No abstract

BackgroundThe risk of sexual HIV transmission in serodiscordant couples when the HIV-positive partner has full virologic suppression on combination antiretroviral therapy (cART) is debated. This study aims to systematically review observational studies and randomized controlled trials (RCTs), evaluating rates of sexual HIV transmission between heterosexual serodiscordant couples when the HIV-positive partner has full suppression on cART.Methods and FindingsWe searched major bibliographic databases to November 2012 for relevant observational studies and RCTs without language restrictions. Conference proceedings, key journals and bibliographies were also searched. Studies reporting HIV transmission rates, cART histories and viral loads of the HIV-positive partners were included. Two reviewers extracted methodologic characteristics and outcomes. Of 20,252 citations, 3 studies met all eligibility criteria with confirmed full virologic suppression in the HIV-positive partner. We included 3 additional studies (2 cohort studies, 1 RCT) that did not confirm viral suppression in the HIV-positive partner at transmission in a secondary meta-analysis. Methodologic quality was reasonable. The rate of transmission in the 3 studies confirming virologic suppression was 0 per 100 person-years (95% CI = 0–0.05), with low heterogeneity (I2 = 0%). When we included the 3 studies that did not confirm virologic suppression, the rate of transmission was 0.14 per 100 person-years (95%CI = 0.04–0.31) (I2 = 0%). In a sensitivity analysis including all 6 studies, the rate of transmission was 0 per 100 person-years (95%CI = 0–0.01) after omitting all transmissions with known detectable or unconfirmed viral loads, as full suppression in these cases was unlikely. Limitations included lack of data on same-sex couples, type of sexual intercourse (vaginal vs. anal), direction of HIV transmission, exact viral load at the time of transmission, sexually transmitted infections (STI) rates, and extent of condom use.ConclusionsOur findings suggest minimal risk of sexual HIV transmission for heterosexual serodiscordant couples when the HIV-positive partner has full viral suppression on cART with caveats regarding information on sexual intercourse type, STIs, and condom use. These findings have implications when counseling heterosexual serodiscordant couples on sexual and reproductive health. More research is needed to explore HIV transmission risk between same-sex couples.

This study aimed to understand gender and ethnicity differences in HIV-related stigma experienced by 1026 HIV-positive individuals living in Ontario, Canada that were enrolled in the OHTN Cohort Study. Total and subscale HIV-related stigma scores were measured using the revised HIV-related Stigma Scale. Correlates of total stigma scores were assessed in univariate and multivariate linear regression. Women had significantly higher total and subscale stigma scores than men (total, median = 56.0 vs. 48.0, p<0.0001). Among men and women, Black individuals had the highest, Aboriginal and Asian/Latin-American/Unspecified people intermediate, and White individuals the lowest total stigma scores. The gender-ethnicity interaction term was significant in multivariate analysis: Black women and Asian/Latin-American/Unspecified men reported the highest HIV-related stigma scores. Gender and ethnicity differences in HIV-related stigma were identified in our cohort. Findings suggest differing approaches may be required to address HIV-related stigma based on gender and ethnicity; and such strategies should challenge racist and sexist stereotypes.

In this work, an ultrasensitive electrogenerated chemiluminescence (ECL) biosensor for exosomes and their surface proteins was developed by the in situ formation of gold nanoparticles (AuNPs) decorated Ti3C2 MXenes hybrid with aptamer modification (AuNPs-MXenes-Apt). In this strategy, the exosomes were efficiently captured on an exosome recognized CD63 aptamer modified electrode interface. Meanwhile, in situ formation of gold nanoparticles on single layer Ti3C2MXenes with aptamer (MXenes-Apt) modification was obtained, in which MXenes acted as both reductants and stabilizer, and no additional reductant and stabilizer involved. The in situ formed AuNPs-MXenes-Apt hybrid not only presented highly efficient recognition of exosomes specifically, but also provide naked catalytic surface with high electrocatalytic activity of gold nanoparticles with predominated (111) facets that significantly improved the ECL signal of luminol. In this way, a highly sensitive ECL biosensor for exosomes detection was constructed ascribing to the synergistic effects of large surface area, excellent conductivity, and catalytic effects of the AuNPs-MXenes-Apt. The detection limit is 30 particles μL–1 for exosomes derived from HeLa cell line, which was over 1000 times lower than that of conventional ELISA method and the linear range was from 102 particles μL–1 to 105 particles μL–1. This ECL sensing platform possessed high selectivity toward exosomes and their surface proteins derived different kinds of tumor cell lines (HeLa cells, OVCAR cells and HepG2 cells), and enabled sensitive and accurate detection of exosomes from human serum, which implied that the ECL biosensor provided a feasible, sensitive, and reliable tool for exosomes detection in exosomes-related clinical diagnostic.

No abstract