Recent studies have suggested that higher overall cumulative HIV viraemia exposure measured as viraemia copy years (VCY) is a better predictor of all-cause mortality compared with routine plasma HIV RNA viral load (pVL) and CD4 cell counts. The ability to identify those individuals at risk of higher VCY would be clinically relevant. We sought to assess predictors of VCY in Australian HIV Observational database (AHOD) participants following initiation of ART.
Methods: Analyses were based on patients recruited to AHOD who had received ≥24 weeks of ART. We established VCY, a measurement akin to smoking pack-years, after 1, 3, 5 and 10 years of ART by calculating the area under the pVL time series. We used multivariable generalised estimating equations to determine predictors of VCY. We evaluated model performance by comparing area under the sensitivity/specificity curve, and compared the performance of a baseline predictor model with a time updated predictor model to discriminate patients with high VCY. We defined high VCY as VCY>100,000 copy-years.
Results: Of the 3495 AHOD patients recruited, 2073(60%), 1667(48%), 1267(36%) and 638(18%) were eligible for analysis at 1, 3, 5 and 10 years of ART respectively. Mean (95% confidence interval) VCY at 1, 3, 5, 10 years of ART was 204(182-229), 1862(1622-2138), 5129(4467-6026) and 19953(16596-24547) copy-years respectively. Several factors were associated (significant at α=0.05) with higher VCY. These included: younger age, earlier periods of ART initiation, lower CD4 cell counts, mono/duo ART experience prior to ART initiation, protease inhibitor as initial ART anchor agent, high baseline pVL, increased number of ART modifications and increased total treatment interruption time. Models that included time updated information were better at discriminating persons with higher VCY compared to baseline predictor models.
Conclusion: Our results show one can reasonably identify patients at risk of higher VCY following ART initiation using typical clinical patient characteristics and factors.
The case is of a 30 year-old HIV positive Zimbabwean woman (UK resident) who arrived in Australia in January 2011 on a one-year working visa. She was diagnosed with HIV in 2003 in the UK and commenced on Atripla® in 2005. She was first seen in Adelaide in May 2011, requesting a script for Atripla.®.
Background: Liquid based anal Papanicolaou smears, followed by High Resolution Anoscopy (HRA) guided biopsies are increasingly being advocated to identify areas of High Grade Anal Intraepithelial Neoplasia (HGAIN). We hypothesized that the ability to identify HGAIN would increase with experience of the anoscopist, and that comparison with contemporary Papanicolaou smears might yield insights into technical abilities.
Indigenous Australians experience a greater burden of sexually transmitted infections, however are less likely than the general population to access sexual health services. We examined the effectiveness of an Indigenous cultural appropriateness audit in assessing a sexual health clinic with low rates of Indigenous clients.
Despite the high proportion of young people annually accessing general practices, including Aboriginal Medical Services (AMS), testing for Chlamydia trachomatis remains relatively low in urban areas. A project officer was employed within the Institute of Urban Indigenous Health (IUIH) to serve a mentoring and facilitation role for the SE Queensland network of AMS and their sexual health workers, with a view to improving testing, management and follow-up of chlamydia and other STIs by community controlled medical services.
Monocytes are a heterogeneous cell population having specialised functions and differing phenotype. They are a link between innate immune system and adaptive immune system therefore, to identify if immune activation exists in HIV-1 individuals with controlled virema and recovered CD4 T cell counts, we assessed cell surface monocyte activation markers (MAM) within the monocyte subsets.
Involving consumers in healthcare decisions is important for high quality care. We previously tested a brief, consumer-led intervention consisting of three questions in a trial employing trained, standardized patients. The intervention enhanced discussion of evidence and increased patient involvement. We now report a research translation study which tested implementation with real patients at a reproductive and sexual health clinic.
This presentation, "Responding to the needs of consumers with complex trauma histories a consumer perspective" focuses on the needs of adult survivors of child abuse, highlighting the frequent