‘I don't care if you think I'm gay … that won't make me either promiscuous or HIV positive’: HIV, stigma, and the paradox of the gay men's sexual health clinic - An exploratory study

Background: The level of agreement between anal cytology and histopathology is not clear with only a few studies evaluating the reliability of anal specimen reporting. Australian data in relation to this are limited. Methods: The results of paired anal cytology and histopathology specimens received between 2002 and 2008 from patients who were referred within the sexual health clinic were retrieved from the anatomical pathology database. A total of 248 paired samples from 154 (21 females, 133 males) participants were extracted. Concurrent high risk human papilloma virus (hrHPV) DNA assay and HIV status for the study group were also collected. Data were tabulated according to reported grade of squamous abnormality based on the Bethesda system. Using the biopsy result as the gold standard the specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) for cytology were calculated and the association between grade of abnormality, HIV status and hrHPV infection estimated. Results: Concordance between cytology and histology showed that in 204 (85%) paired samples both tests were categorised as abnormal (Kappa statistic 0.73, P = 0.013). The cytology result showed a sensitivity of 96%, specificity 14%, PPV 89% and NPV 31% when compared with histopathology. HrHPV assay was positive in 192 (80%) samples. High-grade squamous abnormalities were reported in biopsy specimens from 60% (n = 42/67) of HIV-positive subjects and 25% (n = 22/87) of HIV-negative subjects. HIV-positive individuals were more likely to be hrHPV positive, odds ratio (OR) 6.21 [95% confidence interval (CI) 2.69 to 14.34], when compared with HIV-negative subjects. Conclusion: Anal cytology is highly sensitive for the detection of abnormal squamous cells. While cytology has low specificity for predicting the grade of abnormality compared with biopsy outcome, its application as a screening method in asymptomatic at risk populations warrants further study.

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Renal function change after switching tenofovir disoproxil fumarate for tenofovir alafenamide in the HIV-positive patients of a metropolitan sexual health service

AIDS Research and Therapy ◽

10.1186/s12981-019-0256-9 ◽

2019 ◽

Vol 16 (1) ◽

Author(s):

Dane Turner ◽

Douglas Drak ◽

Catherine C. O’Connor ◽

David J. Templeton ◽

David M. Gracey

Keyword(s):

Renal Function ◽

Renal Impairment ◽

Sexual Health ◽

Tenofovir Disoproxil Fumarate ◽

Statistical Significance ◽

Health Clinic ◽

Hiv Positive ◽

Continuous Variables ◽

Significant Difference ◽

Tenofovir Alafenamide

Abstract Background Tenofovir disoproxil fumarate (TDF) is widely used in the management of HIV-infection, but has been associated with renal impairment in a small proportion of patients. Tenofovir alafenamide (TAF), a novel prodrug of tenofovir, causes less renal impairment and can improve renal function in patients switched from TDF. The factors which predict improved renal function in patients switching from TDF to TAF have yet to be described. Aim To determine which patient factors are associated with an improvement in renal function following the switch from a TDF- to a TAF-based HIV antiretroviral regimen. Methods A retrospective analysis was performed of a cohort from a publicly funded sexual health clinic in Sydney, Australia. All HIV-positive clinic patients switched from a TDF- to TAF-containing regimen between January 2016 and August 2018 were eligible for inclusion. Laboratory results were obtained from patients’ electronic medical records. The statistical significance of differences between pre- and post-switch means was determined by paired t-tests, adjusted for baseline values, and associations between continuous variables by univariate linear regression. Results 79 patients met inclusion criteria. The majority were male (89%), with a median age of 44 years (IQR: 34.5 to 53). Patients had a mean pre-switch estimated glomerular filtration rate (eGFR) of 95 ± 2 mL/min/1.73 m2, and there was no significant change post-switch (p = 0.062). Pre-switch eGFR was a significant predictor of the magnitude of eGFR change after the switch (p < 0.001), but there was no significant association with age (p = 0.189), cumulative TDF exposure (p = 0.454) or baseline urinary protein to creatinine ratio (p = 0.814). Conclusion While there was no significant difference in mean eGFR, in patients switched from TDF to TAF, baseline eGFR was a significant predictor of the change in eGFR. This suggests that patients on TDF with poorer baseline renal function would benefit more from switching to TAF. Further study to explore this association is warranted.

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HIV Care and Viral Load Suppression After Sexual Health Clinic Visits by Out-of-Care HIV-Positive Persons

AIDS Patient Care and STDs ◽

10.1089/apc.2018.0097 ◽

2018 ◽

Vol 32 (10) ◽

pp. 390-398 ◽

Cited By ~ 1

Author(s):

Olga Tymejczyk ◽

Kelly Jamison ◽

Preeti Pathela ◽

Sarah Braunstein ◽

Julia A. Schillinger ◽

...

Keyword(s):

Viral Load ◽

Sexual Health ◽

Hiv Care ◽

Health Clinic ◽

Hiv Positive ◽

Viral Load Suppression ◽

Clinic Visits

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Prevalence and predictors of lymphogranuloma venereum among men who have sex with men at a Sydney metropolitan sexual health clinic

Sexual Health ◽

10.1071/sh12143 ◽

2013 ◽

Vol 10 (2) ◽

pp. 190 ◽

Cited By ~ 4

Author(s):

David J. Templeton ◽

Nicola Sharp ◽

Sophie Gryllis ◽

Catherine C. O'Connor ◽

Sally M. Dubedat

Keyword(s):

Chlamydia Trachomatis ◽

Confidence Interval ◽

Sexual Health ◽

Lymphogranuloma Venereum ◽

Health Clinic ◽

Hiv Positive ◽

Sex With Men

During an 18-month period to June 2012, 1732 anal chlamydia (Chlamydia trachomatis) tests were performed among men who have sex with men (MSM) at RPA Sexual Health in Sydney’s inner west. Positive anal chlamydia samples were subsequently tested for lymphogranuloma venereum (LGV). Seventy-five (4.3%) anal samples were positive for chlamydia among 67 men during the study period. Anal symptoms were reported for 16 out of 75 (21.3%) of anal chlamydia episodes overall. Three episodes of LGV (all serovar L2b) were identified, all three of whom reported anal symptoms (100%, 95% confidence interval (CI): 29.2–100%). In contrast, only 13/72 (18.1%, 95% CI: 10.0–28.9%) of those with non-LGV anal chlamydia reported anal symptoms. LGV was not identified in any of 59 episodes of asymptomatic anal chlamydia (0%, 95% CI: 0–6.1%). Of those with LGV, two were known to be HIV-positive and one subsequently seroconverted to HIV within a year of the LGV diagnosis. Our findings suggest that routine LGV testing among MSM is not warranted, except among those with anal symptoms.

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Pilot of non-invasive (oral fluid) testing for HIV within a clinical setting

Sexual Health ◽

10.1071/sh07014 ◽

2007 ◽

Vol 4 (2) ◽

pp. 105 ◽

Cited By ~ 14

Author(s):

Joseph Debattista ◽

Gregory Bryson ◽

Nicole Roudenko ◽

John Dwyer ◽

Mark Kelly ◽

...

Keyword(s):

Sexual Health ◽

Hiv Testing ◽

Sensitivity And Specificity ◽

Clinical Setting ◽

Oral Fluid ◽

Fluid Collection ◽

Comparative Trial ◽

Health Clinic ◽

Hiv Positive ◽

Blood Testing

Background: The objectives of the present study were: to determine the sensitivity and specificity of oral fluid testing compared with the performance of standard blood-based HIV enzyme immunoassay; to assess the feasibility of oral fluid specimen collection from clients for the purposes of HIV testing within a clinical setting; and to assess the clinical and laboratory impact regarding staffing, material resources, expertise and funding of oral fluid testing. Methods: A parallel comparative trial of oral fluid and blood testing was conducted among a group of HIV positive clients and a group of unknown HIV serostatus clients where each client was offered both tests. An ambulatory HIV clinic recruited 175 known HIV positive clients and 179 persons were recruited through an inner city sexual health clinic while attending for routine sexual health checks. Client responses to oral fluid collection were assessed. The sensitivity and specificity of oral fluid testing were calculated. Results: Of the 176 confirmed HIV reactive blood test results, the OraSure (OraSure Technologies, Beaverton, OR, USA) assay failed to detect only one of these, demonstrating a sensitivity of 99.4%. Of the 178 blood specimens that were tested as non-reactive by the AxSYM (Abbott Laboratories, Abbott Park, IL, USA) Combo system, OraSure recorded four of the corresponding oral fluid specimens as reactive (assumed to be false-positive), giving a specificity of 97.6%. Although evaluation of patients undergoing the test showed a large proportion (88.6%) preferred the OraSure test to conventional blood testing, a large minority of these (22.6%) made such a preference conditional on the OraSure test being as reliable as current blood testing. Conclusions: This limited clinic based trial of oral fluid testing for HIV antibodies among an outpatient population has demonstrated the potential of oral fluid as a specimen for HIV testing. However, the lower performance of the test compared with current serum-based tests may limit the usefulness of OraSure to epidemiological studies or as an alternative screening tool in outreach settings among higher risk populations.

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Short message service broadcasting to improve the uptake of influenza vaccination in HIV-positive patients at a metropolitan sexual health clinic

Sexual Health ◽

10.1071/sh14162 ◽

2014 ◽

Vol 11 (6) ◽

pp. 590 ◽

Cited By ~ 1

Author(s):

Chanelle Stowers ◽

Loretta Healey ◽

Catherine C. O'Connor

Keyword(s):

Sexual Health ◽

Influenza Vaccination ◽

Short Message Service ◽

Health Clinic ◽

Hiv Positive ◽

Short Message ◽

Large Numbers ◽

Number Of Patients ◽

Message Service ◽

Influenza Vaccinations

A trial of using Short Message Service (SMS) broadcasting at a metropolitan sexual health clinic in 2013 to promote the awareness and uptake of influenza vaccinations in HIV-positive patients resulted in a significant increase in the number of patients contacted (35% vs 81% P < 0.0001) and vaccinated by the clinic (26% vs 47% P < 0.001) compared with 2012, when individual telephone calls were made to patients. Additional benefits were less staff time used promoting influenza vaccination and the resultant lower staff cost. SMS broadcasting is an efficient and inexpensive method of communicating health messages to large numbers of patients.

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