Author: Mohsen Shahmanesh

Current HPV vaccines miss half of the carcinogenic types found in London women

Vaccination against human papillomavirus (HPV) types 16 and 18 protects women against cervical cancer associated with these two common phenotypes.

A recent study by Oakshott and her colleagues from the UK has found that 18.5% (95% CI 17-20%) of nearly 2,200 women attending a sexually transmitted infection (genitourinary medicine) clinic were positive for HPV types associated with cervical cancer in samples taken from vaginal swabs. These included 327 women (15%) who were positive for HPV genotypes not covered by the current vaccines currently in use.

By sampling twice a median of 16 months apart the authors were able to provide an annual estimate of new infections (incidence) of nearly 13% of carcinogenic genotypes. Reporting two or more sexual partners in the previous year and concurrent Chlamydia trachomatis or bacterial vaginosis were independent risk factors for prevalent vaginal HPV infection.

Of the 143 women with baseline carcinogenic HPV that provided samples later 14% were infeceted by the same HPV genotype.

The study was performed before the introduction of immunisation against HPV types 16 and 18 for schoolgirls. It highlights the continued need to screen women for cervical cancer.

Development of a questionnaire to measure patients’ satisfaction with HIV Clinics

A STIRF funded project (STIRF-012) has been completed successfully. Professor Jonathan Ross, Consultant in HIV medicine at University Hospital Birmingham and Lucy Land, Reader in Nursing at Birmingham City University have developed a questionnaire that will give patients attending an HIV clinic the opportunity to feedback their experiences of care.

A systematic review of the medical literature provided background information on what factors were important to patients attending a HIV clinic. Current users of the service were then involved in verifying this information and added their views about the issues that were important to them. For example being afforded respect, dignity and autonomy, together with an expectation of expert medical care were considered essential to a good service.

A draft questionnaire was constructed to include questions around these issues as well as others that were relevant and important to patients with HIV. This draft was tested with a group of patients and refined further. The final questionnaire was piloted on 100 clinic patients and showed that the feedback from the questionnaire could provide an accurate reflection of patients’ experiences. In the future, an annual survey using this questionnaire will be conducted and the data will be used to measure the quality of care and inform improvements in HIV clinic services.

The research had been submitted for publication

Dramatic drop in health spending according to OECD

Growth in health spending slowed or fell in real terms in 2010 in almost all OECD countries, reversing a long-term trend of rapid increases, according to OECD Health Data 2012.

In real terms average health spending has declined by over 6% compared to the start of the millenium.

Overall health spending grew by nearly 5% per year in real terms in OECD countries over the period 2000-2009, but this was followed by zero growth in 2010. Preliminary figures for a limited number of countries suggest little or no growth in 2011. The halt in total health spending in 2010 was driven by a fall of 0.5% in public spending for health, following an increase of over 5% per year in 2008 and 2009.

While government health spending tended to be maintained at the start of the economic crisis, cuts in spending really began to take effect in 2010. This was particularly the case in the European countries hardest hit by the recession.

UK gonorrhoea rates increase by 25%

Although overall rates of sexually transmitted infections rose by 2%, there has been an increase of 25% in new infections by gonorrhoea reported to the UK Health Protection Agency (HPA) – the second increase in two years running. Gonorrhoea rates increased from 16,835 to 20,965.

Other significant increases in sexually transmitted infections were in infectious syphilis (10%; 2,650 to 2,915) and genital herpes (5%; 29,794 to 31,154).

In contrast there was only a 1% rise in genital warts, perhaps reflecting the effectiveness of the vaccination programme. Diagnoses of genital warts cases in women aged 15-19 actually fell by 14% (11,251 to 9,700).

The greatest increase in sexually transmitted infections was in men who have sex with men and in heterosexual men and women aged 15-24. The high rates of infection reported in girls aged 15-19 is particularly worrying.

According to Professor Cathy Ison, director of sexually transmitted bacterial reference laboratory, the appearance of resistant strains for which no single antibiotic is effective is particularly worrying. This opens the prospect of having to use combination therapy in the future.

Research on effective behavioural change therefore remains a top priority.

Invitation to apply for research funds

We have entered a new round of invitation to apply for research funds. We are particularly interested in providing initial funding in projects that may allow young researchers to obtain preliminary results as a prelude to acquire further funds from larger funding bodies.

We invite applications from researchers in the East and West Midland, the North East and North West Regions on projects relating to sexually transmitted diseases and HIV. All projects will be initially screened by the Scientific Committee of STIRF and those considered suitable will be sent for peer review by experts in the field. We encourage applications for

The following fields of research will be considerd in relation to STIs and HIV

  • Epidemiology of HIV and other sexually transmitted diseases
  • Health care delivery including views of clients
  • Issues relating to deprived or marginalised communities.
  • Pathophysiology of diseases and syndromes
  • Inter-relationship between diseases
  • Treatment modalities
  • Complications of treatment and co-morbidities

Applications should not exceed £50,000 in the first year. Depending on satisfactory reports a further £25,000 may be available for the second year. Joint funding with other grant giving bodies will be considered.

Further information and guidance on how to apply can be found on

How to Apply for Research funds

 

CROI 2012 Review web cast

Register now for web-cast education on the most important topics covered by CROI (Conference on Retroviruses and Opportunistic Infections) in February 2012. The web-cast will cover the following topics

  1. Review the latest data on anti-retroviral medication.
  2. Describe studies using HCV protease inhibitors in HIV infected patients.
  3. Describe the latest data on treatment of TB and opportunistic infections in HIV patients.
The target audience are

  • Physicians
  • Physician Assistants Nurses
  • Nurse Practitioners
  • Other health care professionals caring for people with HIV

Registration deadline is May 1.

New sensitive DNA assay for PCP infection

Pneumocystis jirovecii pneumonia (PCP) is a leading cause of morbidity and mortality in HIV and other immunocompromised patients. Currently the commonly used PCR for diagnosing P. jirovecii will miss some organisms by staining methods. The authors of a study published in Clinical Microbiology and Infection  developed a new assay using the same targeted genes.

This assay was compared with the currently used PCR and other conventional assays (Giemsa staining and immunofluorescence assay).   Brochoalveolar lavage (BAL) sample collected from human immunodeficiency virus (HIV)-infected (n = 66) and non-HIV (n = 36) immunocompromised patients presenting with fever, dyspnoea, cough and pulmonary infiltrates was tested by all the assays. Pneumocystis jirovecii was diagnosed with Giemsa-stained smear, immunofluorescence assay, conventional single-round and nested PCR, and the new PCR in 46 (45.1%), 53 (52.0%), 69 (67.6%), 74 (72.6%), 87 (85.3%) and 91 (89.2%) patients, respectively.

The new PCR could detectP. jirovecii DNA in BAL fluids two to three orders of magnitude more dilute than conventional PCR.  Although both conventional and new PCR assays were highly specific for diagnosing P. jirovecii, the new PCR yielded more positive results than conventional PCR among BAL samples that were negative by both Giemsa stain and immunofluorescence assay. Hence, the new PCR offered a more sensitive detection of P. jirovecii infection and colonization than conventional PCR.