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1.
AIDS Res Ther ; 16(1): 40, 2019 12 07.
Artículo en Inglés | MEDLINE | ID: mdl-31810490

RESUMEN

BACKGROUND: Tenofovir disoproxil fumarate (TDF) is widely used in the management of HIV-infection, but has been associated with renal impairment in a small proportion of patients. Tenofovir alafenamide (TAF), a novel prodrug of tenofovir, causes less renal impairment and can improve renal function in patients switched from TDF. The factors which predict improved renal function in patients switching from TDF to TAF have yet to be described. AIM: To determine which patient factors are associated with an improvement in renal function following the switch from a TDF- to a TAF-based HIV antiretroviral regimen. METHODS: A retrospective analysis was performed of a cohort from a publicly funded sexual health clinic in Sydney, Australia. All HIV-positive clinic patients switched from a TDF- to TAF-containing regimen between January 2016 and August 2018 were eligible for inclusion. Laboratory results were obtained from patients' electronic medical records. The statistical significance of differences between pre- and post-switch means was determined by paired t-tests, adjusted for baseline values, and associations between continuous variables by univariate linear regression. RESULTS: 79 patients met inclusion criteria. The majority were male (89%), with a median age of 44 years (IQR: 34.5 to 53). Patients had a mean pre-switch estimated glomerular filtration rate (eGFR) of 95 ± 2 mL/min/1.73 m2, and there was no significant change post-switch (p = 0.062). Pre-switch eGFR was a significant predictor of the magnitude of eGFR change after the switch (p < 0.001), but there was no significant association with age (p = 0.189), cumulative TDF exposure (p = 0.454) or baseline urinary protein to creatinine ratio (p = 0.814). CONCLUSION: While there was no significant difference in mean eGFR, in patients switched from TDF to TAF, baseline eGFR was a significant predictor of the change in eGFR. This suggests that patients on TDF with poorer baseline renal function would benefit more from switching to TAF. Further study to explore this association is warranted.

2.
Artículo en Inglés | MEDLINE | ID: mdl-31738869

RESUMEN

Aim: To describe the epidemiology of lymphogranuloma venereum (LGV) in New South Wales (NSW) from 2006 to 2015. Methods: LGV notification data between 2006 and 2015 from New South Wales were analysed to describe time trends in counts and rates by gender, age group and area of residence, as well as anatomical sites of infection. A positivity ratio was calculated using the number of LGV notifications per 100 anorectal chlamydia notifications per year. Data linkage was used to ascertain the proportion of LGV cases that were co-infected with HIV. Results: There were 208 notifications of LGV in NSW from 2006 to 2015; all were among men, with a median age of 42 years, and half were residents of inner-city Sydney. Annual notifications peaked at 57 (1.6 per 100,000 males) in 2010, declined to 16 (0.4 per 100,000 males) in 2014, and then increased to 34 (0.9 per 100,000 males) in 2015. Just under half (47.4%) of LGV cases were determined to be co-infected with HIV. Conclusion: The number of LGV notifications each year has not returned to the low levels seen prior to the peak in 2010. Continued public health surveillance is important for the management and control of LGV.


Asunto(s)
Chlamydia trachomatis/aislamiento & purificación , Monitoreo Epidemiológico , Linfogranuloma Venéreo/epidemiología , Adolescente , Adulto , Anciano , Notificación de Enfermedades , Homosexualidad Masculina , Humanos , Linfogranuloma Venéreo/microbiología , Masculino , Persona de Mediana Edad , Nueva Gales del Sur/epidemiología , Enfermedades del Recto , Minorías Sexuales y de Género , Adulto Joven
3.
Sex Transm Infect ; 2019 Oct 17.
Artículo en Inglés | MEDLINE | ID: mdl-31624177

RESUMEN

OBJECTIVES: Pharyngeal gonorrhoea disproportionately affects men who have sex with men (MSM). We explored temporal trends in pharyngeal gonorrhoea positivity among MSM compared with anorectal and urogenital positivity. METHODS: Data (2011-2015) were extracted from 41 publicly funded sexual health clinics participating in a national surveillance network. Positivity was defined as the proportion of first-visit testing occasions where gonorrhoea was detected. Logistic regression explored trends in positivity and correlates of positive pharyngeal tests. RESULTS: From 2011 to 2015, 24 792 MSM tested (16 710 pharyngeal, 19 810 urogenital and 15 974 anorectal first-visit tests). Pharyngeal positivity increased by 183% from 139/3509 (4.0%) in 2011 to 397/3509 (11.3%) in 2015, p-trend <0.001; urogenital positivity by 39% from 257/4615 (5.6%) to 295/3783 (7.8%), p-trend=0.006; and anorectal positivity by 87% from 160/3469 (4.6%) to 286/3334 (8.6%), p-trend <0.001. The annual temporal increase in positivity was greater in the pharynx (OR 1.33; 95% CI 1.27 to 1.38) than at urogenital (OR 1.06; 95% CI 1.02 to 1.10) and anorectal (OR 1.16; 95% CI 1.11 to 1.21) sites. Factors independently associated with pharyngeal gonorrhoea were: younger age (p<0.001), higher numbers of recent sexual partners (p-trend=0.004), contact with a person with a diagnosed STI (p<0.001), injecting drug use (p<0.001), anogenital symptoms (p<0.001) and HIV-positive status (p=0.050). CONCLUSION: Temporal increases in gonorrhoea positivity occurred at all anatomical sites, with the greatest increase in the pharynx. Risk factors could be used to help to develop testing and prevention strategies among MSM at highest risk. Strengthening sexual health service delivery, testing and surveillance remain priorities for pharyngeal gonorrhoea control.

4.
Sex Transm Infect ; 2019 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-31371447

RESUMEN

OBJECTIVE: Gay, bisexual and other men who have sex with men (GBMSM), particularly HIV-positive GBMSM, are at increased anal cancer risk compared with the general population. This study examined the psychological and quality of life (QoL) impact of receiving abnormal anal cancer screening results during the baseline visit of the Study of the Prevention of Anal Cancer (SPANC). METHODS: SPANC was a prospective cohort study of the natural history of anal human papillomavirus (HPV) and associated abnormalities in GBM aged 35 years and over. Participants completed questionnaires including aspects of health-related QoL (HR-QoL) and psychosocial functioning at baseline. Participants underwent procedures including an anal swab for cytology, and high-resolution anoscopy with biopsy of any possibly HPV-related abnormality. Questionnaires were readministered 2 weeks and 3 months after participants were given cytology and histology results. Perceived test result served as the study factor. RESULTS: Participants with perceived abnormal results (n=232) reported poorer HR-QoL (mean difference=1.8; p=0.004) and lower utility-based QoL (mean difference=0.02; p=0.018) 2 weeks after screening than individuals with perceived normal results (n=268). These differences did not persist at 3-month follow-up. A greater proportion of participants who perceived their results as abnormal reported feeling worse than usual about their anal health and anal cancer fear (p's<0.001), experienced more intrusive thoughts about their results (p's≤0.006) and felt more likely to develop cancer than other gay men their age (p's≤0.025) at both time points than those with perceived normal results. CONCLUSIONS: Providing abnormal results may cause psychological distress and impact HR-QoL, with sustained intrusive thoughts, increased cancer worry and perceived cancer risk. The potential for psychological harm needs to be considered when implementing anal cancer screening programmes.

5.
Aust N Z J Public Health ; 43(5): 424-428, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31287941

RESUMEN

OBJECTIVES: Asian men who have sex with men (MSM) who have recently arrived in Australia are an emergent risk group for HIV; however, little is known about how they compare to Australian MSM diagnosed with HIV. This study compared the characteristics of these two groups. METHODS: A retrospective, cross-sectional study of MSM diagnosed with HIV between January 2014 and October 2017 in Melbourne and Sydney public sexual health clinics. Asian MSM were those who had arrived in Australia within 4 years of diagnosis. RESULTS: Among 111 Asian men, 75% spoke a language other than English, 88% did not have Medicare and 61% were international students. Compared with Australian men (n=209), Asian men reported fewer male sexual partners within 12 months (median 4 versus 10, p<0.001), were less likely to have tested for HIV previously (71% versus 89%, p<0.001) and had a lower median CD4 count (326 versus 520, p<0.001). Among Asian men, HIV subtype CRF01-AE was more common (55% versus 16%, p<0.001) and subtype B less common (29% versus 73%, p<0.001). CONCLUSIONS: Asian MSM diagnosed with HIV reported lower risk and had more advanced HIV. Implications for public health: HIV testing and preventative interventions supporting international students are required.


Asunto(s)
Grupo de Ascendencia Continental Asiática/estadística & datos numéricos , Emigrantes e Inmigrantes/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Homosexualidad Masculina/etnología , Conducta Sexual/etnología , Enfermedades de Transmisión Sexual/etnología , Adolescente , Adulto , Grupo de Ascendencia Continental Asiática/psicología , Australia/epidemiología , Estudios Transversales , Infecciones por VIH/etnología , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Estudios Retrospectivos , Asunción de Riesgos , Parejas Sexuales , Adulto Joven
6.
Sex Health ; 2019 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-31072450

RESUMEN

Background:Anal cancer disproportionately affects people with HIV infection, especially gay and bisexual men (GBM). The awareness and understanding of human papillomavirus (HPV) and anal cancer in a community-based sample of people living with HIV and GBM was explored to inform future evidence-based public health interventions. Methods: Following consultation with affected communities and relevant healthcare professionals, a questionnaire was developed that assessed knowledge, understanding and experience of anal HPV, HPV vaccination, screening and perceived personal risk of anal cancer. Participants were recruited through HIV community and GBM organisations and anonymously completed the questionnaire online. Results: Of 1660 questionnaires returned, 1574 were analysed from men, of whom 1535 (97.5%) identified as GBM and 15.7% reported being HIV-positive. Most (51.8%) of the HIV-positive men and 68.1% of HIV-negative or unknown men thought their risk of anal cancer was the same, or lower, than that of the general population. Only a small minority (12.5%) reported ever having talked to their doctor about anal HPV and/or anal cancer and 11.6% reported ever having had an anal cancer examination. Less than one-third (31.5%) had heard of HPV vaccination and only 2.9% of men recollected receiving HPV vaccination. Conclusions: Knowledge and awareness of anal cancer was generally poor in a sample of HIV-positive and HIV-negative GBM. Specific information targeted at these people could potentially raise awareness, leading to earlier diagnosis, reduced burden of disease among GBM and less demands on the healthcare system. Young GBM might benefit from education regarding the importance of HPV vaccination.

7.
Sex Transm Infect ; 95(7): 477-483, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31018992

RESUMEN

OBJECTIVES: Sexually transmitted infection (STI) notifications are increasing among older individuals. Many older gay and bisexual men (GBM) are sexually active and have multiple partners. We aimed to investigate the prevalence, incidence and predictors of anal chlamydia, anal gonorrhoea and syphilis in older GBM. METHODS: The Study for the Prevention of Anal Cancer (SPANC) was a prospective cohort study of HPV infections and related anal lesions among community-recruited GBM age ≥ 35 years in Sydney, Australia. At baseline and subsequent annual visits, recent STI diagnoses were collected via questionnaire ('interval diagnoses') and STI testing occurred ('study visit diagnoses'). Baseline STI prevalence was calculated using study visit diagnoses. Incidence of anal chlamydia and gonorrhoea was calculated using interval and study visit diagnoses. Syphilis incidence was calculated using interval diagnoses. Univariate and multivariate analysis using Cox proportional hazards were undertaken to investigate the association between risk factors and incident STI. RESULTS: Among 617 GBM, the median age was 49 years (range 35-79) and 35.8% (n=221) were HIV-positive. At baseline, STI prevalence was: anal chlamydia 2.3% (n=14); anal gonorrhoea 0.5% (n=3) and syphilis 1.0% (n=6). During 1428 person-years of follow-up (PYFU), the incidence (per 100 PYFU) of anal chlamydia, anal gonorrhoea and syphilis was 10.40 (95% CI 8.82 to 12.25), 9.11 (95% CI 7.64 to 10.85) and 5.47 (95% CI 4.38 to 6.84), respectively. In multivariate analysis, HIV-positivity, higher number of recent condomless receptive anal intercourse partners and baseline methamphetamine use were associated with each STI. Sex with 'fuck-buddies' was associated with anal chlamydia and gonorrhoea. Age was not associated with any STI. DISCUSSION: There was a high incidence of STI among SPANC participants. Age should not be used as a proxy for sexual risk and older GBM require a detailed sexual behaviour and recreational drug use history. Interventions that specifically target STI risk among older GBM should be considered.

8.
J Int AIDS Soc ; 22(4): e25277, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30983155

RESUMEN

INTRODUCTION: There are few data about the range of strategies used to prevent sexual HIV transmission within gay male serodiscordant couples. We examined HIV prevention strategies used by such couples and compared differences between countries. METHODS: Opposites Attract was a cohort study of male serodiscordant couples in Australia, Brazil and Thailand, from May 2014 (Australia) or May 2016 (Brazil/Thailand) to December 2016. At visits, HIV-positive partners had viral load (VL) tested; HIV-negative partners reported sexual behaviour and perceptions of their HIV-positive partner's VL results. Within-couple acts of condomless anal intercourse (CLAI) were categorized by strategy: condom-protected, biomedically protected (undetectable VL and/or pre-exposure prophylaxis [PrEP]), or not protected by either (HIV-negative partners engaging in insertive CLAI, receptive CLAI with withdrawal, or receptive CLAI with ejaculation). RESULTS: A total of 343 couples were included in this analysis (153 in Australia, 93 in Brazil and 97 in Thailand). Three-quarters of HIV-positive partners were consistently virally suppressed (<200 copies/mL) during follow-up, and HIV-negative partners had correct perceptions of their partner's VL result for 76.5% of tests. One-third of HIV-negative partners used daily PrEP during follow-up. Over follow-up, 73.8% of couples had CLAI. HIV-negative partners reported 31,532 acts of anal intercourse with their HIV-positive partner. Of these, 46.7% were protected by condoms, 48.6% by a biomedical strategy and 4.7% of acts were not protected by these strategies. Australian couples had fewer condom-protected acts and a higher proportion of biomedically protected acts than Brazilian and Thai couples. Of the 1473 CLAI acts where the perceived VL was detectable/unknown and were not protected by PrEP (4.7% of all acts), two-thirds (n = 983) were when the HIV-negative partner was insertive (strategic positioning). Of the 490 acts when the HIV-negative partner was receptive, 261 involved withdrawal and 280 involved ejaculation. Thus, <1% of acts were in the highest risk category of receptive CLAI with ejaculation. CONCLUSIONS: Couples used condoms, PrEP or perceived undetectable VL for prevention in the majority of anal intercourse acts. Only a very small proportion of events were not protected by these strategies. Variation between countries may reflect differences in access to HIV treatment, education, knowledge and attitudes.

9.
AIDS ; 33(8): 1361-1368, 2019 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-30950880

RESUMEN

BACKGROUND: Anal cancer incidence increased markedly in people living with HIV (PLWHIV) after the introduction of HAART, but in a few setting settings, recent declines have been reported. We report the incidence and time trends of anal cancer in PLWHIV in Australia. STUDY DESIGN: A data linkage study between the National HIV Registries and the Australian Cancer Database. METHODS: Cases of anal squamous cell carcinoma (ASCC) in Australians aged 16 years and above diagnosed with HIV between 1982 and 2012 were identified. Standardized incidence ratios (SIRs) were calculated to compare incidence with that of the general population. Poisson regression models were developed to describe the time trends of ASCC over time and to compare ASCC risk within subgroups of PLWHIV. RESULTS: Among 28 696 individuals, a total of 129 cases of ASCC were identified. The crude incidence was 36.3 per 100 000 person-years and it increased sharply from 14.8 to 62.1 per 100 000 person-years between 1982-1995 and 2009-2012 (P trend <0.001). The SIR was 35.3 (95% confidence interval 29.5-42.0), and there was an inverse association between SIR and increasing age (P trend <0.001). In multivariate analyses, ASCC incidence was significantly higher in recent years (P trend <0.001), in those who acquired HIV through male homosexual contact (P = 0.002), and in those who had a history of AIDS (P < 0.001). CONCLUSION: PLWHIV in Australia are at markedly higher risk of anal cancer. Unlike in some industrialized countries with a mature HIV epidemic, the incidence of anal cancer is still increasing in this population in Australia.

10.
Sex Transm Dis ; 46(4): 229-233, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30870323

RESUMEN

BACKGROUND: Men who have sex with men living with human immunodeficiency virus have a high risk of anal cancer. We estimate the likely benefit of human papillomavirus (HPV) vaccination among participants of the Anal Cancer Examination study. METHODS: Anal swabs were collected for the detection and genotyping of anal HPV DNA by linear array (Roche Diagnostics) in this 2-year multicenter prospective cohort. We calculated the proportion of men, stratified by age, without detectable vaccine type-specific DNA. RESULTS: Overall, 255 men, with a median age of 50 years (interquartile range, 44-56 years) contributed 488.9 person-years of follow-up. After 2 years of follow-up, 149 (58%; 95% confidence interval [CI], 52-65) had at least 1 high-risk HPV (HRHPV), and 71 (28%, 95% CI, 22-34) had HPV types 16/18 detected. Assuming that DNA-negative men would receive vaccine protection, vaccination at baseline could potentially prevent HRHPV infection in 10.2% of men (95% CI, 6.8-14.6, 26 of 255) 2 years later from incident HRHPV covered by the bivalent and quadrivalent vaccine, and 29.4% of men (95% CI, 23.9-35.4, 75/255) from incident HRHPV covered by the nonavalent vaccine. CONCLUSION: Though there is high prevalence of anal HPV in men who have sex with men living with human immunodeficiency virus, there was also a high incidence of HRHPV vaccine types in the 2-year follow-up, indicating potential for prevention if these men were not previously infected with HPV vaccine types and were vaccinated at their baseline visit.

11.
Int J STD AIDS ; 30(5): 515-518, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30714874

RESUMEN

An epidemic of lymphogranuloma venereum among men who have sex with men (MSM) has persisted in Australia for over a decade and virtually all diagnoses are made from rectal samples. We discuss two cases of human immunodeficiency virus-negative MSM who presented with a penile ulcer. The diagnosis can be made by ensuring a swab of any such ulcer is tested for Chlamydia trachomatis.


Asunto(s)
Chlamydia trachomatis/aislamiento & purificación , Homosexualidad Masculina , Linfogranuloma Venéreo/diagnóstico , Adulto , Canal Anal/microbiología , Antibacterianos/uso terapéutico , Doxiciclina/uso terapéutico , Seronegatividad para VIH , Humanos , Linfogranuloma Venéreo/tratamiento farmacológico , Linfogranuloma Venéreo/microbiología , Masculino , Resultado del Tratamiento , Úlcera/diagnóstico , Úlcera/tratamiento farmacológico , Úlcera/microbiología
12.
PLoS One ; 14(1): e0210106, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30653509

RESUMEN

BACKGROUND: Pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) significantly reduces the risk of HIV acquisition. TDF is a known nephrotoxin however, renal dysfunction from TDF is mostly reversible following discontinuation. AIMS: To describe the renal function, risk factors for renal disease and associated clinical testing practices in a cohort of PrEP patients. METHODS: A retrospective review was conducted of all PrEP patients commenced on TDF/FTC at an inner metropolitan sexual health clinic in Sydney, Australia between April 2016 and July 2017, with follow-up data obtained at 3-monthly intervals until 18 months. RESULTS: 525 patients met inclusion criteria. Patients were almost exclusively male and median age was 34 years (IQR: 28 to 42). At baseline, 1.5% had an estimated glomerular filtration rate (eGFR) <70 mL/min/1.73m2. A small significant drop in eGFR of -2.5 mL/min/1.73m2 (p<0.05) occurred between PrEP commencement and the first follow-up period, followed by a progressive decline in eGFR of -0.38 mL/min/1.73m2 per month (95%CI: -0.57 to -0.20; p<0.001). Renal impairment (eGFR <70 mL/min/1.73m2) occurred in 6.5% of patients and persisted across consecutive follow-up periods in five (1.0%) patients. Patients aged ≥40 years had a greater risk of renal impairment than younger patients (HR 3.9, 95%CI: 1.8 to 8.4; p<0.001), despite similar rates of eGFR decline (p = 0.19). PrEP was discontinued in two patients (0.4%) due to renal function concerns. CONCLUSION: PrEP use led to an initial drop in eGFR and a more gradual progressive decline subsequently, but significant renal impairment remained uncommon up to 18 months of follow-up.


Asunto(s)
Fármacos Anti-VIH/efectos adversos , Combinación Emtricitabina y Fumarato de Tenofovir Disoproxil/efectos adversos , Riñón/fisiopatología , Profilaxis Pre-Exposición/métodos , Insuficiencia Renal/epidemiología , Adulto , Factores de Edad , Fármacos Anti-VIH/administración & dosificación , Australia/epidemiología , Combinación Emtricitabina y Fumarato de Tenofovir Disoproxil/administración & dosificación , Femenino , Estudios de Seguimiento , Tasa de Filtración Glomerular/efectos de los fármacos , Infecciones por VIH/prevención & control , Humanos , Incidencia , Riñón/efectos de los fármacos , Masculino , Persona de Mediana Edad , Insuficiencia Renal/inducido químicamente , Insuficiencia Renal/fisiopatología , Estudios Retrospectivos , Factores de Riesgo
13.
AIDS Behav ; 23(5): 1287-1296, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30523489

RESUMEN

Adequate adherence to pre-exposure prophylaxis (PrEP) is critical to prevent HIV infection, but accurately measuring adherence remains challenging. We compared two biological [blood drug concentrations in plasma and peripheral blood mononuclear cells (PBMC)] and two self-reported measures (facilitated recall to clinicians and self-report in online surveys) and identified predictors of daily PrEP adherence among gay and bisexual men (GBM) in their first 12 months on PRELUDE, an open-label, single-arm PrEP demonstration project in New South Wales, Australia. 327 participants were enrolled; 263 GBM attended their 12-month follow-up visit (81% retention). Overall, 91% of blood samples had plasma drug concentrations indicative of taking 7 pills/week, and 99% had protective drug concentrations (≥ 4 pills/week). Facilitated recall to clinicians identified 99% of participants with protective adherence as measured by PBMC drug concentrations. Daily adherence measured by facilitated recall was associated with behavioural practices including group sex (aOR 1.33, 95% CI 1.15-1.53, p < 0.001). Retained participants maintained high adherence to daily PrEP over 12 months, confirmed by four different measures. Facilitated recall to clinicians is a suitable measure for assessing PrEP adherence in populations engaged in care where there is established trust and rapport with patients. Trial registration: ClinicalTrials.gov NCT02206555.


Asunto(s)
Bisexualidad/estadística & datos numéricos , Infecciones por VIH/prevención & control , Homosexualidad Masculina/estadística & datos numéricos , Cumplimiento de la Medicación/estadística & datos numéricos , Profilaxis Pre-Exposición/estadística & datos numéricos , Adulto , Bisexualidad/psicología , Infecciones por VIH/psicología , Homosexualidad Masculina/psicología , Humanos , Masculino , Cumplimiento de la Medicación/psicología , Persona de Mediana Edad , Nueva Gales del Sur , Conducta Sexual/psicología
14.
J Int AIDS Soc ; 21(12): e25192, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30516346

RESUMEN

INTRODUCTION: Men who have sex with men (MSM) living with HIV have a high risk of anal cancer, which is often detected at late stages, when morbidity and mortality are high. The objective of this study was to describe the feasibility and challenges to incorporating regular digital anorectal examination (DARE) into routine HIV care for MSM living with HIV, from the perspective of patients, physicians and the health service. METHODS: In 2014, we recruited 327 MSM living with HIV, aged 35 and above from one major sexual health centre (n = 187), two high HIV caseload general practices (n = 118) and one tertiary hospital (n = 22) in Melbourne, Australia. Men were followed up for two years and DARE was recommended at baseline, year 1 and year 2. Data were collected regarding patient and physician experience, and health service use. An ordered logit model was used to assess the relationship between sociodemographic factors and the number of DAREs performed. RESULTS: Mean age of men was 51 (SD ± 9) years, 69% were Australian born, 32% current smokers, and mean CD4 was 630 (SD ± 265) cells per mm3 , with no significant differences between clinical sites. Overall, 232 (71%) men received all three DAREs, 71 (22%) received two DAREs, and 24 (7%) had one DARE. Adverse outcomes were rarely reported: anal pain (1.2% of total DAREs), bleeding (0.8%) and not feeling in control of their body during the examination (1.6%). Of 862 DAREs performed, 33 (3.8%) examinations resulted in a referral to a colorectal surgeon. One Stage 1 anal cancer was detected. CONCLUSION: Incorporation of an early anal cancer detection programme into routine HIV clinical care for MSM living with HIV showed high patient acceptability, uncommon adverse outcomes and specialist referral patterns similar to other cancer screening programmes.


Asunto(s)
Neoplasias del Ano/diagnóstico , Detección Precóz del Cáncer , Infecciones por VIH/complicaciones , Homosexualidad Masculina , Adulto , Canal Anal , Neoplasias del Ano/complicaciones , Australia , Estudios de Cohortes , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Minorías Sexuales y de Género
15.
Sex Transm Dis ; 2018 Nov 30.
Artículo en Inglés | MEDLINE | ID: mdl-30507634

RESUMEN

BACKGROUND: Men who have sex with men (MSM) living with HIV have a high risk of anal cancer. We estimate the likely benefit of HPV vaccination amongst participants of the Anal Cancer Examination (ACE) study. METHODS: Anal swabs were collected for the detection and genotyping of anal HPV DNA by Linear Array (Roche Diagnostics) in this two-year multicentre prospective cohort. We calculated the proportion of men, stratified by age, without detectable vaccine-type-specific DNA. RESULTS: Overall, 255 men, with a median age of 50 years (IQR 44-56) contributed 488.9 person-years of follow-up. After two years of follow up, 149 (58%, 95% CI:52-65) had at least one high-risk HPV (HRHPV), and 71 (28%, 95% CI:22-34) had HPV types 16/18 detected. Assuming that DNA negative men would receive vaccine-protection, vaccination at baseline could potentially prevent HRHPV infection in 10.2% of men (95% CI:6.8-14.6, 26/255) two years later from incident HRHPV covered by the bivalent and quadrivalent vaccine, and 29.4% of men (95% CI:23.9-35.4, 75/255) from incident HRHPV covered by the nonavalent vaccine. CONCLUSION: Though there is high prevalence of anal HPV in MSM living with HIV, there was also a high incidence of HRHPV vaccine types in the two-year follow up indicating potential for prevention if these men were not previously infected with HPV vaccine types and were vaccinated at their baseline visit.

16.
Intern Med J ; 48(12): 1447-1456, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30043439

RESUMEN

BACKGROUND: Individuals aged 13-24 years undergo vast physical, cognitive, social and psychological changes. Australian data regarding clinical outcomes of those diagnosed with HIV in this age are sparse. AIM: We aimed to describe demographic factors, virologic and clinical outcomes of individuals aged 13-24 years diagnosed with human immunodeficiency virus (HIV). METHODS: Patients diagnosed with HIV after 1997 in the Australian HIV Observational Database were divided into young adults, diagnosed at age <25 years (n = 223), and older adults (n = 1957). Demographic and clinical factors were compared between groups. RESULTS: Young adults had a median age at diagnosis of 22 years (inter quartile range (IQR) 20-24) and median age at treatment initiation of 24 years (IQR 22-26). They were more likely to be female than the older cohort (21.1 vs 10.8%; P < 0.001). Men who have sex with men was the most common exposure category in both groups. CD4 count at diagnosis was significantly higher in younger than older adults (median 460 vs 400 cells/mm3 , P = 0.006), whereas HIV viral load at diagnosis was lower (35 400 vs 61 659 copies/mL, P = 0.011). The rate of loss to follow up (LTFU) was higher in young adults (8.0 vs 4.3 per 100PY, P < 0.001). Young adults were more likely to have a treatment interruption compared to older adults (5.3 vs 4.0 per 100PY, P = 0.039). Rates of treatment switch, time to treatment change, and CD4 and viral load responses to treatment were similar between groups. CONCLUSIONS: Young adults were diagnosed with HIV at higher CD4 counts and lower viral loads than their older counterparts. LTFU and treatment interruption were more common highlighting the need for extra efforts directed towards retention in care and education regarding the risks of treatment interruptions.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Recuento de Linfocito CD4/métodos , Infecciones por VIH , VIH/aislamiento & purificación , Carga Viral/métodos , Adolescente , Adulto , Australia/epidemiología , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Masculino , Evaluación de Necesidades , Educación del Paciente como Asunto
17.
Lancet HIV ; 5(8): e438-e447, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-30025681

RESUMEN

BACKGROUND: Evidence on viral load and HIV transmission risk in HIV-serodiscordant male homosexual couples is limited to one published study. We calculated transmission rates in couples reporting condomless anal intercourse (CLAI), when HIV-positive partners were virally suppressed, and daily pre-exposure prophylaxis (PrEP) was not used by HIV-negative partners. METHODS: In the Opposites Attract observational cohort study, serodiscordant male homosexual couples were recruited from 13 clinics in Australia, one in Brazil, and one in Thailand. At study visits, HIV-negative partners provided information on sexual behaviour and were tested for HIV and sexually transmitted infections; HIV-positive partners had HIV viral load tests, CD4 cell count, and sexually transmitted infection tests done. Viral suppression was defined as less than 200 copies per mL. Linked within-couple HIV transmissions were identified with phylogenetic analysis. Incidence was calculated per couple-year of follow-up, focusing on periods with CLAI, no use of daily PrEP, and viral suppression. One-sided upper 95% CI limits for HIV transmission rates were calculated with exact Poisson methods. FINDINGS: From May 8, 2012, to March 31, 2016, in Australia, and May 7, 2014, to March 31, 2016, in Brazil and Thailand, 358 couples were enrolled. 343 couples had at least one follow-up visit and were followed up for 588·4 couple-years. 258 (75%) of 343 HIV-positive partners had viral loads consistently less than 200 copies per mL and 115 (34%) of 343 HIV-negative partners used daily PrEP during follow-up. 253 (74%) of 343 couples reported within-couple CLAI during follow-up, with a total of 16 800 CLAI acts. Three new HIV infections occurred but none were phylogenetically linked. There were 232·2 couple-years of follow-up and 12 447 CLAI acts in periods when CLAI was reported, HIV-positive partners were virally suppressed, and HIV-negative partners did not use daily PrEP, resulting in an upper CI limit of 1·59 per 100 couple-years of follow-up for transmission rate. INTERPRETATION: HIV treatment as prevention is effective in men who have sex with men. Increasing HIV testing and linking to immediate treatment is an important strategy in HIV prevention in homosexual men. FUNDING: National Health and Medical Research Council; amfAR, The Foundation for AIDS Research; ViiV Healthcare; and Gilead Sciences.


Asunto(s)
Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Carga Viral , Adulto , Fármacos Anti-VIH/uso terapéutico , Australia , Brasil , Recuento de Linfocito CD4 , Condones , VIH/genética , Infecciones por VIH/tratamiento farmacológico , Homosexualidad Masculina , Humanos , Masculino , Persona de Mediana Edad , Filogenia , Profilaxis Pre-Exposición , Estudios Prospectivos , Conducta Sexual , Minorías Sexuales y de Género , Tailandia
18.
Cancer Epidemiol Biomarkers Prev ; 27(7): 768-775, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29700009

RESUMEN

Background: Gay and bisexual men (GBM) are at disproportionately high risk of anal cancer. The precursor lesions, high-grade squamous intraepithelial lesions (HSIL), are very common and it is evident that not all HSIL progresses to cancer. The serologic response to anal human papillomavirus (HPV) in GBM has not been well characterized.Methods: The Study of the Prevention of Anal Cancer is an ongoing cohort study of GBM ages 35 years and older. At six visits over three years, anal samples are collected for cytology, HPV DNA testing, and histology. Baseline serum was tested for HPV L1, E6, and E7 antibodies for 10 HPV types. Seroprevalence and associated predictors were analyzed.Results: A total of 588 of 617 participants were included in this analysis. A total of 436 (74.2%) were seropositive for at least one of the 10 HPV types. Almost half had L1 antibodies to HPV6 (48.5%), over a third to HPV11 (36.4%) and HPV16 (34.5%). HIV-positive men were more likely to be HPV L1 seropositive. HSIL detection was highest among participants who were HPV serology and DNA positive. There was a borderline significant association between presence of HPV16 E6 antibodies and prevalent HSIL (OR = 2.97; 95% confidence interval, 0.92-9.60; P = 0.068).Conclusions: HPV L1 seropositivity was common in this cohort of older GBM. These results suggest that HPV L1 seropositivity, in conjunction with anal HPV DNA detection, predicts concurrent HSIL. The apparent association between HPV16 E6 antibodies and prevalent HSIL is a finding with potential clinical significance that needs further exploration.Impact: HPV seropositivity with concurrent DNA detection predicted anal HSIL detection. Cancer Epidemiol Biomarkers Prev; 27(7); 768-75. ©2018 AACR.


Asunto(s)
Canal Anal/virología , Homosexualidad Masculina/estadística & datos numéricos , Papillomaviridae/patogenicidad , Minorías Sexuales y de Género/estadística & datos numéricos , Lesiones Intraepiteliales Escamosas de Cuello Uterino/diagnóstico , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Seroepidemiológicos , Lesiones Intraepiteliales Escamosas de Cuello Uterino/patología
19.
Sex Health ; 15(1): 79-82, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29021080

RESUMEN

Background A substantial increase in gonorrhoea notifications in New South Wales has been observed in recent years. METHODS: We assessed yield of testing and characteristics of those diagnosed with gonorrhoea from January 2008 to December 2013 at RPA Sexual Health in the inner-west of Sydney. Yield was defined as the proportion of testing occasions which were positive for gonorrhoea. Generalised estimating equations were used to calculate trends in yield over time. RESULTS: During the 6-year study period, 6456 individuals (4308 males, 2124 females, 24 transgender individuals) were tested on 12799 occasions; this included 2441 gay and bisexual men (GBM) who were tested on 6945 occasions. Over the study period there was a significant increase in testing at genital, anorectal and pharyngeal sites (P-trend <0.001 for all). In total, gonorrhoea was detected on 668 testing occasions among 536 individuals (5.2%). Overall, 254/12765 (2.0%) of genital tests, 251/7326 (3.4%) of anorectal tests and 342/8252 (4.1%) of pharyngeal tests were positive. There was a significant increase in overall gonorrhoea yield from 2.2% in 2008 to 7.1% in 2013 (P-trend <0.001). This temporal increase in gonorrhoea yield was observed in heterosexual males (P<0.001), heterosexual females (P-trend=0.008), female sex workers (P-trend=0.006), HIV-positive GBM and HIV-negative GBM (both P<0.001) and at all anatomical sites (P-trend <0.001 for all). CONCLUSIONS: From 2008 to 2013, we observed a greater than threefold increase in yield of gonorrhoea testing disproportionately affecting GBM, although the increase also occurred in other subpopulations and at all anatomic sites. More frequent and comprehensive testing could potentially reduce the high and increasing community prevalence of gonorrhoea.


Asunto(s)
Gonorrea/epidemiología , Neisseria gonorrhoeae/aislamiento & purificación , Conducta Sexual/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adulto , Bisexualidad/estadística & datos numéricos , Femenino , Gonorrea/microbiología , Heterosexualidad/estadística & datos numéricos , Humanos , Masculino , Nueva Gales del Sur/epidemiología , Prevalencia , Factores de Riesgo , Trabajadores Sexuales/estadística & datos numéricos , Adulto Joven
20.
Sex Health ; 15(1): 96-98, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-28927494

RESUMEN

The Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men were updated in 2014. An evaluation study targeting Sydney-based general practitioners was conducted among 85 clinicians. Respondents with knowledge of guideline recommendations were significantly more likely to feel comfortable asking men who have sex with men about their sexual history (98.1% vs 81.3%, P=0.039), and to recommend at least annual testing (94.0% vs 68.8%, P=0.015), 3-month retesting after chlamydia or gonorrhoea treatment (96.2% vs 73.3%, P=0.017) and syphilis testing with routine HIV monitoring bloods (90.2% vs 57.1%, P=0.037). Familiarity with the guidelines was associated with a range of positive outcomes on general practitioners' clinical practice. Novel approaches are required to ensure more widespread distribution of future guidelines.


Asunto(s)
Actitud del Personal de Salud , Médicos Generales/organización & administración , Adhesión a Directriz , Infecciones por VIH/prevención & control , Adulto , Australia , Infecciones por VIH/diagnóstico , Homosexualidad Masculina , Humanos , Masculino , Tamizaje Masivo/métodos , Conducta Sexual/estadística & datos numéricos , Parejas Sexuales , Enfermedades de Transmisión Sexual/prevención & control
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