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Das Kaposi-Sarkom (KS) ist eine seltene, maligne, von lymphatischen Endothelzellen ausgehende, multilokuläre Gefäßerkrankung, die vor allem Haut und Schleimhäute, aber auch das lymphatische System und innere Organe wie den Gastrointestinaltrakt, die Lunge oder die Leber befallen kann. Fünf epidemiologische Subtypen des KS mit variablem klinischem Verlauf und unterschiedlicher Prognose werden unterschieden, die in spezifischen Populationen vermehrt auftreten: (1) klassisches KS, (2) iatrogenes KS bei Immunsuppression, (3) endemisches (afrikanisches) lymphadenopathisches KS, (4) epidemisches, HIV-assoziiertes KS und mit einem Immunrekonstitutions-Inflammations-Syndrom (IRIS) assoziiertes KS und (5) KS bei Männern, die Sex mit Männern haben (MSM) ohne HIV-Infektion. Diese interdisziplinäre Leitlinie fasst aktuelle praxisrelevante Empfehlungen zu Diagnostik und Therapie der verschiedenen Formen des KS zusammen. Die in dieser Kurzleitlinie genannten Empfehlungen werden in der Langfassung der Leitlinie (Online-Version des JDDG) detaillierter ausgeführt.

Ziel war es, einen anonymen, selbst durchzuführenden, webbasierten Test zur Bestimmung des persönlichen Risikos für HIV/STI zu entwickeln und zu evaluieren.Der Online-HIV/STI-Risikotest wird seit 12/2017 angeboten. 11 529 Teilnehmer absolvierten den Test vollständig und 10 668 wurden ausgewertet. Der Test beinhaltete Multiple-Choice-Fragen zur Soziodemografie, Sexualität, sexuellem Risikoverhalten und HIV/STI-Tests. Die Daten der Teilnehmer wurden nach Geschlecht und Sexualität stratifiziert und ausgewertet.84,5 % der Teilnehmer waren zwischen 18 und 39 Jahre alt, 7,5 % 18 und 8,1 % 40. Unter den Teilnehmern waren 53,1 % Männer, 46,3 % Frauen und 0,6 % Trans. 12,5 % waren Männer, die Sex mit Männern haben (MSM). 59,1 % und 66 % der Teilnehmer waren gegen Hepatitis A beziehungsweise B geimpft, aber 75,1 % ungeimpft gegen HPV. Die Häufigkeit von früheren und wiederholten Fällen von STI (inklusive HIV) war unter MSM höher. Dennoch waren 61,4 % der Frauen, 70 % der Männer und 55,4 % der MSM noch nie auf eine STI getestet worden. Obwohl die Prävalenz von 3 Sexualpartner in den letzten zwölf Monaten unter MSM am höchsten war, gaben Frauen häufiger kondomlosen Sex an. 34,5 % der Männer, 25,6 % der Frauen und 75 % der MSM hatten Analverkehr.Der Online-HIV/STI-Risikotest ist ein nützliches Instrument zur Erfassung von Daten zum STI-Risikoverhalten für eine strategisch ausgerichtete STI-Prävention, Testung und Impfung und damit zur Verbesserung der sexuellen Gesundheit.

ZusammenfassungHintergrundAnwendungsbezogene Daten zu sexueller Gesundheit und sexuellem Verhalten in unterschiedlich sexuell aktiven Populationen stehen nur begrenzt zur Verfügung, sind aber für Präventions- und Versorgungsstrategien sehr relevant. Das multisektorale Versorgungszentrum WIR – Walk In Ruhr hat aufgrund seiner Besucher*innenstruktur Zugang zu Daten aus diversen Lebenswelten.Ziel der ArbeitAus verschiedenen WIR-internen Datenquellen sollen populationsbezogene Erkenntnisse zu Alter, Geschlecht, sexueller Orientierung, Sexual- und Risikoverhalten gewonnen und Bedarfe für Prävention abgeleitet werden. Einflüsse der SARS-CoV-2-Pandemie auf das Sexualverhalten sollen durch den Vergleich verschiedener Zeiträume untersucht werden.MethodenAusgewertete Datenquellen sind der Onlinerisikotest für HIV und STI, die COWIR- und PrEP-Studie sowie die Immunologische Ambulanz und das Gesundheitsamt im WIR.ErgebnisSexuell übertragbare Infektionen (STI) sind von 2019 auf 2020 trotz Kontaktbeschränkungen gestiegen. Generell haben junge Menschen, Männer, die Sex mit Männern, und Frauen, die Sex mit Frauen haben, ein erhöhtes STI-Risiko aufgrund der gewählten Sexualpraktiken und der Anzahl sexueller Kontakte. Eine hohe Zahl bi- und transsexueller Kontakte ist festzustellen. SARS-CoV‑2 führte zu einer Reduzierung der Sexualkontakte. Sexualpraktiken wurden weiter gelebt. Die STI-Testquote und die Behandlungsrate stiegen an.DiskussionDie Daten aus dem WIR belegen, dass eine junge Klientel mit aktivem Sexualleben erreicht wird. Die Ergebnisse aus Fragebögen und dem Onlinerisikotest zeigen den Zusammenhang von erhöhten positiven STI-Tests mit Sexualverhalten und sexuellen Präferenzen, weshalb spezifische Strategien zu Sexualaufklärung, Prävention, Tests und Therapien erforderlich sind.

Objectives Cardiovascular diseases (CVDs) occur more often in people living with HIV (PLWH) than in the general population. It has been reported that CVD risk scores developed for the general population underestimate the CVD risk in PLWH. Performances of the Framingham Risk Score (FRS), the Systematic Coronary Risk Evaluation (SCORE) and the atherosclerotic cardiovascular disease (asCVD) risk score in PLWH were compared with the general population to quantify score-specific differences in risk prediction. Methods HIV-positive outpatients from the HIV-HEART (HIVH) study (n = 567) were compared with participants from the population-based Heinz Nixdorf Recall (HNR) study (n ~ 4440) both recruited from the German Ruhr area. During a follow-up time of around 5 years, the associations between the FRS and incident CVD and peripheral artery disease (CVD_pAD), SCORE and coronary heart disease (CHD), and asCVD and incident CVD were examined using logistic regression. Score performances were assessed by comparing the areas under the curve (AUCs). Results The mean ages were 52.9 ± 6.7 and 59.1 ± 7.7 years in the HIVH and HNR studies, respectively. There were fewer incident CVD events in the HNR study than in the HIVH study (CVD_pAD: 3.9% vs. 12.1%; CHD: 2.1% vs. 7.8%; CVD: 3.5% vs. 9.9%). Age- and sex-adjusted CVD risk was greater with increasing FRS, SCORE and asCVD in both cohorts, but the scores performed more accurately in the HNR than in HIVH study (AUCs FRS: 0.71 vs. 0.65; SCORE: 0.70 vs. 0.62; asCVD: 0.74 vs. 0.62). Conclusions Associations between risk scores and future CVD were observed in both cohorts, but the score performances were less reliable in PLWH than in the general population.

Anlasse fur eine Diagnostik zum Ausschluss von sexuell ubertragbaren Infektionen (STI) konnen vielfaltig sein. Neben der Abklarung von Symptomen wie Ausfluss, Brennen beim Wasserlassen und genitalen Ulzerationen mussen risikoadaptierte Testangebote gemacht werden. Die Anamnese umfasst die sexuelle Orientierung und sexuelle Praktiken, Symptome und ggf. symptomfreie Intervalle, Symptome der Partner*innen, das Vorliegen vorheriger oder chronischer STI, vorherige Therapien und sonstiger Erkrankungen (insbesondere Antibiotikaallergien), den Impfstatus, Verhutungsmethode(n) und Kondomnutzung. Die klinische Untersuchung richtet sich nach dem Geschlecht, den sexuellen Praktiken und den berichteten Symptomen. Sie sollte die Inspektion der Genitalien und der Analregion, des Rachens und der Haut umfassen. Eine konsequente Diagnostik, immer auch oral und anal, und eine leitliniengerechte Therapie mit Erfolgskontrolle sind notwendig.

Im letzten Jahr hatten in Deutschland 88 % der Manner und 86 % der Frauen mindestens einmal kondomlosen Sex. Analverkehr ist zunehmend verbreitet. Nicht nur die Chlamydienproktitis ist ein unterdiagnostiziertes Krankheitsbild. Auch anale Gonokokkeninfektionen oder Manifestationen der Syphilis werden oft nicht erkannt. Asymptomatische Infektionen fuhren daruber hinaus zu einer weiteren Verbreitung dieser Erkrankungen. Im Rahmen der HIV-Praexpositionsprophylaxe wird regelmasig ein risikoadaptiertes Screening auf sexuell ubertragbare Infektionen (STI) durchgefuhrt. Daruber hinaus ist das Bewusstsein fur anale STI in der Bevolkerung und bei Arzten und Arztinnen kaum vorhanden. Eine konsequente Diagnostik analer STI und eine leitliniengerechte Therapie mit Erfolgskontrolle sind anzustreben. Kostenlose risikoadaptierte Testangebote sollten ausgeweitet werden.

Anogenital and oropharyngeal infections with human papilloma viruses (HPV) are common. Clinically manifest disease may significantly impact quality of life; the treatment of HPV-associated lesions is associated with a high rate of recurrence and invasive neoplasms, such as cervical, anal, vulvar, penile, and oropharyngeal cancers, which are characterized by significant morbidity and mortality. Vaccination against HPV is an effective and safe measure for the primary prevention of HPV-associated lesions, but immunization rates are still low in Germany. The present publication is an abridged version of the German evidence and consensus-based guideline "Vaccination recommendations for the prevention of HPV-associated lesions", which is available on the website of the German Association of the Scientific Medical Societies (AWMF). On the basis of a systematic review with meta-analyses, a representative panel developed and agreed upon recommendations for the vaccination of different populations against HPV. In addition, consensus-based recommendations were developed for specific issues relevant to everyday practice. Based on current evidence and a representative expert consensus, these recommendations are intended to provide guidance in a field in which there is often uncertainty and in which both patients and health care providers are sometimes confronted with controversial and emotionally charged points of view.

BACKGROUND AND OBJECTIVES STIs present a significant threat to individual and public health, disproportionately affecting youth. The study aimed to evaluate (a) the prevalence of asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among youth using a rapid assay platform, (b) the participants' sexual behaviour and STI knowledge, (c) the utility of the rapid assay in reducing diagnosis-to-treatment time. METHODS In this study, 272 subjects (14-31 years) were included between 12/2016 and 7/2018. A questionnaire was used to collect sociodemographic data, sexual behaviour and STI knowledge. Prevalence of CT and NG infections were tested from oral, vaginal and anal swabs for women and oral, anal swabs and urine for men, using the Cepheid Xpert® CT/NG assay. Time intervals between (i) test to the time the patient were informed of the result (turn around time - TAT) and (ii) test to therapy initiation was documented. RESULTS Of the 272 subjects (48.9% female, 48.9% male, undisclosed 2.2%), 56.6 % reported university education. 46.6% were men who have sex with men (MSM), and 47.4% of women and 63.1% of men had anal intercourse. 59.9% had previously been tested for HIV, while only 39.7% had for CT, 20.6% for NG. Among these asymptomatic youth 7.7% were positive for CT and 5.5% for NG. The localization of CT were 3.7% genital, 5.5% anal and 2.2% oral, while the corresponding localization of NG were 0.4%, 2.9%, 4.4% respectively. 91.8% of the participants were informed of a positive result within 24 h with a median TAT of 03:09 h. 73.3% initiated therapy within 24 h, with a median time from testing to therapy initiation being 06:50 h. CONCLUSION Asypmtomatic CT and NG infections are common and often not tested in persons at risk. The Cepheid Xpert® CT/NG assay is an effective strategy as it reduces STI diagnosis-to-treatment time to less than a day.

Objectives: Adolescents and young adults account for 50% of new infections with sexually transmitted infection (STI), while representing only 25% of the sexually active population. An evaluation of sexual behavior, STI knowledge and infection among youth of different age groups is relevant to formulate effective sexual health strategies. Methods: In this monocentric, open, prospective cross-sectional study, 268 asymptomatic subjects (14–30 years) were partitioned into three cohorts I: 14–19 (n = 42), II: 20–25 (n = 147) and III: 25-30 (n = 79) years. A comparative analysis of their sexual behavior and STI knowledge was performed using a 21-item questionnaire at the WIR-Center for Sexual Health and Medicine. Prevalence of chlamydia and gonococcal infections were tested, using the Cepheid Xpert® CT/NG assay. Results: The three age-specific cohorts showed statistically significant differences in their relationship status, their sexual contacts and the number of life-time sexual partners. Independent of age, men who have sex with men had greater number of sexual partners across all age groups. Although >95% of participants were aware of HIV in all age groups, the corresponding awareness of non-HIV STI was consistently lower in cohort I. The awareness of trichomonas, mycoplasma and candida in particular was

Zusammenfassung Hintergrund Zur HIV(„human immunodeficiency virus“)-Präexpositionsprophylaxe (PrEP) wird am WIR – Walk In Ruhr – Zentrum für Sexuelle Gesundheit und Medizin ein innovatives Modellprojekt zur intersektoralen PrEP-Versorgung durchgeführt. Forschungsziele Die vorliegende Studie beschreibt, wer mit der PrEP versorgt wurde und wie sich im Verlauf der PrEP-Einnahme das sexuelle Risikoverhalten änderte sowie welche sexuell übertragbaren Infektionen (STI) und unerwünschte Arzneimittelwirkungen auftraten. Methoden In die Studie wurden bisher N = 139 Probanden eingeschlossen, die zwischen 10/2017 und 12/2018 mit einer PrEP begonnen haben. Alle PrEP-Nutzer erhielten Fragebögen, zudem wurden Nebenwirkungen, HIV und andere STI mittels klinischer Laborwerte über einen Zeitraum von 13 Monaten erfasst. Ergebnisse Die PrEP-Nutzer hatten ein durchschnittliches Alter von 38 Jahren, waren zu 98,6 % Männer, die Sex mit Männern (MSM) hatten, und zeichneten sich durch einen hohen Bildungsstatus und geringe Arbeitslosigkeit aus. Die durchschnittliche Partneranzahl pro Proband innerhalb der letzten 6 Monate stieg im Verlauf signifikant an, während die Kondomnutzung signifikant zurückging. Innerhalb der ersten 4 Monate nach PrEP-Beginn traten 44 STI bei 34 Patienten auf. Es wurde keine HIV-Infektion festgestellt. In den ersten 4 Wochen nach PrEP-Beginn zeigten sich bei 38,8 % der Probanden unerwünschte Arzneimittelwirkungen, hauptsächlich Symptome des Magen-Darm-Trakts. Schlussfolgerung Die PrEP-Nutzer hatten einen guten Bildungsstatus und einen festen Arbeitsplatz bzw. eine Ausbildungsstelle. Das sexuelle Risikoverhalten nahm im Verlauf zu, verbunden mit einem gehäuften Auftreten von STI. Unerwünschte Arzneimittelwirkungen zeigten sich insbesondere zu Anfang der PrEP-Einnahme.

Kaposi's sarcoma (KS) is a rare, malignant, multilocular vascular disease originating from lymphatic endothelial cells that can primarily affect the skin and mucous membranes, but also the lymphatic system and internal organs such as the gastrointestinal tract, lungs or liver. Five epidemiological subtypes of KS with variable clinical course and prognosis are distinguished, with increased incidence in specific populations: (1) Classical KS, (2) Iatrogenic KS in immunosuppression, (3) Endemic (African) lymphadenopathic KS, (4) Epidemic, HIV-associated KS and KS associated with immune reconstitution inflammatory syndrome (IRIS), and (5) KS in men who have sex with men (MSM) without HIV infection. This interdisciplinary guideline summarizes current practice-relevant recommendations on diangostics and therapy of the different forms of KS. The recommendations mentioned in this short guideline are elaborated in more detail in the extended version of the guideline (online format of the JDDG).

Application-based data regarding sexual health and sexual behavior in various sexually active populations are scarce but at the same time relevant with regards to prevention and healthcare supply strategies. Given the structure of its attendees, the Walk In Ruhr (WIR) Center for Sexual Health and Medicine is able to obtain data from diverse living environments.Based on the online HIV/STI risk test, questionnaires, and attendee data from the WIR, this study aims to deduce population-related findings with regards to age, gender, sexual orientation, and sexual and risk behavior as well as the respective needs for prevention. The influence of the SARS-CoV-19 pandemic on sexual behavior is examined by comparing various phases.The analyzed data sources are the online HIV/STI risk test, the COWIR, and the PrEP study as well as the immunological outpatient clinic and the public health department at the WIR.Notwithstanding contact restrictions, sexually transmitted infections (STIs) have increased from 2019 to 2020. Apart from men having sex with men and females having sex with females, young people also have an increased risk of STIs based on sexual practices and the number of sexual contacts. A large number of bisexual and transsexual contacts was found. SARS-CoV‑2 led to a decrease in sexual contacts; sexual practices continued. There was a growing proportion of STI tests and the treatment rate including partner treatment rose.Data from the WIR center show that young attendees with an active sexual life are being reached. The results from questionnaires and the online HIV/STI risk test are mirrored in increased positive STI test results. These results vary depending on sexual behavior and sexual preferences such that specific strategies for sexual education, prevention, testing, and therapy are required.HINTERGRUND: Anwendungsbezogene Daten zu sexueller Gesundheit und sexuellem Verhalten in unterschiedlich sexuell aktiven Populationen stehen nur begrenzt zur Verfügung, sind aber für Präventions- und Versorgungsstrategien sehr relevant. Das multisektorale Versorgungszentrum WIR – Walk In Ruhr hat aufgrund seiner Besucher*innenstruktur Zugang zu Daten aus diversen Lebenswelten.Aus verschiedenen WIR-internen Datenquellen sollen populationsbezogene Erkenntnisse zu Alter, Geschlecht, sexueller Orientierung, Sexual- und Risikoverhalten gewonnen und Bedarfe für Prävention abgeleitet werden. Einflüsse der SARS-CoV-2-Pandemie auf das Sexualverhalten sollen durch den Vergleich verschiedener Zeiträume untersucht werden.Ausgewertete Datenquellen sind der Onlinerisikotest für HIV und STI, die COWIR- und PrEP-Studie sowie die Immunologische Ambulanz und das Gesundheitsamt im WIR.Sexuell übertragbare Infektionen (STI) sind von 2019 auf 2020 trotz Kontaktbeschränkungen gestiegen. Generell haben junge Menschen, Männer, die Sex mit Männern, und Frauen, die Sex mit Frauen haben, ein erhöhtes STI-Risiko aufgrund der gewählten Sexualpraktiken und der Anzahl sexueller Kontakte. Eine hohe Zahl bi- und transsexueller Kontakte ist festzustellen. SARS-CoV‑2 führte zu einer Reduzierung der Sexualkontakte. Sexualpraktiken wurden weiter gelebt. Die STI-Testquote und die Behandlungsrate stiegen an.Die Daten aus dem WIR belegen, dass eine junge Klientel mit aktivem Sexualleben erreicht wird. Die Ergebnisse aus Fragebögen und dem Onlinerisikotest zeigen den Zusammenhang von erhöhten positiven STI-Tests mit Sexualverhalten und sexuellen Präferenzen, weshalb spezifische Strategien zu Sexualaufklärung, Prävention, Tests und Therapien erforderlich sind.

Schnelltests fur sexuell ubertragbare Infektionen wurden ursprunglich fur den Einsatz in der dritten Welt entwickelt, wo Kuhlketten und diagnostische Laborstandards nicht garantiert werden konnen. Doch auch in Deutschland werden die „Point-of-Care-Tests“ fur eine flachendeckende und niederschwellige Diagnostik immer wichtiger.

Aims B-type natriuretic peptide (BNP) has been suggested to improve risk prediction of cardiovascular (CV) events and mortality. We aimed to evaluate the value of BNP to predict the composite primary endpoint of CV events and mortality alongside traditional and HIV specific risk factors in a HIV-infected population. Methods In this prospective multicenter HIV-HEART study we followed 808 HIV-positive subjects in the German Ruhr area for a median follow up of 120 (IQR:113–129) months since 2004. Association of BNP with the composite primary endpoint was assessed using Cox regression adjusting for traditional cardiovascular and HIV specific risk factors. Results At baseline, median BNP was 10.3 (IQR 5.4–18.9) pg/ml. The composite endpoint occurred in 158 (19.6%) patients. Subjects with high BNP levels showed significantly increased frequencies of CV events and death (22% for BNP ≤5 pg/ml, 30% for BNP >5 up to ≤20 pg ml, 38% for BNP >20 up to ≤35 pg ml, 59% for BNP >35 up to ≤100 pg ml and 86% for BNP >100 pg/ml, p-value 100 pg/ml, HR in the fully adjusted model was 3.25 (95%CI 1.50–7.08; p Conclusions Increased BNP is associated with significant excess of incident CV events and mortality in HIV-infected patients. BNP is a valuable marker to improve the prediction of CV events and mortality.

Our goal was to develop and evaluate an anonymous self-administrable web-based test to determine risk for HIV/STI.The Online HIV/STI Risk Test was developed and hosted since 12/2017. 11,529 participants completed the test and 10,668 were analyzed. The test included multiple choice questions about sociodemographic data, sexuality, sexual risk behavior, HIV/STI testing. Participant data was stratified by gender and sexuality and analyzed.84.5 % were aged 18-39, 7.5 % 18 and 8.1 % 40. Males were 53.1 %, female 46.3 % and trans 0.6 %. 12.5 % were men who have sex with men (MSM). 59.1 % and 66.0 % of participants were vaccinated for hepatitis A and B respectively, but 75.1 % unvaccinated for HPV. Prior and repeated instances of HIV or other STI were higher among MSM. Yet, 61.4 % females, 70 % males and 55.4 % MSM had never tested for an STI. Although prevalence of 3 sexual partners in the last twelve months was highest among MSM, condomless sex was greater among women. 34.5 % of males, 25.6 % of females, and 75 % of MSM engaged in anal sex respectively.The online HIV/STI Risk Test is a useful tool to acquire data on STI risk-behavior for strategizing STI prevention, testing, and vaccination, thus improving sexual health.

Background HIV and hepatitis C virus (HCV) have shared routes of transmission among men who have sex with men (MSM). Routine testing facilitates early diagnosis and treatment, thereby preventing morbidity and onward transmission. We evaluated factors associated with HIV and HCV testing in a behaviorally vulnerable cohort of predominantly MSM. Methods From June 2018 through June 2019, the BRAHMS study enrolled adults at ten German outpatient clinics that serve gender and sexual minority populations. Participants completed behavioral questionnaires that captured prior experience with HIV and HCV testing. Multivariable robust Poisson regression was used to evaluate factors potentially associated with testing in the previous 6 months. Results Among 1017 participants with median age 33 (interquartile range 28–39) years, 1001 (98.4%) reported any lifetime history of HIV testing and 787 (77.4%) reported any HCV testing, including 16 (1.6%) known to be living with HCV. Testing within the last 6 months was reported by 921 (90.6%) and 513 (50.4%) for HIV and HCV, respectively. Recent HIV testing was more common among participants with higher education level and recent HCV testing. Recent HCV testing was more common among participants with non-cisgender identity, lifetime history of illicit drug use, hepatitis B immunity or infection, and recent HIV testing. Conclusion Prior testing for HIV was common in this cohort, but interventions are needed to improve HCV risk stratification and access to testing. HIV testing infrastructure can be successfully leveraged to support HCV testing, but differentiated preventive care delivery is needed for some vulnerable populations.

Angeborene kraniofaziale Dysplasie aufgrund von Entwicklungsanomalien der embryonalen Kopfanlage, der ersten beiden Viszeralbogen und der angrenzenden Furchen.

Holistic sexual healthcare factors in diversity of social habitat and aims to improvise client outreach for prevention, testing, counseling, and treatment of STIs. Towards this goal, the immunology outpatient clinic, the public health department of Bochum, the AIDS Service Organization Bochum e. v., and other community-driven NGOs mutually cooperate under the umbrella of WIR - Walk In Ruhr, Centre for Sexual Health and Medicine.WIR is an innovative concept for multi-professional in-house ambulatory healthcare with cross-sectoral and cross-legal reach. It has successfully improved accessibility, testing and treatment rates, and HIV/STI self-assessment. We present the results achieved at WIR.A mixed-method design of qualitative and quantitative surveys.The WIR reaches more women (27.7%) and heterosexuals (56.4%) than other counseling/test centers. The rate of positive test results at the WIR increased from 9.3% in 2017 to 12.6% in 2018 and progress from prevention to medical care is a significant aspect of WIR. The Federal Ministry of Health has externally evaluated WIR for over three years.The integrative care model of WIR allows for early outreach and treatment of individuals with HIV/ST infections. Health advisors remain an important instrument facilitating outreach and psychosocial/psychotherapeutic counseling is administered frequently. Such a multi-layered approach in prevention, testing, and consultation, leads to improvement in both medical outcomes and the self-responsible attitude of patients towards their sexual health. Hence, expansion of integrative care models like WIR on a wider scale could arguably contribute to better health service and sexual health.HINTERGRUND: Ein ganzheitliches Konzept sexueller Gesundheit und Medizin berücksichtigt die Diversität von Lebenswelten, um Klient*innen für Prävention, Testung, Beratung und Behandlung sexuell übertragbarer Infektionen (STI) zu gewinnen. Mit diesem Verständnis arbeiten die Immunologische Ambulanz, das Gesundheitsamt, die Aidshilfe sowie weitere Selbsthilfeorganisationen im WIR – Walk In Ruhr, Zentrum für Sexuelle Gesundheit und Medizin, in Bochum zusammen.Am Beispiel des WIR, das mit seinem innovativen Konzept eines Versorgungszentrums multiprofessionell innerhalb eines Settings sektor- und rechtsformübergreifend arbeitet, wird gezeigt, dass Erreichbarkeit, Test- und Behandlungsquote und HIV/STI-Risiko-Selbsteinschätzung sich verbessern. Das WIR wurde zudem im Auftrag des Bundesministeriums für Gesundheit über 3 Jahre extern evaluiert auch diese Ergebnisse werden dargestellt.Das Konzept des WIR und die im WIR durchgeführten Studien werden deskriptiv dargestellt. Bei der externen Evaluation wurde ein Mixed-Method-Design aus quantitativen und qualitativen Erhebungen angewandt.Durch die Kooperation werden häufiger Frauen (27,7 %) und Heterosexuelle (56,4 %) als in der Ambulanz allein erreicht. Die Rate positiver Testergebnisse im WIR stieg von 2017 bis 2018 von 9,3 % auf 12,6 %.Durch das integrative Versorgungskonzept des WIR gelingt es, Menschen mit HIV/STI früh zu erreichen und zu behandeln. Der Übergang von Prävention zu medizinischer Versorgung ist im WIR von zentraler Bedeutung. Gesundheitsberater sind ein wichtiges Instrument für die aufsuchende Arbeit. Psychosoziale sowie psychotherapeutische Beratung werden in hohem Maße genutzt. Durch die vielschichtigen Angebote von Prävention, Test, Beratung werden bessere medizinische Ergebnisse erreicht sowie die Eigenverantwortung für sexuelle Gesundheit gesteigert. Die Übertragung des Konzeptes in die Fläche kann einen Beitrag zur besseren Versorgung zu sexueller Gesundheit leisten.

HIV pre-exposure prophylaxis (PrEP), a further opportunity to prevent HIV, is available at the WIR-Walk In Ruhr, Centre for Sexual Health and Medicine, as part of an innovative model project for intersectoral PrEP care.The present study describes the collective of persons provided with PrEP and how PrEP use influences sexual risk behaviour, the incidence of sexually transmitted diseases (STD) and adverse drug reactions.A total of 139 men who started PrEP between 10/2017 and 12/2018 have been included in the study. During a period of 13 months of PrEP treatment, all PrEP users received questionnaires; side effects, HIV and other STI were also monitored via clinical laboratory examinations.The participants' average age was 38 years and 98.6% of them were men who had sex with men (MSM). Most of them had a high educational background; the unemployment rate was low. The average number of sexual partners within the last 6 months increased significantly, while the use of condoms decreased. In all, 44 STI were found in 34 participants within the first 4 months. No one was infected with HIV. Within the first 4 weeks of PrEP, 38.8% of the participants suffered from side effects, mainly gastrointestinal symptoms.Most of the participants were working in a job or a vocational training. The sexual risk behaviour increased in the course of using PrEP resulting in a high incidence of STD. Side effects appeared most frequently in the first few weeks after starting PrEP.

Background To date, no studies have successfully shown that a highly specific, blood-based tumour marker to detect clinically relevant HPV-induced disease could be used for screening, monitoring therapy response or early detection of recurrence. This study aims to assess the clinical performance of a newly developed HPV16-L1 DRH1 epitope-specific serological assay. Methods In a multi-centre study sera of 1486 patients (301 Head and Neck Squamous Cell Carcinoma (HNSCC) patients, 12 HIV+ anal cancer patients, 80 HIV-positive patients, 29 Gardasil-9-vaccinees, 1064 healthy controls) were tested for human HPV16-L1 DRH1 antibodies. Analytical specificity was determined using WHO reference-sera for HPV16/18 and 29 pre- and post-immune sera of Gardasil-9-vaccinees. Tumour-tissue was immunochemically stained for HPV-L1-capsidprotein-expression. Findings The DRH1-competitive-serological-assay showed a sensitivity of 95% (95% CI, 77.2–99.9%) for HPV16-driven HNSCC, and 90% (95% CI, 55.5–99.7%) for HPV16-induced anal cancer in HIV-positives. Overall diagnostic specificity was 99.46% for men and 99.29% for women ≥ 30 years. After vaccination, antibody level increased from average 364 ng/ml to 37,500 ng/ml. During post-therapy-monitoring, HNSCC patients showing an antibody decrease in the range of 30–100% lived disease free over a period of up to 26 months. The increase of antibodies from 2750 to 12,000 ng/ml mirrored recurrent disease. We can also show that the L1-capsidprotein is expressed in HPV16-DNA positive tumour-tissue. Interpretation HPV16-L1 DRH1 epitope-specific antibodies are linked to HPV16-induced malignant disease. As post-treatment biomarker, the assay allows independent post-therapy monitoring as well as early diagnosis of tumour recurrence. An AUC of 0.96 indicates high sensitivity and specificity for early detection of HPV16-induced disease. Funding The manufacturer provided assays free of charge.

This guideline updates the 2010 European guideline for the management of hepatitis B and C virus infections. It is primarily intended to provide advice on testing, prevention and initial management of viral hepatitis B and C for clinicians working in sexual health clinical settings in European countries. The guideline is in a new question and answer format based on clinical situations, from which population/intervention/comparison/outcome questions were formulated. Updates cover areas such as epidemiology, point-of-care tests for hepatitis B, hepatitis C risk and ‘chemsex’, and HIV pre-exposure prophylaxis and hepatitis B. We have also included a short paragraph on hepatitis E noting there is no evidence for sexual transmission. The guideline has been prepared in accordance with the Europe protocol for production available at http://www.iusti.org/regions/europe/pdf/2017/ProtocolForProduction2017.pdf

Am 5.2.16 fand am Robert-Koch-Institut in Berlin ein Expertentreffen zum Thema „Schnelltests in der Diagnostik sexuell ubertragbarer Infektionen“ statt. Das Ziel dieser Tagung war, die in einem vorangegangenen Treffen im Januar 2012 erarbeitete Bewertung der Schnelltests fur den Einsatz in der Infektionsdiagnostik von HIV, HBV, HCV, T. pallidum, C. trachomatis und N. gonorrhoeae in „niedrigschwelligen Einrichtungen“ unter Berucksichtigung neuer Erkenntnisse und Entwicklungen dem aktuellen Stand anzupassen. Die von der Bundesregierung kurzlich beschlossene Strategie zur Eindammung von HIV, Hepatitis B und C und anderen sexuell ubertragbaren Infektionen beschreibt einen Mangel an Testmoglichkeiten und verfolgt eine Steigerung der Testangebote und einen besseren Zugang. Eine wichtige Option um Testbarrieren zu senken, reprasentiert der Einsatz von Schnelltests, die als niedrigschwelliges Testangebot in Beratungsstellen angeboten werden und auch als Heimtests durchgefuhrt werden konnen. Basierend auf den in klinischen Studien evaluierten Leistungsmerkmalen sind einige HIV-, HCV- und Syphilis-Schnelltests durchaus als point-of-care Test (POCT) geeignet. Fur C. trachomatis und N. gonorrhoeae erreichen nur PCR-basierte POCTs eine ausreichende diagnostische Genauigkeit. Der Einsatz von Schnelltest ist in Deutschland an bestimmte Vorgaben des IfSG und MPG gebunden. Die Abgabe von HIV-Diagnostika an Privatpersonen (zwecks Heimtestung) ist in Deutschland untersagt (§ 11, MPG). Die Feststellung und Ubermittlung einer Infektionskrankheit ist einem Arzt vorbehalten und darf auch nicht als Ferndiagnose erfolgen (§ 24, IfSG). Daruber hinaus unterliegen Schnelltests, wie alle labormedizinischen Analysen einer Qualitatssicherung entsprechend den Richtlinien der Bundesarztekammer.

Objectives MicroRNA-155 (miR-155) regulates T-cell differentiation and activation. It has also been associated with HIV infection. However, it remains unclear whether miR-155 is related to the T-cell response in HIV-infected individuals (e.g. T-cell activation and exhaustion). Methods We performed a cross-sectional study involving 121 HIV-1-infected patients on highly active antiretroviral therapy (HAART) and 43 HAART-naive patients. MiR-155 levels in the peripheral blood were determined by quantitative reverse transcription–polymerase chain reaction (PCR). T-cell immune activation, exhaustion, and homeostasis were measured by determining the expression of CD38, programmed death 1 (PD-1) and CD127 via flow cytometry. Results The levels of miR-155 in total peripheral blood mononuclear cells, CD4 T cells and CD8 T cells from HIV-1-infected patients were increased (P < 0.01). Nonresponders and HAART-naive patients also exhibited a higher percentage of CD8+CD38+ T cells and a lower percentage of CD4+CD127+ and CD8+CD127+ T cells (P < 0.05). We also found higher levels of PD-1 expression on the CD4+ and CD8+ T cells of HIV-1-infected patients (P < 0.05). Conclusions Our findings suggest that miR-155 levels in the peripheral blood of HIV-1-infected patients are increased and associated with T-cell activation. Therefore, miR-155 is a potential biomarker of the immune response following HIV-1 infection.

IntroductionEven though use of antiretroviral therapy (HAART) decreases the incidence of opportunistic infections (OIs) they are continuing to be a major cause of morbidity and mortality. Studies concerning this problem are scarce in Eastern Africa. The aim of this study was to determine the incidence and predictors of OIs after initiation of HAART in Ethiopia.MethodsA health facility based single centered cohort study using structured data extraction sheet was conducted. The study population was all HIV positive ART naive adolescents and adults who started HAART between January 2009 and May 2012. Simple random sampling technique was used to select 317 patients from the record. Multivariate binary logistic regression model was used to determine factors for the occurrence of OIs after initiation of HAART.ResultsThe incidence of OIs after HAART was 7.5 cases/100person years. Tuberculosis, oral candidiasis, pneumonia and toxoplasmosis were the leading OIs after HAART. A bed ridden functional status at initiation of HAART, presence of OIs before HAART, non-adherence and low hemoglobin level were predictors for the occurrence of OIs after HAART.ConclusionThe incidence of OIs after HAART was higher than in previous studies. Patients with the identified risk factors need strict follow up to reduce the morbidity and mortality attributed to OIs. Earlier initiation of HAART before advanced immune suppression, better management of TB and extended baseline assessment could help to reduce opportunistic infections and mortality after the initiation of HAART in Ethiopian patients.

Background Increasing incidence of sexually transmitted infections (STI) in Germany has shown the necessity of easily accessible sexual health services. Walk In Ruhr (WIR), a unique inter-institutional Center for Sexual Health and Medicine in Germany, unites the Outpatient Clinic, Public Health Department and four community-driven NGO. Together, they provide counseling, testing and treatment for different target groups (e.g. youth, MSM, swinger) in one building. Innovative methods in preventing HIV/STI [Online Partner Notification tool (PN), PrEP, Online Risk Test (ORT), HIV/STI-self-sampling-kit ‘teST-It’] are developed and tested here. Health Advisers offer counseling, outreach-work and guidance to specialists. Methods During a 21-month-evaluation-period, supported by the German Ministry of Health, clients completed a quantitative survey. Additional surveys, conducted independently by the WIR for PrEP- and ‘teST-It’- users were included, the ORT, the PN usage and HIV/STI test diagnosis and treatment were analyzed. Results The evaluation is ongoing. Until 2/2019 approx. 3.200 surveys will be completed. Initial results show that target groups differ regarding age, gender, sex-orientation, visit reason and WIR institutions they approach. Additional studies show that a quarter of the clients are HIV-positive. 10.5% of the clinic’s patients and 10% of the Public Health Dept. clients were tested STI-positive. Treatment of C. trachomatis and N. gonorrhoeae was successful in 98% of all cases and in 93.5% of all M. genitalium cases. PrEP usage has been rising (144 new PrEP users since 10/2017) and the PN tool has been used 208 times since 06/2017. Since 12/2017, 4502 persons used the anonymous ORT. ‘teST-It’ is available since 09/2018. Conclusion In contrast to common care concepts, WIR achieves high levels of recognition and acceptance among different target groups and the average population. The opportunity to access different organizations helps to meet the medical and counseling needs of the clients to reduce further transmission of HIV/STI. Disclosure No significant relationships.

Der unzureichende Zugang zur Pravention und medizinischen Versorgung von Sexarbeiterinnen (SW) stellt eine Herausforderung fur das deutsche Gesundheitssystem dar. Die Erreichbarkeit und die Versorgung der SW in Bochum durch eine Zusammenarbeit zwischen der Interdisziplinaren Immunologischen Ambulanz, Zentrum fur Sexuelle Gesundheit und Medizin des St. Josef-Hospitals (ZSG), dem Gesundheitsamt Bochum und Madonna e. V. zu verbessern stand im Fokus dieser Arbeit. Es wurde ein aufsuchendes medizinisches Angebot zur Diagnostik von sexuell ubertragbaren Infektionen (STI) bei SW im Bochumer Bordellbereich zwischen August 2013 und Januar 2014 bereitgestellt. Nach Aufklarung und mundlichem Einverstandnis der SW wurden pseudonymisierte, kostenlose HIV-, Syphilis-, Chlamydien-, Gonorrho- und Trichomonadentests angeboten und durchgefuhrt. Es wurden 112 SW erreicht (zu 55,4 % im Rahmen der STI-Outreach-Studie), 94,6 % der SW wiesen einen Migrationshintergrund auf. Die Mehrzahl der SW war zwischen 20 und 29 Jahre alt (61,3 %). Im Kollektiv waren lediglich 19,0 % krankenversichert. Folgende STI wurden diagnostiziert: 12,5 % Chlamydien, 6,2 % Syphilis, 3,6 % Gonorrho, 3,6 % Trichomonaden und 0,9 % HIV. Weiterhin erfolgte eine Gegenuberstellung dieser Ergebnisse mit STI-Untersuchungen bei SW in Deutschland. Die Behandlung erfolgte nach den Standards der Deutschen STI-Gesellschaft. Das Angebot verbesserte in Bochum die Erreichbarkeit und die Inanspruchnahme des medizinischen Angebots durch SW. Eine weitere Verbesserung dieses Angebotes ist dringend notwendig.

Hintergrund Im Rahmen der Fordermasnahme „Kompetenznetze in der Medizin“, durch das Bundesministerium fur Bildung und Forschung (BMBF) gefordert, wurde das Kompetenznetz HIV/AIDS (KompNet HIV/AIDS) als ein interdisziplinarer Forschungsverbund aufgebaut. Hier haben sich deutschlandweit wesentliche HIV/AIDS-Forschungsgruppen zusammengeschlossen.

Plasma drug-resistant minority human immunodeficiency virus type 1 variants (DRMVs) increase the risk of virological failure to first-line non-nucleoside reverse transcriptase inhibitor antiretroviral therapy (ART). The origin of DRMVs in ART-naive patients, however, remains unclear. In a large pan-European case-control study investigating the clinical relevance of pre-existing DRMVs using 454 pyrosequencing, the six most prevalent plasma DRMVs detected corresponded to G-to-A nucleotide mutations (V90I, V106I, V108I, E138K, M184I and M230I). Here, we evaluated if such DRMVs could have emerged from apolipoprotein B mRNA editing enzyme, catalytic polypeptide 3G/F (APOBEC3G/F) activity. Out of 236 ART-naive subjects evaluated, APOBEC3G/F hypermutation signatures were detected in plasma viruses of 14 (5.9%) individuals. Samples with minority E138K, M184I, and M230I mutations, but not those with V90I, V106I or V108I, were significantly associated with APOBEC3G/F activity (Fisher's P0.005), defined as the presence of0.5% of sample sequences with an APOBEC3G/F signature. Mutations E138K, M184I and M230I co-occurred in the same sequence as APOBEC3G/F signatures in 3/9 (33%), 5/11 (45%) and 4/8 (50%) of samples, respectively; such linkage was not found for V90I, V106I or V108I. In-frame STOP codons were observed in 1.5% of all clonal sequences; 14.8% of them co-occurred with APOBEC3G/F signatures. APOBEC3G/F-associated E138K, M184I and M230I appeared within clonal sequences containing in-frame STOP codons in 2/3 (66%), 5/5 (100%) and 4/4 (100%) of the samples. In a re-analysis of the parent case control study, the presence of APOBEC3G/F signatures was not associated with virological failure. In conclusion, the contribution of APOBEC3G/F editing to the development of DRMVs is very limited and does not affect the efficacy of non-nucleoside reverse transcriptase inhibitor ART.

Background Human papillomaviruses (HPV) induce condylomata, anogenital cancers and their precursor lesions as anal or penile intraepithelial neoplasia (AIN/PIN). HIV-positive individuals have an increased risk for the development of anogenital HPV-induced lesions. Objective Estimation of the prevalence of HPV-related anogenital benign and malignant lesions in HIV-infected men attending a screening programme. Methods Four hundred HIV-positive men [98% men who have sex with men (MSM)] were enrolled in this prospective study from 2008 to 2011. All patients received an inspection of the anogenital region, digital rectal examination, high-resolution anoscopy (HRA), anal cytology, anal/penile histology if required, and HPV-typing of anal and penile swabs. Results At baseline, 75% (n = 302) of the men had abnormal anal cytological/histological results. 41% presented with low-grade (n = 164), 24% with high-grade anal dysplasia (n = 95) and two men with invasive anal cancer. 2.3% had PIN (n = 9) and one patient had penile cancer at baseline. Throughout the study period, 75% had anal dysplasia (low-grade n = 177, high-grade n = 125), 3.3% (n = 13) had PIN and two further patients developed anal cancer. Within the study period, 52.8% (n = 211) had condylomata (49% anal, 15% penile, 11% anal plus penile condylomata). At baseline, 88.5% of anal and 39.3% of penile swabs were HPV-DNA positive, and 77.8% of anal and 26.5% of penile swabs carried high-risk HPV-types. HPV16 was the most frequent HPV-type. Conclusion HIV-positive MSM have a high risk for HPV-induced condylomata, (pre)malignant anogenital lesions and anogenital cancers. Screening for HPV-induced dysplasia is crucial to avoid progression to invasive carcinomas. Additionally, HPV-vaccination recommendations should be extended to high-risk populations.

SummaryBackground HIV-positive men who have sex with men (HIV+MSM) have an increased risk for anal dysplasia and for sexually transmitted infections (STIs). Objectives We determined the positivity rates of Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG), Mycoplasma genitalium (MG) and syphilis in HIV+MSM participating in an anal cancer screening programme. Methods In total, 852 intra-anal swabs were collected from 503 HIV+MSM between 2012 and 2014. Anal cytology and polymerase chain reaction assays for human papillomavirus (HPV), CT, NG and MG detection were performed. The syphilis status was determined serologically. Risk factors for STIs were explored by multiple logistic regression analysis. Results In total 20·7% (104 of 503) of the patients had an STI other than HPV within the study period. The most common was CT, found in 10·9%, followed by NG (8·9%) and MG (4·2%). Early syphilis was detected in 4·6% and past syphilis in 44·5% of the HIV+MSM. Eighteen patients (3·6%) had more than one STI episode, and 90·6% of the 127 cases of STIs were asymptomatic. Age, anal HPV infection, abnormal anal cytology and previous syphilis were risk factors for STI. Conclusions Anal STIs are frequent and mostly asymptomatic in HIV+MSM participating in anal cancer screening. STI screening should be incorporated into anal cancer screening programmes for HIV+MSM.

Diagnosis of sexually transmitted diseases (STD) has significantly improved in recent years by the application of nucleic acid amplification tests (NAAT). In addition to detection of infectious agents, molecular methods were also used for characterization of pathogens (typing, genotypic resistance testing). In contrast to conventional Sanger sequencing of amplicons, new sequencing technologies (next generation sequencing) are able to identify resistant variants that represent only small minorities in a heterogeneous population. NAATs are also available as fully automated closed systems that can be run independently of centralized laboratories and will become increasingly important for point-of-care testing.

Purpose To evaluate the efficacy, safety, tolerability, and quality of life (QoL) in patients receiving intravenous, intermittent high-dose interferon alfa-2b (IFN-α-2b [iHDI]) compared with standard high-dose IFN-α-2b (HDI). Patient and Methods Patients with stage III resected lymph node or in-transit metastasis from cutaneous malignant melanoma were randomly assigned to receive either a standard HDI regimen or three courses of IFN-α-2b 20 MIU/m2 administered intravenously 5 days a week for 4 weeks then repeated every 4 months. Distant metastasis-free survival was the primary end point for efficacy analysis. In addition, relapse-free survival, overall survival, safety as determined by Common Terminology Criteria for Adverse Events criteria, and QoL were secondary end points. Results Of 649 patients enrolled, 22 patients were excluded from the intent-to-treat analysis. The remaining 627 patients were well balanced between the arms according to sex, age, and stage. After a median follow-up of 55 months, a multivariable Cox model revealed no significant differences for distant metastasis-free survival (hazard ratio [HR], 1.21; P = .12) or overall survival (HR, 1.01; P = .85). In contrast, the difference for relapse-free survival was significant (HR, 1.27; P = .03), favoring standard HDI. Early termination of treatment because of adverse events or QoL occurred significantly more often with HDI than with iHDI (26.0% v 14.8%; P < .001). Conclusion Although the safety and QoL profiles for the intermittent regimen were favorable, no significant difference was observed for survival while the HR for relapse with iHDI was increased. Therefore, an iHDI regimen, as tested here, cannot be recommended as adjuvant treatment for high-risk melanoma.