జర్నల్ ఆఫ్ ఎయిడ్స్ & క్లినికల్ రీసెర్చ్

The use of tenofovir-emtricitabine as pre-exposure prophylaxis (PrEP) represents the latest strategy to prevent the acquisition of HIV by uninfected individuals. Despite clinical trials exhibiting significant risk reductions with PrEP, several limitations may hinder its real-world effectiveness. PrEP functions as one component of a comprehensive prevention program, which should also include intensive counseling on the importance of adherence, reduction of high-risk behaviors, and continued use of traditional preventative methods. Additionally, the greatest impact of PrEP, both clinically and financially, will likely arise from careful application in select high-risk populations. If properly implemented, PrEP has the potential to significantly reduce the incidence of new HIV infections.

Background: HIV-infected subjects present with decreased antioxidant defense and increased activation of inflammatory cells which may lead to overproduction of oxidants. This study determined whether HIV-infected patients without clinical signs and symptoms of opportunistic lung disease (OLD-negative) exhaled more H2O2 than healthy controls and whether there was association between the exhalation of H2O2 and whole blood chemiluminescence (CL) and clinical variables. Methods: A cross-sectional study was conducted. H2O2 in exhaled breath condensate and CL, resting and agonist-induced with N-formyl-methionyl-leucyl-phenylalanine (fMLP) were measured in 36 OLD-negative patients and 14 healthy controls. Univariate linear regression was used to summarize the average relationship and quantile regression analyzed the relationship at different points of the exhaled H2O2 distribution. Multivariate analyses were carried out using multiple linear regressions. Results: The fold increase of the geometric mean exhaled H2O2 against healthy controls was 3.76-times higher in OLD-negative patients than in controls (95% CI: 2.65-5.33, p<0.001), whereas that of either resting or fMLPinduced CL was 1.46 or 1.63, respectively (95%: 1.17-1.83 and 1.27-2.08, p<0.01). Exhaled H2O2 was not associated with CL, either resting or fMLP-induced. Linear regression detected positive relationship between the exhalation of H2O2 and viral load (R-squared 0.23, p<0.05). The effects of viral load were best revealed at a higher exhalation of H2O2 (quantiles 0.6 and 0.7; both Pseudo R-squared 0.21, p<0.05). In a multivariate model, the main independent contributors to the exhalation of H2O2 were viral load and highly active antiretroviral therapy (HAART), which together accounted for 35% of the variance in exhaled H2O2. If the analysis was limited exclusively to HAART-treated, a better model fit was obtained (R-squared 0.79), confirming that viral load is the main contributor to the exhaled H2O2. Conclusion: Inordinate increase in exhaled H2O2 may reflect airway oxidative stress in HIV-1 infection which may be related to viral load.

Background: HIV-associated lipodystrophy involves changes in complex metabolic networks that are associated with increased cardiovascular risk. It has been associated with the use of combined antiretroviral treatment (cART), particularly Protease Inhibitors (PI) and thymidine analogs. This study aims to evaluate characteristics and use of ART associated with lipodystrophy, lipohypertrophy, and lipoatrophy among HIV-infected patients. Methods: A cross-sectional study was conducted in HIV-infected patients of both genders, aged 18 years or older, who sought care at an HIV/AIDS referral service for diagnostic confirmation or treatment between June 2006 and December 2008. Results: 1240 out of 1295 patients with HIV infection were included. Among patients on cART, women had a higher risk of lipohypertrophy than men, as well as a time since diagnosis of HIV greater than 6 years (versus <3 years). For lipoatrophy, age, education, lifestyle, and body mass index were associated with increased risk. Metabolic parameters were higher among patients on ART; and cART and PI use were independently associated with lipohypertrophy, lipoatrophy and lipodystrophy. The use of IPs can be regarded as responsible for 13% of the association of ART and lipodystrophy, and of 11.5% for the thymidine analogs use, independent of gender, skin color, smoking, CD4, and BMI. Conclusions: Risk factors fo

In French Guiana, the prevalence of HIV among pregnant women along the Maroni river, has risen from 0 to over 1% in the 1990’s. Despite this sharp increase, no behavioural surveillance study has ever taken place in this border region. The present study showed that an important proportion of boatmen have risky sexual behaviour. These results underline the importance of targeting prevention interventions on this population that is not currently receiving specific HIV prevention messages.

Interviews were conducted with 24 doctors and nurses in United Arab Emirates and New Zealand to better understand factors that might influence behaviour after occupational exposure to HIV (e.g. following needlestick injury). While participants in both countries held similar beliefs regarding their primary health concerns, open reporting of HIV exposure in United Arab Emirates hospitals appeared threatened by sociocultural and political factors (particularly stigma and risk of deportation) compared to in New Zealand hospitals.