"How well do we know our patients?": Further validation of a complexity rating scale for HIV.

Background: Despite advances in the management and treatment of HIV, identifying risks for disengagement are essential to maximize positive outcomes. The current study investigated the validity of the Clinical Complexity Rating Scale for HIV (CCRS-HIV), a risk-prediction tool, by assessing agreement between patient and clinician scores of patient complexity.

Methods: 207 patients completed the patient version of the CCRS-HIV (CCRS-HIV), and six Attending Medical Officers (AMOs) caring for those individuals completed the original clinician version (CCRS-HIV).

Utility of rapid plasmin reagin titres in assessing treatment response and re-infection for infectious syphilis.

Unlabelled: Background The rapid plasma reagin (RPR) assay is commonly used as a surrogate marker of infectious syphilis, but is non-specific, slow to change and variable in its rate of decline post treatment.

Methods: Within an urban sexual health service testing predominantly men who have sex with men, a file review of RPR changes was undertaken in all subjects who had a dilution level of ≥1:4, between January 2015 to the end of December 2018.

Results: Overall, 248 cases of infectious syphilis were identified in 215 subjects (165 HIV seropositive, 50 HIV seronegative).

The development of an HIV-specific complexity rating scale.

As treatment for HIV improves, an ageing population is experiencing comorbidity which often leads to complex clinical presentations requiring an interdisciplinary care approach. This study sought to quantify clinician assessment of the level of clinical complexity, through the development of a rating scale for people living with HIV (PLHIV), to improve client care through an interdisciplinary care model. An existing alcohol and other drug complexity rating scale was selected and modified for use with PLHIV.

A national study of the clinical management of HIV-positive women in Australia: what are the successes and where are the gaps?

Unlabelled: Background Women comprise ~10% of people living with HIV in Australia, so are often underrepresented in research.

Methods: This study invited clinicians providing care to women living with HIV to complete an anonymous survey containing questions related to four key areas: HIV (including diagnosis, treatment and virological outcomes), reproductive health (including sexual activity, contraception, pregnancy and outcomes) and linkage and retention in care.

Results: In total, 484 surveys were received, with responses from all states and territories.

The barriers to linkage and retention in care for women living with HIV in an high income setting where they comprise a minority group.

Women comprise a minority population of individuals living with HIV in Australia, and are often poorly represented in research and clinical trials so their needs remain largely unknown. Data suggests that they are diagnosed later than men and start antiretroviral therapy at a lower CD4 cell count. This raises the question whether there are sex specific barriers to linkage and retention in care.

HIV in practice: current approaches and challenges in the diagnosis, treatment and management of HIV infection in Australia.

As treatment improves, people living with HIV (PLWHIV) can now expect to live longer, which means that the foci of HIV-related care for them and their medical practitioners continue to change. With an increasingly older cohort of patients with HIV infection, practitioners' key considerations are shifting from issues of acute treatment and patient survival to multiple comorbidities, toxicities associated with chronic therapy, and ongoing health maintenance. Within this context, this paper explores the current standard of practice for the management of HIV infection in Australia.

Non-AIDS complexity amongst patients living with HIV in Sydney: risk factors and health outcomes.

Objective: To assess the prevalence of non-AIDS co-morbidities (NACs) and predictors of adverse health outcomes amongst people living with HIV in order to identify health needs and potential gaps in patient management.

Design: Retrospective, non-consecutive medical record audit of patients attending a publicly funded HIV clinic in metropolitan Sydney analysed for predictors of adverse health outcomes. We developed a scoring system based on the validated Charlson score method for NACs, mental health and social issues and confounders were selected using directed acyclic graph theory under the principles of causal inference.

Case report and evaluation of the frequency of the prozone phenomenon in syphilis serology - an infrequent but important laboratory phenomenon.

Background: Treponema pallidum specific serology generally remains reactive for life. Therefore, the diagnosis of syphilis reinfection relies on clinical assessment and nontreponemal (reagin) serologic testing. The prozone phenomenon can lead to a falsely nonreactive rapid plasma reagin (RPR) assay result.

Improved serological response to H1N1 monovalent vaccine associated with viral suppression among HIV-1-infected patients during the 2009 influenza (H1N1) pandemic in the Southern Hemisphere.

Objectives: Patients infected with HIV-1 were targeted for vaccination against H1N1 influenza because of their anticipated increased risk of mortality associated with H1N1 infection. Reports regarding the efficacy of vaccination in HIV-1-infected patients have suggested a reduced immunogenic response compared with the general population. Hence, the study aimed to determine the serological response to pandemic H1N1 influenza vaccine in HIV-1-infected patients in a clinical setting.

Contact tracing for sexually transmitted infections in New South Wales, Australia.

Background: Contact tracing is an important strategy in the control of sexually transmitted infections (STI) because it encourages individuals who may be unaware they have been exposed to an infection to be tested and treated. The aim of this study was to review STI contact tracing procedures in NSW by sexual health clinics (SHC), public health units (PHU) and general practitioners (GP).

Methods: A questionnaire study carried out in 2004-2005 of SHC, PHU and a random sample of GP in NSW.

Intrafamilial transmission of HIV-1 infection from individuals with unrecognized HIV-1 infection.

Objective: To describe the clinical, epidemiological and molecular evidence for transmission of HIV-1 infection from a person with unrecognized HIV infection to a family member in two unconnected families where the route of transmission could not be conclusively determined.

Design: Case studies, molecular analysis of viral strains and a clinical and laboratory investigation of risk factors for transmission.

Setting: State referral centres for HIV/AIDS in two Australian teaching hospitals.

Fertility and reproductive choice in women with HIV-1 infection.

Objective: To measure fertility and birth rates and to describe the reproductive histories of women diagnosed with HIV-1 infection in Australia.

Methods: The medical records of 294 women with HIV-1 infection in four states of Australia were reviewed. Expected fertility and birth rates were calculated using national statistics.

Managing HIV. Part 6: People living with HIV. 6.2 Women with HIV.

Gay men with HIV often belong to strong mutually supportive groups, but many women with HIV experience the disease in relative isolation. Informed primary care doctors can make a valuable difference to their management.

Safety and efficacy of nandrolone decanoate for treatment of wasting in patients with HIV infection.

Objective: To evaluate the safety and efficacy of the anabolic steroid, nandrolone decanoate (Deca Durabolin) in patients with HIV wasting who are resistant to nutritional intervention.

Design: A 16-week open trial with subjects who had lost 5-15% of their usual body weight.

Setting: HIV/AIDS specialist ambulatory care services, both public and private, in sydney, Australia.

Managing HIV. Part 5: Treating secondary outcomes. 5.18 HIV and sexually transmitted diseases.

Sexually transmitted diseases (STDs) play a key role in the AIDS epidemic. The transmission of HIV is amplified by some STDs, and HIV has been found to alter the natural history and prevalence of others. The control of STDs is fundamental to effective prevention and management of HIV infection.

Zidovudine plus interferon-alpha versus zidovudine alone in HIV-infected symptomatic or asymptomatic persons with CD4+ cell counts > 150 x 10(6)/L: results of the Zidon trial. Zidon Study Group.

Objective: To evaluate the efficacy and safety of zidovudine (ZDV) and lymphoblastoid interferon (IFN)-alpha combination therapy compared with ZDV monotherapy in HIV-infected subjects with CD4+ cell counts between 150 and 500 x 10(6)/l.

Design: Open, randomized controlled trial with subjects stratified by the Centers for Disease Control and Prevention (CDC) 1986 classification of HIV disease (group II/III or IV). The study was amended to a sequential design in February 1992 to allow interim analyses to be conducted.