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The population of people living with human immunodeficiency virus (HIV) is ageing and has an increasing burden of non-acquired immune deficiency syndrome (AIDS)-related morbidity and mortality, including frailty. Frailty is prevalent at a younger age in this population and is associated with multimorbidity, disability and death. This article examines the key interventions to ameliorate the advancement of frailty in people living with HIV. It explores methods of successfully delivering a multidisciplinary holistic approach to this complex patient group, using three case studies. The most effective frailty intervention is exercise. Group-based physiotherapy classes protect against functional decline and frailty symptomatology. Optimisation of medical and psychiatric comorbidities, including deprescribing when appropriate, is also essential. Addressing the social determinants of frailty, such as social isolation and loneliness, are beneficial, but are dependent on local charities and resources. More research is required to assess pharmacological and nutritional interventions in frailty. This requires a greater understanding of the exact pathophysiology of frailty, which remains poorly understood.

There are over 3 million people in sub-Saharan Africa (SSA) aged 50 and over living with HIV. HIV and combined antiretroviral therapy (cART) exposure may accelerate the ageing in this population, and thus increase the prevalence of premature frailty. There is a paucity of data on the prevalence of frailty in an older HIV + population in SSA and screening and diagnostic tools to identify frailty in SSA. Patients aged ≥ 50 were recruited from a free Government HIV clinic in Tanzania. Frailty assessments were completed, using 3 diagnostic and screening tools: the Fried frailty phenotype (FFP), Clinical Frailty Scale (CFS) and Brief Frailty Instrument for Tanzania (B-FIT 2). The 145 patients recruited had a mean CD4 + of 494.84 cells/µL, 99.3% were receiving cART and 72.6% were virally suppressed. The prevalence of frailty by FFP was 2.758%. FFP frailty was significantly associated with female gender (p = 0.006), marital status (p = 0.007) and age (p = 0.038). Weight loss was the most common FFP domain failure. The prevalence of frailty using the B-FIT 2 and the CFS was 0.68%. The B-FIT 2 correlated with BMI (r = − 0.467, p = 0.0001) and CD4 count in females (r = − 0.244, p = 0.02). There is an absence of frailty in this population, as compared to other clinical studies. This may be due to the high standard of HIV care at this Government clinic. Undernutrition may be an important contributor to frailty. It is unclear which tool is most accurate for detecting the prevalence of frailty in this setting as levels of correlation are low.

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Background Globally, 43 million people are living with HIV, 90% in developing countries. Increasing life expectancy with combination antiretroviral therapy (cART) results in chronic complications, including HIV-associated neurocognitive disorders (HAND) and eye diseases. HAND screening is currently challenging. Objectives To evaluate clinical utility of HIV-retinopathy as a screening measure of HAND in older cART-treated individuals in Tanzania and feasibility of smartphone-based retinal screening in this low-resource setting. Methods A cross-sectional systematic sample aged ≥ 50-years attending routine HIV follow-up in Tanzania were comprehensively assessed for HAND by American Academy of Neurology criteria and received ophthalmic assessment including smartphone-based retinal imaging. HAND and ophthalmic assessments were independent and blinded. Diagnostic accuracy was evaluated by AUROC curves. Results Of 129 individuals assessed, 69.8% were visually impairment. Six had suspected HIV retinopathy. HAND prevalence was 66.7%. HIV retinopathy was significantly associated with HAND but HIV-disease factors (CD4, viral load) were not. Diagnostic accuracy of HIV-retinopathy for HAND was poor (AUROC 0.545–0.617) but specificity and positive predictive value were high. Conclusions Ocular pathology and HAND appear highly prevalent in this low-resource setting. Although retinal screening cannot be used alone identify HAND, prioritization of individuals with abnormal retinal screening is a potential strategy in low-resource settings.

Introduction Patients with Human Immunodeficiency Virus (HIV) are at an increased risk of latent Tuberculosis (TB) reactivation. HIV TB concurrent infection increases mortality and reduces patient quality of life. Screening for latent TB allows treatment to commence, preventing reactivation. In accordance with British HIV association guidelines, all patients should have a Chest X-ray (CXR) at diagnosis. If patients are determined to be at a high risk of TB, an Interferon Gamma Release Assay (IGRA) test should be done to determine previous exposure to TB. Methods 95 HIV positive patients diagnosed between 2012-2017 at the Royal Victoria Infirmary (RVI) were assessed for inclusion. 4 patients excluded as they had active TB, n=91. Patients were determined to be high risk if they were from an African or Asian country of origin, or if they had a CD4 count below 200 cells/mm3. Clinic letters and results on eRecord were reviewed (n=95) between 16/02/2019- 21/03/2019. Results 61.5% of patients had a CXR at diagnosis. 72.5% of patients had a CXR or a CT scan. 8 patients had an IGRA test performed, of which 2 were inconclusive. 20% of patients from Africa and 0% of patients from Asia had an IGRA test. Of those patients with a CD4 count below 200 cells/mm3 9.1% had an IGRA test. Discussion An assessment of patient TB risk may need to be undertaken to allow thorough latent TB screening using IGRA tests. Automatic IGRA tests could be done on all patients with a CD4 count

OBJECTIVES: The SD BIOLINE HIV/Syphilis Duo rapid test (SD BIOLINE DUO) is a dual rapid lateral flow immunoassay that detects antibodies to both Human Immunodeficiency Virus (HIV) and Treponema pallidum (TP) “syphilis” via fingerprick whole blood. We evaluated the field performance of the SD BIOLINE HIV/Syphilis Duo test among two populations in Hanoi, Vietnam - men who have sex with men (MSM) and pregnant women. We also surveyed factors that influence participants willingness to test for HIV and syphilis. This test has the potential to increase HIV and syphilis screening in low-resource settings METHODS: Patients who received healthcare services at a sexual health clinic for MSM, and district antenatal care center in Hanoi, Vietnam were recruited for the study. Participants with HIV and syphilis were intentionally recruited for adequate test performance evaluation via convenience sampling. At each facility, venipuncture blood specimens were obtained for reference testing for HIV and TP using SD BIOLINE HIV ½ 3.0 and TP particle agglutination respectively. SD BIOLINE DUO was compared to the standard reference tests and sensitivity and specificity were calculated. We calculated 95% confidence intervals (CI) using the exact binomial method. We used conjoint analysis to identify test attributes that are associated with participant likelihood to seek HIV and syphilis testing. RESULTS: Of 280 participants, 100 (35.7%) were MSM and 180 (64.3%) were pregnant women. Of MSM, 17 (17.0%) were HIV-positive and 49 (49.0%) were TP seropositive. All women were negative for both HIV and syphilis antibodies. For HIV antibody testing, sensitivity and specificity were 100.0% (95% CI: 80.5% - 100.0%) and 100.0% (95% CI: 98.6% - 100.0%), respectively. For the syphilis antibody testing, sensitivity and specificity were 83.1% (95% CI: 71.0% - 91.6%) and 100.0% (95% CI: 98.3% - 100.0%), respectively. Potential for false positives, preference for one blood draw over two, and shorter wait time for testing results were the highest ranked attributes among participants willingness to test. CONCLUSION: The SD BIOLINE HIV/Syphilis Duo rapid test demonstrated very good performance in this field setting and participants preferred attributes that aligned well with this test.

The purpose of this article is to provide a background of the nature of latent print analysis within a modern UK police force. The article aims to provide an explanation as to the legal standing of fingerprint evidence, the methodology behind modern fingerprint examination and its history as a forensic investigation tool. The article also provides an understanding of modern latent mark development techniques and the considerations that should be given to the development and application of new development approaches. Copyright © 2010 John Wiley & Sons, Ltd.