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Biomedical subjects

J Elford

Publications and source records attributed to J Elford.

At least 37 records · Page 2Linked to original sources
PubMed2000

Repeat HIV testing: high-risk behaviour or risk reduction strategy?

OBJECTIVE: To examine the characteristics of repeat and first-time HIV testers and consider their implications for HIV test counselling. METHODS: An anonymous questionnaire was completed by nearly 1500 people seeking an HIV test between September 1997 and July 1998 at a same-day HIV testing clinic in London, United Kingdom. Repeat testers were those people who had previously tested HIV negative and were returning for another test. Information was collected on self-reported unprotected penetrative sex (UPS) in the previous 3 months and reasons for seeking the present test. RESULTS: Overall, 50.6% (721/1446) of all clinic attenders were repeat testers: gay men 71.7% (337/470), heterosexual men 42.1% (208/494) and heterosexual women 38.6% (186/482). No significant differences were found between repeat and first time testers in the frequency of UPS (P > or = 0.06). However, gay men (but not heterosexual men and women) reporting three or more previous HIV tests were significantly more likely to report higher-risk UPS (i.e. with a partner whose HIV status was either positive or unknown) (42.2%) than those who had had one-two or no previous tests (25.3 and 25.4%, respectively; P = 0.002). Over half the heterosexual men and women, and one third of gay men said they were seeking the current HIV test in preparation for a new relationship; these proportions did not differ significantly between repeat and first-time testers (P > 0.1). CONCLUSION: In this London HIV testing clinic, no significant differences were found in the frequency of UPS between repeat and first-time testers with the exception of gay men with a history of three or more previous HIV tests, who reported elevated levels of high-risk sexual behaviour. For many people, repeat HIV testing has become part of a risk reduction strategy to establish seroconcordance with a regular partner. HIV test counselling provides the opportunity both to address high-risk behaviour and to reinforce personal risk-reduction strategies.

Female↗
PubMed2000

Combination therapies for HIV and sexual risk behavior among gay men.

OBJECTIVE: To examine optimism in the light of recent advances in HIV treatment among gay men and its association with sexual risk behavior. METHODS: An anonymous questionnaire was completed by gay men who visited gyms in central London in March and April 1998 regarding their HIV status, unprotected anal intercourse (UAI) in the previous 3 months, and their response on a five-point linear scale to two measures of optimism: "I am less worried about HIV now that treatments have improved," and "I believe that new drug therapies make people with HIV less infectious." RESULTS: Two thirds of the men (67.5%, 522 of 773) did not agree with the statement, "I am less worried about HIV now that treatments have improved," and only 42 (5.4%) said they agreed quite a lot or a lot. HIV-positive men were more likely to agree with this statement than HIV-negative men (p = .001) and men who had never been tested (p < .001). There was no association between agreement with this statement and frequency of UAI among HIV-positive or never-tested men (p > .3); there was, however, a positive association among HIV-negative men who reported UAI with a partner of unknown or discordant status (p = .003). The vast majority of men (81.4%; 634 of 779) did not agree with the statement, "I believe that new drug therapies make people with HIV less infectious." Regardless of HIV status, no significant association was seen between agreement with this statement and frequency of UAI (p > .1 for all comparisons). CONCLUSION: Most gay men surveyed in central London gyms did not endorse the optimism statements concerning improved treatments or reduced infectivity. Although HIV-positive gay men were more likely to be optimistic than other men, there was no association between their optimism and sexual risk behavior. Among HIV-negative men, optimism around improved treatments (but not around reduced infectivity) was associated with UAI with a partner of unknown or discordant HIV status. For some HIV-negative men in London, optimism in the light of recent advances in HIV treatment may have triggered, or have been used as a justification for, sexual risk-taking.

Adult↗
PubMed2000

Computerized strain-gauge plethysmography - An alternative method for the detection of lower limb deep venous thrombosis?

AIM: To test the ability of computerized strain-gauge plethysmography to act as a screening test for lower limb deep venous thrombosis (DVT). MATERIALS AND METHODS: Over an 8-month period, all patients referred to our Medical Assessment Unit with suspected lower limb DVT were considered for inclusion in the study. Each patient underwent both plethysmography and ascending venography within 24 h, and the presence or absence of thrombus in the popliteal, superficial femoral or iliac veins was noted. The results of the two tests were then used to determine the accuracy of computerized strain-gauge plethysmography in detecting above knee DVT. RESULTS: The screening tests and venograms of 239 patients referred with clinically suspected lower limb DVT were compared. The false negative rate of plethysmography was 15.4%, which is significantly different from the 4.8% claimed by the manufacturers of this device (P = 0.00003). CONCLUSIONS: In a population of acute admissions with suspected lower limb DVT, computerized strain-gauge plethysmography is not suitable for use as a screening test due to an unacceptably high proportion of false negative screens.

Diagnosis, Computer-Assisted↗
PubMed2000

Do gay men discuss HIV risk reduction with their GP?

In September/October 1997, 1,004 gay men using one of five gyms in central London completed a confidential anonymous questionnaire which included items on sexual as well as steroid-related injecting behaviour and whether they had ever discussed these behaviours with friends, sexual partners or a general practitioner (GP). Nearly all the men reported having had sex with another man in the previous six months, while a quarter had had unprotected anal intercourse in the previous three months. Less than one-third of the men (30%) had discussed safer sex with their GP, compared with 92% who had talked about it with friends and 87% with lovers (p < 0.001). Of those who had discussed safer sex with their GP, one in six (17%) had not found it easy--this was significantly higher than the proportion who had not found it easy to discuss safer sex with friends, lovers or casual partners (3-9%, p < 0.01). More than 10% of the men had ever injected anabolic steroids. Of those who had injected anabolic steroids, just over one-third (36%) had ever discussed this with their GP. It appears that the majority of gay men in this study had not discussed HIV risk reduction with their GP. Until obstacles to discussing risk reduction and HIV prevention are overcome, the routine consultation in general practice will not be able to fulfill its potential for health promotion.

Adult↗
PubMed2000

Five cases of sarcoidosis in one family: a new immunological link?

We report a family in which five members have been affected with sarcoidosis. The radiological findings of all cases are presented, together with HLA typing, T cell subset and cytokine analysis in four cases. A new HLA association in the presentation of sarcoidosis is suggested.

Adult↗
PubMed1999

Sexual risk behaviour among gay men in a relationship.

OBJECTIVE: To examine whether gay men in a relationship have adopted negotiated safety as an HIV risk reduction strategy. METHODS: A confidential, anonymous questionnaire was completed by 1004 gay men attending gyms in central London in September-October 1997. Information was sought on sociodemographic characteristics, HIV testing and sexual risk behaviour. Men reporting unprotected anal intercourse (UAI) in the previous 3 months were classified as 'status-unknown' if they did not know their own HIV status, that of their UAI partner(s) or both. Men who knew their own and their UAI partner's HIV status were classified as 'status-known'. RESULTS: Of the 1004 men surveyed, 986 provided complete information on relationship, personal HIV test history and HIV status of UAI partner. Over half (539) said they were currently in a relationship with another man, of whom 173 reported UAI in the previous 3 months; 140 (80.9%) with their main partner only, 18 (10.4%) with a casual partner only and 15 (8.7%) with both their main and casual partners. Of the 140 men reporting UAI only with their main partner, 62 (44.3%) did not know their own HIV status or that of their partner. Overall, a quarter (26.0%) of the men in a relationship reported UAI only with their main partner in the previous 3 months; 11.5% status-unknown UAI, 14.5% status-known UAI. In a multivariate logistic model, both age and being in a relationship were significantly associated with UAI (status-unknown and status-known). CONCLUSION: Gay men in a relationship, surveyed in central London gyms, have for the most part adopted the first principle of negotiated safety: only to have UAI with their main partner. However, not all have embraced the second principle: to establish HIV seroconcordance. Nearly half the men reporting UAI only with their main partner were unaware of their own HIV status, their partner's or both. As a consequence, more than one in 10 men in a relationship reported high-risk (i.e. status-unknown) UAI with their main partner. Because the study population, from central London gyms, was not randomly selected, these findings may not be generalizable to all gay men in London. Nonetheless, HIV prevention programmes should continue to encourage gay men in a relationship to seek an HIV test and establish seroconcordance if they wish to have UAI with each other.

Adult↗
PubMed1999

HIV risk behaviours among gay men who use anabolic steroids.

AIMS: To examine the injecting and sexual risk behaviours of gay men in London who use anabolic steroids or other fitness-enhancing substances (referred to as AS). DESIGN: Cross-sectional survey using self-administered questionnaire. SETTING: Five gyms in central London. PARTICIPANTS: 1004 gay men using the gyms during September-October 1997. MEASUREMENTS: Proportion of men who report (i) injecting AS, (ii) sharing needles and (iii) HIV status-unknown unprotected and intercourse (UAI). FINDINGS: Of 1004 men, 136 (13.5%) were current users of AS (range across the five gyms, 2.7-21.2%, p < 0.001), and 81 (8.1%) injected AS (range 0.4-17.5%, p < 0.001). None said they shared a needle with other users and more than 90% said they always used disposable units from sealed packets. Among current AS users, 20.9% (28/136) reported status-unknown UAI compared with 12.9% (107/827) of never-users (p = 0.02), a differential which remained significant after adjusting for confounding factors (adjusted odds ratio = 1.75, 95% CI 1.05, 2.91, p = 0.03). CONCLUSIONS: While nearly one in 10 gay men in this study injected anabolic steroids or other fitness-enhancing substances, none reported sharing needles. Steroid users were, however, more likely to report status-unknown UAI than other men, a differential that remained after adjusting for confounding factors. Since any change in injecting practice could dramatically increase the risk of HIV transmission in this population, behavioural surveillance to monitor risk behaviours among gay men using anabolic steroids is recommended, as are targeted HIV prevention programmes.

Adult↗
PubMed1999

Ultrasound guided percutaneous thrombin injection for the treatment of iatrogenic pseudoaneurysms.

Iatrogenic aneurysms are usually postcatheterisation pseudoaneurysms of the femoral artery. Until recently, the treatment of choice was ultrasound guided compression repair. A case of pseudoaneurysm of the axillary artery, arising as a complication of pacemaker insertion in an 83 year old man is reported. Compression repair was not possible in this case, and so the aneurysm was occluded by percutaneous ultrasound guided thrombin injection directly into the aneurysm sac. Percutaneous ultrasound guided thrombin injection is a promising new minimally invasive technique for the treatment of iatrogenic pseudoaneurysms.

Aged↗
PubMed1997

Relation between soluble CD30 levels measured soon after HIV seroconversion and disease progression in men with hemophilia.

Soluble CD30 (sCD30) levels within 3 years of HIV seroconversion were studied in 85 hemophilic men infected with HIV. All men were coinfected with hepatitis C virus (HCV). Levels of sCD30 were elevated in these men when compared with controls. These elevated levels did not appear to be a result of treatment with intermediate-purity clotting factor concentrates and were unlikely to be due to HCV coinfection inasmuch as hemophilic patients infected with HCV alone showed only mildly elevated sCD30 levels when compared with those of hemophilic controls uninfected with HCV. Initial sCD30 levels were not significantly associated with progression to any endpoint, although a tendency was present for those with the highest initial levels to progress less rapidly than those with lower values. Despite elevated sCD30 levels in these men, we have not been able to confirm that high sCD30 levels are associated with more rapid HIV progression.

Disease Progression↗
PubMed1997

Women with HIV disease attending a London clinic.

OBJECTIVE: To examine ethnic, relationship, health, and mental health factors for a cohort of women with HIV infection attending an inner London clinic. DESIGN AND METHODS: Structured schedules were utilised to analyse ethnic group, family, and reproduction issues, mental and physical health for 100 women drawn consecutively from attenders at an inner London HIV clinic RESULTS: 51% of the women were non-ethnic minority groups and 49% were from ethnic groups. HIV testing was often as a result of symptoms or partner illness. One in five had disclosed their status to one person only or no one. Ethnic minority women were more likely to restrict disclosure. Forty seven per cent of the women had 100 children with more children reported in ethnic minority families; 28% of the children had been tested for HIV and five were confirmed HIV positive; 9% of children were born after HIV diagnosis. Nineteen women reported one or more termination of pregnancy, the majority before HIV diagnosis. Three quarters had a partner of whom 56 knew the partner's status. Women with HIV positive partners were more likely to have children. Women kept in ignorance of partner status were more likely to be ethnic minority women. Thirty two per cent had an AIDS diagnosis, diagnosed mostly in the UK. Medical and counselling service uptake was high. Gynaecological problems were common (49% had one or more problem) and 34% had at least one hospital admission. A wide range of counselling issues were recorded, with variations over time. Suicidal issues were relevant for 13% of women (69% ideation, 31% attempts). Significant life events were noted for many women with allied coping demands. CONCLUSIONS: There are a wide range of issues for women with HIV and systematic differences between ethnic and non-ethnic women and those with or without children.

AIDS Serodiagnosis↗
PubMed1997

Repeat HIV testers at a London same-day testing clinic.

OBJECTIVE: To compare the characteristics of repeat HIV testers with first-time testers in a National Health Service HIV testing clinic in London. SUBJECTS AND METHODS: A self-administered questionnaire was distributed to clinic attenders between September 1995 and January 1996. The sample was stratified by gender and sexual orientation. Repeat and first-time testers were compared with respect to recent sexual risk behaviour, reasons for taking the HIV test, condom use, knowledge of sex partner's HIV status, and sociodemographic and psychosocial variables. RESULTS: Of 965 clinic attenders surveyed, 404 (41.9%) reported at least one previous HIV test outside the window period and were classified as repeat testers: homosexual men, 62.5% (178 out of 285); heterosexual men, 35.1% (126 out of 359); heterosexual women, 31.2% (100 out of 321). Among homosexual men, repeat testers were more likely to report the following: two or more partners in the previous 6 months for both unprotected anal sex (25.8 versus 9.3%; P < 0.01) and unprotected oral sex (53.9 versus 37.4%; P < 0.01); ever having had a sexually transmitted disease (STD) other than HIV (49.4 versus 29.0%; P < 0.01); taking the present test "as part of a regular health check' (48.9 versus 28.0%; P < 0.01); and knowing others who had tested for or been infected with HIV. Repeat testing heterosexual men were more likely to report the following: two or more partners in the previous 6 months for unprotected vaginal sex (42.9 versus 30.9%; P < 0.05) and unprotected oral sex (41.3 versus 25.3%; P < 0.01); ever having had an STD other than HIV (31.7 versus 20.6%; P < 0.05); taking the present test "as part of a regular health check' (36.5 versus 26.2%; P < 0.05); and knowing others who had tested for or been infected with HIV. For heterosexual women, repeat testers were more likely to report ever having had an STD other than HIV (25.0 versus 14.5%; P < 0.05), and knowing others who had tested for or been infected with HIV. CONCLUSIONS: Repeat testing was associated with high-risk sexual behaviour, a previous STD, knowledge of others who have tested for or been infected with HIV, and seeking the test as part of a regular health check. Factors contributing to repeat testing are multi-faceted and vary between groups of different sexual orientation. Use of the impact of knowledge of others infected by HIV and the experience of contracting an STD other than HIV may guide the development of HIV counselling interventions aimed at reducing sexual risk behaviour.

Adult↗
PubMed1996

Serum beta 2-microglobulin at HIV-1 seroconversion as a predictor of severe immunodeficiency during 10 years of followup.

In order to examine the relevance of early immune activation to the long-term course of HIV infection, we evaluated the ability of the serum beta 2-microglobulin level measured in 63 haemophiliacs on average 4.9 months from HIV seroconversion to predict the rate of development of server immunodeficiency (CD4) lymphocyte count 50/mm3) or AIDS over the following 10 years. Patients with higher beta 2-microglobulin values tended to develop severe immunodeficiency/AIDS more rapidly than those with lower levels (relative risk 1.68 per 1 mg/L increase; 95% CI 1.26-2.26; p = 0.0004). Older patients also progressed more rapidly, and these two factors acted independently (relative risk 1.65 per 1 mg/L increase; 95% CI 1.21-2.72; p = 0.002 for beta 2-microglobulin and 1.22 per 10 years; 95% CI 1.01-1.48; p = 0.04 for age). These results provide further evidence that the long-term course of HIV infection can, to some extent, be predicted soon after infection. Older patients with high beta 2-microglobulin levels warrant close monitoring and consideration for early antiretroviral therapy.

Adolescent↗