The Prevalence and Patterns of Menopausal Symptoms in Women Living with HIV.

Increasing numbers of women with HIV are experiencing menopause. We use data from a large, representative sample of women with HIV to describe the prevalence and clustering of menopausal symptoms amongst pre-, peri- and post-menopausal women using hierarchical agglomerative cluster analysis. Of the 709 women included, 21.6%, 44.9% and 33.6% were pre-, peri- and post-menopausal, respectively. Joint pain (66.4%) was the most commonly reported symptom, followed by hot flashes (63.0%), exhaustion (61.6%) and sleep problems (61.4%). All symptoms were reported more commonly by peri- and post-menopausal women compared to pre-menopausal women. Psychological symptoms and sleep problems clustered together at all menopausal stages. Somatic and urogenital symptom clusters emerged more distinctly at peri- and post-menopause. We recommend regular and proactive assessment of menopausal symptoms in midlife women with HIV, with an awareness of how particular patterns of symptoms may evolve over the menopausal transition.

Ethnic disparities in hospitalisation and hospital-outcomes during the second wave of COVID-19 infection in east London.

It is unclear if changes in public behaviours, developments in COVID-19 treatments, improved patient care, and directed policy initiatives have altered outcomes for minority ethnic groups in the second pandemic wave. This was a prospective analysis of patients aged ≥ 16 years having an emergency admission with SARS-CoV-2 infection between 01/09/2020 and 17/02/2021 to acute NHS hospitals in east London. Multivariable survival analysis was used to assess associations between ethnicity and mortality accounting for predefined risk factors. Age-standardised rates of hospital admission relative to the local population were compared between ethnic groups. Of 5533 patients, the ethnic distribution was White (n = 1805, 32.6%), Asian/Asian British (n = 1983, 35.8%), Black/Black British (n = 634, 11.4%), Mixed/Other (n = 433, 7.8%), and unknown (n = 678, 12.2%). Excluding 678 patients with missing data, 4855 were included in multivariable analysis. Relative to the White population, Asian and Black populations experienced 4.1 times (3.77-4.39) and 2.1 times (1.88-2.33) higher rates of age-standardised hospital admission. After adjustment for various patient risk factors including age, sex, and socioeconomic deprivation, Asian patients were at significantly higher risk of death within 30 days (HR 1.47 [1.24-1.73]). No association with increased risk of death in hospitalised patients was observed for Black or Mixed/Other ethnicity. Asian and Black ethnic groups continue to experience poor outcomes following COVID-19. Despite higher-than-expected rates of hospital admission, Black and Asian patients also experienced similar or greater risk of death in hospital since the start of the pandemic, implying a higher overall risk of COVID-19 associated death in these communities.

A descriptive study of British South Asians living with HIV in North East London.

To our knowledge, no published literature has focused on South Asians living with HIV in the U.K. since 2004. We reviewed the case-notes of all patients self-identifying as South Asian attending two HIV centres in North East London between 1st January and 31st December 2017.Of 131 patients, 107 were male, median age 43 (range 24-72). Most (73.3%) were born outside the U.K., 55.7% were Muslim. 56.5% identified as heterosexual. However, 5.4% of heterosexual men may have become infected from sex between men. More men who have sex with men (MSM) (59.6%) were diagnosed on routine screening rather than when symptomatic or through partner notification, compared to heterosexual men (30.6%) and women (48.0%). Heterosexual men and women were diagnosed with lower CD4 counts than MSM (257 vs 307 vs 456 cells/µL). . Almost all of the sample were on antiretroviral treatment (97.7%), of whom 94.5% had an undetectable viral load (<200 copies/ml). The cohort was highly co-morbid (60.3%) and 38.9% had a history of poor mental health.We describe a diverse sample of British South Asians living with HIV We recommend that culturally specific campaigns encouraging routine HIV testing in the British South Asian population should be developed.

"Support for the supporters": a qualitative study of the use of WhatsApp by and for mentor mothers with HIV in the UK.

Third-sector organizations, an important support for people living with HIV, increasingly use digital technology to improve service efficiency and reach. However, there is limited empirical evidence on this use by women living with HIV. The 4M Network (4MNet) is a peer-run UK-wide network of trained Mentor Mothers (MMs) living with HIV; it uses the WhatsApp platform as its primary digital communication tool. We report on a qualitative study about 4MNet MMs' experiences of using WhatsApp, to inform the design of future digital support services. Seven telephone interviews were conducted with five MMs and two project management team (PMT) members in February 2019. Interviews were analyzed using Interpretive Phenomenological Analysis (IPA). WhatsApp was found to have several key features that provided both positive and negative use considerations. WhatsApp eased communication among MMs and supported participation in group activities despite differing schedules and geographic locations. Challenges encountered with WhatsApp included: financial restrictions to data storage and continual access; self-confidence using technology; and security and privacy concerns. Peer-led digital communication is found to be acceptable and effective for women living with HIV. Understanding barriers and valued features of existing digital platforms increasingly used among potentially marginalized groups is vital for informing inclusive innovation.

Incorporating HIV/hepatitis B virus/hepatitis C virus combined testing into routine blood tests in nine UK Emergency Departments: the "Going Viral" campaign.

OBJECTIVES: Routine HIV screening is recommended in those UK hospitals and primary care settings where the HIV prevalence is > 0.2%. For hepatitis B virus (HBV) and hepatitis C virus (HCV), however, testing is targeted at at-risk groups. We investigated the prevalence of these blood-borne viruses (BBVs) during a routine testing pilot in UK Emergency Departments (EDs). METHODS: During the "Going Viral" campaign (13-19 October 2014), nine UK EDs in areas of high HIV prevalence offered routine tests for HIV, HBV and HCV to adults having blood taken as part of routine care. Patients who tested positive were linked to care. RESULTS: A total of 7807 patients had blood taken during their ED visit; of these, 2118 (27%) were tested for BBVs (range 9-65%). Seventy-one BBV tests were positive (3.4%) with 32 (45.1%) new diagnoses. There were 39 HCV infections (15 newly diagnosed), 17 HIV infections (six newly diagnosed), and 15 HBV infections (11 newly diagnosed). Those aged 25-54 years had the highest prevalence: 2.46% for HCV, 1.36% for HIV and 1.09% for HBV. Assuming the cost per diagnosis is £7, the cost per new case detected would be £988 for HCV, £1351 for HBV and £2478 for HIV. CONCLUSIONS: In the first study in the UK to report prospectively on BBV prevalence in the ED, we identified a high number of new viral hepatitis diagnoses, especially hepatitis C, in addition to the HIV diagnoses. Testing for HIV alone would have missed 54 viral hepatitis diagnoses (26 new), supporting further evaluation of routine BBV testing in UK EDs.

Intimate partner violence in women living with HIV attending an inner city clinic in the UK: prevalence and associated factors.

OBJECTIVES: Studies have shown high rates of intimate partner violence (IPV) in women living with HIV, but data from the UK are lacking. We aimed to estimate the prevalence of IPV and identify associated factors in women attending our inner London HIV clinic. METHODS: We conducted a cross-sectional study of women attending our HIV clinic in May to December 2011. Participants completed a standardized questionnaire and exposure to IPV was ascertained using a validated tool. Clinical data were collected from patient records. Logistic regression models were fitted to estimate adjusted odds ratios (AORs). RESULTS: This analysis was based on 191 women with available data on IPV. The median age of women was 38 years (range 21-71 years); 74.1% were African-born Black. Over half (99 of 191; 52%) reported experiencing IPV in their lifetime, with 27 of 191 (14.1%) reporting IPV within the past year and 27 of 191 (14.1%) reporting it in pregnancy. Lifetime experience of IPV was associated with mental health problems [AOR 3.44; 95% confidence interval (CI) 1.24-9.57; P < 0.05] and 'other' Black (born outside sub-Saharan Africa) ethnicity (AOR 4.63; 95% CI 1.06-20.11; P < 0.05). We also found an association between older age and decreased likelihood of lifetime IPV (AOR 0.92; 95% CI 0.86-0.97; P < 0.05). CONCLUSIONS: Over half of the women in this study reported lifetime experience of IPV. We found associations between IPV and mental health problems, younger age and other Black ethnicity. In view of its high prevalence, we advocate greater awareness of IPV among HIV healthcare professionals and recommend universal screening.

Testing the fathers: carrying out HIV and STI tests on partners of pregnant women.

OBJECTIVES: Opt out antenatal HIV testing has significantly reduced mother to child transmission of HIV, but seroconversion during pregnancy from undiagnosed HIV positive male partners remains a risk. The authors report on a pilot initiative for sexual health and HIV screening for male partners of women attending antenatal ultrasound examination at Homerton Hospital, London. METHODS: Men attending with their female partners for routine ultrasound examination between 1 August 2010 and 31 January 2011 were offered on-site serology for HIV, syphilis, hepatitis B and hepatitis C and urine testing for Neiserria gonorrhoeae and Chlamydia trachomatis. RESULTS: were followed up through the genitourinary medicine service. Referral pathways were established for men with positive results. RESULTS: 1243 male partners of 2400 women attended ultrasound examinations, of whom 430 accepted testing (acceptance rate 35% and coverage rate 18%). Median age was 32 years (range 19-52). 112/430 (26%) male partners were of black ethnicity. 41% had previously had a HIV test. There was no difference in prior HIV testing between whites and non-whites. 16 infections were diagnosed, including two cases of hepatitis C, eight cases of hepatitis B and six cases of C trachomatis. No HIV diagnoses were made. CONCLUSIONS: The authors have shown that it is acceptable and feasible to engage heterosexual men for testing in this setting. Of those men who accepted HIV testing, more than half had never been previously tested. 4% of men tested had an infection, which had the potential to affect the outcome of the pregnancy.

Hereditary angioedema: an unusual cause of genital swelling presenting to a genitourinary medicine clinic.

We report a case of a new diagnosis of hereditary angioedema (HAE) presenting with genital swelling to a genitourinary (GU) medicine clinic. There is often a significant delay in diagnosing HAE, but it commonly presents with genital swelling before manifesting as potentially life-threatening visceral attacks. This case highlights the fact that HAE should be considered as an important differential diagnosis of genital oedema, as early recognition may help to prevent more serious future visceral episodes.

Leiomyosarcoma in an HIV-infected adult with renal and central nervous system involvement.

We describe a case of leiomyosarcoma in an HIV-infected adult with renal and central nervous system involvement and possibly the lungs.