Background New late HIV diagnosis (CD4 count <350cells/mm3) are higher in North West England compared to the UK average. A Greater Manchester-wide audit into individuals diagnosed with late or very late HIV was conducted in 2016 and re-audited in 2019. Our aim was to gain intelligence into key demographics of late diagnosed individuals across Greater Manchester, review opportunities for earlier diagnosis and determine if key recommendations from the 2016 audit were followed. Methods Individuals were identified from locally kept data or HIV and AIDS Reporting System (HARS) data. A retrospective case note review was performed for each patient using data from local notes, General Practice summary of care records and relevant clinical letters. Data was collected for 2019 and compared to 2016 results. Results In 2016, nine departments contributed data and 104 individuals were identified as having been diagnosed late. In 2019, seven departments contributed data and 65 individuals were identified as having been diagnosed late. In both years, a greater proportion of males diagnosed late were White British and for females Black African. A greater proportion of late diagnosis occurred in men who have sex with men (MSM) and in heterosexual females. In 2019, a greater proportion of patients had an AIDS-defining illness at time of diagnosis. Whilst in 2016, most patients were asymptomatic. Over one third of patients had a clinical indicator disease in their past medical history, which is an increase in proportion from 2016. The proportion of cases where clinicians felt that there had been probable missed opportunities for earlier diagnosis also increased in 2019. Conclusions There are continued missed opportunities for earlier diagnosis. We recommend targeted interventions for groups at higher risk of late presentation, education in primary/secondary care regarding clinical indicator conditions, a formal review process for all late diagnosed cases, communication with primary/secondary care if missed opportunities are identified and broader HIV testing especially in high prevalence areas.
Background/introduction Female sex workers (FSWs) are often considered as a vector for HIV and other sexually transmitted infections entering the general communities. Aim(s)/objectives This study investigated the effectiveness of a resilience-promoting intervention that targets at psychological well-being to facilitate adaptation and safe sexual practices among FSWs which could be an innovative strategy in controlling the spread of these infections. Methods Using resilience framework, this intervention consisted of six-weekly sessions focused on awareness, expression and management of emotions, identifying roles and personal strengths, and effective problem-solving skills. The primary outcome of resilience and reduction of sexual risk behaviour were assessed at baseline, post-intervention and 3-month follow-ups through self-administered questionnaires. Difference of the differences between the two groups and intention-to-treat analysis were adopted in the analysis. Results 127 FSWs were recruited and randomly assigned to the intervention or usual care (control) groups in a multi-centred randomised controlled trial. There were significant differences on the score on resilience, self-esteem and general mental health status between the two groups at post-intervention and 3-month follow-ups. The rate of condom use improved with time but significant difference between groups was only observed at 3-month follow-ups. Regression models showed that, after controlling for marital status and family size, intervention group assignment (OR = 2.95, 95% CI: 1.19-7.35) and self-efficacy (t = 2.48, p < 0.05) was significantly associated with improved resilience scores. Discussion/conclusion The results suggest that the programme was effective in promoting resilience, self-esteem and the mental health status but with less obvious effect on sexual health among FSWs in Hong Kong. Background/introduction BHIVA/BASHH have published guidelines with auditable outcomes for initiation of PEPSE and follow up. Some UK centres have, however, reported missing these targets. Aim(s)/objectives To explore the patient journey from initiation of PEP to completion of follow-up and to identify areas for improvement within our service in supporting patients to take PEP. Methods Each patient commencing or continuing PEP at our clinic between December 2013 and June 2014 was asked to take part in a survey regarding their experience with PEP. The survey included questions about adherence (motivations and barriers), clinic experience and follow up. Results 31 patients took PEP during the study period, 26 patients participated in the study. Reasons for PEP included occupational exposure (n = 6), sexual assault (n = 9), and consensual sex (n = 11). 4 patients (15.3%) reported not completing the 28 day course of PEP. 9 (34.6%) and 8 patients (30.7%) reported late and missing doses respectively. 88.4% of patients experienced side effects from medication, only 43% of patients sought help for this. The most frequent motivation for completing PEP was "fear of H...
Cerebellar dysfunction is a well-recognised but an infrequent complication of human immunodeficiency virus (HIV) infection. We present the case of a 44-year-old man living with HIV who presented with subacute cerebellar dysfunction and in whom a thorough diagnostic work-up did not identify any opportunistic infections. Cerebrospinal fluid (CSF) analysis showed a high HIV viral load of 1160 copies/ml and magnetic resonance imaging (MRI) showed multiple high signal abnormalities, disproportionately affecting the posterior fossa especially the cerebellum. This is a rare case of HIV encephalopathy presenting with an isolated cerebellar syndrome and highlights the importance of considering HIV as the aetiology in this clinical scenario.
7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK
BackgroundThis audit looked at the use of chest-x-rays (CXRs) in newly diagnosed HIV patients at an inner-city GUM clinic. The Departmental guidelines recommended that all newly diagnosed HIV patients had a baseline CXR. The 2011 British HIV Association guidelines (which were under consultation at the time of the audit) proposed that CXRs should only be done in patients with current or previous chest disease, high-risk for TB or in intravenous drug users.AimsThe aims of this audit were twofold, first to confirm whether all newly diagnosed patients had a CXR as per departmental guidelines, and second to review the results of the CXR in order to see whether, if any, factors predicted abnormal results.MethodsThe audit considered all newly diagnosed HIV patients from 1 April 2009–31 March 2011. Data including demographic details, past medical history, health on diagnosis and details of the CXR (if performed) were collected from electronic HIV summaries and radiology records. Statistical analysis was performed using SPSS.ResultsA total of 196 patients were identified, 69% of whom had had a CXR. In those who had a CXR and in whom results were available (n=132), 92% had a normal CXR and 8% abnormal. Significant predictors of abnormal CXRs included chest symptoms at diagnosis (p<0.001) and a CD4 count <200 (p=0.001). There was no significant link with the patients' country of origin but there was a pattern of association which was clinically relevant.ConclusionsIn this audit all CXRs in asymptomatic patients newly diagnosed with HIV were normal. No latent chest disease was identified as a result of routine asymptomatic screening with CXRs and the practice is not justified. Following this audit clinic guidelines have been appropriately amended in keeping with current British HIV Association guidelines with the additional criteria for performing CXRs in patients presenting with CD4 <200.
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