Summaries of other studies

Simon Collins, HIV i-Base

Many other studies at the conference deserve further reporting but can only be briefly summariesed here. For full details please refer to the conference abstracts and contact the lead authors.

All references are to the Abstracts of the 2nd Joint conference of the BHIVA and BASHH, 20–23 April 2010, Manchester.

Abstracts from the conference are published as a supplement to the May 2010 edition of HIV Medicine; Volume 11, Supplement 1.

Transmission and late diagnosis in older people: half of late diagnoses in people over 50 years old

An oral presentation from the Health Protection Agency highlighted some aspects of how older people are affected by HIV. The number of older adults who are HIV-positive in the UK from 2333 in 2000 to 8268 in 2007, accounting for 16% of adults accessing care in 2007 and 8% of all HIV diagnoses between 2000–2007. [1]

Compared to younger adults, newly diagnosed adults aged 50 years and over were more likely to be men (74% vs. 58%; p<0.001), infected through sex between men (40% vs. 34%; p<0.001) and of white ethnicity (60% vs. 38%; p<0.001). Older heterosexuals adults were more likely to be infected within the UK (16% vs. 12%; p<0.001), with evidence of travel abroad amongst white heterosexual men.

Late diagnosis (CD4 count <200) was significantly higher amongst older adults (48% vs. 33%; p<0.001); with older MSM being twice as likely to present late than younger MSM.

This study estimated that nearly half (48%; 1486) of persons diagnosed between 2000 and 2007 acquired their infection aged 50 and over.

Ref: Smith R et al. Refocusing our efforts – transmission and late diagnosis of HIV among adults aged 50 and over. Oral abstract O3.

Ocular syphilis at first presentation of HIV

Three cases were described where ocular syphilis was the presenting symptom: a 33-year old heterosexual man, a 20-year old gay man, and a 39-year old gay man. The study concluded: “Syphilis should be excluded in cases of uveitis and optic neuritis; other features of secondary syphilis may be absent. All patients had improving visual symptoms after neurosyphilis therapy, and had preceding oral steroids to prevent Jarisch-Herxheimer reaction, as this can worsen ocular symptoms. Early diagnosis is important as ocular syphilis can rapidly cause blindness.

Ref: Dhairyawan R et al. Ocular syphilis as the ?rst presentation of HIV infection. Poster abstract P132.

Perinatally infection diagnosed in late adolescence

Two cases of extremely late diagnosis, in a young man and woman, both 20-year old Ugandan patients, presenting with multiple complications, including HIV-related dementia. These rare cases highlight the importance of family history and HIV testing in children and young adults who were potentially exposed to HIV during pregnancy and at birth.

Ref: Ross S et al. Vertical HIV infection in young adults presenting with HIV-associated dementia. Poster abstract P169.

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