Objectives In this prospective study we aimed to determine the distribution of genotypes by multilocus variable number tandem repeat (VNTR) analysis plus analysis of the ompA gene (MLVAompA) of rectal Chlamydia trachomatis (CT) among MSM attending Brighton GUM Clinic and to examine any correlations with clinical variables including HIV status, and to isolate rectal CT cultures maximising the possibility of obtaining complete genotyping data.Methods Samples were assigned genotypes by PCR and sequencing of the markers of the MLVA-ompA genotyping system. Rectal CT was isolated in cell culture using McCoy cells. Data regarding demographics, HIV status, rectal symptoms, past history of STIs including CT were collected.Results 1809 MSM attending the clinic between October 2011 and January 2013 took part in the study, 112 (6.2%) of whom had rectal samples which tested positive for CT. 85/112 (75.9%) CT positive rectal samples were assigned 66 different genotypes. Two distinct genotype sub-clusters were identified: Sub-cluster 1 consisted of more HIV-negative men than sub-cluster 2 (p=0.025), and the MLVA-ompA genotypes in these sub-clusters reflected this. Isolates were successfully cultured from 37 of the 112 specimens, from which 27 otherwise unobtainable (from direct PCR) MLVA-ompA genotypes were gained.
ConclusionsThe most prevalent genotypes were G, E and D representing some overlap with the heterosexual distribution in UK. Sub-cluster 1 consisted of more "heterosexual genotypes" and significantly more HIV-negative men than sub-cluster 2, associated with "MSM genotypes". There was a higher diversity of CT strains among MSM in Brighton than observed in other cities.
Introduction. There are few data regarding the tolerability, safety, or efficacy of antenatal atazanavir. We report our clinical experience of atazanavir use in pregnancy. Methods. A retrospective medical records review of atazanavir-exposed pregnancies in 12 London centres between 2004 and 2010. Results. There were 145 pregnancies in 135 women: 89 conceived whilst taking atazanavir-based combination antiretroviral therapy (cART), “preconception” atazanavir exposure; 27 started atazanavir-based cART as “first-line” during the pregnancy; and 29 “switched” to an atazanavir-based regimen from another cART regimen during pregnancy. Gastrointestinal intolerance requiring atazanavir cessation occurred in five pregnancies. Self-limiting, new-onset transaminitis was most common in first-line use, occurring in 11.0%. Atazanavir was commenced in five switch pregnancies in the presence of transaminitis, two of which discontinued atazanavir with persistent transaminitis. HIV-VL < 50 copies/mL was achieved in 89.3% preconception, 56.5% first-line, and 72.0% switch exposures. Singleton preterm delivery (<37 weeks) occurred in 11.7% preconception, 9.1% first-line, and 7.7% switch exposures. Four infants required phototherapy. There was one mother-to-child transmission in a poorly adherent woman. Conclusions. These data suggest that atazanavir is well tolerated and can be safely prescribed as a component of combination antiretroviral therapy in pregnancy.
We report here the first two cases of hepatobiliary pathology in HIV-positive men following recreational use of ketamine: >1 g/day over a 12-month period while on ritonavir-based antiretroviral therapy. Presentation in each case was acute with nausea, vomiting and epigastric pain. Alanine aminotransferase was raised at 3.2× and 10.1 × upper limit of normal and alkaline phosphatase was raised at 1.7× and 2.5 × ULN for cases 1 and 2, respectively. Magnetic resonance cholangiopancreatography showed dilatation of the common bile duct; case 1, 18 mm and case 2, 14 mm with no ductal obstruction on endoscopic retrograde cholangiopancreatography. The symptoms resolved, common bile duct dilatation and liver function improved on discontinuation of ketamine use. Time to development of symptoms is shorter than reported in HIV-negative cases (12 months vs. 4 years) which may be explained by an interaction between ketamine and ritonavir.
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