Archive for December, 2011

Comparative Effectiveness of Clostridium difficile Treatments

Annals of Internal Medicine  20 Dec 2011 V.155 N.12 P.839-847

A Systematic Review

Dimitri M. Drekonja, MD, MS; Mary Butler, PhD, MBA; Roderick MacDonald, MS; Donna Bliss, PhD, RN; Gregory A. Filice, MD; Thomas S. Rector, PhD; and Timothy J. Wilt, MD, MPH

From Minneapolis Veterans Affairs Health Care System, University of Minnesota Medical School, Minnesota Evidence-based Practice Center, University of Minnesota School of Public Health, and University of Minnesota School of Nursing, Minneapolis, Minnesota.

Abstract

Background

Clostridium difficile infection is increasing in incidence and severity. The optimal treatment is unknown.

Purpose

To determine whether, among adults with C. difficile infection, treatment with certain antibiotics compared with others results in differences in initial cure, recurrence, and harms.

Data Sources

MEDLINE, AMED, ClinicalTrials.gov, and Cochrane databases (search dates: inception through August 2011, limited to English-language reports); bibliography review.

Study Selection

Randomized, controlled trials of adults with C. difficile infection, independent of outcomes, who were treated with medications available in theUnited States. Observational studies reporting strain were included.

Data Extraction

Study design, inclusion and exclusion criteria, quality and strength of evidence as assessed by 2 reviewers, study definitions, and duration of treatment and follow-up. Outcomes included initial cure, recurrence, and treatment harms.

Data Synthesis

11 trials that included 1463 participants were identified. Three trials compared metronidazole with vancomycin; 8 compared metronidazole or vancomycin with another agent, combined agents, or placebo. Strain was analyzed in 1 trial and 2 cohort studies. No study comparing 2 antimicrobial agents demonstrated a statistically significant difference for initial cure; all comparisons were of low to moderate strength of evidence. Moderate-strength evidence from 1 study demonstrated that recurrence was decreased with fidaxomicin versus vancomycin (15% vs. 25%; difference, −10 percentage points [95% CI, −17 to −3 percentage points]; P = 0.005). Subgroup analysis of a single study comparing metronidazole with vancomycin for patients who have severe C. difficile infection showed no difference by intention-to-treat analysis; this was rated as insufficient-strength evidence. Harms, when reported, did not differ between treatments in any study.

Limitations

Definitions of diarrhea, C. difficile infection, initial cure, and relapse varied. Some studies reported insufficient detail to allow assessment of all randomly assigned participants or of harms.

Conclusion

No antimicrobial agent is clearly superior for the initial cure of C. difficile infection. Recurrence is less frequent with fidaxomicin than with vancomycin.

Primary Funding Source

U.S.Department of Health and Human Services.

Abstract

http://www.annals.org/content/155/12/839.abstract

PDF

http://www.annals.org/content/155/12/839.full.pdf+html

 

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December 30, 2011 at 7:23 pm Leave a comment

Atazanavir Plus Ritonavir or Efavirenz as Part of a 3-Drug Regimen for Initial Treatment of HIV Type-1: A Randomized Trial

Ann of Int Med  05 Apr 2011 V.154 N.7 P.445-456

Eric S. Daar, Camlin Tierney, Margaret A. Fischl, Paul E. Sax, Katie Mollan, Chakra Budhathoki, Catherine Godfrey, Nasreen C. Jahed, Laurie Myers, David Katzenstein, Awny Farajallah, James F. Rooney, Keith A. Pappa,William C. Woodward, Kristine Patterson, Hector Bolivar, Constance A. Benson, Ann C. Collier  for the AIDS Clinical Trials Group Study A5202 Team

From Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center and the University of California, Los Angeles, Los Angeles, California; Harvard School of Public Health, Boston, Massachusetts; University of Miami School of Medicine, Miami, Florida; Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; Social and Scientific Systems, Silver Spring, Maryland; Frontier Science and Technology Research Foundation, Amherst, New York; Stanford University, Palo Alto, California; Bristol-Myers Squibb, Plainsboro, New Jersey; Gilead Sciences, Foster City, California; GlaxoSmithKline, Research Triangle Park, North Carolina; Abbott Laboratories, Abbott Park, Illinois; University of North Carolina, Chapel Hill, North Carolina; University of California, San Diego, San Diego, California; and University of Washington and Harborview Medical Center, Seattle, Washington.

Background

Limited data compare once-daily options for initial therapy for HIV type 1 (HIV-1).

Objective

To compare time to virologic failure; first grade-3 or -4 sign, symptom, or laboratory abnormality (safety); and change or discontinuation of regimen (tolerability) for atazanavir plus ritonavir with efavirenz-containing initial therapy for HIV-1.

Design

A randomized equivalence trial conducted from September 2005 to November 2007, with a median 138 weeks follow-up. Regimens assigned by central computer, stratified by screening HIV-1 RNA less than 100 000 copies/mL or 100 000 copies/mL or more, with blinding only known to the site pharmacist (ClinicalTrials.gov registration number: NCT00118898).

Setting

59 AIDS Clinical Trials Group sites in theUnited StatesandPuerto Rico.

Patients

Antiretroviral-naïve patients.

Intervention

Open-label atazanavir plus ritonavir or efavirenz with placebo-controlled abacavir–lamivudine or tenofovir disoproxil fumarate (DF)–emtricitabine.

Measurements

Primary outcomes were time to virologic failure, safety, and tolerability events. Secondary end points included proportion with HIV-1 RNA less than 50 copies/mL, emergence of drug resistance, changes in CD4 cell counts, calculated creatinine clearance, and lipid levels.

Results

Eligible patients randomly assigned to atazanavir plus ritonavir versus efavirenz with abacavir–lamivudine were 463 and 465, with 322 (70%) and 324 (70%) completing follow-up, respectively. Total participants who received tenofovir DF–emtricitabine were 465 and 464, with 342 (74%) and 343 (74%) completing follow-up, respectively. Primary efficacy was similar between the groups who received atazanavir plus ritonavir and efavirenz with abacavir–lamivudine or tenofovir DF–emtricitabine. Hazard ratios for time to virologic failure were 1.13 (95% CI, 0.82 to 1.56) and 1.01 (CI, 0.70 to 1.46), respectively; although CIs did not meet prespecified criteria for equivalence. There was a longer time to safety (P = 0.048) and tolerability (P < 0.001) events in persons given atazanavir plus ritonavir than efavirenz with abacavir–lamivudine but not with tenofovir DF–emtricitabine.

Limitations

Neither HLA-B*5701 or resistance testing were the standard of care when A5202 enrolled patients. The third drugs, atazanavir plus ritonavir and efavirenz were open-label, the nucleoside reverse transcriptase inhibitors were prematurely unblinded in the high viral load stratum, and 32% of patients modified or discontinued their third drug.

Conclusion

Atazanavir plus ritonavir and efavirenz provide similar antiviral activity when used with abacavir–lamivudine or tenofovir DF–emtricitabine.

Abstract

http://www.annals.org/content/early/2011/02/11/0003-4819-154-7-201104050-00316.abstract?papetoc

FULL  TEXT

http://www.annals.org/content/early/2011/02/11/0003-4819-154-7-201104050-00316.full

PDF

http://www.annals.org/content/154/7/445.full.pdf+html

December 30, 2011 at 6:32 pm Leave a comment

Thirty Years of HIV and AIDS: Future Challenges and Opportunities

Ann Int Med  07 June May 2011 V,154 N.11 P.766-771

Carl W. Dieffenbach and Anthony S. Fauci

From the National Institute of Allergy and Infectious Diseases, Bethesda, Maryland.

Abstract

As the third decade since AIDS was first recognized comes to an end, extraordinary advances have occurred in the understanding, treatment, and prevention of HIV infection and AIDS. As a result of these successes, it is now time to focus on future challenges.Paramountamong these is reaching the goal of truly controlling and ultimately ending the HIV and AIDS pandemic.

To that end, AIDS researchers and public health personnel worldwide are aggressively pursuing 3 key areas of scientific research. Given the availability of highly effective therapeutic regimens for HIV infection, the first challenge is efficiently identifying a maximum number of HIV-infected persons through voluntary HIV testing and initiating antiretroviral therapy (ART). Second, scientists are trying to develop a cure for HIV infection, which would alleviate the need for lifelong ART. Finally, preventing new cases of HIV infection, which currently number approximately 2.6 million per year globally, is critical to any attempt to end this pandemic. This article addresses each of these challenges and provides directions for the future.

Abstract

http://www.annals.org/content/early/2011/05/27/0003-4819-154-11-201106070-00345.abstract?papetoc

PDF

http://www.annals.org/content/early/2011/05/27/0003-4819-154-11-201106070-00345.full.pdf+html

December 30, 2011 at 6:30 pm Leave a comment

International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases

Clinical Infect Diseases  Mar.1, 2011 V.52 N.5 P.561-564

Executive Summary

Kalpana Gupta1, Thomas M. Hooton2, Kurt G. Naber9, Björn Wullt10, Richard Colgan3, Loren G. Miller4, Gregory J. Moran5, Lindsay E. Nicolle8, Raul Raz11, Anthony J. Schaeffer6, and David E. Soper7

1Department of Medicine, Veterans Affairs Boston Health Care System and Boston University School of Medicine, Boston, Massachusetts

2Department of Medicine, University of Miami Miller School of Medicine, University of Miami, Miami Florida

3Department of Family and Community Medicine, University of Maryland, Baltimore, Maryland

4Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance

5Department of Emergency Medicine and Division of Infectious Diseases Olive View-UCLA Medical Center, Slymar, California

6 Deptartment of urology, Northwestern University, Chicago, Illinois

7Departments of Obstetrics and Gynecology and Medicine, Medical University of South Carolina, Charleston, South Carolina

8Department of Internal Medicine and Department of Medical Mirobiology University of Manitoba, Winnipeg, Canada

9Technical University of Munich, Munich, Germany

10Lund University Hospital, Lund, Sweden

11Infectious Diseases Unit, Ha’Emek Medical Center, Afula, and Rappaport Faculty of Medicine, Technion, Haifa, Israel

Abstract

A Panel of International Experts was convened by the Infectious Diseases Society of America (IDSA) in collaboration with the European Society for Microbiology and Infectious Diseases (ESCMID) to update the 1999 Uncomplicated Urinary Tract Infection Guidelines by the IDSA. Co-sponsoring organizations include the American Congress of Obstetricians and Gynecologists, American Urological Association, Association of Medical Microbiology and Infectious Diseases–Canada, and the Society for Academic Emergency Medicine. The focus of this work is treatment of women with acute uncomplicated cystitis and pyelonephritis, diagnoses limited in these guidelines to premenopausal, non-pregnant women with no known urological abnormalities or co-morbidities. The issues of in vitro resistance prevalence and the ecological adverse effects of antimicrobial therapy (collateral damage) were considered as important factors in making optimal treatment choices and thus are reflected in the rankings of recommendations.

abstract

http://cid.oxfordjournals.org/content/52/5/561.abstract

PDF

http://cid.oxfordjournals.org/content/52/5/561.full.pdf+html

– – –

Clinical Infect Diseases  Mar.1, 2011 V.52 N.5 P.e103-e120

International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases

Kalpana Gupta1, Thomas M. Hooton2, Kurt G. Naber9, Björn Wullt10, Richard Colgan3, Loren G. Miller4, Gregory J. Moran5, Lindsay E. Nicolle8, Raul Raz11, Anthony J. Schaeffer6, and David E. Soper7

1Department of Medicine, Veterans Affairs Boston Health Care System and Boston University School of Medicine, Boston, Massachusetts

2Department of Medicine, University of Miami Miller School of Medicine, University of Miami, Miami Florida

3Department of Family and Community Medicine, University of Maryland, Baltimore, Maryland

4Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance

5Department of Emergency Medicine and Division of Infectious Diseases Olive View-UCLA Medical Center, Slymar, California

6Deptartment of urology, Northwestern University, Chicago, Illinois

7Departments of Obstetrics and Gynecology and Medicine, Medical University of South Carolina, Charleston, South Carolina

8Department of Internal Medicine and Department of Medical Mirobiology University of Manitoba, Winnipeg, Canada

9Technical University of Munich, Munich, Germany

10Lund University Hospital, Lund, Sweden

11Infectious Diseases Unit, Ha’Emek Medical Center, Afula, and Rappaport Faculty of Medicine, Technion, Haifa, Israel

Abstract

A Panel of International Experts was convened by the Infectious Diseases Society of America (IDSA) in collaboration with the European Society for Microbiology and Infectious Diseases (ESCMID) to update the 1999 Uncomplicated Urinary Tract Infection Guidelines by the IDSA. Co-sponsoring organizations include the American Congress of Obstetricians and Gynecologists, American Urological Association, Association of Medical Microbiology and Infectious Diseases–Canada, and the Society for Academic Emergency Medicine. The focus of this work is treatment of women with acute uncomplicated cystitis and pyelonephritis, diagnoses limited in these guidelines to premenopausal, non-pregnant women with no known urological abnormalities or co-morbidities. The issues of in vitro resistance prevalence and the ecological adverse effects of antimicrobial therapy (collateral damage) were considered as important factors in making optimal treatment choices and thus are reflected in the rankings of recommendations.

abstract

http://cid.oxfordjournals.org/content/52/5/e103.abstract

PDF

http://cid.oxfordjournals.org/content/52/5/e103.full.pdf+html

December 28, 2011 at 11:40 am Leave a comment

Guillain–Barré Syndrome following Primary Cytomegalovirus Infection: A Prospective Cohort Study

Clinical Infect Diseases  Apr.1, 2011 V.52 N.6 P.837-844

David Orlikowski1,4, Raphaël Porcher5,6, Valérie Sivadon-Tardy4,10, Jean-Charles Quincampoix4,10, Jean-Claude Raphaël1,4,*, Marie-Christine Durand2, Tarek Sharshar1,4, Jacqueline Roussi3,4, Christiane Caudie11, Djillali Annane1,4, Flore Rozenberg7,8, Marianne Leruez-Ville8,9, Jean-Louis Gaillard4,10, and Elyanne Gault4,10

1Service de Réanimation

2Service de Physiologie et Explorations Fonctionnelles

3Service d’Hématologie Immunologie, AP-HP, Hôpital Raymond Poincaré, Garches

4Université de Versailles St-Quentin-en-Yvelines, UPRES EA4342, Guyancourt

5AP-HP, Hôpital St-Louis, Département de Biostatistique et Informatique Médicale, Paris

6Université Paris Diderot Paris 7, Inserm U717

7AP-HP, Hôpital Cochin-St-Vincent-de-Paul, Laboratoire de Virologie, Paris

8Université Paris Descartes Paris 5

9AP-HP, Hôpital Necker, Laboratoire de Virologie, Paris

10AP-HP, Hôpital Ambroise Paré, Laboratoire de Microbiologie, Boulogne-Billancourt

11Hôpital Neurologique de Lyon, Fédération de Biologie, Service d’Immunologie, Bron, France

Background

Little is known about the epidemiology and the prognostic factors of Guillain–Barré syndrome (GBS) following primary infection with cytomegalovirus (CMV-GBS).

Methods

We prospectively followed up 506 patients with cases of GBS who were admitted to our center from 1996 through 2006. We diagnosed 63 (12.4%) CMV-GBS cases by immunoglobulin (Ig) M detection and IgG avidity. Plasma CMV DNA was detected at hospital admission. Patient subgroups were compared using Fisher’s exact test and the Wilcoxon rank-sum test. Temporal variations were analyzed with time series methods.

Results

Patients with CMV-GBS were mostly young (median age, 32 years; sex ratio, 0.85), but we also identified a subpopulation of patients consisting of women aged >50 years. Sensory defects (in 72% of cases) and facial palsy (49%) were frequent, and test results positive for CMV DNA in plasma at hospital admission (found in 62% of cases) tended to be associated with objective sensory defect (P = .052). The main factors associated with long-term neurological sequelae (21%) were older age (P < .001) and assisted ventilation during hospitalization (P = .005). The number of CMV-GBS cases decreased between 1996 and 2006 (P = .019) and displayed an annual periodicity between the months of July and October. The incidence of CMV-GBS was estimated to be between 0.6 and 2.2 cases per 1000 cases of primary CMV infection (versus 0.25 to 0.65 cases per 1000 cases of Campylobacter jejuni infection).

Conclusions

This study provides new insights about the epidemiology of CMV-GBS and shows that the risk of developing GBS is similar following primary CMV infection or C. jejuni infection. Our results also suggest a direct or indirect involvement of viral replication in the neuropathological processes of CMV-GBS.

abstract

http://cid.oxfordjournals.org/content/52/7/837.abstract

PDF

http://cid.oxfordjournals.org/content/52/7/837.full.pdf+html

December 28, 2011 at 11:36 am Leave a comment

Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America

Clinical Infect Diseases  Feb.15, 2011 V.52 N.4 P.427-431

Executive Summary

Alison G. Freifeld1, Eric J. Bow9, Kent A. Sepkowitz2, Michael J. Boeckh4, James I. Ito5, Craig A. Mullen3, Issam I. Raad6, Kenneth V. Rolston6, Jo-Anne H. Young7, and John R. Wingard8

1Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska

2Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York

3Department of Pediatrics, University of Rochester Medical Center, Rochester, New York

4Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research, Seattle, Washington

5Division of Infectious Diseases, City of Hope National Medical Center, Duarte, California

6Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, Texas

7Department of Medicine, University of Minnesota, Minneapolis, Minnesota

8Division of Hematology/Oncology, University of Florida, Gainesville, Florida

9Departments of Medical Microbiology and Internal Medicine, the University of Manitoba, and Infection Control Services, Cancer Care Manitoba, Winnipeg, Manitoba, Canada

This document updates and expands the initial Infectious Diseases Society of America (IDSA) Fever and Neutropenia Guideline that was published in 1997 and first updated in 2002. It is intended as a guide for the use of antimicrobial agents in managing patients with cancer who experience chemotherapy-induced fever and neutropenia.

Recent advances in antimicrobial drug development and technology, clinical trial results, and extensive clinical experience have informed the approaches and recommendations herein. Because the previous iteration of this guideline in 2002, we have a developed a clearer definition of which populations of patients with cancer may benefit most from antibiotic, antifungal, and antiviral prophylaxis. Furthermore, categorizing neutropenic patients as being at high risk or low risk for infection according to presenting signs and symptoms, underlying cancer, type of therapy, and medical comorbidities has become essential to the treatment algorithm. Risk stratification is a recommended starting point for managing patients with fever and neutropenia. In addition, earlier detection of invasive fungal infections has led to debate regarding optimal use of empirical or preemptive antifungal therapy, although algorithms are still evolving.

What has not changed is the indication for immediate empirical antibiotic therapy. It remains true that all patients who present with fever and neutropenia should be treated swiftly and broadly with antibiotics to treat both gram-positive and gram-negative pathogens.

Finally, we note that all Panel members are from institutions in theUnited StatesorCanada; thus, these guidelines were developed in the context of North American practices. Some recommendations may not be as applicable outside ofNorth America, in areas where differences in available antibiotics, in the predominant pathogens, and/or in health care–associated economic conditions exist. Regardless of venue, clinical vigilance and immediate treatment are the universal keys to managing neutropenic patients with fever and/or infection.

abstract

http://cid.oxfordjournals.org/content/52/4/427.abstract

PDF

http://cid.oxfordjournals.org/content/52/4/427.full.pdf+html

– – –

Clinical Infect Diseases  Feb.15, 2011 V.52 N.4 P.e56-e93

Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America

Alison G. Freifeld1, Eric J. Bow9, Kent A. Sepkowitz2, Michael J. Boeckh4, James I. Ito5, Craig A. Mullen3, Issam I. Raad6, Kenneth V. Rolston6, Jo-Anne H. Young7, and John R. Wingard8

1Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska

2Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York

3Department of Pediatrics, University of Rochester Medical Center, Rochester, New York

4Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research, Seattle, Washington

5Division of Infectious Diseases, City of Hope National Medical Center, Duarte, California

6Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, Texas

7Department of Medicine, University of Minnesota, Minneapolis, Minnesota

8Division of Hematology/Oncology, University of Florida, Gainesville, Florida

9Departments of Medical Microbiology and Internal Medicine, the University of Manitoba, and Infection Control Services, Cancer Care Manitoba, Winnipeg, Manitoba, Canada

This document updates and expands the initial Infectious Diseases Society of America (IDSA) Fever and Neutropenia Guideline that was published in 1997 and first updated in 2002. It is intended as a guide for the use of antimicrobial agents in managing patients with cancer who experience chemotherapy-induced fever and neutropenia.

Recent advances in antimicrobial drug development and technology, clinical trial results, and extensive clinical experience have informed the approaches and recommendations herein. Because the previous iteration of this guideline in 2002, we have a developed a clearer definition of which populations of patients with cancer may benefit most from antibiotic, antifungal, and antiviral prophylaxis. Furthermore, categorizing neutropenic patients as being at high risk or low risk for infection according to presenting signs and symptoms, underlying cancer, type of therapy, and medical comorbidities has become essential to the treatment algorithm. Risk stratification is a recommended starting point for managing patients with fever and neutropenia. In addition, earlier detection of invasive fungal infections has led to debate regarding optimal use of empirical or preemptive antifungal therapy, although algorithms are still evolving.

What has not changed is the indication for immediate empirical antibiotic therapy. It remains true that all patients who present with fever and neutropenia should be treated swiftly and broadly with antibiotics to treat both gram-positive and gram-negative pathogens.

Finally, we note that all Panel members are from institutions in theUnited StatesorCanada; thus, these guidelines were developed in the context of North American practices. Some recommendations may not be as applicable outside ofNorth America, in areas where differences in available antibiotics, in the predominant pathogens, and/or in health care–associated economic conditions exist. Regardless of venue, clinical vigilance and immediate treatment are the universal keys to managing neutropenic patients with fever and/or infection.

abstract

http://cid.oxfordjournals.org/content/52/4/e56.abstract

PDF

http://cid.oxfordjournals.org/content/52/4/e56.full.pdf+html

 

December 27, 2011 at 11:35 am Leave a comment

HIV incidence among men who have sex with men in China: a meta-analysis of published studies.

PLoS One. 2011;6(8):e23431.

Li HM, Peng RR, Li J, Yin YP, Wang B, Cohen MS, Chen XS.

Source

Chinese Academy of Medical Sciences Institute of Dermatology, Nanjing, China.

Abstract

BACKGROUND:

Men who have sex with men (MSM) have now become one of the priority populations for prevention and control of HIV pandemic inChina. Information of HIV incidence among MSM is important to describe the spreading of the infection and predict its trends in this population. We reviewed the published literature on the incidence of HIV infection among MSM inChina.

METHODS:

We identified relevant studies by use of a comprehensive strategy including searches of Medline and two Chinese electronic publication databases from January 2005 to September 2010. Point estimate of random effects incidence with corresponding 95% confidence intervals (CI) of HIV infection was carried out using the Comprehensive Meta-Analysis software. Subgroup analyses were examined separately, stratified by study design and geographic location.

RESULTS:

Twelve studies were identified, including three cohort studies and nine cross-sectional studies. The subgroup analyses revealed that the sub-overall incidence estimates were 3.5% (95% CI, 1.7%-5.3%) and 6.7% (95% CI, 4.8%-8.6%) for cohort and cross-sectional studies, respectively (difference between the sub-overalls, Q=5.54, p=0.02); and 8.3% (95% CI, 6.9%-9.7%) and 4.6% (95% CI, 2.4%-6.9%) for studies in Chongqing and other areas, respectively (difference between the sub-overalls, Q=7.58, p<0.01). Syphilis infection (RR=3.33, p<0.001), multiple sex partnerships (RR=2.81, p<0.001), and unprotected receptive anal intercourse in the past six months (RR=3.88, p=0.007) represented significant risk for HIV seroconversion.

CONCLUSIONS:

Findings from this meta-analysis indicate that HIV incidence is substantial in MSM inChina. High incidence of HIV infection and unique patterns of sexual risk behaviors in this population serve as a call for action that should be answered with the innovative social and public health intervention strategies, and development of biological prevention strategies.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3162552/pdf/pone.0023431.pdf

December 24, 2011 at 12:03 am Leave a comment

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