RESUMO
OBJECTIVES: Disruption to sexual health services during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; coronavirus disease 2019 [COVID-19]) pandemic may have adversely affected the provision of HIV post-exposure prophylaxis (PEP), possibly leading to increased HIV transmission. Globally, services have reported a reduction in the number of PEP prescriptions dispensed during lockdowns, although it is unclear why. Our primary objective was to describe the temporal change in weekly HIV PEP dispensed at six English sexual health clinics in 2020. METHODS: We performed a cross-sectional review of PEP prescriptions from six English centres during 2020. RESULTS: During 2020, 2884 PEP prescriptions were dispensed across the six centres studied, a fall of 34.5% from the 4403 PEP prescriptions in 2019. Before the COVID-related lockdown in 2020, the PEP dispensed was stable at 82.5 per week. Following the first lockdown, this fell to a nadir of 13 in week 14 (Figure 1). Prescriptions rose to a peak of 79 in week 37 and then declined to 32 prescriptions in the last week of 2020. There was no difference in the following characteristics of PEP recipients before and during the first lockdown: age, ethnicity, country of birth or the service the recipient attended. CONCLUSION: Whatever the reason for the fall in PEP seen in England over 2020, it is essential that HIV testing and access to HIV prevention is maintained for those in need.
Assuntos
COVID-19 , Infecções por HIV , Saúde Sexual , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Estudos Transversais , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Humanos , Profilaxia Pós-Exposição , SARS-CoV-2RESUMO
Background: To report on the implementation and outcomes of a virtual ward established for the management of mpox during the 2022 outbreak, we conducted a 2-center, observational, cross-sectional study over a 3-month period. Methods: All patients aged ≥17 years with laboratory polymerase chain reaction-confirmed monkeypox virus managed between 14 May and 15 August 2022, at the Hospital for Tropical Diseases at University College London Hospitals National Health Service (NHS) Foundation Trust and sexual health services at Central North and West London NHS Foundation Trust, were included. Main outcomes included the proportion of patients managed exclusively on the virtual ward, proportion of patients requiring inpatient admission, proportion of patients with human immunodeficiency virus, and duration of lesion reepithelialization. Results: Among confirmed cases (N = 221), 86% (191/221) were managed exclusively on the virtual ward, while 14% (30/221) required admission. Treatment for concomitant sexually transmitted infections was provided to 25% (55/221) of patients, antibiotics for other infective complications to 16% (35/221), and symptomatic relief to 27% (60/221). The median time from onset to complete lesion reepithelialization and de-isolation was 18 days (range, 8-56 days). Eleven percent (24/221) of individuals disengaged from services within 4 days of testing. Conclusions: The virtual ward model facilitated safe and holistic outpatient management of mpox, while minimizing admissions. This approach could serve as a model for future outbreak responses.
RESUMO
The incidence of congenital syphilis remains low in the UK, but the morbidity and mortality to babies born to women who are untreated for the condition make testing for the disease antenatally one of the most cost-effective screening programmes. Women attending North Middlesex Hospital, UK with a positive syphilis test at their antenatal booking visit are referred to St Ann's Sexual Health Clinic, London, for management and contact tracing. We were concerned that our initial audit revealed that a large proportion of women referred to our service never attended and recorded partner notification was poor. Following the implementation of recommendations, specifically the introduction of an electronic referral system, re-audit showed an improvement in attendance, contact tracing, documentation and communication.
Assuntos
Busca de Comunicante , Período Pós-Parto , Cuidado Pré-Natal , Encaminhamento e Consulta/organização & administração , Sífilis Congênita/diagnóstico , Sífilis/diagnóstico , Sífilis/terapia , Adolescente , Adulto , Registros Eletrônicos de Saúde , Feminino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/diagnóstico , Diagnóstico Pré-Natal , Sífilis/sangue , Sífilis/tratamento farmacológico , Sorodiagnóstico da Sífilis , Sífilis Congênita/sangue , Fatores de TempoRESUMO
We report on an HIV-positive individual who developed a biochemical hepatitis likely to be due to excessive intake of dietary supplements, highlighting the need for clinicians to be vigilant over their use.
Assuntos
Doença Hepática Induzida por Substâncias e Drogas/etiologia , Suplementos Nutricionais/efeitos adversos , Infecções por HIV/complicações , Adulto , Terapias Complementares , Infecções por HIV/tratamento farmacológico , Humanos , MasculinoRESUMO
Atypical presentations of genital herpes simplex virus have been described in HIV. We report two cases with hypertrophic presentations which were effectively treated with imiquimod, one of which is the first reported case occurring in a patient with HIV-2.
Assuntos
Aciclovir/uso terapêutico , Aminoquinolinas/uso terapêutico , Infecções por HIV/complicações , Herpes Genital/tratamento farmacológico , Úlcera/etiologia , Adulto , Antivirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , HIV-1 , HIV-2 , Herpes Genital/complicações , Herpes Genital/diagnóstico , Herpes Genital/virologia , Herpes Simples/complicações , Herpes Simples/diagnóstico , Herpes Simples/virologia , Humanos , Imiquimode , Masculino , Reação em Cadeia da Polimerase , Simplexvirus , Resultado do Tratamento , Úlcera/complicações , Úlcera/diagnósticoRESUMO
We have investigated the correlation of symptoms, signs and microscopy on the detection of Chlamydia trachomatis infection in men attending our clinic. One hundred and eleven men diagnosed with chlamydia over an 11-month period in our clinic were reviewed. Of these, 70 (63%) were symptomatic and 41 (37%) were asymptomatic. 84% (59/70) of symptomatic and 51% (21/41) of asymptomatic patients met the UK clinical criteria for diagnosis of non-gonococcal urethritis (NGU) and received treatment appropriate for chlamydia and NGU at their initial clinic visit. Our findings show that 19% (21/111) of men with Chlamydia trachomatis infection would leave the clinic untreated if a urethral smear preparation was not performed on those who were clinically asymptomatic at presentation. We feel that this is a sufficient argument to warrant continuing the current practice of testing asymptomatic men attending GUM clinics for NGU.
Assuntos
Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis/isolamento & purificação , Uretrite/diagnóstico , Adolescente , Adulto , Humanos , Masculino , Microscopia , Pessoa de Meia-Idade , Estudos Retrospectivos , Uretrite/microbiologiaRESUMO
The rapid increase in the worldwide prevalence of HIV infection and sexually transmitted diseases (STDs) has prompted research into the effect of STDs on HIV transmission as well as that of STD treatment interventions on HIV incidence. There is conclusive evidence that STDs act as co-factors for HIV transmission but STD treatment intervention studies have demonstrated contradictory results. Current evidence on the effect of STDs on HIV transmission and community-based randomised controlled trials of STD interventions in Uganda and Tanzania is discussed. Further prospective, randomised, community-based STD intervention studies focusing on the treatment of bacterial STDs and herpes simplex virus (HSV) infection are urgently needed in order to clarify the current uncertainty.
Assuntos
Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Infecções por HIV/complicações , Infecções por HIV/transmissão , HIV/crescimento & desenvolvimento , Herpes Simples/complicações , Sífilis/complicações , Adolescente , Adulto , Estudos de Coortes , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Infecções por HIV/epidemiologia , Herpes Simples/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Sífilis/tratamento farmacológico , Tanzânia/epidemiologia , Uganda/epidemiologiaAssuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Serviço Hospitalar de Emergência , Acessibilidade aos Serviços de Saúde , Listas de Espera , Doenças Urogenitais Femininas , Humanos , Doenças Urogenitais Masculinas , Infecções Sexualmente Transmissíveis/diagnóstico , Reino UnidoRESUMO
OBJECTIVE: To evaluate treatment outcome of acute hepatitis C virus (HCV) in HIV-positive individuals. DESIGN: Open-label, prospective study conducted in London, January 1997-December 2003. METHODS: Patients in whom acute HCV infection had been diagnosed had sequential HCV RNA levels measured at 0, 4, 12, 24, 32, and 48 weeks. If HCV RNA positive at 12 weeks, patients were offered pegylated interferon alpha-2b 1.5 microg/kg/wk and ribavirin 800-1200 mg/d for 24 weeks. Patients with increasing HCV RNA titers were offered treatment earlier. RESULTS: Fifty male homosexuals with a mean age 37 years were identified: 44 from abnormal liver function test results, 4 from sexual contact with an HCV-positive partner, and 2 at HIV seroconversion. Overall, 12 individuals became HCV RNA negative spontaneously. This was significantly associated with high baseline median CD4(+) count (P = 0.029), CD4(+) count >500 cells/mm(3) (P = 0.017), and lower HCV RNA titers (P = 0.017). Only 27 patients accepted treatment, 16 (59%) of whom reached sustained virologic response. This was associated with higher peak mean alanine aminotransferase (P < 0.001) and higher baseline CD4% (P = 0.041). CONCLUSIONS: Sustained virologic response rates in HIV-positive patients treated for acute HCV infection are lower than in HIV-negative subjects. Because a high percentage of individuals seroconvert spontaneously, treatment should be delayed until after 12 weeks.
Assuntos
Antivirais/uso terapêutico , Transmissão de Doença Infecciosa , Soropositividade para HIV/complicações , Hepatite C , Interferon-alfa/uso terapêutico , Ribavirina/uso terapêutico , Doença Aguda , Adulto , Quimioterapia Combinada , Hepacivirus/genética , Hepacivirus/isolamento & purificação , Hepatite C/tratamento farmacológico , Hepatite C/etiologia , Hepatite C/transmissão , Homossexualidade Masculina , Humanos , Interferon alfa-2 , Londres , Masculino , Polietilenoglicóis , Estudos Prospectivos , RNA Viral/análise , Proteínas Recombinantes , Fatores de Risco , Resultado do Tratamento , Carga ViralRESUMO
CASE REPORT: an 83-year-old heterosexual man with malaise tested positive for HIV infection antibodies and has responded well to triple antiretroviral therapy. DISCUSSION: HIV should not be discounted on the basis of age when an elderly patient presents for the investigation of illness.