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HIV Seropositivity: HELP
Articles from UCL Medical School
Based on 25 articles published since 2008

These are the 25 published articles about HIV Seropositivity that originated from UCL Medical School during 2008-2019.
+ Citations + Abstracts
1 Review Evidence-based gender findings for children affected by HIV and AIDS - a systematic overview. 2009

Sherr, Lorraine / Mueller, Joanne / Varrall, Rebecca. ·Department of Infection and Population Health, Royal Free UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK. l.sherr@pcps.ucl.ac.uk ·AIDS Care · Pubmed #22380982.

ABSTRACT: This review (under the International Joint Learning Initiative on Children and AIDS) provides a detailed evidence analysis of gender, children and AIDS. Six systematic reviews provide the most up to date evidence base on research surrounding children and HIV on key topics of treatment resistance and adherence, schooling, nutrition, cognitive development and orphaning and bereavement. Traditional systematic review techniques were used to identify all published studies on four key topics, then studies were selected according to adequacy criteria (sufficient size, control group and adequate measures). A gender analysis was performed on included studies, detailing whether gender was measured, results were analysed by gender or any gender-based findings. For family studies, both the gender of the parents and gender of the child are needed. Secondary analysis by gender was performed on existing systematic reviews for treatment resistance and adherence. Of the 12 studies on treatment resistance, 11 did not look at gender. One found boys at a seven-fold risk compared to girls. For medication adherence, gender was not significant. Of the 15 studies on schooling, 12 analysed findings by gender with an overall female disadvantage. Of the 14 studies on nutrition, nine analysed by gender with mixed findings. Of the 54 studies on cognitive development, 17 provided gender data, but only four analysed by gender with few differences established. Of the 15 studies on bereavement, seven analysed data by gender again with mixed findings. Major policies fail to provide gender data for young children. WHO, UNAIDS and the international data sets are not gathered or coded by gender for young children (generally under 15 years of age) despite well-established gender challenges in later life. This review shows that the current evidence base is inadequate. Data on gender variation and outcome are urgently needed to inform policy and research on children and HIV.

2 Review Vertically acquired paediatric HIV infection: the challenges of providing comprehensive packages of care in resource-limited settings. 2008

Little, K E / Bland, R M / Newell, M L. ·Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, UCL, London, UK. ·Trop Med Int Health · Pubmed #18664240.

ABSTRACT: The successes achieved in paediatric disease management in well-resourced countries in recent years highlight the vast divide between the care options, and ultimately survival, between developed and developing areas of the world. Using an extensive literature review, we quantify recent achievements in terms of improved survival and quality of life, and examine current evidence of the effects of treatment on the survival and morbidity of HIV-infected children in developing countries. When provided with the same care as their counterparts in developed countries, children in developing countries show similar improvements in survival and general health, with 1-year survival rates exceeding 90% in many African settings. Despite the challenges of providing comprehensive packages of care in resource-limited settings, there is an urgent need to scale up prevention and treatment of HIV infections in children, focussing on strengthening Prevention of Mother-to-Child Transmission programmes in order to reduce the numbers of infants who are infected in addition to reducing morbidity and mortality among their mothers.

3 Clinical Trial Reactivity of routine HIV antibody tests in children who initiated antiretroviral therapy in early infancy as part of the Children with HIV Early Antiretroviral Therapy (CHER) trial: a retrospective analysis. 2015

Payne, Helen / Mkhize, Nonhlanhla / Otwombe, Kennedy / Lewis, Joanna / Panchia, Ravindre / Callard, Robin / Morris, Lynn / Babiker, Abdel / Violari, Avy / Cotton, Mark F / Klein, Nigel J / Gibb, Diana M. ·Institute of Child Health, University College London, London, UK. Electronic address: helenpayne@doctors.org.uk. · Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa. · Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. · Centre for Maths and Physics in the Life Sciences and Experimental Biology, University College London, London, UK. · Institute of Child Health, University College London, London, UK; Centre for Maths and Physics in the Life Sciences and Experimental Biology, University College London, London, UK. · Clinical Trials Unit, Medical Research Council, London, UK. · Children's Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa. · Institute of Child Health, University College London, London, UK. ·Lancet Infect Dis · Pubmed #26043884.

ABSTRACT: BACKGROUND: Early antiretroviral therapy (ART) and virological suppression can affect evolving antibody responses to HIV infection. We aimed to assess frequency and predictors of seronegativity in infants starting early ART. METHODS: We compared HIV antibody results between two of three treatment groups of the Children with HIV Early Antiretroviral Therapy (CHER) trial, done from July, 2005, until July, 2011, in which infants with HIV infection aged 5·7-12·0 weeks with a percentage of CD4-positive T lymphocytes of at least 25% were randomly assigned to immediate ART for 96 weeks (ART-96W) or deferred ART until clinical or immunological progression (ART-Def). We measured antibody from all available stored samples for ART-96W and ART-Def at trial week 84 using three assays: fourth-generation enzyme immunoassay HIV antigen-antibody combination, HIV-1 and HIV-2 rapid antibody test, and quantitative anti-gp120 IgG ELISA. We also assessed odds of seropositivity with respect to age of ART initiation and cumulative viral load. The CHER trial was registered with ClinicalTrials.gov, number NCT00102960. FINDINGS: The median age of the infants from when samples were taken (184 samples from 268 infants) was 92 weeks (IQR 90·6-93·4). More specimens from the ART-96W group were seronegative than from the ART-Def group by enzyme immunoassay (ART-96W 49 [46%] of 107 vs ART-Def eight [11%] of 75; p<0·0001) and rapid antibody test (54 [53%] of 101 vs eight [11%] of 74; p<0·0001). Median anti-gp120 IgG concentration was lower in the ART-96W group (230 μg/μL [IQR 133-13 129]) than in the ART-Def group (6870 μg/μL [1706-53 645]; p<0·0001). If ART was started between 12 and 24 weeks of age, odds of seropositivity were increased 13·7 times (95% CI 3·1-60·2; p=0·001) compared with starting it between 0 and 12 weeks. All children starting ART aged older than 24 weeks were seropositive. Cumulative viral load to week 84 correlated with anti-gp120 IgG concentrations (coefficient 0·54; p<0·0001) and increased odds of seropositivity (odds ratio 1·59 [95% CI 1·1-2·3]) adjusted for ART initiation age. INTERPRETATION: About half of children starting ART before 12 weeks of age were HIV seronegative by almost 2 years of age. HIV antibody tests cannot be used to reconfirm HIV diagnosis in children starting early ART. Long-term effects of seronegativity need further study. Clear guidelines are needed for retesting alongside improved diagnostic tests. FUNDING: Wellcome Trust, Medical Research Council, and National Institutes of Health.

4 Article HCV reinfection incidence and spontaneous clearance rates in HIV-positive men who have sex with men in Western Europe. 2017

Ingiliz, Patrick / Martin, Thomas C / Rodger, Alison / Stellbrink, Hans-Jürgen / Mauss, Stefan / Boesecke, Christoph / Mandorfer, Mattias / Bottero, Julie / Baumgarten, Axel / Bhagani, Sanjay / Lacombe, Karine / Nelson, Mark / Rockstroh, Jürgen K / Anonymous8050881. ·Center for Infectiology (CIB), Berlin, Germany. Electronic address: ingiliz@zibp.de. · Chelsea and Westminster Hospital, London, United Kingdom. · The Royal Free Hospital, London, United Kingdom. · Infectiology Center Hamburg (ICH), Hamburg, Germany. · Center for HIV and Hepatogastroenterology, Duesseldorf, Germany. · University of Bonn, Department of Medicine I, Bonn, Germany. · Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria. · Service des maladies infectieuses et tropicales, Hôpital Saint-Antoine, AP-HP, France. · Center for Infectiology (CIB), Berlin, Germany. · Service des maladies infectieuses et tropicales, Hôpital Saint-Antoine, AP-HP, France; Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France. · Chelsea and Westminster Hospital, London, United Kingdom; Imperial College School of Medicine, London, United Kingdom. ·J Hepatol · Pubmed #27650285.

ABSTRACT: BACKGROUND & AIMS: Moderate cure rates of acute hepatitis C virus (HCV) infections with pegylated interferon and ribavirin have been described in the last decade in men who have sex with men (MSM), who are also coinfected with the human immunodeficiency virus (HIV). However, a subsequent high incidence of HCV reinfections has been reported regionally in men who both clear the infection spontaneously or who respond to treatment. METHODS: Retrospective analysis of reinfections in HIV infected MSM in eight centers from Austria, France, Germany, and the UK within the NEAT network between May 2002 and June 2014. RESULTS: Of 606 individuals who cleared HCV spontaneously or were successfully treated, 149 (24.6%) presented with a subsequent HCV reinfection. Thirty out of 70 (43%) who cleared again or were successfully treated, presented with a second reinfection, 5 with a third, and one with a fourth reinfection. The reinfection incidence was 7.3/100 person-years (95% CI 6.2-8.6). We found a trend for lower incidence among individuals who had spontaneously cleared their incident infection than among individuals who were treated (Hazard ratio 0.62, 95% CI 0.38-1.02, p=0.06). Spontaneous clearance of reinfection was associated with ALT levels >1000IU/ml and spontaneous clearance of a prior infection. CONCLUSIONS: HCV reinfection is an issue of major concern in HIV-positive MSM. Prevention strategies are needed for high risk groups to reduce morbidity and treatment costs. HIV-positive MSM with a prior HCV infection should be tested every 3 to 6months for reinfection. Those who had achieved a reinfection should be tested every 3months. LAY SUMMARY: We evaluated the occurrence of HCV reinfection in HIV-positive men who have sex with men. We found an alarming incidence of 7.3/100 person-years. Prevention measures need to address this specific subgroup of patients at high risk for HCV.

5 Article Defining cognitive impairment in people-living-with-HIV: the POPPY study. 2016

De Francesco, Davide / Underwood, Jonathan / Post, Frank A / Vera, Jaime H / Williams, Ian / Boffito, Marta / Sachikonye, Memory / Anderson, Jane / Mallon, Patrick W G / Winston, Alan / Sabin, Caroline A / Anonymous230886. ·Research Department of Infection & Population Health, UCL - Royal Free Campus, London, UK. d.defrancesco@ucl.ac.uk. · Division of Infectious Diseases, Imperial College London, London, UK. · King's College London, London, UK. · Brighton and Sussex Medical School, Brighton, UK. · Mortimer Market Centre, UCL, London, UK. · Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK. · UK Community Advisory Board, London, UK. · Homerton University Hospital, London, UK. · UCD School Of Medicine, Dublin, Ireland. · Research Department of Infection & Population Health, UCL - Royal Free Campus, London, UK. ·BMC Infect Dis · Pubmed #27793128.

ABSTRACT: BACKGROUND: The reported prevalence of cognitive impairment (CI) varies widely in cohorts of people living with HIV (PLWH); this may partly be due to the use of different diagnostic criteria. Agreement between diagnostic criteria of CI, the optimal definition to use, and associations with patient-reported cognitive symptoms have not been fully investigated. METHODS: Two hundred ninety PLWH aged >50 years and 97 matched negative controls completed a detailed assessment of cognitive function and three questions regarding cognitive symptoms. Age- and education-adjusted test scores (T-scores) determined if subjects met the following definitions of CI: Frascati, global deficit score (GDS) and the multivariate normative comparison (MNC) method. RESULTS: PLWH were more likely than controls to meet each definition of CI (ORs were 2.17, 3.12 and 3.64 for Frascati, GDS and MNC, respectively). Agreement of MNC with Frascati and GDS was moderate (Cohen's k = 0.42 and 0.48, respectively), whereas that between Frascati and GDS was good (k = 0.74). A significant association was found between all the three criteria and reporting of memory loss but not with attention and reasoning problems. The 41 (14 %) PLWH meeting all the three criteria had the lowest median global T-score (36.9) and highest rate of symptom reporting (42 %). CONCLUSIONS: Different CI criteria show fair diagnostic agreement, likely reflecting their ability to exclude CI in the same group of individuals. Given the lower overall cognitive performance and higher rates of symptom reporting in those meeting all three criteria of CI, further work assessing this as a definition of CI in PLWH is justified.

6 Article Neurocognitive Function and Neuroimaging Markers in Virologically Suppressed HIV-positive Patients Randomized to Ritonavir-boosted Protease Inhibitor Monotherapy or Standard Combination ART: A Cross-sectional Substudy From the PIVOT Trial. 2016

Arenas-Pinto, Alejandro / Stöhr, Wolfgang / Jäger, Hans Rolf / Haddow, Lewis / Clarke, Amanda / Johnson, Margaret / Chen, Fabian / Winston, Alan / Godi, Claudia / Thust, Steffi / Trombin, Rita / Cairns, Janet / Solanky, Bhavana S / Golay, Xavier / Paton, Nicholas I / Anonymous7070866. ·MRC-Clinical Trials Unit at University College London (UCL) UCL Research Department of Infection and Population Health. · MRC-Clinical Trials Unit at University College London (UCL). · Neuroradiology Academic Unit, UCL Department of Brain Repair & Rehabilitation, Institute of Neurology. · UCL Research Department of Infection and Population Health. · Brighton and Sussex University Hospitals NHS Trust, Brighton. · Royal Free Hospital, London. · Royal Berkshire Hospital, Reading. · Imperial College London, United Kingdom. · NMR Research Unit, UCL Department of Neuroinflammation, Queen Square MS Centre, Institute of Neurology, London. · MRC-Clinical Trials Unit at University College London (UCL) Yong Loo Lin School of Medicine, National University of Singapore, Singapore. ·Clin Infect Dis · Pubmed #27143662.

ABSTRACT: BACKGROUND: To determine whether treatment with ritonavir-boosted protease inhibitor (PI) monotherapy is associated with detrimental effects on neurocognitive function or brain imaging markers compared to standard antiretroviral therapy (ART). METHODS: Neuropsychological assessment and brain magnetic resonance imaging were performed at the last study visit in a subset of participants randomized to PI monotherapy (PI-mono group) or ongoing triple ART (OT group) in the PIVOT trial. We calculated a global z-score (NPZ-7) from the average of the individual test z-scores and the proportion of participants with symptomatic neurocognitive impairment (score >1 standard deviation below normative means in ≥2 cognitive domains and neurocognitive symptoms). In a subgroup, white matter hyperintensities, bicaudate index, global cortical (GCA) and medial temporal lobe atrophy scores and single voxel (basal ganglia) N-acetylaspartate (NAA)/Choline, NAA/Creatine and myo-inositol/Creatine ratios were measured. RESULTS: 146 participants (75 PI-mono) had neurocognitive testing (median time after randomization 3.8 years), of whom 78 were imaged. We found no difference between arms in NPZ-7 score (median -0.4 (interquartile range [IQR] = -0.7; 0.1) vs -0.3 (IQR = -0.7; 0.3) for the PI-mono and OT groups respectively, P = .28), the proportion with symptomatic neurocognitive impairment (13% and 18% in the PI-mono and OT groups respectively; P = .41), or any of the neuroimaging variables (P > .05). Symptomatic neurocognitive impairment was associated with higher GCA score (OR = 6.2 per additional score; 95% confidence interval, 1.7-22.3 P = .005) but no other imaging variables. CONCLUSIONS: Based on a comprehensive neuropsychological assessment and brain imaging, PI monotherapy does not increase the risk of neurocognitive impairment in stable human immunodeficiency virus-positive patients.

7 Article Loss to Follow-Up After Pregnancy Among Sub-Saharan Africa-Born Women Living With Human Immunodeficiency Virus in England, Wales and Northern Ireland: Results From a Large National Cohort. 2016

Tariq, Shema / Elford, Jonathan / Chau, Cuong / French, Clare / Cortina-Borja, Mario / Brown, Alison / Delpech, Valerie / Tookey, Pat A. ·From the *School of Health Sciences, City University London; †Population and Practice Programme, UCL Institute of Child Health; and ‡Public Health England, London, United Kingdom. ·Sex Transm Dis · Pubmed #27100763.

ABSTRACT: BACKGROUND: Little is known about retention in human immunodeficiency virus (HIV) care in HIV-positive women after pregnancy in the United Kingdom. We explored the association between loss to follow-up (LTFU) in the year after pregnancy, maternal place of birth and duration of UK residence, in HIV-positive women in England, Wales, and Northern Ireland. METHODS: We analyzed combined data from 2 national data sets: the National Study of HIV in Pregnancy and Childhood; and the Survey of Prevalent HIV Infections Diagnosed, including pregnancies in 2000 to 2009 in women with diagnosed HIV. Logistic regression models were fitted with robust standard errors to estimate adjusted odds ratios (AOR). RESULTS: Overall, 902 of 7211 (12.5%) women did not access HIV care in the year after pregnancy. Factors associated with LTFU included younger age, last CD4 in pregnancy of 350 cells/μL or greater and detectable HIV viral load at the end of pregnancy (all P<0.001). On multivariable analysis, LTFU was more likely in sub-Saharan Africa-born (SSA-born) women than white UK-born women (AOR, 2.17; 95% confidence interval, 1.50-3.14; P<0.001). The SSA-born women who had migrated to the UK during pregnancy were 3 times more likely than white UK-born women to be lost to follow-up (AOR, 3.19; 95% confidence interval, 1.94-3.23; P<0.001). CONCLUSIONS: One in 8 HIV-positive women in England, Wales, and Northern Ireland did not return for HIV care in the year after pregnancy, with SSA-born women, especially those who migrated to the United Kingdom during pregnancy, at increased risk. Although emigration is a possible explanatory factor, disengagement from care may also play a role.

8 Article Prevalence of depressive symptoms in pregnant and postnatal HIV-positive women in Ukraine: a cross-sectional survey. 2016

Bailey, Heather / Malyuta, Ruslan / Semenenko, Igor / Townsend, Claire L / Cortina-Borja, Mario / Thorne, Claire / Anonymous881012. ·Population, Policy and Practice Programme, UCL Institute of Child Health, University College London, London, UK. heather.bailey@ucl.ac.uk. · Perinatal Prevention of AIDS Initiative, Odessa, Ukraine. · UCL Institute of Child Health, University College London, London, UK. ·Reprod Health · Pubmed #27000405.

ABSTRACT: BACKGROUND: Perinatal depression among HIV-positive women has negative implications for HIV-related and other maternal and infant outcomes. The aim of this study was to investigate the burden and correlates of perinatal depression among HIV-positive women in Ukraine, a lower middle income country with one of the largest HIV-positive populations in Europe. METHODS: Cross-sectional surveys nested within the Ukraine European Collaborative Study were conducted of HIV-positive women at delivery and between 1 and 12 months postpartum. Depressive symptoms in the previous month were assessed using a self-report screening tool. Other data collected included demographics, antiretroviral therapy (ART)-related self-efficacy, and perceptions of risks/benefits of interventions to prevent mother-to-child transmission (PMTCT). Characteristics of women with and without a positive depression screening test result were compared using Fisher's exact test and χ2 test for categorical variables. RESULTS: A quarter (27% (49/180) antenatally and 25% (57/228) postnatally) of participants screened positive for depressive symptoms. Antenatal risk factors were living alone (58% (7/12) vs. 25% (42/167) p = 0.02), being somewhat/terribly bothered by ART side effects (40% (17/43) vs. 23% (30/129) not /only slightly bothered, p = 0.05) and having lower ART-related self-efficacy (43% (12/28) vs. 23% (25/110) with higher self-efficacy, p = 0.05). Postnatally, single mothers were more likely to screen positive (44% (20/45) vs. 21% (18/84) of cohabiting and 19% (19/99) of married women, p < 0.01) as were those unsure of the effectiveness of neonatal prophylaxis (40% (20/45) vs. 18% (28/154) sure of effectiveness, p < 0.01), those worried that neonatal prophylaxis could harm the baby (30% (44/146) vs. 14% (10/73) not worried p < 0.01) and those not confident to ask for help with taking ART (48% (11/23) vs. 27% (10/37) fairly confident and 15 % (4/26) confident that they could do this). Of women who reported wanting help for their depressive symptoms, 82% (37/45) postnatally but only 31% (12/39) antenatally were already accessing peer counselling, treatment adherence programmes, support groups or social services. CONCLUSIONS: A quarter of women screened positive for depression. Results highlight the need for proactive strategies to identify depressive symptoms, and an unmet need for provision of mental health support in the perinatal period for HIV-positive women in Ukraine.

9 Article Incidence and factors associated with the risk of sexually transmitted diseases in HIV-infected people seen for care in Italy: data from the Icona Foundation cohort. 2015

Cingolani, A / Zona, S / Girardi, E / Cozzi-Lepri, A / Monno, L / Quiros Roldan, E / Guaraldi, G / Antinori, A / D'Arminio Monforte, A / Marcotullio, S / Anonymous5270829. ·Department of Public Health, Infectious Diseases, Catholic University, Rome, Italy. · Clinic of Infectious Diseases, Univeristy of Modena and Reggio Emilia, Modena, Italy. · Department of Epidemiology, National Institute for Infectious Diseases 'L. Spallanzani', Rome, Italy. · Department of Infection and Population Health, Division of Population Health, University College London Medical School, Royal Free Campus, London, UK. · Institute of Infectious Diseases, University of Bari, Bari, Italy. · Institute of Infectious Diseases, University of Brescia, Brescia, Italy. · Clinical Department, National Institute for Infectious Diseases 'L. Spallanzani', Rome, Italy. · Clinic of Infectious and Tropical Diseases, Department of Health Sciences, San Paolo University Hospital, Milan, Italy. · Nadir Foundation Onlus, Rome, Italy. ·HIV Med · Pubmed #25959419.

ABSTRACT: OBJECTIVES: The aims of this study were to identify temporal trends in the incidence of sexually transmitted diseases (STDs) in a cohort of HIV-infected people and to evaluate factors associated with the risk of a new STD diagnosis. METHODS: All HIV-infected patients in the Icona Foundation Study cohort enrolled after 1998 were included in this study. STD incidence rates (IRs) were calculated and stratified by calendar period. Predictors of STDs were identified using a Poisson regression model with sandwich estimates for standard errors. RESULTS: Data for 9168 participants were analysed [median age 37.3 (range 18-81) years; 74% male; 30% men who have sex with men (MSM)]. Over 46 736 person-years of follow-up (PYFU), 996 episodes of STDs were observed [crude IR 21.3/1000 PYFU; 95% confidence interval (CI) 20.0-22.6/1000 PYFU]. In multivariable Poisson regression analysis, MSM [rate ratio (RR) 3.03; 95% CI 2.52-3.64 versus heterosexuals], calendar period (RR 1.67; 95% CI 1.42-1.97 for 2008-2012 versus 1998-2002), HIV RNA > 50 HIV-1 RNA copies/mL (RR 1.44; 95% CI 1.19-1.74 versus HIV RNA ≤ 50 copies/mL) and a current CD4 count < 100 cells/μL (RR 4.66; 95% CI 3.69-5.89; P < 0.001 versus CD4 count > 500 cells/μL) were associated with an increased risk of STDs. In contrast, older age (RR 0.82 per 10 years older; 95% CI 0.77-0.89) and being currently on ART (RR 0.38; 95% CI 0.33-0.45) compared with being ART-naïve or on a treatment interruption were associated with a lower risk of developing STDs. CONCLUSIONS: An increase in the incidence of STDs was observed in more recent years. Interventions to prevent STDs and potential spread of HIV should target the younger population, MSM and people currently not receiving ART.

10 Article Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study. 2015

Mocroft, Amanda / Lundgren, Jens D / Ross, Michael / Law, Matthew / Reiss, Peter / Kirk, Ole / Smith, Colette / Wentworth, Deborah / Neuhaus, Jacqueline / Fux, Christoph A / Moranne, Olivier / Morlat, Phillipe / Johnson, Margaret A / Ryom, Lene / Anonymous3850825 / Anonymous3860825 / Anonymous3870825 / Anonymous3880825 / Anonymous3890825. ·Department of Infection and Population Health, University College London, London, United Kingdom. · Copenhagen HIV Programme, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. · Division of Nephrology, Mount Sinai School of Medicine, New York, New York, United States of America. · The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia. · Division of Infectious Diseases and Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. · University of Minnesota, Minneapolis, Minnesota, United States of America. · Clinic for Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Aarau, Switzerland. · Nephrology Department, Public Health Department, Centre Hospitalier Universitaire de Nice, Nice, France. · Université de Bordeaux, INSERM U 897, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France. · Department of HIV Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom. ·PLoS Med · Pubmed #25826420.

ABSTRACT: BACKGROUND: Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. METHODS AND FINDINGS: A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with ≥3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR ≤ 60 ml/min/1.73 m2. Poisson regression was used to develop a risk score, externally validated on two independent cohorts. In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1:393 chance of developing CKD in the next 5 y in the low risk group (risk score < 0, 33 events), rising to 1:47 and 1:6 in the medium (risk score 0-4, 103 events) and high risk groups (risk score ≥ 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. CONCLUSIONS: Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.

11 Article Clinical and epidemiological characteristics of patients with early syphilis from three academic centres in Poland, Germany and Ireland: initial findings from the POETS study. 2015

Rowley, D / Swięcki, P / Firlag-Burkacka, E / Sabin, C / Kümmerle, T / Surah, S / Sadlier, C / O'Dea, S / Horban, A / Fätkenheuer, G / Mulcahy, F. ·The GUIDE (genitourinary and infectious disease) Clinic, St. James Hospital, Dublin, Ireland. · The Hospital for Infectious Diseases, Warsaw, Poland. · University College London, Royal Free Campus, Rowland Hill street, London, United Kingdom. · Klinik I für Innere Medizin, Klinische Infektiologie, Uniklinik, Köln, Germany. · Klinik I für Innere Medizin, Klinische Infektiologie, Uniklinik, Köln, Germany German Centre for Infection Research (DZIF), Partner site Bonn-Cologne, Cologne, Germany. ·Sex Transm Infect · Pubmed #25742696.

ABSTRACT: OBJECTIVES: Syphilis recognition in HIV-positive patients has important implications. Initial data from this study, established in June 2012 to better understand the natural history of syphilis and treatment response, examine the characteristics of patients including sexual behaviour, rates of concurrent sexually transmitted infections (STI) and type of treatment given. METHODS: Patients were recruited from Ireland, Poland and Germany. Data gathered included demographics, method of syphilis acquisition, stage of syphilis infection, HIV status, nadir and current CD4 counts and HIV viral suppression rates. Data were then subanalysed into HIV-positive and HIV-negative groups. RESULTS: Of 175 patients recruited, 68% were HIV-positive and 86.3% were men who have sex with men. Most HIV-positive patients presented with secondary syphilis (55.7% vs 13.2%) (p=0.0001) while the majority of HIV-negative patients had primary syphilis noted at the time of recruitment (47.2% vs18.9%, p=0.0002). Approximately half of all patients had a HIV RNA viral load <40 copies/mL (55%). Previous syphilis infection occurred more frequently in HIV-positive than HIV-negative patients (p=0.0001). Concurrent STIs at the time of syphilis diagnosis were found in 26.8%, of whom 31 (25.4%) were HIV-positive (p=0.64). HIV-positive patients received doxycycline more frequently than their HIV-negative counterparts (33.6% vs 1.9%, p=0.0001) while HIV-negative patients were treated with long-acting penicillin in 88.7% of cases vs 58% of HIV-positive patients (p=0.0002). CONCLUSIONS: A 40% rate of unsuppressed viraemia, high levels of STIs and varying treatment regimens represent a public health risk for Europe, suggesting the model of sexual healthcare delivery in HIV-positive patients requires further evaluation.

12 Article A not so simplex case of genital herpes. 2013

Philip, K E J / Goodman, A / Pallawela, S N S / Sathia, L / Webster, D P. ·Department of Virology, Royal Free London NHS Foundation Trust, London, UK. ·BMJ Case Rep · Pubmed #24096072.

ABSTRACT: We report the case of a 28-year-old, HIV-positive woman presenting with painful vesicular and ulcerating lesions in the ano-genital region caused by varicella zoster virus that appeared similar to herpes simplex infection. The case highlights that herpes zoster needs to be considered in the differential diagnosis of genital lesions, particularly in HIV-positive individuals, and the importance of virological diagnosis by PCR to direct appropriate management.

13 Article Natural history of HIV-control since seroconversion. 2013

Madec, Yoann / Boufassa, Faroudy / Porter, Kholoud / Prins, Maria / Sabin, Caroline / d'Arminio Monforte, Antonella / Amornkul, Pauli / Bartmeyer, Barbara / Sannes, Mette / Venet, Alain / Lambotte, Olivier / Meyer, Laurence / Anonymous5220765. ·aInstitut Pasteur, Emerging Diseases Epidemiology Unit, Paris bINSERM U1018, Centre de Recherche en Epidémiologie et Santé des Populations, Le Kremlin-Bicêtre cFaculté de Médecine Paris Sud, Université Paris Sud, Paris dDepartment of Public Health, AP-HP, Bicêtre Hospital, Le Kremlin-Bicêtre, France eMedical Research Council, Clinical Trials Unit, London, UK fCluster Infectious Diseases, Department of Research, Center for Infection and Immunity Amsterdam (CINIMA), Public Health Service, Amsterdam, The Netherlands gResearch Department of Infection and Population Health, UCL Medical School, London, UK hSan Paolo Hospital, Milan, Italy iInternational AIDS Vaccine Initiative, San Francisco, USA jRobert Koch Institut, Berlin, Germany kUlleval Hospital, Oslo, Norway lINSERM U1012, Le Kremlin-Bicêtre mDepartment of Internal Medicine, AP-HP, Bicêtre Hospital, Le Kremlin-Bicêtre nUniversité Paris-Sud, Paris, France. ·AIDS · Pubmed #23912979.

ABSTRACT: OBJECTIVES: HIV-controllers spontaneously maintain HIV viremia at an undetectable level. We aimed to describe the delay to control from seroconversion, the duration of control, and risk factors for losing control. METHODS: HIV-controllers were identified from a pooled dataset of 24 seroconverter cohorts from Europe, Australia, and Canada (CASCADE). HIV-controllers had at least five consecutive viral loads less than 400/500 copies/ml, while antiretroviral therapy naive, for at least 5 years after seroconversion. End of control was defined as two consecutive viral loads above 2000 copies/ml. Duration of control was described using Kaplan-Meier estimates; factors associated with duration of control were identified using a Cox model. CD4⁺ cell count evolution during control was described using a mixed model. RESULTS: Of 9896 eligible seroconverters, we identified 140 (1.4%) HIV-controllers, the largest database of HIV-controllers followed from seroconversion. For 64 with viral load measured within 24 months from seroconversion, median delay to control was 16.7 (interquartile range: 7.8-37.9) months. Probability of maintaining control 20 years after seroconversion was 0.74 [95% confidence interval (CI): 0.64-0.85]. Occurrence of blips followed by return to undetectability did not increase the risk of loss of control [hazard ratio: 0.81 (95% CI: 0.10-6.70)]. However, CD4⁺ cell loss during control was significantly accelerated in individuals with blips. CONCLUSION: In most individuals, control occurred rapidly after seroconversion; however, more than 3 years were required to achieve control in 25% of HIV-controllers. Control may be sustained even when CD4⁺ cell levels are below 500 cells/μl, opening important new perspectives to understand the physiopathology underlying control.

14 Article Predictors of pregnancy and changes in pregnancy incidence among HIV-positive women accessing HIV clinical care. 2013

Huntington, Susie E / Thorne, Claire / Bansi, Loveleen K / Anderson, Jane / Newell, Marie-Louise / Taylor, Graham P / Pillay, Deenan / Hill, Teresa / Tookey, Pat A / Sabin, Caroline A / Anonymous921055. ·Medical Research Council (MRC) Centre of Epidemiology for Child Health, Institute of Child Health, University College London, London, UK. susan.huntington.09@ucl.ac.uk ·AIDS · Pubmed #22713479.

ABSTRACT: OBJECTIVES: To describe predictors of pregnancy and changes in pregnancy incidence among HIV-positive women accessing HIV clinical care. METHODS: Data were obtained through the linkage of two separate studies: the UK Collaborative HIV Cohort study (UK CHIC), a cohort of adults attending 13 large HIV clinics; and the National Study of HIV in Pregnancy and Childhood (NSHPC), a national surveillance study of HIV-positive pregnant women. Pregnancy incidence was measured using the proportion of women in UK CHIC with a pregnancy reported to NSHPC. Generalized estimating equations were used to identify predictors of pregnancy and assess changes in pregnancy incidence in 2000-2009. RESULTS: The number of women accessing care at UK CHIC sites increased as did the number of pregnancies. Older women were less likely to have a pregnancy [adjusted relative rate (aRR) 0.44 per 10 year increment in age, [95% confidence interval (CI) (0.41-0.46)], P < 0.001] as were women with CD4 cell count less than 200 cells/μl compared with CD4 cell count 200-350 cells/μl [aRR 0.65 (0.55-0.77), P < 0.001] and women of white ethnicity compared with women of black African ethnicity [aRR 0.67 (0.57-0.80), P < 0.001]. The likelihood that women had a pregnancy increased over the study period [aRR 1.05 (1.03-1.07), P < 0.001). The rate of change did not significantly differ according to age group, antiretroviral therapy use, CD4 group or ethnicity. CONCLUSION: The pregnancy rate among women accessing HIV clinical care increased in 2000-2009. HIV-positive women with, or planning, a pregnancy require a high level of care and this is likely to continue and increase as more women of older age have pregnancies.

15 Article Using two on-going HIV studies to obtain clinical data from before, during and after pregnancy for HIV-positive women. 2012

Huntington, Susie E / Bansi, Loveleen K / Thorne, Claire / Anderson, Jane / Newell, Marie-Louise / Taylor, Graham P / Pillay, Deenan / Hill, Teresa / Tookey, Pat A / Sabin, Caroline A / Anonymous951055. ·Research Department of Infection & Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK. susan.huntington.09@ucl.ac.uk ·BMC Med Res Methodol · Pubmed #22839414.

ABSTRACT: BACKGROUND: The UK Collaborative HIV Cohort (UK CHIC) is an observational study that collates data on HIV-positive adults accessing HIV clinical care at (currently) 13 large clinics in the UK but does not collect pregnancy specific data. The National Study of HIV in Pregnancy and Childhood (NSHPC) collates data on HIV-positive women receiving antenatal care from every maternity unit in the UK and Ireland. Both studies collate pseudonymised data and neither dataset contains unique patient identifiers. A methodology was developed to find and match records for women reported to both studies thereby obtaining clinical and treatment data on pregnant HIV-positive women not available from either dataset alone. RESULTS: Women in UK CHIC receiving HIV-clinical care in 1996-2009, were found in the NSHPC dataset by initially 'linking' records with identical date-of-birth, linked records were then accepted as a genuine 'match', if they had further matching fields including CD4 test date. In total, 2063 women were found in both datasets, representing 23.1% of HIV-positive women with a pregnancy in the UK (n = 8932). Clinical data was available in UK CHIC following most pregnancies (92.0%, 2471/2685 pregnancies starting before 2009). There was bias towards matching women with repeat pregnancies (35.9% (741/2063) of women found in both datasets had a repeat pregnancy compared to 21.9% (1502/6869) of women in NSHPC only) and matching women HIV diagnosed before their first reported pregnancy (54.8% (1131/2063) compared to 47.7% (3278/6869), respectively). CONCLUSIONS: Through the use of demographic data and clinical dates, records from two independent studies were successfully matched, providing data not available from either study alone.

16 Article Reversible acute kidney injury (AKI) by active removal of serum light chains in an HIV positive patient with myeloma kidney. 2011

Sowole, L / Burns, A / Kaur, B / Davenport, A. ·Center for Nephrology, Royal Free Campus, University College London Medical School, London, UK. ·Clin Nephrol · Pubmed #22000564.

ABSTRACT: BACKGROUND: The association of HIV and myeloma has rarely been reported in the literature. This following case discusses the presentation of acute kidney injury (AKI) in a 53-year-old lady with HIV, subsequently diagnosed with myeloma. Furthermore, we describe recovery of renal function and dialysis independence using a combination of light chain removal by dialysis with a high cut-off dialyzer and chemotherapy. INVESTIGATIONS: Physical examination, urine, blood tests, renal biopsy, bone marrow aspirate and trephine, US scan. DIAGNOSIS: Myeloma. MANAGEMENT: Dialysis and chemotherapy.

17 Article Effect of CD4+ lymphocyte count, viral load, and duration of taking anti-retroviral treatment on presence of oral lesions in a sample of South African children with HIV+/AIDS. 2010

Duggal, M S / Abudiak, H / Dunn, C / Tong, H J / Munyombwe, T. ·Department Paediatric Dentistry, Division of Child Dental Health, Leeds Dental Institute, Clarendon Way, Leeds, England, LS2 9LU. m.s.duggal@leeds.ac.uk ·Eur Arch Paediatr Dent · Pubmed #20932399.

ABSTRACT: AIMS: This was to determine the presence and types of oral mucosal lesions in a sample of HIV(+)/AIDS South African children taking antiretroviral therapy and to investigate the relationship between CD4(+) lymphocyte counts, viral load, duration of taking antiretroviral therapy (DART), and age on presence of oral lesions. METHODS: The samples consisted of 56 South African children aged 0-4 years (mean age =7.09 years) with HIV(+)/AID, infected at birth. Subjects were divided into two groups according to the presence of oral lesions with test group (patients with oral lesions) and control group (patients with no oral lesions). Children were also divided into two groups, those <6 years and those >6 years old to study the effect of age on presence of lesions. RESULTS: Oral Candidiasis was the most common lesion reported in 19/56 children, followed by Recurrent Herpetic Infection in 9 children. Other lesions such as Kaposi's sarcoma, Multifocal Epithelial Hyperplasia, Oral Hairy Leukoplakia, Linear Gingival Erythema, and oral ulceration were also present. A statistical significant difference in CD4(+) lymphocyte count (p value 0.005), and viral load (p value 0.002) was found between the oral lesion and no oral lesion groups, those with oral lesions having a significantly higher viral load and lower CD4+ count. No statisticaly significant difference between the two groups in terms of the DART effect (p value 0.811) was found. Furthermore, there was no effect of age groups on the presence of lesions in children with HIV(+)/AIDS. CONCLUSION: This study contributes to the relatively scant literature on the prevalence of oral lesions in children with HIV infection in South Africa and also the relationship of these lesions to the viral load and CD4(+) lymphocyte counts.

18 Article Death rates in HIV-positive antiretroviral-naive patients with CD4 count greater than 350 cells per microL in Europe and North America: a pooled cohort observational study. 2010

Anonymous160666 / Lodwick, Rebecca K / Sabin, Caroline A / Porter, Kholoud / Ledergerber, Bruno / van Sighem, Ard / Cozzi-Lepri, Alessandro / Khaykin, Pavel / Mocroft, Amanda / Jacobson, Lisa / De Wit, Stephane / Obel, Niels / Castagna, Antonella / Wasmuth, Jan-Christian / Gill, John / Klein, Marina B / Gange, Stephen / Riera, Melchor / Mussini, Cristina / Gutiérrez, Félix / Touloumi, Giota / Carrieri, Patrizia / Guest, Jodie L / Brockmeyer, Norbert H / Phillips, Andrew N. ·HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, UCL Medical School, Royal Free Campus, London, UK. r.lodwick@ucl.ac.uk ·Lancet · Pubmed #20638118.

ABSTRACT: BACKGROUND: Whether people living with HIV who have not received antiretroviral therapy (ART) and have high CD4 cell counts have higher mortality than the general population is unknown. We aimed to examine this by analysis of pooled data from industrialised countries. METHODS: We merged data on demographics, CD4 cell counts, viral-load measurements, hepatitis C co-infection status, smoking status, date of death, and whether death was AIDS-related or not from 23 European and North American cohorts. We calculated standardised mortality ratios (SMRs) standardised by age, sex, and year, stratifying by risk group. Data were included for patients aged 20-59 years who had at least one CD4 count greater than 350 cells per microL while ART naive. All pre-ART CD4 counts greater than 350 cells per microL from January, 1990, to December, 2004, were included. We investigated mortality for four risk groups--men who have sex with men, heterosexual people, injecting drug users, and those at other or unknown risk. The association between CD4 cell count and death rate was investigated by use of Poisson regression methods. FINDINGS: Data were analysed for 40,830 patients contributing 80,682 person-years of follow-up. Of 419 deaths, 401 were used in the SMR analysis: 100 men who have sex with men (SMR 1.30, 95% CI 1.06-1.58); 68 heterosexual people (2.94, 2.28-3.73); 203 injecting drug users (9.37, 8.13-10.75); and 30 in the other or unknown risk category (4.57, 3.09-6.53). Compared with CD4 counts of 350-499 cells per microL, death rate was lower in patients with counts of 500-699 cells per microL (adjusted rate ratio 0.77, 95% CI 0.61-0.95) and counts of 700 cells per microL (0.66, 0.52-0.85). INTERPRETATION: In HIV-infected ART-naive patients with high CD4 cell counts, death rates were raised compared with the general population. In men who have sex with men this was modest, suggesting that a substantial proportion of the increased risk in other groups is due to confounding by other factors. Even though the increased risk is small, new studies of potential benefits of ART in this group are merited. FUNDING: European Commission, FP6. European AIDS Treatment Network (NEAT). Project number LSHP-CT-2006-037570.

19 Article Estimated glomerular filtration rate, chronic kidney disease and antiretroviral drug use in HIV-positive patients. 2010

Mocroft, Amanda / Kirk, Ole / Reiss, Peter / De Wit, Stephane / Sedlacek, Dalibor / Beniowski, Marek / Gatell, Jose / Phillips, Andrew N / Ledergerber, Bruno / Lundgren, Jens D / Anonymous3220662. ·HIV Epidemiology and Biostatistics Group, Research Department of Infection and Population Health, Division of Population Health, University College London Medical School, Royal Free Campus, London, UK. a.mocroft@ucl.ac.uk ·AIDS · Pubmed #20523203.

ABSTRACT: OBJECTIVES: Chronic kidney disease (CKD) in HIV-positive persons might be caused by both HIV and traditional or non-HIV-related factors. Our objective was to investigate long-term exposure to specific antiretroviral drugs and CKD. DESIGN: A cohort study including 6843 HIV-positive persons with at least three serum creatinine measurements and corresponding body weight measurements from 2004 onwards. METHODS: CKD was defined as either confirmed (two measurements >or=3 months apart) estimated glomerular filtration rate (eGFR) of 60 ml/min per 1.73 m or below for persons with baseline eGFR of above 60 ml/min per 1.73 m or confirmed 25% decline in eGFR for persons with baseline eGFR of 60 ml/min per 1.73 m or less, using the Cockcroft-Gault formula. Poisson regression was used to determine factors associated with CKD. RESULTS: Two hundred and twenty-five (3.3%) persons progressed to CKD during 21 482 person-years follow-up, an incidence of 1.05 per 100 person-years follow-up [95% confidence interval (CI) 0.91-1.18]; median follow-up was 3.7 years (interquartile range 2.8-5.7). After adjustment for traditional factors associated with CKD and other confounding variables, increasing cumulative exposure to tenofovir [incidence rate ratio (IRR) per year 1.16, 95% CI 1.06-1.25, P < 0.0001), indinavir (IRR 1.12, 95% CI 1.06-1.18, P < 0.0001), atazanavir (IRR 1.21, 95% CI 1.09-1.34, P = 0.0003) and lopinavir/r (IRR 1.08, 95% CI 1.01-1.16, P = 0.030) were associated with a significantly increased rate of CKD. Consistent results were observed in wide-ranging sensitivity analyses, although of marginal statistical significance for lopinavir/r. No other antiretroviral drugs were associated with increased incidence of CKD. CONCLUSION: In this nonrandomized large cohort, increasing exposure to tenofovir was associated with a higher incidence of CKD, as was true for indinavir and atazanavir, whereas the results for lopinavir/r were less clear.

20 Article Risky sexual behaviour in context: qualitative results from an investigation into risk factors for seroconversion among gay men who test for HIV. 2008

Elam, G / Macdonald, N / Hickson, F C I / Imrie, J / Power, R / McGarrigle, C A / Fenton, K A / Gilbart, V L / Ward, H / Evans, B G / Anonymous1510616. ·Centre for Sexual Health and HIV Research, Royal Free and University College London, Mortimer Market Centre, Mortimer Market, off Capper Street, London WC1E 6BT, UK. gillian@qualitativeresearch.co.uk ·Sex Transm Infect · Pubmed #19028950.

ABSTRACT: OBJECTIVES: The INSIGHT case-control study confirmed that HIV serodiscordant unprotected anal intercourse (SdUAI) remains the primary risk factor for HIV infection in gay men in England. This paper uses qualitative follow-up data to examine the contexts of SdUAI and other risk factors among the case-control study participants. METHODS: In-depth interviews were conducted with 26 recent HIV seroconverters and 22 non-converters. Purposive selection was used to provide diversity in demographics and sexual behaviour and to facilitate exploration of risk factors identified in the case-control study. RESULTS: Condoms were perceived as barriers to intimacy, trust and spontaneity. The potential consequences of the loss of these were traded off against the consequences of HIV infection. Previous negative HIV tests and the adoption of risk reduction strategies diminished the perceived threat of HIV infection, supporting beliefs that HIV was something that happened to others. Depression and low self-esteem, often combined with use of alcohol or other drugs, led to further risk taking and loss of control over risk reduction strategies. CONCLUSIONS: A range of psychosocial reasons led some men to engage in UAI with serodiscordant or unknown partners, despite high levels of risk awareness. Men in their mid-life, those in serodiscordant relationships and men that had experienced bereavement or other significant, negative, life events revealed factors related to these circumstances that contributed to increases in risky UAI. A diverse portfolio of interventions is required to build confidence and control over safer sex practices that are responsive to gay men's wider emotional needs.

21 Article Suicidal ideation in UK HIV clinic attenders. 2008

Sherr, Lorraine / Lampe, Fiona / Fisher, Martin / Arthur, Gilly / Anderson, Jane / Zetler, Sarah / Johnson, Margaret / Edwards, Simon / Harding, Richard. ·Royal Free and University College Medical School, London, UK. l.sherr@pcps.ucl.ac.uk ·AIDS · Pubmed #18670226.

ABSTRACT: BACKGROUND: HIV has been associated with elevated suicidal ideation. Although new treatments have changed prognosis, they also bring new challenges. This study measured suicidal ideation in HIV clinic attenders in the United Kingdom (London/Southeast) and explored associated factors. METHOD: All 1006 attenders at five HIV clinics were approached, of which 903 met inclusion criteria and 778 participated (86% response). Participants provided detailed information on suicidal ideation, demographics, treatment, adherence, symptoms (psychological and physical on Memorial Symptom Assessment Schedule), quality of life (EuroQol) information, HIV disclosure, clinical variables, sexual risk behaviour and treatment optimism. RESULTS: There was a 31% prevalence of suicidal ideation. Factors associated with suicidal ideation were being a heterosexual man, black ethnicity, unemployment, lack of disclosure of HIV status, having stopped antiretroviral treatment (compared to treatment or treatment naive), physical symptoms, psychological symptoms and poorer quality of life. There was no association with sexual risk behaviour. Sex/sexuality and ethnicity were independently associated with suicidal ideation: the odds of suicidal ideation increased almost two-fold for heterosexual men compared with gay men or women and for black respondents compared with White or Asian respondents. Lack of disclosure was independently associated with a two-fold increase in odds of suicidal ideation. Elevated physical and psychological symptoms were strong independent predictors of suicidal ideation. Independent predictors of suicidal ideation were very similar among the subgroup of 492 patients on antiretroviral treatment. CONCLUSION: Despite advances in treatment, suicidal ideation rates among HIV-positive clinic attenders are high. Emotional support and attention to mental health provision and social context are strongly endorsed.

22 Article Cervical intraepithelial neoplasia treatment in Human Immunodeficiency Virus-positive women. 2008

Shah, S / Montgomery, H / Crow, J C / Smith, C J / Moore, A / Sabin, C A / Evans, H / Johnson, M A. ·Department of Primary Care, Royal Free and University College Medical Schools, London, UK. s.shah@pcps.ucl.ac.uk ·J Obstet Gynaecol · Pubmed #18569480.

ABSTRACT: We set out to consider the level of agreement between referral and treatment pathology and to investigate the effectiveness of standard surgical treatment for cervical intraepithelial neoplasia (CIN) in Human Immunodeficiency Virus (HIV)-positive women. This was a case-note review of all women who underwent treatment for CIN between 1995 and 2004. Information on the referral and follow-up smear and biopsy results and the status of the excision margins at treatment were collected. A total of 71 women had at least one large loop excision of the transformation zone (LLETZ) for CIN. Agreement between the referral smear and biopsy was poor (kappa = 0.20) and between the referral and treatment pathology was only fair (kappa = 0.37). Ten treatment samples showed no histological evidence of CIN and were excluded from analysis of the presence of CIN at the resection margins. In only 32.8% of treatment samples were both margins clear of CIN. A high pre-LLETZ CD4 count was strongly associated with clear margins. A total of 55.6% patients had CIN at follow-up, despite both margins being clear. The follow-up smear/biopsy had decreased by >or=1 grade of CIN in only 50.8% patients. Our results show a high degree of discrepancy between cytology/biopsy and LLETZ histology in HIV-positive women. Additionally, there is often incomplete clearance of CIN at the resection margins emphasing the need for close follow-up after surgery.

23 Article Does HIV serostatus affect outcomes of dually diagnosed opiate dependents in residential treatment? 2008

Carra, Giuseppe / Montomoli, Cristina / Monti, Maria Cristina / Clerici, Massimo. ·Department of Mental Health Sciences, Royal Free and University College Medical School, London, UK. ·Epidemiol Psichiatr Soc · Pubmed #18444461.

ABSTRACT: BACKGROUND: Little is known about specific treatment needs of mentally ill clients abusing substances and infected by HIV. The major gap concerns residential programmes. AIMS: To explore differences in outcomes between seropositive and seronegative dually diagnosed opiate dependent clients who participated in a residential therapy programme. METHODS: Data were gathered on 154 clients treated in a therapeutic community in Milan between October 1999 and September 2004. Odds ratios with 95% confidence intervals were used to study the association between HIV serostatus and outcome. RESULTS: At 12-month followup, seropositive clients were more likely to relapse. CONCLUSIONS: The impact of HIV seropositivity on behavioural outcomes should be taken into consideration when planning residential programmes for the HIV (+) dually diagnosed population. Further research could test the need of incorporating dedicated treatments into existing programmes.

24 Minor BASHH/EAGA position statement on the HIV window period. 2015

Webster, Daniel P / Donati, Matthew / Geretti, Anna M / Waters, Laura J / Gazzard, Brian / Radcliffe, Keith. ·Royal Free London NHS Foundation Trust, London, UK daniel.webster@ucl.ac.uk. · Public Health England, Bristol, UK. · University of Liverpool, UK. · St Stephens Centre, Chelsea and Westminster Hospital, London, UK. · Whittall Street Clinic, Birmingham, UK. ·Int J STD AIDS · Pubmed #26232737.

ABSTRACT: -- No abstract --

25 Minor Airway bacteria and respiratory symptoms are common in ambulatory HIV-positive UK adults. 2015

Nimmo, Camus / Capocci, Santino / Honeyborne, Isobella / Brown, James / Sewell, Janey / Thurston, Sarah / Johnson, Margaret / McHugh, Timothy D / Lipman, Marc. ·Division of Medicine, University College London, London, UK. · Division of Medicine, University College London, London, UK Centre for Respiratory Medicine and Dept of Medicine, Royal Free London NHS Foundation Trust, London, UK. · Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK. · Centre for Respiratory Medicine and Dept of Medicine, Royal Free London NHS Foundation Trust, London, UK. · Division of Medicine, University College London, London, UK Centre for Respiratory Medicine and Dept of Medicine, Royal Free London NHS Foundation Trust, London, UK marclipman@nhs.net. ·Eur Respir J · Pubmed #26113673.

ABSTRACT: -- No abstract --