Although anal infections with high-risk HPV and AIN in HIV-positive men are associated with a history of RAI, both conditions are commonly identified in HIV-positive men without this history. Both lower nadir CD4(+) cell counts and lack of current ART were associated with AIN but not with the detection of anal HPV.

Introduction: Screening for acute and early HIV infections (AEHI) among men who have sex with men (MSM) remains uncommon in sub-Saharan Africa (SSA). Yet, undiagnosed AEHI among MSM and subsequent failure to link to care are important drivers of the HIV epidemic. We conducted a systematic review and meta-analysis of AEHI yield among MSM mobilized for AEHI testing; and assessed which risk factors and/or symptoms could increase AEHI yield in MSM. Methods: We systematically searched four databases from their inception through May 2020 for studies reporting strategies of mobilizing MSM for testing and their AEHI yield, or risk and/or symptom scores targeting AEHI screening. AEHI yield was defined as the proportion of AEHI cases among the total number of visits. Study estimates for AEHI yield were pooled using random effects models. Predictive ability of risk and/or symptom scores was expressed as the area under the receiver operator curve (AUC). Results: Twenty-two studies were identified and included a variety of mobilization strategies (eight studies) and risk and/or symptom scores (fourteen studies). The overall pooled AEHI yield was 6.3% (95% CI, 2.1 to 12.4; I 2 = 94.9%; five studies); yield varied between studies using targeted strategies (11.1%; 95% CI, 5.9 to 17.6; I 2 = 83.8%; three studies) versus universal testing (1.6%; 95% CI, 0.8 to 2.4; two studies). The AUC of risk and/or symptom scores ranged from 0.69 to 0.89 in development study samples, and from 0.51 to 0.88 in validation study samples. AUC was the highest for scores including symptoms, such as diarrhoea, fever and fatigue. Key risk score variables were age, number of sexual partners, condomless receptive anal intercourse, sexual intercourse with a person living with HIV, a sexually transmitted infection, and illicit drug use. No studies were identified that assessed AEHI yield among MSM in SSA and risk and/or symptom scores developed among MSM in SSA lacked validation. Conclusions: Strategies mobilizing MSM for targeted AEHI testing resulted in substantially higher AEHI yields than universal AEHI testing. Targeted AEHI testing may be optimized using risk and/or symptom scores, especially if scores include symptoms. Studies assessing AEHI yield and validation of risk and/or symptom scores among MSM in SSA are urgently needed.

Introduction HIV partner notification services (HPN), peer mobilisation with HIV self-testing and acute and early HIV infection (AEHI) screening among gay, bisexual, other men who have sex with men (GBMSM) and transgender women (TGW) were assessed for acceptability, feasibility and linkage to antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) services. Methods Between April-August 2019, peer mobilisers mobilised clients by offering HIV oral self-tests and immediate clinic referral for clients with AEHI symptoms. Mobilised participants received clinic-based rapid antibody testing and point-of-care HIV-RNA testing. Newly diagnosed participants including those derived from HIV testing services were offered immediate ART and HPN. Partners were recruited through HPN. . Results Of 772 mobilised clients, 452 (58.5%) enrolled in the study as mobilised participants. Of these, 16 (3.5%) were HIV newly diagnosed, including 2 (0.4%) with AEHI. All but two (14/16, 87.5%) initiated ART. 35 GBMSM and TGW were offered HPN and 27 (77.1%) accepted it. Provider referral identified a higher proportion of partners tested (39/64; 60.9% vs. 5/14; 35.7%) and partners with HIV (27/39; 69.2% vs. 2/5; 40.0%) than index referral. Of 44 enrolled partners, 10 (22.7%) were newly diagnosed, including 3 (6.8%) with AEHI. All 10 (100%) initiated ART. PrEP was initiated among 24.0% (103/429) mobilised participants and 28.6% (4/14) partners without HIV. Conclusions HPN, combined with a peer mobilisation-led self-testing strategy and AEHI screening for GBMSM and TGW, appears acceptable and feasible. These strategies, especially HPN provider referral, effectively identified undiagnosed HIV infections and linked individuals to ART and PrEP-services.

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drug. The five patients treated initially with nifedipine relapsed within one week of starting placebo treatment. In three patients the relapse was so severe that the code was broken and the patients began treatment with nifedipine again, with symptomatic response. In the remaining two patients in this group and the five initially treated with placebo new chilblains continued to develop and individual lesions resolved slowly over 20 to 28 days from their onset. Nifedipine reduced the pain, soreness, and irritation of the lesions; placebo was ineffective. Irritation resolved within three to five days (20-25 days with placebo), and lesions became painless after five days (25 days with placebo).Mild dizziness, flushing, and occasional headaches were experienced during treatment with nifedipine, but only one patient required a reduction ofthe dose to 40 mg daily because of symptomatic hypotension. This patient continued to derive benefit from the reduced dose. CommentThis study shows that nifedipine is effective in the treatment of severe recurrent idiopathic permiosis. Further research is needed to understand the pathophysiology of this common condition.