HIV Seropositivity: Fisher M

Pozniak A, Gazzard B, Anderson J, Babiker A, Churchill D, Collins S, Fisher M, Johnson M, Khoo S, Leen C, Loveday C, Moyle G, Nelson M, Peter B, Phillips A, Pillay D, Wilkins E, Williams I, Youle M, Anonymous00074. · Chelsea and Westminster Hospital, London, UK. · HIV Med. · Pubmed #14511246 No free full text.

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Watson C, Fisher M. · Brighton University Hospital. · Clin Med. · Pubmed #12848253 No free full text.

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Nandwani R, Fisher M, Anonymous00214. · The Sandyford Initiative, Glasgow and Brownlee Centre, Gartnavel General Hospital, Glasgow, UK. · Int J STD AIDS. · Pubmed #16942650 No free full text.

Abstract: These clinical standards for the screening and management of acquired syphilis in HIV-positive patients in the UK were first made available on the MSSVD website in February 2002. They have been updated by the 2006 UK National Guideline on the Sexual Health of People with HIV which is also published in this issue of the Journal [pp. 594-606]. Many of the recommendations remain in force and therefore the original document is published in full here.

van de Laar T, Pybus O, Bruisten S, Brown D, Nelson M, Bhagani S, Vogel M, Baumgarten A, Chaix ML, Fisher M, Gotz H, Matthews GV, Neifer S, White P, Rawlinson W, Pol S, Rockstroh J, Coutinho R, Dore GJ, Dusheiko GM, Danta M. · Cluster of Infectious Diseases, Health Service, Amsterdam, The Netherlands. · Gastroenterology. · Pubmed #19422083 No free full text.

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.

Warwick Z, Dean G, Fisher M. · Lawson Unit, Royal Sussex County Hospital, Brighton and Sussex University Hospitals Trust, Eastern Road, Brighton BN2 5BE, UK. · Int J STD AIDS. · Pubmed #19304964 No free full text.

Abstract: There has been much debate regarding the optimum treatment for syphilis in HIV-positive patients. There has been a shift in expert opinion in the UK towards using two doses of benzathine penicillin G one week apart regardless of HIV status. We report our experience using a 17-day course of daily procaine penicillin plus probenecid in HIV-positive individuals and two doses of benzathine in HIV-negative patients. Of 350 cases of early syphilis, 37% were in HIV-positive individuals. Ninety-eight percent of HIV-positive patients completing the treatment were followed up for at least six months and met the criteria for treatment success. The treatment response was equally good (98%) for HIV-negative patients using these different schedules. It is currently unclear which patients require an extended course of treatment for syphilis. We have demonstrated that patients adhere well to this regimen, and significantly we have shown comparable treatment success rates in HIV-positive and -negative individuals.

Sherr L, Lampe F, Fisher M, Arthur G, Anderson J, Zetler S, Johnson M, Edwards S, Harding R. · Royal Free and University College Medical School, London, UK. · AIDS. · Pubmed #18670226 No free full text.

Abstract: BACKGROUND: HIV has been associated with elevated suicidal ideation. Although new treatments have changed prognosis, they also bring new challenges. This study measured suicidal ideation in HIV clinic attenders in the United Kingdom (London/Southeast) and explored associated factors. METHOD: All 1006 attenders at five HIV clinics were approached, of which 903 met inclusion criteria and 778 participated (86% response). Participants provided detailed information on suicidal ideation, demographics, treatment, adherence, symptoms (psychological and physical on Memorial Symptom Assessment Schedule), quality of life (EuroQol) information, HIV disclosure, clinical variables, sexual risk behaviour and treatment optimism. RESULTS: There was a 31% prevalence of suicidal ideation. Factors associated with suicidal ideation were being a heterosexual man, black ethnicity, unemployment, lack of disclosure of HIV status, having stopped antiretroviral treatment (compared to treatment or treatment naive), physical symptoms, psychological symptoms and poorer quality of life. There was no association with sexual risk behaviour. Sex/sexuality and ethnicity were independently associated with suicidal ideation: the odds of suicidal ideation increased almost two-fold for heterosexual men compared with gay men or women and for black respondents compared with White or Asian respondents. Lack of disclosure was independently associated with a two-fold increase in odds of suicidal ideation. Elevated physical and psychological symptoms were strong independent predictors of suicidal ideation. Independent predictors of suicidal ideation were very similar among the subgroup of 492 patients on antiretroviral treatment. CONCLUSION: Despite advances in treatment, suicidal ideation rates among HIV-positive clinic attenders are high. Emotional support and attention to mental health provision and social context are strongly endorsed.

Ewings FM, Bhaskaran K, McLean K, Hawkins D, Fisher M, Fidler S, Gilson R, Nock D, Brettle R, Johnson M, Phillips A, Porter K, Anonymous00018. · MRC Clinical Trials Unit, London, UK. · AIDS. · Pubmed #18090396 No free full text.

Abstract: OBJECTIVES: To estimate changes over calendar time in survival following HIV seroconversion in the era of HAART and to provide updated survival estimates. METHODS: Using data from a UK cohort of persons with well estimated dates of HIV seroconversion, we analysed time from seroconversion to death from any cause using Cox models, adjusted for prognostic factors. Kaplan-Meier methods were then used to determine the expected survival in each calendar period. RESULTS: 2275 seroconverters were included with 18 695 person-years of follow up. A total of 444 (20%) died. The relative risk of death, compared with pre-1996, decreased over time to 0.63 [95% confidence interval (CI), 0.48-0.81], 0.24 (0.17-0.34), 0.14 (0.10-0.21), 0.08 (0.05-0.13) and 0.03 (0.02-0.06) in 1996-1997, 1998-1999, 2000-2001, 2002-2003 and 2004-2006, respectively. An elevated risk of death was associated with older age at seroconversion [hazard ratio (HR), 1.49; 95% CI, 1.34-1.66 per 10-year increase] and HIV infection through injecting drug use (HR, 1.53; 95% CI, 1.17-2.00). In 2000-2006, the proportion of individuals expected to survive 5, 10 and 15 years following seroconversion was 99%, 94% and 89%, respectively. CONCLUSIONS: Survival following HIV seroconversion has continued to improve over calendar time in our cohort, even in the more recent years of HAART availability. HIV seroconverters, by definition identified early in their infection, are likely to have the greatest opportunity for intervention; if similar high survival expectations are to be seen in the wider HIV-infected population, early diagnosis is likely to be crucial.

Fisher M, Pao D, Murphy G, Dean G, McElborough D, Homer G, Parry JV. · Department of HIV and Genitourinary Medicine, Brighton and Sussex University Hospitals, Eastern Road, Brighton, BN2 5BE, UK. · AIDS. · Pubmed #18090279 No free full text.

Abstract: OBJECTIVES: To investigate whether combining clinical data with the serological testing algorithm for recent HIV seroconversion (STARHS) reliably identifies otherwise unrecognized recent infections and observe their trends. DESIGN: Incorporation of STARHS into routine HIV diagnosis. METHODS: STARHS was applied to serum collected between 1996 and 2005 at HIV diagnosis and routine clinical/laboratory markers of recent infections were determined. The recent infections were identified by conventional means, by STARHS, and by both combined. RESULTS: Of 1526 infections diagnosed, 812 were new. Of these, 604 were in men who have sex with men (MSM); 208 in heterosexuals; 88% had serum available for STARHS, which identified 88 incident infections that would otherwise have been unrecognized (12% of all new infections, 34% of all recent infections). Of these, 88% reported recent high-risk sex; 47% reported seroconversion symptoms. STARHS confirmed recent infections in 71 of 74 (96%) known to be infected within 6 months by conventional methods. Combining both approaches, recent infections increased over time from 26% (1996) to 45% (2005) [P < 0.001]. STARHS results from 3% new diagnoses and 8% previous diagnoses were deemed false incident (associated with antiretroviral therapy, advanced disease or undetectable viral load). False incident results were only inexplicable in two individuals. CONCLUSION: Adjunctive use of STARHS with clinical data identified a high and increasing proportion of new HIV diagnoses as recent infections, confirming significant ongoing transmission. Since 2002, 50% of new diagnoses among MSM were recent infections. Identification of additional recent infections by STARHS enables effective intervention that may benefit the individual and reduce onward transmission.

Giraudon I, Ruf M, Maguire H, Charlett A, Ncube F, Turner J, Gilson R, Fisher M, Bhagani S, Johnson M, Barton S. · Health Protection Agency, Regional Epidemiology Unit London, 7th Floor, Holborn Gate, 330 High Holborn, London WC1V 7PP, UK. · Sex Transm Infect. · Pubmed #17932125 No free full text.

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.

Pao D, Andrady U, Clarke J, Dean G, Drake S, Fisher M, Green T, Kumar S, Murphy M, Tang A, Taylor S, White D, Underhill G, Pillay D, Cane P. · Royal Sussex County Hospital, Brighton, United Kingdom. · J Acquir Immune Defic Syndr. · Pubmed #15577410 No free full text.

Abstract: Primary infection with drug-resistant HIV-1 is well documented. We have followed up patients infected with such viruses to determine the stability of resistance-associated mutations. Fourteen patients who experienced primary infection with genotypic evidence of resistance were followed for up to 3 years. Drug resistance-associated mutations persisted over time in most patients studied. In particular, M41L, T69N, K103N, and T215 variants within reverse transcriptase (RT) and multidrug resistance demonstrated little reversion to wild-type virus. By contrast, Y181C and K219Q in RT, occurring alone, disappeared within 25 and 9 months, respectively. Multidrug resistance in 2 patients was found to be stable for up to 18 months, the maximum period studied. We conclude that certain resistance-associated mutations are highly stable and these data support the recommendation that all new HIV diagnoses in areas where primary resistance may occur should undergo genotyping irrespective of whether the date of seroconversion is known.

Bhaskaran K, Pillay D, Walker AS, Fisher M, Hawkins D, Gilson R, McLean K, Porter K, Anonymous00258. · Medical Research Council Clinical Trials Unit, London, UK. · AIDS. · Pubmed #15199326 No free full text.

Abstract: Using data from the UK Register of HIV Sero-converters, we compared the rate of CD4 cell decline in antiretroviral-naive individuals with and without evidence of transmitted drug resistance (TDR). Although there was a suggestion that CD4 cell decline in the first year after seroconversion was faster in those with TDR,there was no evidence of a difference in the rate of decline thereafter. The virological and host determinants of this possible phenomenon are worth further exploration.

Curtis S, Poulton M, Fisher M, Teo C. · Brighton Public Health Laboratory, Royal Sussex County Hospital, UK. · Sex Transm Infect. · Pubmed #12473812 links to  free full text

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