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HIV incidence on the increase among homosexual men attending an Amsterdam sexually transmitted disease clinic: using a novel approach for detecting recent infections
AIDS, 2002
Dramatic increases have occurred in sexually transmitted diseases (STD) and in sexual risk behavi... more Dramatic increases have occurred in sexually transmitted diseases (STD) and in sexual risk behaviour among homosexual men in Amsterdam and internationally. We investigated whether these trends indicate a resurgence of the HIV epidemic. HIV incidence was determined among homosexual attendees of an STD clinic in Amsterdam, who had participated in semi-annual anonymous unlinked cross-sectional HIV prevalence studies from 1991 to 2001. Stored HIV-seropositive samples were tested with a less-sensitive HIV assay and, if non-reactive, were further tested for the presence of antiretroviral drugs, indicative of the use of highly active antiretroviral therapy. Seropositive men who tested non-reactive on the less-sensitive assay and had not used antiretroviral drugs were classified as recently infected (< 170 days). Annual HIV incidence and its changes were examined. Among 3090 homosexual participants (median age 34 years), 454 were HIV infected, of whom 37 were recently infectioned. From 1991 to 2001 the overall incidence was 3.0 infections/100 person-years. Incidence increased over time (P = 0.02) and, strikingly, the increase was evident in older (> or = 34 years) men (P < 0.01), but not in the young. Of men recently infected, 84% (n = 31) were unaware of their infection and 70.3% (n = 26) had a concurrent STD. These 26 men reportedly had sex with a total of 315 men in the preceding 6 months. HIV incidence is increasing among homosexual attendees of an STD clinic. It is imperative to trace recently infected individuals, because they are highly infectious, and can thus play a key role in the spread of HIV.
BMC Infectious …, 2005
Background: The functional polymorphism-260 C>T in the LPS sensing TLR4 co-receptor CD14 gene enh... more Background: The functional polymorphism-260 C>T in the LPS sensing TLR4 co-receptor CD14 gene enhances the transcriptional activity and results in a higher CD14 receptor density. Individuals carrying the T/T genotype also have significantly higher serum levels of soluble CD14. The T allele of this polymorphism has recently been linked to Chlamydia pneumoniae infection. We investigated the role of the CD14-260 C>T polymorphism in the susceptibility to and severity (defined as subfertility and/or tubal pathology) of C. trachomatis infection in Dutch Caucasian women. Methods: The different CD14-260 C>T genotypes were assessed by PCR-based RFLP analysis in three cohorts: 1) A cohort (n = 576) of women attending a STD clinic, 2) a cohort (n = 253) of women with subfertility, and 3) an ethnically matched control cohort (n = 170). The following variables were used in the analysis: In cohort 1 the CT-DNA status, CT IgG serology status, self-reported symptoms and in cohort 2, the CT IgG serology status and the tubal status at laparoscopy. Results: In the control cohort the CC, CT and TT genotype distribution was: 28.2%, 48.2%, and 23.5% respectively. No differences were found in the overall prevalence of CD14-260 genotypes (28.1%, 50.7%, and 21.2%) in cohort 1 when compared to the control cohort. Also no differences were observed in women with or without CT-DNA, with or without serological CT responses, with or without symptoms, or in combinations of these three variables. In subfertile women with tubal pathology (cohort 2, n = 50) the genotype distribution was 28.0%, 48.0%, and 24.0% and in subfertile women without tubal pathology (n = 203), 27.6%, 49.3% and 23.2%. The genotype distribution was unchanged when CT IgG status was introduced in the analyses. Conclusion: The CD14-260 C>T genotype distributions were identical in all three cohorts, showing that this polymorphism is not involved in the susceptibility to or severity of sequelae of C. trachomatis infection.
We retrospectively conducted a study of men who have sex with men who visited the Amsterdam, the ... more We retrospectively conducted a study of men who have sex with men who visited the Amsterdam, the Netherlands, sexually transmitted diseases clinic from January 2002 to December 2003 and had rectal Chlamydia trachomatis infections. We found that symptomatic (73%) as well as asymptomatic (43%) patients were infected with a new C. trachomatis LGV variant. I n December 2003, an unusual symptom of early lymphogranuloma venereum (LGV) in a patient infected with HIV-1, who also had proctitis, was reported in Rotterdam (1). In the same city, an outbreak of LGV with similar symptoms, such as proctitis and constipation, subsequently was identified in men who have sex with men (MSM) (2). Here we report 32 patients with, and 13 MSM without, mucous membrane abnormalities in MSM with confirmed LGV in 2002-2003. LGV is a systemic disease caused by the Chlamydia trachomatis serovars L1 to L3. More invasive than disease caused by the urogenital serovars (D-K), LGV can manifest as 1) an inguinal syndrome, with genital ulceration and inguinal lymphadenopathy (buboes) and subsequent suppuration, and 2) an anogenitorectal syndrome, with proctocolitis and hyperplasia of intestinal and perirectal lymphatic tissue. Both syndromes can be accompanied by systemic symptoms including fever, malaise, chills, anorexia, myalgia, and arthralgia. If left untreated, the infection can lead to fistulas, strictures, genital elephantiasis, frozen pelvis, and infertility (3). LGV is endemic in Africa, Southeast Asia, and the Caribbean; it is a sporadic disease in Europe and North America.
Emerging Infectious Diseases, 2005
Slow epidemic of lymphogranuloma venereum L2b strain Spaargaren, J.; Schachter, J.; Moncada, J.; ... more Slow epidemic of lymphogranuloma venereum L2b strain Spaargaren, J.; Schachter, J.; Moncada, J.; de Vries, H.J.C.; Fennema, J.S.A.; Pena, A.S.; Coutinho, R.A.; Morré, S.A.
Nature Physics, 2007
BACKGROUND: Recently, outbreaks of anorectal lymphogranuloma venereum (LGV) have occurred among m... more BACKGROUND: Recently, outbreaks of anorectal lymphogranuloma venereum (LGV) have occurred among men who have sex with men (MSM). This study identifies risk factors and clinical predictors of LGV to determine the implications for clinical practice. METHODS: The Chlamydia trachomatis serovars for all MSM who had anorectal chlamydia diagnosed at a sexually transmitted infection clinic in Amsterdam, The Netherlands, in 2002
HIV incidence on the increase among homosexual men attending an Amsterdam sexually transmitted disease clinic: using a novel approach for detecting recent infections
AIDS, 2002
Dramatic increases have occurred in sexually transmitted diseases (STD) and in sexual risk behavi... more Dramatic increases have occurred in sexually transmitted diseases (STD) and in sexual risk behaviour among homosexual men in Amsterdam and internationally. We investigated whether these trends indicate a resurgence of the HIV epidemic. HIV incidence was determined among homosexual attendees of an STD clinic in Amsterdam, who had participated in semi-annual anonymous unlinked cross-sectional HIV prevalence studies from 1991 to 2001. Stored HIV-seropositive samples were tested with a less-sensitive HIV assay and, if non-reactive, were further tested for the presence of antiretroviral drugs, indicative of the use of highly active antiretroviral therapy. Seropositive men who tested non-reactive on the less-sensitive assay and had not used antiretroviral drugs were classified as recently infected (< 170 days). Annual HIV incidence and its changes were examined. Among 3090 homosexual participants (median age 34 years), 454 were HIV infected, of whom 37 were recently infectioned. From 1991 to 2001 the overall incidence was 3.0 infections/100 person-years. Incidence increased over time (P = 0.02) and, strikingly, the increase was evident in older (> or = 34 years) men (P < 0.01), but not in the young. Of men recently infected, 84% (n = 31) were unaware of their infection and 70.3% (n = 26) had a concurrent STD. These 26 men reportedly had sex with a total of 315 men in the preceding 6 months. HIV incidence is increasing among homosexual attendees of an STD clinic. It is imperative to trace recently infected individuals, because they are highly infectious, and can thus play a key role in the spread of HIV.
BMC Infectious …, 2005
Background: The functional polymorphism-260 C>T in the LPS sensing TLR4 co-receptor CD14 gene enh... more Background: The functional polymorphism-260 C>T in the LPS sensing TLR4 co-receptor CD14 gene enhances the transcriptional activity and results in a higher CD14 receptor density. Individuals carrying the T/T genotype also have significantly higher serum levels of soluble CD14. The T allele of this polymorphism has recently been linked to Chlamydia pneumoniae infection. We investigated the role of the CD14-260 C>T polymorphism in the susceptibility to and severity (defined as subfertility and/or tubal pathology) of C. trachomatis infection in Dutch Caucasian women. Methods: The different CD14-260 C>T genotypes were assessed by PCR-based RFLP analysis in three cohorts: 1) A cohort (n = 576) of women attending a STD clinic, 2) a cohort (n = 253) of women with subfertility, and 3) an ethnically matched control cohort (n = 170). The following variables were used in the analysis: In cohort 1 the CT-DNA status, CT IgG serology status, self-reported symptoms and in cohort 2, the CT IgG serology status and the tubal status at laparoscopy. Results: In the control cohort the CC, CT and TT genotype distribution was: 28.2%, 48.2%, and 23.5% respectively. No differences were found in the overall prevalence of CD14-260 genotypes (28.1%, 50.7%, and 21.2%) in cohort 1 when compared to the control cohort. Also no differences were observed in women with or without CT-DNA, with or without serological CT responses, with or without symptoms, or in combinations of these three variables. In subfertile women with tubal pathology (cohort 2, n = 50) the genotype distribution was 28.0%, 48.0%, and 24.0% and in subfertile women without tubal pathology (n = 203), 27.6%, 49.3% and 23.2%. The genotype distribution was unchanged when CT IgG status was introduced in the analyses. Conclusion: The CD14-260 C>T genotype distributions were identical in all three cohorts, showing that this polymorphism is not involved in the susceptibility to or severity of sequelae of C. trachomatis infection.
We retrospectively conducted a study of men who have sex with men who visited the Amsterdam, the ... more We retrospectively conducted a study of men who have sex with men who visited the Amsterdam, the Netherlands, sexually transmitted diseases clinic from January 2002 to December 2003 and had rectal Chlamydia trachomatis infections. We found that symptomatic (73%) as well as asymptomatic (43%) patients were infected with a new C. trachomatis LGV variant. I n December 2003, an unusual symptom of early lymphogranuloma venereum (LGV) in a patient infected with HIV-1, who also had proctitis, was reported in Rotterdam (1). In the same city, an outbreak of LGV with similar symptoms, such as proctitis and constipation, subsequently was identified in men who have sex with men (MSM) (2). Here we report 32 patients with, and 13 MSM without, mucous membrane abnormalities in MSM with confirmed LGV in 2002-2003. LGV is a systemic disease caused by the Chlamydia trachomatis serovars L1 to L3. More invasive than disease caused by the urogenital serovars (D-K), LGV can manifest as 1) an inguinal syndrome, with genital ulceration and inguinal lymphadenopathy (buboes) and subsequent suppuration, and 2) an anogenitorectal syndrome, with proctocolitis and hyperplasia of intestinal and perirectal lymphatic tissue. Both syndromes can be accompanied by systemic symptoms including fever, malaise, chills, anorexia, myalgia, and arthralgia. If left untreated, the infection can lead to fistulas, strictures, genital elephantiasis, frozen pelvis, and infertility (3). LGV is endemic in Africa, Southeast Asia, and the Caribbean; it is a sporadic disease in Europe and North America.
Emerging Infectious Diseases, 2005
Slow epidemic of lymphogranuloma venereum L2b strain Spaargaren, J.; Schachter, J.; Moncada, J.; ... more Slow epidemic of lymphogranuloma venereum L2b strain Spaargaren, J.; Schachter, J.; Moncada, J.; de Vries, H.J.C.; Fennema, J.S.A.; Pena, A.S.; Coutinho, R.A.; Morré, S.A.
Nature Physics, 2007
BACKGROUND: Recently, outbreaks of anorectal lymphogranuloma venereum (LGV) have occurred among m... more BACKGROUND: Recently, outbreaks of anorectal lymphogranuloma venereum (LGV) have occurred among men who have sex with men (MSM). This study identifies risk factors and clinical predictors of LGV to determine the implications for clinical practice. METHODS: The Chlamydia trachomatis serovars for all MSM who had anorectal chlamydia diagnosed at a sexually transmitted infection clinic in Amsterdam, The Netherlands, in 2002