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Allsopp RC, Guo Q, Page K, Bhagani S, Kasim A, Badman P, Kenny L, Stebbing J, Shaw JA. Circulating tumour DNA dynamics during alternating chemotherapy and hormonal therapy in metastatic breast cancer: the ALERT study. Breast Cancer Res Treat 2024:10.1007/s10549-024-07316-8. [PMID: 38581534 DOI: 10.1007/s10549-024-07316-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/22/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE Although changes in circulating tumour DNA (ctDNA) in breast cancer are well described, the kinetics of their fluctuations has not been described over short timescales. We investigated ctDNA dynamics during alternating cycles of chemotherapy and hormonal treatment in pre-treated patients with oestrogen receptor-positive metastatic breast cancer. METHODS Patients received alternating, 9-week cycles of eribulin and aromatase inhibitors (AIs). The clinical primary endpoint, progression-free survival (PFS), was monitored at 3, 6 and 9 months; secondary endpoints, clinical benefit rate (CBR), safety and tolerability profiles, were also assessed. Importantly, ctDNA fluctuations were monitored using the Oncomine™ Breast cfDNA assay to test whether biomarkers may change rapidly between chemotherapy and aromatase inhibitor (AI) treatment in the setting of advanced breast cancer, potentially reflecting disease dynamics. RESULTS The median PFS was 202 days (95% CI: 135-undefined) and 235 days (95% CI: 235-undefined) at 6 and 9 months, respectively, with a 50% CBR at both 6 and 9 months. Dynamic changes in ctDNA were observed in short timescales between chemotherapy and AI treatment and support the clinical benefit (CB) seen in individual patients and, critically, appear informative of acquired resistance in real time. CONCLUSION Changes in ctDNA can occur rapidly and reflect changes in patients' clinical tumour responses (NCT02681523).
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Affiliation(s)
- Rebecca C Allsopp
- Leicester Cancer Research Centre, Department of Genetics and Genome Biology, University of Leicester, Leicester Royal Infirmary, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX, UK
| | - Qi Guo
- Leicester Cancer Research Centre, Department of Genetics and Genome Biology, University of Leicester, Leicester Royal Infirmary, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX, UK
| | - Karen Page
- Leicester Cancer Research Centre, Department of Genetics and Genome Biology, University of Leicester, Leicester Royal Infirmary, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX, UK
| | - Shradha Bhagani
- Leicester Cancer Research Centre, Department of Genetics and Genome Biology, University of Leicester, Leicester Royal Infirmary, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX, UK
| | - Anna Kasim
- Department of Surgery and Cancer, Imperial College, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Philip Badman
- Department of Surgery and Cancer, Imperial College, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Laura Kenny
- Department of Surgery and Cancer, Imperial College, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Justin Stebbing
- Department of Surgery and Cancer, Imperial College, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK.
- Department of Life Sciences, Anglia Ruskin University, East Road, Cambridge, CB1 1PT, UK.
| | - Jacqueline A Shaw
- Leicester Cancer Research Centre, Department of Genetics and Genome Biology, University of Leicester, Leicester Royal Infirmary, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX, UK
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Moliner L, Zellweger N, Schmidt S, Waibel C, Froesch P, Häuptle P, Blum V, Holer L, Frueh M, Bhagani S, Gray HL, Cox S, Khalid T, Scott D, Robinson S, Hennah L, Handforth C, Mauti L, Califano R, Rothschild S. 66P Real-world data of first-line chemo-immunotherapy for patients with extensive stage SCLC: A multicentre experience from Switzerland and the UK. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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3
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Moliner L, Woodhouse L, Ahmed S, Bhagani S, Sevak P, Vijay A, Steele N, Gray HL, Robinson S, Davidson M, O'Brien M, Cox S, Powell C, Khalid T, T.R. Geldart, Hennah L, Newsom-Davis T, A. Denton, Blackhall F, Califano R. 1541P Real-world data of atezolizumab plus carboplatin-etoposide for patients with extensive stage SCLC: The UK experience. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1635] [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: 11/01/2022] Open
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4
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Bhagani S, Sultan A, Hline AT, Khanji MY. Complete regression of diffuse large B-cell cardiac lymphoma: the role of multimodality cardiovascular imaging in diagnosis and assessing treatment response. Eur Heart J Cardiovasc Imaging 2021; 22:e10. [PMID: 33020842 DOI: 10.1093/ehjci/jeaa204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shradha Bhagani
- Cardiology department, Queen's Hospital, Barking, Havering and Redbridge Hospital Trust, Rom Valley Way, Romford, RM7 0AG, UK.,Cardiology Department, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Anum Sultan
- Cardiology department, Queen's Hospital, Barking, Havering and Redbridge Hospital Trust, Rom Valley Way, Romford, RM7 0AG, UK
| | - Aye Thida Hline
- Cardiology department, Queen's Hospital, Barking, Havering and Redbridge Hospital Trust, Rom Valley Way, Romford, RM7 0AG, UK
| | - Mohammed Y Khanji
- Cardiology Department, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.,Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute, NIHR Barts Biomedical Research Unit, Queen Mary University of London, Charterhouse Square, Barbican, London EC1M 6BQ, UK
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Ryom L, Cotter A, De Miguel R, Béguelin C, Podlekareva D, Arribas JR, Marzolini C, Mallon P, Rauch A, Kirk O, Molina JM, Guaraldi G, Winston A, Bhagani S, Cinque P, Kowalska JD, Collins S, Battegay M. 2019 update of the European AIDS Clinical Society Guidelines for treatment of people living with HIV version 10.0. HIV Med 2020; 21:617-624. [PMID: 32885559 PMCID: PMC7754379 DOI: 10.1111/hiv.12878] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The European AIDS Clinical Society (EACS) Guidelines cover key aspects of HIV management with major updates every two years. GUIDELINE HIGHLIGHTS The 2019 Guidelines were extended with a new section focusing on drug-drug interactions and other prescribing issues in people living with HIV (PLWH). The recommendations for treatment-naïve PLWH were updated with four preferred regimens favouring unboosted integrase inhibitors. A two-drug regimen with dolutegravir and lamivudine, and a three-drug regimen including doravirine were also added to the recommended initial regimens. Lower thresholds for hypertension were expanded to all PLWH and for cardiovascular disease prevention, the 10-year predicted risk threshold for consideration of antiretroviral therapy (ART) modification was lowered from 20% to 10%. Frailty and obesity were added as new topics. It was specified to use urine albumin to creatinine ratio to screen for glomerular disease and urine protein to creatinine ratio for tubular diseases, and thresholds were streamlined with the Kidney Disease: Improving Global Outcomes (KDIGO) recommendations. Hepatitis C virus (HCV) treatment recommendations were split into preferred and alternative treatment options. The algorithm for management of recently acquired HCV infection was updated and includes recommendations for early chronic infection management. Treatment of resistant tuberculosis (TB) was streamlined with the World Health Organization (WHO) recommendations, and new tables on immune reconstitution inflammatory syndrome, on when to start ART in the presence of opportunistic infections and on TB drug dosing were included. CONCLUSIONS The EACS Guidelines underwent major revisions of all sections in 2019. They are available in four different formats including a new interactive web-based version and are translated into Chinese, French, German, Japanese, Portuguese, Russian and Spanish.
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Affiliation(s)
- L Ryom
- CHIP, Center of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section 2100, Center for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Cotter
- University College Dublin Centre for Experimental Pathogen Host Research, Dublin, Ireland
| | - R De Miguel
- Infectious Diseases Unit, La Paz Hospital, Madrid, Spain
| | - C Béguelin
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Podlekareva
- CHIP, Center of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section 2100, Center for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J R Arribas
- Infectious Diseases Unit, La Paz Hospital, Madrid, Spain
| | - C Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital of Basel and University of Basel, Basel, Switzerland.,Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Pgm Mallon
- University College Dublin Centre for Experimental Pathogen Host Research, Dublin, Ireland
| | - A Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - O Kirk
- CHIP, Center of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Section 2100, Center for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J M Molina
- Department of Infectious Diseases, St Louis and Lariboisière Hospitals, APHP and University of Paris, Paris, France
| | - G Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - S Bhagani
- Department of Infectious Diseases/HIV Medicine, Royal Free London NHS Trust, Institute of Global Health, University College London, London, UK
| | - P Cinque
- Division of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - J D Kowalska
- Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - M Battegay
- Division of Infectious Diseases et Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
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Martinello M, Bhagani S, Gane E, Orkin C, Cooke G, Dore GJ, Petoumenos K, Applegate TL, Tu E, Marks P, Pagani N, Grebely J, Nelson M, Matthews GV. Shortened therapy of eight weeks with paritaprevir/ritonavir/ombitasvir and dasabuvir is highly effective in people with recent HCV genotype 1 infection. J Viral Hepat 2018; 25:1180-1188. [PMID: 29660224 DOI: 10.1111/jvh.12917] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/12/2018] [Indexed: 12/13/2022]
Abstract
Paritaprevir/ritonavir/ombitasvir and dasabuvir with or without ribavirin for 12 weeks are approved for treatment of chronic HCV genotype 1 infection. This study assessed the efficacy of shortened duration paritaprevir/ritonavir/ombitasvir and dasabuvir with or without ribavirin for 8 weeks among people with recent HCV infection. In this open-label single-arm trial conducted in Australia, England and New Zealand, adults with recent HCV (duration of infection <12 months) received paritaprevir/ritonavir/ombitasvir and dasabuvir (with weight-based ribavirin for genotypes 1a and 1, no subtype) for 8 weeks. The primary endpoint was sustained virological response at 12 weeks post-treatment (SVR12) in the intention-to-treat (ITT) population. Thirty people (median age 38 years, male 93%) commenced treatment (with ribavirin, 97%), of whom 77% (n = 23) were HIV-positive, 93% (n = 28) had genotype 1a infection and 53% (n = 16) had ever injected drugs. Median maximum ALT in the preceding 12 months was 433 IU/L (IQR 321, 1012). Acute clinical hepatitis with ALT > 10 x ULN was documented in 83% (n = 25); one participant (3%) had jaundice. At baseline, median estimated duration of infection was 30 weeks (range 11, 51), and median HCV RNA was 5.7 log10 IU/mL (range 2.7, 7.3). SVR12 was achieved in 97% (29/30; early discontinuation at week 2, n = 1; per protocol 100%, 29/29). No relapse or reinfection was observed. In conclusion, paritaprevir/ritonavir/ombitasvir and dasabuvir (with ribavirin) for eight weeks were highly effective among HIV-positive and HIV-negative individuals with recent HCV infection. These data support the use of this shortened duration direct-acting antiviral regimen in this population.
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Affiliation(s)
- M Martinello
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases and Immunology, St Vincent's Hospital, Sydney, NSW, Australia
| | - S Bhagani
- Department of Infectious Diseases/HIV Medicine, Royal Free Hospital, London, UK
| | - E Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | - C Orkin
- Barts Health, Royal London Hospital, London, UK
| | - G Cooke
- Department of Infectious Diseases, Imperial College NHS Trust, St Mary's Hospital, London, UK
| | - G J Dore
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases and Immunology, St Vincent's Hospital, Sydney, NSW, Australia
| | - K Petoumenos
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - T L Applegate
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - E Tu
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - P Marks
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - N Pagani
- Chelsea and Westminster Hospital, London, UK
| | - J Grebely
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - M Nelson
- Chelsea and Westminster Hospital, London, UK
| | - G V Matthews
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases and Immunology, St Vincent's Hospital, Sydney, NSW, Australia
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De Wit S, Battegay M, D'Arminio Monforte A, Lundgren JD, Oprea C, Antinori A, Bhagani S, Fätkenheuer G, Friis-Moller N, Furrer H, Mussini C. European AIDS Clinical Society Second Standard of Care Meeting, Brussels 16-17 November 2016: a summary. HIV Med 2017; 19:77-80. [PMID: 29076235 DOI: 10.1111/hiv.12559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2017] [Indexed: 12/01/2022]
Abstract
The European AIDS Clinical Society (EACS) organized a second meeting on Standard of Care in Europe on November 16-17 th, 2016. The aims of the meeting were to discuss and propose actions on three topics, namely: Adherence to guidelines for treatment initiation, treatment monitoring and outcomes, Retention in care and HIV and tuberculosis co-infection. Several actions need to be implemented in order to further improve quality of care and treatment of HIV in Europe. A common ground for standard of care, based on the EACS Guidelines should be established throughout Europe. EACS plans to interact with policy makers and other stakeholders to insure this common minimal level of standard of care, in particular for initiating of ART, accessibility of drugs and monitoring of ART with viral load. Progress should be made to monitor retention in care, prevent lost to follow and insure return to care. Improving integration of services and accessibility to care play a major role. Integration is also key for optimizing care of HIV-tuberculosis co-infection, as well as diagnosis and prevention of tuberculosis in population at risk. The Standard of Care meeting organized every other year by EACS provides a unique opportunity to monitor progresses and pitfalls in HIV patient care throughout Europe. It is also a forum for advocacy towards policy makers and other stakeholders to constantly improve HIV patient global management, aiming to provide the same level of quality on the whole continent.
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Affiliation(s)
- S De Wit
- Department of Infectious Diseases, Saint-Pierre University Hospital, Free University of Brussels (ULB), Brussels, Belgium
| | - M Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | | | - J D Lundgren
- Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - C Oprea
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
| | - A Antinori
- Lazzaro Spallanzani, National Institute for Infectious Diseases, Rome, Italy
| | | | - G Fätkenheuer
- Internal Medicine, University of Cologne, Köln, Germany
| | - N Friis-Moller
- Zealand University Hospital, Unit of Infectious Diseases, Roskilde, Denmark
| | - H Furrer
- Klinik und Poliklinik für Infektiologie, University Hospital Bern, Bern, Switzerland
| | - C Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
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Bhagani S, Winters C, Moreea S. Duodenal variceal bleed: an unusual cause of upper gastrointestinal bleed and a difficult diagnosis to make. BMJ Case Rep 2017; 2017:bcr-2016-218669. [PMID: 28242804 PMCID: PMC5337649 DOI: 10.1136/bcr-2016-218669] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We present a case of recurrent upper gastrointestinal (GI) bleeding in a man aged 57 years with primary biliary cholangitis who was ultimately diagnosed with an isolated duodenal variceal bleed, which was successfully treated with histoacryl glue injection. Duodenal varices are an uncommon presentation of portal hypertension and can result in significant GI bleeding with a high mortality. Diagnosis can be difficult and therapeutic options limited. Endoscopic variceal sclerotherapy with histoacryl glue provides an effective treatment, though endoscopists need to remain aware of and vigilant for the serious complications of this treatment option.
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Affiliation(s)
- Shradha Bhagani
- Department of Gastroenterology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Conchubhair Winters
- Department of Gastroenterology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Sulleman Moreea
- Department of Gastroenterology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Capocci S, Sewell J, Smith C, Cropley I, Bhagani S, Solamalai A, Morris S, Abubakar I, Johnson MA, Lipman MCI. S88 Neither uk tuberculosis infection testing guideline appears cost-effective in a contemporary hiv infected population. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.94] [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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Martin D, Howard J, Agarwal B, Rajalingam Y, Athan B, Bhagani S, Cropley I, Hopkins S, Mepham S, Rodger A, Warren S, Jacobs M. Ebola virus disease: the UK critical care perspective † †This Article is accompanied by Editorial Aew068. Br J Anaesth 2016; 116:590-6. [DOI: 10.1093/bja/aew098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2016] [Indexed: 11/15/2022] Open
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Mussini C, Antinori A, Bhagani S, Branco T, Brostrom M, Dedes N, Bereczky T, Girardi E, Gökengin D, Horban A, Lacombe K, Lundgren JD, Mendao L, Mocroft A, Oprea C, Porter K, Podlekareva D, Battegay M, d'Arminio Monforte A. European AIDS Clinical Society Standard of Care meeting on HIV and related coinfections: The Rome Statements. HIV Med 2015; 17:445-52. [PMID: 26492497 DOI: 10.1111/hiv.12347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of the 1st European AIDS Clinical Society meeting on Standard of Care in Europe was to raise awareness of the European scenario and come to an agreement on actions that could be taken in the future. METHODS Data-driven presentations were given on specific topics followed by interactive panel discussions. RESULTS In Eastern European countries, the epidemic is largely driven by injecting drug use, in contrast with Western Europe where the infection mainly occurs through heterosexual contact. A high proportion of people living with HIV remain unaware of their infection. Substantial differences exist in Eastern Europe and Central Asia with respect to treatment coverage, regimen availability and continuity of drug supply. In 2012, tuberculosis case notification rates were 5-10 times higher in Eastern Europe compared with Western Europe, with an alarming proportion of newly diagnosed multi-drug-resistant cases. Hepatitis C is widespread in selected geographical areas and risk groups. CONCLUSIONS The key conclusion from the meeting was that a high-priority group of actions could be identified, including: increasing HIV awareness and testing, improving training for health care providers, ensuring equitable patient access to treatments and diagnostics for HIV and comorbidities, and implementing best practices in infection control and treatment of HIV-infected patients coinfected with tuberculosis and hepatitis C virus, for whom direct acting antiviral treatment. should be considered.
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Affiliation(s)
- C Mussini
- University of Modena and Reggio Emilia, Modena, Italy
| | - A Antinori
- National Institute for Infectious Disease 'L. Spallanzani', Rome, Italy
| | - S Bhagani
- University College London, London, UK
| | - T Branco
- Department of Infectious Diseases, Hospital Center, Lisbon, Portugal
| | | | | | | | - E Girardi
- National Institute for Infectious Disease 'L. Spallanzani', Rome, Italy
| | | | - A Horban
- Warsaw Medical University and Hospital of Infectious Diseases, Warsaw, Poland
| | | | - J D Lundgren
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - A Mocroft
- University College London, London, UK
| | - C Oprea
- Victor Babes Hospital, Bucharest, Romania
| | - K Porter
- University College London, London, UK
| | - D Podlekareva
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - M Battegay
- University Hospital of Basel, Basel, Switzerland
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Bhagani S, Hutchison C. SP388RENAL RISK: A POPULATION STUDY OF NEW ZEALAND DIABETICS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv192.54] [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: 11/15/2022] Open
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13
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Matthews GV, Neuhaus J, Bhagani S, Mehta SH, Vlahakis E, Doroana M, Naggie S, Arenas-Pinto A, Peters L, Rockstroh JK. Baseline prevalence and predictors of liver fibrosis among HIV-positive individuals: a substudy of the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial. HIV Med 2015; 16 Suppl 1:129-36. [DOI: 10.1111/hiv.12241] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2014] [Indexed: 11/30/2022]
Affiliation(s)
- GV Matthews
- Kirby Institute; University of New South Wales; Sydney Australia
| | - J Neuhaus
- Division of Biostatistics; University of Minnesota; Minneapolis MN USA
| | | | - SH Mehta
- John Hopkins University; Baltimore MD USA
| | - E Vlahakis
- Taylor Square Private Clinic; Sydney Australia
| | - M Doroana
- Hospital Santa Maria; Lisbon Portugal
| | - S Naggie
- Duke University School of Medicine; Durham NC USA
| | - A Arenas-Pinto
- MRC Clinical Trials Unit at University College London; London UK
| | - L Peters
- CHIP; Department of Infectious Diseases and Rheumatology; Rigshospitalet; Copenhagen Denmark
| | - JK Rockstroh
- Department of Medicine; University of Bonn; Bonn Germany
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Capocci S, Sewell J, Smith C, Cropley I, Bhagani S, Morris S, Johnson M, Lipman M. S58 Prospective Health Economic Evaluation Of Different Recommended Strategies For Tb Testing In A Contemporary Hiv Positive Cohort. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.64] [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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Capocci S, Smith C, Cropley I, Bhagani S, Johnson MA, Lipman MCI. S41 Screening for latent TB in HIV: are NICE & BHIVA guidance effective? Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054b.41] [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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Singh R, Marshall N, Reynolds CJ, Breen RAM, Smith CJ, Swaden L, Bhagani S, Hopkins S, Johnson MA, Lipman MCI. P168 Rifabutin is a useful alternative to rifampicin in the treatment of active TB/HIV co-infection. Thorax 2010. [DOI: 10.1136/thx.2010.151043.19] [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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17
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Brook G, Main J, Nelson M, Bhagani S, Wilkins E, Leen C, Fisher M, Gilleece Y, Gilson R, Freedman A, Kulasegaram R, Agarwal K, Sabin C, Deacon-Adams C. British HIV Association guidelines for the management of coinfection with HIV-1 and hepatitis B or C virus 2010. HIV Med 2010; 11:1-30. [PMID: 20059574 DOI: 10.1111/j.1468-1293.2009.00781.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- G Brook
- British HIV Association (BHIVA), BHIVA Secretariat, Mediscript Ltd, London, UK.
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Rodger AJ, Brecker N, Bhagani S, Fernandez T, Johnson M, Tookman A, Bartley A. Attitudes and barriers to employment in HIV-positive patients. Occup Med (Lond) 2010; 60:423-9. [PMID: 20584766 DOI: 10.1093/occmed/kqq077] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Unemployment in the human immunodeficiency virus (HIV) population remains a major issue. Recent changes in the benefits system have triggered concerns about (re)integration into work for adults with HIV. AIMS To examine attitudes and barriers to employment in HIV patients. METHODS We undertook a cross-sectional study in the Royal Free HIV outpatient department from December 2008 to February 2009. The questionnaire collected data on demographics, date of HIV diagnosis, combination antiretroviral therapy, CD4 count, employment status, attitudes to work, psychological health and perception of barriers to employment. Logistic regression analyses were used to assess factors associated with not working. RESULTS Five hundred and forty-five HIV patients took part. Overall, 26% were not working and of these, half (53%) had been unemployed for >5 years. Associations with not working were having been diagnosed with HIV >10 years before, poor psychological health and poor attitudes to employment. There was no association between objective measures of health (CD4 count) and employment status. Those not working were less likely to agree with that 'work is good for physical and mental health' (90 versus 97%: P < 0.01) and more likely to agree that 'should only work if 100% fit and well' (76 versus 51%: P < 0.001) compared to workers. Those currently not working had negative perceptions of their abilities to gain employment and to remain in work. CONCLUSIONS There are opportunities for HIV services to provide psychological support around attitudes associated with unemployment and to help HIV-positive men in particular obtain and remain in work.
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Affiliation(s)
- A J Rodger
- Royal Free Centre for HIV Medicine, Royal Free Hampstead NHS Trust, London, UK
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19
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Walker NF, Kliner M, Turner D, Bhagani S, Cropley I, Hopkins S, Lipman M. Hepatotoxicity and antituberculosis therapy: time to revise UK guidance? Thorax 2009; 64:918. [DOI: 10.1136/thx.2009.115469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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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20
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van de Laar T, Pybus O, Bruisten S, Brown D, Nelson M, Bhagani S, Vogel M, Baumgarten A, Chaix ML, Fisher M, Gőtz H, Matthews G, Neifer S, White P, Rawlinson W, Pol S, Rockstroh J, Coutinho R, Dore G, Dusheiko G, Danta M. Evidence of a large, international network of HCV transmission in HIV-positive men who have sex with men. Gastroenterology 2009; 136:1609-17. [PMID: 19422083 PMCID: PMC4260925 DOI: 10.1053/j.gastro.2009.02.006] [Citation(s) in RCA: 238] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Since 2000, there has been a marked rise in acute hepatitis C virus (HCV) in human immunodeficiency virus (HIV)-positive men who have sex with men (MSM). We conducted an international phylogenetic study to investigate the existence of an HCV transmission network among MSM. METHODS HIV-positive MSM diagnosed with recent HCV (n = 226) in England (107), The Netherlands (58), France (12), Germany (25), and Australia (24) between 2000 and 2006 were enrolled into a molecular phylogenetic study. Using real-time polymerase chain reaction (PCR), the NS5B region of the HCV genome (436 base pair) was amplified, sequenced, and compared with unrelated NS5B sequences. RESULTS NS5B sequences were obtained from 200 (89%) cases. Circulating HCV genotypes were 1a (59%), 4d (23%), 3a (11%), 1b (5%), and 2b/c (3%). Phylogenetic analysis revealed 156 (78%) sequences that formed 11 clusters (bootstrap value > 70%) containing between 4 and 37 individual sequences. Country mixing was associated with larger cluster size (17 vs 4.5 sequences; P = .03). "Molecular clock" analysis indicated that the majority (85%) of transmissions occurred since 1996. CONCLUSIONS Phylogenetic analysis revealed a large international network of HCV transmission among HIV-positive MSM. The rapid spread of HCV among neighboring countries is supported by the large proportion (74%) of European MSM infected with an HCV strain co-circulating in multiple European countries, the low evolutionary distances among HCV isolates from different countries, and the trend toward increased country mixing with increasing cluster size. Temporally, this epidemic coincides with the introduction of highly active antiretroviral therapy and associated increases in sexual risk behaviors. International collaborative public health efforts are needed to mitigate HCV transmission among this population.
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Affiliation(s)
- T van de Laar
- Cluster of Infectious Diseases, Health Service, Amsterdam, Netherlands
| | - O Pybus
- Department of Zoology, University of Oxford, UK
| | - S Bruisten
- Cluster of Infectious Diseases, Health Service, Amsterdam, Netherlands
| | - D Brown
- UCL Centre for Hepatology, Royal Free Hospital, London, UK
| | - M Nelson
- Department of HIV Medicine, Chelsea and Westminster Hospitals, London, UK
| | - S Bhagani
- Department of HIV Medicine, Royal Free and University College, London, UK
| | - M Vogel
- Medizinische Klinik und Poliklinik I, Bonn University, Bonn, Germany
| | - A Baumgarten
- Practice Dupke/Carganico/Baumgarten, Berlin, Germany
| | - ML Chaix
- University Paris Descartes EA3620, Virology CHU Necker AP-HP, Paris France
| | - M Fisher
- Department of HIV Medicine, Brighton and Sussex University Hospitals Trust, Brighton, UK
| | - H Gőtz
- Department of Infectious Diseases, Health Service, Rotterdam, Netherlands
| | - G Matthews
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney Australia
| | - S Neifer
- Practice Dupke/Carganico/Baumgarten, Berlin, Germany
| | - P White
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, Australia
| | - W Rawlinson
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, Australia
| | - S Pol
- Hepatology Unit, Cochin hospital/University Paris-Descartes, Paris France
| | - J Rockstroh
- Medizinische Klinik und Poliklinik I, Bonn University, Bonn, Germany
| | - R Coutinho
- Cluster of Infectious Diseases, Health Service, Amsterdam, Netherlands,Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, Netherlands
| | - G Dore
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney Australia
| | - G Dusheiko
- UCL Centre for Hepatology, Royal Free Hospital, London, UK
| | - M Danta
- UCL Centre for Hepatology, Royal Free Hospital, London, UK,St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Australia
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21
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Danta M, Semmo N, Fabris P, Brown D, Pybus OG, Sabin CA, Bhagani S, Emery VC, Dusheiko GM, Klenerman P. Impact of HIV on host-virus interactions during early hepatitis C virus infection. J Infect Dis 2008; 197:1558-66. [PMID: 18419344 DOI: 10.1086/587843] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) may influence the outcome and natural history of hepatitis C virus (HCV) infection through an impact on acute HCV-specific T cell responses. METHODS Fifty-five HIV-positive males with acute HCV infection were identified; monoinfected individuals (n = 8) were used for peripheral blood mononuclear cell comparison. In 14 coinfected and 8 HCV-monoinfected patients, HCV-specific T cell responses against a range of HCV antigens were assessed using interferon (IFN)-gamma enzyme-linked immunospot (ELISpot) and proliferation assays. E1/E2 region genetic diversity and the selection pressure on the virus were measured in 8 coinfected patients by use of cloned sequences over time. RESULTS HCV persisted in 52 (95%) coinfected individuals. HCV/HIV coinfection significantly reduced IFN-gamma ELISpot responses versus those in HCV-monoinfected individuals, especially against nonstructural proteins (1/10 vs. 5/8; P = .008). In coinfected patients, increased HCV genetic diversity was observed between the first and subsequent time points, with no evidence for positive selection in the E1/E2 region sequenced. CONCLUSION HIV coinfection is associated with increased rates of HCV persistence and a lack of critical CD4 T cell responses, with no evidence of immune selection pressure during early HCV infection. Loss of key cellular immune responses against HCV during acute disease may contribute to the failure of early host control of HCV in HCV/HIV-coinfected patients.
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Affiliation(s)
- M Danta
- Centre for Hepatology, Royal Free and University College Medical School, London.
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22
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Rockstroh JK, Bhagani S, Benhamou Y, Bruno R, Mauss S, Peters L, Puoti M, Soriano V, Tural C. European AIDS Clinical Society (EACS) guidelines for the clinical management and treatment of chronic hepatitis B and C coinfection in HIV-infected adults. HIV Med 2008; 9:82-8. [PMID: 18257771 DOI: 10.1111/j.1468-1293.2007.00535.x] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES With the decline in HIV-associated morbidity and mortality following the introduction of highly active antiretroviral therapy (HAART), liver disease has emerged as a major cause of death in HIV/hepatitis B virus (HBV) and HIV/hepatitis C virus (HCV) coinfected persons. Therefore, screening for underlying viral hepatitis coinfection and the provision of management and treatment recommendations for patients with chronic viral hepatitis are of great importance in preventing, as far as possible, the development of liver disease. With the introduction of new agents for the treatment of hepatitis B and increased knowledge of how best to manage hepatitis C, an update of current guidelines for management of HBV and HCV coinfection with HIV is warranted. SUMMARY Clearly, all HIV-infected patients should be screened for hepatitis A, B and C, taking into account shared pathways of transmission. Patients who are seronegative for hepatitis A and B should be considered for vaccination. In HIV-infected patients with chronic hepatitis B, the first important differentiation is whether HAART is required or not. In the setting of stable HIV infection, with no need for HAART, several treatment options are available, namely treatment with interferon, early initiation of HAART, or selective non-HIV active anti-HBV nucleoside therapy, with the aim of achieving undetectable HBV DNA levels. In most cases, undetectable HBV DNA can only be achieved with combination therapy. With regard to hepatitis C, individualized tailoring of the duration of HCV therapy is advisable, taking into account rapid or delayed virological response. In patients who do not achieve at least a 2 log drop in HCV RNA at week 12, treatment can be terminated because of the low probability of achieving sustained virological response. Overall, with the currently available treatment algorithms, HCV can be eradicated in over 50% of patients. Therefore, HCV therapy should be considered and discussed with the patient if an indication for HCV therapy (elevated liver enzymes, positive HCV RNA and >F1 fibrosis) is present. CONCLUSIONS Management of underlying hepatitis B and/or C in patients with HIV infection is of great importance in preventing liver disease-associated morbidity and mortality.
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Affiliation(s)
- J K Rockstroh
- Department of Medicine I, University of Bonn, Bonn, Germany.
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23
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Breen RAM, Leonard O, Perrin FMR, Smith CJ, Bhagani S, Cropley I, Lipman MCI. How good are systemic symptoms and blood inflammatory markers at detecting individuals with tuberculosis? Int J Tuberc Lung Dis 2008; 12:44-49. [PMID: 18173876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
SETTING The diagnosis of tuberculosis (TB) may be rejected in the absence of symptoms such as fever, sweats or weight loss. OBJECTIVES To determine how frequently these features and blood test evidence of inflammation were absent in individuals with TB. METHODS Prospective cohort study of 175 unselected subjects diagnosed with TB at a UK TB service between 2003 and 2006. RESULTS Eight (5%) subjects identified by screening and 24 (14%) without culture confirmation were excluded. Of the remaining 143, fever, sweats or weight loss were absent in respectively 37%, 39% and 38%. All three symptoms were absent in 25%. In 88 subjects with pulmonary disease, all three symptoms were absent in 20% (10% of smear-positive cases). Overall, C-reactive protein was normal in 15%, erythrocyte sedimentation rate in 21% and lactate dehydrogenase in 55%. In a multivariable model, factors associated with absent symptoms included drug-resistant TB (adjusted odds ratio [aOR] 3.58, P = 0.004) and female sex (aOR 3.15, P = 0.004). CONCLUSIONS In our population, TB, including pulmonary disease, frequently presented without fever, sweats or weight loss and with normal blood inflammatory markers. This information is of as much relevance to policy makers seeking to improve active case detection as to clinicians and the general public.
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Affiliation(s)
- R A M Breen
- Department of Thoracic Medicine, Royal Free Hospital, London, UK.
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24
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Giraudon I, Ruf M, Maguire H, Charlett A, Ncube F, Turner J, Gilson R, Fisher M, Bhagani S, Johnson M, Barton S. Increase in diagnosed newly acquired hepatitis C in HIV-positive men who have sex with men across London and Brighton, 2002-2006: is this an outbreak? Sex Transm Infect 2007; 84:111-5. [PMID: 17932125 DOI: 10.1136/sti.2007.027334] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To determine the incidence of diagnosed newly acquired hepatitis C virus (HCV) in HIV-positive men who have sex with men (MSM) across London and Brighton in order to inform public health interventions. METHODS Cases were defined as MSM attending London and Brighton HIV/genitourinary medicine clinics from January 2002 to June 2006, with HCV PCR RNA or antibody positive, and a negative HCV test in the previous three years. The yearly number of cases and HCV screening policy in MSM were examined. A negative binomial regression model was used to estimate HCV incidence density rate ratio and 95% CI. RESULTS 20 out of 38 clinics provided information, covering 84% of the HIV-positive MSM workload in London and 100% in Brighton. The estimated overall incidence was 9.05 per 1000 HIV-positive MSM patient-years. It increased from 6.86 per 1000 in 2002 to 11.58 per 1000 during January-June 2006. Incidence at clinics ranged from 0 to 15.4 (median 6.52) per 1000 HIV-positive MSM patient-years. There was some evidence of difference in the incidence and trend (p = 0.02) in each clinic. The average annual rise in incidence of HCV was 20% (95% CI 4% to 39%, p = 0.001). There was little evidence of such transmission among MSM with negative or unknown HIV status. CONCLUSIONS HCV incidence clearly increased among HIV-positive MSM in London and Brighton during January 2002 to June 2006. Prospective enhanced surveillance of HCV in MSM, including HIV status and behavioural risk factors, is recommended to help inform control measures and better determine the frequency of transmission in all MSM.
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Affiliation(s)
- I Giraudon
- Health Protection Agency, Regional Epidemiology Unit London, 7th Floor, Holborn Gate, 330 High Holborn, London WC1V 7PP, UK.
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Affiliation(s)
- S Bhagani
- Department of HIV Medicine, Royal Free Hospital, London, UK
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Abstract
Pegylated interferon (pegIFN)/ribavirin has been established as the treatment of choice for chronic hepatitis C in HIV co-infected individuals [1-3]. We report the case of an individual who was well prior to treatment, but was diagnosed with tuberculous adenitis after receiving 12 weeks of pegIFN/ribavirin therapy. The association of pegIFN and ribavirin therapy with tuberculosis (TB) has not been described previously.
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Affiliation(s)
- B Killingley
- Royal Free Centre for HIV Medicine, Royal Free Hospital, London, UK.
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Abstract
An outbreak of trichinellosis that occurred in the United Kingdom is described. Members of four households consumed pork salami from northern Serbia, the Federal Republic of Yugoslavia. Eight cases of trichinellosis occurred. Clinical and laboratory features of the cases were typical with myalgia (7 cases), fever (6), headache (5), periorbital oedema (4), non-specific ST/T wave changes on electrocardiogram (3), Trichinella antibodies (6), eosinophilia (7) and raised serum creatine kinase (3). All recovered. Trichinella larvae were detected in the salami. During pre-travel counselling, travellers should be advised about possible risk from cured pork products which have been produced locally in Trichinella endemic areas.
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Affiliation(s)
- L M Milne
- West Hertfordshire Health Authority, St Albans
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Sabin CA, Telfer P, Phillips AN, Bhagani S, Lee CA. The association between hepatitis C virus genotype and human immunodeficiency virus disease progression in a cohort of hemophilic men. J Infect Dis 1997; 175:164-8. [PMID: 8985212 DOI: 10.1093/infdis/175.1.164] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.4] [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: 02/03/2023] Open
Abstract
Patients coinfected with both hepatitis C virus (HCV) and the human immunodeficiency virus (HIV) have more rapid progression of HCV infection; however, little is known about the effect of coinfection with HCV on the progression of HIV disease. This study assessed the association between infection with different HCV genotypes on progression to AIDS and death in a cohort of men with hemophilia. Patients infected with HCV type 1 experienced a more rapid progression to both AIDS (P = .009) and death (P = .007) than did those infected with other types. This effect was largely independent of age at seroconversion, hemophilia diagnosis, and changes in CD4 cell count over the follow-up period. These results suggest an association between HCV genotype and progression of HIV disease, which, if confirmed, could have important implications for the treatment and care of patients coinfected with both HIV and HCV.
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Affiliation(s)
- C A Sabin
- Haemophilia Centre, Department of Haematology, Royal Free Hospital and School of Medicine, London, United Kingdom
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