Todd Lucas, Caroline Cooney, Amber Prainito, Catherine Godfrey, Valerian Kiggundu, Anne Goldzier Thomas, Renee Ridzon, Carlos Toledo
{"title":"Consolidated Overview of Notifiable Adverse Events in the U.S. President's Emergency Plan for AIDS Relief's Voluntary Medical Male Circumcision Program Through 2020.","authors":"Todd Lucas, Caroline Cooney, Amber Prainito, Catherine Godfrey, Valerian Kiggundu, Anne Goldzier Thomas, Renee Ridzon, Carlos Toledo","doi":"10.1007/s11904-022-00636-8","DOIUrl":"https://doi.org/10.1007/s11904-022-00636-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>Through December 2020, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) supported more than 25 million voluntary medical male circumcisions (VMMC) as part of the combined HIV prevention strategy in 15 African countries. PEPFAR monitors defined adverse events (AEs) occurring within 30 days of VMMC through its notifiable adverse event reporting system (NAERS). All NAERS reports through December 2020 were reviewed to quantify AE type, severity, and relation to the VMMC procedure. Interventions to improve client safety based on NAERS findings are described.</p><p><strong>Recent findings: </strong>Fourteen countries reported 446 clients with notifiable adverse events (NAEs); 394/446 (88%) were determined VMMC-related, representing approximately 18 NAE reports per million circumcisions. Fatalities comprised 56/446 (13%) with 24/56 (43%) of fatalities determined VMMC-related, representing 0.96 VMMC-related fatalities per million circumcisions. The remaining 390 NAEs were non-fatal with 370/390 (95%) VMMC-related. Multiple programmatic changes have been made based on NAERS data to improve client safety. Client safety is paramount in this surgical program designed for individual and population-level benefit. Surveillance of rare but severe complications following circumcision has identified pre-existing or new safety concerns and guided continuous programmatic improvement.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":"19 6","pages":"508-515"},"PeriodicalIF":4.6,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9643893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10633664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Current HIV/AIDS ReportsPub Date : 2022-12-01Epub Date: 2022-10-29DOI: 10.1007/s11904-022-00634-w
Jessica L Prodger, Ronald M Galiwango, Aaron A R Tobian, Daniel Park, Cindy M Liu, Rupert Kaul
{"title":"How Does Voluntary Medical Male Circumcision Reduce HIV Risk?","authors":"Jessica L Prodger, Ronald M Galiwango, Aaron A R Tobian, Daniel Park, Cindy M Liu, Rupert Kaul","doi":"10.1007/s11904-022-00634-w","DOIUrl":"10.1007/s11904-022-00634-w","url":null,"abstract":"<p><strong>Purpose of review: </strong>Voluntary medical male circumcision (VMMC) is a surgical procedure that reduces HIV acquisition risk by almost two-thirds. However, global implementation is lagging, in part due to VMMC hesitancy. A better understanding of the mechanism(s) by which this procedure protects against HIV may increase acceptance of VMMC as an HIV risk reduction approach among health care providers and their clients.</p><p><strong>Recent findings: </strong>HIV acquisition in the uncircumcised penis occurs preferentially across the inner foreskin tissues, due to increased susceptibility that is linked to elevated inflammatory cytokine levels in the sub-preputial space and an increased tissue density of HIV-susceptible CD4 + T cells. Inflammation can be caused by sexually transmitted infections, but is more commonly induced by specific anaerobic components of the penile microbiome. Circumcision protects by both directly removing the susceptible tissues of the inner foreskin, and by inducing a less inflammatory residual penile microbiome. VMMC reduces HIV susceptibility by removing susceptible penile tissues, and also through impacts on the penile immune and microbial milieu. Understanding these mechanisms may not only increase VMMC acceptability and reinvigorate global VMMC programs, but may also lead to non-surgical HIV prevention approaches focused on penile immunology and/or microbiota.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":"19 6","pages":"484-490"},"PeriodicalIF":3.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9617235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10429045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Current HIV/AIDS ReportsPub Date : 2022-12-01Epub Date: 2022-10-19DOI: 10.1007/s11904-022-00628-8
Patricia K Riggs, Antoine Chaillon, Guochun Jiang, Scott L Letendre, Yuyang Tang, Jeff Taylor, Andrew Kaytes, Davey M Smith, Karine Dubé, Sara Gianella
{"title":"Lessons for Understanding Central Nervous System HIV Reservoirs from the Last Gift Program.","authors":"Patricia K Riggs, Antoine Chaillon, Guochun Jiang, Scott L Letendre, Yuyang Tang, Jeff Taylor, Andrew Kaytes, Davey M Smith, Karine Dubé, Sara Gianella","doi":"10.1007/s11904-022-00628-8","DOIUrl":"10.1007/s11904-022-00628-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>Deep tissue HIV reservoirs, especially within the central nervous system (CNS), are understudied due to the challenges of sampling brain, spinal cord, and other tissues. Understanding the cellular characteristics and viral dynamics in CNS reservoirs is critical so that HIV cure trials can address them and monitor the direct and indirect effects of interventions. The Last Gift program was developed to address these needs by enrolling altruistic people with HIV (PWH) at the end of life who agree to rapid research autopsy.</p><p><strong>Recent findings: </strong>Recent findings from the Last Gift emphasize significant heterogeneity across CNS reservoirs, CNS compartmentalization including differential sensitivity to broadly neutralizing antibodies, and bidirectional migration of HIV across the blood-brain barrier. Our findings add support for the potential of CNS reservoirs to be a source of rebounding viruses and reseeding of systemic sites if they are not targeted by cure strategies. This review highlights important scientific, practical, and ethical lessons learned from the Last Gift program in the context of recent advances in understanding the CNS reservoirs and key knowledge gaps in current research.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":"19 6","pages":"566-579"},"PeriodicalIF":3.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9580451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9701587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Current HIV/AIDS ReportsPub Date : 2022-12-01Epub Date: 2022-11-11DOI: 10.1007/s11904-022-00638-6
Supriya D Mehta
{"title":"The Effects of Medical Male Circumcision on Female Partners' Sexual and Reproductive Health.","authors":"Supriya D Mehta","doi":"10.1007/s11904-022-00638-6","DOIUrl":"10.1007/s11904-022-00638-6","url":null,"abstract":"<p><strong>Purpose of review: </strong>Voluntary medical male circumcision (VMMC) reduces the risk of HIV acquisition by 60% among heterosexual men, provides protection against certain sexually transmitted infections (STI), and leads to penile microbiome composition changes associated with reduced risk of HIV infection. Intuitively, the benefits of VMMC for female sex partners in relation to STI are likely and have been evaluated. The purpose of this review is to examine emerging findings of broader sexual and reproductive health (SRH) benefits of VMMC for female sex partners.</p><p><strong>Recent findings: </strong>Systematic reviews find strong evidence for beneficial effects of VMMC on female sex partners risk of HPV, cervical dysplasia, cervical cancer, and with likely protection against trichomoniasis and certain genital ulcerative infections. Few studies assess the direct impact of VMMC on the vaginal microbiome (VMB), though several studies demonstrate reductions in BV, which is mediated by the VMB. Studies are lacking regarding male circumcision status and outcomes associated with non-optimal VMB, such as female infertility and adverse pregnancy outcomes. VMMC has positive effects on women's perceptions of sexual function and satisfaction, and perceptions of disease risk and hygiene, without evidence of risk compensation. VMMC has consistent association with a broad range of women's SRH outcomes, highlighting the biological and non-biological interdependencies within sexual relationships, and need for couples-level approaches to optimize SRH for men and women. The paucity of information on VMMC and influence on VMB is a barrier to optimizing VMB-associated SRH outcomes in female partners.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":"19 6","pages":"501-507"},"PeriodicalIF":4.6,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9759499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10632897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
George Ransley, Stanley Zimba, Yohane Gadama, Deanna Saylor, Laura Benjamin
{"title":"Trends and Clinical Characteristics of HIV and Cerebrovascular Disease in Low- and Middle-Income Countries (LMICs) Between 1990 and 2021.","authors":"George Ransley, Stanley Zimba, Yohane Gadama, Deanna Saylor, Laura Benjamin","doi":"10.1007/s11904-022-00627-9","DOIUrl":"https://doi.org/10.1007/s11904-022-00627-9","url":null,"abstract":"<p><strong>Purpose of the review: </strong>To describe trends and clinical characteristics of HIV and cerebrovascular disease between 1990 and 2021 in LMICs and identify the gaps in our understanding.</p><p><strong>Recent findings: </strong>In the era of antiretroviral therapy (ART), people living with HIV (PLWH) live longer and risk excess cerebrovascular events due to ageing and HIV-driven factors. Despite the highest burden of HIV infection in low-to-middle income countries, there is underreporting in the literature of cerebrovascular events in this population. We systematically reviewed published literature for primary clinical studies in adult PLWH and cerebrovascular disease in LMICs. The clinical phenotype of cerebrovascular disease among PLWH over the last three decades in LMICs has evolved and transitioned to an older group with overlapping cerebrovascular risk factors. There is an important need to increase research in this population and standardise reporting to facilitate understanding, guide development of appropriate interventions, and evaluate their impact.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":"19 6","pages":"548-565"},"PeriodicalIF":4.6,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9759508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9738765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Current HIV/AIDS ReportsPub Date : 2022-12-01Epub Date: 2022-09-26DOI: 10.1007/s11904-022-00630-0
Jessica M Phan, Sangmin Kim, Đoàn Thị Thùy Linh, Lisa A Cosimi, Todd M Pollack
{"title":"Telehealth Interventions for HIV in Low- and Middle-Income Countries.","authors":"Jessica M Phan, Sangmin Kim, Đoàn Thị Thùy Linh, Lisa A Cosimi, Todd M Pollack","doi":"10.1007/s11904-022-00630-0","DOIUrl":"10.1007/s11904-022-00630-0","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review summarizes technology-based interventions for HIV in low- and middle-income countries (LMICs). We highlight potential benefits and challenges to using telehealth in LMICs and propose areas for future study.</p><p><strong>Recent findings: </strong>We identified several models for using telehealth to expand HIV health care access in LMICs, including telemedicine visits for pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) services, telementoring programs for providers, and virtual peer-support groups. Emerging data support the acceptability and feasibility of these strategies. However, further investigations are needed to determine whether these models are scalable and sustainable in the face of barriers related to cost, infrastructure, and regulatory approval. HIV telehealth interventions may be a valuable approach to addressing gaps along the HIV care cascade in LMICs. Future studies should focus on strategies for expanding existing programs to scale and for assessing long-term clinical outcomes.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":"19 6","pages":"600-609"},"PeriodicalIF":3.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9510721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10631895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Does Voluntary Medical Male Circumcision Reduce HIV Risk in Men Who Have Sex with Men?","authors":"Yidie Lin, Yanxiao Gao, Yue Sun, DeAnne Turner, Huachun Zou, Sten H Vermund, Han-Zhu Qian","doi":"10.1007/s11904-022-00637-7","DOIUrl":"https://doi.org/10.1007/s11904-022-00637-7","url":null,"abstract":"<p><strong>Purpose of review: </strong>To review the evidence on the effect of voluntary medical male circumcision (VMMC) on reducing HIV risk among men who have sex with men (MSM) and assess the limitations of available evidence.</p><p><strong>Recent findings: </strong>Individual studies have shown conflicting results, but recent meta-analyses have consistently suggested that VMMC was associated with 7 to 23% reductions in HIV prevalence or incidence in MSM, particularly among a subgroup of men who predominantly practice insertive role in anal sex. Mathematical models have also suggested a moderate population-level impact of VMMC intervention. All original studies have been observational and are subject to confounding and bias. Randomized clinical trials (RCTs) are needed to provide strong evidence of assessing the efficacy of VMMC on HIV risk among MSM. VMMC is a promising HIV risk reduction tool for MSM. RCTs are needed to evaluate the efficacy of VMMC intervention.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":"19 6","pages":"522-525"},"PeriodicalIF":4.6,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10634727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna Bershteyn, Edinah Mudimu, Ingrida Platais, Samuel Mwalili, James E Zulu, Wiza N Mwanza, Katharine Kripke
{"title":"Understanding the Evolving Role of Voluntary Medical Male Circumcision as a Public Health Strategy in Eastern and Southern Africa: Opportunities and Challenges.","authors":"Anna Bershteyn, Edinah Mudimu, Ingrida Platais, Samuel Mwalili, James E Zulu, Wiza N Mwanza, Katharine Kripke","doi":"10.1007/s11904-022-00639-5","DOIUrl":"https://doi.org/10.1007/s11904-022-00639-5","url":null,"abstract":"<p><strong>Purpose of review: </strong>Voluntary male medical circumcision (VMMC) has been a cornerstone of HIV prevention in Eastern and Southern Africa (ESA) and is credited in part for declines in HIV incidence seen in recent years. However, these HIV incidence declines change VMMC cost-effectiveness and how it varies across populations.</p><p><strong>Recent findings: </strong>Mathematical models project continued cost-effectiveness of VMMC in much of ESA despite HIV incidence declines. A key data gap is how demand generation cost differs across age groups and over time as VMMC coverage increases. Additionally, VMMC models usually neglect non-HIV effects of VMMC, such as prevention of other sexually transmitted infections and medical adverse events. While small compared to HIV effects in the short term, these could become important as HIV incidence declines. Evidence to date supports prioritizing VMMC in ESA despite falling HIV incidence. Updated modeling methodologies will become necessary if HIV incidence reaches low levels.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":"19 6","pages":"526-536"},"PeriodicalIF":4.6,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9759505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10639041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Voluntary Medical Male Circumcision to Reduce HIV Acquisition and Transmission.","authors":"Sten H Vermund","doi":"10.1007/s11904-022-00631-z","DOIUrl":"10.1007/s11904-022-00631-z","url":null,"abstract":"<p><strong>Purpose of review: </strong>This commentary introduces the special Global Health Section on the state of voluntary medical male circumcision (VMMC) programs and current knowledge as to role of VMMC prevention of HIV infection acquisition in men and, indirectly, women.</p><p><strong>Recent findings: </strong>Since the first clinical trial of VMMC in Africa was published in 2005, implementation of programs has depended on illuminating best practices and key obstacles in the effort to expand VMMC in areas of high HIV prevalence to reduce HIV acquisition among men, with consequent benefits that uninfected men will not infect others. Global efforts are focused on sub-Saharan Africa, given the favorable expected impact of VMMC deployment where HIV incidence is high and circumcision rates are low. With estimated field effectiveness estimated to exceed 60%, reduced HIV risk for circumcised men in sub-Saharan Africa based on a once-only minor surgical intervention provides extraordinary preventive benefits. Where high VMMC rates have been achieved, declining HIV incidence rates may be partially or substantially attributed to VMMC, but this remains to be investigated. Articles in this special section address achievements, obstacles and risks, and plans for future progress in partnership with affected communities.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":"19 6","pages":"471-473"},"PeriodicalIF":4.6,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10767716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10625033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Current HIV/AIDS ReportsPub Date : 2022-12-01Epub Date: 2022-11-11DOI: 10.1007/s11904-022-00640-y
Megan E Peck, Todd Lucas, Katherine S Ong, Jonathan M Grund, Stephanie Davis, Aisha Yansaneh, Valerian L Kiggundu, Anne G Thomas, Kelly Curran, Catharine Laube, Maaya Sundaram, Wole Ameyan, Lycias Zembe, Carlos Toledo
{"title":"Defining the Global Research and Programmatic Agenda and Priority Actions for Voluntary Medical Male Circumcision for HIV Prevention.","authors":"Megan E Peck, Todd Lucas, Katherine S Ong, Jonathan M Grund, Stephanie Davis, Aisha Yansaneh, Valerian L Kiggundu, Anne G Thomas, Kelly Curran, Catharine Laube, Maaya Sundaram, Wole Ameyan, Lycias Zembe, Carlos Toledo","doi":"10.1007/s11904-022-00640-y","DOIUrl":"10.1007/s11904-022-00640-y","url":null,"abstract":"<p><strong>Purpose of review: </strong>Since 2007, voluntary medical male circumcision (VMMC) programs have been associated with substantially reduced HIV incidence across 15 prioritized countries in Eastern and Southern Africa. Drawing on the programmatic experience of global VMMC leaders, this report reviews progress made in the first 15 years of the program, describes programmatic and research gaps, and presents considerations to maximize the impact of VMMC.</p><p><strong>Recent findings: </strong>Overall, key programmatic and research gaps include a lack of robust male circumcision coverage estimates due to limitations to the data and a lack of standardized approaches across programs; challenges enhancing VMMC uptake include difficulties reaching populations at higher risk for HIV infection and men 30 years and older; limitations to program and procedural quality and safety including variations in approaches used by programs; and lastly, sustainability with limited evidence-based practices. Considerations to address these gaps include the need for global guidance on estimating coverage, conducting additional research on specific sub-populations to improve VMMC uptake, implementation of responsive and comprehensive approaches to adverse event surveillance, and diversifying financing streams to progress towards sustainability. This report's findings may help establish a global VMMC research and programmatic agenda to inform policy, research, and capacity-building activities at the national and global levels.</p>","PeriodicalId":10930,"journal":{"name":"Current HIV/AIDS Reports","volume":"19 6","pages":"537-547"},"PeriodicalIF":3.7,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9651117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10632900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}