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.
Methods: Specimens obtained by a single anoscopist in a tertiary referral clinic in Sydney, Australia, over the periods 2004-6, 2007-8 and 2009-10 were analysed. The proportion of individuals who had anal HGAIN detected in biopsies was linked to the most recent Papanicolaou result. Data were then grouped by the most serious Papanicolaou result.
Results: A total of 283 patients with at least one paired anal histological biopsy and cytological smear were included. The majority (99.3%) were men and the median age was 44 years. More than half (62.5%) were HIV infected.For patients with a Papanicolaou smear of Atypical Squamous Cells of Undetermined Significance (ASCUS) or higher grade, the proportion in whom HGAIN was found at anoscopy increased over the study period from 38.6% to 66.0% (p<0.001). Likewise, for patients with a Papanicolaou smear of Low-grade Squamous Intraepithelial Lesions (LSIL) or higher grade , HGAIN detection increased from 38.8% to 68.3% (p<0.001).
Conclusion: The proportion of cases with histologically proven HGAIN increased over time, suggesting that the anoscopist became better at identifying precancerous lesions. The alternative explanation, that the cytological assessment became less accurate is unlikely, as they were all performed by a team of experienced cytologists in a large, accredited laboratory. This observation has important implications for quality assurance procedures in clinical facilities. Furthermore, such changes over time could potentially impact on long term observational studies, where increasing diagnoses of HGAIN could be expected, regardless of the intervention.
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.®.
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.
Case presentation: A 27 year-old Vietnamese man was diagnosed with HIV in April 2012 when he presented with cerebrospinal fluid (CSF)-culture positive Cryptococcus neoformans meningitis. CD4 count was 4 cells/µL and HIV viral load 228827 copies/mL. He was treated with two weeks of amphotericin B (0.7mg/kg/day) and 5-fluorocytosine (25mg/kg/QID), followed by consolidation and secondary prophylaxis with fluconazole. CSF cultures were negative at two weeks. A ventriculo-peritoneal shunt was inserted to manage persistently raised intracranial pressure and had to be replaced two weeks later due to bacterial shunt infection. Antiretroviral therapy (ART) was commenced after four weeks of treatment, and by September 2012, CD4 count was 107 cells/L and viral load 150 copies/mL.