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PubMed1998

Population screening for neonatal liver disease: a feasibility study.

BACKGROUND: Extra-hepatic biliary atresia and several other causes of neonatal liver disease carry high mortality and morbidity rates, especially if not treated early in life. Despite professional recommendations, delayed referral of infants with prolonged jaundice continues to be a significant problem. One approach to reducing the age of referral and diagnosis is population screening to detect significant conjugated hyperbilirubinaemia as an index of liver dysfunction. METHODS: To investigate this possibility, and to provide reference data on bilirubin and its conjugated and unconjugated fractions in a normal newborn population, 1157 neonates were anonymously tested (median age 7 days, range 4-28 days) using surplus plasma from routinely collected neonatal screening specimens, using dry slide chemistry. RESULTS: Of 2310 specimens received, 50% were suitable for analysis. The remainder were either haemolysed or insufficient (10% and 40% of the total, respectively). Total bilirubin concentrations ranged from 9 to 428 micromol/l and conjugated bilirubin from 0 to 175 micromol/l, although the latter was rarely increased to more than 30 micromol/l (2.5th-97.5th percentile ranges 15-285 micromol/l and 0-18 micromol/l, respectively). The range of the percentage of conjugated bilirubin was 0-57% (2.5th-97.5th percentile; range 0-20%). CONCLUSION: An increased conjugated bilirubin, expressed as a concentration or as the percentage of the total bilirubin, could be used as a specific marker to screen for liver dysfunction in neonates. This approach has the potential to improve the age of referral and the prognosis of infants with neonatal liver disease.

Bilirubin↗
PubMed1992

HIV seroprevalence in hospital patients in rural Georgia.

To determine human immunodeficiency virus (HIV) seroprevalence among hospital patients in three rural community-based hospitals in southern Georgia, we anonymously tested patients 15 to 54 years old for antibodies to HIV-1 from residual blood specimens collected for routine diagnostic purposes. Data collected included age, sex, race, hospital service, presenting condition, physician's knowledge of HIV infection status, and discharge diagnosis. Of 1319 patients tested, seven (0.5%, 95% confidence interval = 0.2% to 1.1%) had antibodies to HIV-1. Of those seven, five had HIV infection unsuspected by their physicians, and four had an infectious disease. HIV seroprevalence was 0.5% for both men and women, 1.0% for blacks, and 0.3% for whites. HIV-positive patients were found on all hospital services. These results suggest that in rural southern Georgia hospitals, HIV should be routinely considered in the differential diagnosis of conditions that may be related to HIV. In addition, these data demonstrate a need for medical services or referral networks for HIV-related illnesses and a need for continuing HIV counseling and testing offered by local health departments in rural southern Georgia.

Adolescent↗
PubMed2000

Design, implementation, and evaluation at entry of a prospective cohort study of homosexual and bisexual HIV-1-negative men in Belo Horizonte, Brazil: Project Horizonte.

BACKGROUND AND OBJECTIVES: Project Horizonte, an open cohort of homosexual and bisexual HIV-1-negative men, is a component of the Minas Gerais AIDS Vaccine Program of the Federal University of Minas Gerais, Belo Horizonte, Brazil. Its objectives included the evaluation of seroincidence of HIV, to ascertain the role of counseling on behavior modification and to assess their willingness to participate in future HIV vaccine trials. METHODS: Various means of recruitment were used, including pamphlets, notices in community newspapers, radio, and television, at anonymous testing centers, and by word of mouth. RESULTS: From October 1994 to May 1999, 470 volunteers were enrolled. Their mean age was 26 years and over 70% of them had high school or college education. During the follow-up, they were seen every 6 months, when they received counseling and condoms, and when HIV testing was done. Eighteen seroconversions were observed, and the incidence rates estimates were 1.75 per 100 and 1.99 per 100 person-years, for 36 and 48 months of follow-up, respectively. During the entire period, 139 volunteers were lost to follow-up. Among them, 59 (42.4%) never returned after the initial visit and 51 (36.7) came only once after their initial visit. No losses were observed for those observed during follow-up for more than 3 years. At enrollment, 50% of participants said they would participate in a vaccine trial, and 30% said they might participate. CONCLUSIONS: The results obtained up to this moment confirm the feasibility of following this type of cohort for an extended period, estimating HIV incidence rate, and evaluating counseling for safe sexual practices in preparation for clinical trials with candidate HIV vaccines in Brazil.

Adult↗
PubMed2003

Regional differences in HIV trends in The Gambia: results from sentinel surveillance among pregnant women.

OBJECTIVE: To monitor HIV-1 and HIV-2 trends in The Gambia, West Africa. METHODS: In 1993-1995 a nationwide survey among 29 670 pregnant women attending eight antenatal clinics estimated the seroprevalence of HIV-1 at 0.6%, and of HIV-2 at 1.1%. Five years later, sentinel surveillance in pregnant women was established, using unlinked anonymous testing in four clinics. A dried blood spot on filter paper was obtained and tested for HIV antibodies. RESULTS: Between May 2000 and August 2001, 8054 analysable samples were collected at four sites. The prevalence of HIV-1 rose sharply in one rural area from 0.6 to 3.0% (P < 0.0001), but the increase was small and non-significant in two other rural sites and in the urban site. The prevalence of HIV-2 did not change significantly at any of the sites. The overall prevalence of HIV-1 was 1.0% [95% confidence interval (CI) 0.8-1.3%], and of HIV-2 0.8% (CI 0.6-1.0%). Site, nationality and higher age were significantly associated with HIV-1 infection, and higher parity and site were significantly associated with HIV-2 infection. CONCLUSION: Fifteen years after the first case of HIV-1 was described in The Gambia, the epidemic is still at a low level. There is heterogeneity within the country, with one rural area experiencing a fivefold increase in 6 years. The prevalence of HIV-2 in The Gambia is stable.

Age Factors↗
PubMed2005

Amphetamine use is associated with increased HIV incidence among men who have sex with men in San Francisco.

We examined the association between amphetamine use and HIV incidence for 2991 men who have sex with men (MSM) who tested anonymously for HIV in San Francisco. HIV incidence among 290 amphetamine users was 6.3% per year (95% CI 1.9-10.6%), compared with 2.1% per year (95% CI 1.3-2.9%) among 2701 non-users (RR 3.0, 95% CI 1.4-6.5). HIV prevention programmes in San Francisco should include efforts to reduce amphetamine use and associated high-risk sexual behaviors.

Adult↗
PubMed2005

Case-finding effectiveness of partner notification and cluster investigation for sexually transmitted diseases/HIV.

OBJECTIVE: To assess the case-finding effectiveness of partner notification(PN) and cluster investigation for sexually transmitted disease (STD)/human immunodeficiency virus (HIV). STUDY: Literature review and quantitative summary. RESULTS: Since 1975, the median case-finding yield for syphilis, gonorrhea, and chlamydia PN reported in the literature is about 1 new case found for every 4 or 5 cases interviewed. The yield from HIV PN is approximately half as large, although there is substantial variability in yield across reports for each disease. Published reports underline the central role provider referral plays in effective PN and case-finding. Successful PN is more likely with index cases who are of majority ethnicity and detected through screening or spontaneous presentation for care with symptoms and with partners with whom index cases have had sexual contact that is recent, frequent, and of long duration. The case-finding yield for HIV PN also is much higher when cases are diagnosed through confidential, rather than anonymous, testing. Cluster investigation and related strategies tend to have lower case-finding yields than PN but can play a very useful case-finding role, especially in settings with high disease incidence. CONCLUSIONS: STD/HIV PN and cluster investigation can contribute meaningfully to case finding. More research is needed to strengthen the empiric foundation of PN and related strategies, including the impact they have on disease transmission.

Chlamydia Infections↗
PubMed2006

Risk factors for HIV infection in a national adult population: evidence from the 2003 Kenya Demographic and Health Survey.

OBJECTIVE: To study demographic, social, behavioral, and biological variables as risk factors for HIV infection among men and women in Kenya. METHODS: Data from the cross-sectional, population-based 2003 Kenya Demographic and Health Survey were used. During the course of survey fieldwork, 3,273 women aged 15 to 49 years and 2,941 men aged 15 to 54 years gave consent to have a few drops of blood taken for anonymous testing. HIV serostatus data for men and women were analyzed for their relationships to key characteristics using bivariate and multivariate techniques to determine factors associated with being HIV-positive. RESULTS: National HIV prevalence in Kenya was found to be 6.7%. In the analysis of the study sample, uncircumcised men were 4 times more likely to be HIV-positive than those who were not. Compared with nonpolygynously married women, widowed women (odds ratio [OR] = 10.9), divorced women (OR = 2.3), and women who were 1 of 3 or more wives (OR = 3.4) were all at higher risk for being HIV-positive. Both men and women from Nyanza province were at a significantly higher risk for infection with HIV (OR = 2.9 and 2.3, respectively) than were the men and women from Nairobi. Men aged 35 to 44 years had the highest risk of being HIV-positive, whereas the ages of highest risk for women were 25 to 29 years. Increased wealth was positively related to risk for HIV: the wealthiest women were 2.6 times more likely than the poorest women to be HIV-positive. A key finding was that both men and women who considered themselves to be at low risk for contracting HIV were, in fact, the most likely to be HIV-positive. CONCLUSIONS: This analysis demonstrates that HIV is a multidimensional epidemic, with demographic, residential, social, biological, and behavioral factors all exerting influence on individual probability of becoming infected with HIV. Although all of these factors contribute to the risk profile for a given individual, the results suggest that differences in biological factors such as circumcision and sexually transmitted infections may be more important in assessing risk for HIV than differences in sexual behavior.

Adolescent↗
PubMed2006

Prevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus and syphilis among prison inmates and officers at Nsawam and Accra, Ghana.

Although the high prevalence of blood-borne viral infections and syphilis in correctional facilities has been well documented globally, such data are sparse from Africa, and there has been no such data from Ghana. This study sought to estimate the prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis among prison inmates and officers at prisons in Nsawan and Accra, Ghana. Prisoners and officers in 3 of the 46 prisons in Ghana were surveyed from May 2004 to May 2005. Subjects voluntarily completed a risk-factor questionnaire and provided blood specimens for unlinked anonymous testing for the presence of antibodies to HIV, HCV and Treponema pallidum, the causative agent of syphilis, and the surface antigen of hepatitis B virus (HBsAg). Almost 16% (3770) of the total of 23,980 prison inmates in Ghana were eligible, and 281 (7.5%) of those eligible took part, whilst almost 23% (1120) of the total of 4910 prison officers were eligible, and 82 (7.3%) of those eligible took part. For the 281 inmates tested, HIV seroprevalence was 19.2%, 17.4% had HBsAg, HCV seroprevalence was 19.2% and reactive syphilis serology was noted in 11%. For the 82 officers tested, HIV seroprevalence was 8.5%, 3.7% had HBsAg, HCV seroprevalence was 23.2% and reactive syphilis serology was noted in 4.9%. The data indicate a higher prevalence of HIV and HCV in correctional facilities (both prison inmates and officers) than in the general population in Ghana, suggesting their probable transmission in prisons in Ghana through intravenous drug use, unsafe sexual behaviour and tattooing as pertains to prisons worldwide.

Adolescent↗
PubMed1992

Life-style factors and social circumstances of syringe sharing in injecting drug users.

Measures taken to reduce HIV risk by injecting drug users have been reported in many countries, but a minority of injectors continue to engage in risky practices. In an ongoing cohort study, 207 drug injectors were interviewed and anonymously tested for HIV antibodies in saliva in 1989. Injectors reporting recent syringe sharing were compared with those not recently sharing; injecting events where sharing did and did not take place were examined. Those recently sharing syringes differed significantly from the non-sharers on several factors, including: use of heroin, dihydrocodeine and temazepam; injection of heroin, temazepam and prescribed methadone; accommodation and contact with other injectors; means of financial support and recent involvement in crime; secondary sources of injecting equipment and unsafe disposal; employment of HIV protective strategies; treatment contact with general practitioners; number of sexual partners and injecting status of sexual partners. The two groups were not significantly different in terms of attendance at syringe-exchange schemes and self-reported HIV antibody status. Syringe sharing would appear to be related to social circumstances and life-style factors rather than just individual choices and motivation.

Adult↗
PubMed2005

Prevalence of, and risk factors for, hepatitis C virus infection among recent initiates to injecting in London and Glasgow: cross sectional analysis.

Our aim was to compare the prevalence of antibody to hepatitis C virus (anti-HCV) among recently initiated injecting drug users (IDUs) in London and Glasgow, and to identify risk factors which could explain differences in prevalence between the cities. Complementary studies of community recruited IDUs who had initiated injection drug use since 1996 were conducted during 2001-2002. Data on HCV risk behaviours were gathered using structured questionnaires with identical core questions and respondents were asked to provide an oral fluid specimen which was tested anonymously for anti-HCV but was linked to the questionnaire. Sensitivities of the anti-HCV assays for oral fluid were 92-96%. Prevalence of anti-HCV was 35% (122/354) in London and 57% (207/366) in Glasgow (P < 0.001). Multifactorially, factors significantly associated with raised odds of anti-HCV positivity were increasing length of injecting career, daily injection, polydrug use, having had a needlestick injury, and having served a prison sentence. In addition lower odds of anti-HCV positivity were associated with non-injection use of crack cocaine and recruitment from drug agencies. After adjustment for these factors, the increased odds of anti-HCV associated with being a Glasgow IDU were diminished but remained significant. HCV continues to be transmitted among the IDU population of both cities at high rates despite the availability of syringe exchange and methadone maintenance. Effectiveness of harm reduction interventions may be compromised by inadequate coverage and failure to reduce sufficiently the frequency of sharing different types of injecting equipment, as well as the high background prevalence of HCV, and its high infectivity. Comprehensive action is urgently required to reduce the incidence of HCV among injectors.

Adult↗
PubMed2006

Antenatal clinic-based HIV prevalence in Zambia: declining trends but sharp local contrasts in young women.

OBJECTIVES: To describe regional variation in human immunodefffeciency virus (HIV) prevalence trends in the period 1994-2002 and to assess the effects on prevalence trends of residence, educational level and age, and potential interaction between these variables. METHODS: The data were from the national HIV sentinel surveillance system comprising information collected using interviews and unlinked anonymous testing of blood among pregnant women attending antenatal clinics in 22 sites in 1994, 1998 and 2002. RESULTS: There was a decline in HIV prevalence in the age group 15-24 years in the period 1994-2002 both in rural (by 11%) and urban (by 26%) areas. The decline was strongest among highly educated women. However, this overall decline masked striking differences at community (site) levels with clearly declining epidemics in many sites contrasted by increasing epidemics in some and stability in others. Urban/rural residence, age, educational attainment, marital status and parity were factors closely associated with HIV infection. Having born many children was associated with lower risk of being infected by HIV, even in the age group 15-24. CONCLUSIONS: The HIV prevalence decline in young women is likely to reflect a drop in incidence during the period. However, there were sharp geographical contrasts in trends. Such local contrasts probably indicate differences in effectiveness of preventive interventions. Understanding factors and mechanisms explaining the differences will be of critical importance to better guide preventive interventions.

Adolescent↗
PubMed2000

Hepatitis E virus immunoglobulin G antibodies in different populations in Campinas, Brazil.

The seroprevalence of anti-hepatitis E virus (HEV) antibodies was investigated by enzyme immunoassay in 205 volunteer blood donors, 214 women who attended a center for anonymous testing for human immunodeficiency virus (HIV) infection, and 170 hospital employees in Campinas, a city in southeastern Brazil. The prevalence of anti-HEV antibodies ranged from 2.6% (3 of 117) in health care professionals to 17.7% (38 of 214) in women who considered themselves at risk for HIV. The prevalence of anti-HEV antibodies in health care professionals was not significantly different from that in healthy blood donors (3.0%, 5 of 165) and blood donors with raised alanine aminotransferase levels (7.5%, 3 of 40). The prevalence of anti-HEV antibodies (13.2%, 7 of 53) in cleaning service workers at a University hospital was similar to that among women at risk for HIV infection. These results suggest that HEV is circulating in southeastern Brazil and that low socioeconomic status is an important risk factor for HEV infection in this region.

Adolescent↗
PubMed1989

Human immunodeficiency viruses in patients attending a sexually transmitted disease clinic in London, 1982-7.

OBJECTIVE: To determine the prevalence of infection with the human immunodeficiency virus (HIV) in all patients attending a London sexually transmitted disease clinic over four weeks at the end of 1987 and to see how it varied from that in similar samples studied between 1982 and 1986. DESIGN: Anonymous testing of serum samples from consecutive heterosexual and homosexual patients having routine serological investigations for syphilis. Testing was for anti-HIV-I, anti-HIV-II, and hepatitis B core antibody (anti-HBc) and P24 antigen. Age, nationality, sexual orientation, and past sexually transmitted diseases were recorded for each patient. Gonorrhoea rates by quarters were analysed among homosexual and bisexual men and heterosexual men and women from 1981 to 1987. SETTING: Outpatient department of genitourinary medicine. PATIENTS: A total of 1074 patients attending consecutively for syphilis serology. Thirty five homosexual and bisexual men were excluded (these were regular attenders as part of a prospective study of the natural course of HIV infection). MEASUREMENTS AND MAIN RESULTS: The prevalence of anti-HIV-I in homosexual and bisexual men in 1987 was 25.6% (64/250). Results in the same clinic population between 1982 and 1984 had shown a rise in prevalence, which flattened out in 1985-6 and continued at that level. Among heterosexual attenders in 1987 the prevalence of anti-HIV-I was 1% (women 4/412; men 4/377), which contrasted with a prevalence of 0.5% (women 2/395; men 3/757) in January 1986. One homosexual man was seropositive for anti-HIV-II and seronegative for anti-HIV-I. Among homosexual and bisexual men the rate of gonorrhoea had declined by an average of 2.7% a year since 1981, such that by 1987--and for the first time in the clinic--there was no significant difference in the rates between these men and heterosexual men and women. CONCLUSIONS: The appearance of HIV-I infection among heterosexuals indicates a need for more aggressive education programmes and intervention strategies along the lines adopted for homosexual men. Surveillance for HIV-II infection is needed to provide information for future policy in national screening programmes.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Continuing transmission of sexually transmitted diseases among patients infected with HIV-1 attending genitourinary medicine clinics in England and Wales.

OBJECTIVE: To determine whether those who are aware of being infected with HIV continue to adopt behaviours that place others at risk of HIV infection. DESIGN: Ongoing survey of current diagnosis of sexually transmitted disease and awareness of HIV infection among patients attending genitourinary medicine clinics. SETTING: Six genitourinary medicine clinics in England and Wales (two in London and four outside) participating in unlinked anonymous HIV serosurveillance during 1990-3. SUBJECTS: All attenders having blood drawn for syphilis serology for the first time during the calendar quarter of attendance. MAIN OUTCOME MEASURES: The proportion of syphilis serology specimens with antibody to HIV-1 detected by unlinked anonymous testing of the residue. The proportion of attenders infected with HIV-1 who remained clinically undetected, and the proportion who had another recently acquired sexually transmitted disease. RESULTS: Of 85441 specimens tested, 2328 (2.7%) were positive for antibodies to HIV-1. About 30% of these specimens were from attenders whose HIV-1 infection remained clinically undetected. HIV-1 infection was found to coexist with another recently acquired sexually transmitted disease in 651 attenders, of whom 522 were homosexual or bisexual men. Of these, 245 (47%) already knew themselves to be infected with HIV-1. This proportion increased between 1990 and 1993. CONCLUSIONS: A considerable proportion of patients infected with HIV-1 are not identified by voluntary confidential HIV testing in genitourinary medicine clinics. Substantial numbers of homosexual or bisexual men attending genitourinary medicine clinics continue to practise unsafe sex despite being aware of their infection with HIV-1.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Risk of hepatitis C virus transmission from patients to surgeons: model based on an unlinked anonymous study of hepatitis C virus prevalence in hospital patients in Glasgow.

BACKGROUND: The risk of a surgeon acquiring the hepatitis C virus (HCV) through occupational exposure is dependent on the prevalence of HCV infection in the patient population, the probability of a percutaneous injury transmitting HCV, and the incidence of percutaneous injury during surgery. AIMS: To estimate the prevalence of HCV infection in the adult surgical patient population in North Glasgow and thereafter estimate the risk of HCV transmission to surgeons through occupational exposure. METHODS: The prevalence of HCV infection was estimated through the unlinked anonymous testing of samples from male surgical patients, aged 16-49 years, in two North Glasgow hospitals from 1996 to 1997, and adjusting these data for age and sex. Using published estimates of the incidence of percutaneous injury during surgery and percutaneous injury transmitting HCV, the risk of occupational transmission of HCV to surgeons was then derived. RESULTS: The estimated prevalence of anti-HCV infection for all adult patients in the two hospitals combined was 1.4% (cardiothoracic/cardiology 0.8%, orthopaedics/rheumatology 1.4%, general surgery/ENT 2.0%). The estimated probability of HCV transmission from an HCV infected patient to an uninfected surgeon was 0.001-0.032% per annum (0.035-1.12% risk over a 35 year professional career). CONCLUSIONS: The risk of an individual surgeon acquiring HCV through occupational exposure is low, even in an area with an extremely high prevalence of HCV among its injecting drug using population. Surgeons however should be encouraged to observe universal precautions and present for assessment after needlestick injuries to protect themselves and their patients from this insidious infection.

Adolescent↗
PubMed1993

HIV prevalence and risk behaviour among prostitutes and clients in Amsterdam: migrants at increased risk for HIV infection.

OBJECTIVES: To study groups of prostitutes and clients of prostitutes in order (i) to determine HIV prevalence and sexual risk behaviour, (ii) to determine differences between samples recruited within and outside a clinic for sexually transmitted diseases (STD) and (iii) to determine correlates of inconsistent condom use (ICU) among both groups. DESIGN: Participants were interviewed and anonymously tested for HIV-antibody; approximately half were recruited at a clinic for sexually transmitted diseases (STD) and half at prostitute working places. SETTING: An STD clinic and prostitute working places in Amsterdam in 1991. SUBJECTS: 201 female prostitutes without a history of injecting drugs and 213 male clients of female prostitutes. MAIN OUTCOME MEASURES: antibodies to HIV, consistency of condom use in commercial vaginal contacts in the preceding 6 months. RESULTS: HIV prevalence was low: three prostitutes (1.5%; 95% CI 0.5-4.6%) and one client (0.5%; 95% CI 0.1-3.3%) were infected. All three HIV positive prostitutes originated from AIDS-endemic countries, came to the Netherlands only recently and were recruited outside the STD clinic. Large differences between subgroups resulted from the two recruitment methods: while clients of prostitutes with relatively high risk behaviour were strongly represented among the STD clinic sample, high risk prostitutes were underrepresented in this sample. Consistent condom use (with 100% of contacts) was reported by 66% of prostitutes and 56% of clients of prostitutes. Inconsistent condom use was found to be high among prostitutes who had migrated from Latin America and among migrant clients of prostitutes. CONCLUSIONS: When monitoring HIV infection one must take into account imported cases. HIV prevention efforts should be particularly focused at prostitutes from Latin America and at clients of prostitutes who migrated to the Netherlands.

AIDS Serodiagnosis↗
PubMed1998

Hepatitis B virus infection in patients attending a genitourinary medicine clinic: risk factors and vaccine coverage.

BACKGROUND: The hepatitis B virus (HBV) immunisation policy in the United Kingdom includes offering vaccines selectively to those at risk by sexual contact. Among genitourinary medicine (GUM) clinic attenders, homosexual men are offered vaccine, but estimates of the vaccine uptake are required to monitor policy and estimate the possible impact on transmission; heterosexuals are not routinely offered vaccine, but this policy might change if the prevalence was found to be high. OBJECTIVE: To determine the prevalence of HBV infection and vaccine uptake among patients attending a GUM clinic. METHODS: HBV seroprevalence determined by unlinked anonymous testing of consecutive blood samples sent for syphilis serology. Demographic and risk factor data and history of HBV immunization extracted from clinic notes before unlinking. Prevalence data were compared with a population of first time blood donors from the same area. SETTING: Open access GUM clinic in central London. RESULTS: Samples were obtained and tested from 441 homosexual and 527 heterosexual men and from 821 women over a 4 month period in 1990. After exclusion of injecting drug users and their sexual partners (n = 30) and HBV carriers attending for follow up (n = 12), the prevalence of antibody to HBV core (anti-HBc) was 38.7% in homosexual men, 5.9% in heterosexual men, and 3.5% in women (50.0%, 6.0%, 3.7% respectively if previous vaccinees were also excluded). The prevalence of HBV surface antigen positivity was 4.2%, 0.60%, and 0.39% respectively after exclusion of vaccinees (chi(2) p < 0.001 for homosexual men versus others). The prevalence of the anti-HBc in first time blood donors was 1.1% (8/749). Among male GUM clinic attenders, the prevalence of anti-HBc was higher in those of non-UK origin or place of birth and/or non-white ethnicity (odds ratios 2.87, 95% CI 1.57-5.24 and 8.06, CI 3.39-19.1, in homosexuals and heterosexuals respectively). In homosexual men anti-HBc prevalence increased with age (OR 1.05, CI 1.02-1.07 for each year) and lifetime number of STDs (OR 6.36, CI 3.77-10.8 for > or = 2 versus < 2) and in clinic reattenders compared with new patients (OR 5.42, 95% CI 3.32-9.16). Among heterosexuals, age was associated with anti-HBc prevalence in women (OR 1.09, CI 1.04-1.12) but not men (OR 0.99, 95% CI 0.95-1.02). There were no other associations in heterosexuals. A history of HBV immunisation in homosexual men was recorded in 13/131 (9.9%) of new patients and 103/305 (33.8%; OR 4.63, CI 2.49-8.60) clinic reattenders. CONCLUSIONS: Although higher than a sample of blood donors, the prevalence of serological markers of HBV infection among heterosexuals was low, providing little support for extending HBV immunisation to all heterosexuals attending GUM clinics as a targeted strategy for control of HBV infection. Homosexual men remain at high risk of infection, but many are now being immunised. Efforts to improve compliance with existing vaccine policies in GUM clinics should be encouraged.

Adult↗
PubMed1999

Trends in undiagnosed HIV-1 infection among attenders at genitourinary medicine clinics, England, Wales, and Northern Ireland: 1990-6.

OBJECTIVE: To describe trends in seroprevalence of undiagnosed HIV-1 infection among attenders at 15 genitourinary medicine clinics in England, Wales, and Northern Ireland between 1990 and 1996. METHOD: Prospective, cross sectional sentinel serosurvey. Unlinked anonymous testing of remnant serum drawn for routine syphilis screening. RESULTS: In 1996, the seroprevalence of undiagnosed HIV-1 infection was 5% in homosexual men, 0.48% in heterosexual men, and 0.33% in heterosexual women. Between 1990 and 1996, there was a significant linear decrease in the seroprevalence of undiagnosed HIV-1 infection among homosexual and bisexual men within and outside London (p < 0.0001; p = 0.0141), equivalent to yearly decreases of 7.65% and 10.73% respectively. However, seroprevalence among homosexual and bisexual men under 25 years of age did not decline either inside or outside London. Seroprevalence among heterosexual men declined outside London (p < 0.005), equivalent to an average annual decrease of 14.54%. There was a significant increase among male heterosexuals inside London (p < 0.05) equivalent to a 8.09% increase per annum. Seroprevalence over time was unchanging among female heterosexuals both inside and outside London. Seroprevalence was significantly higher among those who injected drugs than those who did not report injecting in the following groups: homosexual and bisexual males within London (p < 0.005), male heterosexuals both within and outside London (p < 0.05; p < 0.05) and female heterosexuals within London (p < 0.05). CONCLUSIONS: The study highlights a significant burden of undiagnosed HIV-1 infection more than 15 years since the HIV epidemic began. Methods of offering HIV testing need to be reassessed to extend the practice of routinely testing for HIV in GUM clinics. HIV transmission among young homosexual and bisexual men continues. The contrasting trends between homosexual and bisexual men, injecting drug users, and heterosexuals attending GUM clinics indicate these groups should be considered separately. The substantial HIV seroprevalence in each group indicates that they should be priorities for targeted HIV prevention.

Adult↗