Such isolates should undergo drug susceptibility testing periodically to detect emerging resistance.

BackgroundIndividuals living in sub-Saharan Africa represent 10% of the world's population but almost 2/3 of all HIV-1/AIDS cases. The disproportionate HIV-1 infection rates in this region may be linked to helminthic parasite infections that affect many individuals in the developing world. However, the hypothesis that parasite infection increases an individual's susceptibility to HIV-1 has never been prospectively tested in a relevant in vivo model.Methodology/Principal FindingsWe measured whether pre-existing infection of rhesus monkeys with a parasitic worm would facilitate systemic infection after mucosal AIDS virus exposure. Two groups of animals, one consisting of normal monkeys and the other harboring Schistosoma mansoni, were challenged intrarectally with decreasing doses of R5-tropic clade C simian-human immunodeficiency virus (SHIV-C). Systemic infection occurred in parasitized monkeys at viral doses that remained sub-infectious in normal hosts. In fact, the 50% animal infectious (AID50) SHIV-C dose was 17-fold lower in parasitized animals compared to controls (P<0.001). Coinfected animals also had significantly higher peak viral RNA loads than controls (P<0.001), as well as increased viral replication in CD4+ central memory cells (P = 0.03).Conclusions/SignificanceOur data provide the first direct evidence that acute schistosomiasis significantly increases the risk of de novo AIDS virus acquisition, and the magnitude of the effect suggests that control of helminth infections may be a useful public health intervention to help decrease the spread of HIV-1.

Background: Trichomonias is the most common non-viral STI among women worldwide and is associated with serious reproductive morbidity, poor birth outcomes and amplified HIV transmission. Single-dose metronidazole therapy has been the treatment of choice for over three decades. There is mounting evidence, however, of high rates of repeat positives following single-dose metronidazole, and among HIVinfected women, bacterial vaginosis (BV) was found to alter treatment efficacy. The purpose of this study was to examine the effectiveness of single-dose metronidazole compared to 7 day-dose metronidazole for the treatment of trichomoniasis among HIV-uninfected, non-pregnant women and to determine if this effect was modified by BV. Methods: This was a randomized, parallel, multi-site, open-label trial of single-dose (2 g one-time) versus 7 day-dose (500 mg twice daily) for the treatment of trichomoniasis. The primary outcome was T. vaginalis infection by arm, per nucleic acid amplification test or culture, four weeks post-completion of treatment, in intentto-treat analyses. This analysis was also stratified by BV status. Findings: Of 623 women randomized, those in the 7 day-dose arm were less likely to be T. vaginalis positive at test-of-cure compared to those in the single-dose arm [34/312 (10.9%) vs. 58/311 (18.6%), p=0·001] [R.R. 0.55 (95% C.I. 0.34–0.70)]. Risk was similar by BV status (p=0·17). Self-reported adherence in both arms was > 95%. Side effects were similar by arm. Interpretation: In this sample of HIV-uninfected, non-pregnant women with trichomoniasis, compared to single-dose, 7 day-dose metronidazole treatment resulted in 45% fewer treatment failures. The 7 day-dose metronidazole should be the preferred treatment for trichomoniasis among women.