A 34-year-old HIV-positive man presented in clinic with generalised erythroderma, having been lost to follow-up for the previous 3 years. He was CD4 lymphopenic (100×106/L) and was antiretroviral therapy naive. Initial histology from a skin punch biopsy was non-specific and he was treated with topical steroids and emollients for a suspected eczema. However, the erythroderma worsened with development of cervical lymphadenopathy and significant weight loss over a 6-week period. An incisional biopsy from the left tonsil confirmed a diagnosis of diffuse large B-cell lymphoma. The erythroderma was considered to be a paraneoplastic skin phenomenon. The patient received rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine and prednisolone (CHOP) immunochemotherapy with gradual but complete resolution of the erythroderma. Paraneoplastic dermatoses can manifest as first clinical sign of underlying malignancy, heralding a cancer diagnosis. This is particularly important in people living with HIV given the increased incidence of malignancy in this patient group.
The risk of HIV transmission via breastfeeding is well reported. We conducted a national survey in the UK to look at the current knowledge and postpartum practice of HIV physicians caring for HIV-positive pregnant women. In total, 167 questionnaires were distributed, 85 (51%) questionnaires were returned. All the respondents advised their patients against breastfeeding, 17 (23%) respondents routinely prescribed drugs for postpartum lactation suppression and 32 (43%) detailed awareness of interactions between antiretroviral therapy and dopaminergic lactation suppression agents. Thirteen respondents reported awareness of guidance on lactation suppression. The knowledge and use of lactation suppression agents appears to be low. However, its use will not only reduce postnatal mastitis and breast engorgement but will also help women deal with social pressures to breastfeed. Increased use in specific circumstances will improve the postnatal care of HIV-positive pregnant women in the UK.
With the advent of highly active antiretroviral therapy (HAART), the mother-to-child HIV transmission rate in the UK has reduced to less than 2%. A review of delivery outcomes of 106 HIV-positive pregnant women in a tertiary centre between January 2005 and December 2010 was conducted. A total of 20 women had detectable plasma viral load at 36 weeks, or before in the two women who delivered preterm. Various peripartum management measures were undertaken in women with detectable viral load close to delivery, to accelerate reduction in plasma viral load and to reduce the risk of HIV transmission to the fetus. In our review, the overall mother-to-child transmission rate was less than 1% and in women with undetectable viral load at 36 weeks, it was 0% (zero), which signifies the importance of strict virological control and a multidisciplinary approach, which plays an important role in the successful achievement of this.
Background MSM account for an increasing number of new HIV diagnoses in the UK, with 23% having recently acquired infections. This is largely due to high risk sexual behaviour and lower risk perception. To explore this, we evaluated the sexual behaviour of our MSM cohort and correlated this to their perceived risk of HIV acquisition. Methods HIV negative MSM attending a large sexual health centre were invited to complete an anonymous questionnaire. Information regarding demographics, sexual behaviour in terms of partner number, condom use, type of sexual activity, awareness of partner's HIV status etc was collected. A risk score was calculated and then correlated with their perceived risk of HIV. Results We present preliminary data on 64 MSM. 78% of respondents were White British, 63% aged between 16 and 35 years. 52% of MSM had 2-5 partners, 19% 5-10 and 8% over 10 partners. Only 42% of MSM report consistent use of condoms for receptive anal sex. A large proportion reported using alcohol before sex; only 11% reported drug use. 65% reported unprotected anal sex with 0-1 partners and 32% with between 2-5 partners. Only 15% always discussed HIV status before sex, but more (38%) discussed condom use. Perceived risk of HIV: 34% thought it was low, 59% moderate and only 7% perceived themselves at high risk. Actual risk of HIV: According to the weighted scores 56% had low risk, 42% moderate and 2% high risk of HIV acquisition. Correlation: There is concordance between actual and perceived risk in 55% of respondents. Majority who had low risk perceived themselves as having moderate or high risk of acquisition. Conclusion Evaluating MSM at high risk of HIV acquisition will help identify who would benefit most from behavioural intervention. Full report and statistics will be provided for the conference.
DoxyCyCline ProPhylaxis for syPhilis in a Persistently high risk hiv infeCteD PoPulation
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