Latent and subclinical tuberculosis in HIV infected patients: a cross-sectional study.

BACKGROUND: HIV and tuberculosis (TB) are commonly associated. Identifying latent and asymptomatic tuberculosis infection in HIV-positive patients is important in preventing death and morbidity associated with active TB. METHODS: Cross-sectional study of one time use of an interferon-gamma release assay (T-SPOT.TB - immunospot) to detect tuberculosis infection in patients in a UK inner city HIV clinic with a large sub-Saharan population. RESULTS: 542 patient samples from 520 patients who disclosed their symptoms of TB were tested. Median follow-up was 35 months (range 27-69). More than half (55%) originated from countries with medium or high tuberculosis burden and 57% were women. Antiretroviral therapy was used by 67%; median CD4 count at test was 458 cells/µl. A negative test was found in 452 samples and an indeterminate results in 40 (7.4%) but neither were associated with a low CD4 count. A positive test was found in 10% (50/502) individuals. All patients with positive tests were referred to the TB specialist, 47 (94%) had a chest radiograph and 46 (92%) attended the TB clinic. Two had culture-positive TB and a third individual with features of active TB was treated. 40 started and 38 completed preventive treatment. One patient who completed preventive treatment with isoniazid monotherapy subsequently developed isoniazid-resistant pulmonary tuberculosis. No patient with a negative test has developed TB. CONCLUSIONS: We found an overall prevalence of latent TB infection of 10% through screening for TB in those with HIV infection and without symptoms, and a further 1% with active disease, a yield greater than typically found in contact tracing. Acceptability of preventive treatment was high with 85% of those with latent TB infection eventually completing their TB chemotherapy regimens. IGRA-based TB screening among HIV-infected individuals was feasible in the clinical setting and assisted with appropriate management (including preventive treatment and therapy for active disease). Follow-up of TB incidence in this group is needed to assess the long-term effects of preventive treatment.

Sexual and reproductive health in HIV-positive women: a dedicated clinic improves service.

We run a one-stop clinic for HIV-positive women, offering sexually transmitted infection screening, cervical cytology and family planning. We completed an audit cycle, and showed that all aspects of our care had improved since the introduction of this integrated service.

Patient-delivered partner medication in the UK: an unlawful but popular choice.

Current methods of contact tracing are only partially effective. Patient-delivered partner medication (PDPM), in which patients are dispensed antibiotics for their sexual partner(s), has been shown to reduce persistent and recurrent infections. We performed a questionnaire to canvass opinions of UK staff and patients about PDPM. The response rate was 72% (88/122) for staff and 90% (473/525) for patients. The majority of staff (81%) thought that PDPM would be acceptable to patients, and should be combined with written information and a recommendation to attend a clinic. Patients were mostly (59%) in favour of PDPM, 87% thought it would make it easier to abstain from sex during treatment, and 94% indicated that after being given antibiotics by a partner, they would attend a clinic for tests. Concerns expressed by staff and patients included drug allergies, potential lack of information provided to partners, management of complicated infection, pregnancy and medicolegal implications.

Spontaneous HIV-1 seroreversion in an adult male.

A man developed HIV-1 antibodies, which disappeared spontaneously. He had negative HIV viral load and p24 antigen tests and did not develop immunosuppression. Further investigations suggest the HIV-positive result was a nonspecific reaction. An alternative explanation is that he was exposed to HIV and had a "near-miss" HIV infection.