, indica que dentro del manejo integral en salud es prioritario desarrollar un modelo clínico de divulgación que favorezca procesos de apoyo a familias afectadas...

Objective: To describe quality of life, family functioning and social support for children under 18 years affected with HIV/AIDS and caregivers living in Cali, Buenaventura, Barranquilla, Santa Marta and Cartagena.Materials and methods: 286 personal surveys conducted in 11 children who knew their diagnosis of HIV seropositivity and, 275 to caregivers of children who did not know their HIV status of involvement in health institutions belonging to the State and private sectors. Instruments were used EuroQol (EQ-5D), Family APGAR and MOS Social Support. We performed descriptive analysis of data and tabulation in SPSS Version 15 in Spanish. Results: The reasons for delaying the delivery of diagnosis, reported by health professionals and caregivers of affected children [96.2% (n=275)] are related to avoid psychological or emotional harm to a child, fear of inadvertent disclosure to others leading to situations of stigma and lack of training regarding the procedure and age to deliver this information. The dimensions of quality of life indicated that children have pain/discomfort and anxiety/ depression, moderate/severe [15.4% (n=44), 9.8% (n=28)] respectively. Normal family function was found [73.8% (n=211)] and perception of social support maximum [74.1% (n=212)] in participants. Conclusions: The low rate of disclosure of HIV status to HIV/AIDS on children found in the study, indicating that it is a priority to develop an outreach clinical model in the health management process that encourages support for affected families...

Revelación del estado serológico para VIH/SIDA en niños, niñas y adolescentes: una revisión teórica / Disclosure of HIV serostatus children and adolescents: a theoretical review

El artículo presenta una revisión del estado del arte del proceso de revelación del estado serológico en la población infantil menor de 18 años afectada con VIH/SIDA. Los resultados de la revisión se presentan en torno a las modalidades y factores asociados al proceso revelación y no revelación del diagnóstico de VIH a niños, niñas y adolescentes por parte de sus cuidadores y profesionales que brindan servicios de salud en diversos contextos socioculturales y la situación en Colombia. Se seleccionaron artículos publicados en cinco bases de datos utilizándose como palabras clave para la búsqueda “disclosure”, “disclosure model”, “disclosure in children with HIV/AIDS” y ”pediatric HIV/AIDS”. Para la búsqueda se incluyeron artículos en los idiomas inglés y español entre los años 1990 y 2008.

The article presents a review of HIV serostatus disclosure in the under-18 population living with HIV/AIDS. The results include disclosure models and factors associated with disclosure and non disclosure of children and adolescents' HIV serostatus by their caregivers and health workers.The effects of these factors in various sociocultural contexts were studied, with emphasis on the Colombian context. Articles published in five databases were selected, using the key words “disclosure”, “disclosure model”, “disclosure in children with HIV/AIDS” and “pediatric HIV/AIDS”. Articles published in English and Spanish, and between 1990 and 2008, were included.

Overseas processing of dried blood spots for timely diagnosis of HIV in Haitian infants / Diagnóstico oportuno del VIH en niños haitianos mediante el procesamiento en el extranjero de muestras de sangre seca

OBJECTIVE: To determine the feasibility of sending dried blood spots (DBS) to an overseas processing center for the diagnosis of HIV infection in infants in rural Haiti. METHODS: The program took place in the Central Department of Haiti. Children under 18 months of age who were born to an HIV-infected mother or who had a positive HIV antibody test had blood collected on filter paper. Once dry, specimens were labeled with a unique identifying number, placed in sealed gas-impermeable envelopes containing a desiccant, stored at room temperature, and mailed to a commercial laboratory in The Netherlands, where blood was eluted from the filter paper and analyzed by the RetinaTM rainbow HIV-1 RNA assay. Infants were tested at 1 month of age and again at 4 months of age. RESULTS: The DBS protocol was easily scaled up. During the study period, 138 infants had HIV status confirmed; 15 of them were found to be HIV infected and were enrolled in appropriate HIV care, and 123 were confirmed to be HIV uninfected, avoiding unnecessary prophylactic antibiotics and providing reassurance to caregivers. CONCLUSION: Central, overseas processing of DBS is a feasible solution for the timely diagnosis of HIV infection in infants where local capacity is unavailable. Regional processing centers for DBS could improve the access of millions of children in Latin America and the Caribbean to timely diagnosis of HIV infection.

OBJETIVO: Determinar la factibilidad de enviar muestras de sangre seca (MSS) a un centro en el extranjero para el diagnóstico de la infección por el VIH en niños de zonas rurales de Haití. MÉTODOS: El programa se realizó en el Departamento Central de Haití. Se tomó una muestra de sangre en papel de filtro de los niños menores de 18 meses nacidos de madres infectadas con el VIH o que tuvieran una prueba positiva de anticuerpos contra el VIH. Una vez secas, las muestras se etiquetaron con un número de identificación único, se colocaron en sobres sellados impermeable a gases con desecante, se almacenaron a temperatura ambiente y se enviaron por correo a un laboratorio comercial en los Países Bajos, donde se eluyó la sangre del papel de filtro y se analizó mediante el sistema RetinaTM Rainbow para la detección de ARN del VIH-1. Las pruebas se realizaron a los niños de 1 mes y se repitió a los 4 meses de edad. RESULTADOS: El procedimiento de MSS se llevó fácilmente a una escala mayor. En el período de estudio se confirmó el diagnóstico de 138 niños: 15 de ellos estaban infectados y recibieron los cuidados apropiados; 123 niños no tenían la infección, lo que evitó aplicar innecesariamente el tratamiento antibiótico profiláctico y el personal de salud sintió mayor confianza. CONCLUSIONES: El procesamiento centralizado de MSS en el extranjero es una solución factible para el diagnóstico oportuno de la infección por el VIH en niños cuando no hay capacidad local de diagnóstico. Centros regionales para el procesamiento de MSS podrían mejorar el acceso de millones de niños de América Latina y el Caribe al diagnóstico oportuno de esta infección.

Seropositivity, homosexuality and identity politics in Brazil.

PIP: This paper focuses on the emergence of HIV seropositivity as a new identity, closely linked to male homosexuality, in Brazilian culture. Two distinct conceptions of seropositive identities that emerged in the Brazilian HIV/AIDS movement were examined. These two differing conceptions have taken shape as the basis for social action and activism around AIDS-related issues such as prevention, treatment and care. The first of these conceptions suggest that all people whose lives have been touched by HIV and AIDS can work together, based on principles of solidarity, in seeking to respond to the epidemic--whether or not they were themselves directly infected with HIV. The second, more specific conception suggests that those infected by HIV share a number of common experiences that distinguish them from others, while at the same time recognizing the specificity of homosexual men as opposed to heterosexual women or injecting drug users. Despite the differences, the two conceptions promote various common purposes such as the social integration and participation of HIV-positive persons in confronting AIDS, fighting for better life conditions, defending civil rights and breaking clandestineness and isolation. The differences appear mainly in the ways of organizing and political and social representation.^ieng

Seroreactivity to HIV-1 V3 subtypes A to H peptides of Argentinian HIV-positive sera.

Serologic assays could be useful for determining circulating subtypes in different geographic regions. A total of 175 serum samples from the same number of Argentinian HIV-infected patients from Buenos Aires and Rosario were tested against a panel of peptides representing V3 consensus subtypes A through H. A V3 peptide enzyme immunoassay was used for screening the sera. Most sera were reactive with peptides representing subtypes B (58.28%), F (13.14%), and A (8.57%). Cross-reactivity between the remainder of the peptides was observed. Genotypes of eight patients from Rosario were determined and compared with serotyping. Results showed that seven of eight genotyped patients reacted with their respective consensus B peptide and one reacted with consensus B and F. V3 peptide serology proved to be useful for determining HIV-1 clades circulating in Argentina.

PIP: 175 serum samples were collected from 175 HIV-infected Argentineans in Buenos Aires and Rosario during 1987-95, for testing against a panel of peptides representing V3 consensus HIV-1 subtypes A through H. A V3 peptide enzyme immunoassay was used to screen the sera. 58.28% of the sera were infected with HIV-1 subtype B, 13.14% with subtype F, 8.57% with subtype A, 4% with subtype H, 2.85% with subtype D, 2.28% with subtype G, and 1.71% with subtype C. Some cross-reactivity between peptides was observed. Peripheral blood mononuclear cells (PBMCs) were obtained from 8 HIV-infected subjects from Rosario for use in determining genotypes. 7 of the 8 genotyped patients reacted with their respective consensus B peptide and 1 reacted with consensus B and F. V3 peptide serology proved useful in determining which HIV-1 clades are circulating in Argentina.

HIV prevalence in dental outpatients in Brazil.

A series of dental outpatients in Brazil was anonymously screened for HIV antibodies in whole unstimulated saliva with an immunoglobulin G antibody-capture enzyme-linked immunosorbent assay. Salivary HIV antibodies were detected in 40 patients in the control group who were known to be HIV-seropositive but were not detected in any of a series of 40 known HIV-seronegative patients in the control group, confirming the very high sensitivity and specificity of the immunoglobulin G antibody-capture enzyme-linked immunosorbent assay. Only one patient from 84 consecutive dental outpatients of unknown HIV serostatus who were examined anonymously for HIV by immunoglobulin G antibody-capture enzyme linked immunosorbent assay showed HIV positivity (1.2% of the population).

PIP: Dental outpatients in Sao Paulo, Brazil, were anonymously screened for HIV through use of a salivary immunoglobulin G antibody-capture enzyme-linked immunosorbent assay. The ages of the 84 consecutive emergency dental patients ranged from 16 to 52 years. Pretesting of the saliva test in 40 patients confirmed to be HIV-positive through two serum assays, and 40 known HIV-seronegatives indicated this method is 100% accurate. Only 1 salivary test (1.2%) among the dental outpatients was positive for HIV antibodies. Salivary antibody testing has the advantages of absence of needlestick injuries, simplicity, ease of collection, lack of need for trained staff, greater compliance in high-risk groups, and better acceptability by children. Moreover, because of the lower titer of HIV in saliva than in blood and the HIV inhibitory action of saliva, this diagnostic method is associated with a reduced risk of occupational hazard during sample collection.

Field evaluation of rapid HIV serologic tests for screening and confirming HIV-1 infection in Honduras.

OBJECTIVE: To determine the ability of simple, rapid tests to identify HIV-1 antibody-positive specimens in field settings using the World Health Organization's (WHO) alternative testing strategies. DESIGN: Three-phase evaluation of simple, rapid assays using banked specimens and prospectively collected serum specimens at regional hospitals and rural clinics. METHODS: Seven test (Retrocell, Genie, HIVCHEK, SUDS HIV-1, Testpack, Serodia HIV-1, and HIV-1/2 RTD) were evaluated and results compared with standard enzyme immunoassay (EIA) and Western blot results (phase 1). Further evaluation consisted of prospective testing of routine specimens at regional (phase 2; n = 900) and rural, peripheral laboratories (phase 3; n = 1266) throughout Honduras with selected assays. RESULTS: Sensitivity and specificity were calculated for each assay and combination of assays for each phase to evaluate the effectiveness of the WHO alternative testing strategies. All tests in all phases were > 99% sensitive after correcting for technical errors, with two exceptions (SUDS, phase 1; HIVCHEK, phase 3). In phase 3, where the testing algorithm was diagnostic, several combinations of assays were 100% sensitive and specific using WHO strategy II or III. For the Honduras Ministry of Health, the combination of Retrocell and Genie was found to be equally sensitive, more specific (no indeterminate results), and less expensive than EIA/Western blot. CONCLUSION: Combinations of rapid, simple HIV antibody assays provide sensitivity and specificity performance comparable to EIA/Western blot. Application of these combinations in the WHO alternative testing strategies provides an inexpensive and effective method of determining HIV status. Assay combinations using these strategies can be easily performed in small, rural laboratories and have been implemented in routine HIV screening in Honduras.

PIP: In 1992, the World Health Organization (WHO) introduced 3 HIV testing algorithms designed to provide rapid, accurate results equivalent to those obtained by enzyme immunoassay (EIA) and Western blot but at reduced costs. The capability of the WHO strategy to identify HIV-1 antibodies in field settings was evaluated at regional hospitals and rural clinics in Honduras. In the study's first phase, the results of 7 tests (Retrocell, Genie, HIVCHEK, SUDS HIV-1, Testpack, Serodia HIV-1, and HIV-1/2 RTD) were compared with results for 600 sera previously tested by EIA and Western blot. Phase 2 entailed prospective testing of 900 routine specimens at regional laboratories, while phase 3 screened 1266 specimens at rural, peripheral laboratories. In the first phase of the analysis, 5 assays had a sensitivity of 100%; the remaining 2 were 99.7% and 99.3% sensitive and specificities ranged from 92.8 to 100%. In field settings, sensitivities ranged from 96.4 to 99.3%. Moreover, in the third phase, several combinations of tests were 100% sensitive or specific when the WHO strategy of basing the choice of assay on the purpose of the screening (seroprevalence studies, screening of blood, or patient diagnosis) was employed. The combination of Retrocell and Genie was found to be equally sensitive, more specific, and less expensive than EIA or Western blot.

Using existing health care systems to respond to the AIDS epidemic: research and recommendations for Chile.

Chile is a country with a relatively low prevalence of HIV infection, where successful prevention has the potential to change the future course of the epidemic. A controversial national prevention strategy based upon public education has emerged in response to characterizations of the epidemic as well-dispersed with a growing involvement of heterosexuals. This characterization is not consistent with the observed facts. There is a comparatively well-organized health care system in Santiago that is doing a good job of detecting HIV infection and already has in place the elements of a targeted intervention scheme. Chile should place priority on the use of the existing health care infrastructure for implementing both the traditional public health interventions for sexually transmitted diseases (contact tracing and partner notification) and the AIDS-necessitated strategy of focused counseling and education.

PIP: 93% of the 1016 cumulative AIDS cases reported through June 1994 in Chile have been among men. People aged 20-49 years comprise 85% of cases. The cases are concentrated in the Santiago metropolitan area with a second cluster in the urban sea coast region which includes Valparaiso and Vina-del-Mar. An additional 1627 people have been confirmed HIV seropositive. 86% of AIDS cases are the result of sexual intercourse. Of the 815 adult males diagnosed with AIDS as of the middle of 1994, 58% were homosexual, 24% were bisexual, and 18% were heterosexual. These figures suggested that HIV infection was spreading into the general heterosexual population of the country and prompted the government to implement a mass media HIV/AIDS campaign as the cornerstone of its AIDS prevention plan. However, interview findings suggest that the extent of bisexual- and heterosexual-related HIV transmission reflected in official statistics could be high by as much as 50%. Many men who have sex with men do not identify themselves as homosexual. HIV/AIDS route of infection statistics based upon self-identified sexual categories are therefore inaccurate. The AIDS epidemic in Chile to date is more like the largely homosexual epidemic in San Francisco during the 1980s than that occurring in the countries of the Caribbean or elsewhere with a heterosexual transmission pattern. A highly focused AIDS prevention program effectively slowed the spread of HIV in San Francisco. Rather than continue with the mass media prevention campaign, Chile should use its existing blood donor system combined with partner tracing and case investigation to capture a manageable number of HIV-positive people and identify nascent localized epidemics.

The epidemiology of HIV-1 infection in Peru, 1986-1990.

OBJECTIVE: To determine the extent of the HIV-1 epidemic in Peru. DESIGN: Part of a national serosurvey in Peru. METHODS: Between January 1986 and December 1990, 140,976 serum samples were tested for HIV-1 antibody. RESULTS: HIV-1 antibody was found in a high percentage of serum samples provided by 4300 homosexual men (26%), 2204 male sexually transmitted disease patients (10%), 145 drug users (13%), 269 hemophiliacs (10%), and 146 unlicensed female prostitutes (10%). In addition, the prevalence of HIV-1 infection increased substantially among these groups between the beginning and end of the survey period. A low but rising prevalence of HIV-1 antibody was found during this period among serum samples provided by 83,526 blood donors and 11,101 military personnel:total period prevalence, 0.25 and 0.32%, respectively. CONCLUSION: These data indicate that HIV-1 infection is epidemic in Peru among groups at high risk of sexually and parenterally transmitted diseases, and that the risk of infection appears to be low but possibly increasing among the general population.

PIP: The findings of a national seroprevalence survey conducted in Peru during 1986-90 indicate accelerating rates of human immunodeficiency virus (HIV) among population groups at high risk of sexually transmitted diseases. Two databases were maintained: 1) January 1986-December 1988 and 2) January 1989-December 1990. Of the 140,976 survey participants, 3345 (2.4%) were HIV-positive by Western blot. 2591 participants were selected because of clinical signs suggestive of acquired immunodeficiency syndrome (AIDS); 46.7% were HIV-positive, but the prevalence increased from 19% in the 1986-88 period to 60% during 1989-90. Among the 4300 men who identified themselves as homosexual or bisexual, 26% were seropositive (8% during 1986-88 and 41% during 1989-90). HIV prevalence among 2204 men attending a sexually transmitted diseases clinic was 10.3%, with an increase from 2.0% in the first period to 19.0% in the later period. 10.4% of the 269 hemophiliacs were HIV-infected, with an increase from 8% to 36%. Among the 145 intravenous drug users, the prevalence rose from 1% during 1986-88 to 27% during 1989-90. Among 5827 registered female prostitutes, the prevalence rose from 0.3% to 0.7%; however, a 1990 analysis of 146 unregistered prostitutes revealed a rate of 9.6%. The HIV rates among 285 female and 105 male heterosexual partners of known HIV-positive persons were 50.2% and 40.0%, respectively. HIV prevalence increased from 0.8% during 1986-88 to 8.0% during 1989-90 among 1532 men and 1247 women who requested anonymous HIV testing. The prevalence among 542 male and 615 female medical personnel was 2.3%. Among 78,793 volunteer and 4733 paid blood donors, HIV prevalence was 0.2% (0.3% among paid donors). The period prevalence among 11,101 male military recruits and active duty members increased from 0.009% to 0.5%. Finally, only 0.3% of 21,595 applicants for immigration visas were HIV-positive, and there were no HIV cases among 1234 pregnant women attending antenatal clinics. Although the very low HIV prevalence among military personnel and pregnant women suggests that the virus is not yet widely disseminated within the general population, the finding that 28% of HIV-positive men were married and engaged in bisexual behavior suggests potential for heterosexual transmission in the years ahead.

Counseling and testing for HIV / AIDS prevention.

PIP: Researchers at the Kenya Association of Professional Counselors (KAPC) hope to discover whether HIV testing accompanied by personalized, one-on-one counseling can influence individuals to adopt preventive behaviors and lower their risk of HIV infection. Counseling and testing has long been an essential component of HIV/AIDS programs in developed countries. However, this is the first large-scale randomized research on its effectiveness as a tool for behavior change in developing countries. The AIDS Control and Prevention (AIDSCAP) Project is funding the study at centers in Kenya and Tanzania, which began recruiting volunteers in June 1995. Funding for the centers in Indonesia and Trinidad came from the World Health Organization and the joint UN Program on HIV/AIDS. The Center for AIDS Prevention Studies at the University of California at San Francisco is coordinating the four centers, each which will conduct the study for approximately 18 months.^ieng

HIV heterosexual transmission to stable sexual partners of HIV-infected Brazilian hemophiliacs.

Nineteen Brazilian HIV-infected hemophiliacs and their stable heterosexual sexual partners were studied with the aim of assessing the rate of HIV transmission in this at risk group. The mean length of relationship between couples was 7.4 years. The hemophiliac men were Class II (n = 6), III (n = 11) and IVa (n = 2) of the CDC classification. They had decreased CD4+ and elevated CD8+ cell numbers; five had p24 antigenemia. We found 3 HIV-infected women (15.8 percent) by routine and confirmatory tests, a prevalence similar to that seen in other countries. They were asymptomatic and had no detectable p24 antigenemia. The 3 seropositive women's partners were Class II and III-CDC, and had normal CD4+ and CD8+ values and no p24 antigenemia. All seronegative women also had normal CD4+ and CD8+ numbers, except for elevated CD8+ cells in three of them, but immune abnormalities had already been seen in some seronegative partners at high risk for HIV infection. Our results reinforce previous suggestions that heterosexual transmission to stable female partners occurs preferentially early after initiation of sexual exposure, and possibly when the transmitter had high levels of viremia and regular sexual activity.

PIP: In Brazil, hemophiliacs who received coagulation factor concentrates during 1980-85 have rates of HIV exceeding 50% and rates of heterosexual transmission to their partners in the range of 10-20%. This study investigated the clinical course of HIV infection in 19 male patients from a hematology center in Sao Paulo, Brazil, with hemophilia A or B and their stable, asymptomatic female sexual partners. The mean duration of the relationship was 7.4 years. Compared with 15 normal adult subjects used as controls, CD8+ cell counts of hemophiliacs were significantly higher while CD4+ cell values were significantly reduced. Three sexual partners (15.8%) were HIV-positive, implying a transmission rate of 2.1 per 100 person-years. All female partners were in Centers for Disease Control Class II. Their male partners were in Classes II and III and had normal CD4+ and CD8+ levels. Neither males nor females had p24 antigenemia. Fragments of HIV particles were present in several HIV-negative female partners. These findings suggests early HIV transmission, when the transmitter has high levels of viremia, to stable female partners of hemophiliacs.

Effects of HIV testing and counseling on reducing HIV risk behavior among two ethnic groups.

PIP: The impact of an HIV testing and counseling program on the risk behaviors of drug users was assessed in 981 African American heroin and crack cocaine users living in the US and 144 Puerto Ricans living both in Puerto Rico and the US. Respondents were part of the US National Institute on Drug Abuse's multi-site Cooperative Agreement for Acquired Immunodeficiency Syndrome Community-Based Outreach/Intervention Research. At each site, active drug injectors and crack cocaine users were selected by targeted sampling methods. The intervention included pre-HIV test counseling, voluntary HIV testing, a post-testing counseling session focused on risk-reduction strategies, and an optional session for HIV-positive participants. The mean age of respondents was 38.5 years; 82.9% were unemployed. 62.5% had a history of sexually transmitted diseases and 12.5% (9.3% of African Americans and 31.9% of Puerto Ricans) were HIV-positive. At baseline, 63.5% of African Americans and 47.2% of Puerto Ricans were engaging in unprotected vaginal intercourse and 3.1% and 8.3%, respectively, were practicing unprotected anal intercourse. Injection risk factors after counseling were independent of HIV test result among African Americans; among Puerto Ricans, a positive HIV test increased the likelihood of shared use of cookers. In both ethnic groups, seropositives were significantly less likely to persist in practicing unprotected vaginal sex. Seropositive African Americans were also less likely to continue to practice unprotected oral sex. Since heterosexual relations with an HIV-positive drug user is a major risk factor for sex partners and children, this screening and counseling program can have a substantial impact on control of the AIDS epidemic in the US.^ieng

Screening for active tuberculosis in HIV testing centre.

In industrialised nations HIV-seropositive individuals can be offered skin testing for tuberculosis (TB) and isoniazid prophylaxis, but this approach is neither practicable nor affordable in most developing countries. In Santo Domingo, Dominican Republic, we offered skin testing and a brief clinical examination for active TB to people requesting HIV testing at one centre. 200 newly detected HIV-positive individuals and 200 age and sex-matched HIV-negative ones were compared. 39 (9.7%) of the 400 individuals seeking HIV testing had active TB; 29 were HIV positive and 10 were HIV negative (adjusted odds ratio 3.3, 95% CI 1.3-8.7; p = 0.01). In multivariate analysis, the strongest independent predictors of active TB were 10 mm or more of induration on skin testing, a history of chronic cough, lymphadenopathy, and HIV infection. Of the patients diagnosed with TB, 85% had one or more symptoms readily ascertainable in a brief screening questionnaire. Screening for TB at HIV-testing sites could be an effective approach to early detection of active TB among not just HIV-positive but also HIV-negative people. Integrating screening for TB into HIV testing schemes could help to reduce the spread of TB and allow patients with TB to be diagnosed and treated earlier.

PIP: A relation between tuberculosis (TB) and HIV infection is well established. 20-60% of AIDS patients in developing countries have been found to have or to develop TB. The combined effects of HIV and TB epidemics on the health systems of developing countries is frightening. To check the growing numbers of HIV-associated TB cases, the US Centers for Disease Control and Prevention and the World Health Organization recommended TB skin testing of HIV-positive people. Those found to be dually infected would be offered prophylactic isoniazid. Most developing countries, however, cannot afford such preventive therapy. The authors investigated whether screening for TB infection and disease at HIV-testing sites is an useful approach to TB control in developing countries. The authors offered skin testing and a brief clinical exam for active TB to people requesting HIV testing at one center in Santo Domingo, Dominican Republic. 200 newly detected HIV-positive individuals were subsequently compared against 200 age and sex-matched HIV-negative individuals. 9.7% of the people seeking HIV testing had active TB; 29 were HIV-positive and 10 HIV-negative. Multivariate analysis found the strongest independent predictors of active TB to be 10 mm or more of induration on skin testing, an history of chronic cough, lymphadenopathy, and HIV infection. Of the patients diagnosed with TB, 85% had one or more symptoms readily ascertainable in a brief screening questionnaire. These findings lead the authors to conclude that screening for TB at HIV-testing sites could be an effective approach to early detection of active TB among both HIV-seropositive and HIV-seronegative people. Integrating screening for TB into HIV testing schemes could help reduce the spread of TB and allow patients with TB to be diagnosed and treated earlier.

Serologic evaluation of human immunodeficiency virus type 1-infected individuals from Argentina and the United States indicates a similar distribution of subgroup B isolates.

Utilizing peptides based on the V3 region of gp120, we undertook a serologic examination of human immunodeficiency virus type 1 (HIV-1)-infected individuals from Argentina to determine if prevalent HIV-1 isolates could be identified in this population. Our findings suggest that a similar pool of HIV-1 subgroup B isolates exists in both Argentina and the United States.

PIP: This study examined serum specimens from HIV-1 infected individuals from Argentina (n = 50) and the United States (n = 38) for antibody reactivity to a panel of V3-based synthetic peptides. Serum specimens were further analyzed for the ability to neutralize laboratory and clinical isolates of HIV-1 in vitro. Patterns of antibody reactivity to these V3 peptides, together with neutralizing activity, indicated that infected individuals from both Argentina and the US have been exposed to HIV-1 isolates belonging to subgroup B. Serum specimens from the United States (37 males and 1 female) were obtained from military personnel and their dependents. Of these patients, 35 were asymptomatic and 3 were symptomatic. Specimens from Argentina were obtained from HIV-1-infected individuals examined in Buenos Aires, Argentina (37 males and 13 females). Half of the infected individuals from Argentina were symptomatic. Serum specimens were screened for antibody reactivity to HIV-1 gp160 synthetic peptides by an enzyme-linked immunosorbent assay. Examination of V3 peptide recognition indicated that a higher percentage of Argentinean serum specimens reacted with peptide RP189 than serum specimens from the United States (34% and 5%, respectively). A higher percentage of serum specimens from the United States reacted with peptide RP135 (LAI) than was observed with serum specimens from Argentina (47% vs. 16%, respectively). Neutralization assays again indicated a similar pattern of antibody reactivity with serum specimens from infected individuals from Argentina and the United States. Nucleotide sequence analysis of clinical isolates has demonstrated that the HIV-1 subgroup B is predominant in the United States. Serologic reactivity to V3-based peptides in this study suggests that isolates commonly found in the US (i.e., MN, SF2, and NY-5) are also frequently observed in Argentina. These results suggest that there is similar distribution of HIV-1 subgroup B isolates among infected individuals from Argentina and the United States.