Serological Evolution of VDRL Test after Penicillin Treatment of Non-Pregnant Patients with Early Syphilis Without HIV Infection: Identifying an Efficient Serological Follow-Up Scheme

HIV may indirectly accelerate coronary artery disease through enhancing the effects of conventional and non-conventional cardiovascular risk factors

European Heart Journal ◽

10.1093/ehjci/ehaa946.3310 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Kolossvary ◽

E.K Fishman ◽

G Gerstenblith ◽

D.A Bluemke ◽

R.N Mandler ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Hiv Infection ◽

Cardiovascular Risk Factors ◽

Agatston Score ◽

Funding Source ◽

Significant Difference ◽

Ascvd Risk ◽

Artery Disease

Abstract Background/Introduction Cross-sectional studies are inconsistent on the potential independent adverse effects of human immunodeficiency virus (HIV)-infection on coronary artery disease (CAD). Furthermore, there is no information on the potential effects of HIV-infection on plaque volumes. Also, only the independent effects of HIV-infection on CAD have been investigated. Purpose In a prospective longitudinal observational cohort, we wished to assess whether HIV-infection accelerates CAD independently, or by acting in synergistic fashion with conventional and nonconventional cardiovascular risk factors to accelerate disease progression as assessed by clinical and volumetric parameters of CAD on coronary CT angiography (CCTA). Methods Overall, 300 asymptomatic individuals without cardiovascular symptoms but with CCTA-confirmed coronary plaques (210 males, age: 48.0±7.2 years) with or without HIV (226 HIV-infected) prospectively underwent CCTA at two time points (mean follow-up: 4.0±2.3 years). Agatston-score, number of coronary plaques, segment stenosis score were calculated, and we also segmented the coronary plaques to enumerate total, noncalcified (−100–350HU) and calcified (≥351HU) plaque volumes. Linear mixed models were used to assess the effects of HIV-infection, atherosclerotic cardiovascular disease (ASCVD) risk, years of cocaine use and high-sensitivity C-reactive protein on CCTA markers of CAD. Results In univariate analysis, there was no significant difference in CAD characteristics between HIV-infected and -uninfected, neither at baseline nor at follow-up (p>0.05 for all). Furthermore, there was no significant difference in annual progression rates between the two groups (p>0.05 for all). By multivariate analysis, HIV was not associated with any CAD parameter (p>0.05 for all). However, among HIV-infected individuals, each year of cocaine use significantly increased all CAD parameters (p<0.05 for all), while ASCVD risk score was significantly associated with CAD parameters except for Agatston-score (p<0.05). These associations were only present among HIV-infected individuals. Conclusion(s) Instead of directly worsening CAD, HIV may promote CAD through increased susceptibility to conventional and nonconventional cardiovascular risk factors. Therefore, aggressive management of both conventional and nonconventional cardiovascular risk factors is needed to reduce cardiovascular burden of HIV-infection. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health, National Institute on Drug Abuse

Rates of cardiovascular events and deaths are associated with advanced stages of HIV-infection: results of the HIV HEART study 7, 5 year follow-up

Journal of the International AIDS Society ◽

10.7448/ias.17.4.19542 ◽

2014 ◽

Vol 17 ◽

pp. 19542 ◽

Cited By ~ 5

Author(s):

Stefan Esser ◽

Lewin Eisele ◽

Birte Schwarz ◽

Christina Schulze ◽

Volker Holzendorf ◽

...

Keyword(s):

Hiv Infection ◽

Cardiovascular Events ◽

Heart Study ◽

Advanced Stages

MENTAL DISORDERS AND THEIR INFLUENCE ON THE COMMITMENT TO OBSERVATION IN THE INFECTIONIST IN HIVINFECTED PATIENTS WITH EARLY SYPHILIS

HIV Infection and Immunosuppressive Disorders ◽

10.22328/2077-9828-2018-10-2-69-80 ◽

2018 ◽

Vol 10 (2) ◽

pp. 69-80 ◽

Cited By ~ 3

Author(s):

E. M. Chumakov ◽

N. N. Petrova ◽

V. V. Rassokhin

Keyword(s):

Mental Disorders ◽

Hiv Infection ◽

Brain Damage ◽

Negative Impact ◽

Minor Role ◽

Syphilis Infection ◽

Addictive Disorders ◽

Early Syphilis ◽

Organic Brain ◽

Epidemiological Characteristics

HIV and syphilis have similar epidemiological characteristics which causes a high level of combined infection. Both STDs affect the central nervous system early after infection. Mental disorders occur with a high incidence in HIV-infected patients and patients with syphilis, but data on the effect of combined HIV and syphilis infection on mental disorders are found only in single articles. Objectives. The goal is to study mental disorders and their effect on the commitment to observation in the infectionist in HIV-infected patients with early syphilis. Materials and methods. A comparative study of 148 patients (65 HIV-infected patients with syphilis, 50 patients with syphilis monoinfection, 33 HIV-infected patients, seronegative for syphilis) was carried out. We used clinical, psychopathological, follow-up, psychometric, laboratory and statistical methods of investigation. Results. It was found that mental disorders occur in the majority (83%) of HIV-infected patients with syphilis with the predominance of affective (54%) and addictive (48%) disorders. In HIV-infected patients with early neurosyphilis, psychogenic reactions developed statistically significantly more often than in HIV-infected patients with early syphilis. In contrast, there were no statistically significant differences in the incidence of addictive, affective, personality disorders and mental disorders due to organic brain damage in patients with early neurosyphilis and early syphilis in the case of co-infection with HIV infection. Mental disorders due to organic brain damage had a mixed genesis (including infectious) in all cases and were associated and caused by the already existing HIV infection. HIV-infected patients with syphilis, in general, were characterized by the low commitment to observation in the infectionist which were inﬂuenced by the following factors: social maladjustment, drug abuse and criminal activity. Discussion. The frequency of detected mental disorders in the examined HIV-infected patients with syphilis (83,1%) corresponded to the literature on the incidence of mental illness in HIVinfected patients inSt. Petersburg(85,6%), but was higher than the prevalence of mental disorders in patients with syphilis (68%). Given the established influence of neurosyphilis mono-infection on the development of mental disorders due to organic brain damage, it can be concluded that the disease with early neurosyphilis is important in the development of mental disorders of organic genesis. But the weight of this factor is insufficient in case of co-infection with HIV and early neurosyphilis and can only have additional significance in the development of mental disorders and the key factor is HIV-infection action. Mental disorders (addictive disorders and cognitive impairment) adversely affect the commitment to observation in the infectionist of HIV-infected patients with syphilis, therefore timely correction of mental disorders may be one of the factors improving compliance of patients. Conclusions. The study found a minor role of early neurosyphilis (as opposed to HIV infection) on the formation of mental disorders in the case of a combination of these infections. At the same time, it was found that addictive and cognitive symptomatic complexes have a negative impact on the probability of reference to an infectious disease specialist for initiating therapy in HIV-infected patients with syphilis.

OPTIMAL TIMING OF NEURORADIOLOGY IN EVALUATION AND FOLLOW-UP OF CHILDREN WITH HIV INFECTION. 1084

Pediatric Research ◽

10.1203/00006450-199604001-01106 ◽

1996 ◽

Vol 39 ◽

pp. 183-183

Author(s):

Michael J Rieder ◽

Susan King ◽

Vivianne Edwards ◽

Susan Blaser ◽

Stan Read

Keyword(s):

Hiv Infection ◽

Optimal Timing

Pilot Program of Shared Assistance with Primary Care in Patients Living with HIV, and Satisfaction with The Healthcare Received

10.21203/rs.3.rs-576992/v1 ◽

2021 ◽

Author(s):

Melchor Riera ◽

Adria Ferre ◽

Alfredo Santos-Pinheiro ◽

Helem Hayde Vilchez ◽

Maria Luisa Martin-Peña ◽

...

Keyword(s):

Health Care ◽

Primary Health Care ◽

Viral Load ◽

Hiv Infection ◽

Shared Care ◽

Hiv Care ◽

Pilot Program ◽

Art Adherence ◽

Primary Health

Abstract Background: There are few shared assistance programs with Primary Health Care (PHC) in PLWH. The aim was to develop a Pilot Program of shared HIV care in PLWH ensuring proper HIV control. Methods: Design: Prospective pilot project of a shared care intervention.Setting: HIV specialized outpatient consultations for HIV infection at Son Espases University Hospital which serves 2000 patients. Subjects: Patients who attended HIV specialized consultation between January 1st and June 30th, 2017. Intervention: Basal questionnaire on health services used by patients. HIV Training Program on HIV in Primary Health Care (PHC). Pilot Program of shared assistance (PPAC) with PHC. Main Outcomes: Maintenance of undetectable HIV viral load, antiretroviral therapy (ART) adherence, AIDS and non-AIDS events, loss of follow up, and satisfaction questionnaire. Results: The basal questionnaire was filled out by 918 patients, with 108 (11.7%) patients reporting neither knowing nor having been visited by their GP. A total of 93 patients were included in the PPAC, with a mean age of 49.9 years (SD 11.7), and an average of 14.6 years since the HIV diagnosis. Eleven patients were followed up for less than six months and were excluded from the analysis. Median follow-up during the PPAC of the remaining 82 patients was 728 days (IQR 370-1070). Sixteen patients dropped out of the PPAC (19.5%), three died, three were lost to follow up, one was withdrawn due to medical criteria, and nine withdrew voluntarily.No patient presented any AIDS defining events, although eight patients presented non-AIDS events. All the patients had undetectable viral load (VL) and average ART adherence was 99.4% (SD1.4). The patient’s satisfaction score with PPAC was 8.64 (SD2.5).Conclusion: It is possible to establish shared care programs with PHC in selected patients with HIV infection, thereby reducing hospital visits while maintaining good adherence and virological control and achieving high patient satisfaction.

Screening and management of cardiovascular disease in Australian adults with HIV infection

Sexual Health ◽

10.1071/sh13009 ◽

2013 ◽

Vol 10 (6) ◽

pp. 495 ◽

Cited By ~ 7

Author(s):

Derek Chan ◽

David Gracey ◽

Michael Bailey ◽

Deborah Richards ◽

Brad Dalton

Keyword(s):

Cardiovascular Disease ◽

Primary Care ◽

Clinical Practice ◽

Hiv Infection ◽

Primary Care Physicians ◽

Management Practices ◽

Cvd Risk ◽

Online Forms ◽

Current Screening

Background Cardiovascular disease (CVD) is common in HIV infection. With no specific Australian guidelines for the screening and management of CVD in HIV-infected patients, best clinical practice is based on data from the general population. We evaluated adherence to these recommendations by primary care physicians who treat HIV-infected patients. Methods: Primary care physicians with a special interest in HIV infection were asked to complete details for at least 10 consecutive patient encounters using structured online forms. This included management practices pertaining to blood pressure (BP), blood glucose, electrocardiogram, lipid profile and CVD risk calculations. We assessed overall adherence to screening and follow-up recommendations as suggested by national and international guidelines. Results: Between May 2009 and March 2010, 43 physicians from 25 centres completed reporting for 530 HIV-infected patients, of whom 93% were male, 25% were aged 41–50 years and 83% were treated with antiretrovirals. Risk factors for CVD were common and included smoking (38%), hyperlipidaemia (16%) and hypertension (28%). In men aged >40 years and women aged >50 years without evidence of ischaemic heart disease, only 14% received a CVD risk assessment. Lipid and BP assessments were performed in 87% and 88% of patients, respectively. Conclusions: This Australian audit provides unique information on the characteristics and management of HIV and CVD in clinical practice. We have found a high burden of risk for CVD in HIV-infected Australians, but current screening and management practices in these patients fall short of contemporary guidelines.

Clinical trial protocol to evaluate the efficacy of cefixime in the treatment of early syphilis

Trials ◽

10.1186/s13063-020-04885-z ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Shivani N. Mehta ◽

Chrysovalantis Stafylis ◽

David M. Tellalian ◽

Pamela L. Burian ◽

Cliff M. Okada ◽

...

Keyword(s):

Clinical Trial ◽

Los Angeles ◽

Hiv Infection ◽

Treatment Options ◽

Post Treatment ◽

Penicillin G ◽

Benzathine Penicillin ◽

Open Label ◽

Early Syphilis ◽

Recommended Treatment

Abstract Background Syphilis rates have been increasing both in the USA and internationally with incidence higher among men-who-have-sex-with-men and people living with human immunodeficiency virus (HIV) infection. Currently, benzathine penicillin is the recommended treatment for syphilis in all patients. Global shortages and cost increases in benzathine penicillin call for alternative treatment options. This study evaluates the efficacy of oral cefixime for the treatment of early syphilis. Methods We are conducting a randomized, multisite, open-label, non-comparative clinical trial in Los Angeles and Oakland, CA. Eligible participants are ≥ 18 years old, with primary, secondary, or early latent syphilis (rapid plasma reagin [RPR] titer ≥ 1:8). Patients with HIV infection must have a viral load ≤ 200 copies/mL and CD4+ T cell count ≥ 350 cells/μL during the past 6 months. Participants are randomized to receive either 2.4 M IU benzathine penicillin G intramuscularly once or cefixime 400 mg orally twice a day for 10 days. Participants return at 3, 6, and 12 months post-treatment for follow-up RPR serological testing. The primary outcome is the proportion of participants who achieve ≥ 4-fold RPR titer decrease at 3 or 6 months post-treatment. Discussion Clinical trials evaluating the efficacy of alternative antibiotics to penicillin are urgently needed. Trial registration Clinicaltrials.gov NCT03660488. Registered on 4 September 2018.

Sífilis: Prevalência num Hospital de Lisboa

Acta Médica Portuguesa ◽

10.20344/amp.6247 ◽

2016 ◽

Vol 29 (1) ◽

pp. 52 ◽

Cited By ~ 2

Author(s):

Leonor Lopes ◽

Rita Ferro-Rodrigues ◽

Samuel Llobet ◽

Luís Lito ◽

João Borges-Costa

Keyword(s):

Clinical Laboratory ◽

Transmitted Disease ◽

Public Health Problem ◽

Secondary Syphilis ◽

Disease Classification ◽

Serological Tests ◽

Important Public Health Problem ◽

Early Syphilis ◽

Latent Syphilis

Introduction: Syphilis is a sexual and vertical transmitted disease. Its incidence is increasing in Europe, particularly, in Portugal. Material and Methods: A descriptive, retrospective study was performed based on positive treponemal tests from January to December 2013, at the Santa Maria Hospital, Lisbon. In-patients and out-patients evaluated in medical appointments and at the emergency department were included. We proceeded to epidemiological characterization, disease classification and definition of risk factors. Results: We obtained a sample of 580 patients, of whom 51 with no clinical data and 45 with false positive serologies were excluded. There was a predominance of male patients (75%) and a mean age of 47 years. Most (59%) had syphilis successfully treated in the past and 3.7% were in follow-up. We recorded 13 primaries syphilis, 71 cases of secondary syphilis, 40 cases of early latent syphilis, 49 unknown duration syphilis and five cases of late latent syphilis. In the early syphilis group, 42% (n = 124) were HIV-positive and, in 8% both diagnosis were done simultaneously. Discussion: We emphasize the high prevalence of syphilis/HIV co-infection in patients with early syphilis, reinforcing the importance of promoting the use of preventive measures. We obtained 11% of patients with late clinical forms, which are notifiable since June 2014, in Portugal. All serological tests for the diagnosis of syphilis have limitations which emphasizes the importance of clinical-laboratory correlation. Conclusion: Syphilis remains an important public health problem. It is necessary to establish education programs, screening and follow-up strategies to reduce their prevalence and to perform more efficient screening of the partners.

Promoting condom-only brothels through solidarity and support for brothel managers

International Journal of STD & AIDS ◽

10.1258/0956462971918751 ◽

1997 ◽

Vol 8 (1) ◽

pp. 40-43 ◽

Cited By ~ 15

Author(s):

Chuanchom Sakondhavat ◽

Yuthapong Werawatanakul ◽

Anthony Bennett ◽

Chusri Kuchaisit ◽

Sugree Suntharapa

Keyword(s):

High Risk ◽

Hiv Infection ◽

Condom Use ◽

Bargaining Power ◽

Aids Prevention ◽

The Other ◽

Prevention Programme ◽

Policy Ideas ◽

Khon Kaen

Brothel workers in Thailand are at high risk of HIV infection but they alone do not have adequate bargaining power to insist on condom use with all clients. Brothel managers, on the other hand, are a source of influence over both clients and their workers and can promote universal condom use in their establishments. To test whether brothel managers in Khon Kaen City would adopt and successfully implement a condom-only policy in their establishments, all 24 brothel managers in Khon Kaen City attended a meeting on the dangers of HIV and benefits of an all-condom policy. Ideas on how to implement the policy were discussed. Follow-up visits were made once a month to brothels to resupply condoms, provide reinforcement and to collect data. All brothel managers approved of the condom-only in principle and are now implementing the policy. Results of the evaluation of condom use and degree of solidarity in these 24 brothels are available for the AIDS prevention programme. However, a condom-only policy in brothels can only succeed if managers and brothel workers show solidarity in rejecting all noncondom using clients. Laws to promote condom use may not be needed if brothels are given the opportunity to implement a condom-only policy using their own resourcefulness and determination.

Maraviroc in addition to cART during primary HIV infection: Results from MAIN randomized clinical trial and 96-weeks follow-up

Journal of Clinical Virology ◽

10.1016/j.jcv.2016.10.016 ◽

2016 ◽

Vol 85 ◽

pp. 86-89 ◽

Cited By ~ 2

Author(s):

Marco Ripa ◽

Manuela Pogliaghi ◽

Stefania Chiappetta ◽

Silvia Nozza ◽

Alessandro Soria ◽

...

Keyword(s):

Clinical Trial ◽

Hiv Infection ◽

Randomized Clinical Trial ◽

Primary Hiv Infection