Cytomegalovirus Colitis Mimicking Rectal Tumour in an Undiagnosed HIV Patient

Abstract Background Late presentation remains a key barrier towards controlling the HIV epidemic. Indicator conditions (ICs) are those that are AIDS-defining, associated with a prevalence of undiagnosed HIV > 0.1%, or whose clinical management would be impeded if an HIV infection were undiagnosed. IC-guided HIV testing is an effective strategy in identifying undiagnosed HIV, but opportunities for earlier HIV diagnosis through IC-guided testing are being missed. We present a protocol for an interventional study to improve awareness of IC-guided testing and increase HIV testing in patients presenting with ICs in a hospital setting. Methods We designed a multicentre interventional study to be implemented at five hospitals in the region of Amsterdam, the Netherlands. Seven ICs were selected for which HIV test ratios (proportion of patients with an IC tested for HIV) will be measured: tuberculosis, cervical/vulvar cancer or high-grade cervical/vulvar dysplasia, malignant lymphoma, hepatitis B and C, and peripheral neuropathy. Prior to the intervention, a baseline assessment of HIV test ratios across ICs will be performed in eligible patients (IC diagnosed January 2015 through May 2020, ≥18 years, not known HIV positive) and an assessment of barriers and facilitators for HIV testing amongst relevant specialties will be conducted using qualitative (interviews) and quantitative methods (questionnaires). The intervention phase will consist of an educational intervention, including presentation of baseline results as competitive graphical audit and feedback combined with discussion on implementation and opportunities for improvement. The effect of the intervention will be assessed by comparing HIV test ratios of the pre-intervention and post-intervention periods. The primary endpoint is the HIV test ratio within ±3 months of IC diagnosis. Secondary endpoints are the HIV test ratio within ±6 months of diagnosis, ratio ever tested for HIV, HIV positivity percentage, proportion of late presenters and proportion with known HIV status prior to initiating treatment for their IC. Discussion This protocol presents a strategy aimed at increasing awareness of the benefits of IC-guided testing and increasing HIV testing in patients presenting with ICs in hospital settings to identify undiagnosed HIV in Amsterdam, the Netherlands. Trial registration Dutch trial registry: NL7521. Registered 14 February 2019.

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Remembering the Children: Implementation and Success of a Robust Method for Identifying and Testing Children of HIV Patients

Journal of Sexually Transmitted Diseases ◽

10.1155/2013/828024 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6

Author(s):

Christopher Darlow ◽

Peter Tovey ◽

Fiona Wallis ◽

Clare Knowles ◽

Ian Fairley ◽

...

Keyword(s):

At Risk ◽

Healthcare Providers ◽

Safety Net ◽

Robust Method ◽

Children At Risk ◽

Hiv Patients ◽

Hiv Services ◽

Undiagnosed Hiv ◽

User Friendly ◽

Hiv Negative

Background. Children of HIV patients are a historically neglected demographic by HIV services. It has been recommended by CHIVA that HIV services have a robust method of detecting and testing untested children. We note that no such method is either in widespread use or in the literature. Method. In December 2011, a one-page proforma to identify HIV untested children and a clear multidisciplinary pathway to test them were implemented. Twelve months later the uptake of the proforma and pathway, the numbers of patients and children identified for testing, and their outcomes were audited. Results. The proforma was completed in 192/203 (94.6%) eligible patients. Twenty-five (21.5%) of 118 identified offspring had not been tested. Ten (8.5%) of these were <18 years old. All were reported to be clinically well. Ten children were referred for testing, seven were tested immediately, and three were tested within 18 months of identification. All children were tested HIV negative. Discussion. We have identified a method of identification that is easy and robust and provides a user-friendly safety net to empower healthcare providers to identify and test children at risk. We recommend the implementation of such strategies nationwide to prevent death due to undiagnosed HIV in children.

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P048 HISTORY OF CYTOMEGALOVIRUS COLITIS IS ASSOCIATED WITH POOR LONG-TERM OUTCOMES IN ADALIMUMAB THERAPY IN KOREAN PATIENTS WITH ULCERATIVE COLITIS: A HOSPITAL-BASED COHORT STUDY

Inflammatory Bowel Diseases ◽

10.1093/ibd/izy019.054 ◽

2018 ◽

Vol 24 (suppl_1) ◽

pp. S17-S17

Author(s):

Eun Hye Oh ◽

Eun Mi Song ◽

Sun-Ho Lee ◽

Kiju Chang ◽

Sung Wook Hwang ◽

...

Keyword(s):

Ulcerative Colitis ◽

Cohort Study ◽

Long Term Outcomes ◽

Korean Patients ◽

Cytomegalovirus Colitis ◽

Adalimumab Therapy ◽

History Of

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Detection of Apoptoses in Gastro-intestinal Graft-versus-host Disease and Cytomegalovirus Colitis by a Commercially Available Antibody Against Caspase-3

Pathology - Research and Practice ◽

10.1078/0344-0338-00426 ◽

2003 ◽

Vol 199 (5) ◽

pp. 337-340 ◽

Cited By ~ 10

Author(s):

Alexandar Tzankov ◽

Gerald Stifter ◽

Ines Tschörner ◽

Günther Gastl ◽

Gregor Mikuz

Keyword(s):

Graft Versus Host Disease ◽

Caspase 3 ◽

Host Disease ◽

Graft Versus Host ◽

Cytomegalovirus Colitis

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High percentage of undiagnosed HIV cases within a hyperendemic South African community: a population-based study

Journal of Epidemiology & Community Health ◽

10.1136/jech-2017-209713 ◽

2017 ◽

Vol 72 (2) ◽

pp. 168-172 ◽

Cited By ~ 12

Author(s):

Alain Vandormael ◽

Tulio de Oliveira ◽

Frank Tanser ◽

Till Bärnighausen ◽

Joshua T Herbeck

Keyword(s):

Hiv Testing ◽

South African ◽

Hiv Infections ◽

Population Based ◽

Hiv Positive ◽

Aids Epidemic ◽

Undiagnosed Hiv ◽

African Community ◽

Repeat Hiv Testing ◽

High Level

BackgroundUndiagnosed HIV infections could undermine efforts to reverse the global AIDS epidemic by 2030. In this study, we estimated the percentage of HIV-positive persons who remain undiagnosed within a hyperendemic South African community.MethodsThe data come from a population-based surveillance system located in the Umkhanyakude district of the northern KwaZulu-Natal province, South Africa. We annually tested 38 661 adults for HIV between 2005 and 2016. Using the HIV-positive test results of 12 039 (31%) participants, we then back-calculated the incidence of infection and derived the number of undiagnosed cases from this result.ResultsThe percentage of undiagnosed HIV cases decreased from 29.3% in 2005 to 15.8% in 2011. During this period, however, approximately 50% of the participants refused to test for HIV, which lengthened the average time from infection to diagnosis. Consequently, the percentage of undiagnosed HIV cases reversed direction and steadily increased from 16.1% to 18.9% over the 2012–2016 period.ConclusionsResults from this hyperendemic South African setting show that the HIV testing rate is low, with long infection times, and an unsatisfactorily high percentage of undiagnosed cases. A high level of repeat HIV testing is needed to minimise the time from infection to diagnosis if the global AIDS epidemic is to be reversed within the next two decades.

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