bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3-S3.02 Reiter's syndrome in association with HIV infection: report of three cases
Authors: Inamadar A 
Published: July 2011

IntroductionReiter's syndrome is a relatively rare, non-suppurative, sero-negative arthropathy seen among young adults with HLAB27. Epidemic (post-enteric) and endemic (sexually acquired) variants of the disease may occur. Reiter's disease is difficult to manage because of its chronic recurring course. The prevalence of Reiter's syndrome in HIV-infected patients varies between 1.7% and 11.2%. The course of the disease is more severe and progressive in these patients and often refractory to treatment. Here, clinical features and management of three HIV infected patients with Reiter's syndrome have been described.Case reportsThree heterosexual men, age ranging from 20 to 40 years presented with psoriasiform skin lesions, dystrophic nail changes and incapacitating arthritis involving bilateral knees, ankles and toes of 3–6 months duration. Two of the patients had asymptomatic balanitis. Skin lesions, keratoderma blenorrhagica, were generalised and severe in one patient and were restricted to extremities in two others. There was no history of preceding gastro-intestinal infection or urethritis in any of them. All the three patients had history of unprotected sex with commercial sex workers in the past. They were tested HIV positive (Western blot method) and CD4 T cell count was 550, 489 and 450 respectively. The patients were treated with a combination of indomethacin, sulfasalazine for the arthritis and systemic isotretinoin. Arthritis responded to sulfasalazine and indomethacin. Cutaneous and nail changes responded to systemic isotretinoin. Long term treatment was required for all patients and one had recurrent flare-up of symptoms.ConclusionReiter's syndrome is one of the causes of rheumatic disorders in HIV-infected patients. Direct etiological role of HIV infection in the development of Reiter's syndrome is not established. Reiter's syndrome as a manifestation of immune reconstitution syndrome in a HIV-infected patient has been reported. Clinical severity of the disease may be increased because of underlying immunosuppression. These patients present with therapeutic challenge because of the restricted opportunity to use conventional immunosuppressive therapeutic agents.
P3-S3.03 Clinical profile of Buschke-Lowenstein tumour in HIV infected patients
Authors: Shivanna R 
Published: July 2011

IntroductionBuschke Löwenstein tumour (BLT) is a rare Human Pappiloma Virus (HPV)- triggered indolent lesion involving perineal and/or perianal skin. The lesions are locally invasive and difficult to manage because of the voluminous tissue bulk and recurrence potential. Underlying immune defect in the background of HIV infection may enhance tumour-aggressiveness in these lesions. Three HIV-infected patients with BLT have been reported.Case reportsPatient 1: A 46-year-old woman presented with a cauliflower-like pink, fleshy mass of 18 months duration, protruding through the anal orifice, causing discomfort and disturbance in defecation. She was HIV-infected, acquired through conjugal relation. In addition to the above lesion, she had multiple genital molluscum contagiosum and bowenoid papulosis. Her CD4 T cell count was 350 and she was not on antiretroviral therapy (ART). Histopathology of the lesion was suggestive of BLT. The patient was treated with cryotherapy followed by surgical debulking of the lesion. ART was advised. Patient 2: A 35-year-old commercial sex worker presented with a large, variegated growth involving labia minora, extending to perineum, perianal region and lower part of gluteal folds, since last 5 years. There was sudden increase in extent and ulceration of the lesion since last 6 months. In the pubic region she had a conglomerated lesion of multiple condyloma acuminata and multiple bowenoid papulosis. She was HIV-infected with CD4 T cell count of 660. The lesion was biopsied from multiple sites and histopathological examination was consistent with BLT with grade II squamous cell carcinoma in some specimens. The patient was treated with surgical debulking followed by radiotherapy. Patient 3: A 40-year-old man with history of high risk sexual practices and intravenous drug abuse presented with multiple, fleshy masses over penis, scrotum and peno-scrotal junction, giving rise to deformed appearance of the genitalia. The lesions were present since several years with slow growth. He was HIV positive with a CD4 T cell count of 300. He was on ART since last 6 months. Histopathology of the lesion was suggestive of BLT. The patient was treated with cryotherapy followed by surgery.ConclusionHIV-infected patients with Buschke Löwenstein tumour are at a higher risk of developing invasive squamous cell carcinoma because of higher incidence of abnormal anal and genital cytology, presence of HPV-DNA in these cells and a low CD4 T cell count.
P3-S3.06 Quantifying lactobacillae species with real time PCR methods for HIV prevention trials
Authors: Crucitti T , Jespers V , Menten J , Smet H , Buvé A , Poradosú S 
Published: July 2011

BackgroundThe vaginal flora plays an important role in the defence against HIV infection. It is thus important to assess the impact on the vaginal milieu of products that are developed to protect women against HIV acquisition.ObjectivesUsing Real Time PCR, describe and quantifyLactobacillae spp.in healthy European women who enter microbicide phase I studies.MethodsThirty healthy women who don't use hormones and have a regular menstrual cycle, were sampled with a COPAN flocked vaginal swab on days 7 and 21 of the cycle for a total of 5 visits. Real Time PCR was used to quantify bacterial cells for fourLactobacillus spp.at all visits.ResultsL crispatus, L iners, L jensenii, andL gasseriwere present at least once in 93%, 77%, 73% and 70% of women, respectively. High counts (≥8 log forL crispatus, ≥6 log for other species) were consistently present in 60%, 67%, 53%, and 53% of women. We labelled these latter women “L species-positive”. Using logistic regression we modelled the probability of belonging to this group. The temporal variation of the log counts within this group was modelled using random effects linear regression. No predictors of being “L. species-positive” for any of the studied Lactobacillae were identified. Longitudinal analysis showed thatL crispatuscounts were 0.22 log higher (p<0.001) andL inerscounts were 0.83 log lower (p<0.001) at the end of the menstrual cycle. Furthermore,L crispatuscounts decreased by 0.40 log after intercourse (PSA present) (p=0.002), whileL iners(+0.73 log, p=0.033) andL gasseri(+0.58 log, p=0.052) increased see Abstract P3-S3.06 figure 1.Abstract P3-S3.06 Figure 1Log counts of bacterial cells per ml by day in the menstrual cycle: Note: Lines connect consecutive counts for individual women. Bold line is overall trend in “L. species-positive” women.ConclusionThe menstrual cycle and sexual activity have a significant effect onLactobacillus sp.counts. This should be taken into account when assessing safety of products in HIV prevention trials.
P3-S3.07 Analysis of patients who do not keep or cancel appointments at a university based HIV/AIDS clinic
Authors: Edwards J , Parrish R C , Frieson K , Crawford T , Thornton A 
Published: July 2011

BackgroundThe Bluegrass Care Clinic (BCC), a university based HIV/AIDS clinic, has an annual average patient no show rate of 13.6% to medical appointments. Treatment adherence greater than 95% is needed to obtain maximum benefits of therapy and minimal disease progression requiring attendance to regularly scheduled medical appointments throughout the patient's lifespan. Missed appointments are not only known to interfere with appropriate care but to misspend medical and administrative resources. The BCC sought to identify demographic trends, interpret perception and identify barriers unique to those individuals who frequently do not attend appointments.MethodsQuantitative and qualitative data were collected through focus groups, phone surveys and data from Resource Scheduling Software. Descriptive statistics (frequencies and means) were derived.ResultsDuring a 29 month period the BCC expended roughly $3864 per month due to patients who did not show for appointments. 68 individual patients did not show for more than eight appointments. These 68 patients accounted for 21% of missed appointments, while 1053 patients accounted for the other 79% of missed appointments see Abstract P3-S3.07 figure 1. 13 patient focus groups were held where members cited transportation/coping/stress as potential barriers to attendance. During a phone survey of the 68 individuals only one individual correctly estimated the average number of appointments they missed per year. Female clients seem to disproportionately become frequent non-attenders as compared to their male counterparts. Female clients make up only 20% of the general BCC population, while they make up 34% of the clients who frequently miss appointments. There is a disproportionate effect in black clients. These individuals make up 21% of the BCC's total client population, while they make up 29% of the clients that frequently do not attend appointments.Abstract P3-S3.07 Figure 1Bluegrass care clinic: gender.ConclusionsSurprisingly, a disproportionate percentage of individuals account for 1/5 of patients who do not attend or cancel appointments. Individuals surveyed by phone the majority had no actual perception of the average number of appointments they miss without cancelling. Interestingly, although the BCC serves 63 counties, 78% of those who frequently miss appointments live in the immediate area (within 30 miles of the BCC)- so transportation barriers that were identified during focus group sessions may not have a significant impact on those who frequently miss appointments.
P3-S3.10 An assessment of the effects of ancillary services on CD4 counts and viral loads of people living with HIV/AIDS
Authors: Ball K , Parrish R , Thornton A 
Published: July 2011

BackgroundThe Ryan White Modernisation Care Act 2006 integrated medical case management with supportive social services to ensure that Persons Living with HIV/AIDS (PLWHA) from lower socioeconomic, marginalised groups, and those with mental health/substance use issues are sustained in medical care. This study sought to establish the relationship between the CD4 and viral load of PLWHA and the receipt of ancillary services.MethodsA random sample of N=222 subjects were drawn from the Bluegrass Care Clinic (BCC) database. The cohort was 67% white, 21.6% black, and 8.6% Hispanic with the majority of the subjects between 100 and 149% of the poverty level. Self-reported HIV risk factors for the sample were 59.9% MSM, 28.4% heterosexual, and 8.1% IDU. This sample adequately represents the population of the BCC as ethnicity, socioeconomic status and risk factors were similar for the clinic population as a whole. One way ANOVA tests were used to determine if the receipt of ancillary services by PLWHA in the BCC affects their viral loads and CD4 counts by using a multivariable analysis.ResultsThere was a statistically significant difference in mean CD4 counts when comparing between ethnicities. The ANOVA test showed a statistically significant relationship (p=0.002) between Hispanic ethnicity and mean CD4 count, as subjects in the study that were of Hispanic origin had lower mean CD4 counts (305) than non-Hispanic whites (550) and non-Hispanic African Americans (500). There was also a statistically significant difference (p=0.021) between the mean viral load of PLWHA having one to three mental health visits and PLWHA with no mental health visits at all.ConclusionAt the BCC, patients with adherence issues appear to be referred for mental health services, confirming the essential role of social workers on a multi-disciplinary HIV team. The BCC also has a Hispanic population with disproportionately lower CD4 counts. Implications for program improvement are to continue to target Hispanic patients with lower CD4 counts to retain them in medical care and improve adherence to ART medications. This study was limited by the fact that ancillary social services were lumped in with medical case management in the data set rather than delineated into individual service categories. Future research should use data sets that more accurately capture the various ancillary services provided to the sample subjects.
P3-S4.03 Impact of comprehensive management including counselling on health related quality of life index in Indian patients with anogenital warts
Authors: Gupta S 
Published: July 2011

BackgroundHealth related Quality of life (HRQOL) can be conceptualised as the absence of pain and an ability to function in day-today life. Our earlier study has shown that anogenital warts have an adverse effect on HRQOL because of its impact on physical, psychological and sexual health, even though the lesions are often asymptomatic.1To our knowledge, there are no studies available to show the impact of comprehensive management on HRQOL of these patients.MethodsThirty-five apparently healthy controls (meanage ±SD 34.8±11.2) and twenty patients with anogenital warts (mean age ±SD 32.7±11.8 years) were included in the study. HRQOL of patients was evaluated using the WHOQOL-BREF instrument at the time of presentation and again after 4 months. During this period, all patients were comprehensively counselled by a trained counsellor and received regular treatment for anogenital warts. The questionnaire was available in local language (Hindi) and was self-administered.ResultsAll except two patients showed reduction in the size in response to treatment, however complete clearance was seen only in 10 patients (50%). At the baseline, the HRQOL scores of patients were significantly lower than controls in all domains. The HRQOL scores of patients after 16 weeks of comprehensive management were significantly higher than those at the baseline and comparable to those of controls (Abstract P3-S4.03 table 1).Abstract P3-S4.03 Table 1 HRQOL Scores in different domains of WHOQOLBREF of patients before and 16 weeks after comprehensive management and those of apparently healthy controlsHRQOL domainsPatients with ano-genital wartsp ValueHealthy controls mean (CI)Before comprehensive management mean (CI)After comprehensive management (at 4 months) Mean (C.I.)Physical40.8 (32.3 to 49.3)82.1 (77.9 to 86.3)<0.00172.0 (63.70 to 80.30)Psychological47.55 (37.8 to 57.3)78 (71.6 to 84.4)<0.00168.9 (60.5 to 77.3)Social45.05 (35.3 to 54.8)77.2 (70.8 to 83.6)<0.00174.6 (68 to 81.2)Environmental51.35 (44.9 to 57.8)73.55 (16.4 to 130.7)<0.00164.7 (58.5 to 71)Total184.75 (157.2 to 212.3)310.85 (294.7 to 327)<0.001280.2 (253 to 307.5)Overall QOL2.65 (2.2 to 3.1)4 (3.4 to 4.6)<0.0013.5 (3 to 4)Overall Health2.7 (2.3 to 3.1)4.35 (4 to 4.7)<0.0013.9 (3.5 to 4.4)Sexual health2.95 (2.5 to 3.4)4.15 (3.9 to 4.4)<0.0014.2 (3.8 to 4.5)ConclusionComprehensive management of anogenital warts including counselling has resulted in the significant improvement in HRQOL scores. As anogenital warts are often asymptomatic, the effect on HRQOL appears to be due to its impact on psyche and fear of cancer and interventions including counselling can improve HRQOL more efficiently than in patients with other sexually transmitted diseases.
P3-S4.06 Men with genital warts do consult later than women
Authors: Dolcé P , Séguin V , Bernatchez H 
Published: July 2011

BackgroundCSSSRN is a regional hospital of 240 acute-care beds with a STD clinic which works mainly with clinical nurses, under the supervision of Infectious Diseases physicians (ID). This study aimed to review the clinical data of patients with genital warts.MethodsAll files from patients with genital warts evaluated in our STD clinic between 2005 and 2010 were reviewed for clinical data including the delays before consultation. All data were analysed with Epi Info 3.5.2.ResultsFrom 2005 to 2010, an average of 5950 patients per year attended our STD clinic, and 70% were women. A total of 656 cases of genital warts were diagnosed by visual inspection from the attending ID physician. The specific types of lesions were warts associated with Human Papilloma Virus in 76%, molluscum contagiosum 20%, both 4%. The median age was 24 years (range 16–76) and 57% of patients were men. The patients did not notice any lesion prior to consultation in 61 cases (9.3%). For the others, the delays before consultation were: 0–7 days (16.2%); 8–14 days (8.9%); 15–27 days (12%); 1–2 months (30%); 3–5 months (11.5%); 6–12 months (11.9%); >1 year (8.7%). Significant longer delays before consultation were observed for men in comparison to women. The delays were: ≤7 days (men 42/349 [12%], women 54/244 [22.1%], p<.001); =14 days (men 70/349 [20.1%], women 79/244 [32.4%], p<.001); =27 days (men 113/349 [32.3%], women 107/244 [43.8%], p=0.006); ≥6 months (men 90/349 [25.7%], women 33/244 [13.5%], p<0.001); more than 1 year (men 41/349 [11.7%], women 11/244 [4.1%], p=0.002).ConclusionsIn our population, the median delay before consultation for genital warts was 1–2 months. However, men with genital warts do consult significantly later than women. Specific public health approach should be considered for men with visible genital lesions, in order to promote earlier consultation and limit transmission. More behavioural studies are needed to further investigate this observation.
P3-S5.02 Is urethral smear microscopy In asymptomatic men effective in reducing MajorM genitaliuminfection sequelae in women?
Authors: White P , Birger R , Saunders J , Estcourt C , Hallett T , Caffrey O , Mercer C , Roberts T 
Published: July 2011

BackgroundNon-Chlamydial Non-Gonococcal Urethritis (NCNGU) is as prevalent as Chlamydial urethritis in UK men.Mycoplasma genitaliumlikely explains 10–46% of cases but there is no UK-licensed molecular test. In women,M genitaliumis associated with pelvic inflammatory disease (PID), infertility and ectopic pregnancy. New UK guidelines do not recommend urethral smear microscopy in asymptomatic men, so asymptomatic NCNGU cannot be diagnosed, whereas previously affected men and their sexual partners were treated with antibiotics. The impact of this policy on reproductive health sequelae in women is unknown.MethodsWe used a compartmental mathematical model to synthesise evidence on the natural history ofM genitalium, diagnosis and treatment levels. Uncertainty was accounted-for using Latin hypercube sampling, with rejection sampling to fit to data. The model was stratified by sex, incorporates heterogeneous sexual behaviour, and was parameterised by behaviour data from key UK surveys (NATSAL2, PATSI, MSTIC); STI surveillance data; and natural history data from the literature. It incorporates symptomatic and asymptomatic infection; PID; care-seeking due to symptoms, partner notification, and routine screening; and treatment failure. We fitted to national STI surveillance (KC60) data, (allowing for uncertainty in the amount of NCNGU caused byM genitalium), representing current practice, and examined (i) increasing microscopy in asymptomatic men by making it routine in all genito-urinary medicine clinics and (ii) decreasing rates by discontinuing it in the 20% of clinics currently still using it.ResultsMicroscopy in asymptomatic men reduces the burden of infection in women by reducing prevalence in men thus reducing transmission to women; and treating women via partner notification from diagnosed men. The magnitude of these effects depends upon natural history in men and women, about which there is uncertainty. We determine ranges of parameter values in which routine microscopy would be effective in reducing M genitalium-related sequelae in women.ConclusionsFurther empirical work is required to determine if natural history parameters fall in the ranges that would make routine microscopy in asymptomatic men effective. Particularly important are the prevalence ofM genitalium; proportion of infections that are symptomatic in men and women; duration of untreated infection; and incidence of PID, infertility and ectopic pregnancy attributable toM genitalium.
P3-S6.02 Is fourfold drop of the nontreponemal antibody titrestitres at three or 6 months after early syphilis treatment an effectiveness “criterion?”
Authors: Zhou P , Gu X , Lu H , Guan Z , Qian Y 
Published: July 2011

BackgroundAt present the criteria for treatment effective in early syphilis is the disappearance of clinical symptoms and signs and four-fold decrease of nontreponemal antibody titres within 3 to 6 months after therapy. However, how to evaluate if syphilis is cured after treatment remains difficult and controversial.MethodsSecondary syphilis patients whose rapid plasma reagin (RPR) titres did not turn negative at least 24 months after treatment were enrolled in this study and their CSF were evaluated. The criteria for enrolment were: (1) RPR titres declined fourfold within 3 months after therapy for secondary syphilis; (2) patients denied high risk sexual behaviour following syphilis treatment; (3) RPR titre did not turn negative at least 24 months after treatment; and (4) HIV negative. The criteria for neurosyphilis were: (1) CSF leukocyte count was elevated, and/or (2) proteins were abnormal, and (3) a reactive VDRL-CSF test in the absence of substantial contamination of CSF with blood, and (4) a reactive TPPA-CSF test, and (5) a negative HIV test, and (6) with or without neurological manifestations, and (7) excluding other possible CNS infections.ResultsThere were 14 male and three female patients who met the criteria for neurosyphilis. The CSF leukocyte count was elevated in 10 patients among which nine also had CSF proteins elevated. The other three patients had CSF proteins elevated only. CSF-VDRL and CSF-TPPA were reactive in all 17 patients. There were four cases presenting notable neurological and psychiatric manifestations, and other 13 had no signs and symptoms of CNS when they entered the study. The clinical symptoms and signs disappeared or improved in four patients, and CSF-WBC in those nine patients turned to normal after treatment. CSF-protein declined accordingly but did not turn to normal in four cases see Abstract P3-S6.02 table 1.Abstract P3-S6.02 Table 1RPR and CSF before anti-neurosyphilis treatmentNo.Initial RPRRPR (3 months after treatment*)RPR (24 months after treatment*)CSF/WB (0–8)×106/lCSF/protein (150–450) mg/lCSF/VDRL11:641:81:168.1↑860↑1:421:161:41:434411:131:321:81:81.1890↑1:241:641:61:32300↑1860↑1:851:321:41:83.81050↑1:461:1281:321:648.2↑650↑1:1671:641:161:169.8↑460↑1:481:2561:321:325.8580↑1:891:641:81:826↑460↑1:4101:1281:321:328.8↑2801:8111:161:41:89↑540↑1:8121:1281:161:1617↑570↑1:4131:2561:641:6438↑590↑1:16141:1281:321:82.24301:2151:2561:321:1618.8↑800↑1:4161:641:161:83.34301:1171:161:41:432801:1*Anti-secondary syphilis treatment.ConclusionsA four-fold decrease in serological titres and resolution of lesions of early syphilis may not predict success. The occurrence of failure after standard therapies suggests that the current criteria for “treatment effective” are questionable. There is a need of continuing to evaluate early syphilis patients who meet the criteria for “treatment effective” and whose nontreponemal antibody titres fail to turn negative afterwards.