Pregnancy Management in HIV Viral Controllers: Twenty Years of Experience

(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.

Oral Human Papillomavirus Infection in Men Who Have Sex with Men: A Systematic Review and Meta-Analysis

BACKGROUND

The epidemiology of oral human papillomavirus (HPV) infection in men who have sex with men (MSM) differs from anogenital HPV infection. The impact of HPV vaccination has, to date, largely focussed on anogenital outcomes. Vaccination of MSM in the UK has been recommended and, if implemented, baseline estimates of oral HPV prevalence will be useful.

METHODS

We searched Medline, Embase and psycINFO databases for studies reporting prevalence, incidence, and clearance of oral HPV infection in MSM. We performed a random-effects meta-analysis and meta-regression on prevalence estimates and summarised within-study risk factors for oral HPV DNA detection and incidence/clearance rates. We also performed a meta-analysis of the effect of MSM on oral HPV prevalence compared to heterosexual men.

RESULTS

26 publications were identified. The pooled prevalence of oral HPV16 from twelve estimates was 3.0% (95%CI 0.5-5.5) in HIV-negative and 4.7% (95%CI 2.1-7.3) in HIV-positive MSM. Median age of study participants explained 38% of heterogeneity (p<0.01) in HPV prevalence estimates (pooled = 17% and 29% in HIV-negative and HIV-positive, respectively; 22 estimates). Nine studies compared MSM to heterosexual men and found no difference in oral HPV prevalence (pooled OR 1.07 (95%CI 0.65-1.74)). The clearance rate was higher than incidence within studies. Type-specific concordance between oral and anogenital sites was rare.

CONCLUSION

There was substantial heterogeneity between estimates of oral HPV prevalence in MSM populations that was partly explained by HIV status and median age.

Cholecystectomy or Cholelithiasis - a Missed Marker for Hyperlipidaemia? A Combined Retrospective and Prospective Study

Background

Multiple studies have shown an association between gallstones and abnormal lipids and the latter increases the risk of coronary artery disease and stroke. Our study investigates the current incidence of lipid abnormalities in patients who have undergone cholecystectomy (retrospective study) and who have gallstones (prospective study).

Methods

We conducted a retrospective analysis of the lipid profiles of 715 patients who underwent cholecystectomy in a rural district general hospital from 2003 to 2006. Details of the cholecystectomy patients were obtained from Patient Information and Management System (PIMS) and cross-referenced with biochemical and histological databases. Following this a prospective study was undertaken of 129 patients presenting with gallstones.

Results

Of the 715 patients, three quarters were women. Only 36.2% of women and 36.9% of men who had a cholecystectomy had a full lipid profile including high density lipoproteins (HDL) and low density lipoproteins (LDL). Of these, 76.4% of women and 70.7% of men had an abnormal lipid profile. In the prospective group, 91.1 % of women and 96.3 % of men had a full lipid profile. These were abnormal in 81.4% of women and 70.4 % of men. Hypercholesterolemia and raised LDL were the most common abnormalities in both sexes. Hypertriglyceridaemia was common in both sexes in both the groups.

Conclusions

Patients who have had a cholecystectomy or gallstones should have a full fasting lipid profile, including HDL and LDL, as a large proportion will be abnormal. Current guidelines suggest they are at an increased risk of cardiovascular disease and should be treated.