Inequities in PrEP use according to Medicare status in a publicly funded sexual health clinic; a retrospective analysis.

New HIV diagnoses continue to disproportionately affect overseas-born men who have sex with men (MSM). A retrospective study of all pre-exposure prophylaxis (PrEP)-eligible MSM attending Sydney Sexual Health Centre for the first time in 2021 analysed self-reported PrEP-use, PrEP prescribed at the initial consult, and PrEP taken during 2021 using binomial logistic regression models. A total of 1367 clients were included in the analysis, 716 (52.4%) were born overseas and 414 (57.8%) were Medicare-ineligible. Medicare-ineligible clients were less likely to be on PrEP at initial visit (OR 0.45, 95% CI 0.26-0.77). This study suggests inequities in PrEP access and/or awareness in Medicare-ineligible MSM in Australia.

Chlamydia home sampling in the real world: a cross-sectional analysis.

BACKGROUND: Retesting rates for chlamydia in Australia are low. Chlamydia home sampling has been shown to increase retesting rates. Sydney Sexual Health Centre introduced chlamydia home sampling in 2019. The aim of this study is to describe home sampling in a real world setting. METHODS: In this retrospective study, the total number of heterosexual males and non-sex-working females who tested positive for chlamydia at a urogenital site (1 November 2019 to 31 October 2020) were identified based on local diagnostic codes. Agreeing participants who were sent a home sampling SMS reminder at 2.5months were included for further analysis. Descriptive statistics and attrition rates of the home sampling were calculated using frequencies and percentages. Bivariate analyses of the main covariates by each stage, assessing crude associations, were performed using chi-squared tests. RESULTS: A total of 444 people attending Sydney Sexual Health Centre were eligible for the chlamydia home sampling option, 25.9% agreed to be sent the home sampling SMS invitation, of which 53 (46.1%) replied and were mailed a home sampling kit, with 43.4% returning the kit; of these 3 (13.0%) were positive for chlamydia. The majority (91.3%) of tests were performed within 6months of original diagnosis. Of those who initially agreed but then did not undertake home sampling, 22.6% subsequently tested in clinic at Sydney Sexual Health Centre. There were no associations between any of the variables measured and undertaking home sampling. CONCLUSIONS: Home sampling process for chlamydia reinfection screening in heterosexual men and non-sex-working women had much lower uptake than seen in a previous trial with high attrition rates at each stage.

Dolutegravir with tenofovir disoproxil fumarate-emtricitabine as HIV postexposure prophylaxis in gay and bisexual men.

OBJECTIVES: Completion rates for HIV postexposure prophylaxis (PEP) are often low. We investigated the adherence and safety of dolutegravir (DTG; 50 mg daily) with tenofovir disoproxil fumarate-emtricitabine (TDF-FTC; 300/200 mg, respectively) as three-drug PEP in gay and bisexual men. DESIGN: Open-label, single-arm study at three sexual health clinics and two emergency departments in Australia. METHODS: In total, 100 HIV-uninfected gay and bisexual men requiring PEP received DTG and TDF-FTC for 28 days. The primary end point was PEP failure (premature PEP cessation or primary HIV infection through week 12). Additional end points were adherence by self-report (n = 98) and pill count (n = 55), safety, and plasma drug levels at day 28. RESULTS: PEP completion was 90% (95% confidence interval 84-96%). Failures (occurring at a median 9 days, interquartile range 3-16) comprised loss to follow-up (9%) and adverse event resulting in study drug discontinuation (headache, 1%). No participant was found to acquire HIV through week 12. Adherence to PEP was 98% by self-report and in the 55 participants with corresponding pill count data. The most common clinical adverse events were fatigue (26%), nausea (25%), diarrhoea (21%), and headache (10%). There were only four grade 3-4 subjective adverse events. The most common laboratory adverse event was raised alanine aminotransferase (22%), but there was no case of clinical hepatitis. At day 28, the mean estimated glomerular filtration rate decrease was 14 ml/min/1.73m (SD 17, P = 0.001); an estimated glomerular filtration rate of less than 60 ml/min/1.73m occurred in 3%. CONCLUSIONS: DTG with TDF-FTC is a well tolerated option for once-daily PEP.

Screening of HIV-infected patients for non-AIDS-related morbidity: an evidence-based model of practice.

OBJECTIVE: To develop guidelines to facilitate management of HIV infection as a chronic disease within the setting of a sexual health or other HIV outpatient clinic. METHODS: We undertook a literature search to identify published guidelines and expert panel commentaries on screening and managing non-AIDS comorbidities in the general and HIV-infected population. We developed evidence-based guidelines for screening and management of non-AIDS comorbidities in HIV-positive clients attending the Sydney Sexual Health Centre (SSHC) that could be used in other HIV outpatient settings. RESULTS: Guidelines have been developed that describe the recommended tests and an interpretation of results, and outline actions to take if abnormal. A summary document can be placed in the medical notes to record completed tests, and resources such as lifestyle modification pamphlets and cardiovascular risk assessment tools made easily available in clinics. CONCLUSIONS: These guidelines are being used by nurses and doctors to facilitate the management of HIV as a chronic disease in the SSHC. This represents a significant shift in practice from the traditional role of a sexual health clinic, and is likely to become increasingly important in resource-rich countries such as Australia where individuals with HIV are expected to live beyond their seventh decade. This model could be used in other HIV outpatient settings including general practice.

Downregulation of Fas gene expression in Sézary syndrome is associated with promoter hypermethylation.

Sézary Syndrome (SS) is an aggressive leukemic variant of primary cutaneous T-cell lymphoma characterized by the presence of tumor or Sézary cells that generally display a mature memory T-cell immunophenotype. Sézary cells proliferate poorly and therefore their accumulation may be due to defective T-cell homeostasis involving resistance to apoptosis. In this study, we analyzed Fas expression in CD4+ lymphocytes at the mRNA and protein levels in a large cohort of SS patients as compared with healthy controls. Fas mRNA expression was dysregulated in 34/47 patients, with significant under- and overexpression of Fas mRNA detected in 21 and 13 patients respectively (P<0.01). Examination of cell-surface Fas expression showed correlation with the observed downregulation of mRNA in CD4+ T cells. Mutational analysis demonstrated that functional FAS gene mutations are rare. Moreover, 16 SS patients who showed significant under-expression of Fas mRNA also showed significant positional hypermethylation within the FAS CpG island, which was not present in healthy controls or SS patients determined to have normal or overexpression of Fas mRNA. These data demonstrate that dysregulation of Fas expression is a common feature of SS, and provide a rationale for targeted therapies to restore the extrinsic Fas-dependent apoptotic pathway in this malignancy.