Publications by authors named "Chloe Orkin"

Article Synopsis
  • Long-acting antiretroviral therapy (ART) using cabotegravir (CAB) and rilpivirine (RPV) has the potential to revolutionize HIV treatment, but its uptake remains slow in accessible countries due to operational challenges and lingering clinical questions.
  • Recent clinical trials indicate that CAB+RPV injections are effective and well-tolerated, while real-world studies show high adherence and low virological failure rates in practical settings.
  • Despite the low risk of virological failure, inconsistencies in defining it across studies complicate the interpretation of results, emphasizing the need for more comprehensive long-term studies in varied populations to better assess the treatment's effectiveness.
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Introduction: The equity-focused ILANA study evaluated feasibility, acceptability, appropriateness of delivering on-label two-monthly cabotegravir and rilpivirine (CAB+RPV) injections for HIV-1 therapy in clinics and community settings.

Methods: The study, which mandated inclusive recruitment, was conducted May-December 2022 at six UK sites. Injections were delivered in clinic (months 1-6), and in clinic or community setting according to patient choice (months 6-12).

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Between May 2022 and September 2023, the World Health Organization (WHO) Regional Office for Europe engaged in a collaborative effort with affected communities to address the outbreak of mpox in the region. This concerted endeavor led to the development of a risk communication campaign specifically tailored to address the perceptions and needs of the target audience, thereby contributing to the control and the long-term goal of mpox elimination. Various community engagement interventions were implemented, including the establishment of an informal civil society organizations' working group to provide feedback on the WHO mpox campaign, webinars targeting event organizers, and roundtable discussions with country-level responders.

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Introduction: Persistent infection with high-risk human papillomavirus (HPV) is the causal agent of several cancers including cervical, anal and oropharyngeal cancer. Transgender men and transmasculine non-binary (TMNB) people with a cervix are much less likely to undergo cervical cancer screening than cisgender women. Transgender women and transfeminine non-binary (TWNB) people assigned male at birth may be at increased risk of HPV.

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Background: The ongoing multi-country mpox outbreak in previously unaffected countries is primarily affecting sexual networks of men who have sex with men. Evidence is needed on the effectiveness of recommended preventive interventions. To inform WHO guidelines, a systematic review and qualitative evidence synthesis were conducted on mpox preventive behavioural interventions to reduce: (i) sexual acquisition; (ii) onward sexual transmission from confirmed/probable cases; and (iii) utility of asymptomatic testing.

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Article Synopsis
  • Long-acting injectable cabotegravir + rilpivirine (CAB + RPV LAI) was approved in November 2021 for use in virally suppressed adults in England and Wales, and the evaluation of its delivery processes took place across 12 clinics.* -
  • A total of 518 adults were approved for CAB + RPV LAI from February 2022 to December 2023, with 423 receiving at least one injection; the treatment had a median duration of 7.5 months and a high adherence rate of 97% for timely injections.* -
  • Results indicated only 0.7% experienced virological failure and 6% discontinued treatment, showcasing that effective clinic protocols and
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Objectives: To explore how higher education institutions (HEIs) make transparent the data they collect on staff disability, and how this relates to existing equality, diversity and inclusion (EDI) charters.

Design: Descriptive cross-sector quantitative study based on UK HEIs.

Setting: Higher education sector in the UK.

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Objective: Metabolic dysfunction associated fatty liver disease (MAFLD) is over-represented in people with HIV (PWH). Maraviroc (MVC) and/or metformin (MET) may reduce MAFLD by influencing inflammatory pathways and fatty acid metabolism.

Design: Open-label, 48-week randomized trial with a 2 x 2 factorial design.

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Immunological determinants favouring emergence of broadly neutralising antibodies are crucial to the development of HIV-1 vaccination strategies. Here, we combined RNAseq and B cell cloning approaches to isolate a broadly neutralising antibody (bnAb) ELC07 from an individual living with untreated HIV-1. Using single particle cryogenic electron microscopy (cryo-EM), we show that the antibody recognises a conformational epitope at the gp120-gp41 interface.

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Background: Treatment-simplification strategies are important tools for patient-centred management. We evaluated long-term outcomes from a PI monotherapy switch strategy.

Methods: Eligible participants attending 43 UK treatment centres had a viral load (VL) below 50 copies/ml for at least 24 weeks on combination ART.

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Standalone HIV testing is a missed opportunity- a recent systematic review showed eight cases of viral hepatitis would be missed for each new HIV diagnosis. The review builds on a decade of research demonstrating the additional benefit of BBV testing.

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Article Synopsis
  • - The study assessed the safety and effectiveness of switching to bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) after 144 weeks of dolutegravir (DTG)-based therapy in HIV-1 patients.
  • - After 96 weeks on B/F/TAF, over 99% of participants maintained viral suppression and had stable CD4+ cell counts without emerging resistance, though some experienced mild side effects like diarrhea and weight gain.
  • - The findings support the switch to B/F/TAF as a safe and effective long-term treatment option for people previously on DTG-containing regimens.
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Objective: To understand the experiences and perceptions of sexual health professionals responding to the May 2022 mpox outbreak in the UK.

Design: Cross-sectional, anonymous, online survey collecting quantitative and qualitative data. Convenience sample recruited via an international network of sexual health and HIV clinicians responding to mpox and promoted through clinical associations and social media.

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Background: In two phase 3 trials for first-line therapy in adults with HIV-1, doravirine showed non-inferior efficacy, a favourable safety profile, and a superior lipid profile to darunavir and efavirenz through to 48 and 96 weeks. Here we report 192-week results from both studies.

Methods: DRIVE-FORWARD and DRIVE-AHEAD are multicentre, double-blind, randomised, active comparator-controlled, phase 3 trials of first-line antiretroviral treatment in adults with HIV-1.

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Background: General practice has one of the most diverse medical training programmes in terms of sex and ethnic background. However, this diversity of race and ethnicity is not reflected in academic GP careers, with just 17% ( = 81/473) of academic GPs being from racially minoritised groups, according to the Medical Schools Council.

Aim: To determine whether GP academic clinical fellow (ACF) trainees from racially minoritised backgrounds are proportionally represented, compared with the non-academic training programme, using the annual GP ACF conference as a proxy.

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WHO defines ageism as stereotypes, prejudice, and discrimination based on age. Ageism is a multidimensional concept that encompasses multiple components related to the individual, the social group, and the institution in different cultural and environmental settings. In people ageing with HIV these elements include self-stigma, discrimination in society, and experiences in care, many of which are unique to older people.

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Article Synopsis
  • The study investigates how the gender and ethnicity of panel members influence audience engagement at a large European hybrid conference, focusing on participation trends among attendees.
  • It involves an observational study during the European AIDS Clinical Society conference, collecting data on audience questions and panel demographics to identify patterns in participation.
  • Results show that men and individuals from white ethnic groups predominantly asked questions, with less diverse panels leading to lower engagement, highlighting the need for improved diversity and inclusion in future conferences for better participation.
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Background & Aims: Short duration treatment may aid HCV elimination among key populations. This study evaluated the efficacy of glecaprevir-pibrentasvir for 4 weeks among people with recent HCV infection.

Methods: In this single-arm multicentre international trial, adults with recent HCV (duration of infection <12 months) received glecaprevir-pibrentasvir 300 mg-120 mg daily for 4 weeks.

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Article Synopsis
  • - This study examines how sex differences and dietary inorganic nitrate (found in beetroot juice) affect endothelial function and inflammation following COVID-19 vaccination, addressing a gap in understanding cardiovascular complications linked to COVID-19.
  • - Conducted as a double-blind, randomized trial with 98 healthy participants (49 males and 49 females), it consists of two parts: one focuses on sex's impact on responses to vaccination, while the other assesses the role of dietary nitrate on these responses.
  • - The main goal is to compare changes in blood vessel function (measured by flow-mediated dilatation) pre- and post-vaccination, while also looking at secondary outcomes like inflammation levels and blood flow measurements.
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Background: Since May, 2022, a large global outbreak of human mpox (formerly known as monkeypox) has predominantly affected men who have sex with men. The strain responsible, Clade IIb, has mutated substantially from precursors originating from the 2017-18 outbreak in Nigeria. Immunity to smallpox, another orthopoxvirus, via previous infection or vaccination provides lifelong immunity.

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Article Synopsis
  • Monkeypox (Mpox) is a viral disease with over 87,000 cases reported globally as of May 2023, but predictive hospitalization factors are not well understood.
  • The study aimed to compare the clinical characteristics and outcomes of hospitalized versus nonhospitalized Mpox patients using a retrospective case-control cohort.
  • Key findings indicate that hospitalization for Mpox was more prevalent among Black individuals, those with HIV, and patients experiencing severe proctitis, highlighting the need to identify risk factors for severe outcomes in Mpox infections.
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