In contrast to co-morbidity, multimorbidity among people living with HIV has not been well studied. Multimorbidity is the co-occurrence of more than one chronic health condition in addition to HIV. Higher multimorbidity increases mortality, complexity of care and health care costs while decreasing quality of life. Our aim was to describe the prevalence of and factors associated with multimorbidity among HIV positive patients attending a regional sexual health service.
We conducted a record review of all HIV positive patients attending a regional sexual health service between 1/7/2011 and 30/6/2012. Sociodemographic, general health and HIV related data were collected. Two medical officers reviewed records for chronic health conditions and to rate multimorbidity using the Cumulative Illness Rating Scale (CIRS). We used univariate and multivariate linear regression analyses to determine factors associated with higher CIRS score.
189 individuals were included in the study, the mean age was 51.8 yrs and 92.6% were men. One quarter (25.4%) had ever been diagnosed with AIDS and almost all (94.2%) were prescribed antiretrovirals. Multimorbidity was extremely common with 54.5% of individuals having 2 or more chronic health conditions in addition to HIV, the most common being a mental health diagnosis, followed by vascular disease. In multivariate analysis, older age, having ever been diagnosed with AIDS and being on ARV regimen other than 2 nucleosides and NNRTI or PI were associated with higher CIRS score. Current CD4 count, current viral load and body mass index were not associated with multimorbidity.
This study highlights high levels of multimorbidity among HIV positive patients. To our knowledge it is the only study looking at associations with multimorbidity in the Australian setting and it identifies 2 important factors, age and ever having AIDS. Care models for HIV positive patients should include assessing and managing multimorbidity particularly in older people and those that have ever been diagnosed with AIDS.
Background: STI prevalence is changing. With society aging, life expectancy increasing and changes in sexual practices, STIs in senior citizens are of interest from economic, health related and social burden perspectives. Few studies on STIs in older men greater than 60 years of age exist, hence, a need to obtain further information about this subpopulation.
Conducting clinical audits in the context of continuous quality improvement (CQI) programs in Aboriginal Community Controlled Health Services (ACCHS) has provided valuable information regarding what factors facilitate or create challenges to improving outcomes in sexual health service delivery.
Homosexual men are at increased risk of anal cancer. Screening and treatment of the precursor, HSIL, has been advocated by some, but screening is not recommended in widely-accepted guidelines. We aimed to describe the prevalence, incidence, and clearance rates of anal HSIL, and association with human papillomavirus (HPV) status, in a community-recruited cohort of homosexual men.
Since 2009, the Victorian syphilis enhanced surveillance system has been collecting HIV status and syphilis re-infection status for infectious syphilis cases. Baseline data from 2009 showed that 31% of the infectious syphilis cases were HIV positive and 18% reported were re-infections. This suggested that syphilis transmission among a pool of HIV positive MSM was making a considerable contribution to the syphilis epidemic in Victoria. We analysed the data from 2009 to 2012 to determine whether this pattern of transmission is continuing. Notification data for infectious syphilis between 2009 and 2012 were reviewed by HIV infection status, syphilis re-infection status and risk factor exposures.
HIV positive gay men have high rates of cigarette smoking. The risks of smoking in addition to the elevated risk of cardiovascular disease and some malignancies in people with HIV means smoking cessation interventions should be prioritised.
We investigated the association between chlamydia detection and stage in the menstrual cycle to investigate whether chlamydia detection was higher at different stages of the cycle. Electronic medical records for women attending Melbourne Sexual Health Centre March 2011 - 31st December 2012, who were tested for chlamydia by nucleic acid amplification of high vaginal, cervical, or urinary samples, and who recorded a date of last normal menstrual period (LNMP) between 0-28 days were included in the analysis. Logistic regression was used to calculate OR (95%CI) for the association of chlamydia with menstrual cycle adjusted by demographics and behavioural variables.