The role of bathhouses and sex clubs in HIV transmission: findings from a mathematic model

Can HIV-1 incidence be estimated from plasma viral load and sexual behaviour?

To estimate the impact of sexual practices and HIV-1 viral load status on HIV-1 incidence, we surveyed 38 men who have sex with men (MSM) on their sexual practices in the past three months. HIV-1 RNA load was measured in semen and blood contemporaneously. A Bernoulli model was developed incorporating seminal plasma viral load (SPVL), number and serostatus of partners, and number of protected and unprotected episodes of anal intercourse. Probability of transmission according to SPVL was determined by sensitivity analysis based on the correlation between blood plasma viral load (BPVL) and SPVL. There was a BPVL threshold below which SPVL was low or undetectable and above which SPVL increased geometrically. Seven subjects infected 0.93 HIV-1-negative partners and 13 subjects infected 4.28 unknown serostatus partners. Probability estimates were heavily skewed by a small number of subjects with high rates of unprotected sex and multiple sexual partners. We conclude that more HIV-1 infections may occur from increased episodes of unprotected sex with multiple partners of unknown HIV-1 serostatus. The model can be used to counsel individuals or predict epidemics, and to assess behaviour change or the impact of public health interventions.

Unprotected sex, underestimated risk, undiagnosed HIV and sexually transmitted diseases among men who have sex with men accessing testing services in a New England bathhouse

American men who have sex with men (MSM) continue to have increased rates of HIV and sexually transmitted diseases (STD). Between 2004 and 2010, 1155 MSM were tested for HIV and/or STDs at Providence, RI bathhouse. The prevalence of HIV was 2.3%; syphilis, 2.0%; urethral gonorrhea, 0.1%; urethral chlamydia, 1.3%; 2.2% of the men had hepatitis C antibodies. Although 43.2% of the men engaged in unprotected anal intercourse in the prior 2 months, the majority of the men thought that their behaviors did not put them at increased risk for HIV or STDs. Multivariate analyses found that men who engaged in unprotected anal intercourse were more likely to have had sex with unknown status or HIV-infected partners; have sex although under the influence of drugs; tended to find partners on the internet; and were more likely to have a primary male partner. Men who were newly diagnosed with HIV or syphilis tended to be older than 30 years; had sex with an HIV-infected partner; had a prior STD diagnosis; and met partners on the internet. For 10.5% of the men, bathhouse testing was the first time that they had ever been screened for HIV. Of 24 men who were newly diagnosed with HIV infection, only 1 was not successfully linked to care. These data suggest that offering HIV and STD testing in a bathhouse setting is effective in attracting MSM who are at increased risk for HIV and/or STD acquisition or transmission.

Primary graft failure after Descemet-stripping automated endothelial keratoplasty: clinico-pathological study

PURPOSE

Descemet-stripping automated endothelial keratoplasty (DSAEK) is a selective tissue corneal transplantation procedure in which only the diseased endothelium and the Descemet membrane is replaced. Refractive and visual results have been encouraging with this procedure, but higher rates of primary graft failure have been noted. We herein report histopathologic and ultrastructural changes in 2 cases of primary graft failure after DSAEK. We are not aware of these features being reported previously.

METHODS

Two cases of primary graft failure after DSAEK. One patient underwent DSAEK for Fuchs endothelial dystrophy and the other for pseudophakic bullous keratopathy. Both DSAEK procedures were uneventful. Postoperatively, there was no graft dislocation, but 1 patient had a nasal Descemet detachment that was reapposed with intracameral air. One month postoperatively, there was no improvement in the vision, and both patients had pronounced swelling of the recipient and donor corneas. Both patients underwent graft exchange. Both the recipient and donor corneal edema resolved.

RESULTS

Histopathologic evaluation showed marked corneal edema and loss of endothelial cells. Ultrastructural evaluation showed only remnant endothelial cell membranes present in 1 sample devoid of any intracellular contents. Transmission electron microscopy showed the presence of extensively damaged keratocytes in the deep posterior stroma and also in the interface at the graft-host junction.

CONCLUSIONS

These cases show widespread and irrecoverable endothelial and keratocyte damage in patients with primary graft failure after DSAEK.