Indian Journal of Sexually Transmitted Diseases and AIDS
: 2012  |  Volume : 33  |  Issue : 2  |  Page : 135--137

Abstracts from the currecnt global literature Part I

Anubhav Garg1, Asit Mittal2, Lalit K Gupta2, AK Khare2,  
1 Department of Dermatology, Venereology and Leprosy, G. R. Medical College, Gwalior, M.P., India
2 Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India

Correspondence Address:
Anubhav Garg
Department of Dermatology, Venereology and Leprosy, G. R. Medical College, Gwalior, Madhya Pradesh

How to cite this article:
Garg A, Mittal A, Gupta LK, Khare A K. Abstracts from the currecnt global literature Part I.Indian J Sex Transm Dis 2012;33:135-137

How to cite this URL:
Garg A, Mittal A, Gupta LK, Khare A K. Abstracts from the currecnt global literature Part I. Indian J Sex Transm Dis [serial online] 2012 [cited 2022 Jul 6 ];33:135-137
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Sexually transmitted infections and risk behaviors among transgender persons (Hijras) of Pune, India

Sahastrabuddhe S, Gupta A, Stuart E, Godbole S, Ghate M, Sahay S, et al. J Acquir Immune Defic Syndr 2012:59;72-8.

Background : The objectives of this cross-sectional study were to determine the prevalence of HIV and sexually transmitted infections (STI) among Hijras (self-identified transgenders of South Asia), study-associated risk factors, and compare the prevalence with that in heterosexual men and men having sex with men (MSM) in Pune, India, between 1993 and 2002. Materials and Methods: After informed consent, individuals attending 3 STI clinics were administered a questionnaire regarding their demographic, socioeconomic, and sexual behaviors. Blood samples were collected for STI and HIV diagnosis. Bivariate and multivariate analyses were performed to determine the correlates of HIV infection. Results: The prevalence of HIV (45.2% in Hijras vs. 20% in heterosexual men vs. 18.9% in MSM, P < 0.0001) and warts (10.3% vs. 4.6% vs. 7.0%; P = 0.004) was higher in Hijras as compared with heterosexual men and MSM; whereas that of genital ulcer disease (15.3% vs. 32.6% vs. 21.5%; P < 0.0001) and discharge (5.4% vs. 13.6% vs. 9.0%; P < 0.0001) was lower. Hijras were more likely to have received money for sex and have an earlier sexual debut than the comparison groups. In multivariate analysis, receiving money for sex (adjusted odds ratio: 4.49; P < 0.04) and having genital ulcer disease (odds ratio: 3.87; P < 0.08) were independently associated with high HIV prevalence in Hijras. Conclusions: Considering the high HIV and STI burden, it is important to review current prevention strategies and stress the need to engage Hijra community members through appropriate targeted intervention programs.

Effects of vitamin D deficiency and combination antiretroviral on bone in HIV-positive patients

Childs K, Welz T, Ssamarawickrama A, Post FA. AIDS 2012;26:253-62.

Objectives: In the era of combination antiretroviral therapy (cART), vitamin D deficiency, low bone mineral density (BMD) and fractures have emerged as subjects of concern in HIV-positive patients. Testing for vitamin D deficiency has been widely adopted in clinical practice even though the benefits of vitamin D supplementation in this population remain uncertain. The objective of this review was to evaluate the evidence for such a strategy. Design: Systematic review of the literature on vitamin D deficiency in HIV infection, the effects of cART on vitamin D status, and the effects of vitamin D deficiency and cART on parathyroid hormone (PTH), bone turnover, BMD and the incidence of fractures in HIV-positive patients. Materials and Methods: PubMed was used to identify relevant articles up to September 2011. Results: Vitamin D deficiency, secondary hyperparathyroidism and low BMD are common in HIV-positive patients. Efavirenz is associated with a reduction in 25-hydroxyl vitamin D levels, tenofovir with secondary hyperparathyroidism, and cART with increased bone turnover and low BMD. The clinical significance of low BMD, however, remains unclear, especially in younger patients. Although the incidence of fractures may be increased in HIV-positive patients, the contribution of low BMD and vitamin D deficiency to these fractures is uncertain. Limited data on vitamin D supplementation in HIV-positive patients have shown transient, beneficial effects on PTH, but no effects on BMD. Conclusion: The benefits of vitamin D supplementation in this population need to be demonstrated before widespread "test and treat" policies can be recommended as part of routine clinical practice.

The effects of injectable hormonal contraceptives on HIV seroconversion and on sexually transmitted infections

Wand H, Ramjee G. AIDS 2012;26:375-80.

Objectives: To investigate the association between hormonal contraceptives and risk of HIV-1 seroconversion and prevalence of other sexually transmitted infections. Design: Prospective cohort. Materials and Methods: The study population was 2236 HIV-negative women who were screened in a biomedical intervention trial in Durban, South Africa. The association between the use of hormonal contraceptives and risk of HIV-1 seroconversion was modeled using Cox proportional hazards regression analysis. Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections were assessed using logistic regression models. Results: Hormonal injectables were the most common method of contraceptives (46.47%) followed by condom use (28.04%). Overall, compared with women who reported using condoms or other methods as their preferred form of contraceptive, those who reported using hormonal contraceptives (injectables and oral pills) were less likely to use condoms in their last sexual act. Using hormonal injectables during the study was significantly associated with increased risk for HIV-1 infection [adjusted hazard ratio 1.72, 95% confidence interval (CI) 1.19-2.49, P = 0.005]; hormonal injectables were also significantly associated with higher prevalent of C. trachomatis infections (adjusted odds ratio 2.46, 95% CI 1.52-3.97, P < 0.001). Conclusion: Hormonal injectables are highly effective and well-tolerated family planning methods and have played an important role in reducing unplanned pregnancies and maternal and infant mortality. However, they do not protect against HIV-1 and other sexually transmitted infections. This study reinforces the importance of comprehensive contraceptive counseling to women about the importance of dual protection, such as male condoms and hormonal contraceptives use.

Unresolved antiretroviral treatment management issues in HIV-infected children

Heidari S, Mofenson LM, Hobbs CV, Cotton MF, Marlink R, Katabira E. J Acquir Immune Defic Syndr 2012;59:161-9.

Antiretroviral therapy in children has expanded dramatically in low- and middle-income countries. The World Health Organization revised its pediatric HIV guidelines to recommend initiation of antiretroviral therapy in all HIV-infected children younger than two years, regardless of CD4 count or clinical stage. The number of children starting life-long antiretroviral therapy should therefore expand dramatically over time. The early initiation of antiretroviral therapy has indisputable benefits for children, but there is a paucity of definitive information on the potential adverse effects. In this review, a comprehensive literature search was conducted to provide an overview of our knowledge about the complications of treating pediatric HIV. Antiretroviral therapy in children, as in adults, is associated with enhanced survival, reduction in opportunistic infections, improved growth and neuro-cognitive function, and better quality of life. Despite antiretroviral therapy, HIV-infected children may continue to lag behind their uninfected peers in growth and development. In addition, epidemic concurrent conditions, such as tuberculosis, malaria and malnutrition, can combine with HIV to yield more rapid disease progression and poor treatment outcomes. Additional studies are required to evaluate the long-term effects of antiretroviral therapy in HIV-infected infants, children and adolescents, particularly in resource-limited countries where concomitant infections and conditions may enhance the risk of adverse effects. There is an urgent need to evaluate drug-drug interactions in children to determine optimal treatment regimens for both HIV and co-infections.

Premastication as route of pediatric HIV transmission: Case-control and cross-sectional investigations

Ivy W 3 rd , Dominguez KL, Rakhmanina NY, Iuliano AD, Danner SP, Borkowf CB et al. J Acquir Immune Defic Syndr 2012;59:207-12.

Background: Three cases of pediatric HIV transmission attributed to the feeding practice of premasticating food for children have been reported. The degree of risk that premastication poses for pediatric HIV transmission and the prevalence of this behavior among HIV-infected caregivers is unknown. Materials and Methods: During December 2009 to February 2010, we conducted a case-control investigation of late-diagnosed HIV infection in children at 6 HIV clinics using in-person and telephone interviews. A cross-sectional investigation of premastication was conducted in concert with this case-control investigation. Results: We compared 11 case patients to 35 HIV-exposed controls of similar age. Sixteen (35%) of 46 children were fed premasticated food, 10 (22%) by an HIV-infected caregiver. Twenty-seven percent of case patients received premasticated food from an HIV-infected caregiver compared with 20% of controls (odds ratio = 1.5; 95% confidence interval = 0.3 to 7.1). In the cross-sectional investigation, 48 (31%) of 154 primary caregivers of children aged ≥ 6 months reported the children received premasticated food from themselves or someone else. The prevalence of premastication decreased with increasing caregiver age and had been used to feed children aged 1-36 months. Conclusions: Premastication, a potential route of HIV transmission to children, was a common practice of caregivers. Public health officials and health care providers should educate the public about the potential risk of disease transmission via premastication.

Treatment outcomes of adult patients with recurrent tuberculosis in relation to HIV status in Zimbabwe: A retrospective record review

Takarinda KC, Harries AD, Srinath S, Mutasa-Apollo T, Sandy C, Mugurungi O. BMC Public Health 2012;12:124.

Background: Zimbabwe is a Southern African country with a high HIV-TB burden and is ranked 19th among the 22 tuberculosis high burden countries worldwide. Recurrent TB is an important problem for TB control, yet there is limited information about treatment outcomes in relation to HIV status. This study was therefore conducted in Chitungwiza, a high density dormitory town outside the capital city, to determine in adults registered with recurrent TB how treatment outcomes were affected by type of recurrence and HIV status. Materials and Methods: Data were abstracted from the Chitungwiza district TB register for all 225 adult TB patients who had previously been on anti-TB treatment and who were registered as recurrent TB from January to December 2009. The Chi-square and Fischer's exact tests were used to establish associations between categorical variables. Multivariate relative risks for associations between the various TB treatment outcomes and HIV status, type of recurrent TB, sex and age were calculated using Poisson regression with robust error variance. Results: Of the 225 registered TB patients with recurrent TB, 159 (71%) were HIV tested, 135 (85%) were HIV-positive and 20 (15%) were known to be on antiretroviral treatment (ART). More females were HIV-tested (75/90, 83%) compared with males (84/135, 62%). There were 103 (46%) with relapse TB, 32 (14%) with treatment after default, and 90 (40%) with "retreatment other" TB. There was one failure patient. HIV testing and HIV positivity were similar between patients with different types of TB. Overall, treatment success was 73% with transfer-outs at 14% being the most common adverse outcome. TB treatment outcomes did not differ by HIV status. However, those with relapse TB had better treatment success compared to "retreatment other" TB patients (adjusted RR 0.81; 95% CI 0.68-0.97, P = 0.02). Conclusions: No differences in treatment outcomes by HIV status were established in patients with recurrent TB. Important lessons from this study include increasing HIV testing uptake, a better understanding of what constitutes "retreatment other" TB, improved follow-up of true outcomes in patients who transfer-out and better recording practices related to HIV care and treatment especially for ART.

UK national guideline for the management of gonorrhea in adults, 2011

Bignell C, FitzGerald M, Guideline Development Group. Int J STD AIDS 2011;22:541-7.

The British Association for Sexual Health and HIV (BASHH) UK gonorrhea guideline has been updated in 2011. It offers advice on diagnosis, treatment and health promotion for anogenital and pharyngeal gonorrhea. Nucleic acid amplification tests (NAATs) are now being used more for diagnosis and are increasing detection rates in the pharynx and rectum. First-line treatment using ceftriaxone with azithromycin is now advised, along with routine test of cure (TOC). The aim is to slow the spread of resistant gonorrhea now that fewer antibiotics remain effective. A patient information leaflet has been developed.