Sexual behaviour of HIV-diagnosed men who have sex with men in England in the era of effective antiretroviral therapy: results from the ASTRA study

Transmission of HIV among men who have sex with men (MSM) in the UK is ongoing. Among HIV-diagnosed MSM, condomless sex (CLS) with HIV-serodifferent partners (CLS-D) was considered the main HIV transmission risk before evidence of the favourable impact of antiretroviral treatment (ART). Using data on HIV-diagnosed MSM from the ASTRA study (2011-2012), this thesis assessed: (i) prevalence of different types of CLS, including CLS-D with appreciable risk of HIV transmission (accounting for ART/viral load); (ii) associated co-factors (socio-demographic, lifestyle, psychological, HIV-related); (iii) prevalence and factors associated with other sexually transmitted infections (STIs), and subsequent risk of hepatitis C virus (HCV) co-infection. Among 2189 HIV-diagnosed MSM, 38% had recent CLS; 16% had CLS-D; only 4% had CLS-D with appreciable HIV transmission risk. These CLS measures tended to be associated with younger age, more recent HIV diagnosis, and not being on ART, and were strongly associated with recreational drug and polydrug use (which were prevalent). When classifying MSM into mutually exclusive categories, 36% did not have sex in the past three months; 25% had condom-protected sex only; 22% had CLS with HIV-seroconcordant partners only (‘CLS-C without CLS-D’, which may indicate HIV-serosorting); 16% had CLS-D. Chemsex-associated drug use and disclosure of HIV-status to new sex partners were more common among MSM who had ‘CLS-C without CLS-D’ compared to CLS-D. Over 10% of MSM had recent STI co-infections. Recreational and injection drug use, CLS, and multiple partners were associated with pre-existing STIs, with initial evidence of association with incident HCV. Consideration of different types of CLS among HIV-diagnosed MSM demonstrated differing implications for prevention of HIV versus other STI transmission. Expansion of ART use should further impact favourably on HIV transmission risk. There is a need for focus on harm reduction in recreational drug use and prevention of STI co-infections among HIV-diagnosed MSM

Condomless sex in HIV-diagnosed men who have sex with men in the UK: prevalence, correlates, and implications for HIV transmission

OBJECTIVE: HIV transmission is ongoing among men who have sex with men (MSM) in the UK. Sex without a condom (condomless sex, CLS) is the main risk factor. We investigated the prevalence of and factors associated with types of CLS. METHODS: Cross-sectional questionnaire study in UK HIV clinics in 2011/2012 (ASTRA). MSM diagnosed with HIV for ≥3 months reported on anal and vaginal sex, CLS with HIV-serodifferent partners (CLS-D) and CLS with HIV-seroconcordant (CLS-C) partners in the previous 3 months. Mutually exclusive sexual behaviours were as follows: (1) Higher HIV risk CLS-D (not on antiretroviral therapy (ART) or clinic-recorded viral load(VL) >50 c/mL), (2) Other CLS-D, (3) CLS-C without CLS-D, (4) Condom-protected sex only and (5) No anal or vaginal sex. Associations were examined of sociodemographic, HIV-related, lifestyle, and other sexual measures with the five categories of sexual behaviour. We examined the prevalence of higher HIV risk CLS-D incorporating (in addition to ART and VL) time on ART, ART non-adherence, and recent sexually transmitted infections (STIs). RESULTS: Among 2189 HIV-diagnosed MSM (87% on ART), prevalence of any CLS in the past 3 months was 38.2% (95% CI 36.2% to 40.4%) and that of any CLS-D was 16.3% (14.8%–17.9%). The five-category classification was as follows: (1) Higher HIV risk CLS-D: 4.2% (3.5% to 5.2%), (2) Other CLS-D: 12.1% (10.8% to 13.5%), (3) CLS-C without CLS-D: 21.9% (20.2% to 23.7%), (4) Condom-protected sex only: 25.4% (23.6% to 27.3%) and (5) No anal or vaginal sex: 36.4% (34.3% to 38.4%). Compared with men who reported condom-protected sex only, MSM who reported any CLS in the past 3 months had higher prevalence of STIs, chemsex-associated drug use, group sex, higher partner numbers, and lifetime hepatitis C. Prevalence of higher HIV risk CLS-D ranged from 4.2% to 7.5% according to criteria included. CONCLUSION: CLS was prevalent among HIV-diagnosed MSM, but CLS-D with higher HIV transmission risk was overall low. CLS-D is no longer the most appropriate measure of HIV transmission risk behaviour among people with diagnosed HIV; accounting for VL is important

Depression as a Risk Factor for the Initial Presentation of Twelve Cardiac, Cerebrovascular, and Peripheral Arterial Diseases: Data Linkage Study of 1.9 Million Women and Men

BACKGROUND: Depression is associated with coronary heart disease and stroke, but associations with a range of pathologically diverse cardiovascular diseases are not well understood. We examine the risk of 12 cardiovascular diseases according to depression status (history or new onset). METHODS: Cohort study of 1,937,360 adult men and women, free from cardiovascular disease at baseline, using linked UK electronic health records between 1997 and 2010. The exposures were new-onset depression (a new GP diagnosis of depression and/or prescription for antidepressants during a one-year baseline), and history of GP-diagnosed depression before baseline. The primary endpoint was initial presentation of 12 cardiovascular diseases after baseline. We used disease-specific Cox proportional hazards models with multiple imputation adjusting for cardiovascular risk factors (age, sex, socioeconomic status, smoking, blood pressure, diabetes, cholesterol). RESULTS: Over a median [IQR] 6.9 [2.1-10.5] years of follow-up, 18.9% had a history of depression and 94,432 incident cardiovascular events occurred. After adjustment for cardiovascular risk factors, history of depression was associated with: stable angina (Hazard Ratio = 1.38, 95%CI 1.32-1.45), unstable angina (1.70, 1.60-1.82), myocardial infarction (1.21, 1.16-1.27), unheralded coronary death (1.23, 1.14-1.32), heart failure (1.18, 1.13-1.24), cardiac arrest (1.14, 1.03-1.26), transient ischemic attack (1.31, 1.25-1.38), ischemic stroke (1.26, 1.18-1.34), subarachnoid haemorrhage (1.17, 1.01-1.35), intracerebral haemorrhage (1.30, 1.17-1.45), peripheral arterial disease (1.24, 1.18-1.30), and abdominal aortic aneurysm (1.12,1.01-1.24). New onset depression developed in 2.9% of people, among whom 63,761 cardiovascular events occurred. New onset depression was similarly associated with each of the 12 diseases, with no evidence of stronger associations compared to history of depression. The strength of association between depression and these cardiovascular diseases did not differ between women and men. CONCLUSION: Depression was prospectively associated with cardiac, cerebrovascular, and peripheral diseases, with no evidence of disease specificity. Further research is needed in understanding the specific pathophysiology of heart and vascular disease triggered by depression in healthy populations

Multicenter European Prevalence Study of Neurocognitive Impairment and Associated Factors in HIV Positive Patients

We conducted a cross-sectional study in 448 HIV positive patients attending five European outpatient clinics to determine prevalence of and factors associated with neurocognitive impairment (NCI) using computerized and pen-and-paper neuropsychological tests. NCI was defined as a normalized Z score ≤-1 in at least 2 out of 5 cognitive domains. Participants' mean age was 45.8 years; 84% male; 87% white; 56% university educated; median CD4 count 550 cells/mm(3); 89% on antiretroviral therapy. 156 (35%) participants had NCI, among whom 26 (17%; 5.8% overall) reported a decline in activities of daily living. Prevalence of NCI was lower in those always able to afford basic needs (adjusted prevalence ratio [aPR] 0.71, 95% confidence interval [CI] 0.54-0.94) or with a university education (aPR 0.72, 95% CI 0.54-0.97) and higher in those with severe depressive symptoms (aPR 1.53, 95% CI 1.09-2.14) or a significant comorbid condition (aPR 1.40, 95% CI 1.03-1.90)

Μελέτη της Vaspin σε Πειραματικό Μοντέλο Ήπιου Διαβήτη (Πειραματική Μελέτη σε επίμυες Wistar)

Τα τελευταία χρόνια γίνεται προσπάθεια για την αποτελεσματική αντιμετώπιση του Σακχαρώδους Διαβήτη. Για να επιτευχθεί αυτό, είναι απαραίτητη η κατανόηση των μηχανισμών παθογένειας του διαβήτη. Παρά τα μεγάλα βήματα προόδου σε αυτό τον τομέα, υπάρχουν ακόμη αρκετά πεδία που δεν έχουν αποσαφηνιστεί. Ένα από αυτά είναι και το σύστημα των λιποκινών, το οποίο συμμετέχει σε ποικίλες μεταβολικές διαδικασίες. Μία από τις πιο πρόσφατα ανακαλυφθείσες λιποκίνες, που δεν έχει μελετηθεί σε βάθος, είναι η βασπίνη. Επιπλέον, ένας ολοένα αυξανόμενος αριθμός μελετών κααταδεικνύει τη θετική επίδραση του φυτού Crocus sativus L. στην αντιμετώπιση του Σακχαρώδους Διαβήτη. Σκοπός της συγκεκριμένης Πτυχιακής Εργασίας ήταν η μελέτη των επιπέδων της βασπίνης στον ορό φυσιολογικών και διαβητικών επίμυων τύπου Wistar, προκειμένου να διερευνηθεί η συσχέτιση του διαβήτη με τη βασπίνη. Ακόμη, ελέγχθηκε η χορήγηση εκχυλίσματος κρόκου Κοζάνης σε διαβητικούς επίμυες, σε μια προσπάθεια διερεύνησης της επίδρασης του κρόκου στον διαβήτη. Επίσης, μελετήθηκε η συσχέτιση της χορήγησης κρόκου Κοζάνης με τα επίπεδα της βασπίνης στον ορό των επίμυων. Υλικά-Μέθοδος: Για τη μελέτη χρησιμοποιήθηκαν σαράντα λευκοί επίμυες τύπου Wistar, οι οποίοι τυχαιοποιήθηκαν σε τέσσερις ομάδες: στην πρώτη ομάδα δεν έγινε κάποια παρέμβαση, στην δεύτερη χορήγηθηκε εκχύλισμα κρόκου Κοζάνης, στην τρίτη προκλήθηκε σακχαρώδης διαβήτης με χορήγηση της ουσίας στρεπτοζοτοκίνης και στην τέταρτη προκλήθηκε σακχαρώδης διαβήτης με τον ίδιο τρόπο και οι επίμυες έλαβαν και εκχύλισμα κρόκου Κοζάνης. Καθ΄όλη τη διάρκεια της μελέτης πραγματοποιούνταν αιμοληψίες και ζύγιση των ζώων. Μετά την παρέλευση δύο μηνών από την έναρξη του πειράματος έγιναν οι ευθανασίες των ζώων και συλλέχθηκε αίμα και ιστοί τους. Τα επίπεδα της βασπίνης στον ορό των επίμυων μετρήθηκαν με ενζυμική ανοσοδοκιμασία ELISA. Αποτελέσματα: Η χορήγηση εκχυλίσματος κρόκου Κοζάνης μείωσε τα επίπεδα της γλυκόζης στο αίμα των διαβητικών επίμυων που έλαβαν τον κρόκο. Ακόμη, ο κρόκος φάνηκε ότι μείωσε σημαντικά τη συγκέντρωση χοληστερόλης και λιποπρωτεϊνης χαμηλής πυκνότητας στο αίμα των διαβητικών ζώων. Η συγκέντρωση της βασπίνης αυξήθηκε σε διαβητικούς επίμυες, ενώ μειώθηκε σε βαθμό στατιστικά σημαντικό στους διαβητικούς επίμυες που έλαβαν κρόκο Κοζάνης. Συμπεράσματα: Η χορήγηση εκχυλίσματος κρόκου Κοζάνης περιορίζει την συμπτωματολογία της νόσου και ασκεί σημαντική υπολιπιδαιμική δράση. Τα επίπεδα της βασπίνης στον ορό των διαβητικών επίμυων που έλαβαν κρόκο μείωνονται, αλλά ο μηχανισμός μέσω του οποίου συμβαίνει αυτό, παραμένει άγνωστος. Το εύρημα αυτό είναι πρωτότυπο και άξιο περαίτερω διερεύνησης.As Diabetes mellitus is a heterogeneous group of disorders, the scientific community is forced to confront this disease. In order to cope with this illness, we need to understand the pathogenic mechanisms of diabetes. Adipokines take part in glucose and lipid metabolism as well as the body's immune response and are often correlated to Diabetes mellitus. Vaspin (visceral adipose tissue-derived serine protease inhibitor), is a novel adipokine which could be a potential biomarker for the prevention of diabetes. Furthermore, Crocus sativus is a pharmaceutical plant which is claimed to affect Diabetes mellitus. The aim of this study was to investigate the serum vaspin levels in normal and diabetic Wistar rats in order to understand the correlation between diabetes mellitus and vaspin. Moreover, we administrated Crocus sativus extract in diabetic rats to investigate the effect of Crocus sativus on diabetes. Furthermore, we studied the effect of Crocus sativus on serum vaspin levels. Materials and Methods: Forty rats were randomized initially into 4 experimental groups as follows: Control, Crocus sativus group, Diabetes group where animals received one intraperitoneal injection of relatively low dose streptozotocin and Diabetes and Crocus sativus group. Throughout the whole study, blood samples and weights were collected. Vaspin levels were determined by enzyme-linked immunosorbent assay (ELISA). Results: At the end of the study, regarding the diabetic group receiving Crocus sativus, the biochemical analysis revealed lower serum glucose concentration as compared to the Diabetes group. Furthermore, in the Diabetes and Crocus sativus group we observed lower levels of total cholesterol and low density lipoprotein in comparison to the Diabetes group. Serum vaspin concentrations were increased in Diabeted group as compared to Control group, statistical significant decrease of these levels was observed in Diabetes and Crocus sativus group. Conclusions: Crocus sativus administration in diabetic rats reduces the diabetes mellitus symptoms and enhances the lipidemic profile. Serum vaspin levels in Diabetes and Crocus sativus group are very low, but at the moment the exact mechanism of Crocus's action in vaspin concentration is unknown. Nonetheless, further research is required in order to understand the hidden pathways

Study of novel biomarkers in patients with ascending aortic aneurysm

Thoracic aortic aneurysms (TAA) often go undetected to the point where they strike brutally and cause terrible consequences. Aortic dissection and rupture account for 2%-7% of all sudden cardiac fatalities in the general population, which represents a significant mortality load. Up to 22% of patients who experience acute aortic events are pronounced dead before reaching the hospital. It is estimated that in the Unites States alone, aortic diseases account for about 13.000 deaths annually and act as a contributing factor in more than 16.415 deaths making them the 17th most common cause of mortality in people older than 50 years. Moreover, many thoracic aortic-related sudden deaths can be misdiagnosed as myocardial infarction. As such, it is possible that these data significantly underestimates the true burden of aortic diseases in the population. This evidence highlights the significance of timely detection of TAA since it is rampant but asymptomatic, hence termed “silent killer”.TAA can be categorized as either heritable or degenerative from an etiologic perspective. Less than 30% of all TAA cases are genetically triggered, whereas more than 70% are degenerative. Mutations in genes encoding proteins such as Smooth Muscle (SM) contractile proteins, Extracellular Matrix (ECM) proteins and proteins involved in Transforming Growth Factor beta (TGF-β) signaling are the main causes of genetically triggered TAA. Sporadic TAA are primarily linked to risk factors such as age, male sex, smoking and hypertension. In the context of aneurysmal diseases of the thoracic aorta, ascending (ATAA) and descending (DTAA) aneurysms behave as two distinct types of disorders. This could be explained due to the different embryologic origins of ascending and descending aortic vascular smooth muscle cells (VSMCs), which are in charge of secreting many of the proteolytic factors associated with aneurysm formation, including matrix metalloproteinase (MMP) and plasmin.Currently, the diagnosis of ATAA is largely based on imaging tests (echocardiography, computed tomography and magnetic resonance imaging), which are frequently performed for unrelated purposes; therefore the aneurysm is found by accident. However, ATAA in patients who are not subjected to those imaging studies remains undetected and complications, such as aortic dissection and rupture, might occur. There are no effective preventive strategies for TAA, thus, early detection, surveillance and treatment are critical to improving outcomes.The development of biomarkers that could be helpful in identifying individuals with thoracic aortic illness are investigated. However, to date, the majority of biomarkers are mostly successful in identifying aortic disease after an aortic dissection or rupture has taken place. Hence, in order to improve clinical care and outcomes for this fatal disease it is essential to establish new ways to help in the identification of people at risk of currently having or developing a thoracic aneurysm. Using a targeted proteomic approach, we sought to investigate the effect of the formation of an ascending thoracic aortic aneurysm on the proteomic profile in the serum of patients identified with ATAA in an effort to develop potential biomarkers for the detection of ATAA.In this study, 52 patients were divided into three groups depending on their ascending aorta diameter: 4.0-4.5 cm (N=23), 4.6-5.0 cm (N=20), and >5.0 cm (N=9). A total of 30 controls were in-house populations ethnically matched to cases without known or visible ATAA-related symptoms and had no ATAA familial history. Before the debut of our study, all patients provided medical history and underwent physical examination. Diagnosis was confirmed by echocardiography and angio-computed tomography (CT) scans. Targeted-proteomic analysis was conducted to identify possible biomarkers for the diagnosis of ATAA.Kruskal-Wallis test revealed that C-C motif chemokine ligand 5 (CCL5), defensin beta 1 (HBD1), intracellular adhesion molecule- 1 (ICAM1), interleukin-8 (IL8), tumor necrosis factor alpha (TNFα) and transforming growth factor-beta 1 (TGFB1) expressions are significantly increased in ATAA patients in comparison to control subjects with physiological aorta diameter (p5,0 cm (N=9). Συνολικά 30 άτομα ελέγχου ήταν πληθυσμοί που αντιστοιχούσαν σε περιπτώσεις χωρίς γνωστά ή ορατά συμπτώματα που σχετίζονταν με ανεύρυσμα ανιούσης θωρακικής αορτής και δεν είχαν οικογενειακό ιστορικό ανεύρυσμα ανιούσης θωρακικής αορτής. Πριν από την έναρξη της μελέτης μας, όλοι οι ασθενείς παρείχαν ιατρικό ιστορικό και υποβλήθηκαν σε φυσική εξέταση. Η διάγνωση επιβεβαιώθηκε με υπερηχοκαρδιογραφία και αξονική τομογραφία (CT). Διεξήχθη στοχευμένη πρωτεωμική ανάλυση για τον εντοπισμό πιθανών βιοδεικτών για τη διάγνωση της ανεύρυσμα ανιούσης θωρακικής αορτής.Η στατιστική ανάλυση Kruskal-Wallis αποκάλυψε ότι οι εκφράσεις των α) CCL5 (προσδέτης 5 της χημειοκίνης (μοτίβο C-C)), β) HBD1 (β1 ντιφενσίνης), γ) ICAM1 (ενδοκυτταρικό μόριο προσκόλλησης 1), δ) IL8 (ιντερλευκίνη 8), ε) TNFα (παράγοντας νέκρωσης όγκων άλφα) και TGFB1 (μετασχηματιστικός αυξητικός παράγοντας β1) είναι σημαντικά αυξημένες στους ασθενείς με ανεύρυσμα ανιούσης θωρακικής αορτής σε σύγκριση με τα άτομα ελέγχου με φυσιολογική διάμετρο αορτής (p<0,0001). Η ανάλυση χαρακτηριστικών δέκτη-λειτουργίας έδειξε ότι οι τιμές της περιοχής κάτω από την καμπύλη για την CCL5 (0,84), την HBD1 (0,83) και την ICAM1 (0,83) ήταν ανώτερες από εκείνες των άλλων πρωτεϊνών που αναλύθηκαν.Συμπερασματικά, η μελέτη μας έδειξε ότι οι CCL5, HBD1 και ICAM1 είναι πολύ υποσχόμενοι βιοδείκτες με ικανοποιητική ευαισθησία και ειδικότητα που θα μπορούσαν να είναι χρήσιμοι στη διαστρωμάτωση του κινδύνου για την ανάπτυξη ανευρύσματος ανιούσης θωρακικής αορτής. Αυτοί οι βιοδείκτες μπορούν να βοηθήσουν στη διάγνωση και την παρακολούθηση των ασθενών που διατρέχουν κίνδυνο ανάπτυξης ανευρύσματος ανιούσης θωρακικής αορτής. Η μελέτη μας είναι πολύ ενθαρρυντική- ωστόσο, θεωρείται αναγκαίο να διεξαχθούν περαιτέρω εμπεριστατωμένες μελέτες για τη διερεύνηση του ρόλου αυτών των βιοδεικτών στην παθογένεια του ανευρύσματος ανιούσης θωρακικής αορτής

The screening role of an introductory course in cognitive therapy training

Objective: This study examines the role of an introductory course in cognitive therapy and the relative importance of trainees’ characteristics in the selection process for an advanced course in cognitive therapy. Method: The authors assessed the files of all trainees who completed one academic year introductory course in cognitive therapy over the last seven consecutive years (N = 203). The authors examined variables such as previous training, overall involvement during the course, performance, and ability to relate to others, as well as the trainer’s evaluations of their performance. Results: Interaction skills in group situations and performance in written assignments were better predictors for admission into the advanced course. Conclusions: Trainees’ abilities to learn and to successfully relate to others in group situations are critical for entering an advanced cognitive therapy training course. These findings question the policy of full-scale training in cognitive therapy based merely on the candidates’ professional background, stressing instead the merits of an introductory course as an appropriate screening procedure