Sexually transmitted infections, including HIV, in the Netherlands in 2013

Het aantal mensen dat zich bij een Centrum Seksuele Gezondheid heeft laten testen op een seksueel overdraagbare aandoening (soa) is verder gestegen in 2013. Het percentage mensen met een soa is voor het eerst licht gedaald (met 0,4 procent) sinds 2007. Desondanks blijft dit percentage hoog (14,7 procent). Een goed functionerende soa-monitoring blijft daarom essentieel om zicht te houden op relevante trends, opkomende soa binnen groepen die een grotere kans hebben er een op te lopen, en de effectiviteit van preventieprogramma's. De Centra Seksuele Gezondheid (CSG), voorheen soa-poli's, bieden hoogrisicogroepen de mogelijkheid om zich gratis te laten testen op soa en verstrekken medicatie als er een wordt vastgesteld. Het totaal aantal consulten in 2013 bedroeg 133.585 en is met 10 procent toegenomen ten opzichte van 2012. Van alle bezoekers werden de meeste soa gediagnosticeerd bij mensen die ervoor gewaarschuwd waren dat ze mogelijk een soa hadden opgelopen, mensen jonger dan 25 jaar, migranten uit gebieden waar soa en hiv veel voorkomen (bijvoorbeeld Afrika, Zuid-Amerika of Oost-Europa), of mannen die seks hebben met mannen (MSM). Chlamydia Net als in voorgaande jaren was chlamydia de meest gediagnosticeerde soa bij de CSG in 2013 (15.767 diagnoses). Het percentage mensen dat chlamydia had, daalde licht ten opzichte van 2012 (van 12,2 naar 11,8 procent). Chlamydia werd het meest vastgesteld bij heteroseksuelen, zowel mannen als vrouwen, onder de 25 jaar. Na de uitschieter in 2012 van het aantal en percentage mensen met een agressieve variant van chlamydia, lymphogranuloma venereum, zijn deze cijfers weer afgenomen naar het niveau van de jaren daarvoor (7 procent in 2013). Gonorroe Het percentage personen met een gonorroe-infectie bij de CSG bleef in 2013 stabiel ten opzichte van 2012 (3,6 procent in 2012 en 3,4 procent in 2013), nadat het in de voorgaande jaren licht was gestegen. Deze soa werd het meest gediagnosticeerd bij MSM. Het blijft belangrijk om te volgen of de gonorroe-bacterie resistent raakt tegen de antibiotica die in Nederland voorgeschreven worden, de zogenoemde derde generatie cefalosporines. In diverse Europese landen is deze resistentie waargenomen. Hiv Het aantal personen met een hiv-infectie, gediagnosticeerd bij een van de CSG, is in 2013 gelijk gebleven ten opzichte van 2012 (358 versus 356 in 2012). Het percentage positieve testen daalt sinds 2008: van 3,0 procent naar 1,4 procent bij MSM in 2013. Het percentage mensen dat in een laat stadium van een hiv-infectie bij een hiv-behandelcentrum komt, is de afgelopen jaren gedaald. Het is van belang om tijdig de hiv-diagnose te stellen en zo snel mogelijk de behandeling te starten, omdat hierdoor de gezondheidsschade bij de patiënt verkleind kan worden. Ook neemt door behandeling de besmettelijkheid af, waardoor de kans kleiner is dat hiv wordt overgedragen.In 2013, more people were tested for sexually transmitted infections (STI) at Dutch STI clinics than in previous years. Although the percentage of people with an STI showed a slight decrease (0.4 per cent) for the first time since 2007, it remained high at 14.7 per cent. Effective STI monitoring remains essential for the identification of relevant trends, emerging STIs in high-risk groups, and the effectiveness of prevention programmes. STI clinics offer high-risk groups access to free testing for STI and provide care and treatment if an STI is diagnosed. The total number of consultations in 2013 was 133,585, an increase of 10% compared with 2012. In 2013, STI clinic attendees with an STI were mainly people who reported having been notified of their possible exposure to STI, people aged 20-24, people originating from areas in which STI/HIV is common (e.g. Africa, South America or Eastern Europe), and men who have sex with men (MSM). Chlamydia With 15,767 cases, chlamydia remains the most commonly diagnosed STI in 2013. The percentage of people diagnosed with chlamydia was slightly lower in 2013 than in 2012 (11.8 versus 12.2 respectively). Chlamydia was primarily diagnosed in heterosexuals younger than 25 years old and in both men and women. Following the increase in the number and percentage of lymphogranuloma venereum (LGV; an aggressive variant of chlamydia) infections in 2012, these numbers declined to a level comparable to previous years in 2013. Gonorrhoea Whereas the percentage of people with a gonorrhoea infection slightly had increased in previous years, the percentage remained stable in 2013 (3.4 per cent) compared with 2012 (3.6 per cent). Gonorrhoea was mostly diagnosed in MSM. It remains important to monitor the resistance of the gonorrhoea bacteria against the antibiotic currently recommended in the Netherlands, a third-generation cephalosporin. A rising rate of resistance to this antibiotic has been observed in several European countries. HIVThe number of people diagnosed with HIV at STI clinics in 2013 was similar to that of 2012 (358 versus 356 respectively). Among MSM, the percentage of positive HIV tests decreased from 3.0 per cent in 2008 to 1.4 per cent in 2013. The percentage of HIV-positive people who were diagnosed at a late stage of the infection has decreased in previous years. Early diagnosis and treatment of an HIV infection is important because of individual health benefits and the potential reduction of HIV transmission

Dementia incidence trend over 1992-2014 in the Netherlands: analysis of primary care data

$\textbf{Background:}$ Recent reports have suggested declining age-specific incidence rates of dementia in high-income countries over time. Improved education and cardiovascular health in early age have been suggested to bring about this effect. The aim of this study was to estimate the age- specific dementia-incidence trend in primary care records from a large population in the Netherlands. $\textbf{Methods and findings:}$ A dynamic cohort representative of the Dutch population was composed using primary care records from general practice registration networks (GPRN) across the country. Data regarding dementia incidence were obtained using general practitioner-recorded diagnosis of dementia within the electronic health records. Age-specific dementia incidence rates were calculated for all persons aged 60 years and over; negative binomial regression analysis was used to estimate the time trend. Nine out of eleven GPRNs provided data on more than 800,000 older people between 1992 and 2014, corresponding to over 4 million person- years and 23,186 incident dementia cases. The annual growth in dementia incidence rate was estimated to be 2.1% (95%CI 0.5 to 3.8%), and incidence rates were 1.08 (95%CI 1.04 to 1.13) times higher for women compared to men. There was no significant overall change since the start of a national dementia program in 2003. Despite their relatively low numbers of person years, the highest age groups contributed most to the increasing trend. Increased awareness of dementia by patients and doctors in more recent years may have influenced dementia diagnosis in GPs’ electronic health records, and needs to be taken into account when interpreting the data. $\textbf{Conclusions:}$ Within the clinical records of a large, representative sample of the Dutch population, we found no evidence for a declining incidence trend of dementia in the Netherlands. This could indicate true stability in incidence rates, or a balance between increased detection and a true reduction. Irrespective of the exact rates and mechanisms underlying these findings, they illustrate that the burden of work for physicians and nurses in general practice associated with newly diagnosed dementia has not been subject to substantial change in the past two decades. Hence, with the ageing of Western societies, we still need to anticipate on a dramatic absolute increase of dementia occurrence over the years to come

Citrullination facilitates cross-reactivity of rheumatoid factor with non-IgG1 Fc epitopes in rheumatoid arthritis

Rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPAs) are the two most prevalent autoantibodies in rheumatoid arthritis (RA), and are thought to have distinct autoantigen targets. Whilst RF targets the Fc region of antibodies, ACPAs target a far broader spectrum of citrullinated peptides. Here we demonstrate significant sequence and structural homology between proposed RF target epitopes in IgG1 Fc and the ACPA target fibrinogen. Two of the three homologous sequences were susceptible to citrullination, and this modification, which occurs extensively in RA, permitted significant cross-reactivity of RF+ patient sera with fibrinogen in both western blots and ELISAs. Crucially, this reactivity was specific to RF as it was absent in RF− patient and healthy control sera, and could be inhibited by pre-incubation with IgG1 Fc. These studies establish fibrinogen as a common target for both RF and ACPAs, and suggest a new mechanism in RF-mediated autoimmune diseases wherein RF may act as a precursor from which the ACPA response evolves

Antibodies against cyclic citrullinated peptide don’t decrease after 6 months of infliximab treatment in refractory rheumatoid arthritis

Anti-citrullinated peptide antibodies (ACPA) and the rheumatoid factor (RF) are well-established serological markers for rheumatoid arthritis (RA). ACPA are very useful in the diagnosis of RA, especially at the early stages of the disease when ACPA have a greater diagnostic value than RF. The aim of the study was to assess the influence of infliximab treatment on RF IgM and ACPA serum levels and RA activity during 6 months of treatment. Thirty-two patients with refractory RA were treated with infliximab during a 6-month period. At baseline, 3 and 6 months of treatment the patients were examined for the number swollen and tender joints out of 28 (SJC, TJC) and the visual analogue scale of arthritis activity according to the patient (VAS). Serum samples were tested for erythrocyte sedimentation rate (ESR), C-reactive protein level (CRP), ACPA and RF IgM. The disease activity score (DAS-28) parameter was also calculated at the same time. During the course of our study, we observed statistically significant improvement in ESR, CRP, TJC, SJC, VAS DAS-28, and RF IgM after 3 and 6 months of infliximab treatment when compared to the baseline, whereas the ACPA level remained unchanged after 3 and 6 months of treatment (P = 0.96 and P = 0.85). The changes in the ACPA level are not a factor for evaluation of successful infliximab treatment but the changes in RF IgM are. According to different behavior of these antibodies during infliximab treatment, we suggest that the roles of ACPA and RF in the pathogenesis of RA are different

Predicting the Risk of Rheumatoid Arthritis and Its Age of Onset through Modelling Genetic Risk Variants with Smoking

The improved characterisation of risk factors for rheumatoid arthritis (RA) suggests they could be combined to identify individuals at increased disease risks in whom preventive strategies may be evaluated. We aimed to develop an RA prediction model capable of generating clinically relevant predictive data and to determine if it better predicted younger onset RA (YORA). Our novel modelling approach combined odds ratios for 15 four-digit/10 two-digit HLA-DRB1 alleles, 31 single nucleotide polymorphisms (SNPs) and ever-smoking status in males to determine risk using computer simulation and confidence interval based risk categorisation. Only males were evaluated in our models incorporating smoking as ever-smoking is a significant risk factor for RA in men but not women. We developed multiple models to evaluate each risk factor's impact on prediction. Each model's ability to discriminate anti-citrullinated protein antibody (ACPA)-positive RA from controls was evaluated in two cohorts: Wellcome Trust Case Control Consortium (WTCCC: 1,516 cases; 1,647 controls); UK RA Genetics Group Consortium (UKRAGG: 2,623 cases; 1,500 controls). HLA and smoking provided strongest prediction with good discrimination evidenced by an HLA-smoking model area under the curve (AUC) value of 0.813 in both WTCCC and UKRAGG. SNPs provided minimal prediction (AUC 0.660 WTCCC/0.617 UKRAGG). Whilst high individual risks were identified, with some cases having estimated lifetime risks of 86%, only a minority overall had substantially increased odds for RA. High risks from the HLA model were associated with YORA (P<0.0001); ever-smoking associated with older onset disease. This latter finding suggests smoking's impact on RA risk manifests later in life. Our modelling demonstrates that combining risk factors provides clinically informative RA prediction; additionally HLA and smoking status can be used to predict the risk of younger and older onset RA, respectively