Herring roe oil in treatment of psoriasis - influence on immune cells and cytokine network

Background

Psoriasis is a chronic immune-mediated skin disease with systemic inflammation and comorbidities. Although the disease severity may vary over time, many patients suffer from mild to moderate disease. Often local treatment will be sufficient to control the symptoms, but they may have several side effects. ω-3 polyunsaturated fatty acids have shown promising results in clinical trials with mild-to-moderate psoriasis.

Methods

We explored the impact of phospholipid bound docosahexaenoic acid and eicosapentaenoic acid in a 3:1 ratio on immune cells and cytokine networks in peripheral blood of patients with psoriasis. We investigated the inter-relation of plasma cytokine levels and disease severity in 58 patients, and explored the status of circulating immune cell activity in 18 patients with non-severe psoriasis before and during herring roe oil supplementation. Plasma concentration of 22 cytokines was measured by Luminex technology and circulating immune cells were analyzed by multicolor flow cytometry.

Results

CCL2 levels decreased over time, and IFN-γR1 increased, possibly related to the action of ω-3 polyunsaturated fatty acids. We observed a shift from naïve to effector CD4+ T cells and decreases of CD38 expression on CD4+ and CD8+ T cells, CD56bright NK cells and CD14+CD16- classical monocytes.

Conclusions

These findings support the beneficial effect of herring roe oil supplementation.

Biomarkers of inflammation and left ventricular remodelling in psoriasis patients treated with infliximab

Objective: Psoriasis is an immune mediated disorder associated with T cell activation and cardiovascular disease (CVD). We explored the association of inflammation with left ventricular (LV) remodelling in psoriasis patients receiving treatment with the tumour necrosis factor-α (TNF-α) blocker infliximab. Methods: Psoriasis patients (n = 47, age 47 ± 14 years, 66% men) and 99 control subjects without psoriasis (age 47 ± 11 years, 72% men) were examined by echocardiography in a cross-sectional study. LV remodelling was assessed by LV mass index for height in the allometric power of 2.7. Serum concentrations of C-reactive protein (CRP), serum amyloid A (SAA), neopterin, kynurenine:tryptophan ratio (KTR) and the pyridoxic acid ratio (PAr) index were measured. Results: Serum concentration of neopterin (p = .007) was higher in psoriasis patients, while the other inflammatory biomarkers had similar levels. LV mass index was lower in patients than controls (35.6 ± 9.6 g/m^2.7 vs. 40.3 ± 9.8 g/m^2.7, p = .008). In the total study population, serum SAA (β = 0.18, p = .02), KTR (β = 0.20, p = .02) and the PAr index (β = 0.26, p = .002) were all associated with higher LV mass index independent of age, sex, body mass index, hypertension, smoking, renal function and psoriasis. Also in psoriasis patients, higher SAA level (β = 0.34, p = .02), KTR (β = 0.32, p = .02) and the PAr index (β = 0.29, p = .05) were associated with higher LV mass index independent of body mass index, hypertension and diabetes. Conclusion: Higher levels of the inflammatory biomarkers SAA, KTR and the PAr index were associated with greater LV mass index in psoriasis patients, indicating a role of chronic inflammation in LV remodelling evident even during treatment with TNF-α blockers.

Psoriasis severity and the risk of left ventricular remodelling in psoriasis patients treated with infliximab

Background

Psoriasis is an immune mediated skin disorder with a great variation in disease severity. Chronic inflammation predisposes to subclinical cardiac damage like left ventricular (LV) remodelling. However, the association of psoriasis severity with LV remodelling is not known.

Purpose

To assess LV remodelling in patients with moderate to severe psoriasis treated with infliximab.

Methods

Psoriasis severity was assessed by the Psoriasis Area Severity Index (PASI) before initiation of treatment with the tumour necrosis factor α inhibitor infliximab in 53 patients (age 47±15 years, 30% women, body mass index (BMI) 29.2±5.5 kg/m2). Echocardiography was preformed after a mean follow-up of 4.9±3.8 years and compared to 99 control subjects (age 47±11 years, 28% women, BMI 29.9±3.9 kg/m2). LV remodelling was assessed from LV relative wall thickness and LV mass index by echocardiography.

Results

Both psoriasis patients and controls had high prevalence of hypertension (66% vs. 61%, p=0.54) and obesity (34% vs. 33% p=0.94). Psoriasis patients were more likely to be smokers than controls (37% vs. 17%, p=0.005), but other cardiovascular risk factors were similarly distributed. Psoriasis patients had higher LV relative wall thickness (0.38±0.09 vs. 0.34±0.07, p=0.001), but lower LV mass index (36.1±9.6 g/m2.7 vs. 40.3±9.8 g/m2.7, p=0.014), compared to controls. Having psoriasis remained associated with higher LV relative wall thickness (β 0.25, p=0.002) and lower LV mass index (β-0.20, p=0.02) in multivariable analyses after adjustment for age, sex, smoking, hypertension and BMI. In psoriasis patients mean PASI decreased from 16.1±11.5 to 0.8±0.8 during infliximab treatment, p<0.001. Higher PASI at start of treatment was associated with a higher LV relative wall thickness at follow-up (Table), but not with higher LV mass index in univariable analyses. After adjusting for sex, age and hypertension, higher PASI at start of treatment (β 0.36, p=0.006) still predicted greater LV relative wall thickness at follow-up in psoriasis patients (Table).

Conclusion

Higher psoriasis severity before infliximab treatment predicted presence of adverse LV remodelling after 4.9 years treatment despite nearly complete clinical remission.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Western and South-Eastern Regional Health Authorities of Norway and Hjertefondet, University of Bergen.

Subclinical cardiac organ damage in patients with moderate to severe psoriasis treated with infliximab

Background

Psoriasis is an immune mediated disease that has been associated with elevated risk of cardiovascular (CV) disease. Comorbidities, psoriasis treatment and presence of subclinical cardiac organ damage can modulate CV risk in psoriasis.

Purpose

To assess the prevalence and covariables of subclinical cardiac organ damage in patients with moderate-to-severe psoriasis on infliximab treatment.

Methods

Echocardiography was performed in 53 psoriasis patients (age 47±15 years, 30% women) and 99 control subjects (age 47±11 years, 28% women). Subclinical cardiac organ damage was defined as presence of left ventricular (LV) hypertrophy, concentric LV geometry and/or dilated left atrium. Psoriasis area and severity index (PASI) was used to assess the severity of psoriasis. Hypertension was defined as use of antihypertensive medication/history of hypertension and/or elevated ambulatory blood pressure ≥130/80 mmHg.

Results

Hypertension was the most common comorbidity, present in 66% of patients and 61% of control subjects (p=0.54). Smoking was more prevalent in psoriasis patients than controls (37% vs 17%, p=0.005), while other CV risk factors and antihypertensive treatment did not differ between groups. Subclinical cardiac organ damage was less prevalent in psoriasis patients than controls (51% vs. 73%, p=0.007, Figure). In the total study cohort, having psoriasis was associated with lower prevalence of subclinical cardiac organ damage independent of hypertension, smoking, age and sex (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.13–0.72, p=0.007) in logistic regression analysis. Among psoriasis patients, hypertension was associated with a near seven-fold increased risk of cardiac organ damage (OR 6.88 [95% CI 1.32–35.98], p=0.022) independent of age, sex and body mass index. PASI at start of treatment or current PASI was not associated with presence of subclinical cardiac organ damage.

Conclusion

Psoriasis patients on infliximab treatment had less subclinical cardiac organ damage compared with controls, suggesting that inhibition of CV inflammation may attenuate cardiac organ damage in psoriasis. Hypertension was the strongest covariable for subclinical cardiac organ damage in psoriasis patients.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Western and South-Eastern Regional Health Authorities of Norway and Hjertefondet, University of Bergen.

Temperature-dependent autoactivation associated with clinical variability of PDGFRB Asn666 substitutions

Ocular pterygium-digital keloid dysplasia (OPDKD) presents in childhood with ingrowth of vascularized connective tissue on the cornea leading to severely reduced vision. Later the patients develop keloids on digits but are otherwise healthy. The overgrowth in OPDKD affects body parts that typically have lower temperature than 37°C. We present evidence that OPDKD is associated with a temperature sensitive, activating substitution, p.(Asn666Tyr), in PDGFRB. Phosphorylation levels of PDGFRB and downstream targets were higher in OPDKD fibroblasts at 37°C but were further greatly increased at the average corneal temperature of 32°C. This suggests that the substitution cause significant constitutive autoactivation mainly at lower temperature. In contrast, a different substitution in the same codon, p.(Asn666Ser), is associated with Penttinen type of premature aging syndrome. This devastating condition is characterized by widespread tissue degeneration, including pronounced chronic ulcers and osteolytic resorption in distal limbs. In Penttinen syndrome fibroblasts, equal and high levels of phosphorylated PDGFRB was present at both 32°C and 37°C. This indicates that this substitution causes severe constitutive autoactivation of PDGFRB regardless of temperature. In line with this, most downstream targets were not affected by lower temperature. However, STAT1, important for tissue wasting, did show further increased phosphorylation at 32°C. Temperature-dependent autoactivation offers an explanation to the strikingly different clinical outcomes of substitutions in the Asn666 codon of PDGFRB.

A Randomized, Double-blind, Placebo-controlled Clinical Study to Investigate the efficacy of Herring Roe Oil for treatment of Psoriasis

The effect of omega-3 polyunsaturated fatty acid supplements in patients with psoriasis vulgaris has previously been investigated, but interventions varied in source, composition, dose, administration route and duration of treatment. The observed beneficial effects in patients with psoriasis vulgaris using herring roe oil as a dietary supplement prompted this investigation. This randomised, double-blind and placebo-controlled study was designed and performed to explore the efficacy and safety of herring roe oil supplementation in 64 patients with plaque psoriasis (ClinicalTrials.gov: NCT03359577). The primary end-point was comparing the change in mean Psoriasis Area Severity Index (PASI) scores in the herring roe oil treatment group and the placebo group from baseline to week 26. In the intention-to-treat population, a statistically significant improvement in the mean PASI score was observed with herring roe oil compared to placebo at 26 weeks. In the recruited patient group, the measured improvement was greatest in patients with a PASI score from 5.5-9.9 at baseline.

A young male with epitheliolysis in the small bowel and colon

Background: Toxic epidermal necrolysis (TEN) is characterized by epidermal necrosis of various degree, and can affect the entire body surface. Affection of small bowel and colon is a rare manifestation of TEN. We present a case with an unusual appearance of epitheliolysis of the small bowel and colon due to a toxic reaction.Case report: A 19 year old male was diagnosed with ulcerative colitis (UC) after treatment with tetracyclines followed by isotretinoin due to acne vulgaris. Medical treatment did not lead to improvement of his UC, and an emergency resection of the colon was performed. Postoperatively his condition worsened due to small bowel epitheliolysis, and he recovered finally 6 months later after a partial small bowel resection.Conclusion: The true cause of this very serious situation with severe gastrointestinal involvement is not fully understood. In this case, successive treatment with antibiotics and isotretinoin given to a patient with an inflamed colon might have triggered the destruction of the epithelial barrier, leading to an immense immunological reaction in the intestinal wall. We suggest that physicians should be aware of UC-like symptoms occurring prior to or during treatment with tetracyclines and/or isotretinoin.

P6373Serum amyloid A and left ventricular mass in psoriasis patients treated with infliximab

Background

Serum amyloid A (SAA) is an acute phase reactant associated with amyloid tissue deposition. Chronic skin inflammation in psoriasis could cause increased production of SAA in the liver and subsequent deposition in cardiac tissue.

Purpose

To assess if higher SAA is associated with higher left ventricular (LV) mass in psoriasis patients treated with infliximab

Methods

Data from 47 psoriasis patients treated with the tumour necrosis factor-α blocker infliximab (mean age 47±14 years, 66% men) was compared to 106 age and sex-matched control subjects (mean age 47±11 years, 70% men). LV mass was assessed by echocardiography and index to height m2.7. SAA was analysed by Matrix-Assisted Laser Desorption/Ionization Time-Of-Flight mass spectrometry.

Results

Psoriasis patients were more likely to be smokers than controls (38% vs. 16%, p=0.005), while other cardiovascular risk factors and SAA levels were similar. Psoriasis patients had lower LV mass index than controls (35.6±9.6 g/m2.7 vs. 40.3±9.8 g/m2.7, p=0.008). In the total study population, higher SAA level (β=0.23, p=0.003) was associated with higher LV mass index independent of presence of psoriasis (Table). In psoriasis patients, higher SAA level (β=0.48, p<0.001) was associated with higher LV mass index after adjustment for age and body mass index in multivariable analysis (Table). No association between SAA and LV mass index was found in controls.

Table 1. Multivariable associations of LV mass index in the total study population and in psoriasis patients Total study population Psoriasis LV mass index LV mass index R2=0.33, p<0.001 R2=0.43, p<0.001 β P β P Psoriasis −0.21 0.006 na na SAA, μg/ml 0.23 0.003 0.48 <0.001 BMI, kg/m2 0.39 <0.001 0.50 <0.001 Age, years 0.18 0.03 0.11 0.35 Female gender −0.11 0.15 – – Hypertension 0.08 0.35 – – Smoking 0.03 0.75 – – BMI, body mass index; LV, left ventricular; SAA, serum amyloid A; na, not applicable.

Conclusion

In psoriasis patients on infliximab treatment, higher SAA level was associated with greater LV mass index, pointing to a potential role of chronic inflammation and SAA production in the development of subclinical cardiac disease in psoriasis.

Acknowledgement/Funding

Western Regional Health Authority of Norway, Hjertefondet

Long-term efficacy and safety of biosimilar infliximab (CT-P13) after switching from originator infliximab: open-label extension of the NOR-SWITCH trial

BACKGROUND AND OBJECTIVES

The 52-week, randomized, double-blind, noninferiority, government-funded NOR-SWITCH trial demonstrated that switching from infliximab originator to less expensive biosimilar CT-P13 was not inferior to continued treatment with infliximab originator. The NOR-SWITCH extension trial aimed to assess efficacy, safety and immunogenicity in patients on CT-P13 throughout the 78-week study period (maintenance group) versus patients switched to CT-P13 at week 52 (switch group). The primary outcome was disease worsening during follow-up based on disease-specific composite measures.

METHODS

Patients were recruited from 24 Norwegian hospitals, 380 of 438 patients who completed the main study: 197 in the maintenance group and 183 in the switch group. In the full analysis set, 127 (33%) had Crohn's disease, 80 (21%) ulcerative colitis, 67 (18%) spondyloarthritis, 55 (15%) rheumatoid arthritis, 20 (5%) psoriatic arthritis and 31 (8%) chronic plaque psoriasis.

RESULTS

Baseline characteristics were similar in the two groups at the time of switching (week 52). Disease worsening occurred in 32 (16.8%) patients in the maintenance group vs. 20 (11.6%) in the switch group (per-protocol set). Adjusted risk difference was 5.9% (95% CI -1.1 to 12.9). Frequency of adverse events, anti-drug antibodies, changes in generic disease variables and disease-specific composite measures were comparable between arms. The study was inadequately powered to detect noninferiority within individual diseases.

CONCLUSION

The NOR-SWITCH extension showed no difference in safety and efficacy between patients who maintained CT-P13 and patients who switched from originator infliximab to CT-P13, supporting that switching from originator infliximab to CT-P13 is safe and efficacious.

Quality of life and contact with healthcare systems among patients with psoriasis and psoriatic arthritis: results from the NORdic PAtient survey of Psoriasis and Psoriatic arthritis (NORPAPP)

Psoriasis (skin psoriasis, PsO) is a chronic inflammatory condition. In about one-third of cases, the joints are affected (psoriatic arthritis, PsA). Both conditions, especially PsA, profoundly impact patients’ health-related quality of life (HRQoL). To describe the impact of psoriasis on HRQoL and patients’ contact with the healthcare system in Sweden, Denmark, and Norway, the NORdic PAtient survey of Psoriasis and Psoriatic arthritis (NORPAPP) asked 22,050 adults randomly selected in Sweden, Denmark and Norway if they had psoriasis. 1264 individuals who reported physician-diagnosed PsO/PsA were invited to the full survey; 1221 responded (74.6% diagnosed with PsO alone; 25.4% with PsA ± PsO). Respondents with PsA most frequently consulted a rheumatologist; however, 14.3% had never seen a rheumatologist. Respondents with PsO alone most frequently consulted a general practitioner and 10.7% had never seen a dermatologist (although those with severe symptoms visited dermatologists more often). Negative impacts on HRQoL were reported by 38.1% of respondents with PsO [mostly limitations on clothing (22.6%), sleep disorders (16%), and depression/anxiety (16%)] and by 73% of respondents with PsA [mostly limitations on clothing (41.8%), sports/leisure (44.0%), or daily routine (45.1%) and sleeping disorders]. Absence from work/education was more common with PsA ± PsO (51.9%) than PsO alone (15.1%). In this survey in Sweden, Denmark, and Norway, the impact of psoriasis on the respondents’ HRQoL was profound and was greater for PsA than for PsO, as was sickness absence. Sleeping disorders and depression were common and should not be overlooked.

Prevalence of Psoriasis and Psoriatic Arthritis and Patient Perceptions of Severity in Sweden, Norway and Denmark: Results from the Nordic Patient Survey of Psoriasis and Psoriatic Arthritis

Optimal clinical management of psoriasis and psoriatic arthritis (PsA) Optimal clinical management of psoriasis and psoriatic arthritis (PsA) requires understanding of the impact on patients. The NORdic PAtient survey of Psoriasis and PsA (NORPAPP) aimed to obtain current data on disease prevalence and patient perceptions in Sweden, Denmark and Norway. Among 22,050 individuals questioned, the reported prevalence of psoriasis and/or PsA was 9.7% (5.7% physician-diagnosed plus 4.0% self-diagnosed only); prevalence was similar in Sweden (9.4%) and Denmark (9.2%) but significantly higher in Norway (11.9%). Of those reporting a physician's diagnosis, 74.6% reported psoriasis alone, 10.3% PsA alone and 15.1% both. Patients with PsA perceived their disease to be more severe than those with psoriasis; patients with PsA and psoriasis reported greater disease severity than those with each condition alone. Patient's perceptions of psoriasis severity correlated weakly (Spearman's rho 0.42) with clinical severity; both patient perceptions and clinical measures are important in the assessment and management of psoriasis.

A tyrosine kinase-activating variant Asn666Ser in PDGFRB causes a progeria-like condition in the severe end of Penttinen syndrome

Missense variants located to the "molecular brake" in the tyrosine kinase hinge region of platelet-derived growth factor receptor-β, encoded by PFGFRB, can cause Penttinen-type (Val665Ala) and Penttinen-like (Asn666His) premature ageing syndromes, as well as infantile myofibromatosis (Asn666Lys and Pro660Thr). We have found the same de novo PDGFRB c.1997A>G p.(Asn666Ser) variants in two patients with lipodystrophy, acro-osteolysis and severely reduced vision due to corneal neovascularisation, reminiscent of a severe form of Penttinen syndrome with more pronounced connective tissue destruction. In line with this phenotype, patient skin fibroblasts were prone to apoptosis. Both in patient fibroblasts and stably transduced HeLa and HEK293 cells, autophosphorylation of PDGFRβ was observed, as well as increased phosphorylation of downstream signalling proteins such as STAT1, PLCγ1, PTPN11/SHP2-Tyr580 and AKT. Phosphorylation of MAPK3 (ERK1) and PTPN11/SHP2-Tyr542 appeared unaffected. This suggests that this missense change not only weakens tyrosine kinase autoinhibition, but also influences substrate binding, as both PTPN11 tyrosines (Tyr542 and Tyr580) usually are phosphorylated upon PDGFR activation. Imatinib was a strong inhibitor of phosphorylation of all these targets, suggesting an option for precision medicine based treatment.

Treatment use and satisfaction among patients with psoriasis and psoriatic arthritis: results from the NORdic PAtient survey of Psoriasis and Psoriatic arthritis (NORPAPP)

Background

There are scarce data in Scandinavia about treatment satisfaction among patients with psoriasis (PsO) and/or psoriatic arthritis (PsA). The number of patients receiving systemic treatment is unknown.

Objective

To describe patients’ experience of treatments for PsO/PsA in Sweden, Denmark and Norway, addressing communication with physicians, satisfaction with treatment and concerns regarding treatment options.

Methods

The NORdic PAtient survey of Psoriasis and Psoriatic arthritis (NORPAPP) asked 22 050 adults (randomly selected from the YouGov panels in Sweden, Denmark and Norway) whether they had PsO/PsA. A total of 1264 individuals who reported physician‐diagnosed PsO/PsA were invited to participate in the full survey; 96.6% responded positively.

Results

Systemic treatment use was reported by 14.6% (biologic: 8.1%) of respondents with PsO only and by 58.5% (biologic: 31.8%) of respondents with PsA. Biologic treatments were more frequently reported by respondents considering their disease severe (26.8% vs 6.7% non‐severe) and those who were members of patient organizations (40.7% vs 6.9% non‐members). Discussing systemic treatments with their physician was reported significantly more frequently by respondents with PsA, those perceiving their disease as severe (although 35.2% had never discussed systemic treatment with their physician) and those reporting being a member of a patient organization (P < 0.05). Many respondents reported health risk concerns and dissatisfaction with their treatment. Of special interest was that respondents aged 45–75 years reported less experience with biologics (8.1%) than those aged 18–44 years (21.5%). The older respondents also reported more uncertainty regarding long‐term health risks related to systemic treatments (most [66.7–72.9%] responded ‘do not know’ when asked about the risk of systemic options).

Conclusion

It appears likely that substantial numbers of Scandinavians suffering from severe PsO/PsA are not receiving optimal treatment from a patient perspective, particularly older patients. Also, one‐third of respondents with severe symptoms had never discussed systemic treatment with a physician.

Ocular pterygium--digital keloid dysplasia

We describe an adolescent Peruvian male with marked, aggressive ingrowth of conjunctiva (pterygium-like) over the cornea associated with keloid formation on his distal limbs. He has in addition camptodactyly of all fingers and to some extent of his toes, and unusual skin pigmentations. He resembles an earlier described family from Norway in which a mother and two children showed a similar combination of signs. We present the follow-up of the Norwegian family. The entity resembles the Penttinen syndrome but can be differentiated due to the early aging in the latter, which is lacking in the presently reported entity. We suggest naming this entity ocular pterygium-digital keloid dysplasia. The condition follows likely an autosomal dominant pattern of inheritance.

Casual sex, extramarital sex, condom use and alcohol intake among heterosexual patients attending an STD clinic in Norway

A study excluding homosexuals was performed to study casual sex, extramarital sex, the use of a condom with a casual sexual partner and the combination of alcohol intake and casual sex among patients attending a clinic for sexually transmitted diseases (STDs). Heterosexual patients (467) received a questionnaire, and 458 were included. Men reported more (94%) casual sexual partners than did women (76%). According to a multiple logistic regression analysis a condom was used significantly less frequently in "old" respondents, those having a permanent sexual partner, those having low education, those infected with STDs (earlier STDs), those who had had more than 4 sexual partners over the last year, and those combining alcohol intake and casual sex. Intravenous drug users/prostitutes used a condom more often than did men with paid sex and "other heterosexuals". To have an effect on STD patients, innovative forms of health education may be necessary, and greater emphasis should be placed on more informal means of information, including interactive health education and communication strategies to promote positive attitudes regarding condom use.

Knowledge of HIV infection and the fear of mixing socially with HIV-infected and AIDS-sick patients among STD patients in Bergen, Norway

This is a study of data from 599 STD (sexually transmitted disease) clinic patients in Bergen, Norway who visited the clinic in April-June 1989. We studied the patients' knowledge of modes of HIV transmission and their degree of ignorance of how HIV is not transmitted. Particular interest was focused on how misconceptions influenced the respondents' perception of HIV/AIDS sick persons and the importance of confidence in AIDS information from the health authorities. The objective of the study was to compare the data from this investigation of STD patients with data from similar studies in the general public conducted in Norway between 1986 and 1991. HIV-infected blood (98.3%; 589/599) and unprotected vaginal intercourse (91%; 545/599) were frequently suggested as a mode of HIV transmission, while 22.4% (134/599) did not recognize anal sex as an unsafe sexual practice. There was no statistically significant difference in their knowledge of modes of HIV transmission between the following patient subgroups: homosexuals/bisexuals, intravenous drug users (IVDUs)/prostitutes, sex customers and respondents classified as 'other heterosexuals'. Regarding ways in which HIV is not transmitted, ignorance was first and foremost related to whether the HIV virus could be passed on by oral kissing (wrong: 38.5%). Knowledge of how HIV is not transmitted was positively correlated with education (p < 0.05) and confidence in the HIV/AIDS information from health authorities (p < 0.05), and negatively correlated with age (p < 0.05). Respondents knowing how HIV is not transmitted considered social contact with HIV/AIDS sick persons to be harmless (p < 0.001). The present information campaigns on HIV/AIDS have been less effective than expected. In the future we must find new ways of informing the public by identifying the essential components that are missing from the information campaigns we have today.

Casual sexual experience abroad in patients attending an STD clinic and at high risk for HIV infection

OBJECTIVE

To study possible "import" routes of HIV infection to Norway (by obtaining information on casual sexual contacts abroad from patients attending an STD clinic), and to assess their behavioural risk factors (such as alcohol intake, use of condom) for HIV infection.

DESIGN AND SETTING

Patients visiting the clinic for sexually transmitted diseases (STD), April-June 1989, received a questionnaire.

SUBJECTS

606 consecutive persons of whom 599 agreed (98.8%) to participate. We grouped the patients in four categories. 1: Sex with a prostitute during the last 5 years, 2: Homosexuals/bisexuals, 3: prostitutes/intravenous drug abusers (IVDUs) and 4: Other heterosexuals.

RESULTS

245 patients (41%) reported having a casual sex partner abroad (M: 182, F: 63), mainly in Europe, particularly in Spain, Denmark and Greece. Outside Europe such contacts were most frequently reported from USA, Brazil and Thailand. Among men who had had sex with a prostitute, 93.5% reported such sex abroad (homosexuals/bisexuals: 63.6%, prostitutes/IVDUs: 66.7%, "other heterosexuals: 32.1%). Homosexual/bisexual men with casual partner(s) abroad used a condom more frequently than did others.

CONCLUSION

245 of 599 persons reported casual sex abroad during 1985-1989, and the different "risk groups" reported countries where most HIV infected persons belonged to their own "risk group". We have reason to believe that alcohol intake increased the likelihood of casual sexual activity and decreased the use of condom. Norwegian travellers need more information on the risks of casual sex abroad, the use of condoms and the combination of alcohol intake and casual sex.

HIV-seropositive rate and HIV test activity among STD clinic attendees in Bergen, Norway

We wanted to determine the HIV seropositive rate and to study the connection between previous HIV testing, acceptance of HIV testing and sexual behaviour among STD clinic patients in Bergen, Norway. Patients attending the STD clinic in 1986-93 requesting HIV testing were registered, and all patients visiting the clinic in April-June 1989 received a questionnaire and were asked if they wanted to be HIV tested. The overall HIV seropositive rate was 0.4% (14/3805); in homo-/bisexual men: 2.9% (8/278); IVDUs: 0.4% (1/236) and in heterosexual non-IVDUs: 0.2% (5/3291). Among the 599 individuals offered anonymous HIV testing, 42.2% were HIV tested and 69.2% did not object to HIV-testing. IVDUs/prostitutes (p < 0.001), customers of prostitutes (p < 0.001), homo-/bisexuals (p < 0.01), and patients receiving blood transfusion (p < 0.005) had all been HIV tested more frequently than 'other heterosexuals'. Respondents reporting casual sex, casual sex abroad, infection with STDs, and a greater number of partners were more frequently HIV tested and also accepted HIV testing more frequently than respondents without such behaviour, indicating that there is some rationale behind the decision to be tested.