Increases in Condomless Sex in the Swiss HIV Cohort Study

Condomless sex is a key driver of sexually transmitted diseases. In this study, we assess the long-term changes (2000-2013) of the occurrence of condomless sex among human immunodeficiency virus (HIV)-infected individuals enrolled in the Swiss HIV Cohort study. The frequencies with which HIV-infected individuals reported condomless sex were either stable or only weakly increasing for 2000-2008. For 2008-2013, these rates increased significantly for stable relationships among heterosexuals and men who have sex with men (MSM) and for occasional relationships among MSM. Our results highlight the increasing public health challenge posed by condomless sex and show that condomless sex has been increasing even in the most recent years.

Strong Impact of Smoking on Multimorbidity and Cardiovascular Risk Among Human Immunodeficiency Virus-Infected Individuals in Comparison With the General Population.

Background.  Although acquired immune deficiency syndrome-associated morbidity has diminished due to excellent viral control, multimorbidity may be increasing among human immunodeficiency virus (HIV)-infected persons compared with the general population. Methods.  We assessed the prevalence of comorbidities and multimorbidity in participants of the Swiss HIV Cohort Study (SHCS) compared with the population-based CoLaus study and the primary care-based FIRE (Family Medicine ICPC-Research using Electronic Medical Records) records. The incidence of the respective endpoints were assessed among SHCS and CoLaus participants. Poisson regression models were adjusted for age, sex, body mass index, and smoking. Results.  Overall, 74 291 participants contributed data to prevalence analyses (3230 HIV-infected; 71 061 controls). In CoLaus, FIRE, and SHCS, multimorbidity was present among 26%, 13%, and 27% of participants. Compared with nonsmoking individuals from CoLaus, the incidence of cardiovascular disease was elevated among smoking individuals but independent of HIV status (HIV-negative smoking: incidence rate ratio [IRR] = 1.7, 95% confidence interval [CI] = 1.2-2.5; HIV-positive smoking: IRR = 1.7, 95% CI = 1.1-2.6; HIV-positive nonsmoking: IRR = 0.79, 95% CI = 0.44-1.4). Compared with nonsmoking HIV-negative persons, multivariable Poisson regression identified associations of HIV infection with hypertension (nonsmoking: IRR = 1.9, 95% CI = 1.5-2.4; smoking: IRR = 2.0, 95% CI = 1.6-2.4), kidney (nonsmoking: IRR = 2.7, 95% CI = 1.9-3.8; smoking: IRR = 2.6, 95% CI = 1.9-3.6), and liver disease (nonsmoking: IRR = 1.8, 95% CI = 1.4-2.4; smoking: IRR = 1.7, 95% CI = 1.4-2.2). No evidence was found for an association of HIV-infection or smoking with diabetes mellitus. Conclusions.  Multimorbidity is more prevalent and incident in HIV-positive compared with HIV-negative individuals. Smoking, but not HIV status, has a strong impact on cardiovascular risk and multimorbidity.

Hepatitis B viral load in dried blood spots: A validation study in Zambia

Background: Access to hepatitis B viral load (VL) testing is poor in sub-Saharan Africa (SSA) due toeconomic and logistical reasons.Objectives: To demonstrate the feasibility of testing dried blood spots (DBS) for hepatitis B virus (HBV)VL in a laboratory in Lusaka, Zambia, and to compare HBV VLs between DBS and plasma samples.Study design: Paired plasma and DBS samples from HIV-HBV co-infected Zambian adults were analyzedfor HBV VL using the COBAS AmpliPrep/COBAS TaqMan HBV test (Version 2.0) and for HBV genotypeby direct sequencing. We used Bland-Altman analysis to compare VLs between sample types and bygenotype. Logistic regression analysis was conducted to assess the probability of an undetectable DBSresult by plasma VL.Results: Among 68 participants, median age was 34 years, 61.8% were men, and median plasma HBV VLwas 3.98 log IU/ml (interquartile range, 2.04–5.95). Among sequenced viruses, 28 were genotype A1 and27 were genotype E. Bland–Altman plots suggested strong agreement between DBS and plasma VLs. DBSVLs were on average 1.59 log IU/ml lower than plasma with 95% limits of agreement of −2.40 to −0.83 logIU/ml. At a plasma VL ≥2,000 IU/ml, the probability of an undetectable DBS result was 1.8% (95% CI:0.5–6.6). At plasma VL ≥20,000 IU/ml this probability reduced to 0.2% (95% CI: 0.03–1.7).

Molecular epidemiology of hepatitis B virus infection in Switzerland: a retrospective cohort study.

BACKGROUND Chronic hepatitis B virus (HBV) infection affects up to 7 % of the European population. Specific HBV genotypes are associated with rapid progression to end-stage liver disease and sub-optimal interferon treatment responses. Although the geographic distribution of HBV genotypes differs between regions, it has not been studied in Switzerland, which lies at the crossroads of Europe. METHODS In a retrospective analysis of 465 HBV samples collected between 2002 and 2013, we evaluated the HBV genotype distribution and phylogenetic determinants, as well as the prevalence of serological evidence of hepatitis delta, hepatitis C and HIV infections in Switzerland. Baseline characteristics of patients were compared across their region of origin using Fisher's exact test and ANOVA, and risk factors for HBeAg positivity were assessed using logistic regression. RESULTS The Swiss native population represented 15.7 % of HBV-infected patients living in Switzerland. In the overall population, genotype D was most prevalent (58.3 %), whereas genotype A (58.9 %) was the predominant genotype among the Swiss native population. The prevalence of patients with anti-HDV antibodies was 4.4 %. Patients of Swiss origin were most likely to be HBeAg-positive (38.1 %). HBV genotypes of patients living in Switzerland but sharing the same original region of origin were consistent with their place of birth. CONCLUSIONS The molecular epidemiology of HBV infection in Switzerland is driven by migration patterns and not by the genotype distribution of the native population. The prevalence of positive anti-HDV antibodies in our cohort was very low.

Decreasing Proportion of Recent Infections among Newly Diagnosed HIV-1 Cases in Switzerland, 2008 to 2013 Based on Line-Immunoassay-Based Algorithms.

BACKGROUND: HIV surveillance requires monitoring of new HIV diagnoses and differentiation of incident and older infections. In 2008, Switzerland implemented a system for monitoring incident HIV infections based on the results of a line immunoassay (Inno-Lia) mandatorily conducted for HIV confirmation and type differentiation (HIV-1, HIV-2) of all newly diagnosed patients. Based on this system, we assessed the proportion of incident HIV infection among newly diagnosed cases in Switzerland during 2008-2013. METHODS AND RESULTS: Inno-Lia antibody reaction patterns recorded in anonymous HIV notifications to the federal health authority were classified by 10 published algorithms into incident (up to 12 months) or older infections. Utilizing these data, annual incident infection estimates were obtained in two ways, (i) based on the diagnostic performance of the algorithms and utilizing the relationship 'incident = true incident + false incident', (ii) based on the window-periods of the algorithms and utilizing the relationship 'Prevalence = Incidence x Duration'. From 2008-2013, 3'851 HIV notifications were received. Adult HIV-1 infections amounted to 3'809 cases, and 3'636 of them (95.5%) contained Inno-Lia data. Incident infection totals calculated were similar for the performance- and window-based methods, amounting on average to 1'755 (95% confidence interval, 1588-1923) and 1'790 cases (95% CI, 1679-1900), respectively. More than half of these were among men who had sex with men. Both methods showed a continuous decline of annual incident infections 2008-2013, totaling -59.5% and -50.2%, respectively. The decline of incident infections continued even in 2012, when a 15% increase in HIV notifications had been observed. This increase was entirely due to older infections. Overall declines 2008-2013 were of similar extent among the major transmission groups. CONCLUSIONS: Inno-Lia based incident HIV-1 infection surveillance proved useful and reliable. It represents a free, additional public health benefit of the use of this relatively costly test for HIV confirmation and type differentiation.

Dossier: Voces del Caribe / Dossier: La autoficción en América Latina

En este nuevo número de los Cuadernos del CILHA reunimos una serie de trabajos referidos a los temas de la literatura del Caribe y de la autoficción en América Latina. El conjunto de trabajos referidos a la literatura del Caribe constituye un esfuerzo que le debemos a Lancelot Cowie y Nina Bruni, ambos de la University of West Indies, de Trinidad y Tobago. Estos profesores, para mayores datos, han creado en la Universidad anglófona el Centre for Latin America and Caribbean (CENLAC), un centro de estudios de la cultura latinoamericana. El dossier del Caribe, entonces, presenta una serie de investigaciones que abordan nuevas problemáticas y autores poco conocidos en el Cono Sur, por no decir desconocidos debido a la escasa o nula circulación editorial; así como también el dossier contiene trabajos sobre autores consagrados, aunque en esta oportunidad se ofrecen nuevas y renovadas miradas. Los estudios literarios del área del Cono Sur presentan una marcada ausencia de investigaciones sobre la producción caribeña. Entre las razones de tal déficit se puede mencionar la secular incomunicación que existe entre las diversas naciones latinoamericanas, una problemática que abarca por lo menos todo el período republicano, y que se intensifica, en la actualidad, con ciertas políticas editoriales metropolitanas. Una segunda razón, derivada de lo anterior, es el escaso conocimiento del movimiento cultural del Caribe que se posee en el Cono Sur. El título de este dossier, “Voces del Caribe", es bastante elocuente respecto de su contenido, ya que ofrece un panorama a través de discursos polifónicos, plurales y heterogéneos. Ello es así en virtud de que tales características son las que mejor representan el abigarrado universo caribeño, que es además plurirracial, plurilingüístico y caótico, en el sentido que le dio Antonio Benítez Rojo al Caos en su ya clásico estudio sobre la cultura del Caribe, La isla que se repite. Esperamos que con este esfuerzo de los Cuadernos contribuyamos en algo al acercamiento entre el Caribe y el resto de América Latina. El segundo dossier de este número ha estado a cargo de Miriam Di Gerónimo, investigadora y docente de la Universidad Nacional de Cuyo, especialista en narrativa breve y en la obra de Julio Cortázar. La Dra. Di Gerónimo ha reunido un conjunto de investigadores de prestigio internacional para tratar el tema de la autoficción en la literatura de lengua hispana. Como ella misma dice en la introducción los autores

Diversity of ocean acidification effects on marine N2 fixers

Considering the important role of N2 fixation for primary productivity and CO2 sequestration, it is crucial to assess the response of diazotrophs to ocean acidification. Previous studies on the genus Trichodesmium suggested a strong sensitivity towards ocean acidification. In view of the large functional diversity in N2 fixers, the objective of this study was to improve our knowledge of the CO2 responses of other diazotrophs. To this end, the single-celled Cyanothece sp. and two heterocystous species, Nodularia spumigena and the symbiotic Calothrix rhizosoleniae, were acclimated to two pCO2 levels (380 vs. 980 µatm). Growth rates, cellular composition (carbon, nitrogen and chlorophyll a) as well as carbon and N2 fixation rates (14C incorporation, acetylene reduction) were measured and compared to literature data on different N2 fixers. The three species investigated in this study responded differently to elevated pCO2, showing enhanced, decreased as well as unaltered growth and production rates. For instance, Cyanothece increased production rates with pCO2, which is in line with the general view that N2 fixers benefit from ocean acidification. Due to lowered growth and production of Nodularia, nitrogen input to the Baltic Sea might decrease in the future. In Calothrix, no significant changes in growth or production could be observed, even though N2 fixation was stimulated under elevated pCO2. Reviewing literature data confirmed a large variability in CO2 sensitivity across diazotrophs. The contrasting response patterns in our and previous studies were discussed with regard to the carbonate chemistry in the respective natural habitats, the mode of N2 fixation as well as differences in cellular energy limitation between the species. The group-specific CO2 sensitivities will impact differently on future biogeochemical cycles of open-ocean environments and systems like the Baltic Sea and should therefore be considered in models estimating climate feedback effects.

Combined effects of different CO2 levels and N sources on the diazotrophic cyanobacterium Trichodesmium

To predict effects of climate change and possible feedbacks, it is crucial to understand the mechanisms behind CO2 responses of biogeochemically relevant phytoplankton species. Previous experiments on the abundant N2 fixers Trichodesmium demonstrated strong CO2 responses, which were attributed to an energy reallocation between its carbon (C) and nitrogen (N) acquisition. Pursuing this hypothesis, we manipulated the cellular energy budget by growing Trichodesmium erythraeum IMS101 under different CO2 partial pressure (pCO2) levels (180, 380, 980 and 1400?µatm) and N sources (N2 and NO3-). Subsequently, biomass production and the main energy-generating processes (photosynthesis and respiration) and energy-consuming processes (N2 fixation and C acquisition) were measured. While oxygen fluxes and chlorophyll fluorescence indicated that energy generation and its diurnal cycle was neither affected by pCO2 nor N source, cells differed in production rates and composition. Elevated pCO2 increased N2 fixation and organic C and N contents. The degree of stimulation was higher for nitrogenase activity than for cell contents, indicating a pCO2 effect on the transfer efficiency from N2 to biomass. pCO2-dependent changes in the diurnal cycle of N2 fixation correlated well with C affinities, confirming the interactions between N and C acquisition. Regarding effects of the N source, production rates were enhanced in NO3-grown cells, which we attribute to the higher N retention and lower ATP demand compared with N2 fixation. pCO2 effects on C affinity were less pronounced in NO3- users than N2 fixers. Our study illustrates the necessity to understand energy budgets and fluxes under different environmental conditions for explaining indirect effects of rising pCO2.

Las tres purpuras de Alzira. Bernardo, Maria y Gracia vida y martirio de los tres santos hermanos ...

Contiene: Fe de erratas, Indice de las cosas contenidas a dos col., p. 130-139 ; Indice locorum sacrae, p. 140-146 ; Indice axiomatum, p. 147-150 ; Biografía de S. Bernardo en latín, p. 151-152