519 results on '"Vera, Jaime"'
Search Results
202. On Central Cantor Sets with Self-Arithmetic Difference of Positive Lebesgue Measure
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Bamón, Rodrigo, primary, Plaza, Sergio, additional, and Vera, Jaime, additional
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- 1995
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203. On the arithmetic sum of middle-cantor sets
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Muñoz, Eduardo, primary, Vera, Jaime, additional, and Plaza, Sergio, additional
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- 1995
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204. Anal cancer screening in the UK: serial cross-sectional surveys on attitudes and practices
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Ascott, Anna Shanti, Mohammed, Hamish, and Vera, Jaime H
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- 2021
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205. El dibujo en las artes gráficas
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Hernández Vera, Jaime and Lite Lahiguera, Enrique
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Diseño gráfico - Abstract
Estudio sobre las técnicas de impresión con matrices planas: la litografía con las técnicas clásicas (impresión de piedra a papel) y la litografía-offset con las técnicas actuales y se enumeran las diferencias más importantes entre ambos procedimientos. En el procedimiento offset las formas o matrices, están enrolladas sobre un cilindro llamado portaplancha, y, en lugar de utilizar la piedra, se emplea una plancha, generalmente metálica, procesada fotoquímicamente. La impresión se realiza de forma indirecta, la imagen es transmitida del cilindro portaplancha a uno intermedio de caucho, también cilíndrico, el cual transmitirá a un tercero portador del soporte a imprimir, cartón, papel. Este sistema es uno de los más empleados en las artes gráficas. El trabajo incluye 15 láminas del autor.
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- 1981
206. LA LOCURA EN LOS NIÑOS.
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VERA, Jaime
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- 1984
207. Improved Central Nervous System Symptoms in People with HIV without Objective Neuropsychiatric Complaints Switching from Efavirenz to Rilpivirine Containing cART.
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Vera, Jaime H., Bracchi, Margherita, Alagaratnam, Jasmini, Lwanga, Julianne, Fox, Julie, Winston, Alan, Boffito, Marta, and Nelson, Mark
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CENTRAL nervous system , *EFAVIRENZ , *APATHY , *HIV , *SLEEP - Abstract
Objective: Occult central nervous system (CNS) symptoms not recognized by people living with HIV (PLWH) receiving efavirenz or their clinicians could occur and impact people's quality of life. The aim of this study was to determine whether CNS parameters improve in PLWH when switching from efavirenz to rilpivirine. Methods: PLWH receiving tenofovir disoproxil fumarate, emtricitabine, efavirenz (Atripla™) with undetectable HIV RNA, and no CNS symptoms were switched cART to tenofovir disoproxil fumarate, emtricitabine, rilpivirine (Eviplera™). CNS parameters including sleep, anxiety, and depressive symptoms were evaluated using patient-reported outcome measures at baseline, 4, 12, and 24 weeks after switching therapy. A median CNS score was derived from the sum of CNS toxicities of all the grades collected in the study questionnaires. Cognitive function was assessed using a computerized test battery. Results: Of 41 participants, median age was 47 years, Interquartile range (IQR) 31, 92% were male and 80% were of white ethnicity. A significant reduction in total CNS score (10 to 7) was observed at 4 weeks (p = 0.028), but not thereafter. Significant improvements in sleep and anxiety were observed 4, 12 and 24 weeks after switching therapy (p < 0.05). No significant change in global cognitive scores was observed. Conclusions: Switching from efavirenz to rilpivirine based regimens in virologically suppressed PLWH without perceived CNS symptoms was well tolerated and slightly improved overall CNS symptoms. [ABSTRACT FROM AUTHOR]
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- 2019
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208. El Partido Socialista Obrero ante la Comisión de Reformas Sociales : informe escrito por el doctor Jaime Vera López, por encargo de la Agrupación de Madrid
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Vera, Jaime 1858-1918 and Vera, Jaime 1858-1918
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- 1928
209. La verdad social y la acción
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Vera, Jaime 1858-1918 and Vera, Jaime 1858-1918
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- 1918
210. El Partido Socialista Obrero ante la Comisión de informe sobre el estado y necesidades de la clase trabajadora y las relaciones entre capital y trabajo
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Vera, Jaime 1858-1918 and Vera, Jaime 1858-1918
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- 1895
211. Informe presentado a la Comisión de Reformas Sociales por la Agrupación Socialista Madrileña en el año 1883
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Vera, Jaime 1858-1918, Agrupación Socialista Madrileña, Vera, Jaime 1858-1918, and Agrupación Socialista Madrileña
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- 1946
212. Additional file 3 of Disability and self-care living strategies among adults living with HIV during the COVID-19 pandemic
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O���Brien, Kelly K., Bayoumi, Ahmed M., Chan Carusone, Soo, Davis, Aileen M., Aubry, Rachel, Avery, Lisa, Solomon, Patricia, Erlandson, Kristine M., Bergin, Colm, Harding, Richard, Brown, Darren A., Vera, Jaime H., and Hanna, Steven E.
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3. Good health - Abstract
Additional file 3. Living strategies use and change of use since the COVID-19 pandemic (n = 63).
213. Global phylogeny of Treponema pallidum lineages reveals recent expansion and spread of contemporary syphilis
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Beale, Mathew A, Marks, Michael, Cole, Michelle J, Lee, Min-Kuang, Pitt, Rachel, Ruis, Christopher, Balla, Eszter, Crucitti, Tania, Ewens, Michael, Fern��ndez-Naval, Candela, Grankvist, Anna, Guiver, Malcolm, Kenyon, Chris R, Khairullin, Rafil, Kularatne, Ranmini, Arando, Maider, Molini, Barbara J, Obukhov, Andrey, Page, Emma E, Petrovay, Fruzsina, Rietmeijer, Cornelis, Rowley, Dominic, Shokoples, Sandy, Smit, Erasmus, Sweeney, Emma L, Taiaroa, George, Vera, Jaime H, Wenner��s, Christine, Whiley, David M, Williamson, Deborah A, Hughes, Gwenda, Naidu, Prenilla, Unemo, Magnus, Krajden, Mel, Lukehart, Sheila A, Morshed, Muhammad G, Fifer, Helen, and Thomson, Nicholas R
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631/114/739 ,631/326/107 ,45 ,631/208/457/649 ,692/699/255/1318 ,article ,45/22 ,45/23 ,15. Life on land ,631/326/41/2530 ,3. Good health - Abstract
Funder: Queensland Government (State of Queensland); doi: https://doi.org/10.13039/501100003550, Syphilis, which is caused by the sexually transmitted bacterium Treponema pallidum subsp. pallidum, has an estimated 6.3 million cases worldwide per annum. In the past ten years, the incidence of syphilis has increased by more than 150% in some high-income countries, but the evolution and epidemiology of the epidemic are poorly understood. To characterize the global population structure of T. pallidum, we assembled a geographically and temporally diverse collection of 726 genomes from 626 clinical and 100 laboratory samples collected in 23 countries. We applied phylogenetic analyses and clustering, and found that the global syphilis population comprises just two deeply branching lineages, Nichols and SS14. Both lineages are currently circulating in 12 of the 23 countries sampled. We subdivided T. p. pallidum into 17 distinct sublineages to provide further phylodynamic resolution. Importantly, two Nichols sublineages have expanded clonally across 9 countries contemporaneously with SS14. Moreover, pairwise genome analyses revealed examples of isolates collected within the last 20 years from 14 different countries that had genetically identical core genomes, which might indicate frequent exchange through international transmission. It is striking that most samples collected before 1983 are phylogenetically distinct from more recently isolated sublineages. Using Bayesian temporal analysis, we detected a population bottleneck occurring during the late 1990s, followed by rapid population expansion in the 2000s that was driven by the dominant T. pallidum sublineages circulating today. This expansion may be linked to changing epidemiology, immune evasion or fitness under antimicrobial selection pressure, since many of the contemporary syphilis lineages we have characterized are resistant to macrolides.
214. Additional file 3 of Disability and self-care living strategies among adults living with HIV during the COVID-19 pandemic
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O���Brien, Kelly K., Bayoumi, Ahmed M., Chan Carusone, Soo, Davis, Aileen M., Aubry, Rachel, Avery, Lisa, Solomon, Patricia, Erlandson, Kristine M., Bergin, Colm, Harding, Richard, Brown, Darren A., Vera, Jaime H., and Hanna, Steven E.
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3. Good health - Abstract
Additional file 3. Living strategies use and change of use since the COVID-19 pandemic (n = 63).
215. Global phylogeny of Treponema pallidum lineages reveals recent expansion and spread of contemporary syphilis
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Beale, Mathew A, Marks, Michael, Cole, Michelle J, Lee, Min-Kuang, Pitt, Rachel, Ruis, Christopher, Balla, Eszter, Crucitti, Tania, Ewens, Michael, Fernández-Naval, Candela, Grankvist, Anna, Guiver, Malcolm, Kenyon, Chris R, Khairullin, Rafil, Kularatne, Ranmini, Arando, Maider, Molini, Barbara J, Obukhov, Andrey, Page, Emma E, Petrovay, Fruzsina, Rietmeijer, Cornelis, Rowley, Dominic, Shokoples, Sandy, Smit, Erasmus, Sweeney, Emma L, Taiaroa, George, Vera, Jaime H, Wennerås, Christine, Whiley, David M, Williamson, Deborah A, Hughes, Gwenda, Naidu, Prenilla, Unemo, Magnus, Krajden, Mel, Lukehart, Sheila A, Morshed, Muhammad G, Fifer, Helen, and Thomson, Nicholas R
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Drug Resistance, Bacterial ,Humans ,Macrolides ,Syphilis ,Treponema pallidum ,15. Life on land ,Genome, Bacterial ,Phylogeny ,3. Good health ,Anti-Bacterial Agents - Abstract
Funder: Queensland Government, Syphilis, which is caused by the sexually transmitted bacterium Treponema pallidum subsp. pallidum, has an estimated 6.3 million cases worldwide per annum. In the past ten years, the incidence of syphilis has increased by more than 150% in some high-income countries, but the evolution and epidemiology of the epidemic are poorly understood. To characterize the global population structure of T. pallidum, we assembled a geographically and temporally diverse collection of 726 genomes from 626 clinical and 100 laboratory samples collected in 23 countries. We applied phylogenetic analyses and clustering, and found that the global syphilis population comprises just two deeply branching lineages, Nichols and SS14. Both lineages are currently circulating in 12 of the 23 countries sampled. We subdivided T. p. pallidum into 17 distinct sublineages to provide further phylodynamic resolution. Importantly, two Nichols sublineages have expanded clonally across 9 countries contemporaneously with SS14. Moreover, pairwise genome analyses revealed examples of isolates collected within the last 20 years from 14 different countries that had genetically identical core genomes, which might indicate frequent exchange through international transmission. It is striking that most samples collected before 1983 are phylogenetically distinct from more recently isolated sublineages. Using Bayesian temporal analysis, we detected a population bottleneck occurring during the late 1990s, followed by rapid population expansion in the 2000s that was driven by the dominant T. pallidum sublineages circulating today. This expansion may be linked to changing epidemiology, immune evasion or fitness under antimicrobial selection pressure, since many of the contemporary syphilis lineages we have characterized are resistant to macrolides.
216. Additional file 1 of Disability and self-care living strategies among adults living with HIV during the COVID-19 pandemic
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O���Brien, Kelly K., Bayoumi, Ahmed M., Chan Carusone, Soo, Davis, Aileen M., Aubry, Rachel, Avery, Lisa, Solomon, Patricia, Erlandson, Kristine M., Bergin, Colm, Harding, Richard, Brown, Darren A., Vera, Jaime H., and Hanna, Steven E.
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3. Good health - Abstract
Additional file 1. PHQ8 (mental health) and mastery scores���pre and during the COVID-19 pandemic.
217. Defining cognitive impairment in people-living-with-HIV: the POPPY study
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De Francesco, Davide, Underwood, Jonathan, Post, Frank A., Vera, Jaime H., Williams, Ian, Boffito, Marta, Sachikonye, Memory, Anderson, Jane, Mallon, Patrick W. G., Winston, Alan, and Sabin, Caroline A.
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Male ,SYMPTOMS ,HIV Infections ,Neuropsychological Tests ,Microbiology ,ANTIRETROVIRAL THERAPY ,1108 Medical Microbiology ,INFECTION ,HIV Seropositivity ,COMPLAINTS ,Humans ,Cognitive Dysfunction ,Papaver ,BATTERY ,VALIDITY ,Science & Technology ,HIV-associated neurocognitive disorder ,NEUROCOGNITIVE IMPAIRMENT ,HIV ,1103 Clinical Sciences ,Middle Aged ,AIDS DEMENTIA COMPLEX ,Patient-reported cognitive symptoms ,NEUROPSYCHOLOGICAL PERFORMANCE ,COGSTATE ,Cognitive impairment ,Infectious Diseases ,Neurology ,Case-Control Studies ,Female ,Self Report ,Life Sciences & Biomedicine ,0605 Microbiology ,Research Article - Abstract
Background The reported prevalence of cognitive impairment (CI) varies widely in cohorts of people living with HIV (PLWH); this may partly be due to the use of different diagnostic criteria. Agreement between diagnostic criteria of CI, the optimal definition to use, and associations with patient-reported cognitive symptoms have not been fully investigated. Methods Two hundred ninety PLWH aged >50 years and 97 matched negative controls completed a detailed assessment of cognitive function and three questions regarding cognitive symptoms. Age- and education-adjusted test scores (T-scores) determined if subjects met the following definitions of CI: Frascati, global deficit score (GDS) and the multivariate normative comparison (MNC) method. Results PLWH were more likely than controls to meet each definition of CI (ORs were 2.17, 3.12 and 3.64 for Frascati, GDS and MNC, respectively). Agreement of MNC with Frascati and GDS was moderate (Cohen’s k = 0.42 and 0.48, respectively), whereas that between Frascati and GDS was good (k = 0.74). A significant association was found between all the three criteria and reporting of memory loss but not with attention and reasoning problems. The 41 (14 %) PLWH meeting all the three criteria had the lowest median global T-score (36.9) and highest rate of symptom reporting (42 %). Conclusions Different CI criteria show fair diagnostic agreement, likely reflecting their ability to exclude CI in the same group of individuals. Given the lower overall cognitive performance and higher rates of symptom reporting in those meeting all three criteria of CI, further work assessing this as a definition of CI in PLWH is justified. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1970-8) contains supplementary material, which is available to authorized users.
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218. Informe a la Comisión de Reformas Sociales
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Vera, Jaime 1858-1918 and Vera, Jaime 1858-1918
219. Differences in neuroinflammation in people who started antiretroviral treatment during primary versus chronic HIV infection: an 18kDa Translocator protein (TSPO) positron emission tomography (PET) study.
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Alagaratnam, Jasmini, Thornhill, John P., Fan, Zhen, Vera, Jaime H., Underwood, Jonathan, Hall, Rebecca, Searle, Graham, Owen, David, Edison, Paul, Fidler, Sarah, and Winston, Alan
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POSITRON emission tomography , *HIV infections , *TRANSLOCATOR proteins , *ANTIRETROVIRAL agents , *HIV-positive persons - Abstract
Persistent inflammation is described in people with HIV (PWH) on antiretroviral treatment (ART). Early ART initiation is associated with reduced inflammation. We aimed to evaluate neuroinflammation, using translocator protein (TSPO) [11C]PBR28 PET neuroimaging in PWH who initiated ART during acute HIV (aPWH) versus chronic HIV infection (cPWH) versus a control population. This was a cross-sectional, observational study. All participants underwent [11C]PBR28 PET-CT neuroimaging. Using a two-tissue compartment model, total volume of distribution (VT) and distribution volume ratios (DVR) using cortical grey matter as a pseudo-reference region at 20 regions of interest (ROIs) were calculated. Differences in VT and DVR were compared between groups using the Kruskall-Wallis test. Seventeen neuro-asymptomatic male PWH on ART (9 aPWH, 8 cPWH) and 8 male control participants (CPs) were included. Median (interquartile range, IQR) age was 40 (30, 46), 44 (41, 47) and 21 (20, 25) years in aPWH, cPWH and CPs, respectively. Median (IQR) CD4 (cells/µL) and CD4:CD8 were 687 (652, 1014) and 1.37 (1.24, 1.42), and 700 (500, 720) and 0.67 (0.64, 0.82) in aPWH and cPWH, respectively. Overall, no significant difference in VT and DVR were observed between the three groups at any ROIs. cPWH demonstrated a trend towards higher mean VT compared with aPWH and CPs at most ROIs. No significant differences in neuroinflammation, using [11C]PBR28 binding as a proxy, were identified between cPWH, aPWH and CPs. A trend towards lower absolute [11C]PBR28 binding was seen amongst aPWH and CPs, suggesting early ART may mitigate neuroinflammation. [ABSTRACT FROM AUTHOR]
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- 2024
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220. HIV and type 2 diabetes: An evolving story.
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Daultrey, Harriet, Levett, Tom, Oliver, Nick, Vera, Jaime, and Chakera, Ali J
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HIV infection complications , *MEDICAL protocols , *ANTIRETROVIRAL agents , *GLYCOSYLATED hemoglobin , *HIV seroconversion , *TYPE 2 diabetes , *MEDICAL screening , *EVIDENCE-based medicine , *PHENOTYPES , *DISEASE risk factors - Abstract
Introduction: Diabetes is widely reported to be more common in people living with HIV (PLWH). Much of the data supporting this originated during the earlier HIV era. The perceived increased risk of type 2 diabetes is reflected in HIV clinical guidelines that recommend screening for diabetes in PLWH on anti‐retroviral therapy (ART). However, international HIV clinical guidelines do not agree on the best marker of glycaemia to screen for diabetes. This stems from studies that suggest HbA1c underestimates glycaemia in PLWH. Methods: Within this review we summarise the literature surrounding the association of HIV and type 2 diabetes and how this has changed over time. We also present the evidence on HbA1c discrepancy in PLWH. Conclusion: We suggest there is no basis to any international guidelines to restrict HbA1c based on HIV serostatus. We recommend, using the current evidence, that PLWH should be screened annually for diabetes in keeping with country specific guidance. Finally, we suggest future work to elucidate phenotype and natural history of type 2 diabetes in PLWH across all populations. [ABSTRACT FROM AUTHOR]
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- 2024
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221. Implementation of frailty screening for older people living with HIV in Brighton, UK.
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Clair‐Sullivan, Natalie St, Bristowe, Katherine, Khan, Inayat, Maddocks, Matthew, Harding, Richard, Bremner, Stephen, Levett, Thomas, Roberts, Jonathan, Adler, Zoe, Yi, Deokhee, and Vera, Jaime H.
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MEDICAL protocols , *HUMAN services programs , *FOCUS groups , *RESEARCH funding , *FRAIL elderly , *HIV-positive persons , *INTERVIEWING , *DESCRIPTIVE statistics , *LONGITUDINAL method , *METROPOLITAN areas , *GERIATRIC assessment , *AGING , *MEDICAL screening , *COMPARATIVE studies - Abstract
Objectives: To evaluate the implementation of frailty screening in people living with HIV (PLWH) in a large urban cohort of patients in Brighton, UK. Methods: Focus group discussions with HIV professionals and PLWH interviews helped inform the design and implementation of the frailty screening pathway in the clinic. Data were collected from PLWH aged over 60 years attending their HIV annual health check from July 2021 to January 2023 (n = 590), who were screened for frailty by nurses using the FRAIL scale. We assessed the proportions of PLWH who screened as frail, prefrail or robust and compared patient characteristics across groups. All PLWH identified as frail were offered a comprehensive geriatric assessment delivered by a combined HIV geriatric clinic, and uptake was recorded. Results: A total of 456/590 (77.3%) PLWH aged over 60 years were screened for frailty. Median age and time since HIV diagnosis (range) for those screened were 66 (60–99) years and 21 (0–32) years, respectively. In total, 56 (12.1%) of those screened were identified as frail, 118 (25.9%) as prefrail and 282 (61.8%) as robust. A total of 10/56 (18%) people identified as frail declined an appointment in the geriatric clinic. Compared with non‐frail individuals, frail PLWH had been living with HIV for longer and had a greater number of comorbidities and comedications but were not chronologically older. Conclusions: Implementing frailty screening in PLWH over 60 years old is feasible in a large cohort of PLWH, as recommended by the European AIDS Clinical Society. More research is needed to determine if frailty screening can improve clinical outcomes of older PLWH and the use of the comprehensive geriatric assessment within HIV services. [ABSTRACT FROM AUTHOR]
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- 2024
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222. A multi-country comparative study of two treponemal tests for the serodiagnosis of syphilis amongst men who have sex with men (MSM): Chemo-luminescent assay vs Treponema pallidum particle agglutination assay.
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Gios, Lorenzo, Mirandola, Massimo, Cordioli, Maddalena, Zorzi, Antonella, Sherriff, Nigel, Vera, Jaime, Wlazly, Dominika, Hassan-Ibrahim, Mohammed Osman, Padovese, Valeska, Anabel Darmanin, Peeling, Rosanna W., Unemo, Magnus, Blondeel, Karel, and Toskin, Igor
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TREPONEMA pallidum , *SYPHILIS , *SERODIAGNOSIS , *CHEMILUMINESCENCE immunoassay , *AGGLUTINATION - Abstract
Introduction: International guidelines recommend routine screening for syphilis (aetiological agent: Treponema pallidum subspecies pallidum) amongst key populations and vulnerable populations using tests detecting treponemal and non-treponemal antibodies. Whilst treponemal tests have high sensitivities and specificities, they differ regarding subjective or objective interpretation, throughput and workload. Chemiluminescence immunoassays (CLIAs) are cost- and time-effective automated methods for detecting treponemal antibodies. The Treponema pallidum particle agglutination assay (TPPA) has been considered the "gold standard" treponemal assay, however, this includes a highly manual procedure, low throughput and subjective interpretation. The present multi-country study evaluated the ADVIA Centaur® Syphilis CLIA (Siemens Healthcare) assay compared to the reference SERODIA-TP·PA® (Fujirebio Diagnostics) for the serodiagnosis of syphilis amongst men who have sex with men (MSM). Method: 1,485 MSM were enrolled in Brighton (UK), Malta, and Verona (Italy) as part of a larger WHO multi-country and multi-site ProSPeRo study. Ethical approval was obtained. Serum was tested with the ADVIA Centaur® Syphilis CLIA assay and SERODIA-TP·PA®, in accordance with the manufacturers' instructions, for a first round of validation. A second round of validation was carried out for discrepant results that were additionally tested with both Western Blot (Westernblot EUROIMMUN®) and an Immunoblot (INNO-LIA, Fujirebio Diagnostics). Sensitivity, specificity, positive and negative predictive value (PPV and NPV), likelihood ratios (positive/negative), and the Diagnostic Odds Ratio (DOR)/pre-post-test probability (Fagan's nomogram) were calculated. Results: Out of 1,485 eligible samples analysed in the first phase, the SERODIA-TP·PA® identified 360 positive and 1,125 negative cases. The ADVIA Centaur® Syphilis CLIA assay (Siemens) identified 366 positives, missclassifying one TPPA-positive sample. In the second phase, the ADVIA Centaur® Syphilis CLIA resulted in 1 false negative and 4 false positive results. Considering the syphilis study prevalence of 24% (95% CI: 22–26.7), The sensitivity of the ADVIA Centaur® Syphilis CLIA assay was 99.7% (95% CI: 98.5–100), and the specificity was 99.4% (95% CI: 98.7–99.7). The ROC area values were 0.996 (95% CI: 0.992–0.999), and both the PPV and NPV values were above 98% (PPV 98.1%, 95% CI: 96.1–99.2; NPV 99.9%, 95% CI: 99.5–100). Conclusions: The ADVIA Centaur® Syphilis CLIA assay showed similar performance compared to the SERODIA-TP·PA®. Considering the study is based on QUADAS principles and with a homogeneous population, results are also likely to be generalisable to MSM population but potentially not applicable to lower prevalence populations routinely screened for syphilis. The automated CLIA treponemal assay confirmed to be accurate and appropriate for routine initial syphilis screening, i.e. when the reverse testing algorithm is applied. [ABSTRACT FROM AUTHOR]
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- 2024
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223. Independent clinic-based evaluation of dual POCTs for screening for HIV and syphilis in men who have sex with men in Italy, Malta, Peru, and the United Kingdom.
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Sherriff, Nigel, Mirandola, Massimo, Silva, Ronaldo, Cordioli, Maddalena, Sawyer, Alexandra, Gios, Lorenzo, Zorzi, Antonella, Huber, Jorg, Vera, Jaime, Richardson, Daniel, Hassan-Ibrahim, Mohammed, Wlazly, Dominika, Padovese, Valeska, Barbara, Christopher, Darmanin, Anabel, Schembri, Aaron, Caceres, Carlos, Vargas, Silver, Blondeel, Karel, and Kiarie, James
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SYPHILIS , *MEDICAL personnel , *MEDICAL screening , *HIV , *RESOURCE-limited settings , *TREPONEMA pallidum - Abstract
Introduction: Globally, the incidence of HIV and syphilis can be reduced by the use of validated point of care tests (POCTs). As part of the WHO PRoSPeRo Network, we aimed to evaluate the performance, acceptability, and operational characteristics of two dual HIV/syphilis POCTs (Bioline HIV/Syphilis Duo (Abbott) and DPP® HIV-Syphilis assay (Chembio) for the screening of HIV and syphilis amongst men who have sex with men (MSM). Method and analyses: A cross sectional study of 2,577 MSM in Italy, Malta, Peru, and the United Kingdom (UK) presenting to seven clinic sites, were enrolled. Finger prick blood was collected to perform POCTs and results compared with standard laboratory investigations on venepuncture blood. Acceptability and operational characteristics were assessed using questionnaires. Diagnostic meta-analysis was used to combine data from the evaluation sites. Results: Based on laboratory tests, 23.46% (n = 598/2549) of participants were confirmed HIV positive, and 35.88% of participants (n = 901/2511) were positive on treponemal reference testing. Of all participants showing evidence of antibodies to Treponema pallidum, 50.56% (n = 455/900) were Rapid Plasma Reagin (RPR) test reactive. Of HIV positive individuals, 60.62% (n = 354/584) had evidence of antibodies to T. pallidum, and of these 60.45% (n = 214/354) exhibited reactive RPR tests indicating probable (co)infection. For Bioline POCT, pooled sensitivities and specificities for HIV were 98.95% and 99.89% respectively, and for syphilis were 73.79% and 99.57%. For Chembio pooled sensitivities and specificities for HIV were 98.66% and 99.55%, and for syphilis were 78.60% and 99.48%. Both tests can detect greater than 90% of probable active syphilis cases, as defined by reactive RPR and treponemal test results. These dual POCTs were preferred by 74.77% (n = 1,926) of participants, due to their convenience, and the operational characteristics made them acceptable to health care providers (HCPs). Conclusions: Both the Bioline and the Chembio dual POCT for syphilis and HIV had acceptable performance, acceptability and operational characteristics amongst MSM in the PRoSPeRo network. These dual POCTs could serve as a strategic, more cost effective, patient and healthcare provider (HCP) friendly alternative to conventional testing; in clinical and other field settings, especially those in resource-limited settings. [ABSTRACT FROM AUTHOR]
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- 2024
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224. Global sexual health education: STIF in Zambia.
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Vera, Jaime H., Ngalamika, Owen, Fox, Ashini, Collins, Emma, and Grundy-Bowers, Matthew
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- 2018
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225. Episodic disability questionnaire (EDQ) measurement properties among adults living with HIV in Canada, Ireland, United Kingdom, and United States.
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O'Brien, Kelly K., Erlandson, Kristine M., Brown, Darren A., Carusone, Soo Chan, Vera, Jaime H., Bergin, Colm, Avery, Lisa, Bayoumi, Ahmed M., Hanna, Steven E., Harding, Richard, Solomon, Patricia, Clair-Sullivan, Natalie St., O'Shea, Noreen, Murray, Carolann, Boffito, Marta, Da Silva, George, Torres, Brittany, McDuff, Kiera, and Davis, Aileen M.
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STATISTICAL reliability , *CRONBACH'S alpha , *HIV , *MEASUREMENT errors , *TEST validity - Abstract
Background: The Episodic Disability Questionnaire (EDQ) is a generic 35-item patient-reported outcome measure of presence, severity and episodic nature of disability. We assessed the measurement properties of the Episodic Disability Questionnaire (EDQ) with adults living with HIV. Methods: We conducted a measurement study with adults living with HIV in eight clinical settings in Canada, Ireland, United Kingdom, and United States. We electronically administered the EDQ followed by three reference measures (World Health Organization Disability Assessment Schedule; Patient Health Questionnaire; Social Support Scale) and a demographic questionnaire. We administered the EDQ only 1 week later. We assessed the internal consistency reliability (Cronbach's alpha; > 0.7 acceptable), and test–retest reliability (Intra Class Correlation Coefficient; > 0.7 acceptable). We estimated required change in EDQ domain scores to be 95% certain that a change was not due to measurement error (Minimum Detectable Change (MDC95%)). We evaluated construct validity by assessing 36 primary hypotheses of relationships between EDQ scores and scores on the reference measures (> 75% hypotheses confirmed indicated validity). Results: Three hundred fifty nine participants completed the questionnaires at time point 1, of which 321 (89%) completed the EDQ approximately 1 week later. Cronbach's alpha for internal consistency ranged from 0.84 (social domain) to 0.91 (day domain) for the EDQ severity scale, and 0.72 (uncertainty domain) to 0.88 (day domain) for the EDQ presence scale, and 0.87 (physical, cognitive, mental-emotional domains) to 0.89 (uncertainty domain) for the EDQ episodic scale. ICCs for test–retest reliability ranged from 0.79 (physical domain) to 0.88 (day domain) for the EDQ severity scale and from 0.71 (uncertainty domain) to 0.85 (day domain) for the EDQ presence scale. Highest precision was demonstrated in the severity scale for each domain (MDC95% range: 19–25 out of 100), followed by the presence (MDC95% range: 37–54) and episodic scales (MDC95% range:44–76). Twenty-nine of 36 (81%) construct validity hypotheses were confirmed. Conclusions: The EDQ possesses internal consistency reliability, construct validity, and test–retest reliability, with limited precision when administered electronically with adults living with HIV across in clinical settings in four countries. Given the measurement properties, the EDQ can be used for group level comparisons for research and program evaluation in adults living with HIV. [ABSTRACT FROM AUTHOR]
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- 2024
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226. Hepatic steatosis in people older and younger than fifty who are living with HIV and HIV‐negative controls: A cross‐sectional study nested within the POPPY cohort.
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Arenas‐Pinto, Alejandro, Bakewell, Nicholas, Milinkovic, Ana, Williams, Ian, Vera, Jaime, Post, Frank A., Anderson, Jane, Beynon, Michelle, O'Brien, Alastair, Doyle, Nicki, Gilson, Richard, Pett, Sarah L., Winston, Alan, and Sabin, Caroline A.
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HIV-positive persons , *KRUSKAL-Wallis Test , *ULTRASONIC imaging , *CONFIDENCE intervals , *FATTY liver , *CROSS-sectional method , *FISHER exact test , *RISK assessment , *COMPARATIVE studies , *WAIST-hip ratio , *RESEARCH funding , *CHI-squared test , *DESCRIPTIVE statistics , *LOGISTIC regression analysis , *ODDS ratio , *DISEASE risk factors , *ADULTS , *MIDDLE age - Abstract
Background: Hepatic steatosis is a major cause of chronic liver disease associated with several negative health outcomes. We compared the prevalence of and factors associated with steatosis in people living with and without HIV. Methods: Older (>50 years) and younger (<50 years) people with HIV and older HIV‐negative controls (>50 years) underwent liver transient elastography examination with controlled attenuation parameter (steatosis ≥238 dB/m, moderate/severe steatosis ≥280 dB/m, liver fibrosis ≥7.1 kPa). We compared groups using logistic regression/Chi‐squared/Fisher's exact/Kruskal–Wallis tests. Results: In total, 317 participants (109 older people with HIV; 101 younger people with HIV; 107 HIV‐negative controls) were predominantly white (86%) and male (76%), and 21% were living with obesity (body mass index ≥30 kg/m2). Most (97%) people with HIV had undetectable HIV RNA. The prevalence of fibrosis was 8.4%, 3.0%, and 6.5% in the three groups, respectively (p = 0.26). Fibrosis was predominately (>65%) mild. The prevalence of steatosis was the same in older people with HIV (66.4%) and controls (66.4%) but lower in younger people with HIV (37.4%; p < 0.001). After adjustment, younger people with HIV were less likely to have steatosis (odds ratio [OR] 0.26; 95% confidence interval [CI] 0.14–0.52) than controls, but male sex (OR 2.45; 95% CI 1.20–4.50) and high waist‐to‐hip ratio (OR 3.04; 95% CI 1.74–5.33) were associated with an increased odds of steatosis. We found no association between steatosis and HIV‐related variables. Conclusions: The prevalence of hepatic steatosis and fibrosis was similar between older participants regardless of HIV status. Age, sex, and abdominal obesity, but not HIV‐related variables, were associated with steatosis. Interventions for controlling obesity should be integrated into routine HIV care. [ABSTRACT FROM AUTHOR]
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- 2024
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227. Research priorities in HIV, aging and rehabilitation: building on a framework with the Canada-International HIV and Rehabilitation Research Collaborative.
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O'Brien, Kelly K., Ibáñez-Carrasco, Francisco, Birtwell, Kelly, Donald, Graeme, Brown, Darren A., Eaton, Andrew D., Kasadha, Bakita, Stanmore, Emma, St. Clair-Sullivan, Natalie, Townsend, Liam, Vera, Jaime H., and Solomon, Patricia
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HIV infections , *SOCIAL participation , *ACTIVE aging , *PRIORITY (Philosophy) , *STAKEHOLDER analysis , *DIGITAL health , *COMMUNITY health services , *CONCEPTUAL structures , *INTERPROFESSIONAL relations , *REHABILITATION , *HIV , *REHABILITATION research ,RESEARCH evaluation - Abstract
Background: In 2016, the Canada-International HIV and Rehabilitation Research Collaborative established a framework of research priorities in HIV, aging and rehabilitation. Our aim was to review and identify any new emerging priorities from the perspectives of people living with HIV, clinicians, researchers, and representatives from community organizations. Methods: We conducted a multi-stakeholder international consultation with people living with HIV, researchers, clinicians and representatives of community-based organizations. Stakeholders convened for a one-day Forum in Manchester, United Kingdom (UK) to discuss research priorities via a web-based questionnaire and facilitated discussions. We analyzed data using conventional content analytical techniques and mapped emerging priorities onto the foundational framework. Results: Thirty-five stakeholders from the UK(n = 29), Canada(n = 5) and Ireland(n = 1) attended the Forum, representing persons living with HIV or representatives from community-based organizations(n = 12;34%), researchers or academics(n = 10;28%), service providers(n = 6;17%), clinicians(n = 4;11%); and trainees(n = 4;11%). Five priorities mapped onto the Framework of Research Priorities across three content areas: A–Episodic Health and Disability Aging with HIV (disability, frailty, social participation), B-Rehabilitation Interventions for Healthy Aging across the Lifespan (role, implementation and impact of digital and web-based rehabilitation interventions) and C–Outcome Measurement in HIV and Aging (digital and web-based rehabilitation health technology to measure physical activity). Stakeholders indicated methodological considerations for implementing digital and web-based rehabilitation interventions into research and practice and the importance of knowledge transfer and exchange among the broader community. Conclusion: Results highlight the sustained importance of the Framework of Research Priorities and provide further depth and areas of inquiry related to digital and web-based rehabilitation interventions and technology aging with HIV. [ABSTRACT FROM AUTHOR]
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- 2023
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228. People with HIV and healthcare workers views on screening for cognitive impairment in people with HIV: A qualitative study.
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Alford, Kate, Sidat, Shiraaz, Bristowe, Katherine, St. Clair‐Sullivan, Natalie, Parteger, Gary, Matthew, Maddocks, Yi, Deokhee, Harding, Richard, Levett, Tom, Bremner, Stephen, and Vera, Jaime H.
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COGNITION disorders , *POPULATION , *STRATEGIC planning , *ATTITUDES of medical personnel , *MEDICAL screening , *INTERVIEWING , *QUALITATIVE research , *HOLISTIC medicine , *AGING , *ACCESS to information , *RESEARCH funding , *THEMATIC analysis , *DATA analysis software , *PSYCHOLOGY of HIV-positive persons - Abstract
Objectives: People with HIV are an ageing population with an increased risk of cognitive impairment. Although cognitive impairment is dependent upon assessment, the acceptability of screening for cognitive impairment is unclear. This study aimed to explore the views of people with HIV and healthcare workers regarding routine screening for cognitive impairment. Methods: In‐depth individual qualitative interviews were conducted with purposively sampled people with HIV and focus groups of healthcare workers from a UK HIV service. Verbatim pseudonymized transcripts were analysed using reflexive thematic analysis supported by NVivo. Results: Twenty people with HIV were interviewed and 12 healthcare workers participated in three focus groups. People with HIV were concerned about developing cognitive issues and were receptive to routine screening. Screening was seen as relevant and an important part of managing health in older age. Healthcare workers expressed concerns regarding the capacity of HIV services to implement routine screening and questioned the validity of screening measures used. People with HIV felt that screening and subsequent detection of cognitive impairment, if present, may help them to prepare for future issues and promote active management strategies and care pathways that would support cognitive health. People with HIV felt that screening should be brief and delivered by the HIV service and that they should be given a choice of administration method. Indications of cognitive impairment detected by a brief screening assessment should be discussed face to face and followed up with a comprehensive assessment. Conclusions: People with HIV are concerned about cognitive impairment and would welcome regular screening for this as part of the holistic care provided by the HIV team. Both people with HIV and healthcare workers would like more information on cognitive impairment, its screening and ways to support cognitive health. [ABSTRACT FROM AUTHOR]
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- 2023
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229. Health-related quality of life in people living with HIV who have cognitive impairment
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Alford, Katie, Vera, Jaime, Daley, Stephanie, and Banerjee, Sube
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Health-related quality of life is an essential end point in the disease management of chronic conditions, such as HIV, with calls to include good quality of life as a 'fourth 90' in the 90-90- 90 HIV testing and treatment targets introduced by Joint United Nations Programme on AIDS in 2016. Cognitive impairments impact a broad spectrum of experiences and are seen in 14- 28% of people living with HIV. In this thesis, the health-related quality of life of people living with HIV who have cognitive impairment is explored. First a scoping review was conducted to examine what is currently known about the health related quality of life of this group and to identify gaps in current knowledge. Research was limited; sixteen articles met inclusion criteria, assessments used a variety of different patient reported outcome measures, and findings were indicative of poor overall health-related quality of life. Second, qualitative study was conducted with 25 people living with HIV with cognitive impairment attending specialist HIV memory clinics in Brighton and London. Analysis employed techniques from grounded theory and led to the identification of seven broad interrelated domains driving health-related quality of life experiences. The domains identified were: Physical function, Cognition, Social connectedness, Physical and Mental Health and Wellbeing, HIV Stigma, Self-concept, and Acceptance of cognitive impairment and Perceived control over health outcomes. These were interpreted and conceptualised using a modified health-related quality of life framework. Following this, 103 people living with HIV with cognitive issues, from two HIV services in Brighton and London, participated in a questionnaire-based quantitative study. The domains identified were operationalised using existing domain-specific scales to quantitatively explore and validate our health-related quality of life framework. Clinical cut-offs confirmed poor health-related quality of life. Factor analysis corroborated the relevance of the domains identified and hierarchical linear regression confirmed that cognitive function significantly predicted health-related quality of life score. Furthermore, the inclusion of other domains into the regression model increased the predictive efficacy, explaining 56% of the variance in overall quality of life score. Finally, we examined the psychometric properties (reliability, construct validity, convergent and discriminant validity, and content and face validity) of purposefully selected generic, HIV specific, and dementia-specific quality of life and health-related quality of patient reported outcome measures for use in people with HIV with cognitive impairment. Psychometric evaluation indicated when assessing health-related quality of life in this population the DEMQOL measure should be employed, along with a broader measure of generic or HIV-specific health-related quality of life. The health-related quality of life in people with HIV and cognitive impairment could be improved and this thesis has identified important domains driving these experiences and provided recommendations for its assessment. This provides targets for intervention development and clinical consultation to maintain or improve health-related quality of life in people with HIV and cognitive impairment.
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- 2022
230. P3.129 How can we use phylogenetics to facilitate clinical case finding and partner notification in hiv: lessons from a systematic review of its use in stigmatised infectious diseases
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Mulka, Larissa, Vera, Jaime H, Leigh-Brown, Andrew J, and Cassell, Jackie A
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IntroductionPhylogenetic information provides new horizons for clinical case finding in HIV, but raises issues of acceptability, privacy and even criminalisation. We reviewed studies describing use of phylogenetics to directly inform case finding in community acquired stigmatised infectious diseases.MethodsA search in MEDLINE, Embase, CINAHL and PsychINFO for articles where phylogenetics have been used to facilitate case finding in sexually transmitted infections, TB, HBV or HCV, published until July 2016 in English. Results26 of 6042 papers screened met the inclusion criteria; 17 TB, 9 HIV. 19 studies reported using phylogenetics to identify and investigate HIV outbreaks but did not report its role in case finding. Case finding strategies included confirming the source of an outbreak to prompt wider investigation (HIV); investigation of phylogenetically clustered cases (TB, HIV); combined cluster and geographical information to target screening (TB); screening informed by discrepancies between genotypic and epidemiological data (TB); phylogenetic characterisation to inform a screening intervention (HIV); epidemiological data to identify of a source (HIV); and contact tracing with genotype matching to a phenotype (HIV). Facilitators included sharing molecular surveillance data to establish community support in targeted TB screening. Barriers included delayed results, time lapse between cases and refusal of access to premises for screening. However patient barriers were rarely reported. Ethical issues included media coverage of an HIV sources identity.ConclusionPhylogenetics-informed approaches to case finding are feasible in stigmatised infections. However studies reporting their use in clinical and public health practice provide limited information on patient related barriers, acceptability, or on ethical challenges such as identification of “core” transmitters or criminalisation. Research into patient views on acceptability, risks and preferred approaches to using phylogenetic information for case finding in HIV is needed to inform interventions.
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- 2017
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231. Cognitive impairment in people living with HIV: consensus recommendations for a new approach.
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Nightingale, Sam, Ances, Beau, Cinque, Paola, Dravid, Ameet, Dreyer, Anna J., Gisslén, Magnus, Joska, John A., Kwasa, Judith, Meyer, Ana-Claire, Mpongo, Nombeko, Nakasujja, Noeline, Pebody, Roger, Pozniak, Anton, Price, Richard W., Sandford, Christopher, Saylor, Deanna, Thomas, Kevin G. F., Underwood, Jonathan, Vera, Jaime H., and Winston, Alan
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HIV-positive persons , *COGNITION disorders , *NEUROBEHAVIORAL disorders , *COGNITIVE testing , *BRAIN injuries - Abstract
Current approaches to classifying cognitive impairment in people living with HIV can overestimate disease burden and lead to ambiguity around disease mechanisms. The 2007 criteria for HIV-associated neurocognitive disorders (HAND), sometimes called the Frascati criteria, can falsely classify over 20% of cognitively healthy individuals as having cognitive impairment. Minimum criteria for HAND are met on the basis of performance on cognitive tests alone, which might not be appropriate for populations with diverse educational and socioeconomic backgrounds. Imprecise phenotyping of cognitive impairment can limit mechanistic research, biomarker discovery and treatment trials. Importantly, overestimation of cognitive impairment carries the risk of creating fear among people living with HIV and worsening stigma and discrimination towards these individuals. To address this issue, we established the International HIV-Cognition Working Group, which is globally representative and involves the community of people living with HIV. We reached consensus on six recommendations towards a new approach for diagnosis and classification of cognitive impairment in people living with HIV, intended to focus discussion and debate going forward. We propose the conceptual separation of HIV-associated brain injury — including active or pretreatment legacy damage — from other causes of brain injury occurring in people living with HIV. We suggest moving away from a quantitative neuropsychological approach towards an emphasis on clinical context. Our recommendations are intended to better represent the changing profile of cognitive impairment in people living with HIV in diverse global settings and to provide a clearer framework of classification for clinical management and research studies. Current approaches to classifying cognitive impairment in people living with HIV can overestimate disease burden and lead to ambiguity around disease mechanisms. In this Consensus Statement, the International HIV-Cognition Working Group have outlined six recommendations towards a new approach, intended to better represent changes in the spectrum of HIV disease in the modern era of antiretroviral therapy. [ABSTRACT FROM AUTHOR]
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- 2023
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232. Nanoflow-Nanospray Mass Spectrometry Metabolomics Reveals Disruption of the Urinary Metabolite Profiles of HIV-Positive Patients on Combination Antiretroviral Therapy.
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Chetwynd, Andrew J., Samarawickrama, Amanda, Vera, Jaime H., Bremner, Stephen A., Abdul-Sada, Alaa, Gilleece, Yvonne, Holt, Stephen G., and Hill, Elizabeth M.
- Abstract
Background: The use of combination antiretroviral therapy (cART) has substantially improved the outlook for patients with HIV infection. However, lifelong exposure to cART is also associated with adverse metabolic changes and an enhanced risk of renal, hepatic, and cardiovascular dysfunction. This study investigated disruptions of the urinary metabolome of cART-exposed patients, thereby furthering our understanding of some of the side effects of pharmaceutical intervention. Methods: HIV-positive patients were recruited from an HIV clinic and divided into cART-naive and cART-exposed groups. HIV-negative patients were recruited from a sexual health clinic. All 89 subjects were white males. Targeted biochemistry analyses were performed on plasma samples. Urine samples were collected after an overnight fast and analyzed with a highly sensitive untargeted metabolomic method using nanoflow/nanospray liquid chromatography–time-of-flight mass spectrometry. Data sets were analyzed using projection modeling to detect metabolite markers of cART exposure. Results: Metabolites or parent compounds of all cART drugs were detected in urine extracts of all but one of the cART-exposed patients confirming adherence to the pharmaceutical regimen. Analysis of urine samples from patients on cART revealed significant reductions in selected bile acids, lipid, nucleoside, and androgen metabolites. However, plasma concentrations of free or conjugated testosterone remained unchanged indicating possible disruption of androgen transport or excretion in urine of patients on cART. Conclusions: Discovery-based metabolomics reveals the potential to identify novel markers of cART intervention and metabolite disruption in HIV-positive patients, which may enable investigation of the efficacy, compliance, and side effects of these pharmaceutical mixtures to be investigated. [ABSTRACT FROM AUTHOR]
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- 2017
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233. How can we develop acceptable and effective phylogenetically informed approaches to HIV prevention in the UK?
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Mulka, Larissa, Cassell, Jackie A., Vera, Jaime, and Leigh-Brown, Andrew
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Due to technical and computational advances, the use of phylogenetics in HIV is evolving. Previously, analyses were time consuming and expensive allowing only retrospective analyses on relatively small scales, but now phylogenetic analyses can be, and are, used in near-real time to describe transmission dynamics and guide public health response, aiming to prevent further transmission. While phylogenetically underpinned prevention is being implemented in the USA as part of its epidemic response, there is less experience in the UK, and there has been little research into the ethical and acceptability issues in this context. This thesis aims to identify how the use of real-time phylogenetics to guide HIV prevention interventions could be acceptably implemented in the UK. A literature review and two empirical studies were conducted to address two research questions: 1. How could phylogenetics be implemented in a way that is acceptable to patients?; 2. Can real-time phylogenetically guided interventions be piloted on a local scale, providing evidence for effectiveness and real-life acceptability? A systematic review was conducted to identify and draw lessons from the use of approaches for case finding of infectious disease guided by phylogenetics, and the barriers, facilitators and ethical issues associated with this. A phylogenetic analysis sought to identify sources of HIV infection in incident cases of HIV in Brighton, to identify whether this was a relatively ‘closed’ cohort, and inform piloting of a real-time phylogenetically led prevention system. A qualitative study explored acceptability of the use of phylogenetics with key stakeholders, and potential negative outcomes of its use. The findings of these studies were synthesised to inform intervention development. There has been a paucity of previous research or reporting of barriers, facilitators, and acceptability and ethical issues in the context of phylogenetic data used for purposes of infectious disease case finding. The acceptability of such data use to patients and healthcare staff depends on the perceived risks balanced against potential public health benefits of this use of data, and use of phylogenetics in a manner deemed unacceptable risks disengaging patients from testing for HIV. Acceptability of the use of phylogenetics to guide public health interventions increases as the potential prevention benefits increase, and is enhanced by certain protections, including strict security measures and limiting access to data, informed consent, protection from police use and improved understanding of the purposes and limitations of phylogenetic analysis. Sources of transmission to patients attending Brighton’s HIV centre were found to be geographically dispersed throughout the UK, suggesting piloting a phylogenetic system locally would limit its utility in terms of prevention benefits, and to be effective, such a system would require large scale, national input. To introduce phylogenetically guided public health interventions in the UK, evidence of clear public health benefit is required, which may be achieved through nationwide anonymous realtime phylogenetic surveillance to identify whether clusters that may be disrupted by interventions exist, and will be supplemented by outcomes reported in the USA. If we gain evidence of benefit, strategies to mitigate risk require development, including protections from judicial use, approaches for informed consent and stringent security and data management policies. Introducing phylogenetics to guide public health interventions in the UK without addressing these considerations risks disengaging individuals from testing and on-going care.
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- 2019
234. Frailty status and associated factors among older PLHIV in Southern Ethiopia.
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Woldesemayat, Endrias Markos, St Clair-Sullivan, Natalie, Kassa, Andargachew, Gari, Taye, Gutema, Keneni, Chea, Nana, Woubshet, Kindie, Bogale, Netsanet, Assefa, Amare, and Vera, Jaime
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FRAILTY , *LOGISTIC regression analysis , *STATISTICAL sampling , *BODY mass index , *OLDER people , *HIV-positive persons , *HIV - Abstract
Background: Studies addressing frailty are limited in the global south, including Ethiopia. We estimated the prevalence of frailty and associated factors among older people living with HIV (PLHIV) attending a large Comprehensive Specialized Hospital in southern Ethiopia. Methods: A systematic sample of 187 PLHIV and 187 HIV-negative controls > 50 years old were recruited between October 1 and November 30, 2021. Data on socio-demographic, behavioural and clinical characteristics were collected using a structured questionnaire. Frailty assessments were completed using the brief frailty instrument (B-FIT-2), which consists of 6 components. Scoring 5–6 points was frail, 2–4 points were pre-frail and below 2 was considered as non-frail. Logistic regression model was used to measure association between variables. Results: Median (IQR) age was 53 (50, 80) for PLWH and 59 (55–66) for controls. Prevalence of frailty was 9.1% for PLHIV Versus 5.9% for controls. A significant proportion of PLHIV was pre-frail; 141 (75.4%) compared to controls 110 (58.8%). Pre-frailty status was associated with HIV diagnosis (adjusted odds ratio (aOR) 4.2; 95% CI 1.8–9.9), low age (aOR 0.3; 95% CI 0.1–0.6), lower educational attainment (aOR 2.2; 95% CI 1.0–4.9), being farmer (aOR 3.2; 95% CI 1.0–10.2) and having high or low body mass index (BMI) (aOR 11.3; 95% CI 4.0–25.8). HIV diagnosis (aOR 9.7; 95% CI 1.6–56.8), age (aOR 0.2; 95% CI 0.1–0.7), lower educational attainment (aOR 5.2; 95% CI 1.5–18.2), single status (aOR 4.2; 95% CI 1.3–13.6), farmer (aOR 19.5; 95% CI 3.5–109.1) and high or low BMI (aOR 47.3; 95% CI 13.8–161.9) predicted frailty. Conclusion: A high proportion of frailty and pre-frailty was observed in a cohort of older PLHIV attending care in Southern Ethiopia. Future research should focus on interventions targeting factors associated with frailty. [ABSTRACT FROM AUTHOR]
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- 2023
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235. Frailty and frailty screening: A qualitative study to elicit perspectives of people living with HIV and their healthcare professionals.
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St Clair‐Sullivan, Natalie, Simmons, Kiersten, Harding, Richard, Levett, Thomas, Maddocks, Matthew, Roberts, Jonathan, Trotman, Daniel, Yi, Deokhee, Vera, Jaime H., and Bristowe, Katherine
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FRAIL elderly , *FOCUS groups , *ATTITUDES of medical personnel , *MEDICAL screening , *INTERVIEWING , *PATIENTS' attitudes , *ATTITUDES toward illness , *QUALITATIVE research , *HEALTH , *INFORMATION resources , *DESCRIPTIVE statistics , *RESEARCH funding , *JUDGMENT sampling , *PSYCHOLOGY of HIV-positive persons , *OLD age - Abstract
Objectives: People living with HIV are an ageing population with an increasing prevalence of frailty. Management of frailty requires assessment, communication and information sharing with patients. However, evidence regarding the meaning of frailty for this population, and the acceptability of frailty screening, is limited. This study aimed to explore the perceptions of older people living with HIV and HIV professionals towards frailty and routine screening for frailty. Methods: Data collection consisted of in‐depth individual qualitative interviews with older people living with HIV and focus groups with HIV professionals purposively sampled from outpatient HIV clinics in London and Brighton, UK. Verbatim pseudonymised transcripts were analysed using reflexive thematic analysis supported by NVivo. Results: A total of 45 people living with HIV were interviewed, and 12 HIV professionals participated in two focus groups. Frailty was described as a series of losses around mobility, social inclusion, independence and mental acuity, which could happen at any age. Regarding language, for people living with HIV, explicitly using the word frail was acceptable during screening when approached sensitively and alongside provision of information and support to slow the progression of frailty. However, HIV professionals described concerns about using the word frail for fear of causing distress or offence. Conclusion: Professionals described frailty in terms of functional deficits, whereas people living with HIV described a loss of personhood. Although there is a clear desire among people living with HIV to be informed of their frailty status, approaching conversations about frailty with understanding and compassion is vital. To gain the most from the screening, it is essential that frailty status is shared alongside a clear plan of actionable steps in their care. [ABSTRACT FROM AUTHOR]
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- 2023
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236. Changes in multimorbidity burden over a 3-5 year period among people with HIV.
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Sukumaran, Luxsena, De Francesco, Davide, Winston, Alan, Mallon, Patrick W. G., Doyle, Nicki, Anderson, Jane, Boffito, Marta, Williams, Ian, Post, Frank A., Vera, Jaime, Sachikonye, Memory, Johnson, Margaret A., and Sabin, Caroline A.
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HIV-positive persons , *COMORBIDITY , *DRUG abuse , *HIV , *SEXUALLY transmitted diseases , *PRINCIPAL components analysis - Abstract
Introduction: As people living with HIV age, the increasing burden of multimorbidity poses a significant health challenge. The aims of this study were to identify common patterns of multimorbidity and examine changes in their burden, as well as their associations with risk factors, over a 3-5 year period in people with HIV, enrolled in the Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) study. Methods: Common multimorbidity patterns were identified in POPPY participants with HIV using principal component analysis, based on Somers' D statistic. Multimorbidity burden scores were calculated for each participant/pattern at study entry/follow-up and were standardised relative to the mean in the sample at baseline (scores >0 thus reflect a greater number of comorbidities relative to the mean). Two multivariable linear regression models were fitted to examine the associations between risk factors and burden z-scores at baseline and change in z-scores over a 3-5 year period. Results: Five patterns were identified among the 1073 POPPY participants with HIV {median age [interquartile range (IQR)], 52 (47-59) years; 85% male and 84% white}: Cardiovascular diseases (CVDs), Sexually transmitted diseases (STDs), Neurometabolic, Cancer and Mental-gastro-joint. The multivariable linear regression showed that older age, behavioural factors (i.e., body mass index (BMI), history of injection drug use, current recreational drug use and sex between men), and HIV-specific factors (i.e., duration since HIV diagnosis and a prior AIDS diagnosis) were associated with higher multimorbidity burden at baseline. However, only three of the factors (age, BMI and duration since HIV diagnosis) were significantly associated with an increase in burden across specific patterns over time. Discussion: Key modifiable and non-modifiable factors contributing to an increase in burden of multimorbidity were identified. Our findings may inform the development of more targeted interventions and guidelines to effectively prevent and manage the rising burden of multimorbidity in people with HIV. [ABSTRACT FROM AUTHOR]
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- 2023
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237. Management approach including pembrolizumab for fingolimod-associated progressive multifocal leukoencephalopathy in a patient with relapsing-remitting multiple sclerosis.
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Barritt, Andrew W, Das, Esther, Morley, Nadine, Seymour, Matthew, Saha, Romi, Vera, Jaime, Vundavalli, Sriram, Dizdarevic, Sabina, Nicholas, Richard, Berger, Joseph R, and Fisniku, Leonora K
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PROGRESSIVE multifocal leukoencephalopathy , *JOHN Cunningham virus , *MULTIPLE sclerosis , *IMMUNE reconstitution inflammatory syndrome , *SEIZURES (Medicine) , *PEMBROLIZUMAB - Abstract
A 62-year-old man with relapsing-remitting multiple sclerosis developed progressive multifocal leukencephalopathy (PML) after 6 years on fingolimod. The fingolimod was immediately discontinued and preexisting mirtazepine increased. Three weeks later, with brain magnetic resonance imaging (MRI) appearances worsening and cerebrospinal fluid (CSF) JC virus (JCV) titres increasing, maraviroc was introduced. At 6 weeks, subtle punctate contrast enhancement raised the possibility of immune reconstitution inflammatory syndrome (IRIS), followed by a single focal-to-generalised tonic clonic seizure and a further deterioration in clinical disability. Mefloquine was commenced alongside three doses of pembrolizumab administered a month apart. Serial CSF examinations and several imaging modalities including spectroscopy and fused FDG-PET-MRI (18F-fluoro-deoxy-glucose–positron emission tomography–magnetic resonance imaging) were used to help distinguish between PML, PML-IRIS and rebound MS activity and guide optimal management at each stage. A handful of small, enhancing ovoid lesions developed between the first two doses of pembrolizumab, probably representative of a mild rebound phenomenon. A sustained improvement became obvious thereafter with CSF JCV-DNA undetectable 16 weeks following fingolimod withdrawal. To our knowledge, this is the first case of combined therapy and use of pembrolizumab in a fingolimod-associated PML. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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238. Current screening for HIV
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Vera, Jaime H and Shaw, Andrew
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- 2009
239. "A fog that impacts everything": a qualitative study of health-related quality of life in people living with HIV who have cognitive impairment.
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Alford, Kate, Daley, Stephanie, Banerjee, Sube, Hamlyn, Elizabeth, Trotman, Daniel, and Vera, Jaime H.
- Abstract
Background: Cognitive impairment (CI) in people living with HIV (PLWH) is an important health concern in the context of an ageing HIV population. Impacting 14-28% of PLWH, CI is associated with lower health-related quality of life (HRQoL), however, evaluation of the illness-specific factors comprising HRQoL in PLWH with CI have not been assessed.Objective: We sought to contribute evidence toward an understanding of HRQoL and identify domains of HRQoL in PLWH with CI.Methods: Qualitative interviews with 25 PLWH with objective CI related to HIV disease were conducted with participants attending HIV clinics in the UK. Clinically significant CI was defined based on The European AIDS Clinical Society guidelines, requiring: (i) subjective reporting of cognitive symptoms; (ii) symptoms to be related to HIV (e.g. potentially confounding non-HIV related conditions have been excluded or are being optimally managed) and; (iii) formal neuropsychological assessment confirming CI. Median age was 56 years (range 35-80); 18 participants were men (72%); 11 (44%) were white British and 8 (32%) were Black African; 14 (56%) were men that have sex with men and 10 (40%) were heterosexual; median number of years living with HIV was 17 (range 1-34); and all participants were on combination antiretroviral therapy. Analyses employed techniques from grounded theory, underpinned by an inductive, collaborative team-based approach.Results: Findings revealed seven interrelated domains comprising HRQoL experiences were identified: Physical function, Cognition, Social connectedness, Physical and mental health, Stigma, Self-concept, and Control and acceptance, and each was defined by specific descriptive components.Conclusion: This study provides valuable insights on the factors that drive HRQoL in PLWH with CI and contribute to a body of evidence which provides targets for the development of targeted interventions to maintain or improve quality of life. [ABSTRACT FROM AUTHOR]- Published
- 2022
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- View/download PDF
240. The impact of COVID‐19 on HIV testing in the UK's first Fast‐Track HIV city.
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Wenlock, Rhys D, Shillingford, Chante, Mear, John, Churchill, Duncan, Vera, Jaime H., and Dean, Gillian
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DIAGNOSIS of HIV infections , *HEALTH services accessibility , *HOSPITAL emergency services , *CONVALESCENCE , *MEDICAL screening , *DESCRIPTIVE statistics , *SECONDARY care (Medicine) , *COVID-19 pandemic , *SEXUAL health , *PATIENT self-monitoring - Abstract
Objectives: To describe the impact that the COVID‐19 pandemic has had on HIV testing in Brighton and Hove, United Kingdom. Methods: All HIV tests performed in Brighton and Hove from January 2016 to June 2021 were extracted, de‐duplicated and anonymized. Analysis was performed to compare the monthly numbers of tests and diagnoses before and during the pandemic across different services. Results: The number of patients having tests for HIV in sexual health services (SHS) decreased by 64% in April 2020, followed by a recovery to baseline levels by the start of 2021. Similarly, the monthly number of diagnoses decreased drastically after April 2020, with almost half of diagnoses made by SHS in 2020 occurring in the three pre‐pandemic months of the year. 'Self‐sampling', used more by women and younger patients, has contributed significantly to the recovery. The number of patients tested in secondary care was seemingly unaffected by the pandemic. However, testing numbers were reduced in specialist services, whereas in the emergency department (ED) testing increased four‐fold (most notably in the elderly) without finding any cases. General practice saw decreases in both the number of HIV tests performed and the number of new diagnoses made, which had not returned to baseline by June 2021. Discussion: The COVID‐19 pandemic has had a large impact on the number of HIV tests performed in Brighton and Hove with sizeable decreases in the number of patients tested likely leading to 'missed' diagnoses. By June 2021 testing had still not returned to normal across the city. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
241. Reply to 'Cognitive criteria in HIV: greater consensus is needed'.
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Nightingale, Sam, Cinque, Paola, Dravid, Ameet, Dreyer, Anna J., Gisslén, Magnus, Joska, John A., Kwasa, Judith, Meyer, Ana-Claire, Mpongo, Nombeko, Nakasujja, Noeline, Pebody, Roger, Pozniak, Anton, Price, Richard W., Saylor, Deanna, Thomas, Kevin G. F., Underwood, Jonathan, Vera, Jaime H., and Winston, Alan
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HIV , *CHEMOKINE receptors , *HIV-positive persons - Abstract
This document is a reply to a letter discussing the consensus recommendations for a new approach to cognitive impairment in people living with HIV. The authors of the reply emphasize that their approach does not seek to undermine the experiences of individuals with HIV, but rather aims to accurately delineate the underlying mechanisms and provide clear prognostic information. They propose separating 'HIV-associated brain injury' caused directly by HIV from 'cognitive impairment in people living with HIV' which can have multiple causes. The authors also address concerns about distinguishing active from legacy HIV-associated brain injury and the use of advanced neuroimaging techniques. They express a desire for broader consensus on this topic and aim to improve care for people living with HIV. [Extracted from the article]
- Published
- 2024
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242. "I have the strength to get through this using my past experiences with HIV": findings from a mixed-method survey of health outcomes, service accessibility, and psychosocial wellbeing among people living with HIV during the Covid-19 pandemic.
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Pantelic, Marija, Martin, Kevin, Fitzpatrick, Colin, Nixon, Eileen, Tweed, Marc, Spice, William, Jones, Martin, Darking, Mary, Whetham, Jennifer, and Vera, Jaime H.
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WELL-being , *HEALTH services accessibility , *CROSS-sectional method , *QUANTITATIVE research , *HEALTH status indicators , *QUALITATIVE research , *SOCIOECONOMIC factors , *SUICIDAL ideation , *QUESTIONNAIRES , *MENTAL depression , *SOCIODEMOGRAPHIC factors , *ANXIETY , *COVID-19 pandemic , *PSYCHOLOGY of HIV-positive persons , *PSYCHOLOGICAL resilience - Abstract
We examined the impact of Covid-19 restrictions on the wellbeing and access to care among people living with HIV (PLWH) in the UK. A cross-sectional anonymous online survey was circulated to PLWH attending care at three HIV services in Sussex. The questionnaire covered key themes: socio-demographic characteristics; changes in physical and mental health; accessibility of essential health services and information; and socio-economic concerns. Free-text qualitative responses were examined through framework analysis. Quantitative data from 653 respondents were available, with a subset of 385 free-text qualitative responses. In terms of mental health, 501 (77.6%) respondents reported feeling more anxious; 464 (71.8%) reported feeling more depressed than usual; and 128 (19.8%) reported having suicidal thoughts since the start of the pandemic. Respondents worried about running out of HIV medicine (n = 264, 40.7%); accessing HIV services (n = 246, 38.0%) as well as other health services (n = 408, 63.0%). Widespread resilience was also noted: 537 (83.3%) of respondents felt that living with HIV had equipped them with the strength to adapt to the Covid-19 pandemic. Findings highlight important gaps between the multifaceted needs of PLWH. Multisectoral collaborations and investments are needed to adequately support PLWH and to build resilience to future shocks within HIV services. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
243. Facilitators and barriers to point-of-care testing for sexually transmitted infections in low- and middle-income countries: a scoping review.
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Martin, Kevin, Wenlock, Rhys, Roper, Tom, Butler, Ceri, and Vera, Jaime H.
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SEXUALLY transmitted diseases , *POINT-of-care testing , *MIDDLE-income countries , *INFRASTRUCTURE (Economics) , *THEMATIC analysis , *GENETIC testing , *HEALTH policy - Abstract
Background: Sexually transmitted infections (STIs) in low- and middle-income countries (LMICs) are predominantly managed by syndromic management. However, most STIs are asymptomatic. These untreated STIs cause individual morbidity, and lead to high STI prevalences. There is increasing interest in the use of point-of-care tests (POCTs) for STIs in LMICs, which could facilitate same day testing and treatment. To best utilise these tests, we must understand the facilitators and barriers to their implementation. The aim of this review is to explore how point-of-care testing for STIs has been implemented into healthcare systems in LMIC and the facilitators and barriers to doing so.Methods: A scoping review was conducted by searching MEDLINE, Embase, Emcare, CINAHL, Scopus, LILACS, the Cochrane Library, and ProQuest Dissertations and Theses for studies published between 1st January 1998 and 5th June 2020. Abstracts and full articles were screened independently by two reviewers. Studies were considered for inclusion if they assessed the acceptability, feasibility, facilitators, or barriers to implementation of point-of-care testing for chlamydia, gonorrhoea, trichomoniasis or syphilis in LMICs. Thematic analysis was used to analyse and present the facilitators and barriers to point-of-care STI testing.Results: The literature search revealed 82 articles suitable for inclusion; 44 (53.7%) from sub-Saharan Africa; 21 (25.6%) from Latin American and the Caribbean; 10 (12.2%) from East Asia and the Pacific; 6 (7.3%) from South Asia; and one (1.2%) multi-regional study. Thematic analysis revealed seven overarching themes related to the implementation of POCTs in LMICs, namely (i) Ideal test characteristics, (ii) Client factors, (iii) Healthcare provision factors, (iv) Policy, infrastructure and health system factors, (v) Training, audit, and feedback, (vi) Reaching new testing environments, and (vii) Dual testing.Conclusion: Implementation of POCTs in LMICs is complex, with many of the barriers due to wider health system weakness. In addition to pressing for broader structural change to facilitate basic healthcare delivery, these themes may also be used as a basis on which to develop future interventions. The literature was heavily skewed towards syphilis testing, and so more research needs to be conducted assessing chlamydia, gonorrhoea, and trichomoniasis testing, as well as home or self-testing. [ABSTRACT FROM AUTHOR]- Published
- 2022
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- View/download PDF
244. Rilpivirine exposure in plasma and sanctuary site compartments after switching from nevirapine-containing combined antiretroviral therapy.
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Mora-Peris, Borja, Watson, Victoria, Vera, Jaime H., Weston, Rosy, Waldman, Adam D., Kaye, Steve, Khoo, Saye, Mackie, Nicola E., Back, David, and Winston, Alan
- Subjects
- *
ANTIRETROVIRAL agents , *RILPIVIRINE , *NEVIRAPINE , *PHARMACOKINETICS , *ANTI-infective agents - Abstract
Objectives Pharmacokinetic parameters following modifications to antiretroviral therapy and sanctuary site exposure are often unknown for recently licensed antiretrovirals. We assessed plasma, CSF and seminal plasma (SP) exposure of rilpivirine after switching from nevirapine. Methods HIV-infected male subjects receiving tenofovir/emtricitabine/nevirapine (245/200/400 mg) once daily switched to tenofovir/emtricitabine/rilpivirine (245/200/25 mg) once daily for 60 days when CSF and semen samples were collected. Mean and individual plasma concentrations of nevirapine and rilpivirine were compared with the proposed plasma target concentration for nevirapine (3000 ng/mL) and the protein binding-adjusted EC90 for rilpivirine (12.1 ng/mL). Mean rilpivirine CSF and SP concentrations were calculated and individual values compared with the EC50 and EC90 for wild-type virus (0.27 and 0.66 ng/mL, respectively). Results Of 13 subjects completing study procedures including CSF examination, 8 provided seminal samples. By day 3, the mean plasma rilpivirine trough concentration was 29.7 ng/mL (95% CI: 23.8–37). No patient presented rilpivirine plasma concentrations under the proposed threshold. The mean rilpivirine concentration in CSF was 0.8 ng/mL (95% CI: 0.7–1.0), representing a CSF : plasma ratio of 1.4%, with concentrations above the EC90 in 85% (11/13) of patients. In SP, the mean rilpivirine concentration was 4.9 ng/mL (95% CI: 3.3–7.2), representing an SP : plasma ratio of 9.5%, with all concentrations above the EC90. Conclusions Switching from nevirapine- to rilpivirine-containing antiretroviral therapy was safe and well tolerated, with plasma rilpivirine concentrations above the protein binding-adjusted EC90 in all subjects. Rilpivirine concentrations were always above the EC50 in the CSF and the EC90 in SP. [ABSTRACT FROM PUBLISHER]
- Published
- 2014
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245. Quality of life in people living with HIV-associated neurocognitive disorder: A scoping review study.
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Alford, Kate, Daley, Stephanie, Banerjee, Sube, and Vera, Jaime H.
- Subjects
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NEUROBEHAVIORAL disorders , *COGNITION disorders , *HIV-positive persons , *MEDLINE , *QUALITY of life , *BIBLIOGRAPHIC databases , *DISEASE management - Abstract
Quality of life (QoL) is recognized as an essential end point in the disease management of chronic conditions such as HIV with calls to include good QoL as a 'fourth 90' in the 90-90-90 testing and treatment targets introduced by World Health Organization in 2016. Cognitive impairments impact a broad spectrum of experiences and are a common issue effecting people living with HIV (PLWH). Despite this, few studies have examined QoL in PLWH who also have a cognitive disorder. This study aimed to synthesize and describe what is known about QoL in those living with HIV-associated neurocognitive disorders (HAND). A scoping review of peer-reviewed literature was conducted to identify how QoL has been investigated and measured in PLWH with HAND, and how PLWH with HAND report and describe their QoL. We searched PsychInfo, Medline, Scopus, and Web of Science along with hand-searching reference lists from relevant studies found. Included studies were those published in English after 1st January 2003 which included PLWH with cognitive impairment not due to other pre-existing conditions. Fifteen articles met criteria for inclusion. Two studies measured QoL as a primary aim, with others including QoL assessment as part of a broader battery of outcomes. The MOS-HIV and SF-36 were the most commonly used measures of overall QoL, with findings generally suggestive of poorer overall QoL in PLWH with HAND, compared to PLWH without cognitive impairment. Studies which examined dimensions of QoL focused exclusively on functionality, level of independence, and psychological QoL domains. There is a considerable dearth of research examining QoL in PLWH with HAND. The initiatives which advocate for healthy aging and improved QoL in PLWH must be extended to include and understand the experiences those also living with cognitive impairment. Research is needed to understand the broad experiential impacts of living with these two complex, chronic conditions, to ensure interventions are meaningful to patients and potential benefits are not missed. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
246. Changes in functional connectivity in people with HIV switching antiretroviral therapy.
- Author
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Toniolo, Sofia, Cercignani, Mara, Mora-Peris, Borja, Underwood, Jonathan, Alagaratnam, Jasmini, Bozzali, Marco, Boffito, Marta, Nelson, Mark, Winston, Alan, and Vera, Jaime H.
- Subjects
- *
RALTEGRAVIR , *FUNCTIONAL connectivity , *EFAVIRENZ , *ANTIRETROVIRAL agents , *COGNITION , *FUNCTIONAL magnetic resonance imaging , *VISUAL memory - Abstract
We assessed changes in functional connectivity by fMRI (functional magnetic resonance imaging) and cognitive measures in otherwise neurologically asymptomatic people with HIV (PWH) switching combination antiretroviral therapy (cART). In a prospective study (baseline and follow-up after at least 4 months), virologically suppressed PWH switched non-nuclease reverse-transcriptase inhibitors (NNRTI; tenofovir-DF/emtricitabine with efavirenz to rilpivirine) and integrase-strand-transfer inhibitors (INSTI; tenofovir-DF/emtricitabine with raltegravir to dolutegravir). PWH were assessed by resting-state fMRI and stop-signal reaction time (SSRT) task fMRI as well as with a cognitive battery (CogState™) at baseline and follow-up. Switching from efavirenz to rilpivirine (n = 10) was associated with increased functional connectivity in the dorsal attention network (DAN) and a reduction in SSRTs (p = 0.025) that positively correlated with the time previously on efavirenz (mean = 4.8 years, p = 0.02). Switching from raltegravir to dolutegravir (n = 12) was associated with increased connectivity in the left DAN and bilateral sensory-motor and associative visual networks. In the NNRTI study, significant improvements in the cognitive domains of executive function, working memory and speed of visual processing were observed, whereas no significant changes in cognitive function were observed in the INSTI study. Changes in fMRI are evident in PWH without perceived neuropsychiatric complaints switching cART. fMRI may be a useful tool in assisting to elucidate the underlying pathogenic mechanisms of cART-related neuropsychiatric effects. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
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247. Measurement of Retinal Vessels as a Biomarker of Cerebrovascular Aging in Older HIV-Positive Men Compared With Controls.
- Author
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Haddow, Lewis, Laverick, Rosanna, Leung, Irene, Post, Frank, Vera, Jaime, Gilson, Richard, Williams, Ian, Boffito, Marta, Sabin, Caroline, Winston, Alan, and Peto, Tunde
- Abstract
Background: To compare retinal vascular measurements, biomarkers of cerebral small vessel disease, in HIV-positive men aged 50 years and older with similarly aged HIV-negative men and younger HIV-positive men. Methods: We recruited white, nondiabetic men into a cross-sectional substudy of a larger cohort including 3 demographically matched groups. Optic disc-centered 45-degree color fundus photographs were used to calculate central retinal arterial and venous caliber and the arterial-venous ratio (AVR). We used univariate and multivariable linear regression to compare retinal vessel measurements in the 3 groups and to identify factors associated with AVR. Results: All HIV-positive men were virologically suppressed. In a multivariable model, study group was not associated with AVR [adjusted β 0.010 for HIV-positive men <50 (n = 39) compared with HIV-positive men aged ≥50 years (n = 120), 95% confidence interval [CI] -0.018 to 0.038, P = 0.47; adjusted β 0.00002 for HIV-negative men ≥50 years (n = 52), 95% CI -0.022 to 0.022, P = 0.99]. Factors associated with lower AVR were systolic blood pressure (adjusted β -0.009 per +10 mm Hg, 95% CI -0.015 to -0.003, P = 0.002), history of stroke or transient ischemic attack (adjusted β -0.070, 95% CI -0.12 to -0.015, P = 0.01), and recent recreational drug use (adjusted β -0.037, 95% CI -0.057 to -0.018, P = 0.0002). Conclusions: There were no differences in retinal vascular indices between HIV-positive men aged =50 years and HIV-negative men aged =50 years or HIV-positive men aged <50 years, suggesting that HIV is not associated with an increased burden of cerebral small vessel disease. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
248. La imagen gráfica del Museo de Santa Clara
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Rodríguez Alfonso, María Inmaculada and Hernández Vera, Jaime
- Subjects
Diseño gráfico ,Imagen corporativa - Published
- 2014
249. Imagen corporativa de las editoriales canarias en el diseño del libro. Colecciones y series (1980-1999). Análisis crítico y síntesis de propuestas
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Torres Franquis, Francisco Javier and Hernández Vera, Jaime
- Subjects
Editoriales de Canarias ,Diseño de Libros ,Imagen corporativa - Abstract
Partiendo de una -- en la que se relata la historia de la escritura y del libro, la tesis va encaminándose hacia la aplicación del diseño editorial en España y más concretamente en Canarias. El trabajo analiza las publicaciones de ocho editoriales Canarias en el periodo 1980-1999 desde el punto de vista del diseño, tanto en su estructura interna como en el aspecto de sus portadas. Una vez hecho ese análisis exhaustivo de todas las series y colecciones objeto del estudio, se entra en una última fase crítica que valora la situación actual del diseño editorial en Canarias. La Tesis cuenta con un completo apéndice en el que pueden encontrarse imágenes de todas y cada una de las otras estudiadas.
- Published
- 2002
250. Abundancia de no hiperbolicidad en la familia cuadratica
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Pérez-Arancibia, Rodrigo, Vera, Jaime, and Universidad Católica del Norte
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En este trabajo se considera el estudio de las propiedades dinámicas de la familia de aplicaciones cuadráticas sobre la recta Fa= F (.; a) R - Fa(x) = 1– ax2 , a > O. A pesar de tener una formulación matemática simple esas aplicaciones exhiben una dinámica muy complicada en lo que concierne al comportamiento asintótico de las órbitas, esto es, el comportamiento de los iterados F (x) cuando n — +00, además tales características pueden cambiar de manera drástica bajo pequeñas variaciones del parámetro a. Esto está relacionado con el hecho que para n grande F (x) es un polinomio de grado alto y depende en forma compleja de x y a. Es posible mostrar que para O O (conocida como familia logística), obteniéndose una descripción más o menos precisa de la órbita de un punto en la recta. (por ejemplo, para ,\ > 1 si x [0, 1] entonces f (x) -* - cx. luego la dinámica interesante se encuentra justamente en 1 = [0, 11). A medida que el parámetro a crece surgen órbitas periódicas atractoras o repulsoras de diferentes periodos (duplicación de período), órbitas densas y conjuntos invariantes, enriqueciendo la dinámica hasta tomarla caótica (véase [DJ, [H] para un detallado análisis de esta aplicación). Del hecho que = WA dado por w (x) = + a x con a = - es una conjugación entre f. y Fa , esto es foço = çooF, las propiedades dinámicas son preservadas y por lo tanto, F presenta también un comportamiento similar al descrito para f, siendo estos fenómenos considerados desde el punto de vista topológico de la dinámica. Otro enfoque tiene relación con el estudio de aquellos fenómenos que son persistentes desde el punto de vista de la teoría de la medida, en el sentido que ellos ocurren para un conjunto de parámetros con medida de Lebesgue positiva. Esta persistencia se trarluce en que el fenómeno es detectable en la observación física del sistema dinámico. Magister en Ciencias Mención Matemática TERMINADA PFCHA-Becas 86p. PFCHA-Becas
- Published
- 2000
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