Acute Alcohol Consumption Directly Increases HIV Transmission Risk: A Randomized Controlled Experiment.

Mon, 18 Sep 2017 00:00:00 GMT-05:00 - Shuper, Paul A.; Joharchi, Narges; Monti, Peter M.; Loutfy, Mona; Rehm, JΓΌrgen
Εισαγωγή: Alcohol consumption has frequently been purported as a driver of condomless sex and HIV transmission, but to date, experimental evidence for the causal risk-taking impact of alcohol among HIV-positive populations is lacking. The present experiment sought to determine whether acute alcohol consumption has a direct causal impact on condomless sex intentions among HIV-positive men-who-have-sex-with-men (MSM), and to assess whether alcohol's impact differs between MSM who are HIV-positive versus HIV-negative.
Μέθοδοι: In a randomized controlled alcohol administration experiment, HIV-positive and HIV-negative MSM were brought into a specialized barroom laboratory and randomly assigned to beverage consumption condition: alcohol (target BAC=.080%), placebo alcohol (target BAC=.000%), or water (control). Participants then underwent a video-based sexual arousal manipulation (sexually aroused/non-aroused) and indicated their intentions to engage in condom-protected and condomless sexual acts in a standardized paradigm. The primary outcome entailed intentions to engage in condomless receptive and condomless insertive anal sex.
Αποτελέσματα: A total of 282 MSM (141 HIV-positive; 141 HIV-negative) completed experimental procedures. MSM who received alcohol reported significantly stronger intentions to engage in condomless sex than those who received placebo alcohol or water (F(1,274)=9.43, p=0.002). The impact of alcohol did not differ between HIV-positive and HIV-negative MSM (F(1,274)=1.86, p=0.174).
Συμπεράσματα: The present investigation entailed the first risk-focused alcohol administration experiment to involve an HIV-positive sample, and results demonstrated that consuming alcohol had an independent, causal impact on intentions to engage in sexual behaviors that can result in HIV transmission. Findings strongly suggest that alcohol-focused initiatives should be incorporated into HIV prevention efforts. - (C) 2017

Infection Staging and Incidence Surveillance Applications of High Dynamic Range Diagnostic Immuno-Assay Platforms.

Mon, 18 Sep 2017 00:00:00 GMT-05:00 - Grebe, Eduard; Welte, Alex; Hall, Jake; Keating, Sheila M.; Facente, Shelley N.; Marson, Kara; Martin, Jeffrey N.; Little, Susan J.; Price, Matthew A.; Kallas, Esper G.; Busch, Michael P.; Pilcher, Christopher D.; Murphy, Gary; on behalf of the Consortium for the Evaluation and Performance of HIV Incidence Assays (CEPHIA)
Εισαγωγή: Custom HIV staging assays, including the Sedia(TM) HIV Limiting Antigen Avidity EIA (LAg) and avidity modifications of the Ortho VITROS(R) anti-HIV+2 and Abbott ARCHITECT HIV Ag/Ab Combo assays, are used to identify 'recent' infections in clinical settings and for cross-sectional HIV incidence estimation. However, the high dynamic range of chemiluminescent platforms allows differentiating recent and longstanding infection on signal intensity, and this raises the prospect of using unmodified diagnostic assays for infection timing and surveillance applications.
Μέθοδοι: We tested a panel of 2,500 well-characterised specimens with estimable duration of HIV infection with the three assays and the unmodified ARCHITECT. Regression models were used to estimate mean durations of recent infection (MDRI), context-specific false-recent rates (FRR) and correlation between diagnostic signal intensity and LAg measurements. Hypothetical epidemiological scenarios were constructed to evaluate utility in surveillance applications.
Αποτελέσματα: Over a range of MDRIs (reflecting recency discrimination thresholds), a diluted ARCHITECT-based RITA produced lower FRRs than the VITROS platform (FRR [almost equal to] 0.5% and 1.5% respectively at MDRI [almost equal to] 200 days) and the unmodified diagnostic ARCHITECT produces incidence estimates with comparable precision to LAg (RSE [almost equal to] 17.5% and 15% respectively at MDRI [almost equal to] 200 days). ARCHITECT S/CO measurements were highly correlated with LAg ODn measurements (r = 0.80) and values below 200 are strongly predictive of LAg recency and duration of infection less than one year.
Συμπεράσματα: Low quantitative measurements from the unmodified ARCHITECT obviate the need for additional recency testing and its use is feasible in clinical staging and incidence surveillance applications. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. - (C) 2017