[Evaluation of the efficacy of the Toxoplasma gondii screening program among pregnant women in Nunavik, 1994-2003]. / Evaluation du Programme de dépistage de la toxoplasmose chez les femmes enceintes du Nunavik, 1994-2003.

OBJECTIVES: (1) To evaluate the efficacy of the Toxoplasma gondii screening program among Nunavik pregnant women in identifying seroconversions during pregnancy and performing an appropriate follow-up of the seroconverted women and their child; and (2) to evaluate the consequences of congenital Toxoplasma gondii infection. PARTICIPANTS: Women of child-bearing age and their children born between January 1994 and September 2003. SETTING: Nunavik. INTERVENTION: Potential cases of infection during pregnancy and of congenital toxoplasmosis were identified on the basis of serologic and hospitalization data. A medical chart revision was then performed. Descriptive statistics regarding the medical follow-up and treatment of suspected cases were compiled. OUTCOMES: 31 women who gave birth to 32 children were identified as potential cases. According to the medical charts, 19 women had a potential infection during pregnancy, the others were deemed to have been infected before conception. One woman had a definite infection. This woman and most of the 18 other potentially infected women and their children were treated appropriately. Because of missing data, it was impossible to determine with certainty the final status of two children. A diagnosis of congenital infection was rejected among the other children. CONCLUSION: Women with suspected infection and their children were generally well managed by the health care system. No clinical effect of congenital toxoplasmosis was noted during the studied period.

Determinants of HIV seroconversion among men who have sex with men living in a low HIV incidence population in the era of highly active antiretroviral therapies.

OBJECTIVE: To estimate human immunodeficiency virus (HIV) incidence and associated risk factors among men who have sex with men (MSM) participating in the Omega Cohort Study in Montreal, 1996-2003. METHODS: Longitudinal study of 1587 MSM seronegative at baseline with > or =1 six-month follow-up visit. Multivariate Cox regression with time-dependent variables was used for data analysis. RESULTS: HIV incidence was 0.62 per 100 person-years (95% confidence interval: 0.41-0.84). In multivariate analyses compared with subjects not reporting any anal sex with serodiscordant or casual partners, those reporting anal sex with such partners (all P values <0.05), whether consistently protected [hazard ratio (HR) = 3.4], or unprotected exclusively receptive (HR = 12.0), exclusively insertive (HR = 4.7), or both receptive and insertive (HR = 8.3), were at increased risk of seroconversion. Sexual behaviors with seroconcordant regular partners were not associated with seroconversion. CONCLUSION: These results observed in a cohort of MSM with low HIV incidence provide new insights regarding the debate about harm-reduction strategies to prevent sexual HIV transmission.