Objective and subjective rapid frailty screening tools in people with HIV.

OBJECTIVES: As people with HIV (PWH) age, the prevalence of frailty increases. Rapid screening tests to identify frailty within HIV outpatient settings are required to identify at-risk individuals. We undertook a service evaluation to assess three short frailty assessments in PWH. METHODS: We assessed two objective [gait speed (GS), timed-up-and-go test (TUGT)] and one subjective [the self-reported health questionnaire (SRH)] frailty screening tools in PWH aged > 40 years attending a single HIV outpatient department. Factors associated with positive frailty screening tests (defined as GS < 0.8 m/s, TUGT ≥ 10 s and SRH score < 6) were assessed using logistic regression models. ETHICAL CONSIDERATIONS: This was a service evaluation and was approved as a service evaluation by the Imperial College Healthcare NHS trust HIV clinical research committee (February 2020). All participants were given verbal information and were able to terminate the screening tests at any time. RESULTS: Of 84 PWH approached, 80 individuals completed all screening tests (median age = 56 years, range: 40-80) with a positive frailty screening prevalence in 19%, 33% and 20% for GS, TUGT and SRH, respectively. All tests were considered acceptable to participants. Factors statistically significantly associated with frailty included age (GS and TUGT), detectable HIV RNA (TUGT), number of comorbidities (GS and TUGT), presence of polypharmacy (GS and TUGT) and total number of concomitant medication (GS and SRH). CONCLUSIONS: Rates of positive screening tests for frailty are dependent on screening tool used, with all three tools being acceptable to participants. Objective measures of frailty screening (GS and TUGT) are more closely associated with clinical parameters than is a subjective measure of frailty screening (SRH).

Lymphogranuloma venereum detected from the pharynx in four London men who have sex with men.

Lymphogranuloma venereum (LGV) is an established cause of proctitis in men who have sex with men (MSM). Currently in the UK, testing for pharyngeal Chlamydia trachomatis (CT) is not routine, and LGV typing is usually only performed in patients with anorectal symptoms. We report four cases where LGV-associated CT DNA was detected from the pharynx in MSM, demonstrating that nucleic acid amplification testing (NAAT) can be used for detecting and typing pharyngeal CT infection. These cases also highlight other possible routes of infection for LGV, and add to the broad spectrum of clinical presentations associated with this infection.

Methicillin-resistant Staphylococcus aureus as a cause of genital ulcer-adenopathy syndrome.

The differential diagnosis in anogenital ulcer-adenopathy syndrome in men who have sex with men (MSM) is becoming more complex, particularly with lymphogranuloma venereum and syphilis re-establishing endemicity among MSM. Sexual contact has been shown to transmit methicillin-resistant Staphylococcus aureus (MRSA), probably through intimate skin-to-skin contact. We present a case of MRSA genital ulceration and local lymphadenopathy in a man whose sexual partners are men, reporting high-risk sexual behaviour, highlighting the importance of also considering MRSA infection in these cases, and the potential for spread of MRSA infection in the MSM community.

It's not all swine flu...are we missing opportunities to diagnose primary HIV infection in patients with flu symptoms?

The advantages of diagnosis of primary HIV infection (PHI) for the individual and public health are well documented. However, symptoms of HIV seroconversion are often not recognized by health-care professionals. Also, symptomatic patients themselves often do not present to health-care services. With the emergence of H1N1 infection, many patients with flu-like symptoms are seeking medical advice. Currently in the UK, the management of H1N1 is in the treatment phase, that is, patients are diagnosed and treated for H1N1 influenza based on clinical observation rather than laboratory testing. Symptoms of H1N1 infection are often similar to those of PHI. We present two cases of men who have sex with men from Brighton, UK presenting to general practice and accident and emergency with flu-like symptoms. Both were initially diagnosed on clinical grounds with H1N1 infection and treated empirically with antivirals but were later confirmed to, in fact, have symptomatic PHI. It is important in high-risk patients with flu symptoms attributed to swine flu infection, that PHI is also considered and excluded.

Immunosuppression among HIV-1-positive patients attending for care: experience from two large HIV centres in the United Kingdom.

OBJECTIVES: The aim of the study was to describe the prevalence of and examine the factors associated with immunosuppression (CD4 < 200 cells/microL) among HIV-infected patients attending two large inner London treatment centres. METHODS: Patients attending for care who had a CD4 count < 200 cells/microL during a 6-month period (1 January to 30 June 2007) were identified from the UK national CD4 surveillance database. Corresponding case notes were reviewed and factors associated with the most recent immunosuppressive episode examined. Patients either previously had a CD4 count > 200 cells/microL at any time under follow-up which had decreased (group A) or never had a CD4 count > 200 cells/microL (group B; late presenters). RESULTS: Of 4589 patients, 10.2% (467) had at least one CD4 count < 200 cells/microL. In group A (60.1% of patients), 70.4% were not receiving antiretroviral therapy (ART) at the time at which the CD4 count fell to < 200 cells/microL. Reasons included: treatment interruption (TI; 32.6%), patient declined ART (20.2%), infrequent attendance (19.1%), physician delay in offer (23.1%) and transient CD4 cell count decrease (3.9%). Among those receiving ART, one in three had poor adherence. In group B, 92.3% had started ART after presentation: most had recently started and were responding virologically. AIDS-defining diagnoses occurred in the year preceding the decrease in CD4 cell count in 12.6% of patients in group A and 33.3% of those in group B. CONCLUSION: The majority of patients became immunosuppressed while under care. Our findings suggest that, in addition to strategies aimed at earlier diagnosis, there are further opportunities to reduce severe immunosuppression in patients already attending for HIV care.