scholarly journals Neurosyphilis: Old Disease, New Implications for Emergency Physicians

2019 ◽  
Vol 4 (1) ◽  
pp. 46-50 ◽  
Author(s):  
Laura Mercurio ◽  
Lynn Taylor ◽  
Angela Jarman
Keyword(s):  
At Risk ◽  
Human Immunodeficiency Virus ◽  
Cranial Nerve ◽  
Emergency Physicians ◽  
Hiv Diagnosis ◽  
Neurologic Deficits ◽  
Epidemiologic Data ◽  
Immunodeficiency Virus ◽  
Risk Patients ◽  
Sex With Men

Recent epidemiologic data demonstrate increasing rates of neurosyphilis, particularly among those in the community of men who have sex with men and those coinfected with the human immunodeficiency virus (HIV). Here we discuss a case of early neurosyphilis and new HIV diagnosis in a 27-year-old previously-healthy trans woman presenting for the second time with progressive, ascending weakness and cranial nerve VI palsy. Emergency physicians should consider this rare but highly morbid diagnosis, given the rising prevalence of neurosyphilis among at-risk patients and those with new neurologic deficits.

scholarly journals Decreased Time to Viral Suppression After Implementation of Targeted Testing and Immediate Initiation of Treatment of Acute Human Immunodeficiency Virus Infection Among Men Who Have Sex With Men in Amsterdam

2020 ◽  
Author(s):  
Maartje Dijkstra ◽  
Martijn S van Rooijen ◽  
Mariska M Hillebregt ◽  
Ard van Sighem ◽  
Colette Smit ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Viral Suppression ◽  
Standard Of Care ◽  
Combination Antiretroviral Therapy ◽  
Hiv Diagnosis ◽  
Cart Initiation ◽  
Immunodeficiency Virus ◽  
Targeted Testing ◽  
Sex With Men

Abstract Background Men who have sex with men (MSM) with acute human immunodeficiency virus (HIV) infection (AHI) are a key source of new infections. To curb transmission, we implemented a strategy for rapid AHI diagnosis and immediate initiation of combination antiretroviral therapy (cART) in Amsterdam MSM. We assessed its effectiveness in diagnosing AHI and decreasing the time to viral suppression. Methods We included 63 278 HIV testing visits in 2008–2017, during which 1013 MSM were diagnosed. Standard of care (SOC) included HIV diagnosis confirmation in < 1 week and cART initiation in < 1 month. The AHI strategy comprised same-visit diagnosis confirmation and immediate cART. Time from diagnosis to viral suppression was assessed for 3 cART initiation periods: (1) 2008–2011: cART initiation if CD4 < 500 cells/μL (SOC); (2) January 2012–July 2015: cART initiation if CD4 < 500 cells/μL, or if AHI or early HIV infection (SOC); and (3a) August 2015–June 2017: universal cART initiation (SOC) or (3b) August 2015–June 2017 (the AHI strategy). Results Before implementation of the AHI strategy, the proportion of AHI among HIV diagnoses was 0.6% (5/876); after implementation this was 11.0% (15/137). Median time (in days) to viral suppression during periods 1, 2, 3a, and 3b was 584 (interquartile range [IQR], 267–1065), 230 (IQR, 132–480), 95 (IQR, 63–136), and 55 (IQR, 31–72), respectively (P < .001). Conclusions Implementing the AHI strategy was successful in diagnosing AHI and significantly decreasing the time between HIV diagnosis and viral suppression.

Public health counselling following an HIV diagnosis among men who have sex with men: tensions between individual needs and health protection mandates

2020 ◽  
pp. 174498712093296
Author(s):  
Lauren Orser ◽  
Patrick O'Byrne
Keyword(s):  
Public Health ◽  
Human Immunodeficiency Virus ◽  
Qualitative Interviews ◽  
Primary Objective ◽  
Public Health Nurses ◽  
Hiv Diagnosis ◽  
Immunodeficiency Virus ◽  
Sex With Men ◽  
Health Counselling

Background In Ontario, provincial regulations stipulate that public health units must complete post-test counselling with all persons newly diagnosed with human immunodeficiency virus. Public health nurses conduct this follow-up and are responsible for ensuring appropriate surveillance and management of human immunodeficiency virus with the primary objective of reducing ongoing human immunodeficiency virus transmission in their health jurisdiction. To date, little research has explored the effectiveness of this mandatory public health counselling from the perspective of patients – the majority of whom are men who have sex with men. Aims To address gaps in public health nursing practice, a pilot study was conducted with men who have sex with men in Ottawa to explore their attitudes and experiences of receiving mandatory human immunodeficiency virus follow-up after their diagnosis. Methods Qualitative interviews were conducted and interpreted using thematic analysis. Results This analysis revealed a contrariety between the needs of individuals and of public health units, with patients' perceiving their personal wishes to be secondary to public health mandates – and led patients to simultaneously want to evade, and be assisted by, public health nurses. Conclusions Public health units and nurses should consider adopting a more patient-centered approach to HIV case management, which incorporates patients’ experiences of receiving an HIV diagnosis.

scholarly journals Identifying subgroups within at-risk populations that drive late HIV diagnosis in a Southern U.S. state

2020 ◽  
pp. 095646242094756
Author(s):  
Sabina O Nduaguba ◽  
Kentya H Ford ◽  
James P Wilson ◽  
Kenneth A Lawson ◽  
Robert L Cook
Keyword(s):  
At Risk ◽  
Older Individuals ◽  
Hiv Diagnosis ◽  
Interaction Terms ◽  
Late Hiv Diagnosis ◽  
Increased Risk ◽  
At Risk Populations ◽  
Sex With Men ◽  
Aids Diagnosis ◽  
Racial Ethnic

We aimed to identify subgroups within age, racial/ethnic, and transmission categories that drive increased risk for late HIV diagnosis (LHD). A 1996–2013 retrospective study of HIV-diagnosed individuals (N = 77,844) was conducted. The proportion of individuals with LHD (AIDS diagnosis within 365 days of HIV diagnosis) was determined, stratified by age, race/ethnicity, and transmission category. Logistic regression with interaction terms was used to identify groups/subgroups at risk for LHD during 1996–2001, 2002–2007, and 2008–2013. Respectively, 78%, 27%, 38%, and 31% were male, White, Black, and Hispanic. Overall, 39% had LHD with a 6.7% reduction for each year increase (OR = 0.93, 95% CI = 0.93–0.94, p < 0.01). Older age was significantly associated with increased odds of LHD (OR range = 1.90–4.55). Compared to their White counterparts, all Hispanic transmission categories (OR range = 1.31–2.58) and only Black female heterosexuals and men who have sex with men (MSM) (OR range = 1.14–1.33) had significantly higher odds of LHD during 1996–2001 and/or 2002–2007. Significance was limited to Hispanic MSM (all age categories), MSM/IDUs (30–59 years), and heterosexuals (18–29 years) and Black MSM (30–39 years) during 2008–2013. Older individuals and Hispanics (driven by MSM) are at increased risk for LHD. HIV testing interventions directed at seniors and Hispanic MSM can further reduce rates of LHD.

scholarly journals Estimates of the Time From Seroconversion to Antiretroviral Therapy Initiation Among People Newly Diagnosed With Human Immunodeficiency Virus From 2006 to 2015, New York City

2019 ◽  
Vol 71 (8) ◽  
pp. e308-e315
Author(s):  
McKaylee M Robertson ◽  
Sarah L Braunstein ◽  
Donald R Hoover ◽  
Sheng Li ◽  
Denis Nash
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Hiv Testing ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Population Based ◽  
Cd4 Count ◽  
Hiv Diagnosis ◽  
Art Initiation ◽  
Immunodeficiency Virus

Abstract Background We estimated the time from human immunodeficiency virus (HIV) seroconversion to antiretroviral therapy (ART) initiation during an era of expanding HIV testing and treatment efforts. Methods Applying CD4 depletion parameters from seroconverter cohort data to our population-based sample, we related the square root of the first pretreatment CD4 count to time of seroconversion through a linear mixed model and estimated the time from seroconversion. Results Among 28 162 people diagnosed with HIV during 2006–2015, 89% initiated ART by June 2017. The median CD4 count at diagnosis increased from 326 (interquartile range [IQR], 132–504) cells/µL to 390 (IQR, 216–571) cells/µL from 2006 to 2015. The median time from estimated seroconversion to ART initiation decreased by 42% from 6.4 (IQR, 3.3–11.4) years in 2006 to 3.7 (IQR, 0.5–8.3) years in 2015. The time from estimated seroconversion to diagnosis decreased by 28%, from a median of 4.6 (IQR, 0.5–10.5) years to 3.3 (IQR, 0–8.1) years from 2006 to 2015, and the time from diagnosis to ART initiation reduced by 60%, from a median of 0.5 (IQR, 0.2–2.1) years to 0.2 (IQR, 0.1–0.3) years from 2006 to 2015. Conclusions The estimated time from seroconversion to ART initiation was reduced in tandem with expanded HIV testing and treatment efforts. While the time from diagnosis to ART initiation decreased to 0.2 years, the time from seroconversion to diagnosis was 3.3 years among people diagnosed in 2015, highlighting the need for more effective strategies for earlier HIV diagnosis.

scholarly journals Trends in human immunodeficiency virus diagnoses among men who have sex with men in North America, Western Europe, and Australia, 2000–2014

2018 ◽  
Vol 28 (12) ◽  
pp. 874-880 ◽  
Author(s):  
Johanna Chapin-Bardales ◽  
Axel J. Schmidt ◽  
Rebecca J. Guy ◽  
John M. Kaldor ◽  
Skye McGregor ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
North America ◽  
Western Europe ◽  
Immunodeficiency Virus ◽  
Sex With Men
Sign in / Sign up

Export Citation Format

Share Document