Background Studying HIV transmission networks provides insight into the spread of HIV and opportunities for intervention. We identified transmission dynamics among risk groups and racial/ethnic groups in the United States. Methods For HIV-1 pol sequences reported to the U.S. National HIV Surveillance System during 2001–2012, we calculated pairwise genetic distance, identified linked pairs of sequences (those with distance ≤1.5%), and examined transmission category and race/ethnicity of these potential transmission partners. Results Of 40,950 sequences, 12,910 (32%) linked to ≥1 other sequence. Of men who have sex with men (MSM) who linked to ≥1 sequence, 88% were linked to other MSM and only 4% were linked to heterosexual women. Of heterosexual women for whom we identified potential transmission partners, 29% linked to MSM, 21% to heterosexual men, and 12% to persons who inject drugs. Older and black MSM were more likely to be linked to heterosexual women. Assortative mixing was present for all racial/ethnic groups; 81% of blacks/African Americans linked to other blacks. Conclusions This analysis is the first use of U.S. surveillance data to infer an HIV transmission network. Our data suggest that HIV infections among heterosexual women predominantly originate from MSM, followed by heterosexual men. Although few MSM were linked to women, suggesting that a minority of MSM are involved in transmission with heterosexual women, these transmissions represent a substantial proportion of HIV acquisitions by heterosexual women. Interventions that reduce transmissions involving MSM are likely to also reduce HIV acquisition among other risk groups.
Posterior dislocations of the shoulder are rare, comprising only 4% of shoulder dislocations. Several operative procedures have been described in treating recurrent dislocations, and results have been varied. A retrospective review of eight shoulders in eight patients treated by posterior glenoidplasty with capsulorrhaphy and infraspinatus advancement revealed generally good results. Followup ranged from 10 to 114 months, with an average of 36 months. Seven patients were classified as recurrent traumatic dislocators and one as a recurrent atraumatic voluntary dislocator. Results graded as good, fair, and failure were based on pain, range of motion, return to activities, recurrence, and roentgenograms. Six patients had good results with return to full activity, full range of motion, no pain, no recurrence, and no degenerative changes of roentgenograms. One patient, who has not returned to athletic activities and has occasional pain and limited range of motion, was graded as a fair result. The patient classified as an atraumatic voluntary dislocator has occasional feelings of instability and slight pain with strenuous activity, but has not had a recurrence and has no difficulty with activities of daily living. She was also classified as a fair result. There have been no recurrences or degenerative changes on followup radiographs. Computerized tomography performed on two patients documented a definite change in orientation of the glenoid. We feel that glenoidplasty with capsular reefing and infraspinatus advancement, if performed carefully, provides an excellent operative treatment for recurrent posterior dislocations of the shoulder.
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