164 research outputs found
Public and Healthcare Practitioner attitudes towards HIV testing:A review of the evidence in the UK
No full textAims: To explore attitudes towards HIV testing in the United Kingdom (UK) from the public and healthcare practitioners (HCP) to more fully understand the barriers and motivators towards testing.Methodology: Electronic databases Pubmed, Web of Science, OVID Medline and Google were searched. We included studies conducted in the UK that had explored public and HCP attitudes towards HIV testing, published in the combination antiretroviral therapy era (1996-2014). We excluded studies relating to HIV testing or screening of pregnant women.Results: In a total of 64 studies identified, 41 and 23 were on positive and negative attitudes towards HIV testing of the public and HCP, respectively. Common barriers reported by the public were stigma, fear, denial, and low perception of risk. Common barriers reported by HCP were lack of confidence or anxiety around offering a test, privacy and confidentiality, and insufficient knowledge/training in HIV. Public motivators towards testing were: HCP offering/recommending a test, universal testing at practice registration, outreach rapid point-of-care (POC) testing offered as part of a check-up, availability of home testing/sampling, and informing patients about HIV and the benefit of receiving treatment.Conclusions: Recommendations to overcome barriers include making HIV testing routine, easier and more accessible. Outreach POC testing, home testing and sampling offer motivators to testing such as ease of access, privacy and confidentiality. A proactive offer of an HIV test by the HCP is an important factor which could help increase testing rates. This could be facilitated by further education and training of HCP in General Practice
Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy.
No full textThe objective of this study is to estimate life expectancies of HIV-positive patients conditional on response to antiretroviral therapy (ART)
Use and Effectiveness of HIV Indicator Conditions in Guiding HIV testing:A Review of the Evidence
No full textAims: To identify the most commonly reported HIV indicator conditions (HIV ICs) found in or associated with HIV infection and to review interventions incorporating HIV ICs to aid or guide offering of an HIV test and discuss their effectiveness in increasing HIV testing rates and diagnosing new cases of HIV-infection.Methodology: The following electronic databases were searched; OVID Medline, Google, Web of Science and PubMed. We included studies conducted in high income countries within the adult population (>18yrs of age) that were published in the era of combination antiretroviral therapy between 1996 and 2016. We excluded studies relating to HIV testing or screening of pregnant women.Results: We identified 42 studies investigating ICs associated with HIV infection either prior to or after diagnosis within primary, secondary and tertiary care settings. The most common ICs and symptoms associated with HIV infection were; sexually transmitted infections (syphilis, chlamydia, gonorrhoea and condyloma acuminata) and blood borne viruses (Hepatitis C and Hepatitis B), pneumonia, tuberculosis, blood dyscrasia, thrombocytopenia, oral and oesophageal candidiasis, seborrhoeic dermatitis, herpes zoster, Kaposi sarcoma, fever, weight loss, diarrhoea and lymphadenopathy. Twelve intervention studies that used HIV prediction tools and computer prompts based on HIV ICs demonstrated that these are effective in helping healthcare professionals to offer more targeted approaches to HIV testing. Conclusion: Our review may aid policy makers and healthcare professionals in developing strategies to improve and increase HIV testing in individuals that present with defined HIV ICs. ICs have the potential to be used more effectively as triggers for earlier HIV testing and importantly for patients to receive a more timely diagnosis
The effects of age on associations between markers of HIV progression and markers of metabolic function including albumin, haemoglobin and lipid concentrations.
No full textWe investigated whether age modified associations between markers of HIV progression, CD4 T lymphocyte count and HIV RNA viral load (VL), and the following markers of metabolic function: albumin, haemoglobin, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC)
The use of funnel plots with regression as a tool to visually compare HIV treatment outcomes between centres adjusting for patient characteristics and size: A UK Collaborative HIV Cohort study
No full textObjectives A measure used for assessing the effectiveness of HIV care and comparing clinical centres is the proportion of people starting antiretroviral therapy (ART) with viral suppression (VS) after 1 year. We propose a method that adjusts for patients’ demographic characteristics, and visually compares this measure between different sites accounting for centre size.Methods We analysed viral load measurements for UK Collaborative HIV Cohort (UK CHIC) patients starting ART between 2006 and 2013. We used logistic regression to estimate the proportion with VS after 1 year of ART adjusted for patient mix (in terms of age and a combined gender/ethnicity/acquisition mode variable) and calendar year. We compared outcomes between centres using funnel plots which account for centre size. Results The overall proportion of the cohort with VS 1 year after starting ART was 90% and increased from 83% to 93% between 2006 and 2013. VS was lower in younger individuals. White men who have sex with men (MSM) had the highest (94%), and black African (81%) and white (82%) heterosexual women the lowest proportions achieving VS. Comparing the unadjusted funnel plot with the adjusted, there were movements of some centres from outside to inside the 95% contour limits, which was largely explained by the patient mix of these centres. ConclusionsVS 1 year after ART start was associated with demographic characteristics and centre size; therefore, to compare the performances of centres, adjustment for these factors is required. Adjusted funnel plot is an effective tool which accounts for both the demographic characteristics and the centre size. Social factors, rather than treatment decisions within the control of the centres, may drive differences in outcomes. <br/
A family with a novel CTLA4 haploinsufficiency mutation and neurological symptoms
No full textCTLA4 haploinsufficiency is a rare autosomal dominant immune dysregulation disorder first described in 2014 [1, 2]. Patients with this disorder exhibit reduced expression of CTLA4, an inhibitory receptor that is found on activated and regulatory T lymphocytes, with subsequent T cell hyperactivation and lymphoproliferation. Here we report three members of the same family with a novel CTLA4 haploinsufficiency and neurological complications
Switching from boosted PIs to dolutegravir decreases soluble CD14 and adiponectin in high cardiovascular risk people living with HIV
No full textSwitching from boosted PIs to dolutegravir in people living with HIV (PLWH) with high cardiovascular risk improved plasma lipids at 48 weeks in the NEAT022 trial. Whether this strategy may have an impact on cardiovascular biomarkers is unknown
Long-term effects on subclinical cardiovascular disease of switching from boosted protease inhibitors to dolutegravir
No full textBackground In the NEAT022 trial, switching from boosted PIs (PI/r) to dolutegravir in people with HIV (PWH) with high cardiovascular risk decreased plasma lipids, soluble CD14 and adiponectin, and showed consistent favourable, although non-significant, effects on carotid intima-media thickness (CIMT) progression at 48 weeks. We hereby communicate planned final 96 week results on biomarker changes and CIMT progression. Methods PWH on a PI/r-based triple therapy regimen were randomly assigned (1:1) to switch the PI/r component to dolutegravir either immediately (DTG-I group) or after 48 weeks (DTG-D group) and were followed up to 96 weeks. We assessed changes in biomarkers associated with inflammation, endothelial dysfunction, monocyte immune activation, oxidation, insulin resistance, hypercoagulability, heart failure, myocardial injury and glomerular and tubular kidney injury, and right and left CIMT progression at 48 and 96 weeks. Results Of 415 PWH randomized, 287 (69%) and 143 (34%) contributed to the biomarker and CIMT substudies respectively. There were significant 96 week changes in biomarkers associated with inflammation, immune activation, oxidation, insulin resistance and myocardial injury. Most changes were favourable, except for adiponectin reduction, which may suggest higher insulin resistance. We were unable to detect significant changes in the progression of CIMT between arms or within arms at 96 weeks. Discussion After 96 weeks, switching from PI/r to dolutegravir in PWH with high cardiovascular risk led to significant changes in several biomarkers associated with cardiovascular disease. Although most changes were favourable, adiponectin reduction was not. There were non-significant changes in CIMT progression
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