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Short CES, Byrne L, Hagan-Bezgin A, Quinlan RA, Anderson J, Brook G, De Alwis O, de Ruiter A, Farrugia P, Fidler S, Hamlyn E, Hartley A, Murphy S, Noble H, Oomeer S, Roedling S, Rosenvinge M, Rubinstein L, Shah R, Singh S, Thorne E, Toby M, Wait B, Sarner L, Taylor GP. Pregnancy Management in HIV Viral Controllers: Twenty Years of Experience. Pathogens 2024; 13:308. [PMID: 38668263 PMCID: PMC11054990 DOI: 10.3390/pathogens13040308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 04/29/2024] Open
Abstract
(1) Background: The evidence base for the management of spontaneous viral controllers in pregnancy is lacking. We describe the management outcomes of pregnancies in a series of UK women with spontaneous HIV viral control (<100 copies/mL 2 occasions before or after pregnancy off ART). (2) Methods: A multi-centre, retrospective case series (1999-2021) comparing pre- and post-2012 when guidelines departed from zidovudine-monotherapy (ZDVm) as a first-line option. Demographic, virologic, obstetric and neonatal information were anonymised, collated and analysed in SPSS. (3) Results: A total of 49 live births were recorded in 29 women, 35 pre-2012 and 14 post. HIV infection was more commonly diagnosed in first reported pregnancy pre-2012 (15/35) compared to post (2/14), p = 0.10. Pre-2012 pregnancies were predominantly managed with ZDVm (28/35) with pre-labour caesarean section (PLCS) (24/35). Post-2012 4/14 received ZDVm and 10/14 triple ART, p = 0.002. Post-2012 mode of delivery was varied (5 vaginal, 6 PLCS and 3 emergency CS). No intrapartum ZDV infusions were given post-2012 compared to 11/35 deliveries pre-2012. During pregnancy, HIV was detected (> 50 copies/mL) in 14/49 pregnancies (29%) (median 92, range 51-6084). Neonatal ZDV post-exposure prophylaxis was recorded for 45/49 infants. No transmissions were reported. (4) Conclusion: UK practice has been influenced by the change in guidelines, but this has had little impact on CS rates.
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Affiliation(s)
- Charlotte-Eve S. Short
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK
- Imperial College NIHR BRC, Imperial College London, London W2 1NY, UK
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Laura Byrne
- School of Medicine, St Georges, University of London, London SW17 0RE, UK
- St. George’s University Hospitals NHS Trust, London SW17 0RE, UK
| | - Aishah Hagan-Bezgin
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK
- School of Medicine, University of Liverpool, Liverpool L69 3GE, UK
| | - Rachael A. Quinlan
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK
- Imperial College NIHR BRC, Imperial College London, London W2 1NY, UK
| | - Jane Anderson
- Homerton Healthcare NHS Foundation Trust, London E9 6SR, UK
- London North West University Healthcare NHS Trust, Harrow HA1 3UJ, UK
| | - Gary Brook
- London North West University Healthcare NHS Trust, Harrow HA1 3UJ, UK
| | | | - Annemiek de Ruiter
- Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
- ViiV Healthcare, Brentford TW8 9GS, UK
| | - Pippa Farrugia
- Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK
- Imperial College NIHR BRC, Imperial College London, London W2 1NY, UK
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Eleanor Hamlyn
- Royal Free London NHS Foundation Trust, London NW3 2QG, UK
| | - Anna Hartley
- Barts Health NHS Trust, London E1 1BB, UK
- Leeds University Teaching Hospital NHS Trust, Leeds LS1 3EX, UK
| | - Siobhan Murphy
- London North West University Healthcare NHS Trust, Harrow HA1 3UJ, UK
| | | | - Soonita Oomeer
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
- Central and North West London NHS Foundation Trust, London NW1 3AX, UK
| | - Sherie Roedling
- Central and North West London NHS Foundation Trust, London NW1 3AX, UK
| | | | | | - Rimi Shah
- Royal Free London NHS Foundation Trust, London NW3 2QG, UK
| | | | - Elizabeth Thorne
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | | | - Brenton Wait
- Homerton Healthcare NHS Foundation Trust, London E9 6SR, UK
| | | | - Graham P. Taylor
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK
- Imperial College NIHR BRC, Imperial College London, London W2 1NY, UK
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
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Nyatsanza F, Gubbin J, Gubbin T, Seery P, Farrugia P, Croucher A, Gilleece Y, Rosenvinge M, Roedling S, Sarner L, Nayagam D, Stradling C, Namiba A, Fearnley N, Lyall H. Over a third of childbearing women with HIV would like to breastfeed: A UK survey of women living with HIV. Int J STD AIDS 2021; 32:856-860. [PMID: 33629917 DOI: 10.1177/0956462421999951] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The World Health Organisation advice for post-partum women living with HIV (WLHs) in low- and middle-income countries is to breastfeed on suppressive antiretroviral treatment and use infant postnatal prophylaxis. In resource-rich settings, where formula feeding is safe, avoidance of breastfeed is advised. A questionnaire was created to survey attitudes to breastfeeding in WLHs in the United Kingdom. This was offered to all eligible pregnant women in the third trimester or within 3 months post-partum who attended HIV outpatient clinics from 2017 to 2018. Ninety-four women completed the questionnaire, 69% were Black African and 92% had an undetectable HIV viral load. Thirty eight percent stated they would like to breastfeed and 89% said they would breastfeed if they were HIV negative. Sixty two percent had community members question why they did not breastfeed, and 66% felt forced to invent a reason why they were not breastfeeding. Current UK guidelines recommend formula feeding, proposing a harm reduction approach to support women with suppressed HIV who wish to breastfeed. Over a third of respondents said they would like to breastfeed because stigma and secrecy remain an issue for WLHs. This suggests that over time more women may choose this option.
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Affiliation(s)
- Farai Nyatsanza
- 8946Imperial College Healthcare NHS Trust, London, UK.,215332Cambridgeshire Community Services NHS Trust, Huntingdon, UK
| | | | - Thomas Gubbin
- 8946Imperial College Healthcare NHS Trust, London, UK
| | - Paula Seery
- 8946Imperial College Healthcare NHS Trust, London, UK.,9762Chelsea and Westminster NHS Trust, London, UK
| | | | - Adam Croucher
- 4721Homerton University Hospitals NHS Trust, London, UK
| | - Yvonne Gilleece
- 1949Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Sherie Roedling
- 8964Central and Northwest London NHS Foundation Trust, London, UK
| | | | | | - Clare Stradling
- 1732University Hospitals Birmingham NHS Foundation Trust, Bradford, UK
| | | | - Nicola Fearnley
- 1906Bradford University Teaching Hospitals NHS Trust, Bradford, UK
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Alagaratnam J, Peters H, Francis K, Kay N, Gilleece Y, Finnerty FP, Grimes RE, Parry S, Portman M, Wait BC, Shah R, Roedling S, Hawkins DA, Chitty S, Sarner L, Marcus R, Hartley A, Nori AV, Rosenvinge M, Taylor GP. An observational study of initial HIV RNA decay following initiation of combination antiretroviral treatment during pregnancy. AIDS Res Ther 2020; 17:41. [PMID: 32660502 PMCID: PMC7359473 DOI: 10.1186/s12981-020-00297-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/04/2020] [Indexed: 01/29/2023] Open
Abstract
Background In pregnancy, reduction of HIV plasma viral load (pVL) for the prevention of vertical transmission is time-constrained. The study primary objective is to investigate factors associated with faster initial HIV RNA half-life decay when combination antiretroviral treatment (cART) is initiated in pregnancy. Methods This was a multicentre, retrospective, observational study, conducted in south England, United Kingdom, between August 2001 and February 2018. Data were extracted from case notes of eligible women initiating cART during the index pregnancy. Anonymised data were collated and analysed centrally. Regression analyses were conducted to determine factors associated with faster HIV RNA half-life decay in the first 14 days after commencing cART (first-phase), and with achieving an undetectable maternal pVL by 36 weeks’ gestation. We then assessed whether HIV- and obstetric- related parameters differed by antiretroviral third agent class and whether the proportions of women with undetectable pVL at 36 weeks’ gestation and at delivery differed by antiretroviral third agent class. Results Baseline pVL was the only independent factor associated with faster first-phase HIV RNA half-life decay on commencing cART. Lower pVL on day 14 after starting cART was associated with an increased likelihood of achieving an undetectable pVL by 36 weeks’ gestation. Integrase inhibitor-based cART was associated with a faster first-phase HIV RNA half-life decay on commencing cART. Overall, 73% and 85% of women had an undetectable pVL at 36 weeks’ gestation and at delivery respectively, with no significant difference by antiretroviral third agent class. Conclusions Only high baseline pVL independently contributed to a faster rate of first-phase viral half-life decay. pVL at 14 days after initiating cART allows early identification of treatment failure. In the first 14 days after initiating cART in pregnancy, integrase inhibitor-based cART reduced maternal pVL faster than protease inhibitor- and non-nucleoside reverse transcriptase-based cART. While our study findings support INSTI use when initiated in pregnancy especially when initiated at later gestations and in those with higher baseline pVL, other non-INSTI based cART with more data on safety in pregnancy also performed well.
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Toorabally N, Mercer CH, Mitchell KR, Blell M, Burns F, Gilson R, McGregor-Read J, Allan S, De Ruiter A, Dhairyawan R, Fox J, Gilleece Y, Jones R, Mackie N, Obeyesekera S, Post F, Reeves I, Rosenvinge M, Ross J, Sarner L, Sullivan A, Tariq A, Ustianowski A, Sabin CA, Tariq S. Association of HIV status with sexual function in women aged 45-60 in England: results from two national surveys. AIDS Care 2020; 32:286-295. [PMID: 31411046 PMCID: PMC7034538 DOI: 10.1080/09540121.2019.1653436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 08/02/2019] [Indexed: 01/23/2023]
Abstract
Increasing numbers of women living with HIV are reaching their midlife. We explore the association of HIV status with sexual function (SF) in women aged 45-60 using two national cross-sectional surveys: the third British National Survey of Sexual Attitudes and Lifestyles ("Natsal-3") and "PRIME", a survey of women living with HIV attending HIV clinics across England. Both studies asked the same questions about SF that take account not only sexual difficulties but also the relationship context and overall level of satisfaction, which collectively allowed an overall SF score to be derived. We undertook analyses of sexually-active women aged 45-60 from Natsal-3 (N = 1228, presumed HIV-negative given the low estimated prevalence of HIV in Britain) and PRIME (N = 386 women living with HIV). Women living with HIV were compared to Natsal-3 participants using multivariable logistic regression (adjusting for key confounders identified a priori: ethnicity, ongoing relationship status, depression and number of chronic conditions) and propensity scoring. Relative to Natsal-3 participants, women living with HIV were more likely to: have low overall SF (adjusted odds ratio (AOR) 3.75 [2.15-6.56]), report ≥1 sexual problem(s) lasting ≥3 months (AOR 2.44 [1.49-4.00]), and report almost all 8 sexual problems asked about (AORs all ≥2.30). The association between HIV status and low SF remained statistically significant when using propensity scoring (AOR 2.43 [1.68-3.51]). Among women living with HIV (only), low SF was more common in those who were postmenopausal vs. Premenopausal (55.6% vs. 40.4%). This study suggests a negative association between HIV status and sexual function in women aged 45-60. We recommend routine assessment of SF in women living with HIV.
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Affiliation(s)
| | - Catherine H. Mercer
- Institute for Global Health, University College London, London, UK
- NIHR Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - Kirstin R. Mitchell
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mwenza Blell
- The Policy Ethics and Life Sciences (PEALS) Research Centre, School of Geography, Politics, and Sociology, Newcastle University, Newcastle, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK
- Ian Charleson Day Centre, Royal Free London NHS Foundation Trust, London, UK
| | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| | | | - Sris Allan
- City of Coventry Health Centre (Integrated Sexual Health Services), Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Annemiek De Ruiter
- Harrison Wing, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
- ViiV Healthcare, London, UK
| | | | - Julie Fox
- Harrison Wing, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
| | - Yvonne Gilleece
- Lawson Unit, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | - Rachael Jones
- Kobler Outpatient Clinic, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nicola Mackie
- The Wharfside Clinic, Imperial College Healthcare NHS Trust, London, UK
| | | | - Frank Post
- Caldecot Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Iain Reeves
- Jonathan Mann Clinic, Homerton University Hospital Foundation Trust, London, UK
| | | | - Jonathan Ross
- Queen Elizabeth Hospital Birmingham HIV Clinic, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Liat Sarner
- Grahame Hayton Unit, Barts NHS Trust, London, UK
| | - Ann Sullivan
- Kobler Outpatient Clinic, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Anjum Tariq
- Wolverhampton Sexual Health Service, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Andrew Ustianowski
- Department of Infectious Diseases, North Manchester General Hospital, Penine Acute Hospitals NHS Trust, Manchester, UK
| | - Caroline A. Sabin
- Institute for Global Health, University College London, London, UK
- NIHR Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - Shema Tariq
- Institute for Global Health, University College London, London, UK
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Abstract
A 39-year-old HIV-positive black African woman with previously treated cerebral toxoplasmosis experienced a foetal intra-uterine death due to congenital toxoplasmosis. This case demonstrates the complexities of screening for maternal toxoplasmosis in the context of pregnancy and HIV infection-related cell-mediated immunosuppression. Additionally, the case highlights the challenges in providing effective preventative and therapeutic drug options for congenital toxoplasmosis.
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Affiliation(s)
- Subathira Dakshina
- 1 Ambrose King Centre, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Robert F Miller
- 2 Research Department of Infection and Public Health, Institute for Global Health, University College London, London, UK
| | - Cheuk Yw Tong
- 3 Department of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Liat Sarner
- 1 Ambrose King Centre, Royal London Hospital, Barts Health NHS Trust, London, UK
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Sarner L, Fakoya AO, Tawana C, Allen E, Copas AJ, Chiodini PL, Fenton KA. The utility of screening for parasitic infections in HIV-1-infected Africans with eosinophilia in London. Int J STD AIDS 2016; 18:626-9. [PMID: 17785008 DOI: 10.1258/095646207781568420] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The presence of asymptomatic eosinophilia in HIV patients has been demonstrated to have a wide variety of causes. Untreated parasitic infections in immunocompromised individuals can have potentially serious consequences. The utility of screening for parasitic infections in immigrant HIV-positive Africans with eosinophilia was investigated in a UK-based HIV clinic. HIV-positive African patients with eosinophilia were matched with HIV-positive African controls without eosinophilia. More than half of African HIV patients with eosinophilia had positive parasitic serology, and were significantly more likely to have positive serology compared with African HIV patients without eosinophilia. This study shows that asymptomatic eosinophilia in HIV-1-infected Africans is strongly suggestive of underlying parasitic infection. Individuals with eosinophilia should thus be screened for parasitic infections according to the infections prevalent in the countries they have lived in or visited for substantial periods of time.
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Affiliation(s)
- Liat Sarner
- The Greenway Centre, Newham General Hospital, Glen Road, London E13 8SL, UK.
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7
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Pasvol T, Khan P, Thiagarajan A, Dakshina S, Sarner L, Orkin C. O028 Low proportion of men who have sex with men (MSM) tested for hepatitis C despite high prevalence in 2 genito-urinary medicine (GUM) clinics. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Williams E, Bandara M, Ahmad M, Bayley J, Sarner L. P078 Closing the audit cycle in the management of Pelvic Inflammatory Disease (PID): updating Trust guidelines leads to a huge improvement in PID treatment. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Symonds M, Sarner L. P215 Patient telephone consultations in a sexual health service. What do they tell us about service efficiency and patient need?: Abstract P215 Table 1. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052718.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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10
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Perry MEO, Taylor GP, Sabin CA, Conway K, Flanagan S, Dwyer E, Stevenson J, Mulka L, McKendry A, Williams E, Barbour A, Dermont S, Roedling S, Shah R, Anderson J, Rodgers M, Wood C, Sarner L, Hay P, Hawkins D, deRuiter A. Lopinavir and atazanavir in pregnancy: comparable infant outcomes, virological efficacies and preterm delivery rates. HIV Med 2015. [PMID: 26200570 DOI: 10.1111/hiv.12277] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of the study was to identify differences in infant outcomes, virological efficacy, and preterm delivery (PTD) outcome between women exposed to lopinavir/ritonavir (LPV/r) and those exposed to atazanavir/ritonavir (ATV/r). METHODS A retrospective case note review was carried out. The case notes of 493 women who conceived while on LPV/r or ATV/r or initiated LPV/r or ATV/r during pregnancy and who delivered between 1 September 2007 and 30 August 2012 were reviewed. Data collected included demographics, antiretroviral use, HIV markers, and pregnancy and infant outcomes. Infant outcomes, virological efficacies and PTD rates for LPV/r and ATV/r were compared. RESULTS A total of 306 women received LPV/r (82 conceiving while on the drug and 224 commencing it post-conception) and 187 received ATV/r (96 conceiving while on the drug and 91 commencing it post-conception). Comparing the two protease inhibitors (PIs), viral suppression rates were similar and, in women starting antiretroviral therapy (ART) post-conception, the median times to first undetectable HIV viral load were not significantly different (P = 0.64). PTD rates did not differ by therapy overall (ATV/r, 13%; LPV/r, 14%) or when considering the timing of first exposure (conceiving on ART, P = 0.81; commencing ART in pregnancy, P = 0.08). Poor fetal outcomes were very uncommon. There were two transmissions, giving a mother-to-child transmission (MTCT) rate of 0.4% (95% confidence interval 0.05-1.5%). CONCLUSIONS Both ART regimens were well tolerated and successful in preventing MTCT. No significant differences in tolerability or in pregnancy or infant outcomes were observed, which supports the provision of a choice of PI in pregnancy.
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Affiliation(s)
- M E O Perry
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - G P Taylor
- Imperial College Healthcare NHS Trust, London, UK
| | - C A Sabin
- Research Department of Infection and Population Health, University College London, London, UK
| | - K Conway
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S Flanagan
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - E Dwyer
- Croydon University Hospital NHS Trust, London, UK
| | - J Stevenson
- Croydon University Hospital NHS Trust, London, UK
| | - L Mulka
- Imperial College Healthcare NHS Trust, London, UK
| | - A McKendry
- The North Middlesex University Hospital NHS Trust, London, UK
| | | | | | - S Dermont
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - S Roedling
- (Mortimer Market Centre) Central and North West London NHS Foundation Trust, London, UK
| | - R Shah
- Barnet and Chase Farm Hospital NHS Trust, London, UK
| | - J Anderson
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - M Rodgers
- Croydon University Hospital NHS Trust, London, UK
| | - C Wood
- The North Middlesex University Hospital NHS Trust, London, UK
| | - L Sarner
- Barts Health NHS Trust, London, UK
| | - P Hay
- St George's NHS Trust, London, UK
| | - D Hawkins
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - A deRuiter
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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Hartley A, Marcus R, Tariq S, Begum J, Purkis J, Sarner L. P55 The use of web-based technology to measure patient experience in sexual health services: Abstract P55 Table 1. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052126.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Marcus R, Tiab M, Teague S, Gorman G, Portman M, Sarner L. P147 A trust-wide audit on pelvic inflammatory disease management in a genitourinary medicine setting. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052126.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Umaipalan A, Parry L, Kiritharan L, Anderson H, Sarner L, Portman M. P141 How accurate is clinical coding in recently integrated sexual health services?:. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052126.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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14
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Shepherd L, Heke S, Sarner L, O'Donovan A. Are UK services meeting the need of patients with sexual problems and where should psychosexual services be provided? Sexual and Relationship Therapy 2010. [DOI: 10.1080/14681990903483146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Abstract
A nurse-led clinic offering screening for sexual infections to men within an existing HIV outpatient service was created. A retrospective case-note review was undertaken of those having a sexual health (SH) screen between May and December 2007. A total of 125 men had an SH screen, 117 identified as men who have sex with men and 84 were asymptomatic. Six (7%) asymptomatic men had chlamydial and two (2%) had gonococcal infection. Six new diagnoses of syphilis and two of hepatitis C virus infection were made. We suggest that introducing a nurse-led clinic offering SH screening within HIV services has helped to achieve national standards and improved the SH of our patients.
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Affiliation(s)
- K M Forbes
- Department of Infection and Immunology, Andrewes Outpatients, St Bartholomews' Hospital, London EC1A, UK
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16
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Forbes KM, Lomax N, Cunningham L, Hardie J, Noble H, Sarner L, Anderson J. Partner notification in pregnant women with HIV: findings from three inner-city clinics. HIV Med 2009; 9:433-5. [PMID: 18484979 DOI: 10.1111/j.1468-1293.2008.00580.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
British HIV Association guidelines recommend that all HIV-positive pregnant women should be encouraged to disclose their HIV infection to their partner and that this should be viewed as a process rather than an event. The aim of this study was to describe local practice of partner notification (PN) and patterns of disclosure in a group of HIV-positive women in an antenatal setting. A retrospective case note and local pregnancy database review was undertaken. Women who had accessed specialist HIV antenatal care at one of three east London hospitals with an expected delivery date between 1 March 2004 and 30 June 2006 were identified. In total, 145 women were identified. HIV status had not been disclosed to a partner in 19% (n=27) of case notes reviewed. There was no documented discussion about PN in 18% (n=26) of case notes. Forty-three per cent (n=62) of case notes documented that the male partner had accessed HIV testing after PN was discussed. All HIV-positive pregnant women should have a documented discussion about PN. Concurrent HIV testing offered to both partners may improve HIV testing uptake in male partners and should be explored further. Care plans should include screening for intimate partner violence and housing problems; referral pathways should be established clearly when involving other agencies.
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Affiliation(s)
- K M Forbes
- Barts and the London NHS Trust, London, UK.
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17
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Martin F, Navaratne L, Khan W, Sarner L, Mercey D, Anderson J, Noble H, Fakoya A, Hawkins DA, De Ruiter A, Taylor GP. Pregnant women with HIV infection can expect healthy survival: three-year follow-up. J Acquir Immune Defic Syndr 2006; 43:186-92. [PMID: 16940856 DOI: 10.1097/01.qai.0000233311.28602.4d] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To document postpartum disease-free survival of HIV-infected women taking antiretroviral therapy (ART) during pregnancy. METHODS Laboratory and clinical data were collected on all HIV-infected pregnant women delivering from 1998 to 2002 and followed up until September 2004 at 6 hospitals in London. Mothers were grouped according to receipt of zidovudine monotherapy (ZDVm), highly active antiretroviral therapy (HAART) given during and continued after pregnancy (cHAART), and short-term HAART given during pregnancy and discontinued on delivery (START). RESULTS Eight-five women took ZDVm, 155 took cHAART, and 71 took START. The mean follow-up for all mothers was 33 months, with a total of 847 person-years. At the first antenatal clinic (ANC) visit, 72% of women were in Centers for Disease Control and Prevention (CDC) stage A, 85% were treatment naive, and the ZDVm group had a median HIV viral load (VL) 10-fold less than those mothers who started HAART during pregnancy. At last follow-up, 1 patient had died and 6 (1.9%) had progressed to CDC stage C; 62% of all women, including a quarter of the ZDVm group, were receiving HAART for their own health; and 83% of all mothers had a VL <50 HIV RNA copies/mL of plasma regardless of whether they were on treatment or not. CONCLUSIONS The median-term postpartum prognosis of HIV-infected pregnant women with access to HAART is good. Exposure to short-course ZDVm or START during pregnancy did not jeopardize their response to subsequent therapy.
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Smith PR, Sarner L, Murphy M, James B, Thomas JM, Skinner CJ, Aitken C. Ethnicity and discordance in plasma HIV-1 RNA viral load and CD4+ lymphocyte count in a cohort of HIV-1-infected individuals. J Clin Virol 2003; 26:101-7. [PMID: 12589840 DOI: 10.1016/s1386-6532(02)00180-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Guidelines for commencing therapy for HIV infection have been based upon HIV-1 RNA and CD4 lymphocyte thresholds. The influence of confounding factors such as gender, ethnicity and co-infections is unproven. OBJECTIVES To analyse ethnic discordance in plasma HIV-1 viral load (VL) and CD4+ count and its potential clinical significance in Black and Caucasian groups. STUDY DESIGN Retrospective, cross-sectional, observational study of 537 antiretroviral nai;ve HIV-1-positive individuals attending two East London clinics. Baseline data were obtained from individuals who registered at the clinic from November 1996 to August 1999. An analysis was performed comparing ethnic differences in plasma HIV-1 VL, CD4+ count, CD8+ count, co-infections, CDC disease category, AIDS-defining illnesses and mode of transmission. RESULTS Plasma HIV-1 VL was significantly lower in Blacks (4.5 copies/ml versus 4.7 copies/ml; P<0.05) despite lower baseline CD4+ counts and similar rates of disease progression to Caucasian groups. This association remained for patients with less advanced disease after stratification for CD4+ count (CD4+ 200-500, VL 4.5 copies/ml versus 4.7 copies/ml, P<0.01; CD4+ >500, VL 3.4 copies/ml versus 4.3 copies/ml, P<0.001) and disease category (non-AIDS, 4.4 copies/ml versus 4.7 copies/ml; P<0.005). On multivariate analysis, the association persisted following adjustment for gender, age, co-infections, CD4+ count and mode of transmission. CONCLUSIONS These results suggest that plasma HIV-1 VL is discordantly low in Black compared with Caucasian groups stratified for CD4+ count, in this cohort of antiretroviral nai;ve HIV-1-positive individuals living in London. Although there are a number of possible explanations for this finding, it has considerable clinical relevance for the management of Black HIV-1-infected patients within UK, with significant implications for the decision about when to commence antiretroviral or immune-based therapies.
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Affiliation(s)
- Penelope R Smith
- Department of Virology, Barts and the London NHS Trust, 51-53 Bartholomew Close, West Smithfield, London EC1A 7BE, UK
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Sarner L, Fakoya A. Acute onset lactic acidosis and pancreatitis in the third trimester of pregnancy in HIV-1 positive women taking antiretroviral medication. Sex Transm Infect 2002; 78:58-9. [PMID: 11872862 PMCID: PMC1763698 DOI: 10.1136/sti.78.1.58] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report the case histories of two HIV-1 positive women in the third trimester of pregnancy who presented with acute lactic acidosis and acute pancreatitis, respectively. One case was fatal for mother and baby. Both women had been stable on regimens containing stavudine and didanosine for at least 2 years before their acute presentations. We speculate on the differential diagnosis, discuss possible reasons for an increased risk of these presentations in pregnant women taking antiretrovirals, and advocate increased vigilance of these women, particularly in the last trimester.
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Affiliation(s)
- L Sarner
- The Greenway Centre, Newham General Hospital, London E13 8SL, UK.
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Abstract
CONTEXT Therapeutic Touch (TT) is a widely used nursing practice rooted in mysticism but alleged to have a scientific basis. Practitioners of TT claim to treat many medical conditions by using their hands to manipulate a "human energy field" perceptible above the patient's skin. OBJECTIVE To investigate whether TT practitioners can actually perceive a "human energy field." DESIGN Twenty-one practitioners with TT experience for from 1 to 27 years were tested under blinded conditions to determine whether they could correctly identify which of their hands was closest to the investigator's hand. Placement of the investigator's hand was determined by flipping a coin. Fourteen practitioners were tested 10 times each, and 7 practitioners were tested 20 times each. MAIN OUTCOME MEASURE Practitioners of TT were asked to state whether the investigator's unseen hand hovered above their right hand or their left hand. To show the validity of TT theory, the practitioners should have been able to locate the investigator's hand 100% of the time. A score of 50% would be expected through chance alone. RESULTS Practitioners of TT identified the correct hand in only 123 (44%) of 280 trials, which is close to what would be expected for random chance. There was no significant correlation between the practitioner's score and length of experience (r=0.23). The statistical power of this experiment was sufficient to conclude that if TT practitioners could reliably detect a human energy field, the study would have demonstrated this. CONCLUSIONS Twenty-one experienced TT practitioners were unable to detect the investigator's "energy field." Their failure to substantiate TT's most fundamental claim is unrefuted evidence that the claims of TT are groundless and that further professional use is unjustified.
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Affiliation(s)
- L Rosa
- Questionable Nurse Practices Task Force, National Council Against Health Fraud Inc, Loveland, Colo, USA
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