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Abstract. We describe an in vitro culture technique for a microsporidian isolated from the corneal biopsy of an HIV‐infected patient. The corneal biopsy was inoculated into a monolayer culture of fibroblasts derived from newborn mouse brain and incubated at 37°C in an atmosphere of 5% CO2. Minimum essential medium supplemented with 2% fetal bovine serum appeared to be an optimum medium for growth and maintenance of the parasite and for production of large numbers of spores. This microsporidian was identified as Trachipleistophora anthropophthera based on ultrastructural features. It forms two types of sporophorous vesicles and two types of spores simultaneously: polysporous vesicle type I with eight or more oval spores, 3.7–4.0 μm by 2.0–2.3 μm, and bisporous vesicle type II with two round spores, 1.7–2.2 μm by 1.6–2.0 μm in size.

Honduras has one of the highest HIV prevalence rates in Central America. Data on HIV incidence are needed to identify groups at greatest need of prevention interventions to inform the national HIV response. We applied a test for recent infection to HIV-positive specimens from a biological and behavioral survey to estimate assay-derived incidence among men who have sex with men (MSM), female sex workers (FSW), and the Garifuna population in Honduras. Assay-derived estimates were compared to the mathematically modeled estimates in the same populations to assess plausibility of the assay-based estimates. Assay-derived incidence was 1.1% (95% CI 0.2-2.0) among MSM, 0.4% (95% CI 0.1-0.8) among the Garifuna, and 0% (95% CI 0-0.01) among FSWs. The modeled incidence estimates were similar at 1.03% among MSM, 0.30% among the Garifuna, and 0.23% among FSWs. HIV incidence based on the assay was highest among MSM in Honduras, lowest among FSWs, and similar to modeled incidence in these groups. Targeted programs on HIV prevention, care, and treatment are urgently needed for the MSM population. Continued support for existing prevention programs for FSWs and Garifuna are recommended.

dFour HIV rapid tests were subjected to field validation in Panama and compared to an enzyme-linked immunosorbent assay/ Multispot-based testing algorithm. The sensitivities of Determine, Uni-Gold, SD Bioline, and INSTI were 99.8%. The specificities of Determine, SD-Bioline, and Uni-Gold were 100%, and the specificity of INSTI was 99.8%. On the basis of these data, we determined that these rapid tests can be used in an appropriate algorithm to diagnose HIV infection and are suitable for use in testing and counseling settings in Panama. Early diagnosis of HIV infection is important for prevention and patient management; delays in diagnosis of HIV infection represent a loss of opportunities for improving individual health and public health. The risk of transmitting the virus is higher if the patient does not know his/her status, does not reduce risk behaviors, and has a high viral load. The late start of treatment adversely affects the patient's prognosis, increasing morbidity and mortality (1). Several different assays are available for the detection of specific antibodies to diagnose HIV infection (2). Although the enzyme immunoassay (EIA) is most commonly used for diagnosis, the disadvantages of EIA are the need for well-trained technicians, appropriate equipment, laboratory infrastructure, and batch testing (3). In developing countries, such as those in Central America, technical support is not available in most of the peripheral primary care units (4-6). The number of samples screened per day is usually small, and the infrastructure and facilities for performing the EIA are not ideal or cost-effective. There is also a need to establish voluntary counseling and testing (VCT) facilities as part of the HIV infection prevention strategy. In these situations, tests need to be simple and rapid, reducing the time between infection and diagnosis (7,8). The development of HIV rapid tests has facilitated the massive scale-up of HIV testing and counseling at thousands of testing venues, allowing millions of individuals to receive their HIV diagnosis outside of a primary care facility (9, 10).The purpose of this field validation was to evaluate the performance of four rapid diagnostic tests: Determine HIV-1/2 (Alere Medical Co., Ltd., Japan), SD Bioline HIV-1/2 (Standard Diagnostics, Inc., South Korea), INSTI HIV antibody test (Biolytical Laboratories, Canada), and Uni-Gold HIV-1/2 (Trinity Biotech, Ireland), to accurately diagnose HIV infection.Venous whole-blood specimens were collected into EDTA tubes from consenting patients who tested for HIV infection at eight selected health facilities, representing five regions of Panama (Western Panama, Colón, Gnobe Bugle, Chiriquí, and Guna Yala) during May through August 2014. Eligible patients included men and nonpregnant women Ն18 years of age and pregnant women of any age recruited at these selected sites, which represented ϳ20% of the participants. All samples were tested onsite by the four rapid tests listed above. Kit protocols were strictly followed in carrying out the ...

Background Pre-treatment HIV drug resistance (HIVDR) to NNRTIs has consistently increased in low-/middle-income countries during the last decade. Objectives To estimate the prevalence of pre-treatment HIVDR and acquired HIVDR among persons living with HIV (PLHIV) on ART for 12 ± 3 months (ADR12) and ≥48 months (ADR48) in Honduras. Patients and methods A nationwide cross-sectional survey with a two-stage cluster sampling was conducted from October 2016 to November 2017. Twenty-two of 54 total ART clinics representing >90% of the national cohort of adults on ART were included. HIVDR was assessed for protease and reverse transcriptase Sanger sequences using the Stanford HIVdb tool. Results A total of 729 PLHIV were enrolled; 26.3% (95% CI 20.1%–33.5%) ART initiators reported prior exposure to antiretrovirals. Pre-treatment HIVDR prevalence was 26.9% (95% CI 20.2%–34.9%) to any antiretroviral and 25.9% (19.2%–33.9%) to NNRTIs. NNRTI pre-treatment HIVDR was higher in ART initiators with prior exposure to antiretrovirals (P = 0.001). Viral load (VL) suppression rate was 89.7% (85.1%–93.0%) in ADR12 and 67.9% (61.7%–73.6%) in ADR48. ADR12 to any drug among PLHIV with VL ≥1000 copies/mL was 86.1% (48.9%–97.6%); 67.1% (37.4%–87.5%) had HIVDR to both NNRTIs and NRTIs, and 3.8% (0.5%–25.2%) to PIs. ADR48 was 92.0% (86.8%–95.3%) to any drug; 78.1% (66.6%–86.5%) to both NNRTIs and NRTIs, and 7.3% (1.8%–25.1%) to PIs. Conclusions The high prevalence of NNRTI pre-treatment HIVDR observed in Honduras warrants consideration of non-NNRTI-based first-line regimens for ART initiation. Programmatic improvements in HIVDR monitoring and adherence support may also be considered.