Myron Cohen

..South China faces expanding syphilis and sexually transmitted HIV epidemics, but health systems characteristics important for scaling up syphilis and HIV testing have not been defined...

..Antiretroviral therapy that reduces viral replication could limit the transmission of human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples...

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..This article provides a review of the data on the use of ART to prevent the sexual transmission of HIV and identify challenges to improving and clarifying this approach...

..In the absence of more-reliable options, such as a vaccine, factors that define HIV infectivity and susceptibility and factors that amplify the risk of HIV transmission, may serve as critical targets for containment of the HIV epidemic...

..Prevention of sexual transmission of HIV likely requires maximal suppression of genital tract HIV viral burden, either through treatment of STDS or use of antiretroviral agents...

..Above all, prevention of HIV requires decision-makers to focus resources on strategies that are most effective. Finally, treatment of HIV and prevention of HIV must be considered and deployed together...

..In this article, we review the data supporting the use of ART to prevent HIV transmission and critically examine the public health implications of this strategy...

..Lastly, we review important achievements of and future challenges facing China as she steps into her eighth year of the National Free Antiretroviral Treatment Program...

..The experimental model has proven to be an efficient means of studying gonococcal infection and focusing vaccine development. In addition, this model should allow vaccines to be tested quickly and efficiently...

..Among men presenting for care for symptomatic sexually transmitted infections (STIs) in Malawi, trichomoniasis is not considered for first-line treatment...

..We investigated the hypothesis that STDs increase the likelihood of transmission of HIV-1 through increased concentration of the virus in semen...

..Such treatment should be strongly considered as part of empirical therapy for urethritis in men in Malawi and places where T vaginalis infection in men is common...

..Semen was the most sensitive single specimen, and, in 25.6% of cases, only semen specimens tested positive. Thus, prevalence of T. vaginalis infection in men is underestimated if only 1 specimen is tested...

..This study was conducted to compare viral dynamics in blood and semen between subjects with antibody negative, acute HIV-1 infection and other subjects with later stages of infection...

..Alternative screening methods are required for diagnosis of acute HIV infection; such screening could be important for research and for prevention of the sexual transmission of HIV in select populations...

..However, the etiologic pathogens of GUD vary temporally and geographically, and current criteria may not reflect changes in the prevalence of specific pathogens...

..Greater efforts are needed in identifying acute HIV infection in STD clinics. This article summarizes a presentation by Myron S. Cohen, MD, at the International AIDS Society-USA course in Chicago in May...

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..In this article, we explore the rationale for using antiretroviral therapy to prevent sexual transmission of HIV, as well as the limitations of this approach...

..The absence of unique variants and the lack of significant differences in the relative abundance of variants between these compartments support the conclusion that viruses in the blood plasma and breast milk are well equilibrated...

..To evaluate the case-finding effectiveness of a clinic-based partner notification effort for early syphilis in Madagascar...

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..This analysis focuses on the subset of sexually experienced young women with only one reported lifetime sex partner (n = 1708)...

..To facilitate the efficient use of these tests, we sought to develop a risk score algorithm for identifying likely AHI cases and targeting the tests towards those individuals...

..Dual HIV rapid tests have high sensitivity and specificity. HIV testing should be repeated in the third trimester and/or at delivery...

..vaginalis in male partners required multiple specimens. The majority of male sexual partners in this study were infected, emphasizing the importance of partner evaluation and treatment...

..The objective of this study was to assess the validity of women's reports of recent unprotected sex by testing for prostate-specific antigen (PSA) in vaginal samples...

..We conducted a prospective study to evaluate methods of detecting clients with sexually transmitted diseases (STDs) who were acutely coinfected with human immunodeficiency virus (HIV) in Lilongwe, Malawi...

..We sought to establish current laboratory-based Neisseria gonorrhoeae antibiotic susceptibility patterns for Malawi and describe the pattern of susceptibility since syndromic management began...

..001 was estimated among stable couples with low prevalences of high-risk cofactors, and represents a lower bound. Cofactor effects are important to include in epidemic models, policy considerations, and prevention messages...

..To quantitate extracellular and intracellular zidovudine (ZDV) and lamivudine (3TC) concentrations in blood and semen of HIV-1-infected men...

..Such findings have led to hypotheses that the probability of HIV transmission from men to women must be far higher than previously appreciated...

..Successful treatment of parasitic infections had no effect on HIV RNA levels. Although common, parasitic infections did not impact HIV RNA levels...

..For clinical research settings in which vaginal specimens are not available and culture conditions are not feasible, urine-based PCR-ELISA may be useful for the detection of trichomoniasis in women...

..Although screening for Chlamydia trachomatis is widely recommended among young adult women, little information is available regarding the prevalence of chlamydial and gonococcal infections in the general young adult population...

..North Carolina has added nucleic acid amplification testing for the human immunodeficiency virus (HIV) to standard HIV antibody tests to detect persons with acute HIV infection who are viremic but antibody-negative...

..We examined whether viral dynamics in the genital tract during the natural history of acute human immunodeficiency virus type 1 (HIV-1) infection could explain efficient heterosexual transmission of HIV...

..In this review article, we will highlight critical opportunities for HIV treatment and prevention that are presented by these diagnostic strategies...

..Nucleic acid amplification tests can increase detection of T. vaginalis in men compared with culture...

..The prevalence of trichomoniasis in the general population of the United States is unknown. This study provides the first population-based prevalence estimates of trichomoniasis among young adults in the United States...

..Targeted STD detection and treatment should have a central role in HIV prevention in these emerging epidemics...

..Whole milk demonstrated higher sensitivity and mean concentration than any other single component. Sensitivity was enhanced by analyzing all 4 components of breast milk...

..Trichomonas vaginalis is the most common nonviral sexually transmitted pathogen. Wet mount microscopy performs poorly compared with culture; however, universal screening using culture would be cost-prohibitive...

..In SP, EFV reaches concentrations above the HIV-1 IC(90)(WT) throughout the dosing interval. EFV-containing regimens effectively suppress HIV-1 RNA in SP...

..Of 8 ARVs, CVF concentrations ranged from <10% to >100% of BP concentrations. These large differences in CVF penetration suggest that further research into ARV pharmacokinetics and drug efficacy in the FGT is necessary...

..The rationale for antiretroviral and HSV-2-specific interventions and studies to test these strategies are described...

..However, some patients may not benefit from combination antiretroviral therapy (cART) because of inadequate access to HIV care, including attrition after care initiation...

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..To measure tenofovir (TFV) concentrations in the male genital tract (GT) after single and multiple doses of tenofovir disoproxil fumarate (TDF) and evaluate the HIV-1 RNA response to monotherapy...

..For clinical research settings in which urethral swabs are not available and culture is not feasible, the urine-based PCR-ELISA may be useful for detection of trichomoniasis in men...

..While the effect of HIV-1 on depletion of gut CD4(+) T cells in acute HIV-1 infection is well described, we studied blood and tissue B cells soon after infection to determine the effect of early HIV-1 on these cells...

..Human papillomavirus (HPV) prevalence and type distribution were estimated among 90 female sex workers (FSWs) aged 18 to 58 years in Antananarivo, Madagascar...

..Influencing adolescents' sexual behaviors has the potential to influence trajectories of risk for sexually transmitted infections (STIs) among young adults...

..Recently, this simple and sensitive method was used to determine amprenavir concentrations in seminal samples collected from HIV-1 positive subjects receiving amprenavir antiretroviral therapy as part of a multicenter clinical trial...

..We conclude that further technical advances are essential to allow more widespread detection of patients with AHI and to affect HIV treatment outcomes and transmission prevention...

..To describe first dose and steady state antiretroviral drug exposure in the female genital tract...

..qLCR will be useful for studies of chlamydial infection aimed at understanding the associations of organism burden with clinical manifestations and transmission...

..To evaluate a pilot prevention of mother-to-child transmission post-natal programme in Lilongwe, Malawi, through observed retention and infant diarrhoeal rates...

..Sexually transmitted diseases are increasing rapidly in China. Surveillance data imperfectly indicate current prevalence and risk factors...

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..From a sociological perspective, we believe that surplus men and sex workers will have a profound effect on the future of HIV spread in China and on the success or failure of future interventions...

..We estimated HIV prevalence rates among young adults in the United States...

..The objective of this study was to investigate syphilis prevalence among low- and high-risk groups in China...

..We examined the cost-effectiveness of providing first-line treatment for male trichomoniasis in Malawi, a condition not commonly considered in syndromic management throughout sub-Saharan Africa...

..CCR5 expression appears to be greater in the Dai minority than in the other minorities investigated. The mechanism for this increased expression requires further study...

..Sporadic reports have provided clues to the magnitude of the spread of syphilis, but a national surveillance effort is needed to provide data for planning and intervention...

..To measure prevalence of syphilis among the STI clinic population in Guangxi, China, and to assess the socioeconomic and behavioural characteristics associated with the infection...

..Human immunodeficiency virus (HIV) has spread throughout China and to some degree has penetrated the general heterosexual population in some regions...

..These results have important implications for studies related to the sexual transmission of HIV, and development of HIV prevention strategies...

..A high percentage of the population is black, and STD/HIV rates are particularly high among this group. Control and treatment of STDs offers promise as an HIV prevention strategy, and nowhere more than in the South...

..Such interventions depend on detailed knowledge of its organization. The results of this study demonstrate the importance of prevention activities directed at the brothel managers and clients, as well as the sex workers...

..The results of these studies should provide further insight into the regulation of excretion of HIV in semen, transmission of HIV, and to inform public health HIV prevention policies. ..

..In summary, we believe the mentors, the trainees and the environment are well suited to support the goals of the application, and ongoing critical research issues in the pathogenesis and epidemiology of infectious diseases. ..

..We believe the studies proposed in this Application will provide unique insight into the biology of acute HIV infection and HIV transmission, and information critical for both biological and behavioral prevention strategies. ..

..We believe that this information will be important in further development of both behavioral and vaccine HIV prevention strategies. ..