Seasonal influenza viruses are a common cause of acute respiratory illness worldwide and generate a significant socioeconomic burden. Influenza viruses mutate rapidly, necessitating annual vaccine reformulation because traditional vaccines do not typically induce broad-spectrum immunity. In addition to seasonal infections, emerging pandemic influenza viruses present a continued threat to global public health. Pandemic influenza viruses have consistently higher attack rates and are typically associated with greater mortality compared with seasonal strains. Ongoing strategies to improve vaccine efficacy typically focus on providing broad-spectrum immunity; although B and T cells can mediate heterosubtypic responses, typical vaccine development will augment either humoral or cellular immunity. However, multipronged approaches that target several Ags may limit the generation of viral escape mutants. There are few vaccine platforms that can deliver multiple Ags and generate robust cellular and humoral immunity. In this article, we describe a novel vaccination strategy, tested preclinically in mice, for the delivery of novel bivalent viral-vectored vaccines. We show this strategy elicits potent T cell responses toward highly conserved internal Ags while simultaneously inducing high levels of Abs toward hemagglutinin. Importantly, these humoral responses generate long-lived plasma cells and generate Abs capable of neutralizing variant hemagglutinin-expressing pseudotyped lentiviruses. Significantly, these novel viral-vectored vaccines induce strong immune responses capable of conferring protection in a stringent influenza A virus challenge. Thus, this vaccination regimen induces lasting efficacy toward influenza. Importantly, the simultaneous delivery of dual Ags may alleviate the selective pressure that is thought to potentiate antigenic diversity in avian influenza viruses.
BASHH guidelines recommend that ‘the hepatitis A virus total antibody test can be offered to at-risk patients whose immune status is unknown … depending on local funding arrangements’. We sought to measure the local prevalence of anti-hepatitis A (HAV) IgG in HIV-negative men who have sex with men (MSM), to inform the utility of pre-vaccination screening. We assessed the prevalence of anti-HAV IgG in HIV-negative MSM who attended sexual health services in County Durham and Darlington, UK, from March to August 2017. Data were extracted from electronic patient records and analysed in Excel. Our study was granted local Caldicott approval. Seventy four per cent of 244 HIV-negative MSM who attended for review were screened. Anti-HAV IgG was detected in 42% who did not report definite previous infection or vaccination; not detected in 57.4%; and was equivocal in 0.6%. Vaccine was administered to 48% of eligible patients. The estimated financial costs of universal vaccination of MSM (£4235.40) and pre-vaccination screening with vaccination of susceptible patients (£4188.13) are similar. Pre-vaccination screening and vaccination of susceptible patients does not save resources compared to a policy of universal vaccination of MSM in our setting. Universal vaccination of MSM attending genitourinary medicine clinics may improve vaccine uptake.
Background Establishing effective postnatal contraception is essential for HIV-seropositive women to avoid the risk of unwanted pregnancy and minimise HIV transmission to HIV-seronegative partners. The authors describe their experience of providing postnatal contraception to HIV-seropositive women who attend a community-based integrated sexual health clinic. Methods The authors performed a retrospective case note review of all women who received care for HIV in pregnancy to term at their clinic from September 2000 to October 2010. Results A total of 107 pregnancies among 95 women were eligible for review. Attendance for contraceptive advice within 4 weeks of delivery occurred in 82/107 (77%) pregnancies. Depo-Provera® was prescribed in 21 (21/82, 26%) cases; an intrauterine contraceptive was arranged in 22/82 (27%) cases and sterilisation had occurred as part of a Caesarean delivery in 10/82 (12%) cases. In seven women who discontinued antiretroviral therapy at delivery one subdermal implant was fitted and the combined contraceptive pill was prescribed six times. In 17/82 (21%) cases women opted to use condoms alone. Attendance for postpartum contraceptive advice was missed following 21/107 (20%) pregnancies. Conclusions Uptake of a second contraceptive method in addition to condoms is high among women who attend clinic for contraceptive advice in the immediate postnatal period. However, 20% of women did not attend and their contraceptive choices remain unknown. These women are at risk of unwanted pregnancy and transmission of HIV to seronegative partners if appropriate contraceptive methods are not re-established postpartum.
Untreated or inadequately treated gonorrhoea is associated with significant morbidity and may act as a co-factor in HIV transmission. The WHO currently recommends treatment of gonorrhoea with quinolone, oral cefixime, intramuscular ceftriaxone or spectinomycin. In Kenya, syndromic treatment of male dysuria or discharge includes presumptive treatment for gonorrhoea with quinolone and …
Introduction Young people aged 18–24 years old are a key demographic target for eliminating HIV transmission globally. Pre-exposure prophylaxis (PrEP), a prevention medication, reduces HIV transmission. Despite good uptake by gay and bisexual men who have sex with men, hesitancy to use PrEP has been observed in other groups, such as young people and people from ethnic minority backgrounds. The aim of this study was to explore young people’s perceptions and attitudes to using PrEP. Design A qualitative transcendental phenomenological design was used. Participants and setting A convenience sample of 24 young people aged between 18 and 24 years was recruited from England. Methods Semistructured interviews and graphical elicitation were used to collect data including questions about current experiences of HIV care, awareness of using PrEP and decision-making about accessing PrEP. Thematic and visual analyses were used to identify findings. Results Young people had good levels of knowledge about HIV but poor understanding of using PrEP. In this information vacuum, negative stigma and stereotypes about HIV and homosexuality were transferred to using PrEP, which were reinforced by cultural norms portrayed on social media, television and film—such as an association between using PrEP and being a promiscuous, white, gay male. In addition, young people from ethnic minority communities appeared to have negative attitudes to PrEP use, compared with ethnic majority counterparts. This meant these young people in our study were unable to make decisions about when and how to use PrEP. Conclusion Findings indicate an information vacuum for young people regarding PrEP. A strength of the study is that theoretical data saturation was reached. A limitation of the study is participants were largely from Northern England, which has low prevalence of HIV. Further work is required to explore the information needs of young people in relation to PrEP.
Since 2004, we have run a fortnightly in-reach sexual health clinic in a medium security male prison which houses 1200 inmates, with a specific wing for men who have committed drugs related offences. In 2007, we reported that the prevalence of Hepatitis C (HCV) in the prisoners we tested was 9% [1]. Since then, there has been increased awareness of the burden of HCV in prison settings and new recommendations to increase HCV testing [2]. We aimed to review the current prevalence of HCV in local prisoner sexual health screens, and compare this firstly, to our previous 2007 estimate, and secondly, to that in a contemporary male sexual health clinic population.
Methods
We performed a retrospective review of all Hepatitis C antibody tests requested for prisoners and male sexual health clinic patients by our service from 1.09.10 – 30.9.11. Samples were identified by laboratory electronic records and supplementary data was acquired by case note review.
Results
HCV antibody screens were performed in 118 prisoners, and 716 men attending our general sexual health clinic. The prevalence of HCV antibody was significantly greater in the prison population compared with the sexual health clinic population (11.1% V 1.1%, 2 sample test of proportion p < 0.0005) however the prevalence in prisoners was unchanged from the 2007 estimate (11.1% V 9%, 2 sample test of proportion p < 0.6). Injecting drug use was reported in 89% of HCV positive cases.
Conclusion
The prevalence of HCV in our local institution remains high and injecting drug use is the most commonly reported risk factor. Implementing expanded testing strategies in prisons is a priority of great importance, along with further work to examine the effectiveness of currently strategies to address intravenous drug use. Int J STD & AIDS 2007 (18) 4: 228–30. NICE PH43 http://guidance.nice.org.uk/PH43.
Continuation of HIV Pre-Exposure Prophylaxis (PrEP) is key to realising its public health benefit. This study sought to evaluate retention in care amongst individuals receiving a prescription of PrEP from our large level 3 integrated sexual health service in the north east of England.
Methods
We identified all patients prescribed PrEP between 01.01.21 and 31.12.21 using GUMCAD2 coding. Results were cross-checked against PrEP clinic attendances and duplicates excluded. We assessed retention in care at 3, 6 and 9 months following the first PrEP prescription.
Results
402 patients were prescribed PrEP during the study period. Nearly all were men who have sex with men (98%) with a median age of 30 (range 17-77). Two thirds lived locally to our clinic. 239 patients reported no previous PrEP use, 109 were IMPACT PrEP participants (IPP) and 61 had previously sourced PrEP by another means. Overall continuation was 75%, 68% and 61% at 3, 6 and 9 months respectively. Univariate analysis reveals retention in care was greater amongst IPP compared with new-starters (3 months 83% v 74% p=0.09; 6 months 76% v 61% p=0.02; 9 months 74% v 45% p=0.0009).
Discussion
61% of patients prescribed HIV PrEP remained in care at 9 months, with a higher proportion lost to follow-up amongst new starters. Whilst patients might have accessed other services, higher retention rates amongst IPP could reflect higher perceived value of PrEP (associated with HIV risk, access or normalisation) or a need to better support new users, warranting further evaluation.
We read with interest the letter by Lakhi and Govind highlighting the potential failure of Implanon® if used in combination with antiretroviral therapy.1 The letter demonstrates the consequent importance of disclosure of HIV status to reproductive health care services, and the responsibility of HIV physicians to discuss contraceptive choices with female patients.
Our clinic has provided an integrated sexual health service since 1995, aiming to provide a holistic approach to HIV and reproductive health care. All female patients are invited to attend a dedicated ‘Family Planning …
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