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Tariq S, Burns FM, Gilson R, Sabin C. PRIME (Positive Transitions Through the Menopause) Study: a protocol for a mixed-methods study investigating the impact of the menopause on the health and well-being of women living with HIV in England. BMJ Open 2019; 9:e025497. [PMID: 31171548 PMCID: PMC6561408 DOI: 10.1136/bmjopen-2018-025497] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Advances in antiretroviral therapy have transformed HIV into a long-term condition with near-normal life expectancy for those in whom viral replication is well controlled on treatment. This means that age-related events, including menopause, is of increasing importance in the care of people living with HIV. The PRIME (Positive Transitions Through the Menopause) Study aims to explore the impact of the menopause on the health and well-being of women living with HIV (WLHIV). METHODS AND ANALYSIS The PRIME Study is a multicentre, mixed-methods observational study deploying a multiphase sequential design with explanatory and exploratory phases. Phase 1 comprised three focus group discussions with WLHIV. In phase 2 we aimed to administer questionnaires comprising detailed assessment of menopausal status and symptoms to 1500 WLHIV aged 45-60 attending HIV clinics in England. Phase 3 comprised semistructured interviews with a subsample of phase 2 participants. Ongoing quantitative follow-up of 100 participants is planned between October 2018 and September 2019. Qualitative and quantitative data will be kept analytically distinct and analysed using appropriate methods. We will integrate quantitative and qualitative findings using coding matrices. ETHICS AND DISSEMINATION The PRIME Study has ethical approval from the South East Coast-Surrey Research Ethics Committee on behalf of all National Health Service (NHS) sites, and approval from University College London Research Ethics Committee for qualitative work conducted in non-NHS sites. In conjunction with the study Expert Advisory Group (which includes WLHIV), we have drafted a dissemination strategy that takes into account a wide range of stakeholders, including patients, policy makers and healthcare providers. This includes at least five empirical research papers to be submitted to peer-reviewed journals, as well as an accessible report aimed primarily at a non-technical audience (published in May 2018 and launched at a live-streamed event). Both quantitative and qualitative data are held by the PRIME Study team and are available by request.
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Affiliation(s)
- Shema Tariq
- Institute for Global Health, University College London, London, UK
| | - Fiona M Burns
- Institute for Global Health, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| | - Caroline Sabin
- Institute for Global Health, University College London, London, UK
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Sewell J, Cambiano V, Speakman A, Lampe FC, Phillips A, Stuart D, Gilson R, Asboe D, Nwokolo N, Clarke A, Rodger AJ. Changes in chemsex and sexual behaviour over time, among a cohort of MSM in London and Brighton: Findings from the AURAH2 study. Int J Drug Policy 2019; 68:54-61. [PMID: 30999243 DOI: 10.1016/j.drugpo.2019.03.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 03/21/2019] [Accepted: 03/24/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent evidence has suggested that chemsex (the use of mephedrone, crystal methamphetamine and γ -hydroxybutyrate/ γ -butryolactone (GHB/GBL) to enable, enhance and prolong sexual interactions) has increased among men having sex with men (MSM) attending sexual health clinics in large UK cities. To date there has been no data from the UK or Europe that describes changes in chemsex over time within a cohort of MSM. METHODS The prospective cohort study, Attitudes to and Understanding Risk of Acquisition of HIV over Time (AURAH2), collected online questionnaire data from HIV negative or undiagnosed MSM (at enrolment) from 2015 to 2018, recruited from sexual health clinics. We aim to investigate changes in chemsex, three individual drugs associated with chemsex, frequency of chemsex sessions and measures of sexual behaviour, among the cohort of MSM over the study's 3 year follow-up period. RESULTS In total 622 MSM completed at least one online questionnaire for the AURAH2 study, of which 400 (64.3%) were still engaged with the study within the last six months of follow-up. Prevalence of chemsex significantly declined during the follow-up from 31.8% (198/622) at the first online questionnaire, to 11.1% (8/72; p < 0.001) at the 9th. This decline was reflected in the proportion of MSM reporting use of two of the three individual chemsex drugs: mephedrone use had significantly declined from 25.2% at the first online questionnaire to 9.7% (p < 0.001) at the 9th, GHB/GBL use had also declined from 19.9% to 8.3% (p = 0.001). While crystal methamphetamine use declined, but not significantly (11.1%-6.9% [p = 0.289]). Most measures of sexual behaviour (any anal sex, group sex, recent HIV test and bacterial STI) also tended to decline over the follow-up period, with the exception of CLAI with more than one and more than two partners. CONCLUSIONS Chemsex and use of two individual chemsex drugs (mephedrone and GHB/GBL) significantly declined over time among individuals in the study, alongside most measures of sexual behaviour with the exception of those related to CLAI. Focusing health promotion and HIV prevention, such as awareness of post-exposure prophylaxis (PEP) and access to pre-exposure prophylaxis (PrEP), on MSM that report chemsex, and in particular problematic chemsex, would be highly beneficial, potentially only necessary for a relatively short period of time for individuals, and could have long term benefits for HIV and STI prevention.
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Affiliation(s)
- Janey Sewell
- UCL Institute for Global Health, UCL, London, United Kingdom
| | | | - Andrew Speakman
- UCL Institute for Global Health, UCL, London, United Kingdom
| | - Fiona C Lampe
- UCL Institute for Global Health, UCL, London, United Kingdom
| | - Andrew Phillips
- UCL Institute for Global Health, UCL, London, United Kingdom
| | - David Stuart
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard Gilson
- UCL Institute for Global Health, UCL, London, United Kingdom
| | - David Asboe
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Nneka Nwokolo
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Amanda Clarke
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Alison J Rodger
- UCL Institute for Global Health, UCL, London, United Kingdom.
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King C, Llewellyn C, Shahmanesh M, Abraham C, Bailey J, Burns F, Clark L, Copas A, Howarth A, Hughes G, Mercer C, Miners A, Pollard A, Richardson D, Rodger A, Roy A, Gilson R. Sexual risk reduction interventions for patients attending sexual health clinics: a mixed-methods feasibility study. Health Technol Assess 2019; 23:1-122. [PMID: 30916641 PMCID: PMC6452239 DOI: 10.3310/hta23120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) continue to represent a major public health challenge. There is evidence that behavioural interventions to reduce risky sexual behaviours can reduce STI rates in patients attending sexual health (SH) services. However, it is not known if these interventions are effective when implemented at scale in SH settings in England. OBJECTIVES The study (Santé) had two main objectives - (1) to develop and pilot a package of evidence-based sexual risk reduction interventions that can be delivered through SH services and (2) to assess the feasibility of conducting a randomised controlled trial (RCT) to determine effectiveness against usual care. DESIGN The project was a multistage, mixed-methods study, with developmental and pilot RCT phases. Preparatory work included a systematic review, an analysis of national surveillance data, the development of a triage algorithm, and interviews and surveys with SH staff and patients to identify, select and adapt interventions. A pilot cluster RCT was planned for eight SH clinics; the intervention would be offered in four clinics, with qualitative and process evaluation to assess feasibility and acceptability. Four clinics acted as controls; in all clinics, participants would be consented to a 6-week follow-up STI screen. SETTING SH clinics in England. PARTICIPANTS Young people (aged 16-25 years), and men who have sex with men. INTERVENTION A three-part intervention package - (1) a triage tool to score patients as being at high or low risk of STI using routine data, (2) a study-designed web page with tailored SH information for all patients, regardless of risk and (3) a brief one-to-one session based on motivational interviewing for high-risk patients. MAIN OUTCOME MEASURES The three outcomes were (1) the acceptability of the intervention to patients and SH providers, (2) the feasibility of delivering the interventions within existing resources and (3) the feasibility of obtaining follow-up data on STI diagnoses (primary outcome in a full trial). RESULTS We identified 33 relevant trials from the systematic review, including videos, peer support, digital and brief one-to-one sessions. Patients and SH providers showed preferences for one-to-one and digital interventions, and providers indicated that these intervention types could feasibly be implemented in their settings. There were no appropriate digital interventions that could be adapted in time for the pilot; therefore, we created a placeholder for the purposes of the pilot. The intervention package was piloted in two SH settings, rather than the planned four. Several barriers were found to intervention implementation, including a lack of trained staff time and clinic space. The intervention package was theoretically acceptable, but we observed poor engagement. We recruited patients from six clinics for the follow-up, rather than eight. The completion rate for follow-up was lower than anticipated (16% vs. 46%). LIMITATIONS Fewer clinics were included in the pilot than planned, limiting the ability to make strong conclusions on the feasibility of the RCT. CONCLUSION We were unable to conclude whether or not a definitive RCT would be feasible because of challenges in implementation of a pilot, but have laid the groundwork for future research in the area. TRIAL REGISTRATION Current Controlled Trials ISRCTN16738765. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Carina King
- Institute for Global Health, University College London, London, UK
| | - Carrie Llewellyn
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | | | | | - Julia Bailey
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK
| | - Laura Clark
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
- London Hub for Trials Methodology Research, Medical Research Council Clinical Trials Unit, London, UK
| | - Alison Howarth
- Institute for Global Health, University College London, London, UK
| | - Gwenda Hughes
- Sexually Transmitted Infection Surveillance, Public Health England, London, UK
| | - Cath Mercer
- Institute for Global Health, University College London, London, UK
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Alex Pollard
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | | | - Alison Rodger
- Institute for Global Health, University College London, London, UK
| | - Anupama Roy
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
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Forster AS, Gilson R. Challenges to optimising uptake and delivery of a HPV vaccination programme for men who have sex with men. Hum Vaccin Immunother 2019; 15:1541-1543. [PMID: 30570380 PMCID: PMC6746470 DOI: 10.1080/21645515.2018.1560783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/13/2018] [Indexed: 11/05/2022] Open
Abstract
Human papillomavirus (HPV) vaccine programmes targeted at men who have sex with men (MSM) may reduce HPV-related disease burden among this at-risk group in countries where uptake of the vaccine among adolescent girls is sub-optimal and where adolescent boys are not routinely vaccinated. There are challenges to optimising the impact of a MSM programme: ensuring good uptake, understanding the effectiveness of the vaccine in this population and considering the longevity of the programme. Furthermore, monitoring of uptake and ensuring that delivery of the programme does not deprive other aspects of sexual health service resources may present challenges to programme evaluation and delivery. We draw on experience from the UK HPV vaccination programme for MSM, delivered in sexual health and HIV clinics, to better understand these challenges with the aim of supporting the implementation of similar programmes elsewhere in the world.
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Affiliation(s)
- Alice S. Forster
- Research Department of Behavioural Science and Health, UCL, London, UK
| | - Richard Gilson
- UCL Centre for Clinical Research in Infection and Sexual Health, The Mortimer Market Centre, UCL, London, UK
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Murray ML, Meadows J, Doré CJ, Copas AJ, Haddow LJ, Lacey C, Jit M, Soldan K, Bennett K, Tetlow M, Nathan M, Gilson R. Human papillomavirus infection: protocol for a randomised controlled trial of imiquimod cream (5%) versus podophyllotoxin cream (0.15%), in combination with quadrivalent human papillomavirus or control vaccination in the treatment and prevention of recurrence of anogenital warts (HIPvac trial). BMC Med Res Methodol 2018; 18:125. [PMID: 30400777 PMCID: PMC6220496 DOI: 10.1186/s12874-018-0581-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 10/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anogenital warts are the second most common sexually transmitted infection diagnosed in sexual health services in England. About 90% of genital warts are caused by human papillomavirus (HPV) types 6 or 11, and half of episodes diagnosed are recurrences. The best and most cost-effective treatment for patients with anogenital warts is unknown. The commonly used treatments are self-administered topical agents, podophyllotoxin (0.15% cream) or imiquimod (5% cream), or cryotherapy with liquid nitrogen. Quadrivalent HPV (qHPV) vaccination is effective in preventing infection, and disease, but whether it has any therapeutic effect is not known. METHODS AND DESIGN To investigate the efficacy of clearance and prevention of recurrence of external anogenital warts by topical treatments, podophyllotoxin 0.15% cream or imiquimod 5% cream, in combination with a three-dose regimen of qHPV or control vaccination. 500 adult patients presenting with external anogenital warts with either a first or subsequent episode of anogenital warts will be entered into this randomised, controlled partially blinded 2 × 2 factorial trial. DISCUSSION The trial is expected to provide the first high-quality evidence of the comparative efficacy and cost-effectiveness of the two topical treatments in current use, as well as investigate the potential benefit of HPV vaccination, in the management of anogenital warts. TRIAL REGISTRATION The trial was registered prior to starting recruitment under the following reference numbers: International Standard Randomized Controlled Trial Number (ISRCTN) Registry - ISRCTN32729817 (registered 25 July 2014); European Union Clinical Trials Register (EudraCT) - 2013-002951-14 (registered 26 June 2013).
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Affiliation(s)
- Macey L Murray
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Jade Meadows
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Caroline J Doré
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Andrew J Copas
- UCL Centre for Clinical Research in Infection and Sexual Health, The Mortimer Market Centre, Institute for Global Health, University College London, London, WC1E 6JB, UK
| | - Lewis J Haddow
- UCL Centre for Clinical Research in Infection and Sexual Health, The Mortimer Market Centre, Institute for Global Health, University College London, London, WC1E 6JB, UK
| | - Charles Lacey
- Centre for Immunology and Infection, Hull York Medical School, University of York, York, YO10 5DD, UK
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.,Public Health England, London, NW9 5EQ, UK
| | | | - Kate Bennett
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Michelle Tetlow
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Mayura Nathan
- Homerton Anal Neoplasia Service, Homerton University Hospital NHS Foundation Trust, London, E9 6SR, UK
| | - Richard Gilson
- UCL Centre for Clinical Research in Infection and Sexual Health, The Mortimer Market Centre, Institute for Global Health, University College London, London, WC1E 6JB, UK.
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King C, Hughes G, Furegato M, Mohammed H, Were J, Copas A, Gilson R, Shahmanesh M, Mercer CH. Predicting STI Diagnoses Amongst MSM and Young People Attending Sexual Health Clinics in England: Triage Algorithm Development and Validation Using Routine Clinical Data. EClinicalMedicine 2018; 4-5:43-51. [PMID: 31193629 PMCID: PMC6537562 DOI: 10.1016/j.eclinm.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/16/2018] [Accepted: 11/15/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Sexual health (SH) services increasingly need to prioritise those at greatest risk of sexually transmitted infections (STIs). We used SH surveillance data to develop algorithms to triage individuals attending SH services within two high-risk populations: men who have sex with men (MSM) and young people (YP). METHODS Separate multivariable logistic regression models for MSM and YP were developed using surveillance data on demographics, recent sexual history, prior STI diagnoses and drug/alcohol use from five clinics in 2015-2016 to identify factors associated with new STI diagnoses. The models were prospectively applied in one SH clinic in May 2017 as an external validation. FINDINGS 9530 YP and 1448 MSM SH episodes informed model development. For YP, factors associated with new STI diagnosis (overall prevalence: 10.6%) were being of black or mixed white/black ethnicity; history of chlamydia diagnosis (previous year); and multiple partners/new partner (previous 3-months). The YPs model had reasonable performance (c-statistic: 0.703), but poor discrimination when externally validated (c-statistic: 0.539). For MSM, being of South Asian ethnicity; being born in Europe (excluding the UK); and condomless anal sex or drug use (both in previous 3-months) were associated with STI diagnosis (overall prevalence: 22.0%). The MSM model had a c-statistic of 0.676, reducing to 0.579 on validation. INTERPRETATION SH surveillance data, including limited behavioural data, enabled triage algorithms to be developed, but its implementation may be problematic due to poor external performance. This approach may be more suitable to self-triage, including online, ensuring patients are directed towards appropriate services. FUNDING NIHR HTA programme (12/191/05).
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Affiliation(s)
- Carina King
- Institute for Global Health, University College London, 30 Guilford Street, London, UK
- Corresponding author at: Institute for Global Health, 30 Guilford Street, London WC1N 1EH, UK.
| | - Gwenda Hughes
- Institute for Global Health, University College London, 30 Guilford Street, London, UK
- Department of HIV & STIs, Centre for Infectious Disease Surveillance & Control, Public Health England, 61 Colindale Avenue, London, UK
| | - Martina Furegato
- Department of HIV & STIs, Centre for Infectious Disease Surveillance & Control, Public Health England, 61 Colindale Avenue, London, UK
- Applied Diagnostic Research and Evaluation Unit, St George's University of London, Cranmer Terrace, London, UK
| | - Hamish Mohammed
- Institute for Global Health, University College London, 30 Guilford Street, London, UK
- Department of HIV & STIs, Centre for Infectious Disease Surveillance & Control, Public Health England, 61 Colindale Avenue, London, UK
| | - John Were
- Department of HIV & STIs, Centre for Infectious Disease Surveillance & Control, Public Health England, 61 Colindale Avenue, London, UK
| | - Andrew Copas
- Institute for Global Health, University College London, 30 Guilford Street, London, UK
| | - Richard Gilson
- Institute for Global Health, University College London, 30 Guilford Street, London, UK
| | - Maryam Shahmanesh
- Institute for Global Health, University College London, 30 Guilford Street, London, UK
| | - Catherine H Mercer
- Institute for Global Health, University College London, 30 Guilford Street, London, UK
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Lechner M, Vassie C, Kavasogullari C, Jones O, Howard J, Masterson L, Fenton T, Yarbrough W, Waller J, Gilson R. A cross-sectional survey of awareness of human papillomavirus-associated oropharyngeal cancers among general practitioners in the UK. BMJ Open 2018; 8:e023339. [PMID: 30056394 PMCID: PMC6067376 DOI: 10.1136/bmjopen-2018-023339] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To examine the level of awareness of the link between human papillomavirus (HPV) and oropharyngeal cancer (OPC) and epidemiological trends in HPV-related OPC among general practitioners (GPs) in the UK. DESIGN Cross-sectional survey. PARTICIPANTS 384 GPs from England, Scotland, Wales and Northern Ireland. SETTING The survey was administered at GP training courses and via email to lists of training course attendees. PRIMARY AND SECONDARY OUTCOME MEASURES Proportion of respondents aware of the link between HPV and OPC; respondents' self-rated knowledge of OPC; proportion of participants aware of the epidemiological trends in HPV-associated OPC. RESULTS 384 questionnaires were completed with an overall response rate of 72.9%. 74.0% of participants recognised HPV as a risk factor for OPC, which was lower than knowledge about the role of smoking, chewing tobacco and alcohol consumption (all >90% recognition). Overall, 19.4% rated their knowledge of OPC as very good or good, 62.7% as average and 17.7% as poor or very poor. The majority (71.9%) were aware that rates of HPV-associated OPC have increased over the last two decades. Fewer than half (41.5%) of the participants correctly identified being male as a risk factor of HPV-associated OPC, while 58.8% were aware that patients with HPV-associated OPC tend to be younger than those with non-HPV-associated disease. CONCLUSIONS The association of HPV infection with OPC is a relatively recent discovery. Although the level of awareness of HPV and OPC among GPs was high, the characteristics of HPV-associated OPC were less well recognised, indicating the need for further education.
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Affiliation(s)
- Matt Lechner
- UCL Cancer Institute, University College London, London, UK
- Head and Neck Centre, University College London Hospitals NHS Trust, London, UK
| | - Claire Vassie
- UCL Cancer Institute, University College London, London, UK
- Institute for Global Health, University College London, London, London, UK
| | | | - Oliver Jones
- UCL Cancer Institute, University College London, London, UK
| | - James Howard
- ENT Department, Wrexham Maelor Hospital, Wrexham, UK
| | - Liam Masterson
- Department of Otolaryngology, Lister Hospital, Stevenage, UK
| | - Tim Fenton
- UCL Cancer Institute, University College London, London, UK
| | - Wendell Yarbrough
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jo Waller
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, London, UK
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Haddow LJ, Laverick R, Daskalopoulou M, McDonnell J, Lampe FC, Gilson R, Speakman A, Antinori A, Balestra P, Bruun T, Gerstoft J, Nielsen L, Vassilenko A, Collins S, Rodger AJ. Multicenter European Prevalence Study of Neurocognitive Impairment and Associated Factors in HIV Positive Patients. AIDS Behav 2018; 22:1573-1583. [PMID: 28144792 PMCID: PMC5902513 DOI: 10.1007/s10461-017-1683-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We conducted a cross-sectional study in 448 HIV positive patients attending five European outpatient clinics to determine prevalence of and factors associated with neurocognitive impairment (NCI) using computerized and pen-and-paper neuropsychological tests. NCI was defined as a normalized Z score ≤-1 in at least 2 out of 5 cognitive domains. Participants' mean age was 45.8 years; 84% male; 87% white; 56% university educated; median CD4 count 550 cells/mm3; 89% on antiretroviral therapy. 156 (35%) participants had NCI, among whom 26 (17%; 5.8% overall) reported a decline in activities of daily living. Prevalence of NCI was lower in those always able to afford basic needs (adjusted prevalence ratio [aPR] 0.71, 95% confidence interval [CI] 0.54-0.94) or with a university education (aPR 0.72, 95% CI 0.54-0.97) and higher in those with severe depressive symptoms (aPR 1.53, 95% CI 1.09-2.14) or a significant comorbid condition (aPR 1.40, 95% CI 1.03-1.90).
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Affiliation(s)
- Lewis J Haddow
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK.
| | - Rosanna Laverick
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK
| | - Marina Daskalopoulou
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK
| | | | - Fiona C Lampe
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK
| | - Richard Gilson
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK
| | - Andrew Speakman
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK
| | - Andrea Antinori
- National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy
| | - Pietro Balestra
- National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy
| | - Tina Bruun
- Department of Infectious Diseases, Rigshospitalet, Centre for Health & Infectious Disease Research (CHIP), University of Copenhagen, Copenhagen, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Rigshospitalet, Centre for Health & Infectious Disease Research (CHIP), University of Copenhagen, Copenhagen, Denmark
| | - Lars Nielsen
- Infektionsmedicinsk Afdeling, Nordsjællands Hospital, Hillerød, Denmark
| | | | | | - Alison J Rodger
- Research Department of Infection and Population Health, Mortimer Market Centre, University College London, Capper Street, London, WC1E 6JB, UK
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Sewell J, Cambiano V, Miltz A, Speakman A, Lampe FC, Phillips A, Stuart D, Gilson R, Asboe D, Nwokolo N, Clarke A, Hart G, Rodger A. Changes in recreational drug use, drug use associated with chemsex, and HIV-related behaviours, among HIV-negative men who have sex with men in London and Brighton, 2013-2016. Sex Transm Infect 2018; 94:494-501. [PMID: 29700052 PMCID: PMC6227813 DOI: 10.1136/sextrans-2017-053439] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/05/2018] [Accepted: 03/18/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The objective of this study was to compare the prevalence of polydrug use, use of drugs associated with chemsex, specific drug use, and HIV-related behaviours, between two time periods, using two groups of HIV-negative men who have sex with men (MSM) attending the same sexual health clinics in London and Brighton, in two consecutive periods of time from 2013 to 2016. METHODS Data from MSM in the cross-sectional Attitudes to and Understanding Risk of Acquisition of HIV (AURAH) study (June 2013 to September 2014) were compared with baseline data from different MSM in the prospective cohort study Attitudes to and Understanding Risk of Acquisition of HIV over Time (AURAH2) (November 2014 to April 2016). Prevalence of polydrug use, drug use associated with chemsex and specific drug use, and 10 measures of HIV-related behaviours including condomless sex, post-exposure prophylaxis (PEP) use, pre-exposure prophylaxis (PrEP) use, and HIV testing, were compared. Prevalence ratios (PRs) for the association of the study (time period) with drug use and HIV-related behaviour measures were estimated using modified Poisson regression analysis, unadjusted and adjusted for sociodemographic factors. RESULTS In total, 991 MSM were included from AURAH and 1031 MSM from AURAH2. After adjustment for sociodemographic factors, use of drugs associated with chemsex had increased (adjusted PR (aPR) 1.30, 95% CI 1.11 to 1.53) and there were prominent increases in specific drug use; in particular, mephedrone (aPR 1.32, 95% CI 1.10 to 1.57), γ-hydroxybutyric/γ-butryolactone (aPR 1.47, 95% CI 1.15 to 1.87) and methamphetamine (aPR 1.42, 95% CI 1.01 to 2.01). Use of ketamine had decreased (aPR 0.54, 95% CI 0.38 to 0.78). Certain measures of HIV-related behaviours had also increased, most notably PEP use (aPR 1.50, 95% CI 1.21 to 1.88) and number of self-reported bacterial STI diagnoses (aPR 1.24, 95% CI 1.08 to 1.43). CONCLUSIONS There have been significant increases in drug use associated with chemsex and some measures of HIV-related behaviours among HIV-negative MSM in the last few years. Changing patterns of drug use and associated behaviours should be monitored to enable sexual health services to plan for the increasingly complex needs of some clients.
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Affiliation(s)
- Janey Sewell
- Research Department of Infection and Population Health, Institute for Global Health, UCL, London, UK
| | - Valentina Cambiano
- Research Department of Infection and Population Health, Institute for Global Health, UCL, London, UK
| | - Ada Miltz
- Research Department of Infection and Population Health, Institute for Global Health, UCL, London, UK
| | - Andrew Speakman
- Research Department of Infection and Population Health, Institute for Global Health, UCL, London, UK
| | - Fiona C Lampe
- Research Department of Infection and Population Health, Institute for Global Health, UCL, London, UK
| | - Andrew Phillips
- Research Department of Infection and Population Health, Institute for Global Health, UCL, London, UK
| | - David Stuart
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Richard Gilson
- Research Department of Infection and Population Health, Institute for Global Health, UCL, London, UK
| | - David Asboe
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nneka Nwokolo
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Amanda Clarke
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Graham Hart
- Research Department of Infection and Population Health, Institute for Global Health, UCL, London, UK
| | - Alison Rodger
- Research Department of Infection and Population Health, Institute for Global Health, UCL, London, UK
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Miners A, Llewellyn C, King C, Pollard A, Roy A, Gilson R, Rodger A, Burns F, Shahmanesh M. Designing a brief behaviour change intervention to reduce sexually transmitted infections: a discrete choice experiment. Int J STD AIDS 2018; 29:851-860. [PMID: 29629651 DOI: 10.1177/0956462418760425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
To understand whether people attending sexual health (SH) clinics are willing to participate in a brief behavioural change intervention (BBCI) to reduce the likelihood of future sexually transmitted infections (STIs) and to understand their preferences for different service designs, we conducted a discrete choice experiment (DCE) with young heterosexual adults (aged 16-25 years), and men who have sex with men (MSM) aged 16 or above, attending SH clinics in England. Data from 368 participants showed that people particularly valued BBCIs that involved talking (OR 1.45; 95%CI 1.35, 1.57 compared with an 'email or text'-based BBCIs), preferably with a health care professional rather than a peer. Findings also showed that 26% of respondents preferred 'email/texts' to all other options; the remaining 14% preferred not to participate in any of the offered BBCIs. These results suggest that most people attending SH clinics in England are likely to participate in a BBCI if offered, but the type/format of the BBCI is likely to be the single important determinant of uptake rather than characteristics such as the length and the number of sessions. Moreover, participants generally favoured 'talking'-based options rather than digital alternatives, which are likely to require the most resources to implement.
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Affiliation(s)
- Alec Miners
- 1 Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Carrie Llewellyn
- 2 Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Carina King
- 3 Research Department of Infection and Population Health, University College London, London, UK
| | - Alex Pollard
- 2 Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Anupama Roy
- 2 Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Richard Gilson
- 3 Research Department of Infection and Population Health, University College London, London, UK
| | - Alison Rodger
- 3 Research Department of Infection and Population Health, University College London, London, UK
| | - Fiona Burns
- 3 Research Department of Infection and Population Health, University College London, London, UK
| | - Maryam Shahmanesh
- 3 Research Department of Infection and Population Health, University College London, London, UK
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Pufall EL, Kall M, Shahmanesh M, Nardone A, Gilson R, Delpech V, Ward H. Sexualized drug use ('chemsex') and high-risk sexual behaviours in HIV-positive men who have sex with men. HIV Med 2018; 19:261-270. [PMID: 29368440 PMCID: PMC5900961 DOI: 10.1111/hiv.12574] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 01/28/2023]
Abstract
Objectives The incidence of sexually transmitted infections (STIs) and HIV infection remains high in gay, bisexual, and other men who have sex with men (MSM) in the UK, and sexualized drug use (“chemsex”) and injecting drug use (“slamsex”) may play a part in this. We aimed to characterize HIV‐positive MSM engaging in chemsex/slamsex and to assess the associations with self‐reported STI diagnoses and sexual behaviours. Methods Data from a 2014 survey of people attending HIV clinics in England and Wales were linked to clinical data from national HIV surveillance records and weighted to be nationally representative. Multivariable logistic regression assessed the associations of chemsex and slamsex with self‐reported unprotected anal intercourse (UAI), serodiscordant UAI (sdUAI) (i.e. UAI with an HIV‐negative or unknown HIV status partner), sdUAI with a detectable viral load (>50 HIV‐1 RNA copies/mL), hepatitis C, and bacterial STIs. Results In the previous year, 29.5% of 392 sexually active participants engaged in chemsex, and 10.1% in slamsex. Chemsex was significantly associated with increased odds of UAI [adjusted odds ratio (AOR) 5.73; P < 0.001], sdUAI (AOR 2.34; P < 0.05), sdUAI with a detectable viral load (AOR 3.86; P < 0.01), hepatitis C (AOR 6.58; P < 0.01), and bacterial STI diagnosis (AOR 2.65; P < 0.01). Slamsex was associated with increased odds of UAI (AOR 6.11; P < 0.05), hepatitis C (AOR 9.39; P < 0.001), and bacterial STI diagnosis (AOR 6.11; P < 0.001). Conclusions Three in ten sexually active HIV‐positive MSM engaged in chemsex in the past year, which was positively associated with self‐reported depression/anxiety, smoking, nonsexual drug use, risky sexual behaviours, STIs, and hepatitis C. Chemsex may therefore play a role in the ongoing HIV and STI epidemics in the UK.
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Affiliation(s)
- E L Pufall
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - M Kall
- HIV and STI Surveillance Department, Public Health England, London, UK
| | - M Shahmanesh
- Department of Infection and Population Health, University College London, London, UK
| | - A Nardone
- HIV and STI Surveillance Department, Public Health England, London, UK
| | - R Gilson
- Department of Infection and Population Health, University College London, London, UK
| | - V Delpech
- HIV and STI Surveillance Department, Public Health England, London, UK
| | - H Ward
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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Lin A, Ong KJ, Hobbelen P, King E, Mesher D, Edmunds WJ, Sonnenberg P, Gilson R, Bains I, Choi YH, Tanton C, Soldan K, Jit M. Impact and Cost-effectiveness of Selective Human Papillomavirus Vaccination of Men Who Have Sex With Men. Clin Infect Dis 2017; 64:580-588. [PMID: 28011615 PMCID: PMC5404831 DOI: 10.1093/cid/ciw845] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 12/14/2016] [Indexed: 02/01/2023] Open
Abstract
Background. Men who have sex with men (MSM) have a high lifetime risk of anogenital warts and cancers related to infection with human papillomavirus (HPV). They also benefit less from herd protection than heterosexual males in settings with female-only HPV vaccination. Methods. We evaluated the potential health impact and cost-effectiveness of offering vaccination to MSM who visit genitourinary medicine (GUM) clinics. We used a mathematical model of HPV 6/11/16/18 sexual transmission within an MSM population in England, parameterized with sexual behaviour, GUM attendance, HPV prevalence, HIV prevalence, warts, and cancer incidence data. Interventions considered were offering HPV vaccination to either HIV-positive MSM or MSM regardless of HIV status, for age bands 16–25, 16–30, 16–35, and 16–40 years. Results. Substantial declines in anogenital warts and male HPV-related cancer incidence are projected to occur following an offer of vaccination to MSM. MSM not attending GUM clinics will partially benefit from herd protection. Offering vaccination to HIV-positive MSM up to age 40 is likely to be cost-effective if vaccine procurement and administration costs are below £96.50 a dose. At £48 a dose, offering vaccination to all MSM up to age 40 is likely to be cost-effective. Conclusions. Quadrivalent HPV vaccination of MSM via GUM clinics is likely to be an effective and cost-effective way of reducing the burden of HPV-related disease in MSM.
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Affiliation(s)
- Allen Lin
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Department of Systems Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Koh J Ong
- National Infections Service-Colindale, Public Health England, London, UK
| | - Peter Hobbelen
- National Infections Service-Colindale, Public Health England, London, UK
| | - Eleanor King
- Research Department of Infection and Population Health, University College London, London, UK
| | - David Mesher
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,National Infections Service-Colindale, Public Health England, London, UK
| | - W John Edmunds
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, University College London, London, UK
| | - Richard Gilson
- Research Department of Infection and Population Health, University College London, London, UK
| | - Irenjeet Bains
- National Infections Service-Colindale, Public Health England, London, UK
| | - Yoon H Choi
- National Infections Service-Colindale, Public Health England, London, UK
| | - Clare Tanton
- Research Department of Infection and Population Health, University College London, London, UK
| | - Kate Soldan
- National Infections Service-Colindale, Public Health England, London, UK
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,National Infections Service-Colindale, Public Health England, London, UK
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Saunders J, Brima N, Orzol M, Phillips L, Milinkovic A, Carpenter G, Copas A, Gilson R. Prospective observational study to evaluate the performance of the BioSure HIV Self-Test in the hands of lay users. Sex Transm Infect 2017; 94:169-173. [PMID: 28924053 DOI: 10.1136/sextrans-2017-053231] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/20/2017] [Accepted: 08/08/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES In order to assess whether the BioSure HIV Self-Test could be reliably performed by users at home and to determine whether they were able to perform and correctly interpret the test, we carried out an evaluation study among attendees at a sexual health service. METHODS A prospective observational study of clinic attendees to determine their ability to follow the instructions, complete the test on themselves and correctly interpret the results. The evaluation included interpretation of three dummy (contrived) devices, chosen at random from a sample of 12 devices, to ensure that a sufficient number of all possible test outcomes were included. RESULTS Two hundred participants were recruited. 97.0% (95% CI 93.5 to 98.9) conducted the test so as to achieve a valid result. 99.5% correctly identified the test result. Participants correctly interpreted the result of 94.0% (95% CI 91.4 to 95.9) of 586 contrived devices. CONCLUSIONS The majority of participants were able to follow the instructions and perform the test in order to get a valid result. Interpretation of the test results was good and the majority of participants were able to correctly read the result of their own and contrived tests. The availability of HIV self-tests will provide another option to increase access to testing particularly for those who may not wish or are unable to access clinical services.
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Affiliation(s)
- John Saunders
- Research Department of Infection and Population Health, University College London, London, UK
| | - Nataliya Brima
- Research Department of Infection and Population Health, University College London, London, UK
| | - Marzena Orzol
- Research Department of Infection and Population Health, University College London, London, UK
| | - Laura Phillips
- Research Department of Infection and Population Health, University College London, London, UK
| | - Ana Milinkovic
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Andrew Copas
- Research Department of Infection and Population Health, University College London, London, UK
| | - Richard Gilson
- Research Department of Infection and Population Health, University College London, London, UK
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Brima N, Lampe FC, Copas A, Gilson R, Williams I, Johnson MA, Phillips AN, Smith CJ. Early virological response to HIV treatment: can we predict who is likely to experience subsequent treatment failure? Results from an observational cohort study, London, UK. J Int AIDS Soc 2017; 20:21567. [PMID: 28853518 PMCID: PMC5577691 DOI: 10.7448/ias.20.21567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 08/14/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION For people living with HIV, the first antiretroviral treatment (ART) regimen offers the best chance for a good virological response. Early identification of those unlikely to respond to first-line ART could enable timely intervention and increase chances of a good initial treatment response. In this study we assess the extent to which the HIV RNA viral load (VL) at 1 and 3 months is predictive of first-line treatment outcome at 6 months. Methods All previously ART-naive individuals starting ART at two London centres since 2000 with baseline (-180 to 3 days) VL >500 c/mL had a VL measurement between 6 and 12 months after starting ART, and at least one at month 1 (4-60 days) or month 3 (61-120 days) were included. Lack of treatment response was defined as (i) VL >200 copies/mL at 6 months or (ii) VL >200 copies/mL at 6 months or simultaneous switch in drugs from at least two different drug classes before 6 months. The association with VL measurements at 1 and 3 months post-ART; change from pre-ART in these values; and CD4 count measurements at 1 and 3 months were assessed using logistic regression models. The relative fit of the models was compared using the Akaike information criterion (AIC). RESULTS A total of 198 out of 3258 individuals (6%) experienced lack of treatment response at 6 months (definition i), increasing to 511 (16%) for definition (ii). Those with a 1-month (day 4-60 window) VL of <1000, 1000-9999, 10,000-99,999 and >100,000 copies/ml had a 4%, 8%, 23% and 24% chance, respectively, of subsequently experiencing treatment non-response at 6 months (definition (i)). When considering the 3-month (day 61-120 window) VL, the chances of subsequently experiencing treatment non-response were, respectively, 3%, 25%, 67% and 75%. Results were similar for definition (ii). CONCLUSIONS Whilst 3-month VL provides good discrimination between low and high risk of treatment failure, 1-month VL does not. Presence of a VL >10,000 copies/ml after 3 months of ART is a cutoff above which individuals are at a sufficiently higher risk of non-response that they may be considered for intervention.
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Affiliation(s)
| | | | | | | | | | - Margaret A. Johnson
- Department of HIV Medicine, Royal Free London NHS Foundation Trust, London, UK
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Gourlay A, Fox J, Gafos M, Fidler S, Nwokolo N, Clarke A, Gilson R, Orkin C, Collins S, Porter K, Hart G. A qualitative study exploring the social and environmental context of recently acquired HIV infection among men who have sex with men in South-East England. BMJ Open 2017; 7:e016494. [PMID: 28851787 PMCID: PMC5629694 DOI: 10.1136/bmjopen-2017-016494] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES A key UK public health priority is to reduce HIV incidence among gay and other men who have sex with men (MSM). This study aimed to explore the social and environmental context in which new HIV infections occurred among MSM in London and Brighton in 2015. DESIGN A qualitative descriptive study, comprising in-depth interviews, was carried out as a substudy to the UK Register of HIV Seroconverters cohort: an observational cohort of individuals whose date of HIV seroconversion was well estimated. An inductive thematic analysis was conducted in NVivo, guided by a socio-ecological framework. SETTING Participants were recruited from six HIV clinics in London and Brighton. Fieldwork was conducted between January and April 2015. PARTICIPANTS All MSM eligible for the UK Register Seroconverter cohort (an HIV-positive antibody test result within 12 months of their last documented HIV-negative test or other laboratory evidence of HIV seroconversion) diagnosed within the past 12 months and aged ≥18 were eligible for the qualitative substudy. 21 MSM participated, aged 22-61 years and predominantly white. RESULTS A complex interplay of factors, operating at different levels, influenced risk behaviours and HIV acquisition. Participants saw risk as multi-factorial, but the relative importance of factors varied for each person. Individual psycho-social factors, including personal history, recent life stressors and mental health, enhanced vulnerability towards higher risk situations, while features of the social environment, such as chemsex and social media, and prevalent community beliefs regarding treatment and HIV normalisation, encouraged risk taking. CONCLUSIONS Recently acquired HIV infection among MSM reflects a complex web of factors operating at different levels. These findings point to the need for multi-level interventions to reduce the risk of HIV acquisition among high-risk MSM in the UK and similar settings.
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Affiliation(s)
- Annabelle Gourlay
- Faculty of Population Health Sciences, University College London, London, UK
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, London, UK
| | - Julie Fox
- Guys and St Thomas’ NHS Trust/ King’s College London, London, UK
| | - Mitzy Gafos
- Faculty of Population Health Sciences, University College London, London, UK
| | - Sarah Fidler
- Department of Medicine, Imperial College London, London, UK
| | - Nneka Nwokolo
- 56 Dean Street, Department of HIV/GUM, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Amanda Clarke
- Elton John Centre, Royal Sussex County Hospital, Brighton and Sussex University Hospital, Brighton, UK
| | - Richard Gilson
- Faculty of Population Health Sciences, University College London, London, UK
| | - Chloe Orkin
- Ambrose King Centre, Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - Kholoud Porter
- Faculty of Population Health Sciences, University College London, London, UK
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, London, UK
| | - Graham Hart
- Faculty of Population Health Sciences, University College London, London, UK
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Jones OS, Vassie C, Gilson R, Lechner M. Until eradication, awareness. Lancet Infect Dis 2017; 17:368-369. [PMID: 28346176 DOI: 10.1016/s1473-3099(17)30125-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 02/17/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Oliver S Jones
- UCL Cancer Institute, University College London, London, UK
| | - Claire Vassie
- Research Department of Infection & Population Health, University College London, London, UK
| | - Richard Gilson
- Research Department of Infection & Population Health, University College London, London, UK; Mortimer Market Centre, Central and North West London NHS Trust, UK
| | - Matt Lechner
- UCL Cancer Institute, University College London, London, UK; Head and Neck Centre, University College London Hospitals NHS Trust, London, UK.
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Milinkovic A, Benn P, Arenas-Pinto A, Brima N, Copas A, Clarke A, Fisher M, Schembri G, Hawkins D, Williams A, Gilson R. Randomized controlled trial of the tolerability and completion of maraviroc compared with Kaletra® in combination with Truvada® for HIV post-exposure prophylaxis (MiPEP Trial). J Antimicrob Chemother 2017; 72:1760-1768. [PMID: 28369381 DOI: 10.1093/jac/dkx062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/06/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ana Milinkovic
- Centre for Sexual Health and HIV Research, University College London, UK
| | - Paul Benn
- Central and North West London NHS Foundation Trust, The Mortimer Market Centre, UK
| | - Alejandro Arenas-Pinto
- Centre for Sexual Health and HIV Research, University College London, UK
- Central and North West London NHS Foundation Trust, The Mortimer Market Centre, UK
| | - Nataliya Brima
- Centre for Sexual Health and HIV Research, University College London, UK
| | - Andrew Copas
- Centre for Sexual Health and HIV Research, University College London, UK
| | - Amanda Clarke
- The Claude Nicol Unit, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Martin Fisher
- The Claude Nicol Unit, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Gabriel Schembri
- Manchester Centre for Sexual Health, Manchester Royal Infirmary, Manchester, UK
| | - David Hawkins
- Chelsea and Westminster NHS Foundation Trust, The John Hunter Clinic, London, UK
| | - Andy Williams
- Royal London Hospital, Ambrose King Centre, London, UK
| | - Richard Gilson
- Centre for Sexual Health and HIV Research, University College London, UK
- Central and North West London NHS Foundation Trust, The Mortimer Market Centre, UK
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Sewell J, Miltz A, Lampe FC, Cambiano V, Speakman A, Phillips AN, Stuart D, Gilson R, Asboe D, Nwokolo N, Clarke A, Collins S, Hart G, Elford J, Rodger AJ. Poly drug use, chemsex drug use, and associations with sexual risk behaviour in HIV-negative men who have sex with men attending sexual health clinics. Int J Drug Policy 2017; 43:33-43. [PMID: 28189979 DOI: 10.1016/j.drugpo.2017.01.001] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/20/2016] [Accepted: 01/03/2017] [Indexed: 10/24/2022]
Abstract
BACKGROUND Recreational drug use and associated harms continue to be of significant concern in men who have sex with men (MSM) particularly in the context of HIV and STI transmission. METHODS Data from 1484 HIV-negative or undiagnosed MSM included in the AURAH study, a cross-sectional, self-completed questionnaire study of 2630 individuals from 20 sexual health clinics in the United Kingdom in 2013-2014, was analysed. Two measures of recreational drug use in the previous three months were defined; (i) polydrug use (use of 3 or more recreational drugs) and (ii) chemsex drug use (use of mephedrone, crystal methamphetamine or GHB/GBL). Associations of socio-demographic, health and lifestyle factors with drug use, and associations of drug use with sexual behaviour, were investigated. RESULTS Of the 1484 MSM, 350 (23.6%) reported polydrug use and 324 (21.8%) reported chemsex drug use in the past three months. Overall 852 (57.5%) men reported condomless sex in the past three months; 430 (29.0%) had CLS with ≥2 partners, 474 (31.9%) had CLS with unknown/HIV+ partner(s); 187 (12.6%) had receptive CLS with an unknown status partner. For polydrug use, prevalence ratios (95% confidence interval) for association with CLS measures, adjusted for socio-demographic factors were: 1.38 (1.26, 1.51) for CLS; 2.11 (1.80, 2.47) for CLS with ≥2 partners; 1.89 (1.63, 2.19) for CLS with unknown/HIV+ partner(s); 1.36 (1.00, 1.83) for receptive CLS with an unknown status partner. Corresponding adjusted prevalence ratios for chemsex drug use were: 1.38 (1.26, 1.52); 2.07 (1.76, 2.43); 1.88 (1.62, 2.19); 1.49 (1.10, 2.02). Polydrug and chemsex drug use were also strongly associated with previous STI, PEP use, group sex and high number of new sexual partners. Associations remained with little attenuation after further adjustment for depressive symptoms and alcohol intake. CONCLUSION There was a high prevalence of polydrug use and chemsex drug use among HIV negative MSM attending UK sexual health clinics. Drug use was strongly associated with sexual behaviours linked to risk of acquisition of STIs and HIV.
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Affiliation(s)
- Janey Sewell
- Research Department of Infection & Population Health, University College London, London, United Kingdom
| | - Ada Miltz
- Research Department of Infection & Population Health, University College London, London, United Kingdom
| | - Fiona C Lampe
- Research Department of Infection & Population Health, University College London, London, United Kingdom
| | - Valentina Cambiano
- Research Department of Infection & Population Health, University College London, London, United Kingdom
| | - Andrew Speakman
- Research Department of Infection & Population Health, University College London, London, United Kingdom
| | - Andrew N Phillips
- Research Department of Infection & Population Health, University College London, London, United Kingdom
| | - David Stuart
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard Gilson
- Research Department of Infection & Population Health, University College London, London, United Kingdom
| | - David Asboe
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Nneka Nwokolo
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Amanda Clarke
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | | | - Graham Hart
- Research Department of Infection & Population Health, University College London, London, United Kingdom
| | | | - Alison J Rodger
- Research Department of Infection & Population Health, University College London, London, United Kingdom.
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Burch LS, Smith CJ, Anderson J, Sherr L, Rodger AJ, O'Connell R, Geretti AM, Gilson R, Fisher M, Elford J, Jones M, Collins S, Azad Y, Phillips AN, Speakman A, Johnson MA, Lampe FC. Socioeconomic status and treatment outcomes for individuals with HIV on antiretroviral treatment in the UK: cross-sectional and longitudinal analyses. Lancet Public Health 2016; 1:e26-e36. [PMID: 28299369 PMCID: PMC5341147 DOI: 10.1016/s2468-2667(16)30002-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Few studies have assessed the effect of socioeconomic status on HIV treatment outcomes in settings with universal access to health care. Here we aimed to investigate the association of socioeconomic factors with antiretroviral therapy (ART) non-adherence, virological non-suppression, and virological rebound, in HIV-positive people on ART in the UK. Methods We used data from the Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) questionnaire study, which recruited participants aged 18 years or older with HIV from eight HIV outpatient clinics in the UK between Feb 1, 2011, and Dec 31, 2012. Participants self-completed a confidential questionnaire on sociodemographic, health, and lifestyle issues. In participants on ART, we assessed associations of financial hardship, employment, housing, and education with: self-reported ART non-adherence at the time of the questionnaire; virological non-suppression (viral load >50 copies per mL) at the time of questionnaire in those who started ART at least 6 months ago (cross-sectional analysis); and subsequent virological rebound (viral load >200 copies per mL) in those with initial viral load of 50 copies per mL or lower (longitudinal analysis). Findings Of the 3258 people who completed the questionnaire, 2771 (85%) reported being on ART at the time of the questionnaire, and 2704 with complete data were included. 873 (32%) of 2704 participants reported non-adherence to ART and 219 (9%) of 2405 had virological non-suppression in cross-sectional analysis. Each of the four measures of lower socioeconomic status was strongly associated with non-adherence to ART, and with virological non-suppression (prevalence ratios [PR] adjusted for gender/sexual orientation, age, and ethnic origin: greatest financial hardship vs none 2·4, 95% CI 1·6–3·4; non-employment 2·0, 1·5–2·6; unstable housing vs homeowner 3·0, 1·9–4·6; non-university education 1·6, 1·2–2·2). 139 (8%) of 1740 individuals had subsequent virological rebound (rate=3·6/100 person-years). Low socioeconomic status was predictive of longitudinal rebound risk (adjusted hazard ratio [HR] for greatest financial hardship vs none 2·3, 95% CI 1·4–3·9; non-employment 3·0, 2·1–4·2; unstable housing vs homeowner 3·3, 1·8–6·1; non-university education 1·6, 1·1–2·3). Interpretation Socioeconomic disadvantage was strongly associated with poorer HIV treatment outcomes in this setting with universal health care. Adherence interventions and increased social support for those most at risk should be considered. Funding National Institute for Health Research.
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Affiliation(s)
- Lisa S Burch
- Research Department of Infection and Population Health, University College London, London, UK
| | - Colette J Smith
- Research Department of Infection and Population Health, University College London, London, UK
| | - Jane Anderson
- Centre for the Study of Sexual Health and HIV, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Lorraine Sherr
- Research Department of Infection and Population Health, University College London, London, UK
| | - Alison J Rodger
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Anna-Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Richard Gilson
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Jonathan Elford
- School of Health Sciences, City, University of London, London, UK
| | - Martin Jones
- East Sussex Healthcare NHS Trust, Eastbourne, UK
| | | | | | - Andrew N Phillips
- Research Department of Infection and Population Health, University College London, London, UK
| | - Andrew Speakman
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Fiona C Lampe
- Research Department of Infection and Population Health, University College London, London, UK
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Long L, Abraham C, Paquette R, Shahmanesh M, Llewellyn C, Townsend A, Gilson R. Brief interventions to prevent sexually transmitted infections suitable for in-service use: A systematic review. Prev Med 2016; 91:364-382. [PMID: 27373209 DOI: 10.1016/j.ypmed.2016.06.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 05/26/2016] [Accepted: 06/27/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are more common in young people and men who have sex with men (MSM) and effective in-service interventions are needed. METHODS A systematic review of randomized controlled trials (RCTs) of waiting-room-delivered, self-delivered and brief healthcare-provider-delivered interventions designed to reduce STIs, increase use of home-based STI testing, or reduce STI-risk behavior was conducted. Six databases were searched between January 2000 and October 2014. RESULTS 17,916 articles were screened. 23 RCTs of interventions for young people met our inclusion criteria. Significant STI reductions were found in four RCTs of interventions using brief one-to-one counselling (2 RCTs), video (1 RCT) and a STI home-testing kit (1 RCT). Increase in STI test uptake was found in five studies using video (1 RCT), one-to-one counselling (1 RCT), home test kit (2 RCTs) and a web-based intervention (1 RCT). Reduction in STI-risk behavior was found in seven RCTs of interventions using digital online (web-based) and offline (computer software) (3 RCTs), printed materials (1 RCT) and video (3 RCTs). Ten RCTs of interventions for MSM met our inclusion criteria. Three tested for STI reductions but none found significant differences between intervention and control groups. Increased STI test uptake was found in two studies using brief one-to-one counselling (1 RCT) and an online web-based intervention (1 RCT). Reduction in STI-risk behavior was found in six studies using digital online (web-based) interventions (4 RCTs) and brief one-to-one counselling (2 RCTs). CONCLUSION A small number of interventions which could be used, or adapted for use, in sexual health clinics were found to be effective in reducing STIs among young people and in promoting self-reported STI-risk behavior change in MSM.
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Affiliation(s)
- L Long
- Psychology Applied to Health Group, University of Exeter Medical School, University of Exeter, UK
| | - C Abraham
- Psychology Applied to Health Group, University of Exeter Medical School, University of Exeter, UK.
| | - R Paquette
- Research Department of Infection and Population Health, University College London, UK
| | - M Shahmanesh
- Research Department of Infection and Population Health, University College London, UK
| | - C Llewellyn
- Division of Public Health and Primary Care, Brighton and Sussex Medical School, UK
| | - A Townsend
- Psychology Applied to Health Group, University of Exeter Medical School, University of Exeter, UK
| | - R Gilson
- Research Department of Infection and Population Health, University College London, UK
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Abstract
Technology advances and increased application of UAVs will demand greater attention to human factors concerns in design, deployment, and training.
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Aghaizu A, Wayal S, Nardone A, Parsons V, Copas A, Mercey D, Hart G, Gilson R, Johnson AM. Sexual behaviours, HIV testing, and the proportion of men at risk of transmitting and acquiring HIV in London, UK, 2000-13: a serial cross-sectional study. Lancet HIV 2016; 3:e431-e440. [PMID: 27562744 DOI: 10.1016/s2352-3018(16)30037-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/29/2016] [Accepted: 05/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND HIV incidence in men who have sex with men (MSM) in the UK has remained unchanged over the past decade despite increases in HIV testing and antiretroviral therapy (ART) coverage. In this study, we examine trends in sexual behaviours and HIV testing in MSM and explore the risk of transmitting and acquiring HIV. METHODS In this serial cross-sectional study, we obtained data from ten cross-sectional surveys done between 2000 and 2013, consisting of anonymous self-administered questionnaires and oral HIV antibody testing in MSM recruited in gay social venues in London, UK. Data were collected between October and January for all survey years up to 2008 and between February and August thereafter. All men older than 16 years were eligible to take part and fieldworkers attempted to approach all MSM in each venue and recorded refusal rates. Data were collected on demographic and sexual behavioural characteristics. We analysed trends over time using linear, logistic, and quantile regression. FINDINGS Of 13 861 questionnaires collected between 2000 and 2013, we excluded 1985 (124 had completed the survey previously or were heterosexual reporting no anal intercourse in the past year, and 1861 did not provide samples for antibody testing). Of the 11 876 eligible MSM recruited, 1512 (13%) were HIV positive, with no significant trend in HIV positivity over time. 35% (531 of 1505) of HIV-positive MSM had undiagnosed infection, which decreased non-linearly over time from 34% (45 of 131) to 24% (25 of 106; p=0·01), while recent HIV testing (ie, in the past year) increased from 26% (263 of 997) to 60% (467 of 777; p<0·0001). The increase in recent testing in undiagnosed men (from 29% to 67%, p<0·0001) and HIV-negative men (from 26% to 62%, p<0·0001) suggests that undiagnosed infection might increasingly be recently acquired infection. The proportion of MSM reporting unprotected anal intercourse (UAI) in the past year increased from 43% (513 of 1187) to 53% (394 of 749; p<0·0001) and serosorting (exclusively) increased from 18% (207 of 1132) to 28% (177 of 6369; p<0·0001). 268 (2%) of 11 570 participants had undiagnosed HIV and reported UAI in the past year were at risk of transmitting HIV. Additionally 259 (2%) had diagnosed infection and reported UAI and non-exclusive serosorting in the past year. Although we did not collect data on antiretroviral therapy or viral load, surveillance data suggests that a small proportion of men with diagnosed infection will have detectable viral load and hence might also be at risk of transmitting HIV. 2633 (25%) of 10 364 participants were at high risk of acquiring HIV (defined as HIV-negative MSM either reporting one or more casual UAI partners in the past year or not exclusively serosorting). The proportions of MSM at risk of transmission or acquisition changed little over time (p=0·96 for MSM potentially at risk of transmission and p=0·275 for MSM at high risk of acquiring HIV). Undiagnosed men reporting UAI and diagnosed men not exclusively serosorting had consistently higher partner numbers than did other MSM over the period (median ranged from one to three across surveys in undiagnosed men reporting UAI, two to ten in diagnosed men not exclusively serosorting, and none to two in other men). INTERPRETATION An increasing proportion of undiagnosed HIV infections in MSM in London might have been recently acquired, which is when people are likely to be most infectious. High UAI partner numbers of MSM at risk of transmitting HIV and the absence of a significant decrease in the proportion of men at high risk of acquiring the infection might explain the sustained HIV incidence. Implementation of combination prevention interventions comprising both behavioural and biological interventions to reduce community-wide risk is crucial to move towards eradication of HIV. FUNDING Public Health England.
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Affiliation(s)
- Adamma Aghaizu
- HIV and STI Department, National Infection Service, Public Health England, London, UK
| | - Sonali Wayal
- Centre for Sexual Health and HIV Research, University College London, London, UK
| | - Anthony Nardone
- HIV and STI Department, National Infection Service, Public Health England, London, UK
| | - Victoria Parsons
- Centre for Sexual Health and HIV Research, University College London, London, UK
| | - Andrew Copas
- Centre for Sexual Health and HIV Research, University College London, London, UK
| | - Danielle Mercey
- Centre for Sexual Health and HIV Research, University College London, London, UK
| | - Graham Hart
- Centre for Sexual Health and HIV Research, University College London, London, UK
| | - Richard Gilson
- Centre for Sexual Health and HIV Research, University College London, London, UK
| | - Anne M Johnson
- Centre for Sexual Health and HIV Research, University College London, London, UK.
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Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J, Corbelli GM, Estrada V, Geretti AM, Beloukas A, Asboe D, Viciana P, Gutiérrez F, Clotet B, Pradier C, Gerstoft J, Weber R, Westling K, Wandeler G, Prins JM, Rieger A, Stoeckle M, Kümmerle T, Bini T, Ammassari A, Gilson R, Krznaric I, Ristola M, Zangerle R, Handberg P, Antela A, Allan S, Phillips AN, Lundgren J. Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy. JAMA 2016; 316:171-81. [PMID: 27404185 DOI: 10.1001/jama.2016.5148] [Citation(s) in RCA: 915] [Impact Index Per Article: 114.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE A key factor in assessing the effectiveness and cost-effectiveness of antiretroviral therapy (ART) as a prevention strategy is the absolute risk of HIV transmission through condomless sex with suppressed HIV-1 RNA viral load for both anal and vaginal sex. OBJECTIVE To evaluate the rate of within-couple HIV transmission (heterosexual and men who have sex with men [MSM]) during periods of sex without condoms and when the HIV-positive partner had HIV-1 RNA load less than 200 copies/mL. DESIGN, SETTING, AND PARTICIPANTS The prospective, observational PARTNER (Partners of People on ART-A New Evaluation of the Risks) study was conducted at 75 clinical sites in 14 European countries and enrolled 1166 HIV serodifferent couples (HIV-positive partner taking suppressive ART) who reported condomless sex (September 2010 to May 2014). Eligibility criteria for inclusion of couple-years of follow-up were condomless sex and HIV-1 RNA load less than 200 copies/mL. Anonymized phylogenetic analysis compared couples' HIV-1 polymerase and envelope sequences if an HIV-negative partner became infected to determine phylogenetically linked transmissions. EXPOSURES Condomless sexual activity with an HIV-positive partner taking virally suppressive ART. MAIN OUTCOMES AND MEASURES Risk of within-couple HIV transmission to the HIV-negative partner. RESULTS Among 1166 enrolled couples, 888 (mean age, 42 years [IQR, 35-48]; 548 heterosexual [61.7%] and 340 MSM [38.3%]) provided 1238 eligible couple-years of follow-up (median follow-up, 1.3 years [IQR, 0.8-2.0]). At baseline, couples reported condomless sex for a median of 2 years (IQR, 0.5-6.3). Condomless sex with other partners was reported by 108 HIV-negative MSM (33%) and 21 heterosexuals (4%). During follow-up, couples reported condomless sex a median of 37 times per year (IQR, 15-71), with MSM couples reporting approximately 22,000 condomless sex acts and heterosexuals approximately 36,000. Although 11 HIV-negative partners became HIV-positive (10 MSM; 1 heterosexual; 8 reported condomless sex with other partners), no phylogenetically linked transmissions occurred over eligible couple-years of follow-up, giving a rate of within-couple HIV transmission of zero, with an upper 95% confidence limit of 0.30/100 couple-years of follow-up. The upper 95% confidence limit for condomless anal sex was 0.71 per 100 couple-years of follow-up. CONCLUSIONS AND RELEVANCE Among serodifferent heterosexual and MSM couples in which the HIV-positive partner was using suppressive ART and who reported condomless sex, during median follow-up of 1.3 years per couple, there were no documented cases of within-couple HIV transmission (upper 95% confidence limit, 0.30/100 couple-years of follow-up). Additional longer-term follow-up is necessary to provide more precise estimates of risk.
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Affiliation(s)
- Alison J Rodger
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Valentina Cambiano
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Tina Bruun
- Department of Infectious Diseases/CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Pietro Vernazza
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital, St Gallen, Switzerland
| | | | - Jan van Lunzen
- University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | | | - Vicente Estrada
- Hospital Clinico San Carlos and Universidad Complutense, Madrid, Spain
| | - Anna Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Apostolos Beloukas
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - David Asboe
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | | | - Félix Gutiérrez
- Hospital General de Elche & Universidad Miguel Hernández, Alicante, Spain
| | - Bonaventura Clotet
- IrsiCaixa Foundation, UAB, UVIC-UCC, Hospital Universitari "Germans Trias i Pujol," Badalona, Catalonia, Spain
| | - Christian Pradier
- Department of Public Health, Nice University Hospital and EA 6312, University Nice Sophia-Antipolis, France
| | | | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Katarina Westling
- Unit of Infectious Diseases and Dermatology, Department of Medicine, Karolinska Institutet, and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan M Prins
- Academic Medical Center, Amsterdam, the Netherlands
| | | | - Marcel Stoeckle
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Tim Kümmerle
- Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | | | | | - Richard Gilson
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | | | - Matti Ristola
- Helsinki University Central Hospital, Helsinki, Finland
| | | | - Pia Handberg
- Hvidovre Universitets Hospital, Hvidovre, Denamrk
| | - Antonio Antela
- Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Sris Allan
- Coventry and Warwickshire Hospital, Coventry, United Kingdom
| | - Andrew N Phillips
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Jens Lundgren
- Department of Infectious Diseases/CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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King EM, Oomeer S, Gilson R, Copas A, Beddows S, Soldan K, Jit M, Edmunds WJ, Sonnenberg P. Oral Human Papillomavirus Infection in Men Who Have Sex with Men: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0157976. [PMID: 27384050 PMCID: PMC4934925 DOI: 10.1371/journal.pone.0157976] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/08/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The epidemiology of oral human papillomavirus (HPV) infection in men who have sex with men (MSM) differs from anogenital HPV infection. The impact of HPV vaccination has, to date, largely focussed on anogenital outcomes. Vaccination of MSM in the UK has been recommended and, if implemented, baseline estimates of oral HPV prevalence will be useful. METHODS We searched Medline, Embase and psycINFO databases for studies reporting prevalence, incidence, and clearance of oral HPV infection in MSM. We performed a random-effects meta-analysis and meta-regression on prevalence estimates and summarised within-study risk factors for oral HPV DNA detection and incidence/clearance rates. We also performed a meta-analysis of the effect of MSM on oral HPV prevalence compared to heterosexual men. RESULTS 26 publications were identified. The pooled prevalence of oral HPV16 from twelve estimates was 3.0% (95%CI 0.5-5.5) in HIV-negative and 4.7% (95%CI 2.1-7.3) in HIV-positive MSM. Median age of study participants explained 38% of heterogeneity (p<0.01) in HPV prevalence estimates (pooled = 17% and 29% in HIV-negative and HIV-positive, respectively; 22 estimates). Nine studies compared MSM to heterosexual men and found no difference in oral HPV prevalence (pooled OR 1.07 (95%CI 0.65-1.74)). The clearance rate was higher than incidence within studies. Type-specific concordance between oral and anogenital sites was rare. CONCLUSION There was substantial heterogeneity between estimates of oral HPV prevalence in MSM populations that was partly explained by HIV status and median age.
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Affiliation(s)
- Eleanor M. King
- Research Department of Infection and Population Health, University College London, WC1E 6JB, London, United Kingdom
| | - Soonita Oomeer
- The Mortimer Market Centre, Central and North West London NHS Foundation Trust, WC1E 6JB, London, United Kingdom
| | - Richard Gilson
- Research Department of Infection and Population Health, University College London, WC1E 6JB, London, United Kingdom
- The Mortimer Market Centre, Central and North West London NHS Foundation Trust, WC1E 6JB, London, United Kingdom
| | - Andrew Copas
- Research Department of Infection and Population Health, University College London, WC1E 6JB, London, United Kingdom
| | - Simon Beddows
- Virus Reference Department, Public Health England, 61 Colindale Avenue, NW9 5EQ, London, United Kingdom
| | - Kate Soldan
- Centre for Communicable Disease Surveillance and Control (CIDSC), Public Health England, 61 Colindale Avenue, NW9 5EQ, London, United Kingdom
| | - Mark Jit
- Modelling and Economics Unit, Public Health England, 61 Colindale Avenue, NW9 5EQ, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, WC1E 7HT, London, United Kingdom
| | - W. John Edmunds
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, WC1E 7HT, London, United Kingdom
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, University College London, WC1E 6JB, London, United Kingdom
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Sewell J, Speakman A, Phillips AN, Cambiano V, Lampe FC, Gilson R, Asboe D, Nwokolo N, Clarke A, Ogilvy A, Collins S, Rodger AJ. Attitudes to and Understanding of Risk of Acquisition of HIV Over Time: Design and Methods for an Internet-based Prospective Cohort Study Among UK Men Who Have Sex With Men (the AURAH2 Study). JMIR Res Protoc 2016; 5:e128. [PMID: 27307218 PMCID: PMC4927873 DOI: 10.2196/resprot.5582] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 02/29/2016] [Accepted: 03/16/2016] [Indexed: 11/18/2022] Open
Abstract
Background The annual number of new human immunodeficiency virus (HIV) infections among men who have sex with men (MSM) has risen in the United Kingdom and, of those who are HIV positive, the proportion undiagnosed is high. Objective The prospective AURAH2 study aims to assess factors associated with HIV acquisition among MSM in the United Kingdom and to investigate changes over time within individuals in sexual behavior and HIV-testing practices. Methods AURAH2 is a prospective study among MSM without diagnosed HIV, aiming to recruit up to 1000 sexually active MSM attending sexual health clinics in London and Brighton in the United Kingdom. Participants complete an initial paper-based questionnaire, followed by online follow-up questionnaires every 4 months collecting sociodemographic, health and behavioral data, including sexual behavior, recreational and other drug use, HIV testing practices, and pre-exposure prophylaxis use, over a planned 3-year period. Results The study is ongoing. Conclusions The results from AURAH2 study will provide important insight into established and emerging risk behaviors that may be associated with acquisition of HIV in MSM in the United Kingdom, changes over time within individuals in sexual behavior, and information on HIV testing practices. These data will be crucial to inform future HIV prevention strategies.
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Affiliation(s)
- Janey Sewell
- Department of Infection and Population Health, UCL, London, United Kingdom.
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King C, Roy A, Shahmanesh M, Gilson R, Richardson D, Burns F, Rodgers A, Massie N, Bailey J, Llewellyn C. P110 The Santé Project: a mixed-methods assessment of opportunities and challenges for the delivery of brief risk reduction interventions in sexual health clinics in England - a healthcare provider’s perspective: Abstract P110 Table 1. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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King C, Mercer C, Furegato M, Mohammed H, Copas A, Shahmanesh M, Gilson R, Hughes G. O037 Predicting STI risk among people attending sexual health services: Development of a triage tool targeting behavioural interventions among young people. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Roy A, King C, Miners A, Llewellyn C, Pollard A, Gilson R, Richardson D, Clark L, Burns F, Rodgers A, Bailey J, Shahmanesh M. P109 The Santé project: Attitude towards STI risk assessment, preferences for STI behavioural risk reduction interventions: Service Users Perspectives. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Nightingale S, Michael BD, Fisher M, Winston A, Nelson M, Taylor S, Ustianowski A, Ainsworth J, Gilson R, Haddow L, Ong E, Leen C, Minton J, Post F, Beloukas A, Borrow R, Pirmohamed M, Geretti AM, Khoo S, Solomon T. CSF/plasma HIV-1 RNA discordance even at low levels is associated with up-regulation of host inflammatory mediators in CSF. Cytokine 2016; 83:139-146. [PMID: 27131579 PMCID: PMC4889775 DOI: 10.1016/j.cyto.2016.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/04/2016] [Accepted: 04/05/2016] [Indexed: 12/20/2022]
Abstract
Discordant HIV in CSF is associated with raised inflammatory mediators in CSF. CSF mediators are raised with discordance both at high and low levels. Discordance on ultrasensitive testing can also be also associated with raised mediators.
Introduction HIV-1 RNA can be found at higher levels in cerebrospinal fluid (CSF) than in plasma, termed CSF/plasma discordance. The clinical significance of CSF/plasma discordance is not known and the degree of discordance considered important varies. We aimed to determine whether a panel of CSF cytokines, chemokines and associated mediators were raised in patients with CSF/plasma discordance at different levels. Methods A nested case-control study of 40 CSF samples from the PARTITION study. We used a cytometric bead array to measure CSF mediator concentrations in 19 discordant and 21 non-discordant samples matched for plasma HIV-1 RNA. Discordant samples were subdivided into ‘high discordance’ (>1log10) and ‘low discordance’ (0.5–1log10, or ultrasensitive discordance). CSF mediators significant in univariate analysis went forward to two-way unsupervised hierarchical clustering based on the patterns of relative mediator concentrations. Results In univariate analysis 19 of 21 CSF mediators were significantly higher in discordant than non-discordant samples. There were no significant differences between samples with high versus low discordance. The samples grouped into two clusters which corresponded to CSF/plasma discordance (p < 0.0001). In cluster one all mediators had relatively high abundance; this included 18 discordant samples and three non-discordant samples. In cluster two all mediators had relatively low abundance; this included 18 non-discordant samples and one non-discordant sample with ultrasensitive discordance only. Conclusions CSF/plasma discordance is associated with potentially damaging neuroinflammatory process. Patients with discordance at lower levels (ie. 0.5–1log10) should also be investigated as mediator profiles were similar to those with discordance >1log10. Sensitive testing may have a role to determine whether ultrasensitive discordance is present in those with low level CSF escape.
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Affiliation(s)
- Sam Nightingale
- Institute of Infection and Global Health, University of Liverpool, UK; Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK; Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK.
| | - Benedict D Michael
- Institute of Infection and Global Health, University of Liverpool, UK; Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Martin Fisher
- Brighton and Sussex University Hospitals NHS Trust, UK
| | - Alan Winston
- St Marys' Hospital, Imperial College Heathcare NHS Trust, London, UK
| | - Mark Nelson
- St Stephen's AIDS Research Trust and Chelsea and Westminster Hospital NHS Foundation Trust, UK
| | - Steven Taylor
- Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, UK
| | - Andrew Ustianowski
- North Manchester General Hospital, Pennine Acute Hospitals NHS Trust, UK
| | | | - Richard Gilson
- Research Department of Infection and Population Health, University College London, UK
| | - Lewis Haddow
- Research Department of Infection and Population Health, University College London, UK
| | - Edmund Ong
- Victoria Royal Infirmary, Newcastle upon Tyne Hospitals NHS Trust, UK
| | | | - Jane Minton
- Leeds General Infirmary, Leeds Teaching Hosptials NHS Trust, UK
| | - Frank Post
- Kings College Hospital NHS Foundation Trust, London, UK
| | | | - Ray Borrow
- Vaccine Evaluation Unit at the Health Protection Agency (HPA) North West, Manchester, UK
| | - Munir Pirmohamed
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | | | - Saye Khoo
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Tom Solomon
- Institute of Infection and Global Health, University of Liverpool, UK; Walton Centre for Neurology and Neurosurgery, Liverpool, UK
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Sewell J, Speakman A, Phillips AN, Lampe FC, Miltz A, Gilson R, Asboe D, Nwokolo N, Scott C, Day S, Fisher M, Clarke A, Anderson J, O'Connell R, Apea V, Dhairyawan R, Gompels M, Farazmand P, Allan S, Mann S, Dhar J, Tang A, Sadiq ST, Taylor S, Collins S, Sherr L, Hart G, Johnson AM, Miners A, Elford J, Rodger A. A Cross-Sectional Study on Attitudes to and Understanding of Risk of Acquisition of HIV: Design, Methods and Participant Characteristics. JMIR Res Protoc 2016; 5:e58. [PMID: 27091769 PMCID: PMC4858591 DOI: 10.2196/resprot.4873] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 11/05/2015] [Accepted: 11/29/2015] [Indexed: 11/13/2022] Open
Abstract
Background The annual number of new human immunodeficiency virus (HIV) infections in the United Kingdom among men who have sex with men (MSM) has risen, and remains high among heterosexuals. Increasing HIV transmission among MSM is consistent with evidence of ongoing sexual risk behavior in this group, and targeted prevention strategies are needed for those at risk of acquiring HIV. Objective The Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) study was designed to collect information on HIV negative adults at risk of HIV infection in the United Kingdom, based on the following parameters: physical and mental health, lifestyle, patterns of sexual behaviour, and attitudes to sexual risk. Methods Cross-sectional questionnaire study of HIV negative or undiagnosed sexual health clinic attendees in the United Kingdom from 2013-2014. Results Of 2630 participants in the AURAH study, 2064 (78%) were in the key subgroups of interest; 580 were black Africans (325 females and 255 males) and 1484 were MSM, with 27 participants belonging to both categories. Conclusions The results from AURAH will be a significant resource to understand the attitudes and sexual behaviour of those at risk of acquiring HIV within the United Kingdom. AURAH will inform future prevention efforts and targeted health promotion initiatives in the HIV negative population.
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Affiliation(s)
- Janey Sewell
- Institute of Epidemiology and Health Care, Research Department of Infection and Population Health, UCL, London, United Kingdom.
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Tariq S, Anderson J, Burns F, Delpech V, Gilson R, Sabin C. The menopause transition in women living with HIV: current evidence and future avenues of research. J Virus Erad 2016. [DOI: 10.1016/s2055-6640(20)30476-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Tariq S, Anderson J, Burns F, Delpech V, Gilson R, Sabin C. The menopause transition in women living with HIV: current evidence and future avenues of research. J Virus Erad 2016; 2:114-6. [PMID: 27482447 PMCID: PMC4965243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
As the life expectancy of people living with HIV improves as a result of antiretroviral therapy, increasing numbers of women living with HIV (WLHIV) are now reaching menopausal age. The menopause transition in WLHIV remains a relatively overlooked area in clinical HIV research. Whilst there is some evidence to suggest that WLHIV experience menopause at an earlier age and that they have more menopausal symptoms, there is no clear consensus in the literature around an impact of HIV infection on either timing or symptomatology of the menopause. Data are also conflicting on whether HIV-related factors such as HIV viral load and CD4 cell count have an impact on the menopause. Furthermore, menopausal symptoms in WLHIV are known to go under-recognised by both healthcare providers and women themselves. There is likely to be a burden of unmet health needs among WLHIV transitioning through the menopause, with significant gaps in the evidence base for their care. With this in mind, we have developed the PRIME study (Positive Transitions Through the Menopause). This mixed-methods observational study will explore, for the first time in the UK, the impact of the menopause on the health and wellbeing of 1500 ethnically diverse WLHIV. In establishing a cohort of women in their midlife and following them up longitudinally, we hope to develop a nuanced understanding of the gendered aspects of ageing and HIV, informing the provision of appropriate services for WLHIV to ensure that they are supported in maintaining optimal health and wellbeing as they get older.
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Affiliation(s)
- Shema Tariq
- Corresponding author: Shema Tariq,
Research Department of Infection and Population Health,
University College London,
Mortimer Market Centre, Off Capper Street,
LondonWC1E 6JB,
UK
| | - Jane Anderson
- Centre for the Study of Sexual Health and HIV,
Homerton University Hospital NHS Foundation Trust,
London,
UK
| | - Fiona Burns
- Research Department of Infection and Population Health,
University College London,
UK
| | | | - Richard Gilson
- Research Department of Infection and Population Health,
University College London,
UK
| | - Caroline Sabin
- Research Department of Infection and Population Health,
University College London,
UK
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83
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Dolling DI, Desai M, McOwan A, Gilson R, Clarke A, Fisher M, Schembri G, Sullivan AK, Mackie N, Reeves I, Portman M, Saunders J, Fox J, Bayley J, Brady M, Bowman C, Lacey CJ, Taylor S, White D, Antonucci S, Gafos M, McCormack S, Gill ON, Dunn DT, Nardone A. An analysis of baseline data from the PROUD study: an open-label randomised trial of pre-exposure prophylaxis. Trials 2016; 17:163. [PMID: 27013513 PMCID: PMC4806447 DOI: 10.1186/s13063-016-1286-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 03/14/2016] [Indexed: 01/20/2023] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) has proven biological efficacy to reduce the sexual acquisition of the human immunodeficiency virus (HIV). The PROUD study found that PrEP conferred higher protection than in placebo-controlled trials, reducing HIV incidence by 86 % in a population with seven-fold higher HIV incidence than expected. We present the baseline characteristics of the PROUD study population and place the findings in the context of national sexual health clinic data. Methods The PROUD study was designed to explore the real-world effectiveness of PrEP (tenofovir-emtricitabine) by randomising HIV-negative gay and other men who have sex with men (GMSM) to receive open-label PrEP immediately or after a deferral period of 12 months. At enrolment, participants self-completed two baseline questionnaires collecting information on demographics, sexual behaviour and lifestyle in the last 30 and 90 days. These data were compared to data from HIV-negative GMSM attending sexual health clinics in 2013, collated by Public Health England using the genitourinary medicine clinic activity database (GUMCAD). Results The median age of participants was 35 (IQR: 29–43). Typically participants were white (81 %), educated at a university level (61 %) and in full-time employment (72 %). Of all participants, 217 (40 %) were born outside the UK. A sexually transmitted infection (STI) was reported to have been diagnosed in the previous 12 months in 330/515 (64 %) and 473/544 (87 %) participants reported ever having being diagnosed with an STI. At enrolment, 47/280 (17 %) participants were diagnosed with an STI. Participants reported a median (IQR) of 10 (5–20) partners in the last 90 days, a median (IQR) of 2 (1–5) were condomless sex acts where the participant was receptive and 2 (1–6) were condomless where the participant was insertive. Post-exposure prophylaxis had been prescribed to 184 (34 %) participants in the past 12 months. The number of STI diagnoses was high compared to those reported in GUMCAD attendees. Conclusions The PROUD study population are at substantially higher risk of acquiring HIV infection sexually than the overall population of GMSM attending sexual health clinics in England. These findings contribute to explaining the extraordinary HIV incidence rate during follow-up and demonstrate that, despite broad eligibility criteria, the population interested in PrEP was highly selective. Trial registration Current Controlled TrialsISRCTN94465371. Date of registration: 28 February 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1286-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David I Dolling
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Monica Desai
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH, UK.,HIV/STI Department, Public Health England, London, UK
| | - Alan McOwan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Richard Gilson
- The Mortimer Market Centre, Central and Northwest London NHS Foundation Trust, London, UK
| | - Amanda Clarke
- Claude Nichol Centre, Royal Surrey Sussex County Hospital, Brighton, UK
| | - Martin Fisher
- Claude Nichol Centre, Royal Surrey Sussex County Hospital, Brighton, UK
| | - Gabriel Schembri
- Manchester Centre for Sexual Health, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ann K Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nicola Mackie
- St Mary's Hospital, Imperial College NHS Foundation Trust, London, UK
| | - Iain Reeves
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - Mags Portman
- Ambrose King Centre, Barts Health NHS Trust, London, UK
| | - John Saunders
- Ambrose King Centre, Barts Health NHS Trust, London, UK
| | - Julie Fox
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jake Bayley
- King's College Hospital NHS Foundation Trust, London, UK
| | - Michael Brady
- King's College Hospital NHS Foundation Trust, London, UK
| | - Christine Bowman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | - David White
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - Simone Antonucci
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Mitzy Gafos
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Sheena McCormack
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH, UK.
| | - Owen N Gill
- HIV/STI Department, Public Health England, London, UK
| | - David T Dunn
- MRC Clinical Trials Unit at UCL, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
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Ferns RB, Tarr AW, Hue S, Urbanowicz RA, McClure CP, Gilson R, Ball JK, Nastouli E, Garson JA, Pillay D. Hepatitis C virus quasispecies and pseudotype analysis from acute infection to chronicity in HIV-1 co-infected individuals. Virology 2016; 492:213-24. [PMID: 26971243 DOI: 10.1016/j.virol.2016.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/14/2016] [Accepted: 02/05/2016] [Indexed: 01/01/2023]
Abstract
HIV-1 infected patients who acquire HCV infection have higher rates of chronicity and liver disease progression than patients with HCV mono-infection. Understanding early events in this pathogenic process is important. We applied single genome sequencing of the E1 to NS3 regions and viral pseudotype neutralization assays to explore the consequences of viral quasispecies evolution from pre-seroconversion to chronicity in four co-infected individuals (mean follow up 566 days). We observed that one to three founder viruses were transmitted. Relatively low viral sequence diversity, possibly related to an impaired immune response, due to HIV infection was observed in three patients. However, the fourth patient, after an early purifying selection displayed increasing E2 sequence evolution, possibly related to being on suppressive antiretroviral therapy. Viral pseudotypes generated from HCV variants showed relative resistance to neutralization by autologous plasma but not to plasma collected from later time points, confirming ongoing virus escape from antibody neutralization.
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Affiliation(s)
- R Bridget Ferns
- Division of Infection & Immunity, Faculty of Medical Sciences, University College London, United Kingdom; Clinical Microbiology & Virology, UCL Hospital NHS Foundation Trust, United Kingdom.
| | - Alexander W Tarr
- School of Life Sciences & NIHR Biomedical Research Unit in Gastrointestinal & Liver Diseases, Faculty of Medicine and Health Sciences, University of Nottingham, United Kingdom
| | - Stephane Hue
- Division of Infection & Immunity, Faculty of Medical Sciences, University College London, United Kingdom
| | - Richard A Urbanowicz
- School of Life Sciences & NIHR Biomedical Research Unit in Gastrointestinal & Liver Diseases, Faculty of Medicine and Health Sciences, University of Nottingham, United Kingdom
| | - C Patrick McClure
- School of Life Sciences & NIHR Biomedical Research Unit in Gastrointestinal & Liver Diseases, Faculty of Medicine and Health Sciences, University of Nottingham, United Kingdom
| | - Richard Gilson
- Research Department of Infection and Population Health, University College London, United Kingdom
| | - Jonathan K Ball
- School of Life Sciences & NIHR Biomedical Research Unit in Gastrointestinal & Liver Diseases, Faculty of Medicine and Health Sciences, University of Nottingham, United Kingdom
| | - Eleni Nastouli
- Clinical Microbiology & Virology, UCL Hospital NHS Foundation Trust, United Kingdom
| | - Jeremy A Garson
- Division of Infection & Immunity, Faculty of Medical Sciences, University College London, United Kingdom
| | - Deenan Pillay
- Division of Infection & Immunity, Faculty of Medical Sciences, University College London, United Kingdom; Wellcome Trust Africa Centre for Health and Population Sciences, University of KwaZulu, Natal, South Africa
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McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, Sullivan AK, Clarke A, Reeves I, Schembri G, Mackie N, Bowman C, Lacey CJ, Apea V, Brady M, Fox J, Taylor S, Antonucci S, Khoo SH, Rooney J, Nardone A, Fisher M, McOwan A, Phillips AN, Johnson AM, Gazzard B, Gill ON. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet 2016; 387:53-60. [PMID: 26364263 PMCID: PMC4700047 DOI: 10.1016/s0140-6736(15)00056-2] [Citation(s) in RCA: 1309] [Impact Index Per Article: 163.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Randomised placebo-controlled trials have shown that daily oral pre-exposure prophylaxis (PrEP) with tenofovir-emtricitabine reduces the risk of HIV infection. However, this benefit could be counteracted by risk compensation in users of PrEP. We did the PROUD study to assess this effect. METHODS PROUD is an open-label randomised trial done at 13 sexual health clinics in England. We enrolled HIV-negative gay and other men who have sex with men who had had anal intercourse without a condom in the previous 90 days. Participants were randomly assigned (1:1) to receive daily combined tenofovir disoproxil fumarate (245 mg) and emtricitabine (200 mg) either immediately or after a deferral period of 1 year. Randomisation was done via web-based access to a central computer-generated list with variable block sizes (stratified by clinical site). Follow-up was quarterly. The primary outcomes for the pilot phase were time to accrue 500 participants and retention; secondary outcomes included incident HIV infection during the deferral period, safety, adherence, and risk compensation. The trial is registered with ISRCTN (number ISRCTN94465371) and ClinicalTrials.gov (NCT02065986). FINDINGS We enrolled 544 participants (275 in the immediate group, 269 in the deferred group) between Nov 29, 2012, and April 30, 2014. Based on early evidence of effectiveness, the trial steering committee recommended on Oct 13, 2014, that all deferred participants be offered PrEP. Follow-up for HIV incidence was complete for 243 (94%) of 259 patient-years in the immediate group versus 222 (90%) of 245 patient-years in the deferred group. Three HIV infections occurred in the immediate group (1·2/100 person-years) versus 20 in the deferred group (9·0/100 person-years) despite 174 prescriptions of post-exposure prophylaxis in the deferred group (relative reduction 86%, 90% CI 64-96, p=0·0001; absolute difference 7·8/100 person-years, 90% CI 4·3-11·3). 13 men (90% CI 9-23) in a similar population would need access to 1 year of PrEP to avert one HIV infection. We recorded no serious adverse drug reactions; 28 adverse events, most commonly nausea, headache, and arthralgia, resulted in interruption of PrEp. We detected no difference in the occurrence of sexually transmitted infections, including rectal gonorrhoea and chlamydia, between groups, despite a suggestion of risk compensation among some PrEP recipients. INTERPRETATION In this high incidence population, daily tenofovir-emtricitabine conferred even higher protection against HIV than in placebo-controlled trials, refuting concerns that effectiveness would be less in a real-world setting. There was no evidence of an increase in other sexually transmitted infections. Our findings strongly support the addition of PrEP to the standard of prevention for men who have sex with men at risk of HIV infection. FUNDING MRC Clinical Trials Unit at UCL, Public Health England, and Gilead Sciences.
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Affiliation(s)
- Sheena McCormack
- MRC Clinical Trials Unit at UCL, London, UK; 56 Dean Street, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
| | | | - Monica Desai
- MRC Clinical Trials Unit at UCL, London, UK; HIV & STI Department, Public Health England Centre for Infectious Disease Surveillance and Control, London, UK
| | | | | | - Richard Gilson
- The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK; Research Department of Infection and Population Health, University College London, London, UK
| | - Ann K Sullivan
- St Stephen's Centre, Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Amanda Clarke
- Claude Nicol Centre, Royal Sussex County Hospital, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | - Iain Reeves
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - Gabriel Schembri
- Manchester Centre for Sexual Health, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Nicola Mackie
- St Mary's Hospital, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Christine Bowman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Charles J Lacey
- York Teaching Hospital and Hull York Medical School, University of York, York, UK
| | - Vanessa Apea
- Ambrose King Centre and Barts Sexual Health Centre, Barts Health NHS Trust, London, UK
| | - Michael Brady
- King's College Hospital NHS Foundation Trust, London, UK
| | - Julie Fox
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stephen Taylor
- Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Simone Antonucci
- 56 Dean Street, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | - Anthony Nardone
- HIV & STI Department, Public Health England Centre for Infectious Disease Surveillance and Control, London, UK
| | - Martin Fisher
- Claude Nicol Centre, Royal Sussex County Hospital, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | - Alan McOwan
- 56 Dean Street, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Andrew N Phillips
- Research Department of Infection and Population Health, University College London, London, UK
| | - Anne M Johnson
- Research Department of Infection and Population Health, University College London, London, UK
| | - Brian Gazzard
- St Stephen's Centre, Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Owen N Gill
- HIV & STI Department, Public Health England Centre for Infectious Disease Surveillance and Control, London, UK
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Wayal S, Parsons V, Copas A, Danielle M, Nardone A, Aghaizu A, Hart G, Gilson R, Johnson AM. O20.5 Trends in undiagnosed hiv and hiv testing behaviour in community samples of men who have sex with men in london, uk: results from repeat cross-sectional surveys between 2000–2013. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Winston A, Jose S, Fisher M, Walsh J, Nelson M, Gilson R, Post F, Johnson M, Leen C, Chadwick D, Hay P, Pritchard J, Tariq A, Sabin C. Host, disease, and antiretroviral factors are associated with normalization of the CD4:CD8 ratio after initiating antiretroviral therapy. J Allergy Clin Immunol 2015; 136:1682-1685.e1. [PMID: 26253341 DOI: 10.1016/j.jaci.2015.05.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/07/2015] [Accepted: 05/13/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Alan Winston
- Section of Infectious Diseases, Department of Medicine, Imperial College London, London, United Kingdom; Department of HIV and GU Medicine, Imperial Healthcare NHS Trust, London, United Kingdom.
| | - Sophie Jose
- Research Department of Infection and Population Health, UCL, Royal Free Campus, London, United Kingdom
| | - Martin Fisher
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - John Walsh
- Department of HIV and GU Medicine, Imperial Healthcare NHS Trust, London, United Kingdom
| | - Mark Nelson
- Section of Infectious Diseases, Department of Medicine, Imperial College London, London, United Kingdom; Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard Gilson
- Centre for Sexual Health & HIV Research, University College London, London, United Kingdom; Mortimer Market Centre, London, United Kingdom
| | - Frank Post
- Kings College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Clifford Leen
- Edinburgh Infectious Diseases, Edinburgh University Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, United Kingdom; Edinburgh University, Edinburgh, United Kingdom
| | - David Chadwick
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Phillip Hay
- St George's Healthcare NHS Trust, London, United Kingdom
| | - Jillian Pritchard
- Ashford and St Peter's Hospitals NHS Foundation Trust, Surrey, United Kingdom
| | - Anjum Tariq
- The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
| | - Caroline Sabin
- Research Department of Infection and Population Health, UCL, Royal Free Campus, London, United Kingdom
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Inshaw J, Leen C, Fisher M, Gilson R, Hawkins D, Collins S, Fox J, McLean K, Fidler S, Phillips A, Lattimore S, Babiker A, Porter K. The Impact of HCV Infection Duration on HIV Disease Progression and Response to cART amongst HIV Seroconverters in the UK. PLoS One 2015. [PMID: 26225723 PMCID: PMC4520682 DOI: 10.1371/journal.pone.0132772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction The effect of HCV infection on HIV disease progression remains unclear; the effect of HCV infection duration on HIV disease progression is unknown. Methods We used data from a cohort of HIV seroconverters to investigate the effect of HCV infection duration on time from HIV seroconversion to CD4 <350cells/mm3, AIDS or death, censoring at the earlier of cART initiation or last clinic visit, adjusting for confounders and splitting data into follow up periods from HIV seroconversion (<2, 2–4 and >4 years). We additionally compared CD4 cell decline following HCV infection to that of mono-infected individuals with similar HIV infection duration by fitting a random effects model. In a separate analysis, we used linear mixed models to we examine the effect of HCV infection and its duration on CD4 increase over 48 weeks following cART. Results Of 1655 individuals, 97 (5.9%) were HCV co-infected. HCV<1 year was associated with a higher risk of endpoint in each follow-up period from HIV seroconversion (HR [95% CI] 2.58 [1.51, 4.41], p = 0.001; 3.80 [1.20, 12.03], p = 0.023; 2.03 [0.88, 4.71], p = 0.098 for <2, 2–4 and >4 years respectively), compared to mono-infected individuals. However, we found no evidence of an association for those with HCV>2 years (all p>0.89). Individuals experienced a somewhat greater decrease in CD4 count following HCV infection lasting 13 months, relative to individuals with HIV alone, (estimate = -3.33, 95% CI [-7.29, 0.63] cells/mm3 per month, p = 0.099). Of 1502 initiating cART, 106 (7.1%) were HCV co-infected, with no evidence of HCV duration at cART being associated with immunological response (p = 0.45). Conclusions The impact of HCV co-infection on HIV disease progression appears to be restricted to the first year after HCV infection.
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Affiliation(s)
- Jamie Inshaw
- MRC Clinical Trials Unit at University College London, London, United Kingdom
- * E-mail:
| | | | - Martin Fisher
- Brighton and Sussex University NHS Trust, Brighton, United Kingdom
| | - Richard Gilson
- Department of Infection and Population Health, University College London, London, United Kingdom
| | - David Hawkins
- Chelsea and Westminster Hospital, London, United Kingdom
| | | | - Julie Fox
- Guy’s and St. Thomas NHS Trust at Kings College, London, United Kingdom
| | - Ken McLean
- Charing Cross Hospital, London, United Kingdom
| | - Sarah Fidler
- Imperial College NHS Trust, London, United Kingdom
| | - Andrew Phillips
- Department of Infection and Population Health, University College London, London, United Kingdom
| | | | - Abdel Babiker
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Kholoud Porter
- MRC Clinical Trials Unit at University College London, London, United Kingdom
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Aghaizu A, Nardone A, Copas A, Mercey D, Wayal S, Parsons V, Hart G, Gilson R, Johnson A. O5 Understanding continuing high hiv incidence: sexual behavioural trends among msm in london, 2000–2013. Sex Transm Infect 2015. [DOI: 10.1136/sextrans-2015-052126.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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90
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Miltz A, Rodger A, Sewell J, Speakman A, Phillips A, Sherr L, Gilson R, Asboe D, Nwokolo N, Scott C, Day S, Fisher M, Clarke A, Anderson J, O’Connell R, Lascar M, Apea V, Dhairyawan R, Gompels M. O7 Depression and sexual behaviour among men who have sex with men in the UK. Sex Transm Infect 2015. [DOI: 10.1136/sextrans-2015-052126.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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King EM, Gilson R, Beddows S, Soldan K, Panwar K, Young C, Jit M, Edmunds WJ, Sonnenberg P. Oral human papillomavirus (HPV) infection in men who have sex with men: prevalence and lack of anogenital concordance. Sex Transm Infect 2015; 91:284-6. [PMID: 25887283 PMCID: PMC4453633 DOI: 10.1136/sextrans-2014-051955] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/19/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of oral detectable human papillomavirus (HPV) DNA in HIV-negative men who have sex with men (MSM) attending a sexual health clinic in London and concordance with anogenital HPV infection. Such data are important to improve our understanding of the epidemiology of oral HPV and the potential use of vaccines to prevent oropharyngeal cancers. METHODS Paired oral rinse samples and anogenital samples were available from 151 HIV-negative MSM within a larger cross-sectional survey. All samples were tested in parallel for 21 types of HPV DNA using an in-house assay. RESULTS The median age of participants was 30 (IQR 25-35). The prevalence of any oral HPV and of high-risk HPV (HR-HPV) was 13.7% (n=21; 95% CI 8.7 to 20.2) and 5.9% (n=9; 95% CI 2.7 to 10.9) compared with 64.9% (n=98; 95% CI 56.7 to 72.5) and 34.4% (n=52; 95% CI 26.9 to 42.6) in any anogenital sample, respectively. The prevalence of types prevented by the bivalent (HPV16/18), quadrivalent (HPV6/11/16/18) and nonavalent (HPV6/11/16/18/31/33/45/52/58) vaccines was 1.3% (95% CI 0.2 to 4.7), 2.6% (95% CI 0.7 to 6.6) and 4.6% (95% CI 1.9 to 9.3), respectively. There was no concordance between HPV genotypes detected in oral and anogenital sites. CONCLUSIONS HR-HPV DNA, including HPV 16/18, was detected in oral specimens from HIV-negative MSM attending sexual health clinics, suggesting a potential role for vaccination, but is far less common than anogenital infection. How this relates to the risk and natural history of HPV-related head and neck cancers warrants further study. Lack of concordance with anogenital infection also suggests that oral HPV infection should be considered separately when estimating potential vaccine impact.
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Affiliation(s)
- Eleanor M King
- Research Department of Infection and Population Health, University College London, London, UK
| | - Richard Gilson
- Research Department of Infection and Population Health, University College London, London, UK The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Simon Beddows
- Virus Reference Department, Public Health England, London, UK
| | - Kate Soldan
- Centre for Communicable Disease Surveillance and Control (CIDSC), Public Health England, London, UK
| | - Kavita Panwar
- Virus Reference Department, Public Health England, London, UK
| | - Carmel Young
- Research Department of Infection and Population Health, University College London, London, UK The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Mark Jit
- Modelling and Economics Unit, Public Health England, London, UK Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - W John Edmunds
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, University College London, London, UK
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92
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Arenas-Pinto A, Milinkovic A, Peppa D, McKendry A, Maini M, Gilson R. Systemic inflammation and residual viraemia in HIV-positive adults on protease inhibitor monotherapy: a cross-sectional study. BMC Infect Dis 2015; 15:138. [PMID: 25888119 PMCID: PMC4374398 DOI: 10.1186/s12879-015-0889-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 03/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increased levels of markers of systemic inflammation have been associated with serious non-AIDS events even in patients on fully suppressive antiretroviral therapy. We explored residual viremia and systemic inflammation markers in patients effectively treated with ritonavir-boosted protease inhibitor monotherapy (PImono). METHODS HIV-infected adults with persistent HIV-RNA<50 copies/ml and treated with either a) PImono or b) standard triple-drug cART were recruited for this cross-sectional, exploratory study. Plasma samples were tested for high-sensitivity CRP (hsCRP), Serum Amyloid A (SAA), soluble CD14, IL-6, IL-8 and Cytochrome C. HIV-RNA was measured by real-time PCR (detection limit of 10 copies/ml). RESULTS 81 patients were recruited (31% on PImono). Two out of 25 (8%) and 3 of 56 (5.4%) patients from the PImono and cART groups respectively had detectable HIV-RNA. Significant correlation between SAA and hsCRP was observed (0.804). No difference between groups was found on prevalence of hsCRP>3 mg/l (21% vs 20% in the PImono and cART groups respectively; p=0.577) or SAA>6.4 mg/l (38% vs 22% in the PImono and cART groups respectively; P=0.172). In a univariate analysis IL6 and IL8 levels were associated with SAA>6.4 mg/l (OR=1.74 and 1.46; 95% CI=1.00-3.03 and 1.06-2.01; p=0.051 and 0.02 respectively) and hsCRP>3 mg/l in (OR=2.00 and 1.37; 95% CI=1.09-3.69 and 1.02-1.85; p=0.026 and 0.039 respectively). CONCLUSIONS We found no evidence of increased levels of inflammatory biomarkers or higher prevalence of residual viraemia in patients effectively suppressed on PImono as compared with patients on standard cART.
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Affiliation(s)
- Alejandro Arenas-Pinto
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, The Mortimer Market Centre, Off Capper Street, London, WC1E 6JB, UK. .,MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, University College London, London, UK.
| | - Ana Milinkovic
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, The Mortimer Market Centre, Off Capper Street, London, WC1E 6JB, UK.
| | - Dimitra Peppa
- The Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK. .,Research Department of Infection and Immunity, University College London, London, UK.
| | - Anna McKendry
- The Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK.
| | - Mala Maini
- Research Department of Infection and Immunity, University College London, London, UK.
| | - Richard Gilson
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, The Mortimer Market Centre, Off Capper Street, London, WC1E 6JB, UK.
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93
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King EM, Gilson R, Beddows S, Soldan K, Panwar K, Young C, Prah P, Jit M, Edmunds WJ, Sonnenberg P. Human papillomavirus DNA in men who have sex with men: type-specific prevalence, risk factors and implications for vaccination strategies. Br J Cancer 2015; 112:1585-93. [PMID: 25791874 PMCID: PMC4453685 DOI: 10.1038/bjc.2015.90] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/02/2015] [Accepted: 02/07/2015] [Indexed: 11/09/2022] Open
Abstract
Background: Human papillomavirus (HPV) vaccination of girls will have relatively little effect on HPV-related disease in men who have sex with men (MSM). We determined HPV prevalence and risk factors in MSM to inform the potential effectiveness of vaccinating MSM. Methods: Cross-sectional study of 522 MSM aged 18–40 attending a London sexual health clinic who completed a computer-assisted self-interview. Urine and two swabs (anal and penile/scrotal/perianal) were collected and tested using an in-house Luminex-based HPV genotyping system. Results: Prevalence of DNA of the vaccine-preventable HPV types in ano-genital specimens of men was 87/511 (17.0%), 166/511 (32.5%) and 232/511 (45.4%) for the bivalent (HPV16/18), quadrivalent (HPV6/11/16/18) and nonavalent (HPV6/11/16/18/31/33/45/52/58) vaccine types, respectively. A total of 25.1% had one of the quadrivalent types, and 7.4% had 2+ types. Median age at first anal sex was 19 (IQR 17–23) and at first clinic attendance was 24 (IQR 20–27). The increase in the odds of any HPV infection per year of age was 4.7% (95% CI 1.2–8.4). Conclusions: On the basis of the current infection status, most MSM, even among a high-risk population attending a sexual health clinic, are not currently infected with the vaccine-type HPV. A targeted vaccination strategy for MSM in the UK could have substantial benefits.
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Affiliation(s)
- E M King
- Research Department of Infection and Population Health, University College London, London WC1E 6JB, UK
| | - R Gilson
- 1] Research Department of Infection and Population Health, University College London, London WC1E 6JB, UK [2] The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London WC1E 6JB, UK
| | - S Beddows
- Virus Reference Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - K Soldan
- HIV/STI Department, Centre for Communicable Disease Surveillance and Control (CIDSC), Public Health England, 61 Colindale Avenue London, NW9 5EQ, UK
| | - K Panwar
- Virus Reference Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - C Young
- 1] Research Department of Infection and Population Health, University College London, London WC1E 6JB, UK [2] The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London WC1E 6JB, UK
| | - P Prah
- Research Department of Infection and Population Health, University College London, London WC1E 6JB, UK
| | - M Jit
- 1] Modelling and Economics Unit, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK [2] Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - W J Edmunds
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - P Sonnenberg
- Research Department of Infection and Population Health, University College London, London WC1E 6JB, UK
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94
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Desai M, Woodhall SC, Nardone A, Burns F, Mercey D, Gilson R. Active recall to increase HIV and STI testing: a systematic review. Sex Transm Infect 2015; 91:314-23. [PMID: 25759476 DOI: 10.1136/sextrans-2014-051930] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 02/14/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Active recall can improve reattendance rates and could increase retesting rates and detection of HIV and sexually transmitted infections (STIs), but the best strategy remains uncertain. METHODS We conducted a systematic review and meta-analysis of active recall for HIV and/or STI testing. We searched six electronic databases using terms for HIV, STIs, tests and active recall (defined as a reminder to retest for HIV/STIs) for randomised, non-randomised and observational English-language studies published between 1983 and 2013. Outcomes included reattendance/retesting rate and STI diagnosis at follow-up. RESULTS Of 5634 papers identified, 17 met the inclusion criteria. Of the 14 comparative studies, all but one demonstrated higher reattendance/retesting rates in the intervention group, but the range was wide (17.5-89%). Meta-analysis of nine RCTs found reattendance/retesting rates were significantly higher in the intervention versus control groups (pooled OR 2.42 (95% CI 1.84 to 3.19)). In a subgroup analysis, home sampling increased retesting compared with clinic testing (pooled OR 2.20 (95% CI 1.65 to 2.94)). In observational studies SMS reminders increased retesting compared with standard clinic care (pooled OR 2.19 (95% CI 1.46 to 3.29)), but study estimates were highly heterogeneous (I(2)=94%, p<0.001). CONCLUSIONS Active recall interventions are associated with higher reattendance/retesting rates for HIV/STI. Although home sampling and SMS reminders were associated with higher reattendance/retesting rates in most studies, evidence is limited by the heterogeneity of interventions and control groups and the quality of studies. Further work is needed to explore which active recall modality is clinically cost-effective and acceptable for HIV/STI screening.
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Affiliation(s)
- Monica Desai
- HIV & STI Department, Public Health England, London, UK Research Department of Infection and Population Health, University College London, London, UK
| | - Sarah C Woodhall
- HIV & STI Department, Public Health England, London, UK Research Department of Infection and Population Health, University College London, London, UK
| | | | - Fiona Burns
- Research Department of Infection and Population Health, University College London, London, UK Royal Free London NHS Foundation Trust, London, UK
| | - Danielle Mercey
- Research Department of Infection and Population Health, University College London, London, UK Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Richard Gilson
- Research Department of Infection and Population Health, University College London, London, UK Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
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95
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McDonnell J, Haddow L, Daskalopoulou M, Lampe F, Speakman A, Gilson R, Phillips A, Sherr L, Wayal S, Harrison J, Antinori A, Maruff P, Schembri A, Johnson M, Collins S, Rodger A. Minimal cognitive impairment in UK HIV-positive men who have sex with men: effect of case definitions and comparison with the general population and HIV-negative men. J Acquir Immune Defic Syndr 2015; 67:120-7. [PMID: 24991974 PMCID: PMC4175121 DOI: 10.1097/qai.0000000000000273] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background: To determine the prevalence of neurocognitive impairment (NCI) in UK HIV-positive and HIV-negative men who have sex with men (MSM). Methods: HIV-positive and HIV-negative participants were recruited to a cross-sectional study from 2 London clinics and completed computer-assisted neuropsychological tests and questionnaires of depression, anxiety, and activities of daily living. Published definitions of HIV-associated neurocognitive disorders (HAND) and global deficit scores were used. Age- and education-adjusted neuropsychological test scores were directly compared with reference population data. Results: A total of 248 HIV-positive and 45 HIV-negative MSM participated. In the HIV-positive group, median time since diagnosis was 9.4 years, median CD4+ count was 550 cells per cubic millimeter, and 88% were on antiretroviral therapy. Prevalence of HAND was 21.0% in HIV-positive MSM (13.7% asymptomatic neurocognitive impairment, 6.5% mild neurocognitive disorder, and 0.8% HIV-associated dementia). Using a global deficit score threshold of 0.5, the prevalence of NCI was 31.5% (when averaged over 5 neuropsychological domains) and 40.3% (over 10 neuropsychological test scores). These results were not significantly different from the HIV-negative study sample. No consistent pattern of impairment was seen in HIV-positive patients relative to general male population data (n = 380). Conclusions: We found a prevalence of HAND and degree of impairment on neuropsychological testing of HIV-positive MSM that could represent a normal population distribution. These findings suggest that NCI may be overestimated in HIV-positive MSM, and that the attribution of NCI to HIV infection implied by the term HAND requires revision.
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Affiliation(s)
- Jeffrey McDonnell
- *Research Department of Infection and Population Health, University College London, London, United Kingdom; †Department of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom; ‡National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy; §CogState, Melbourne, Victoria, Australia; ‖Department of Sexual Health and HIV, Royal Free London NHS Foundation Trust, London, United Kingdom; and ¶HIV I-Base, London, United Kingdom
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96
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Daskalopoulou M, Rodger A, Phillips AN, Sherr L, Speakman A, Collins S, Elford J, Johnson MA, Gilson R, Fisher M, Wilkins E, Anderson J, McDonnell J, Edwards S, Perry N, O'Connell R, Lascar M, Jones M, Johnson AM, Hart G, Miners A, Geretti AM, Burman WJ, Lampe FC. Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study. Lancet HIV 2014; 1:e22-31. [PMID: 26423813 DOI: 10.1016/s2352-3018(14)70001-3] [Citation(s) in RCA: 226] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Recreational drug use in men who have sex with men (MSM) is of concern because it might be linked to the transmission of HIV and other sexually transmitted infections. Evidence about drug use in HIV-diagnosed MSM in the UK is limited by representativeness of the study populations. We describe patterns of drug use and associations with sexual behaviours in HIV-diagnosed MSM in the UK. METHODS We used data from the cross-sectional ASTRA study, which recruited participants aged 18 years or older with HIV from eight HIV outpatient clinics in the UK between Feb 1, 2011, and Dec 31, 2012. We examined data for MSM, assessing the prevalence of recreational drug use and polydrug use in the previous 3 months and associations with sociodemographic and HIV-related factors. We examined the association of polydrug use with measures of condomless sex in the previous 3 months and with other sexual behaviours. FINDINGS Our analysis included data for 2248 MSM: 2136 (95%) were gay, 1973 (89%) were white, 1904 (85%) were on antiretroviral treatment (ART), and 1682 (76%) had a viral load of 50 copies per mL or lower. 1138 (51%) used recreational drugs in the previous 3 months; 608 (27%) used nitrites, 477 (21%) used cannabis, 460 (21%) used erectile dysfunction drugs, 453 (20%) used cocaine, 280 (13%) used ketamine, 258 (12%) used 3,4-methylenedioxy-N-methylamphetamine (MDMA), 221 (10%) used gamma-hydroxybutyrate or gamma-butyrolactone, 175 (8%) used methamphetamine, and 162 (7%) used mephedrone. In the 1138 individuals who used drugs, 529 (47%) used three or more drugs and 241 (21%) used five or more. Prevalence of injection drug use was 3% (n = 68). Drug use was independently associated with younger age (p < 0·0001), not being religious (p = 0·001), having an HIV-positive stable partner (p = 0·0008), HIV-serostatus disclosure (p = 0·009), smoking (p < 0·0001), evidence of harmful alcohol drinking (p = 0·0001), and ART non-adherence (p < 0·0001). Increasing polydrug use was associated with increasing prevalence of condomless sex (prevalence range from no drug use to use of five or more drugs was 24% to 78%), condomless sex with HIV-seroconcordant partners (17% to 69%), condomless sex with HIV-serodiscordant partners (10% to 25%), and higher-HIV-risk condomless sex after taking viral load into account (4% to 16%; p ≤ 0·005 for all). Associations were similar after adjustment for sociodemographic and HIV-related factors. Methamphetamine was more strongly associated with higher-HIV-risk condomless sex than were other commonly used drugs. INTERPRETATION Polydrug use is prevalent in HIV-diagnosed MSM and is strongly associated with condomless sex. Specialist support services for MSM with HIV who use recreational drugs might be beneficial in the reduction of harm and prevention of ongoing transmission of HIV and other sexually transmitted infections. FUNDING National Institute for Health Research.
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Affiliation(s)
- Marina Daskalopoulou
- Research Department of Infection and Population Health, University College London, London, UK.
| | - Alison Rodger
- Research Department of Infection and Population Health, University College London, London, UK
| | - Andrew N Phillips
- Research Department of Infection and Population Health, University College London, London, UK
| | - Lorraine Sherr
- Research Department of Infection and Population Health, University College London, London, UK
| | - Andrew Speakman
- Research Department of Infection and Population Health, University College London, London, UK
| | | | | | | | - Richard Gilson
- Research Department of Infection and Population Health, University College London, London, UK
| | - Martin Fisher
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Ed Wilkins
- Pennine Acute Hospitals NHS Trust, Manchester, UK
| | | | - Jeffrey McDonnell
- Research Department of Infection and Population Health, University College London, London, UK
| | - Simon Edwards
- Central and North West London Community Foundation Trust, London, UK
| | - Nicky Perry
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | | | - Martin Jones
- East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - Anne M Johnson
- Research Department of Infection and Population Health, University College London, London, UK
| | - Graham Hart
- Research Department of Infection and Population Health, University College London, London, UK
| | - Alec Miners
- London School of Hygiene & Tropical Medicine, London, UK
| | - Anna-Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | | | - Fiona C Lampe
- Research Department of Infection and Population Health, University College London, London, UK
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97
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Rodger AJ, Phillips A, Speakman A, Gilson R, Fisher M, Wilkins E, Anderson J, Johnson M, O'Connell R, Collins S, Elford J, Sherr L, Lampe FC. Attitudes of people in the UK with HIV who Are Antiretroviral (ART) Naïve to starting ART at high CD4 counts for potential health benefit or to prevent HIV transmission. PLoS One 2014; 9:e97340. [PMID: 24869805 PMCID: PMC4037177 DOI: 10.1371/journal.pone.0097340] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/18/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess if a strategy of early ART to prevent HIV transmission is acceptable to ART naïve people with HIV with high CD4 counts. DESIGN ASTRA is a UK multicentre, cross sectional study of 3258 HIV outpatients in 2011/12. A self-completed questionnaire collected sociodemographic, behavioral and health data, and attitudes to ART; CD4 count was recorded from clinical records. METHODS ART naïve participants with CD4 ≥350 cells/µL (n = 281) were asked to agree/disagree/undecided with the statements (i) I would want to start treatment now if this would slightly reduce my risk of getting a serious illness, and (ii) I would want to start treatment now if this would make me less infectious to a sexual partner, even if there was no benefit to my own health. RESULTS Participants were 85% MSM, 76% white, 11% women. Of 281 participants, 49.5% and 45.2% agreed they would start ART for reasons (i) and (ii) respectively; 62.6% agreed with either (i) or (ii); 12.5% agreed with neither; 24.9% were uncertain. Factors independently associated (p<0.1) with agreement to (i) were: lower CD4, more recent HIV diagnosis, physical symptoms, not being depressed, greater financial hardship, and with agreement to (ii) were: being heterosexual, more recent HIV diagnosis, being sexually active. CONCLUSIONS A strategy of starting ART at high CD4 counts is likely to be acceptable to the majority of HIV-diagnosed individuals. Almost half with CD4 >350 would start ART to reduce infectiousness, even if treatment did not benefit their own health. However a significant minority would not like to start ART either for modest health benefit or to reduce infectivity. Any change in approach to ART initiation must take account of individual preferences. Transmission models of potential benefit of early ART should consider that ART uptake may be lower than that seen with low CD4 counts.
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Affiliation(s)
| | | | | | | | - Martin Fisher
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Ed Wilkins
- Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
| | - Jane Anderson
- Homerton University Hospital NHS Foundation Trust, London, United Kingdom
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98
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May MT, Gompels M, Delpech V, Porter K, Orkin C, Kegg S, Hay P, Johnson M, Palfreeman A, Gilson R, Chadwick D, Martin F, Hill T, Walsh J, Post F, Fisher M, Ainsworth J, Jose S, Leen C, Nelson M, Anderson J, Sabin C. Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy. AIDS 2014. [DOI: http://doi.org.10.1097/qad.0000000000000243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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99
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May MT, Gompels M, Delpech V, Porter K, Orkin C, Kegg S, Hay P, Johnson M, Palfreeman A, Gilson R, Chadwick D, Martin F, Hill T, Walsh J, Post F, Fisher M, Ainsworth J, Jose S, Leen C, Nelson M, Anderson J, Sabin C. Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy. AIDS 2014. [DOI: http:/doi.org.10.1097/qad.0000000000000243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
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100
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May MT, Gompels M, Delpech V, Porter K, Orkin C, Kegg S, Hay P, Johnson M, Palfreeman A, Gilson R, Chadwick D, Martin F, Hill T, Walsh J, Post F, Fisher M, Ainsworth J, Jose S, Leen C, Nelson M, Anderson J, Sabin C. Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy. AIDS 2014; 28:1193-202. [PMID: 24556869 PMCID: PMC4004637 DOI: 10.1097/qad.0000000000000243] [Citation(s) in RCA: 390] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The objective of this study is to estimate life expectancies of HIV-positive patients conditional on response to antiretroviral therapy (ART). METHODS Patients aged more than 20 years who started ART during 2000-2010 (excluding IDU) in HIV clinics contributing to the UK CHIC Study were followed for mortality until 2012. We determined the latest CD4 cell count and viral load before ART and in each of years 1-5 of ART. For each duration of ART, life tables based on estimated mortality rates by sex, age, latest CD4 cell count and viral suppression (HIV-1 RNA <400 copies/ml), were used to estimate expected age at death for ages 20-85 years. RESULTS Of 21 388 patients who started ART, 961 (4.5%) died during 110 697 person-years. At start of ART, expected age at death [95% confidence interval (CI)] of 35-year-old men with CD4 cell count less than 200, 200-349, at least 350 cells/μl was 71 (68-73), 78 (74-82) and 77 (72-81) years, respectively, compared with 78 years for men in the general UK population. Thirty-five-year-old men who increased their CD4 cell count in the first year of ART from less than 200 to 200-349 or at least 350 cells/μl and achieved viral suppression gained 7 and 10 years, respectively. After 5 years on ART, expected age at death of 35-year-old men varied from 54 (48-61) (CD4 cell count <200 cells/μl and no viral suppression) to 80 (76-83) years (CD4 cell count ≥350 cells/μl and viral suppression). CONCLUSION Successfully treated HIV-positive individuals have a normal life expectancy. Patients who started ART with a low CD4 cell count significantly improve their life expectancy if they have a good CD4 cell count response and undetectable viral load.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Richard Gilson
- Mortimer Market Centre, University College Medical School, London
| | | | | | - Teresa Hill
- Research Department of Infection & Population Health, UCL
| | - John Walsh
- Imperial College Healthcare NHS Foundation Trust
| | - Frank Post
- Kings College Healthcare NHS Foundation Trust and Kings College London, London
| | - Martin Fisher
- Brighton and Sussex University Hospitals NHS Trust, Brighton
| | | | - Sophie Jose
- Research Department of Infection & Population Health, UCL
| | - Clifford Leen
- The Lothian University Hospitals NHS Trust, Edinburgh
| | - Mark Nelson
- Chelsea and Westminster NHS Foundation Trust
| | | | - Caroline Sabin
- Research Department of Infection & Population Health, UCL
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