Background HIV infection disproportionately affects men who have sex with men (MSM) in the industrialised world. Rectal infections are objective markers of HIV risk behaviour. We examined the association between rectal chlamydia/gonorrhoea (CT/GC) infections and HIV seroconversion. Methods MSM attending New York City public STD clinics who report receptive anal sex are offered rectal testing using GC culture and CT nucleic acid amplification tests (NAAT); patients not known to have HIV are offered HIV testing. We created a retrospective cohort of MSM diagnosed with rectal CT or GC in 2008e2009 at STD clinics who tested HIV-negative by pooled NAAT at that visit. The outcome was time to HIV infection, defined as a STD clinic diagnosis or identified through a match against the citywide HIV/ AIDS registry (HARS) for HIV diagnosed elsewhere during the analytic period. For MSM who seroconverted, HIV-free time-at-risk was from rectal infection to date of positive HIV test; those not reported with HIV were presumed uninfected and censored on 31 December 2010. Cox proportional hazards models were used to explore demographic and behavioural factors associated with HIV acquisition. Results A total of 229 HIV-negative MSM diagnosed with rectal infections contributed 368.29 person-years of follow-up; 22/229 (9.6%) were diagnosed with HIV (16 in STD clinics and an additional 6 found in HARS), for an annual HIV incidence of 5.97% (95% CI 3.84 to 8.90). Median time from rectal infection to HIV diagnosis was 290 days (range 98e748). The small subgroups of black and <20-year-old MSM had markedly high incidence (14.19% and 10.79%, respectively) (see Abstract P1-S5.23 table 1). MSM reporting inconsistent condom use had an annual HIV incidence of 6.33% (95% CI 3.43 to 10.75). Black race was associated with a 6.5-fold increased risk of HIV; after adjusting for age this finding did not reach statistical significance (HR¼5.05, 95% CI 1.00 to 25.68). Conclusions More than 1 in 20 MSM with rectal infections are diagnosed with HIV within a year; risk is higher for subgroups such as young and black MSM. Local data on risk for seroconversion may be more compelling than national data in risk-reduction counselling. As the majority of rectal infections are due to CT, and CT is associated with substantial HIV risk, routine rectal CT screening is indicated for MSM. STD/HIV registry matching/integration permit more accurate incidence estimates and definition of affected populations with which to focus prevention activities.

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IntroductionIn recent years Syphilis has been a priority public health problem in Latin American and Caribbean countries (LAC), added to the problem of mother-to-child transmission (MTCT) of HIV. Our goal is to determine the prevalence of HIV/syphilis and measure the quality of antenatal care for prevention of MTCT in parturient and postpartum women attending public health facilities in Paraguay in 2013.MethodsDescriptive cross-sectional study using a standard survey and linked confidential serological tests. Data included public units at National level. A stratified two-stage cluster sampling was performed and data were expressed in measures of central tendency, dispersion and tables of proportions.ResultsA total of 8.256 postpartum and parturient women were admitted to the study and 92.48% attending prenatal care. HIV prevalence in postpartum/parturient women was 0.50% (95% CI 0.36–0.69) and of Syphilis was 4.18% (CI 95% 3.75 to 4.65). In 65.93% of them, the first prenatal visit was performed before 20 weeks of gestation. 72.04% performed 4 or more prenatal visits and 58.03% of pregnant women presented both, prenatal visit before 20 weeks and ≥4 prenatal visits. In 85.59% and 83%, the tests for HIV and syphilis diagnosis were performed during pregnancy. The diagnostic tests fo sexual partners were available in 12.50% and 24.40% for HIV and syphilis, respectively. The treatment of sexual partners of pregnant women with syphilis was 21.40%.ConclusionHIV prevalence was low; however the prevalence of syphilis was high in postpartum and in parturient women in Paraguay. The percentage of prenatal care before 20 weeks of gestation was low and the percentages of performing the tests on the sexual partners and the treatment of syphilis were very low. Improving the access to and quality of antenatal care services and implement effective strategies for the notification and treatment of sexual partners in health services the timely implementation of 1 st prenatal care and, in particular, to include strategies for testing sexual partners.

IntroductionParaguay has made efforts to improve the response to HIV infection, and it is important to assess the impact of interventions in paediatrics. To estimate predictors of mortality in children who acquired HIV from mother to child transmission, between January 2000 and December 2014.MethodsA birth cohort study among persons living with HIV infection (PLWH), they were <15 years of age at enrollment. We abstracted data from clinic records, using a standardised form; obtained the data of death from clinic records and confirmations of deaths from deaths’ certificates. We used survival analysis techniques to estimate the incidence of death.ResultsA total of 302 subjects were included in the survey. 71.4% younger than six years of age, 51.0% female, 74.3% were from the metropolitan area. There were 52 deaths (17.2% of participants), resulting in an overall mortality rate of 1.86 deaths/100 person-years [95% confidence interval (CI) 1.39, 2.44]. The Children with baseline HIV viral load >1 00 000 copies/mL were four times more likely to die than children with baseline HIV viral load ≤100.000 (HR, 4.47; 95% CI: 1.79, 11.10). Regarding age-stratified staging of disease, those children with stage 3 were four times more likely to die compared with children on Stage (1 and 2) (HR: 4,19; 95% CI: 1,50,11,70). Those children with haemoglobin level ≤9 g/dL at baseline have four time more chance to die compared with haemoglobin level ≥9 g/dL (HR: 3.90; 95% CI1.61, 9.80).ConclusionThe mortality of children with HIV in Paraguay is low. High HIV viral load, late stage and moderate or severe anaemia at first diagnosis time are associated with mortality. Improving prenatal care and paediatric follow-up in an effort to diagnose vertically infected children as early as possible should be an integrated part of the healthcare provided to the child with AIDS, and it is very important an action that may increase survival in these children. Support: University of California, San Francisco’s International Traineeships in AIDS Prevention Studies (ITAPS), U.S. NIMH, R25MH064712

Approximatly 90% were receiving NNRTI+ NRTI and just 13% and 10% were taking tenofovir and a protease inhibitor. Beside 11% were smokers while 14% as diabetic. Dyslipidemia was seen at least in 45% of population. Equally 8% had CD4 count < 200 cells/mm 3 and 9% hepatitis C. Importantly 10% and 4% had intermediate and high CHD risks (FRS 1998) and 6.6% and 3.3% with intermediate and high risks for CHD based on FRS (2002) intermediate and high risk of CVDs was prevalent in while 39% and 8% of HIV subjects. Among all studied variables, higher total cholesterol levels and older age were the strong risk predictors for CHD and CVDs (p < 0.05). Conclusions We found a high prevalence of dyslipidemia while the CHD risks measured by the Framingham scales 1998 and 2002 were low. Notably CVDs risk was high thus further investigations as well preventive management should be prioritised in this population.