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Associations of Anogenital Low-Risk Human Papillomavirus Infection With Cancer and Acquisition of HIV

ABSTRACT: α-Mucosal human papillomavirus (HPV) types are implicated in a range of clinical conditions and categorized as “low-risk” (LR) and “high-risk” (HR) types according to their degree of association with cervical cancers. The causative role of LR HPV infection in the development of anogenital warts and in low-grade squamous intraepithelial lesions is well established. In addition, there is a growing body of evidence that infection with LR HPV types may be associated with an elevated risk of cancers and potentiation of coinfections. Prospective and case-control studies consistently report a higher risk of anogenital cancers in men and women with a history of anogenital warts. Based on currently available evidence, this higher risk may be due to shared exposure to HR HPV types or an underlying immune impairment, rather than a direct role of LR HPV types in subsequent cancer risk. Data also suggest that infection with LR HPV, HR HPV, or both may increase the risk of HIV acquisition, although the relative contribution of different HPV types is not yet known. There is also evidence implicating HPV clearance, rather than HPV infection, in increased risk of HIV acquisition. 10/01/2015 01:00 AM

Morbidity and Mortality Associated With Anogenital Human Papillomavirus “Low Risk” Genotypes

No abstract available 10/01/2015 01:00 AM

Rapidly Invasive Buschke-Löwenstein Tumor Associated With Human Papillomavirus Types 6 and 52

imageAbstract: Buschke-Löwenstein tumor, or giant condyloma acuminatum, represents a rare, sexually transmitted disorder, with a slow evolution and the tendency to infiltrate in the adjacent tissues associated with human papillomavirus (HPV). This article reports the first case of male Buschke-Löwenstein tumor associated with HPV6 and HPV52. 10/01/2015 01:00 AM

Sex Partner Meeting Places Over Time Among Newly HIV-Diagnosed Men Who Have Sex With Men in Baltimore, Maryland

imageBackground: Sex partner meeting places may be important locales to access men who have sex with men (MSM) and implement targeted HIV control strategies. These locales may change over time, but temporal evaluations have not been performed. Methods: The objectives of this study were to describe the frequency of report of MSM sex partner meeting places over time and to compare frequently reported meeting places in the past 5 years and past year among newly HIV-diagnosed MSM in Baltimore City, Maryland. Public health HIV surveillance data including partner services information were obtained for this study from the Baltimore City Health Department from May 2009 to June 2014. Results: A total of 869 sex partner meeting places were reported, including 306 unique places. Bars/clubs (31%) and Internet-based sites (38%) were the most frequently reported meeting place types. Over the 5-year period, the percentage of bars/clubs decreased over time and the percentage of Internet-based sites increased over time. Among bars/clubs, 4 of 5 of those most frequently reported in the past 5 years were also most frequently reported in the most recent year. Among Internet-based sites, 3 of 5 of those most frequently reported in the past 5 years were also in the top 5 most frequently reported in the past year. Conclusion: This study provides a richer understanding of sex partner meeting places reported by MSM over time and information to health departments on types of places to access a population at high risk for HIV transmission. 10/01/2015 01:00 AM

Chlamydia and Gonorrhea in HIV-Infected Pregnant Women and Infant HIV Transmission

imageBackground: Sexually transmitted infections (STIs) such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) can lead to adverse pregnancy and neonatal outcomes. The prevalence of STIs and its association with HIV mother-to-child transmission (MTCT) were evaluated in a substudy analysis from a randomized, multicenter clinical trial. Methodology: Urine samples from HIV-infected pregnant women collected at the time of labor and delivery were tested using polymerase chain reaction testing for the detection of CT and NG (Xpert CT/NG; Cepheid, Sunnyvale, CA). Infant HIV infection was determined by HIV DNA polymerase chain reaction at 3 months. Results: Of the 1373 urine specimens, 249 (18.1%) were positive for CT and 63 (4.6%) for NG; 35 (2.5%) had both CT and NG detected. Among 117 cases of HIV MTCT (8.5% transmission), the lowest transmission rate occurred among infants born to CT- and NG-uninfected mothers (8.1%) as compared with those infected with only CT (10.7%) and both CT and NG (14.3%; P = 0.04). Infants born to CT-infected mothers had almost a 1.5-fold increased risk for HIV acquisition (odds ratio, 1.47; 95% confidence interval, 0.9–2.3; P = 0.09). Conclusions: This cohort of HIV-infected pregnant women is at high risk for infection with CT and NG. Analysis suggests that STIs may predispose to an increased HIV MTCT risk in this high-risk cohort of HIV-infected women. 10/01/2015 01:00 AM

Screening for Sexually Transmitted Infections in Antenatal Care Is Especially Important Among HIV-Infected Women

No abstract available 10/01/2015 01:00 AM

Impact of a Brief Intervention for Substance Use on Acquisition of Sexually Transmitted Diseases Including HIV: Findings From an Urban Sexually Transmitted Disease Clinic Population

imageBackground: Unhealthy substance use is associated with increased rates of sexually transmitted diseases (STDs), including HIV. The screening, brief intervention, and referral to treatment strategy is effective at reducing substance use over time. We investigated whether STD clinic patients who received a brief intervention (BI) had lower rates of STD/HIV acquisition over time than those who did not. Methods: A retrospective sample of 7665 patients who screened positive for substance abuse or dependence between May 1, 2008, and December 31, 2010, was matched with STD and HIV surveillance registries for a 1-year follow-up period to determine incidence of STD and HIV infection. Results: Overall, 44.6% (n = 3420) received BI; 7.0% of this population acquired a bacterial STD compared with 8.8% of persons who did not receive BI (P < 0.005). In multivariate analysis, BI had a protective effect against STD infection for men (odds ratio, 0.774; 95% confidence interval [CI], 0.63–0.96), after controlling for age, race/ethnicity, and sex of partner. There were 61 new HIV infections over the follow-up period; however, we found no significant association between BI and subsequent HIV diagnosis. Conclusions: Brief intervention is associated with a reduction in STD incidence among men who screen positive for substance abuse and should be considered as an STD prevention strategy. Further study is needed to identify mechanisms through which BI may impact STD outcomes. 10/01/2015 01:00 AM

The Significant Impact of Different Insurance Enrollment Criteria on the HEDIS Chlamydia Screening Measure for Young Women Enrolled in Medicaid and Commercial Insurance Plans

imageObjective: The impact of length of enrollment in a health plan on eligibility of women under the Healthcare Effectiveness Data and Information Set (HEDIS) chlamydia screening measure is not fully understood. We assessed the representativeness of the measure among the proportion of women aged 15 to 24 years with a gap in coverage for Medicaid and commercial health insurance. Methods: Truven Health Marketscan Medicaid and commercial health insurance data from 2006 to 2012 were used to make comparisons between proportions of women with a gap in coverage to those enrolled in insurance plans for different numbers of months. Results: Approximately 48% of Medicaid-insured women and 31% of commercially insured women had an at least 2-month gap that disqualified them from eligibility for inclusion in the HEDIS chlamydia screening measure. Extending eligibility to women with at least 6 months of coverage, regardless of gap, would increase the proportion of insured women included in the HEDIS measure to 76% (from 52%) for Medicaid and 83% (from 69%) for commercial insurance, without much effect on chlamydia testing rate. This would make the measure more representative of all insured women. Conclusions: The large proportion of young women who had a 2-month or greater gap in coverage in Medicaid had a significant impact on the overall representativeness of the current HEDIS chlamydia screening measure. 10/01/2015 01:00 AM