IntroductionHIV-1 is often acquired in the presence of pre-existing co-infections, such as Herpes Simplex Virus 2 (HSV-2). We examined the impact of HSV-2 status at the time of HIV-1 acquisition for its impact on subsequent clinical course, and total CD4+ T cell phenotypes.MethodsWe assessed the relationship of HSV-1/HSV-2 co-infection status on CD4+ T cell counts and HIV-1 RNA levels over time prior in a cohort of 186 treatment naïve adults identified during early HIV-1 infection. We assessed the activation and differentiation state of total CD4+ T cells at study entry by HSV-2 status.ResultsOf 186 recently HIV-1 infected persons, 101 (54 %) were sero-positive for HSV-2. There was no difference in initial CD8+ T cell count, or differences between the groups for age, gender, or race based on HSV-2 status. Persons with HIV-1/HSV-2 co-infection sustained higher CD4+ T cell counts over time (+69 cells/ul greater (SD = 33.7, p = 0.04) than those with HIV-1 infection alone (Figure 1), after adjustment for HIV-1 RNA levels (−57 cells per 1 log10 higher HIV-1 RNA, p<0.0001). We did not observe a relationship between HSV-2 infection status with plasma HIV-1 RNA levels over time. HSV-2 acquistion after HIV-1 acquisition had no impact on CD4+ count or viral load. We did not detect differences in CD4+ T cell activation or differentiation state by HSV-2+ status.DiscussionWe observed no effect of HSV-2 status on viral load. However, we did observe that treatment naïve, recently HIV-1 infected adults co-infected with HSV-2+ at the time of HIV-1 acquisition had higher CD4+ T cell counts over time. If verified in other cohorts, this result poses a striking paradox, and its public health implications are not immediately clear.

An 82-year-old male presented to the hospital because of acute exacerbation of abdominal pain and biliary vomiting. Contrast-enhanced computed tomography of the abdomen was performed. A left paraduodenal hernia associated with volvulus, intussusception, and bowel wall ischemia were radiologically diagnosed. Surgery confirmed the diagnostic imaging findings. We present the first case of an association of these acute abdominal conditions.

BackgroundRecent studies have sought to describe HIV infection and transmission characteristics around the world. Identification of early HIV-1 infection is essential to proper surveillance and description of regional transmission trends. In this study we compare people recently infected (RI) with HIV-1, as defined by Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS), to those with chronic infection.Methodology/Principal FindingsSubjects were identified from 2002–2004 at four testing sites in São Paulo. Of 485 HIV-1-positive subjects, 57 (12%) were defined as RI. Of the participants, 165 (34.0%) were aware of their serostatus at the time of HIV-1 testing. This proportion was statistically larger (p<0.001) among the individuals without recent infection (n = 158, 95.8%) compared to 7 individuals (4.2%) with recently acquired HIV-1 infection. In the univariate analysis, RI was more frequent in <25 and >59 years-old age strata (p<0.001). The majority of study participants were male (78.4%), 25 to 45 years-old (65.8%), white (63.2%), single (61.7%), with family income of four or more times the minimum wage (41.0%), but with an equally distributed educational level. Of those individuals infected with HIV-1, the predominant route of infection was sexual contact (89.4%), with both hetero (47.5%) and homosexual (34.5%) exposure. Regarding sexual activity in these individuals, 43.9% reported possible HIV-1 exposure through a seropositive partner, and 49.4% reported multiple partners, with 47% having 2 to 10 partners and 37.4% 11 or more; 53.4% of infected individuals reported condom use sometimes; 34.2% reported non-injecting, recreational drug use and 23.6% were reactive for syphilis by VDRL. Subjects younger than 25 years of age were most vulnerable according to the multivariate analysis.Conclusions/SignificanceIn this study, we evaluated RI individuals and discovered that HIV-1 has been spreading among younger individuals in São Paulo and preventive approaches should, therefore, target this age stratum.

Objectives HIV self‐testing is an effective tool to improve diagnostic coverage in key populations, enabling linkage to care and access to antiretroviral therapy. Its implementation requires better understanding of patients’ perspectives on this novel strategy. The aim of the study was to investigate the perception of men who have sex with men (MSM) regarding the HIV oral fluid self‐test (HIVST) in São Paulo, Brazil, and to analyse the sociodemographic characteristics and testing strategy preferences of individuals registered to undertake HIVST. Methods Preceding the implementation of HIVST use as public policy in 2019, we recruited MSM living in São Paulo to undertake HIVST using a digital platform, and investigated their sociodemographic profiles, testing experiences and testing preferences. Results were compared according to reported lifetime HIV testing. Results A total of 6477 MSM (median age 28 years) were recruited to the study from April 9th to December 31st, 2018. Seventy‐eight per cent reported previous HIV testing. The opening hours of health facilities (53%), concern about disclosing intimate personal information to health care providers (34%) and fear of stigma (21%) were reported as the main barriers to testing. Older age, higher education, illicit drug use and self‐identifying as gay were associated with prior HIV testing (P < 0.001). Most participants (67%) were unaware that HIVST was available before enrolling in the study. Preference for HIVST over other testing technologies was higher among those never tested (71%) than among participants with previous HIV testing (61%; P < 0.001). Conclusions HIVST was found to be an effective tool to improve testing uptake among MSM, particularly those who had never been tested before. Characterization of the most likely users of HIVST among MSM will help to inform implementation and scaling up of this novel testing method in the Brazilian public health system.

Resumo: As reuniões gerenciais, reuniões técnicas, capacitações e atualizações profissionais sempre foram frequentes na Coordenadoria de Infecções Sexualmente Transmissíveis/ Aids da cidade de São Paulo, mas de forma presencial. Porém, em razão da pandemia de COVID-19, houve a necessidade de fazermos adequações para que as capacitações pudessem ser realizadas, pois houve a necessidade de atendermos as orientações de distanciamento social. Dessa forma, começamos as reuniões, atualizações e capacitações virtuais em vírus da imunodeficiência humana/sífilis/hepatites e, consequentemente, atingimos expressivo número de profissionais de saúde. O Projeto ECHO tem seu foco em discussão de casos clínicos complexos e teve início em São Paulo em 2017, porém, por conta da pandemia de COVID-19, foi autorizado que realizássemos capacitações e reuniões nos temas de infecções sexualmente transmissíveis/vírus da imunodeficiência humana e aids. É desenvolvido por meio da plataforma Zoom Pro, única plataforma possível de desenvolver o Projeto ECHO. Cada sala de reuniões é possível recebermos até 1.500 participantes. Ao longo do ano de 2020 foram realizadas 2 teleclínicas de testes rápidos para vírus da imunodeficiência humana/ sífilis/hepatites, com 283 pontos conectados, 6 teleclínicas com 1.115 pontos conectados, 25 teleclínicas de profilaxia pós-exposição e profilaxia pré-exposição com 691 pontos conectados, 34 reuniões com gerentes da Rede Municipal Especializada com 3.036 pontos conectados, 49 capacitações virtuais com 9.415 pontos conectados, ou seja, foram 116 eventos com 14.540 pontos conectados no total, e em cada ponto temos no mínimo 1 participante. Vale ressaltar que o custo para desenvolvimento das capacitações é praticamente zero. Com os números apresentados, referentes às participações dos profissionais de saúde, nesses eventos virtuais em 2020, fica evidente como foi importante a aceleração digital que a pandemia de COVID-19 proporcionou. Com isso, as capacitações e atualizações virtuais tornaram- -se parte importante dos processos de trabalho. Por fim, a metodologia de se comunicar a distância, em tempo real, mostrou-se muito eficaz, importante e fundamental que se torne parte do processo de trabalho definitivo.