bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1-S3.04 Death in the era of HAART: not all about AIDS
Authors: Smith R , Kall M , Delpech V 
Published: July 2011

BackgroundMortality from AIDS has dramatically reduced since the introduction of effective antiretroviral therapy, Nevertheless, HIV infected individuals remain at higher risk of early death. We investigate all causes of deaths among HIV diagnosed adults reported nationally in the HAART era.MethodsAnalyses of data from national HIV surveillance linked to the Office National Statistics. Deaths among all adults (≥15) diagnosed between 1997 and 2008 in England and Wales (E&W) were reviewed and grouped by cause of death (COD) and risk information. Death rates were calculated using a census of all persons accessing HIV care in 2008 (SOPHID).ResultsThe crude mortality rate among HIV-infected individuals (15−59 yrs) fell from 21.8 to 8.2 per 1000 persons living with diagnosed HIV in 2008. A total of 3640 (5.6%) persons diagnosed over the 12-year period were reported to have died [3544 had a cause of death]. The overall median age at death was 41 yearss [IQR: 35−50 years]. AIDS related mortality accounted for 56% of all deaths: 51% among MSM, 61% among heterosexuals and 34% among IDUs. AIDS-related respiratory infection (including PCP) was the most common COD in MSM and heterosexuals whereas external causes were the most common COD among IDUs. Non AIDS mortality increased sixfold since 1997 (36−226), with particular increases in cardio/cerebrovascular disease, non-AIDS defining malignancies and external causes. Infectious diseases (mostly respiratory) was the most common underlying cause of non AIDS deaths for MSM and heterosexuals aged 15−59: (38% and 36% respectively) and also high among IDUs (35%). External causes (mostly due to overdose and suicide) was the most common COD among IDUs (36%) and high among MSM (19%). Cardio/cerebrovascular disease and non AIDS malignancies accounted for 16% and 11% of non-AIDS deaths (15−59 years) respectively. Three quarters (76%) of all AIDS deaths and 47% of non AIDS deaths occurred within a year of diagnosis.ConclusionOverall mortality rates in HIV positive persons have substantially declined in the HAART era but remain high compared to the general population. Clinical AIDS associated with late presentation continues to account for the majority of deaths. Our analyses also reveal that a disproportionate number of deaths are due to infectious diseases, overdose and suicide occur in this population, many of which may be preventable. Surveillance of non-AIDS causes of death is critical in the HAART era.
P1-S1.14 Is HIV prevalence declining in Southern India? Evidence from two rounds of general population surveys in Bagalkot District, Karnataka
Authors: Rajaram S P , Bradley J E , Ramesh B M , Isac S , Washington R G , Moses S , Blanchard J F , Becker M , Alary M 
Published: July 2011

BackgroundAs a part of the evaluation of Avahan, the India AIDS initiative of the Bill & Melinda Gates Foundation, a cross-sectional survey was undertaken in the general population of Bagalkot district, Karnataka state, South India, in 2009. This replicated an earlier survey in 2003 that had examined HIV prevalence and risk behaviours.MethodsThe repeat survey in 2009 was conducted in the same rural and urban areas as the 2003 study. The study covered 10 rural villages and 20 urban blocks of three of the six talukas (sub-district units) in the district. In both surveys, a target sample of 6600 adult males and females was selected. Urine and blood samples were collected from all consenting participants for HIV and STI testing. An individual was deemed HIV positive, if positive on two different tests. We compared HIV and STI prevalence in 2003 and 2009. We also examined the age-specific distribution of HIV prevalence among rural and urban males and females at both time points. These analyses used logistic regression that considers survey design to adjust for characteristics of the population that may have changed between the two rounds.ResultsOverall, HIV prevalence in the district declined from 3.16% in 2003 to 2.58% in 2009, although this decline was not statistically significant (OR=0.82, p=0.278). The prevalence of active syphilis was <1% and was similar in both periods. A slight decline in the prevalence of HSV-2 was observed over the period, but the difference was not statistically significant. There was a significant decline observed in HIV prevalence among persons aged 15–24, among persons below 30 years in urban areas, and among all women younger than 20 years of age (Abstract P1-S1.14 table 1). Among rural males aged 40 and above, we observed a significant increase in HIV prevalence from 0.71 to 5.33 (Abstract P1-S1.14 table 1), a level similar to that found in the younger age group in 2003.Abstract P1-S1.14 Table 1HIV prevalence and adjusted OR among selected population groupsSub-groupRound 1, 2003 (%)Round 2, 2009 (%)Adjusted OR, 2009 vs 2003 (95% CI)p ValueOverall3.162.580.82 (0.57 to 1.18)0.278Age 15–242.41.260.54 (0.30 to 0.96)0.038Age 15–29, urban2.040.770.36 (0.20 to 0.63)0.001Age 15–19, female2.250.490.15 (0.04 to 0.61)0.009Age 40+, rural males0.715.3313.80 (2.59 to 73.45)0.006ConclusionWe observed a downward overall trend in HIV prevalence in Bagalkot district over the period examined, and a significant decline in HIV prevalence among younger age groups, where HIV prevalence more closely reflects incidence. The increase in HIV prevalence among older rural males may have been due to a cohort effect, as they aged over time. This may also have in part reflected increased survival in those age groups, as a result of the scaling-up of antiretroviral treatment programs throughout the state.
P1-S3.08 Pelvic inflammatory disease (PID) in adolescents after treatment for cervicitis
Authors: Risser W , Risser J 
Published: July 2011

BackgroundWe did a prospective study of incarcerated adolescents who had been treated for gonorrhoeal and/or chlamydial cervicitis to determine what proportion subsequently developed PID.MethodsWe performed the study at the Harris County Juvenile Detention Center, Texas, where PID is relatively common. At the time of their mandated medical assessment, all incarcerated women submitted first-catch urine samples for chlamydia and gonorrhoea testing. We used Gen-Probe NAAT assays. At the time of treatment among those infected, we performed bimanual pelvic examinations to determine if they had PID. We used the PID diagnostic criteria of the US Centers for Disease Control and Prevention: the presence of adnexal or cervical motion or uterine tenderness. The bimanual examinations were performed by one of three experienced practitioners. We treated infected patients with no evidence of PID for chlamydial and gonococcal cervicitis with 1 gm of azithromycin and 400 mg of cefixime, even if they were positive for only one of the two organisms. We treated for both organisms in case that one test was falsely negative. Treatment was observed by clinic staff; if the medicine was vomited, treatment was repeated following the administration of an anti-emetic. We followed all treated women for 30 days or until released, to determine if they developed PID after treatment for cervicitis. During incarceration, they had no opportunity for sexual intercourse.ResultsWe evaluated 61 adolescents with no evidence of PID, who were treated for chlamydia and gonorrhoea between 29 March 2010 and 27 December 2010. Their mean age was 15.6 (SD 1.2) years; 45% were black, 31% Hispanic, and 24% white. Duration of follow-up after treatment ranged from 6 to 30 days. During follow-up, 8 of 62 (13%) developed lower abdominal pain and had bimanual pelvic examination findings that supported the diagnosis of PID. All but one patient developed PID at least 10 days after cervicitis treatment (range 3−30 days).ConclusionIn incarcerated adolescents treated for gonorrhoeal and/or chlamydial cervicitis, 13% met the criteria for PID in the month subsequent to treatment, even though their therapy was directly observed, and they were not re-exposed to these organisms. Our data suggest that appropriate treatment for cervicitis does not rule out the possibility of subsequent PID even without exposure to gonorrhoea or chlamydia.
P1-S3.10 The role of Chlamydia trachomatis in the development of symptomatic pelvic inflammatory disease: a multi-parameter synthesis
Authors: Price M , Ades T , Welton N , Macleod J , Soldan K , De Angelis D , Simms I , Turner K , Horner P 
Published: July 2011

BackgroundChlamydia trachomatis(CT) is an important risk factor for the development of Pelvic Inflammatory Disease (PID), but despite much study the extent of its causal role remains unclear. Knowledge of the role of Chlamydia is critical for assessing the cost-effectiveness of screening programmes.MethodsWe perform a Bayesian multi-parameter synthesis of evidence from a range of prospective, retrospective, and routine data sources. These were; randomised trials following screened and unscreened women to PID; retrospective studies of Chlamydia in PID cases and controls, from which an etiologic fraction can be estimated; routine data on the number of PID cases diagnosed in England in 1 year; survey data on the probability of diagnosis of PID. We also used information on the incidence and prevalence of CT in England and the clearance rate of asymptomatic infection.ResultsWe found that the different data sources provided consistent estimates of the critical parameters. We estimate the probability an episode of Chlamydia causes an episode of PID to be 0.09 (0.04 to 0.16) and that the Excess fraction of PID cases due to Chlamydia to be 0.20 (0.09 to 0.35). We estimate that prior to the start of the current screening program in the UK the annual population incidence of PID in women in England was 0.022 (0.016 to 0.028) in women aged 16−24 and 0.013 (0.009 to 0.019) in women aged 25−44 and that 42% (31% to 54%) of these cases were diagnosed.ConclusionsIn the absence of direct data, it is possible to statistically combine evidence from different types of data, to check the consistency of the data sources, and to estimate the relation between CT and PID. In considering the effect on PID risk of treating women who screen positive for Chlamydia, it is important to note that this is a survivor population who acquired CT an unknown time previously and who have not developed PID.
P1-S4.01 HIV/STD Coinfection in Arizona, 2000−2008: identifying opportunities for integrated surveillance and partner services
Authors: Taylor M , Winscott M , Skinner J , Ereth R , Kenney K , Bailey R 
Published: July 2011

BackgroundPersons with HIV who acquire STDs such as chlamydia, gonorrhoea, and syphilis likely represent high-risk sources of HIV and STD transmission. Some state and local STD and HIV programs do not allow data sharing that would identify these individuals due to concerns with data security and confidentiality.ObjectiveTo identify the number of STD cases that were known to have HIV prior to the time of the STD diagnosis.MethodsA probabilistic matching method was used to merge the HIV and STD surveillance databases at the Arizona Department of Health Services (ADHS). Partial matches were reviewed by hand to avoid misclassification. The person and diagnosis events from the HIV-STD merge were limited to gonorrhoea (GC), chlamydia (CT), primary and secondary syphilis (PS) and early latent syphilis (EL) diagnosed during 2000−2008. Persons diagnosed with GC, CT, PS or EL diagnosis were considered to be co-infected with HIV if the HIV diagnosis date was more than 60 days before the STD diagnosis date.ResultsDuring 2000−2008, 1494 reported STD cases occurred among persons with previously diagnosed HIV. These cases included 14% (271/1960) of the PS, 9% (173/2043) of the EL, 2% (725/39 779) of the gonorrhoea, and 0.2% (325/171 010) of the CT cases reported to ADHS. HIV coinfection among syphilis cases was highest among males ages 35−39 (PS 25%, EL 19%), 40−44 (PS 27%, EL 24%) and 45−49 (PS 22%, EL 34%). Among male GC cases the age group with the greatest percentage of HIV coinfection was 40−44 at 9%. HIV coinfection among females reported with syphilis was highest in the age group 25−29 for PS (4%, 3 cases) and 40―44 for EL (2.4%, 2 cases). Among syphilis cases, white males had the greatest percentage of HIV co-infection (PS 31%, EL 32%). Similarly among GC and CT cases, white males had the highest percentages of HIV coinfection at 7% and 1% respectively. HIV coinfection was less than 1% among women in all age groups with CT and GC. A dramatic increase in the overall percent of HIV coinfection for syphilis was seen during the study period ranging from 0.5% in 2000 to 24% in 2008 for PS and 2% to 21% during the same time interval for EL. A similar but smaller increase in the overall percent of HIV co-infection for gonorrhoea was seen during the study period ranging from 0.7% in 2000 to 2.6% in 2008.ConclusionRetrospective data integration identified many coinfected HIV/STD cases. Timely integrated HIV and STD surveillance would allow rapid identification of these persons who could be reached for more intensive counselling and partner services. Public STD and HIV programs should address comorbidity using methods that facilitate public health intervention.
P1-S4.02 Ethnicity based on the country of birth is better to identify the young population at high risk for Chlamydia infection than self-defined ethnicity
Authors: Haasnoot A , Koedijk F D H , Op de Coul E L M , van der Sande M A B , Götz H M , Fennema J F A , van den Broek I V F ,   on behalf of the CSI group
Published: July 2011

BackgroundChlamydia infections are frequently found in young persons and ethnic minorities. Ethnicity can be defined in different ways. In this study, ethnic disparities inChlamydia trachomatispositivity in the Netherlands were assessed comparing two definitions of ethnicity. The study objective was to determine which definition is most useful to discriminate persons at risk for Chlamydia infection.MethodsChlamydia positivity rates in persons aged 16−29 years, were investigated using data from the first round of the Chlamydia Screening Implementation (CSI, 2008−2009) and surveillance data from specialised at STI centres in the Netherlands (2009), comparing self-defined ethnicity and ethnicity based on the country of birth of a person and his parents (first and second generation immigrants). The relation between ethnicity and Chlamydia positivity rates were evaluated using logistic regression, adjusting for age, sex and SES, in both data sets.ResultsOverall, the Chlamydia positivity rate was 13 % in the STI centres, and 5% in CSI. Being a young (first or second generation) immigrant was associated with Chlamydia positivity in both CSI (adjusted OR 2.3 [95% CI 2.0 to 2.6]) and the STI centres (adjusted OR 1.4 [95% CI 1.3 to 1.5]). Classifying the population by self-defined ethnicity resulted in a considerable group labelling themselves as Dutch (57% of the immigrants in CSI and 60% of those in the STI centres), especially second generation immigrants (72% in CSI and 80% in the STI centres). Self-defined non-Dutch ethnicity showed similar associations with testing positive in CSI (OR 2.4 [95% CI 2.1 to 2.7]) and the STI centres (OR 1.2 [95% CI 1.0 to 1.3]), but the model basing ethnicity on country of birth of a person and his parents had a better fit (higher likelihood). Self-defined ethnicity may allow for more personal input, this however also makes it a dynamic variable: in the second round of CSI, 15% of the immigrants identified themselves by a different ethnicity than in the first round see Abstract P1-S4.02 Figure 1.Abstract P1-S4.02 Figure 1Chlamydia positivity rate by region of origin, by self-defined ethnicity, in young persons in the Chlamydia Screening Implementation (CSI) and the Dutch STI centres.ConclusionsBoth self-defined ethnicity and ethnicity based on the country of birth of a person and his parents, can be used to detect young persons at a higher risk of Chlamydia infection. However the definition of ethnicity based on the country of birth explains variation in the Chlamydia data better and is objective and constant, whereas self-defined ethnicity would disregard a large part of the young population at higher risk for Chlamydia infection.
P1-S4.03 Using organism load ofChlamydia trachomatisandNeisseria gonorrhoeaein clinical specimens as an epidemiologic tool
Authors: Van Der Pol B , Pantone A , Williams J 
Published: July 2011

BackgroundThe Abbott Realtime m2000 system (m2000) is a qualitative real-time PCR assay for the detection of CT and NG that has the capability to provide a relative measure of target DNA. Results from the m2000 were used to determine CT and NG organism load by comparing the delta cycle (DC) value of each specimen to a set of lab developed standards containing known concentrations of each organism.MethodsVaginal swabs and male urine specimens were evaluated. Six standards of each organism were prepared by inoculating collection tubes with lab strains in concentrations ranging from 0 to 4×105 organisms. The log10 organism load for each positive specimen was determined by comparing the DC value to the calibration curve. Self-reported symptoms were available for each patient.ResultsA total of 99 vaginal and 284 urine specimens were available for analysis. There was no statistical difference in DC value of mean organism load by gender. Neither was there a difference based on the presence or absence of symptoms in people infected with CT. For NG, there was a significant difference in mean DC value and organism load by gender (p<0.001 for both DC and organism load) with men having higher loads. In NG positive men the mean DC was 15.2 [95% CI 14.7 to 15.8] and 11.4 [95% CI 9.0 to 13.7] for men with and without symptoms (p=0.003). This translated in mean log10 organism loads of 6.5 [95% CI 6.3 to 6.6] and 5.4 [95% CI 4.7 to 6.1] for men with and without symptoms (p=0.005). In NG positive women there was no difference in organism load based on presence or absence of symptoms (p=0.220).ConclusionsAdvantages to using this methodology include being able to quantify organism load from specimens obtained for routine diagnostic testing, using standardised test reagents that can be purchased commercially, and using an automated platform. Even in those settings that do not have the capacity for calibration, the DC values may provide useful relative loads. This exploratory study demonstrated the feasibility of using this method to obtain relative quantitation measures. Application of this tool to epidemiologic questions using larger data sets may prove useful.
P1-S1.15 The status of the HIV epidemic in Lebanon—systematic review and synthesis
Authors: Mumtaz G , Hilmi N , Abu-Raddad L 
Published: July 2011

BackgroundThe Middle East and North Africa (MENA) continues to be perceived as a region with limited HIV epidemiological data. The objective of this work was to review and synthesise for the first time all available data related to HIV in Lebanon, in order to assess the status of the epidemic in this country and provide the basis for future interventions, prevention, and research needs.MethodsA comprehensive systematic review of HIV and risk behaviour studies in Lebanon was undertaken. Sources of data included (1) PubMed using a strategy with both free text and MeSH headings, (2) country-level reports and databases including governmental and non-governmental organisations publications, and (3) international organisations reports and databases.ResultsAvailable data indicate that HIV prevalence among the high risk groups ranged between 0 and 3.6% among men who have sex with men (MSM), 0 and 3.9% among injecting drug users (IDUs), and 0%–0.3% among female sex workers (FSWs). HIV prevalence in the general population was very limited (∼0%). Analysis of HIV notified cases indicated a substantial recent increase in the contribution of male same-sex sex, whereby 52% of notified cases in 2008 were due to MSM transmission compared to 13% in the cumulative period until 2008. Substantial levels of risk behaviour were reported by the three high-risk groups. MSM reported an average of 9.5 sexual partners in the last year and up to 36% engaged in male sex work. Seventeen to 65% of IDUs shared needles/syringes, 33%–47% had sex with FSWs, 17%–33% engaged in sex work, and 24.7% reported male same-sex sex. FSWs reported an average of 11.7 sexual partners per week. Despite relatively high levels of risk behaviour, condom use in Lebanon was high and among the highest in the MENA region, so were the levels of knowledge of HIV/AIDS and of its modes of transmission. Molecular epidemiology evidence indicated a diverse HIV subtype distribution suggesting multiple exogenous introductions of the virus.ConclusionsThe evidence gathered in this review indicates that HIV endemic transmission appears to be still limited in Lebanon with most diagnosed cases representing exogenous exposures. There are however few indications suggesting an emerging epidemic among MSM. HIV surveillance of high-risk groups needs to be actively expanded in Lebanon to track such potential emerging epidemics and prevent further HIV transmission among population groups at high risk of HIV infection.
P1-S4.07 The use of the Arizona Department of Health Services surveillance database to identify discordant syphilis treponemal laboratory results, Arizona
Authors: Winscott M , Betancourt A , Ereth R 
Published: July 2011

BackgroundIn March of 2010 a large commercial lab performing STD testing in Arizona implemented the reverse algorithm for syphilis testing with the use of the syphilis treponemal enzyme immunoassay (EIA).MethodsPer the Arizona Department of Health Services (ADHS) Sexually Transmitted Disease Control Program protocol, manual review of positive syphilis lab results is performed by one epidemiologist. During May through October 2010, this epidemiologist recorded negative syphilis EIA results identified among reported syphilis cases with a prior history of positive treponemal tests (TP-PA, FTA-ABS).ResultsFrom 6 May 2010 to 29 October 2010 78 syphilis EIA tests were reported as negative in individuals with a previously positive treponemal test. Fifty of these tests were completed among males and 28 among females. This discrepancy was brought to the attention of the reporting lab in May and again in October 2010. In November, a coordinated investigation between the reporting laboratory, the ADHS public health lab, and the ADHS Sexually Transmitted Disease Control Program (ADHS STDCP) was undertaken. This investigation resulted in the identification and correction in a specimen transfer procedure at the local laboratory level. All providers of patients with possible incorrect lab results completed during this time period were notified of the problem and advised to retest their patients, if indicated. The ADHS STDCP continues to monitor syphilis lab results for this particular error and has not identified any further discordant results since the corrections were implemented in November 2010.ConclusionsDiscrepancies in syphilis EIA results have been reported from other regions. The detailed manual review of all reported syphilis lab results by an epidemiologist at the ADHS STDCP aided in the detection of this particular issue. Upon implementation of electronic lab reporting, this program and others, should continue routine, manual quality assurance checks of syphilis laboratory results. Such practices are imperative to ensure that these errors do not go undetected and that syphilis patients do not go undiagnosed.