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Geographic and racial disparities may contribute to variation in the incidence and outcomes of HIV-associated cancers in the United States. Using the Surveillance, Epidemiology, and End Results (SEER) database, we analyzed Kaposi sarcoma (KS) incidence and survival by race and geographic region during the combined antiretroviral therapy era. Reported cases of KS in men from 2000 to 2013 were obtained from 17 SEER cancer registries. Overall and age-standardized KS incidence rates were calculated and stratified by race and geographic region. We evaluated incidence trends using joinpoint analyses and calculated adjusted hazard ratios (aHR) for overall and KS-specific mortality using multivariable Cox proportional hazards models. Of 4,455 KS cases identified in men younger than 55 years (median age 40 years), the annual percent change (APC) for KS incidence significantly decreased for white men between 2001 and 2013 (APC -4.52, p = 0.02). The APC for AA men demonstrated a non-significant decrease from 2000-2013 (APC -1.84, p = 0.09). Among AA men in the South, however, APC has significantly increased between 2000 and 2013 (+3.0, p = 0.03). In addition, compared with white men diagnosed with KS during the same time period, AA men were also more likely to die from all causes and KS cancer-specific causes (aHR 1.52, 95% CI 1.34-1.72, aHR 1.49, 95% CI 1.30-1.72 respectively). Although overall KS incidence has decreased in the U.S., geographic and racial disparities in KS incidence and survival exist.

Background. Human immunodeficiency virus type 1 (HIV-1)-infected men are at increased risk for anal cancer. Human papillomavirus (HPV) vaccination may prevent anal cancer caused by vaccine types. Methods. AIDS Malignancy Consortium Protocol 052 is a single-arm, open-label, multicenter clinical trial to assess the safety and immunogenicity of the quadrivalent HPV (types 6, 11, 16, and 18) vaccine in HIV-1-infected men. Men with high-grade anal intraepithelial neoplasia or anal cancer by history or by screening cytology or histology were excluded. Men received 0.5 mL intramuscularly at entry, week 8, and week 24. The primary end points were seroconversion to vaccine types at week 28, in men who were seronegative and without anal infection with the relevant HPV type at entry, and grade 3 or higher adverse events related to vaccination. Results. There were no grade 3 or greater adverse events attributable to vaccination among the 109 men who received at least 1 vaccine dose. Seroconversion was observed for all 4 types: type 6 (59 [98%] of 60), type 11 (67 [99%] of 68), type 16 (62 [100%] of 62), and type 18 (74 [95%] of 78). No adverse effects on CD4 counts and plasma HIV-1 RNA levels were observed. Conclusions. The quadrivalent HPV vaccine appears safe and highly immunogenic in HIV-1-infected men. Efficacy studies in HIV-1-infected men are warranted. Clinical trials registration. NCT 00513526.

PurposeThe COVID-19 pandemic has brought about a contingent shift to remote working and learning worldwide. However, little is known regarding the impact of this shift on internships. Moreover, much of the available literature studies on internships are focused largely on perceptions by students, less so by supervisors. This paper describes the impact of COVID-19 on public health (PH) internships and examines interns' and supervisors' perspectives on their experiences in internships before and during the pandemic.Design/methodology/approachA cross-sectional study design was conducted on two cohorts of undergraduate students and their supervisors in Singapore. Participants were surveyed using questionnaires with both close-ended and open-ended questions about various aspects of the internship experience. Data were triangulated from these surveys and module evaluation reports, and analyzed quantitatively and qualitatively.FindingsCOVID-19 disrupted internships significantly, with a reduction in the number of placements offered and necessary changes to the internship scope. Overall, the internship experience has been positive. Supervisors and e-interns reported high levels of satisfaction and documented learning gains such as the development of technical skills and soft skills unique to remote work.Originality/valueThe study findings fill current gaps in the literature on supervisor perceptions and internship experiences during COVID-19. Recommendations are proposed to optimize e-internships, a potentially authentic workplace in the post-COVID era.

Background/Objectives: Food insecurity during pregnancy is associated with higher risks of negative physical outcomes for both mother and child. This study aims to understand experiences of food insecurity among low-income Singaporean pregnant women and its impact on nutritional status. Methods: In this cross-sectional, mixed-methods study, 49 food-insecure pregnant women were recruited from KK Women’s and Children’s Hospital between November 2021 and November 2023, among which 11 in-depth interviews were conducted. Questionnaires, anthropometric measurements, 24-Hour dietary recalls, metabolic and nutritional blood tests were conducted for all subjects. Descriptive quantitative analysis was performed and integrated with qualitative thematic analysis to explain findings. Results: On average, women were overweight pre-pregnancy (body mass index 26.1 ± 6.9 kg/m2) and had low haemoglobin and 25-hydroxyvitamin D levels. Calorie intake and intake from major food groups did not meet recommendations during pregnancy, except for “Grains”. From interviews, effects of financial constraints, how participants managed their food supply and pregnancy-related symptoms, supported findings from 24-Hour dietary recalls. Conclusions: Food insecurity led to suboptimal nutritional status and diets in Singaporean pregnant women despite appearing well-nourished. Further exploration of perspectives of food-insecure mothers, healthcare providers and welfare organisations is needed to devise long-term solutions to improve food security and alleviate malnutrition.

B cell activation factor of the TNF family (BAFF) is a potent B cell survival factor. BAFF overexpressing transgenic mice (BAFF-Tg mice) exhibit features of autoimmune disease, including B cell hyperplasia and hypergammaglobulinemia, and develop fatal nephritis with age. However, basal serum IgA levels are also elevated, suggesting that the pathology in these mice may be more complex than initially appreciated. Consistent with this, we demonstrate here that BAFF-Tg mice have mesangial deposits of IgA along with high circulating levels of polymeric IgA that is aberrantly glycosylated. Renal disease in BAFF-Tg mice was associated with IgA, because serum IgA was highly elevated in nephritic mice and BAFF-Tg mice with genetic deletion of IgA exhibited less renal pathology. The presence of commensal flora was essential for the elevated serum IgA phenotype, and, unexpectedly, commensal bacteria-reactive IgA antibodies were found in the blood. These data illustrate how excess B cell survival signaling perturbs the normal balance with the microbiota, leading to a breach in the normal mucosal-peripheral compartmentalization. Such breaches may predispose the nonmucosal system to certain immune diseases. Indeed, we found that a subset of patients with IgA nephropathy had elevated serum levels of a proliferation inducing ligand (APRIL), a cytokine related to BAFF. These parallels between BAFF-Tg mice and human IgA nephropathy may provide a new framework to explore connections between mucosal environments and renal pathology.

Like cervical cancer, anal cancer is often caused by a human papillomavirus and has a premalignant stage called high-grade squamous intraepithelial lesion or anal intraepithelial neoplasia. A randomized trial showed that treating HSIL led to a 57% reduction in progression to anal cancer as compared with active surveillance.

Abstract Background Mycoplasma genitalium can result in pelvic inflammatory disease and adverse pregnancy outcomes. We analyzed data collected from a prospective study of asymptomatic bacterial vaginosis (BV) to determine the natural history of M. genitalium. Methods Women aged 15-25 years, with asymptomatic BV and ≥2 risk factors for sexually transmitted infection were recruited from 10 sites throughout the United States. Vaginal swab samples were collected at enrollment and through home-based testing every 2 months over 12 months. M. genitalium nucleic acid amplification testing was performed for M. genitalium using transcription-mediated assays (Hologic). The prevalence, incidence, and persistence of M. genitalium, defined as all positive specimens during follow-up, were estimated with 95% confidence intervals (CIs). Adjusted odds ratios (AOR) were calculated using logistic and Poisson regression to evaluate participant characteristics associated with M. genitalium infection. Results Among 1139 women, 233 were M. genitalium positive, for a prevalence of 20.5% (95% CI, 18.2%-22.9%); 42 of 204 had persistent M. genitalium (20.6%). Among 801 M. genitalium-negative women at baseline, the M. genitalium incidence was 36.6 per 100 person-years (95% CI, 32.4-41.3). Black race (AOR, 1.92; 95% CI, 1.09-3.38), age ≤21 years (1.40; 1.03-1.91), and prior pregnancy (1.36; 1.00-1.85) were associated with prevalent M. genitalium; only black race was associated with incident M. genitalium (P = .03). Conclusions We identified high rates of prevalent, incident, and persistent M. genitalium infections among young, high-risk women with asymptomatic BV, supporting the need for clinical trials to evaluate the impact of M. genitalium screening on female reproductive health outcomes. Young, asymptomatic, high-risk women in the United States have high rates of prevalent, incident and persistent Mycoplasma genitalium infections, highlighting the need for clinical trials to assess the impact of M. genitalium screening programs on female reproductive health outcomes.

Background Oral human papillomavirus (HPV) infection has been causally linked to a subset of oropharyngeal cancers in Western populations, and both oropharyngeal cancer and oral HPV infection are increased among HIV-positive individuals. India has high incidences of oral and oropharyngeal cancers, and Indian HIV-positive men who have sex with men (MSM) may be at increased risk of developing oropharyngeal cancers. However, there is little information available on the prevalence of oral HPV in this population. Methods We tested 302 HIV-positive Indian MSM for oral HPV infection using L1 HPV DNA PCR with probes specific for 29 types and a mixture of 10 additional types. CD4+ level and plasma HIV viral load (VL) were measured. Participants completed an interviewer-administered questionnaire including a sexual history. Results The prevalence of oral HPV was 23.7% (95% CI: 19–29%) and 2.4% of participants had oncogenic HPV types. No participants had oral HPV type 16 (HPV-16) and the prevalence of other anogenital HPV types was low. Participants with higher CD4+ levels had reduced odds of having any oral HPV infection (OR: 3.1 [1.4–6.9]) in multivariable analyses. Conclusions This is the first report of oral HPV among Indian HIV-positive MSM. Our results show a high prevalence of oral HPV infection consistent with studies from Western populations. However, oncogenic anogenital HPV types were relatively uncommon in our study population. It is unknown what the impact of this distribution of oral HPV will be on oropharyngeal cancers. HIV-positive MSM in India should be monitored closely for oral and oropharyngeal pre-cancer and cancer.

The efficacy of azithromycin vs. doxycycline for urogenital Chlamydia trachomatis infection was assessed in this randomized clinical trial. In a directly observed treatment context, the efficacy of azithromycin was 97% and that of doxycycline was 100%. Urogenital Chlamydia trachomatis infection is the most prevalent bacterial sexually transmitted infection in the United States and worldwide. 1 , 2 Females are disproportionately affected by this infection because of the risk of pelvic inflammatory disease, which can lead to ectopic pregnancy and infertility. Efforts to prevent and control chlamydia infection, which have been aimed mainly toward the reduction of sequelae, have not diminished the high prevalence. Along with screening, the provision of effective treatment is a cornerstone of chlamydia control programs. For the treatment of chlamydia infection, the Centers for Disease Control and Prevention (CDC) recommends oral administration of either 1 . . .