Contraceptive use is important for women of reproductive age living with HIV both to plan and optimise safety of pregnancies. Clinicians play a vital role in counselling patients about contraceptive options and safe sexual activity. Discussion regarding relationship status, sexual activity and contraception should occur routinely and regularly. This study aims to determine the frequency and predictors of such discussions and contraceptive use.
A retrospective clinical audit of all reproductive-aged women (n = 128) treated for HIV between 2010 and 2012 at two metropolitan hospitals in Melbourne, Australia. Medical records were reviewed for documentation of discussions regarding sexual activity, relationship status, and contraception. Poisson regression modelling was performed to determine predictors. Variables included were age of patient, gender of doctor, previous pregnancy, country of birth and antiretroviral regimen.
Sexual activity status was documented for 53% (n=69) of women and contraception use was recorded for 28% (n=36) of women. 27% (n=34) of women used contraception, 10% (n=13) did not use contraception and contraceptive use was not recorded in 63% (n=81). When a discussion regarding sexual activity was documented, women were 3.63 times more likely to also have documented a discussion about contraception (p=0.01), with a trend towards this being less likely if the woman was on NNRTIs compared with protease inhibitors. Excluding women who were pregnant, women who used contraception were 2.0 times more likely to have had a discussion about contraception (p=0.03).
Discussion regarding sexual activity, relationship status and contraception between HIV positive women of reproductive age and their clinicians remains inconsistent and suboptimal. Women who had a documented discussion regarding contraception were more likely to actually use contraception, which may suggest benefit in clinician-led discussions. Mechanisms to facilitate regular discussion about sexual activity and contraception between clinicians and women with HIV, warrants further investigation.
The majority of HIV diagnoses including delayed diagnoses in Australia occur among men who report homosexual contact – hereafter called gay and bisexual men (GBM). Delayed diagnosis is strongly associated with increased HIV-related mortality and morbidity. People who are unaware of their HIV-positive status may also be unwittingly transmitting HIV. We assessed trends in delayed HIV diagnoses among GBM in Australia.
HIV-associated leishmaniasis, endemic in the Mediterranean basin is a growing problem in India, Brazil and East Africa. Despite surviving for than 20 years, the clinical course of our visceral-leishmania (VL)-HIV co-infected patient illustrates several management challenges including diagnosis, speciation and drug resistance; monitoring burden of disease; access to and use of VL-treatments; end-organ toxicity and the combined immunosuppressive effects of HIV-VL.
Adherence to combination antiretroviral therapy (cART ) plays an important role on treatment outcomes. The TREAT Asia Studies to Evaluate Resistance – Monitoring Cohort Study (TASER-M) collects patients’ adherence based on a Visual Analogue Scale. The aim of this analysis was to assess the rates of, and factors associated with, suboptimal adherence in the first 24 months of initial cART in Asian patients.
REACH was a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership.
HIV disease is associated with chronic inflammation and activation of the innate immune system. This state, as measured using plasma markers of inflammation, persists following suppression of HIV viremia using antiretroviral therapy, and may increase risk of non-AIDS co-morbidities. The causes of innate immune activation in the setting of virological suppression are unclear. Natural killer (NK) cells are innate immune cells that kill virus-infected and transformed cells without prior sensitization. We have shown that NK cells are activated both phenotypically (elevated expression of HLA-DR) and functionally (increased spontaneous degranulation measured by CD107a surface expression) in virologically suppressed (VS) HIV+ individuals. NK cells also lose expression of CD16, the receptor which mediates antibody-dependent cellular cytotoxicity.
Regular HIV testing is recommended in men who take sexual risks. We assessed the relationship between perceived barriers to HIV testing, and frequency of testing among men who engaged in unprotected anal intercourse with casual partners (UAIC), to inform HIV testing strategies.
Gay men remain the primary population affected by HIV in Australia. While recent attention has been focused on increasing HIV testing and the use of antiretroviral-based prevention to reduce infections, it is equally important to sustain safe sex and other risk reduction practices. Increases in unprotected anal intercourse (UAI), for example, may counteract any beneficial changes in testing and treatment.