We report two cases of dolutegravir (DTG) resistance in highly treatment experienced patients. Monitoring for treatment failure and adherence support is important in highly treatment experienced patients taking DTG. What this study adds: Dolutegravir is the mainstay of HIV treatment programmes and emergence of drug resistance to DTG is of public health relevance.

BACKGROUND: Human papillomavirus (HPV) associated invasive cervical cancer (ICC) is common in Zimbabwe, disproportionately affecting women living with HIV (WLHIV). Understanding high-risk HPV (hrHPV) infection in relation to cervical disease is important for ICC prevention amongst WLHIV. OBJECTIVES: To describe the prevalence of cervical hrHPV, type distribution, associated risk factors and ICC screening outcomes in an urban cohort of Zimbabwean women. METHODS: In this cohort study, WLHIV were tested for hrHPV infection using the Cepheid Xpert® HPV assay and followed up for incident cervical disease. Follow-up assessments were done by visual inspection with acetic acid (VIA). Descriptive statistics and logistic regression were used to describe hrHPV burden and association between hrHPV and potential risk factors. Incidence rates (IR) and rate ratios of cervical disease by hrHPV infection status were also calculated. RESULTS: Amongst 321 WLHIV recruited, hrHPV prevalence was 24.9% (n = 80). Fifty-two of these women (65%) were positive for hrHPV types other than 16 or 18/45. Younger age (22-29 years), early sexual debut (13-16 years) and antiretroviral therapy (ART) regimen (second-line ART) were independently associated with hrHPV positivity. Positive VIA IR ratio between hrHPV-positive and -negative women was 12.57 (95% confidence interval [CI]: 4.14-38.19). Only women with hrHPV infection had incident cervical disease (IR: 6.41/100 person-years, (95% CI: 3.33-12.32). There were no ICC cases by the end of the 2-year follow-up. CONCLUSION: There was a high prevalence of hrHPV infection other than 16 and 18/45 in this cohort. Integrating HPV testing in cervical cancer screening programmes may increase screening intervals in hrHPV-negative women, reducing costs for programmes. We recommend further research into cross protectivity of the bivalent and quadrivalent HPV vaccines against these other hrHPV types.

Abstract: Understanding the factors shaping the niche of parasites and its expression over geographical space and through time continues to be a modern scientific challenge with the results of research in this area directly influencing both theoretical and applied biology. This is especially important for proactive management of zoonotic parasites such as Echinococcus multilocularis, the etiologic agent of alveolar echinococcosis. Echinococcus multilocularis has a Holarctic distribution; with its geographic range and prevalence increasing recently in areas of the western Palearctic, while its distribution dynamics are poorly understood in the Nearctic. In this paper, we use an ecological niche modeling (ENM) approach to: i) estimate the current spatial distribution of suitable conditions for the parasite in the Nearctic. ii) Evaluate the abiotic and biotic factors influencing the species distribution. iii) Assess the potential impact of climatic change on the distribution of this species in the Nearctic. Additionally, we report two new occurrence records of this parasite that significantly expands its known geographic range. We reviewed the occurrence records of E. multilocularis for the Nearctic. This was complemented by two new records of the species from Maryland and New Mexico identified using morphology and multivariate morphometrics of the rostellar hooks. From these data we created two ENMs using the software Maxent. The first ENM included climatic variables, while the second included the same abiotic data plus biotic information consisting of four host community-related data sets. We evaluated model performance and variable importance to explore the relation of these variables to the parasite niche. Finally, we projected the resulting niche model onto future climate change scenarios. We found that an important portion of the Nearctic has suitable conditions for E. multilocularis with adequate habitat in the West and East of the continent where the parasite has not been detected. We also found that the proposed biotic variables improve the model performance and provide unique information, while the most critical abiotic variable was related to the amount of solar radiation. Finally, under the future emission scenarios explored, the distribution of suitable habitat for the parasite is predicted to increase by 56 % to 76 %. We obtained a robust model that provides detail on the distribution of suitable areas for E. multilocularis, including areas that have not been explored for the presence of the parasite. The host community variables included in this study seem a promising way to include biotic data for ecological parasite niche modeling.

Resumen: El estudio de los factores que moldean el nicho de los parásitos y como este se expresa en la distribución espacial y temporal de estos organismos es un reto de importancia para la biología aplicada y teórica. Esta información puede ser de especial importancia para parásitos zoonóticos tales como Echinococcus multilocularis, el cestodo causante de echinococcosis alveolar. Este parasito presenta una distribución Holártica, con un incremento reciente en rango geográfico y prevalencia documentados en Asia y Europa, mientras que en el Neártico, se desconoce la dinámica de distribución de la especie. En este estudio usamos modelos de nicho ecológico para: i) estimar la distribución actual de hábitat para la especie en Norteamérica. ii) Evaluar el efecto de factores bióticos y abióticos sobre la distribución de este parasito. iii) Evaluar el impacto potencial del cambio climático sobre su distribución. Adicionalmente, reportamos dos nuevos registros para la especie. En este trabajo revisamos los registros de ocurrencia de E. multilocularis en el Neártico. Esta información es complementada con dos nuevos registros provenientes de Maryland y Nuevo México identificados a partir de análisis morfológicos y morfométricos. Empleando el software Maxent, creamos dos modelos de nicho a partir de estos registros. El primer modelo se basó únicamente en variables abióticas, mientras que el segundo además de incluir las variables abióticas incluyó variables bióticas relacionadas con la comunidad de hospederos potenciales. Evaluamos el desempeño de cada modelo y la contribución de cada variable para explorar la relación de estas con el nicho del parásito. Finalmente, proyectamos los modelos al futuro bajo dos escenarios de emisiones de CO2. Encontramos que existen condiciones adecuadas para la especie en una porción importante del área de estudio, con áreas predichas al Este y Occidente del continente donde no se ha registrado el parásito. La inclusión de las variables bióticas resulta en modelos con mejor desempeño, así mismo, se evidencio que estas variables presentan información única no contenida en otras capas. La radiación solar fue la variable abiótica de mayor importancia. Finalmente, bajo los escenarios de cambio climático explorados, el área de hábitat adecuado para el parasito presenta un importante aumento de entre el 56 % y 76 %. En este trabajo obtuvimos un modelo robusto y detallado de la distribución de las condiciones ambientales adecuadas para E. multilocularis, el cual incluye zonas donde no ha sido reportada la presencia del parásito. Las variables relacionadas con la comunidad de hospederos incluidas en este trabajo parecen ser una manera prometedora de incluir información biótica en modelos de nicho de simbiontes.

BACKGROUND: Coinfection rates of HIV and sexually transmitted infections (STIs) are not widely reported in Zimbabwe and no local guidelines regarding the screening of STIs in people living with HIV exist OBJECTIVES: This cross-sectional study was conducted to determine the prevalence and associated risk factors for STI coinfection in a cohort of HIV-infected women. METHODS: Between January and June 2016, 385 HIV-infected women presenting for routine cervical cancer screening were tested for five STIs: Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), Herpes Simplex Virus (HSV) type 2 and Treponema pallidum (TP). Socio-demographic characteristics and sexual history were recorded. Multiple logistic regression was used to identify factors associated with the diagnosis of non-viral STIs. RESULTS: Two hundred and thirty-three participants (60.5%) had a confirmed positive result for at least one STI: HSV 2 prevalence 52.5%, TV 8.1%, CT 2.1%, NG 1.8% and TP 11.4%. Eighty-seven per cent of the women were asymptomatic for any STI; 62.3% of women with a non-viral STI were asymptomatic. Women who had attended tertiary education were 90% less likely to have a non-viral STI (adjusted odds ratio [aOR]: 0.10, 95% confidence interval [CI]: 0.03-0.39, p < 0.01). Having more than three lifetime sexual partners was a significant predictor for a non-viral STI diagnosis (aOR: 3.3, 95% CI: 1.5-7.2, p < 0.01. CONCLUSION: A high prevalence of predominantly asymptomatic STIs is reported in a cohort of HIV-infected women. Syndromic management results in underdiagnosis of asymptomatic patients. More than three lifetime sexual partners and less formal education are risk factors for coinfection with non-viral STI. High-risk women should be screened using aetiological methods.

OBJECTIVE: To establish the proportion of adolescents among children infected with human immunodeficiency virus (HIV) in Zimbabwe who receive HIV care and support, and what clinic staff perceives to be the main problems faced by HIV-infected children and adolescents. METHODS: In July 2008, we sent a questionnaire to all 131 facilities providing HIV care in Zimbabwe. In it we requested an age breakdown of the children (aged 0-19 years) registered for care and asked what were the two major problems faced by younger children (0-5 years) and adolescents (10-19 years). FINDINGS: Nationally, 115 (88%) facilities responded. In 98 (75%) that provided complete data, 196 032 patients were registered and 24 958 (13%) of them were children. Of children under HIV care, 33% were aged 0-4 years; 25%, 5-9 years; 25%, 10-14 years; and 17%, 15-19 years. Staff highlighted differences in the problems most commonly faced by younger children and adolescents. For younger children, such problems were malnutrition and lack of appropriate drugs (cited by 46% and 40% of clinics, respectively); for adolescents they concerned psychosocial issues and poor drug adherence (cited by 56% and 36%, respectively). CONCLUSION: Interventions for the large cohort of adolescents who are receiving HIV care in Zimbabwe need to target the psychosocial concerns and poor drug adherence reported by staff as being the main concerns in this age group.

OBJETIVO: Determinar la proporción de adolescentes que reciben atención y apoyo contra el VIH entre los niños infectados por el virus de la inmunodeficiencia humana (VIH) en Zimbabwe, así como los principales problemas que, en opinión del personal de los dispensarios, afrontan los niños y adolescentes infectados por el virus. MÉTODOS: En julio de 2008 enviamos un cuestionario a los 131 centros que atienden a pacientes con VIH en Zimbabwe. En él solicitamos un desglose por edades de los niños (de 0 a 19 años) registrados para recibir atención y preguntamos cuáles eran los dos problemas que más afectaban a los niños más pequeños (0-5 años) y a los adolescentes (10-19 años). RESULTADOS: A nivel nacional, respondieron en total 115 centros (88%). En 98 (75%) que proporcionaron datos completos, había registrados 196 032 pacientes, 24 958 (13%) de los cuales eran niños. De los niños atendidos por ser seropositivos, el 33% tenían entre 0 y 4 años; el 25%, 5-9 años, otro 25%, 10-14 años; y el 17%, 15-19 años. El personal resaltó las diferencias entre los problemas más comunes sufridos por los niños más pequeños y los que afectaban a los adolescentes. Ente los primeros cabe destacar la malnutrición y la falta de medicamentos apropiados (citados por el 46% y el 40% de los dispensarios, respectivamente); y en el caso de los adolescentes, los problemas psicosociales y el escaso seguimiento de la medicación (citados por el 56% y el 36%, respectivamente). CONCLUSIÓN: En las intervenciones aplicadas en la extensa cohorte de adolescentes que están recibiendo atención para el VIH en Zimbabwe se debería centrar la atención en los aspectos psicosociales y el cumplimiento del tratamiento, cuestiones identificadas por el personal como los principales motivos de preocupación en ese grupo de edad.

OBJECTIF: Déterminer la proportion d'adolescents parmi les enfants infectés par le virus de l'immunodéficience humaine (VIH) au Zimbabwe recevant des soins et un soutien en rapport avec le VIH et ce que le personnel des dispensaires perçoit comme les principaux problèmes rencontrés par les enfants et les adolescents infectés par ce virus. MÉTHODES: En juillet 2008, nous avons envoyé un questionnaire à l'ensemble des 131 établissements délivrant des soins liés au VIH au Zimbabwe. Il était demandé dans ce questionnaire de classer par âge les enfants (0-19 ans) enregistrés pour recevoir des soins et d'indiquer les deux principaux problèmes se posant pour les plus jeunes (0-5 ans) et pour les adolescents (10-19 ans). RÉSULTATS: A l'échelle du pays, 115 (88 %) établissements ont répondu. Dans 98 établissements (75 %) ayant fourni des données complètes, 196 032 patients ont été enregistrés, dont 24 958 (13 %) enfants. Parmi les enfants soignés contre le VIH/sida, 33 % étaient âgés de 0 à 4 ans, 25 % de 5 à 9 ans, 25 % de 10 à 14 ans et 17 % de 15 à 19 ans. Le personnel a mis en lumière des différences entre les problèmes qui se posaient le plus fréquemment pour les jeunes enfants et pour les adolescents. Pour les plus jeunes, ces problèmes concernaient la malnutrition et le manque de médicaments adaptés (cités par 46 et 40 % des dispensaires respectivement) ; pour les adolescents, il s'agissait plutôt de problèmes psychosociaux et d'une mauvaise observance du traitement (cités par 56 et 36 % des dispensaires respectivement). CONCLUSION: Les interventions destinées à l'importante cohorte d'adolescents qui reçoit des soins liés au VIH au Zimbabwe doivent viser les difficultés psychosociales et les défauts d'observance du traitement rapportés par le personnel en tant que problèmes les plus préoccupants dans cette tranche d'âges.