Category: News

NHS Bill: the case against

As the NHS Bill plods its slow passage into law it has become increasingly clear that a majority of health care workers, both doctors and nurses, do not agree with it in its current form. However most people who oppose the bill are not fully familiar with its details. Dr Clive Peedell, Consultant Clinical Oncologist and member of the NHS Consultant Association has dissected the case against the Bill and presented it in a powerpoint presentation that will be very useful in familiarising opponents of the bill with its details and for arguing the case against it.

Click on Case against NHS Bill to download the powerpoint.

Antiretroviral prophylaxis: a defining moment in HIV control

According to an editorial by Salim Abdool Karim in the Lancet  a defining moment in the global AIDS response has been reached. The discourse is no longer about HIV prevention or HIV treatment; it is now about HIV control through the implementation of antiretroviral treatments as key components of combination interventions.

Barely a year ago, visions of HIV control would have been considered far-fetched. The impetus for this change in mindset, which has been building since the XVIII International AIDS Conference in Vienna last year, emanates from the compelling evidence that antiretroviral drugs prevent HIV infection in the general heterosexual population, which is released this week and presented at the 6th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Rome by the Partners PrEP and Botswana TDF2 trials.

The Partners PrEP trial, involving 4758 HIV discordant couples from Kenya and Uganda, found that daily oral tenofovir disoproxil fumarate (TDF) and TDF-emtricitabine reduced HIV transmission by 62% and 73%, respectively. The Bostwana TDF2 trial, in 1200 heterosexual men and women from the general population, found that daily oral TDF-emtricitabine reduced HIV transmission by 63%.

Both these are of a similar order of magnitude to that seen with male circumcision and is probably caused by a significant reduction of HIV in the genital tract.

see fig 1 for comparison between different prevension strategies

Several issues were raised by the authors that need further research. There is now no doubt that antiretroviral drugs prevent HIV infection. However, important scientific questions remain. Does the inclusion of emtricitabine in pre-exposure prophylaxis (PrEP) formulations provide sufficient additional benefit to warrant the additional costs and side-effects? Are levels of effectiveness and safety similar for daily use and use-with-sex of PrEP? Do the safety, effectiveness, cost, and acceptability profiles of oral and topical PrEP merit implementation of both formulations? Does PrEP lead to masking of HIV acquisition that is then revealed once PrEP is withdrawn?

WHO asks for 16 days of activism against gender violence

According to the World Health Organisation 1 in 4 women worldwide are physically or sexually abused during pregnancy, usually by her partner. The WHO multi-country study on women’s health and domestic violence against women has highlighted the extent of violence by intimate partners against women across a wide range of societies. WHO has asked for 16  days leading up to December 10, International Human Rights Day, for global activism to counter violence perpetuated against women.

STIRF funds new research on chlamydia and gonorrhoea

Chlamydia and gonorrhoea are the most common treatable bacterial sexually transmitted infections diagnosed within theUnited Kingdom. Most sexual health clinics now use Nucleic Acid Amplification based Tests (NAATs), which test for DNA sequences particular to the organism in question, to diagnose these infections.

These tests are highly sensitive and specific but can remain positive for a while after the infection is successfully treated with antibiotics. This is because NAAT tests, unlike bacterial culture, do not distinguish between live and dead organisms. This means that if individuals are retested too soon after completing treatment, their test result will still be positive from the initial treated infection. We do not know for how long this will be the case, making interpretation of repeat tests difficult.

This is particularly important in clinical practice, where where a test of cure is recommended, such as in pregnancy and after gonorrhoea. The research will allow better interpretation of test of cure results, thereby avoiding the need to retreat individuals and their partners with antibiotics unnecessarily.

The proposed project will follow up individuals known to have chlamydia or gonorrhoea who have been treated as per national guidelines and then retested every week (using NAAT tests) for the initial infection until this is no longer detected. Non-compliance and possible re-infection will be ruled out through structured questionnaires during the follow up period.

This is a collaborative study in conjunction with centres in London. STIRF will be funding the part of the study to be performed in Manchester.

Title of project: Testing for chlamydia and gonorrhoea: persistence of a positive test result after successful treatment.

Lead researcher:   Dr Gabriel Schembri

Place of Research: Manchester Centre for Sexual Health, Manchester Royal Infirmary.

Collaborating Centres: Sexual health centres in London

Proposed Duration of Study: One year

Funding from STIRF: £27,000 (subject to satisfactory report at six months)

 

US Committee recommends HPV vaccine for men

Human papilloma virus (HPV) causes warts but also is the underlying cause of various cancers, particularly cervical cancer in women.  HPV vaccines are now available and recommended for young women to prevent cervical cancer, and in the case of quadrivalent vaccine also genital warts. [see our news item: Quadrivalent wart vaccine would prevent high cost of care for genital warts ] The vaccine is more effective if administered to children aged 11-12 years, before they become sexually active

Now a study published in the New England Journal of Medicine showed that the quadrivalent vaccine can prevent intraepithelial neoplasia, a precursor of anal cancer, in young gay men. anal intraepithelial neoplasia associated with the HPV types linked to cervical cancer (HPV 16 and 18) were reduced by 55% in the vaccinated group. Consequently the US Advisory Committee on Immunisation Practice has recommended the roll out of vaccination to all children aged 11-12, regardless of sex.

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Delay in diagnosis of HIV can cut 15 years off your life

Current treatment with antiviral drugs has changed a previously fatal disease into a chronic condition where those infected can expect to live a normal and healthy life for many years.

Forward projections from a number of large cohorts have, however, suggested that with current treatment regimens patients may still have a slightly shorter life expectancy than uninfected persons. This is because patients with HIV appear to experience diseases associated with aging such as heart attacks, diabetes and cancer at a younger age,

A recent study from a UK-based large cohort by May and colleagues confirm these projections with men expected to do worse than women. They estimated that for an average 20 year old man HIV decreases life expectancy by 18.1 years compared with 11.4 years for women. This may reflect life-style differences between the sexes (alcohol, smoking) but may also be because women of child-baring age are more likely to be diagnosed early during routine antenatal screening.

Their study showed that persons starting antiviral therapy with a low CD4 count of less than 100 – which is sign of severe immunological damage – rather than earlier (CD4 200-350) lose over 15 years of life. Currently guidelines recommend starting antiviral therapy when the CD4 falls at or below 350.

While there are problems with making accurate projections into the future this research further highlights the importance of routinely offering and testing for HIV at all clinical settings in order to identify the infection early and before any significant immunological damage has taken place.

See BMJ 2011:343-d6016

Doi:10.1136/bmj.d6016

Older swingers at risk of STI

Swingers – straight couples who regularly swap sexual partners at organised gatherings and clubs and indulge in group sex – have rates of sexually transmitted infections comparable with those of recognised high risk groups, reveals research published ahead of print in the journal Sexually Transmitted Infections.

Those who are over the age of 45 are particularly vulnerable, indicates the research, yet swingers are largely ignored by healthcare services, representing a “missed target,” say the authors.