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Cervical screening intervals can be extended in women living with HIV following an initial negative human papillomavirus DNA test
Firmer evidence is needed to guide cervical cancer screening in women with HIV. A study from India enrolled women with no history of cervical intraepithelial neoplasia (CIN) or cancer and with normal colposcopy at baseline. Participants underwent annual colposcopies followed by three yearly human papillomavirus (HPV) DNA testing. Among 869 women observed over a median of 3.5 years (IQR 2.8–4.3), 54 had incident CIN (CIN 1=35, CIN 2+=19). Among women with CIN endpoint assessments, CIN incidence was lower in women with a negative baseline HPV test (20 of 575, 3.5%) compared with those with baseline HPV detection (30 of 148, 20.3%). Most women who tested HPV negative at baseline remained HPV negative during follow-up. CIN incidence was lower among persistently HPV-negative women (14 of 499, 2.8%) compared with women with incident HPV infections (6 of 76, 7.9%). The findings support the WHO recommendation to perform HPV screening after 3–5 years in HIV-infected women who test negative for HPV.
Joshi S, Muwonge R, Kulkarni V, et al. Can we increase the cervical cancer screening interval with an HPV test for women living with HIV? Results of a cohort study from Maharashtra, India. Int J Cancer 2023;152:249–58.
Doxycycline post-exposure prophylaxis prevents gonorrhoea, chlamydia and syphilis in men who have sex with men irrespective of HIV status
This open-label trial recruited men and transgender women taking HIV pre-exposure prophylaxis (PrEP, n=327) or living with HIV (n=174) and had a history of condomless anal or oral sex with a man and a diagnosis of gonorrhoea, chlamydia or syphilis in the past year. Participants were randomised 2:1 to be prescribed 200 mg of doxycycline for self-initiation within 72 hours of condomless anogenital, vaginal or oral sex, or to standard of care without doxycycline post-exposure prophylaxis (PEP). Sexually transmitted infection (STI) testing was performed quarterly. Over 12 months, doxycycline reduced the incidence of bacterial STIs by 62% (HIV group) and 66% (PrEP group); the effect was stronger for chlamydia (74% and 88%) and syphilis (77% and 87%) than for gonorrhoea (57% and 55%). Most participants described good PEP adherence and no serious adverse events were reported. The data support the use of doxycycline PEP for men who have sex with men (MSM) with a previous STI diagnosis, regardless of HIV status. Further studies are needed in other populations and settings.
Luetkemeyer AF, Donnell D, Dombrowski JC, et al. Postexposure doxycycline to prevent bacterial sexually transmitted infections. NEJM 2023;388:1296–306.
Among people who inject drugs, younger individuals and women remain especially vulnerable to HIV and hepatitis C virus acquisition
A meta-analysis of global data determined the incidence of HIV infection (64 studies, mostly from high-income and middle-income countries) and of a first infection with hepatitis C virus (HCV) (66 studies, mostly from high-income countries) among people who inject drugs. Over 180 857 person-years, the pooled incidence (per 100 person-years) was 1.7 (95% CI 1.3 to 2.3) in 1987–2021 for HIV and 12.1 (95% CI 10.0 to 14.6) in 1992–2021 for HCV, with considerable heterogeneity across regions and populations. Younger individuals (≤25 years) had higher incidence of HIV (relative risk (RR) 1.5) and HCV (RR 1.5) than older people, and women had a higher incidence of HIV (RR 1.4) and HCV (RR 1.2) than men. Given the substantial data gap, intensified efforts are needed to monitor the HIV and HCV epidemics among people who inject drugs. Appropriate prevention and harm reduction measures are needed to reduce the risk of infection among younger individuals and women.
Artenie A, Stone J, Fraser H, et al. Incidence of HIV and hepatitis C virus among people who inject drugs, and associations with age and sex or gender: a global systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2023;8:533–52.
One-third of individuals living with both HIV and HCV have not commenced direct-acting antiviral treatment in spite of unrestricted access
A pooled analysis of nine observational cohorts assessed uptake of direct-acting antivirals (DAAs) among 4553 individuals with HIV/HCV coinfection in the context of unrestricted access in 2014–2017 in Australia, Canada, France, the Netherlands, Spain and Switzerland. Almost one-third (n=1365; 30%) remained untreated during a median follow-up of 22 months (IQR 8–30), with substantial variation between countries and populations. Those linked to care in Australia, France and the Netherlands, receiving antiretroviral therapy with undetectable plasma HIV RNA, with shorter duration since a first positive HCV test, and with a history of HCV treatment, were more likely to commence DAAs. Compared with MSM, heterosexual males and females with unknown/other transmission route (neither heterosexual nor injecting drug use) had lower rates of DAA commencement. Differences in access to care and barriers to treatment need addressing to ensure all people with HCV infection are treated.
Isfordink CJ, Boyd A, Sacks-Davis R, et al. Reasons for not commencing direct-acting antiviral treatment despite unrestricted access for individuals with HIV and hepatitis C virus: a multinational, prospective cohort study. Lancet Public Health. 2023;8:e294–304. doi: 10.1016 /S2468-2667(23)00056-7
Published in Sexually Transmitted Infections: three-site screening continues to be indicated for asymptomatic MSM who access online STI testing
Extragenital infections with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are commonly asymptomatic in MSM, and three-site (oropharyngeal, rectal and urethral) STI screening is currently recommended. This study of asymptomatic MSM who accessed online STI testing in 2016–2020 in the UK sought to determine the proportion of extragenital infections that would have been missed if, to simplify testing and/or minimise cost, screening had been limited to urine alone. From a total of 5601 self-collected samples returned, the number of valid samples for all three sites (urine, throat swab and urethral swab) was 5051 for CT testing and 5040 for NG testing. Of these, 5.9% (298 of 5051) and 4.5% (228 of 5040) were positive, respectively. Most CT (214 of 298, 72%) and NG (205 of 228, 90%) infections were extragenital, without concurrent urethral infection. As online STI testing services expand, three-site screening should remain standard for MSM. The potential for pooling samples from multiple sites is being explored in separate studies.
Charin G, Symonds Y, Scholfield C, et al. Three-site screening for STIs in men who have sex with men using online self-testing in an English sexual health service. Sex Transm Infect 2023;99:195–97.
A single dose of the JYNNEOS vaccine lowers the risk of mpox among men
The Modified Vaccinia Ankara-Bavarian Nordic JYNNEOS vaccine currently available against mpox is to be administered in two subcutaneous doses. However, a single dose has been recommended for immunocompetent people where supplies are limited. This retrospective cohort study reports preliminary observations on the real-world effectiveness of a single vaccine dose among 2054 men in Israel. A total of 1037 (50%) were vaccinated, including 136 of 647 (21%) living with HIV. Over 90–147 days of follow-up, mpox occurred in 16 unvaccinated and 5 vaccinated individuals, yielding an adjusted HR of 0.14 (95% CI 0.05 to 0.41) in favour of vaccination. No influence of HIV coinfection on vaccine effectiveness was detected. Additional data are needed to assess the effectiveness of mpox vaccination in populations with and without HIV.
Wolff Sagy Y, Zucker R, Hammerman A, et al. Real-world effectiveness of a single dose of mpox vaccine in males. Nat Med 2023;29:748–52.
Patient consent for publication
Handling editor Anna Maria Geretti
Contributors RKJT, NAV and DZ contributed equally to writing the article.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.