Hepatitis B and hepatitis C testing outcomes among service users of Sexual Health London: an online sexually transmitted infection testing service for London residents.

OBJECTIVES: The UK signed up to the 2016 global health strategy to eliminate viral hepatitis as a public health problem. Effective monitoring of hepatitis testing outcomes is required to track progress against targets. National reporting does not include hepatitis B and hepatitis C infections (HBV/HCV) detected by online sexually transmitted infection (STI) testing services (e-services). We identify HBV/HCV infection rates among individuals using Sexual Health London (SHL), a large e-service. METHODS: SHL e-records of individuals receiving reactive HBsAg and/or HepCAb screening results between 1 January 2021 and 1 January 2022 were reviewed. Only at-risk groups are offered HBV/HCV testing, with risks captured via an online triage/consultation. Roche Cobas e801 HBV/HCV screening assay uses a cut-off index of reactivity (COI) to categorise results: low reactive (COI >1-9) and reactive (COI ≥10). SHL refers individuals with any reactive result for confirmatory testing (CT) at a sexual health clinic that provides hepatitis outpatient management. Clinic staff performing the CT access the shared SHL e-record and electronically take over the patient's care. RESULTS: 67, 718 HBV and 61 064 HCV tests were performed, representing 16% of all kit returns. HBV reactivity was 1.4% (922/67 718): 474 low-reactive, 302 reactive and 146 unconfirmed-reactive. HCV reactivity was 0.3% (163/61 064): 53 low-reactive, 99 reactive and 11 unconfirmed-reactive.Among individuals with reactive (COI ≥10) screening HBV results, 85% results confirmed, 12% negative and 3% unknown. For HCV, 79% results confirmed, 13% negative and 8% unknown. 57 out of 57 new HBV/HCV infections were electronically transferred. HBV prevalence was 299/67 718 (0.4%). The rate of previously undiagnosed cases detected was 40 out of 67 338 (0.06%) for HBV and 17 out of 61 016 (0.03%) for HCV. CONCLUSIONS: 16% of SHL service users received targeted testing for hepatitis in 2021. Testing volumes significantly exceeded and new HBV/HCV diagnosis rates were similar to those reported by sentinel laboratory surveillance. 100% new infections transitioned to care, demonstrating effective integration between online and local sexual health services.

Retrospective testing for mpox virus in routine STI screens from men who have sex with men in England, August-October 2022.

OBJECTIVES: A global outbreak of mpox (monkeypox) has been ongoing since 2022, with most cases in the UK detected in gay, bisexual and other men who have sex with men (GBMSM). Asymptomatic and pauci-symptomatic mpox infection has been reported outside of the UK. We aimed to investigate whether mpox could be detected in specimens from GBMSM in England who were attending sexual health services (SHSs) for asymptomatic sexually transmitted infection screening. METHODS: Anonymised, residual clinical specimens from GBMSM undertaking routine asymptomatic screening for gonorrhoea (Neisseria gonorrhoeae (NG)) and chlamydia (Chlamydia trachomatis (CT)) infection were tested for the presence of mpox virus. Specimens were collected between 1 August and 7 October 2022 from three SHSs in high-mpox incidence areas in England. Testing was performed using a dual-clade, mpox virus-specific real-time PCR. RESULTS: During the collection period, 2927 clinical specimens (951 pharyngeal swabs, 1022 urine specimens and 954 rectal swabs) were obtained from 1159 GBMSM. Mpox virus was detected in four specimens from two participants who attended the same SHS at different times (the first during the week 8-12 of August, the second during the week 19-23 of September). One participant was positive in the urine specimen only, while the other tested positive at all three sites. CONCLUSIONS: A very low prevalence (2 of 1159, 0.17%) of mpox infection was detected in GBMSM attending SHS in England for asymptomatic NG/CT screening, suggesting that undetected infection in this population was unlikely to be a main driver of transmission. Confirmed mpox cases in the UK declined from over 1100 per month in June and July to 764 cumulatively during the collection period. These data give reassurance that the observed reduction in cases during the collection period was not due to undetected infection or changes in presentation among SHS attendees. Currently, there is insufficient evidence to support routine testing of asymptomatic GBMSM for mpox infection in England.

Serum hypophosphatemia in tenofovir disoproxil fumarate recipients is multifactorial in origin, questioning the utility of its monitoring in clinical practice.

Tenofovir disoproxil fumarate (TDF) has been anecdotally associated with isolated hypophosphatemia (HP) as well as proximal tubular toxicity and renal dysfunction in which HP has consistently been a feature. Consequently, routine phosphate measurements in TDF recipients have been recommended. We identified and compared the frequency of HP in TDF recipients with that in non-TDF recipients; assessed the reproducibility of HP; identified the incidence of renal dysfunction in hypophosphatemic patients; and evaluated associations between HP and host, HIV infection, or treatment factors. This prospective observational study measured serum phosphate, urea, and creatinine in HIV-positive individuals among the following treatment groups: TDF-containing highly active antiretroviral therapy (HAART, group A), TDF-sparing HAART (group B), HAART naive (group C), and off HAART but treatment experienced (group D). Phosphate measurements were obtained in 252 patients. Seventy-two percent of patients prescribed TDF received a phosphate measurement. The frequency of HP in groups A, B, C, and D was 31%, 22%, 10%, and 14%, respectively. Seventy-eight percent of phosphate measurements were reproducible. Kaletra (P = 0.016) administration and duration of antiretroviral therapy (P = 0.023) were independently associated with HP, but elevated creatinine and urea or use of TDF was not. The etiology of HP seems to be multifactorial and unrelated to TDF or renal dysfunction. This questions the utility of routine phosphate testing, in isolation, in TDF recipients.