ABSTRACT
Four broad themes run through this year's N'Galy-Mann lecture: clinical medicine, HIV, health security, and global health. Three patterns of disease characterized medicine in East Africa at the time that AIDS was first described in the United States: diseases of poverty, mainly infectious;non-communicable diseases with differing international epidemiology;and classic tropical diseases restricted in distribution by ecologic needs of parasites and vectors. Limited resources did not prevent the practice of good medicine under adverse circumstances, nor application of basic principles of research. The recognition of a second AIDS virus (HIV-2) in West Africa in the mid-late 1980s required applied research to assess implications and potential global impact of this novel infection. CDC established a second collaborative research site in sub-Saharan Africa, Projet RETRO-CI, in Abidjan, Cote d'Ivoire (the first was Projet SIDA in the Democratic Republic of Congo, where N'Galy and Mann made seminal contributions). Controversy around HIV-2 diagnosis, transmission, and pathogenicity was slowly resolved through West African research showing HIV-2 was an AIDS-causing pathogen, slower than HIV-1 in its progression, and less transmissible until late in the course of infection. Mother-to-child transmission was exceptionally rare. Claims that HIV-2 protected against HIV-1 were not substantiated. Projet RETRO-CI clarified the spectrum of HIVassociated disease and the dominant role of tuberculosis. Placebo-controlled trials demonstrated efficacy of short-course zidovudine for prevention of perinatal transmission of HIV-1, and of cotrimoxazole prophylaxis in reducing hospitalization and mortality in persons with HIV. Global health today is dominated by discourse around health security. The West African and Congolese Ebola epidemics since 2014 aroused strong declarations, yet the world was poorly prepared to address the pandemic of COVID-19. Health in the world has changed substantially since AIDS emerged. As 2030, the year for delivery on the Sustainable Development Goals, approaches, development assistance for health remains essential to address traditional, unfinished commitments yet does not match today's global burden of disease. CROI attendees are encouraged to remember colleagues lost to COVID-19 and other challenges;to assess priorities in today's global health, including relating to HIV;and to reflect on what issues? N'Galy and Mann would focus on today.
ABSTRACT
IntroductionThe aim of this study was to assess faecal immunochemical test (FIT) negativity in terms of its effect on cancer risk in the local symptomatic two-week wait (2WW) population. FIT was introduced to the colorectal 2WW pathway at the start of the pandemic. This study analyses the FIT-negative (<10µg Hb/g) cohort and calculates the relative risk and odds ratio associated with a negative FIT test.MethodsFIT tests were sent to symptomatic 2WW patients without rectal bleeding, iron-deficient anaemia or palpable mass. Where FIT was <10µg Hb/g investigations were moved to a radiology protocol.ResultsThe test return rate was 91% with a FIT-negative (<10µg Hb/g) rate of 82%. The FIT-negative group in the symptomatic referral pathway in Cornwall have a low (1.4%) risk of colon cancer but a significant risk (6.6%) when all cancer types are considered. The impact of a negative quantitative FIT changes the odds ratio of a patient having a luminal cancer by 0.26. The odds ratio for ‘all cancer' risk was affected by 0.83.ConclusionA negative FIT test within the local NG12 symptomatic patient group signifies a low risk of colon cancer and identifies patients who can be initially investigated with cross-sectional imaging. However, when all cancer types are considered, cancer prevalence in this group remains above 6%. In relative risk terms a negative FIT represents a small change in overall risk and this patient group still qualify for investigation through 2WW pathways.