Outcomes of an HCV elimination program targeting the Viennese MSM population.

BACKGROUND AND AIMS: Recent reports suggest an increasing incidence of hepatitis C virus (HCV) infections among MSM (men-who-have-sex-with-men). Early treatment with direct-acting antivirals (DAAs) achieves high cure rates and prevents further HCV transmission. We offered barrier-free HCV screening in the Viennese MSM population and immediate access to DAA treatment. METHODS: In collaboration with gay health specialists, we screened for HCV seropositivity in Viennese MSM between 2019 and 2020. Barrier-free HCV-RNA-PCR tests, transient elastography (TE) and immediate access to DAA treatment were offered. RESULTS: A total of 310 HCV-seropositive patients were identified. Of those, 145 could be contacted and 109 attended their appointment at our clinic. HIV-coinfection was highly prevalent in our cohort (n = 86/145; 78.9%), while pre-exposure prophylaxis (PrEP) was taken by 21.7% (n = 5/23) of non-HIV patients. Sexual risk behavior and (history of) intravenous drug use was reported by 32.1% and 13.8% of patients, respectively. Most MSM had already achieved sustained virological response (SVR) to previous antiviral treatment (n = 72, 66.1%) or experienced spontaneous clearance (n = 10, 9.2%). Advanced fibrosis was only detected in 3/109 (2.8%) patients. 30 MSM tested positive for HCV-RNA and DAA treatment was initiated in 29 patients - all achieved SVR. CONCLUSION: A targeted HCV test-and-treat program revealed a high prevalence of HCV seropositivity among Viennese MSM, potentially associated with high-risk sexual behavior and drug use. Early DAA treatment seems warranted in viremic HCV-MSM as SVR was 100%, which in turn prevents further HCV transmission.

Substantial underdiagnosis of lymphogranuloma venereum in men who have sex with men in Europe: preliminary findings from a multicentre surveillance pilot.

OBJECTIVES: Understanding the public health impact of lymphogranuloma venereum (LGV) in Europe is hampered by inadequate diagnostics and surveillance systems in many European countries. We developed and piloted LGV surveillance in three European countries without existing systems and performed a preliminary investigation of LGV epidemiology, where little evidence currently exists. METHODS: We recruited STI or dermatovenereology clinics and associated laboratories serving men who have sex with men (MSM) in Austria, Croatia and Slovenia, using the UK for comparison. We undertook centralised LGV testing of Chlamydia trachomatis (CT)-positive rectal swabs collected between October 2016 and May 2017 from MSM attending these clinics. Stored specimens from Austria (2015-2016) and Croatia (2014) were also tested. Clinical and sociodemographic data were collected using a standardised proforma. The ompA gene of LGV-positive specimens was sequenced. RESULTS: In total, 500 specimens from CT-positive MSM were tested, and LGV positivity was 25.6% (128/500; 95% CI 22.0% to 29.6%) overall, and 47.6% (79/166; 40.1% to 55.2%) in Austria, 20.0% (3/15; 7.1% to 45.2%) in Croatia, 16.7% (1/6; 3.0% to 56.4%) in Slovenia and 14.4% (45/313; 10.9% to 18.7 %) in the UK. Proformas were completed for cases in Croatia, Slovenia and in the UK; proformas could not be completed for Austrian cases, but limited data were available from line listings. Where recorded, 83.9% (78/93) of LGV-CT cases were HIV-positive compared with 65.4% (149/228) of non-LGV-CT cases; MSM with LGV-CT were more likely to have proctitis (Austria, 91.8% vs 40.5%, p<0.001; Croatia, 100% vs 25%, p=0.04; UK, 52.4% vs 11.7%, p<0.001) than those with non-LGV-CT. Six different ompA sequences were identified, including three new variants; the L2 ompA sequence predominated (58.6%, 51/87). CONCLUSIONS: LGV is substantially underdiagnosed in MSM across Europe. Unified efforts are needed to overcome barriers to testing, establish effective surveillance, and optimise diagnosis, treatment and prevention.

Prevalence and Associations of Illicit Drug and Polydrug Use in People Living with HIV in Vienna.

We aimed to determine the prevalence of drug and polydrug use in people living with HIV in Austria for the first time for which a two center cross-sectional study was performed. Participants were recruited from consecutive patients during their regularly scheduled visits. In total 438 participants were included in the analysis. For this study we used paper-pencil and online-based questionnaires. The prevalence of illicit drug use was 60.5%; with cannabis use at 31.5%, nitrates at 31.5%, sildenafil/tadalafil at 24% and cocaine at 14%, being the most used substances. Use of more than one substance (polydrug) in drug users was 69.4% or 42.0% in the total study population. Younger age, male gender, and living in an urban area were associated with drug use. Moreover, drug use during clubbing and sex, HIV therapy non-adherence and younger age were associated with polydrug use. Drug users reported condomless sex in 42.4% and performing sexual acts they would not do sober in 44.1%. Results indicate a high prevalence of illicit drug use in PLWHIV in Austria. New research focusing on illicit drug use in PLWHIV should focus on the use of substances during sex and surrounding practices.

Clinical setting-based smoking cessation programme and the quality of life in people living with HIV in Austria and Germany.

PURPOSE: To report on the global quality of life (QOL) in people living with HIV (PLWHIV) and how a smoking cessation intervention influences the changes in QOL. METHODS: Participants were asked to fill out a questionnaire during visits to their HIV outpatient clinic consisting of sociodemographic information, general health data and the WHOQOL HIV-Bref. Exhaled carbon monoxide measurements were used to confirm the smoking status, based on which participants classified as smokers received a short 5 min structured intervention and were offered participation in a full smoking cessation programme consisting of five sessions. Follow-up was done 8 months after the baseline. RESULTS: Overall 447 (mean age = 45.5) participants took part with 221 being classified as smokers. A total of 165 (74.6%) participants received a short intervention and 63 (29.4%) agreed to participate in the full program. At baseline, differences in QoL were observed, where smokers had lower QoL in domains of physical (M = 16.1 vs. 15.3, p = 0.009) and psychological (M = 15.3 vs. 14.6, p = 0.021) well-being, independency level (M = 16.1 vs. 15.2, p = 0.003) and environment (M = 16.5 vs. 16.0, p = 0.036). At study end, 27 (12.2%) participants quit smoking; 12 (19.0%) participants of the full programme and 15 (14.7%) that received the short intervention. There were no significant differences in QoL between those that continued to smoke and quitters at follow-up. CONCLUSION: Quality of life results may be used to better understand the underlying motivation of PLWHIV who start cessation programs. In order to reduce the high prevalence and health burden that smoking causes in PLWHIV, it is necessary to introduce effective interventions that can be used in the clinical settings.

Prevalence and Correlates of Smoking and Readiness to Quit Smoking in People Living with HIV in Austria and Germany.

We aimed to investigate the prevalence and correlates of smoking in people living with HIV (PLWHIV) in Germany and Austria and their readiness to quit. A total of 447 consecutive patients with confirmed positive HIV status who were treated in different outpatient HIV centres in Austria and Germany were included. Nicotine dependence and stages of change were assessed by standardized questionnaires, and this was confirmed by measuring exhaled carbon monoxide. Prevalence of smoking was 49.4%. According to a multivariate logistic regression analysis, higher age (for each year of life OR = 0.96; 95% CI 0.92-1.00) and tertiary education level (OR = 0.43; 95% CI 0.15-0.79) were associated with a lower chance, and occasional (OR = 3.75; 95% CI 1.74-8.07) and daily smoking of the partner (OR 8.78; 95% CI 4.49-17.17) were significantly associated with a higher chance of smoking. Moderate (OR = 3.41; 95% CI = 1.30-9.05) and higher nicotine dependency level (OR = 3.40; 95% CI 1.46-7.94), were significantly associated with higher chance, and older age (for each year of life OR = 0.95; 95% CI = 0.91-0.99), with lower chance for readiness to quit smoking. Those results may be used to address preventive measures to quit smoking aimed at PLWHIV and the importance of addressing smoking habits.

Impaired lipid profile and insulin resistance in a cohort of Austrian HIV patients.

INTRODUCTION: Traditional risk factors for cardiovascular diseases have been shown to have an even higher impact in the HIV infected population. Cardiovascular risk factors amongst people living with HIV treated in doctor's offices in Austria have not been documented before. Our study aimed to close this gap, focusing on dyslipidemia, diabetes mellitus and diabetes risk. PATIENTS AND METHODS: After ethics approval, consecutive patients who visited their treating physicians for routine checks were enrolled. The lipid profile was assessed by measuring total cholesterol, triglycerides, HDL and apolipoprotein B and calculating LDL and non-HDL-cholesterol. The diabetes risk was calculated by measuring insulin and blood glucose levels and assessing insulin resistance and beta cell function using the HOMA-IR model. RESULTS: 522 patients were included in the analysis. 90.2% of the participants were on antiretroviral therapy. Two third had an impaired lipid profile, but dyslipidemia had been diagnosed only in 46.3% of the patients. There was a clear correlation between protease inhibitor use and pathologic blood lipids. Of the persons with dyslipidemia, 18.4% received lipid lowering drugs. 8 persons (1.6%) fulfilled the criteria for diabetes mellitus. Of those, 4 patients already had a diagnosed diabetes mellitus. 50.1% of the study participants showed an increased insulin resistance. Patients on nucleoside reverse transcriptase inhibitors had significantly higher markers for impaired glucose metabolism. DISCUSSION: We found a high percentage of increased insulin resistance, of impaired lipid profile and in contrast to this a low treatment rate with lipid lowering drugs in this cohort of people living with HIV.

Smoking prevalence, readiness to quit and smoking cessation in HIV+ patients in Germany and Austria.

INTRODUCTION: Due to the interaction between smoking and the virus and the antiretroviral therapy, the excess health hazard due to smoking is higher in HIV+ patients than in the general population. International studies suggest a higher prevalence of smoking in HIV+ subjects compared to the general population. It was the aim of the study to assess prevalence of smoking, to analyze determinants of smoking, and to evaluate readiness to quit in HIV+ patients in Germany and Austria. MATERIAL AND METHODS: Consecutive patients with positive tested HIV status, smokers and non-smokers, who are treated in seven different HIV care centres in Austria and Germany were included. Nicotine dependence was assessed with the Fagerström Test for Nicotine Dependency (FTND), and stages of change by a standardized readiness to quit questionnaire. Self-reported smoking status was objectified by measuring exhaled carbon monoxide levels. Smokers who wanted to quit were offered a structured smoking cessation programme, and those who did not want to quit received a 1-minute consultation. After six months, the smoking status of all included subjects was reassessed. RESULTS: A total of 447 patients were included; the response rate was 92%. Prevalence of smoking was 49.4%. According to a multivariate logistic regression analysis, lower age, male sex, lower educational level, and smoking of the partner were significantly associated with the smoking status. According to the FTND, 25.3% showed a low (0-2 points), 27.6 a moderate (3-4 points) and 47.1% a high (5-10 points) dependency. Regarding stages of change, 15.4% of the smokers were in the stadium precontemplation, 48.4 in contemplation, 15.4 in preparation and 10.0 in the stadium action. 11.0% were not assignable in any stadium. Higher education level and lower grade of dependency were significantly associated with the wish to quit smoking. Six months after the baseline examination, smoking cessation visits (at least one session) was performed in 28.5% of the smokers. 13% of the smokers have quit smoking, 23% have reduced smoking and 63% did not change smoking habits positively 6 months after the first visit. CONCLUSIONS: Prevalence rates for smoking in HIV+ subjects are higher than in the general population. Readiness to quit is, however, high, and 13% of smokers who have quit smoking after six months is a remarkable short-term success. This observation underlines the importance and feasibility of addressing smoking habits in HIV care.

Anal human papillomavirus testing with Digene's hybrid capture 2 using two different sampling methods.

PURPOSE: The incidence of human papillomavirus detection in the anal canal is rising. Efficient anal screening by cytology is hampered because of poor specificity. Human papillomavirus (HPV) testing is proposed in addition to Papanicolaou (Pap) testing for the detection of cervical neoplasia. The purpose of this study was to determine the usefulness of a human papillomavirus-DNA detection test to detect human papillomavirus-associated disease and to compare two different methods of sample collection. METHODS: In 555 patients, anal samples were obtained by using a cervical brush and a Dacron swab to test for high-risk and low-risk human papillomavirus-DNA. Patients positive for human papillomavirus-DNA underwent anoscopy. Biopsies were taken from visible lesions. RESULTS: Low-risk human papillomavirus-DNA was found in 325 of 555 patients (58.6 percent) and high-risk human papillomavirus-DNA in 285 of 555 patients (51.4 percent). Positive results confined to one single test method were higher for Dacron swab sampling (2.3 vs. 4.3 percent for low-risk human papillomavirus, P < 0.0001; 3.1 vs. 4.9 percent for high-risk human papillomavirus, P < 0.001). A positive correlation of relative light units was found for both sampling methods in the total cohort (P < 0.0001) as well as for patients who tested human papillomavirus-positive by both sampling techniques (P < 0.0001). Sampling with Dacron swabs yielded higher relative light units values compared with sampling with cervical brush for low-risk human papillomavirus-DNA and high-risk human papillomavirus-DNA. CONCLUSIONS: Anal screening for human papillomavirus-DNA by hybrid capture 2 is a useful method for detection of human papillomavirus-associated disease. Sample collection using Dacron swabs identifies more human papillomavirus-positive patients, and yields higher relative light unit values than using the cervical brush. Further studies are needed to determine the exact value of hybrid capture 2 in the screening for (pre)cancerous lesions of the anal canal.