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Biomedical subjects

J Elford

Publications and source records attributed to J Elford.

At least 55 records · Page 3Linked to original sources
PubMed1996

Screening for sexually transmitted diseases in an HIV testing clinic; uptake and prevalence.

OBJECTIVE: To estimate the prevalence of sexually transmitted diseases (STDs) and the acceptability of STD screening among people seeking an HIV antibody test in an established free standing HIV testing clinic. DESIGN: A 9 month period prevalence study conducted between August 1993 and April 1994. SETTING: The Same Day Testing Clinic (SDTC) for HIV antibodies at the Royal Free Hampstead NHS Trust Hospital, London. SUBJECTS: 242 males and 160 females attending the Same Day Testing Clinic. OUTCOME MEASURES: The prevalence of STDs including gonorrhoea, chlamydia, syphilis and hepatitis B and the percentage of clinic attenders accepting an STD screen. RESULTS: Of those invited to take part in the study 69% of the males (242/350) and 59% (160/269) of the females agreed to be screened although for a variety of reasons not everyone agreed to a full screen. Two cases of untreated syphilis, no cases of gonorrhoea and six cases of chlamydia were detected. Four people had active, previously undiagnosed herpes while three had genital warts. Evidence of previously unknown hepatitis B infection was found in 26 people. Despite a high level of previous contact with genitourinary medicine services, uptake of hepatitis B vaccination among those homosexual men eligible for immunisation was low (28%; 23/83). Nine (4%) of the males, but none of the females screened for STD were found to be HIV antibody positive. CONCLUSION: Among people seeking an HIV antibody test in an established free standing HIV testing clinic, the prevalence of acute STDs was low. However, evidence of previously undiagnosed hepatitis B infection was found in a number of subjects and uptake of vaccination among those most at risk had been low. While opportunistic screening for STD was acceptable to almost two thirds of HIV testing clinic attenders, a substantial minority nonetheless declined this offer. Selective STD screening could be offered to those people seeking an HIV test who report never having been screened before, as both cases of positive syphilis serology and all those of chlamydia were in people who had not previously been screened. All those at risk for hepatitis B infection should be encouraged to establish their infection status and be immunised where appropriate.

Ambulatory Care↗
PubMed1995

Antenatal HIV antibody testing in Australia.

OBJECTIVE: To evaluate the role of voluntary antenatal testing in HIV surveillance and prevention by examining antenatal HIV antibody testing practice and policy in Australia. DESIGN: Cross-sectional study using a self-administered questionnaire. SUBJECTS AND SETTING: Specialist obstetricians and gynaecologists and general practitioners (GPs) affiliated with the Royal Australian College of Obstetricians and Gynaecologists and Australian public hospital antenatal clinics, August-November 1992. MAIN OUTCOME MEASURES: The percentage of public hospital antenatal clinics and specialist and GP obstetricians in Australia who tested pregnant women for HIV antibody as part of their antenatal care, and the proportion of pregnant women in Australia who had an antenatal HIV antibody test in the 1991-92 financial year. RESULTS: Questionnaires concerning antenatal HIV antibody testing were completed by 90% (993/1108) of specialists, 87% (2134/2461) of GPs and 93% (215/230) of public hospitals surveyed. Of the 706 specialists and 1503 GPs who reported that they were currently engaged in obstetric care, approximately 60% (430/706) and 935/1503, respectively) offered antenatal HIV testing either to all pregnant women or to selected groups at risk. There were significant differences in testing patterns between States and Territories. For the 95 public hospitals with antenatal clinics, 81% (77) offered the HIV antibody test to all or selected groups of pregnant women; these percentages did not differ significantly between States and Territories. It was estimated that 25% of pregnant women seen by specialists, 29% seen by GPs and 9% seen in public hospital clinics were tested for HIV antibody as part of their antenatal care in 1991-92. CONCLUSIONS: In Australia approximately one in five pregnant women were tested for HIV antibody as part of their antenatal care in 1991-92. Voluntary HIV testing in pregnancy may provide unrepresentative data for measuring the prevalence of HIV infection in pregnant women.

AIDS Serodiagnosis↗
PubMed1995

Reporting of occupational exposures to blood-borne pathogens in Australian teaching hospitals.

OBJECTIVE: To describe the reporting of occupational exposures to blood and body fluids in Australian teaching hospitals. DESIGN: Survey by questionnaire of the major teaching hospitals in Australia, December 1992. RESULTS: Completed questionnaires were received from 88% of the 69 teaching hospitals in Australia. All responding hospital reported an established procedure for reporting and managing occupational exposures to blood and body fluids and 82% indicated willingness to contribute data to a national monitoring project. Information concerning the actual incident was recorded by all hospitals and two-thirds of hospitals had forms which specifically detailed exposures history. Patient and healthcare worker risk factors for HIV were recorded less frequently. but in 87% of hospitals blood tests were performed on both the staff member and source patient. Among 87 026 equivalent full time staff employed by the responding hospitals, 5803 injuries were reported in 1991. The median number of reported injuries as a percentage of equivalent full time staff was 7%. Estimates of non-reporting ranged from 5% to 70% (median 25%). Prophylactic zidovudine was prescribed for 50 staff from 21 hospitals in 1991. CONCLUSIONS: All Australian teaching hospitals have an established procedure for documenting occupational exposure to blood and body fluids. Although there is limited standardisation at a national level, the information already collected and the willingness to participate indicated by a large number of teaching hospitals are sufficient for a national surveillance mechanism to be established.

Accidents, Occupational↗
PubMed1995

Staging system for clinical AIDS patients. Royal Free/Chelsea and Westminster Hospitals Collaborative Group.

Although there are wide differences in prognosis between patients with AIDS they are often thought of as a single homogeneous group. We think a simple staging system that accounts for important prognostic factors including type and number of AIDS diseases and the CD4 lymphocyte count is required. We followed 363 AIDS patients at the Royal Free Hospital and reported the occurrence of 680 AIDS-defining diseases (ADDs). We measured CD4 counts at approximately monthly intervals. Severity of AIDS diseases was defined a priori on the basis of survival in the AIDS in Europe study of 6578 AIDS patients: mild-oesophageal candidiasis, Kaposis sarcoma (cutaneous), Pneumocystis carinii pneumonia, extrapulmonary tuberculosis; severe-all other ADDs except lymphoma; very severe-lymphoma. The risk of death increased by 15% (p = 0.08) for each mild condition experienced, by 89% (p < 0.0001) for each new severe condition and by 535% (p < 0.0001) when a lymphoma developed. Estimates from the Cox model were used to derive a score reflecting the risk of death. Patient experience was divided into three categories. Patients in AIDS Grade I had an average death rate of one per 10.1 years, compared with one per 2.8 years in AIDS Grade II and one per 1.1 years in AIDS Grade III. Similar rates were seen in an independent validation study on 1230 AIDS patients at different hospital. Our grading system should be useful for patient management, clinical trial design, surveillance, and resource management.

AIDS-Related Opportunistic Infections↗
PubMed1994

Use of CD4 lymphocyte count to predict long-term survival free of AIDS after HIV infection.

OBJECTIVE: To estimate the probability of remaining free of AIDS for up to 25 years after infection with HIV by extrapolation of changes in CD4 lymphocyte count. DESIGN: Cohort study of subjects followed from time of HIV seroconversion until 1 January 1993. Creation of model by using extrapolated linear regression slopes of CD4 count to predict development of AIDS after 1993. SETTING: Regional haemophilia centre in teaching hospital. SUBJECTS: 111 men with haemophilia infected with HIV during 1979-85. Median length of follow up 10.1 years, median number of CD4 counts 17. The model was not fitted for three men because only one CD4 measurement was available. MAIN OUTCOME MEASURES: Development of AIDS. INTERVENTIONS: From 1989 prophylaxis against candida and Pneumocystis carinii pneumonia and antiretroviral drugs when CD4 count fell below 200 x 10(6)/l. RESULTS: 44 men developed AIDS up to 1 January 1993. When AIDS was defined as a CD4 count of 50 x 10(6)/l the model predicted that 25% (95% confidence interval 16% to 34%) would survive for 20 years after seroconversion and 18% (11% to 25%) for 25 years. Changing the CD4 count at which AIDS was assumed to occur did not alter the results. Younger patients had a higher chance of 20 year survival than older patients (32% (12% to 52%) for those aged < 15, 26% (14% to 38%) for those aged 15-29, and 15% (0% to 31%) for those aged > or = 30). CONCLUSIONS: These results suggest that even with currently available treatment up to a quarter of patients with HIV infection will survive for 20 years after seroconversion without developing AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Clinical practice and the perceived importance of identifying high risk patients.

The Royal Free NHS Trust is implementing a Universal Precautions policy for blood and body fluids. Anticipating the introduction of this policy, a questionnaire was sent to a sample of staff and students who work with patients or clinical specimens. The questionnaire covered: views about identifying 'high risk' patients and specimens; perceived risks of human immunodeficiency virus (HIV) and hepatitis B infection from blood exposures; and current practices to avoid exposure to blood. Over half the respondents thought it important to identify high risk patients and specimens. Such respondents were more likely to overestimate the risks of HIV and hepatitis B virus transmission after blood exposures, they were less likely to wear gloves and more likely to resheathe needles. Although two-thirds of respondents thought Universal Precautions would reduce their risk of blood-borne infections, they identified a number of reasons why it would be difficult for them to practice it. Those who thought it important to identify high risk patients gave more reasons than other respondents. This survey indicates that many staff believe it is important to identify high risk patients and this belief seems to influence clinical practice. In order to implement a policy of Universal Precautions successfully, it is necessary to address underlying beliefs as well as giving staff information and training.

Acquired Immunodeficiency Syndrome↗
PubMed1994

HIV seroprevalence in a London same-day testing clinic.

OBJECTIVES: To determine the prevalence of HIV infection among people attending a confidential, non-genitourinary medicine based testing clinic that provides HIV antibody test results on the day of consultation. METHODS: Retrospective analysis of data collected on 2635 individuals attending the Same-Day HIV Testing Clinic at the Royal Free Hospital, London between March 1992 and February 1993. RESULTS: A total of 1612 men and 1023 women were tested for HIV antibody. The primary risk for HIV infection was heterosexual (71.7%; 1889 out of 2635) and homosexual contact (24.5%; 646 out of 2635). Fifty-four individuals were given positive HIV test results (46 men, median age 34 years; eight women, median age 27 years). Overall HIV seroprevalence was 2.0% (95% confidence interval, 1.5-2.5). HIV seroprevalence was highest among homosexual men (6.5%; 41 out of 635) and injecting drug users (5.7%; four out of 70). The rates for heterosexual men and women were 0.2% (two out of 915) and 0.7% (seven out of 974), respectively. Of the 54 individuals who were HIV-antibody-positive, 44 were Centers for Disease Control and Prevention stage II/III, eight stage IV and one was tested at the time of seroconversion (stage I; data were not available for one patient). Of the total numbers attending this clinic 27% (702 out of 2635) had previously been tested and received a negative result. Of a total of 54 HIV-antibody-positive individuals, 40% (21) had previously received a negative test result. CONCLUSIONS: The data suggest that seroprevalence amongst homosexual men attending a designated HIV testing clinic in London is lower than that reported by genitourinary clinic based testing sites. The large number of repeat testers who subsequently became infected with HIV suggests that there is a population requiring specific targetting for HIV risk reduction.

AIDS Serodiagnosis↗
PubMed1994

Beta-2 microglobulin as a predictor of prognosis in HIV-infected men with haemophilia: a proposed strategy for use in clinical care.

Whilst the prognostic value of serum beta-2 microglobulin (s-beta 2m) is well documented, the lack of a simple strategy for its use means that it is rarely ever measured in clinical practice. The prognosis associated with s-beta 2m at two different points in HIV infection, as defined by the CD4 count, was studied in a cohort of 111 men with haemophilia registered at the Royal Free Hospital School of Medicine, London. At CD4 counts of 0.5 and 0.2 x 10(9)/l, a raised s-beta 2m level was significantly associated with an increased risk of developing AIDS (P = 0.002 and 0.022 respectively, adjusted for the patient's age). Kaplan-Meier progression rates to AIDS by 4.5 years after a CD4 count of 0.5 x 10(9)/l were 57% (95% CI 32-82%) in those with s-beta 2m levels of 3 mg/l or more, but 20% (95% CI 4-36%) in those with s-beta 2m levels of less than 3 mg/l. By 3.5 years after a CD4 count of 0.2 x 10(9)/l, Kaplan-Meier progression rates to AIDS were 75% (95% CI 52-98%) in those with s-beta 2m levels of 3.8 mg/l or more, and 47% (95% CI 29-66%) in those with s-beta 2m levels of less than 3.8 mg/l. In the absence of acute viral infections, a raised s-beta 2m indicates those who will tend to progress to AIDS more rapidly than those with lower s-beta 2m levels and the same CD4 count. S-beta 2m levels in general are likely to be higher in haemophilia patients than in other, non-haemophilic risk groups. Whilst care should be taken, therefore, when applying our chosen cut-off values to non-haemophilic patients, our findings support the introduction of prophylaxis and antiviral therapies at a higher CD4 count in those with raised s-beta 2m levels relative to other patients in the same risk group whilst delaying treatment in those with lower CD4 counts, but relatively normal s-beta 2m levels.

Acquired Immunodeficiency Syndrome↗
PubMed1994

CD4+ counts before and after switching to monoclonal high-purity factor VIII concentrate in HIV-infected haemophilic patients.

Allogenic proteins that contaminate intermediate purity clotting factor concentrates may activate the immune system of HIV-infected haemophilic patients. In 37 haemophilic patients infected with HIV who had originally been treated with intermediate purity factor VIII concentrate and then changed to monoclonally-purified high purity factor VIII concentrate the rates of CD4+ decline (10(9)/l per year) were 0.06 before and 0.02 after a switch to high purity products (p = 0.01). The median follow-up of patients after the switch to high purity products was 1.7 years (range 0.2 to 3 years). This significant change in the rate of CD4 decline was independent of the starting CD4 count, age and antiretroviral therapy. This result is consistent with those from randomised trials of the introduction of high-purity concentrate. Given the strong association between the CD4+ count and survival, treatment with high purity rather than intermediate purity clotting factor concentrate may confer a survival benefit for HIV-infected haemophilic patients.

AIDS-Related Opportunistic Infections↗
PubMed1993

Acquired immunodeficiency syndrome (AIDS) risk in recent and long-standing human immunodeficiency virus type 1 (HIV-1)-infected patients with similar CD4 lymphocyte counts.

The loss of CD4 lymphocytes is known to be an important component of human immunodeficiency virus type 1 (HIV-1) pathogenesis. It remains unclear, however, whether the importance of the CD4 lymphocyte count is such that individuals who have been infected for widely different lengths of time, but for whom the CD4 lymphocyte count is the same, have the same risk of developing acquired immunodeficiency syndrome (AIDS). The authors directly addressed this question for 111 HIV-1-infected hemophiliacs who had been followed for up to 12 years from seroconversion and for whom a median of 16 CD4 lymphocyte counts had been made. Thirty-eight patients had developed AIDS by January 1, 1992. As of August 1, 1985, the time from seroconversion to AIDS ranged from 3 weeks to almost 6 years. The risk of AIDS increased with time from seroconversion (relative hazard = 1.25 per year; p = 0.09). CD4 lymphocyte count was strongly related to time from seroconversion and also to the risk of AIDS (relative hazard = 3.25 per 100/mm3; p < 0.00005). In a bivariate Cox regression model, the relative hazard for time from seroconversion fell markedly towards unity (1.05; p = 0.7), while that for CD4 lymphocyte count remained unchanged. This suggests that time from seroconversion is a relevant factor in HIV-1 infection only insofar as it provides information as to the probable degree of loss of CD4 lymphocytes. If the number of these cells is known, time from seroconversion seems to be of little additional value in assessing the risk of AIDS. This finding has implications for the clinical assessment of individual patient prognosis, for the design of epidemiologic studies of HIV-1 infection, and for our understanding of how HIV-1 causes disease.

Acquired Immunodeficiency Syndrome↗