Seksueel overdraagbare aandoeningen, waaronder HIV, in Nederland in 2007

Net als in 2006 was chlamydia in 2007 de meest gediagnosticeerde bacterikle geslachtsziekte in de soacentra, vooral bij jongeren. Het percentage positieve chlamydiatesten nder heteroseksuele mannen en vrouwen daalde enigszins, voor het eerst sinds vier jaar (van 10,6% naar 10,1%). In 2006 stabiliseerde dit percentage bij mannen die seks hebben met mannen (MSM), en die trend zette door in 2007. Het percentage positieve gonorroe-, syfilis- en hivtesten nam net als voorgaande jaren af in 2007 (respectievelijk 2,4%, 0,9% en ,5%). Deze infecties werden het meest gediagnosticeerd bij MSM. In 2007 zijn er 306 nieuwe hivdiagnoses gesteld in de soacentra, ongeveer een derde van de 864 hivpositieven die dat jaar landelijk in de hivcentra zijn gemeld. Eind 2007 waren in totaal 14.019 personen in Nederland met hiv geregistreerd. Het aandeel van MSM onder de nieuw hivinfecties nam in 2007 verder toe. Net als eerdere jaren werd in de soacentra bij MSM die bekend zijn met hun positieve hivstatus vaak nog een andere geslachtsziekte gevonden (45%). In deze groep is sinds 2004 regelmatig LGV, een agressieve variant van chlamydia, en sinds 2007 hepatitis C gediagnosticeerd. Versterkte surveillance en innovatieve interventies zijn nodig om verdere verspreiding onder MSM en naar andere groepen te voorkomen. Onder bepaalde migrantengroepen in Nederland (onder andere afkomstig uit Suriname, de Nederlandse Antillen en Aruba) komen hiv, chlamydia, gonorroe en syfilis relatief vaker voor dan onder autochtone Nederlanders. Ook deze constatering vraagt om vernieuwende maatregelen die op de bevolkingsgroepen zijn toegespitst. De soacentra bieden soazorg aan hoogrisicogroepen. In 2007 hebben ruim 78.000 personen zich daar laten testen, een toename van 13% ten opzichte van 2006. Net als in 2006 was chlamydia in 2007 de meest gediagnosticeerde bacterikle geslachtsziekte in de soacentra, vooral bij jongeren. Het percentage positieve chlamydiatesten onder heteroseksuele mannen en vrouwen daalde enigszins, voor het eerst sinds vier jaar (van 10,6% naar 10,1%). In 2006 stabiliseerde dit percentage bij mannen die seks hebben met mannen (MSM), en die trend zette door in 2007. Het percentage positieve gonorroe-, syfilis- en hivtesten nam net als voorgaande jaren af in 2007 (respectievelijk 2,4%, 0,9% en 0,5%). Deze infecties werden het meest gediagnosticeerd bij MSM.In 2007, chlamydia was the most common bacterial sexually transmitted infection (STI) diagnosed in Dutch STI centres. Similar to previous years, infections were reported especially in young heterosexuals. The proportion of positive chlamydia tests among heterosexual men and women decreased slightly for the first time in four years (from 10.6% to 10.1%). In 2006, this proportion had stabilized in men who have sex with men (MSM) with the trend continuing in 2007. The positivity rate for gonorrhoea (2.4%), syphilis (0.9%) and HIV (0.5%) continued to decrease in 2007. These infections were most frequently diagnosed in MSM. In 2007, 306 new positive HIV cases were diagnosed in STI centres in the Netherlands. This number amounts to about one third of the total number of 864 positive HIV cases registered nationally. At the end of 2007, a total of 14,019 HIV cases in care were registered in the Netherlands. The proportion of MSM among new HIV cases rose further in 2007. In line with previous years, concurrent STIs were diagnosed very frequently among MSM visiting STI centres (45%) who had known HIV positive status. In this group of men, Lymphogranuloma Venereum (LGV) an aggressive type of chlamydia, has been reported frequently since 2004; this has also been the case for hepatitis C since 2007. In this group of men, strengthened surveillance and innovative interventions are warranted in order to prevent further transmission both among MSM and to other population groups. In some specific migrant groups in the Dutch population -- for example, people from Surinam, the Netherlands Antilles and Aruba -- HIV, chlamydia, gonorrhoea and syphilis are more common than in the autochthonous Dutch population. This indicates the need for targeted intervention by risk profile. The specialised STI centres in the Netherlands offer STI testing and care targeted at high risk groups. In 2007, approximately 78,000 people used this service amounting to a rise of 13% compared to 2006

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

Seksueel overdraagbare aandoeningen, waaronder hiv, in Nederland in 2016

In 2016, the number of people who were tested at a Dutch STI clinic for a sexually transmitted infection (STI) increased, after a decrease in 2015. The percentage of people diagnosed with an STI has also increased, to 18.4 percent in 2016. It is estimated that the number of STI consultations at the general practitioner has decreased slightly. Chlamydia remains the most common STI in heterosexuals. Gonorrhoea is more common than chlamydia in men who have sex with men (MSM). STI clinics offer high-risk groups the opportunity for free STI testing. In 2016, a total of 143,139 consultations were registered at the STI clinics, an increase of 5 percent compared to 2015. The percentage of detected STIs varied per municipal health centre (GGD), ranging from 12.8 to 20.9 percent. Most STIs were detected in people infected with HIV, followed by people who had been notified for an STI. Chlamydia In 2016, 14.5 percent of STI clinic attendees were infected with chlamydia (20,698 diagnoses; an increase of 11 percent compared to the previous year). This increase can be explained in part because, since 2015, STI clinics more strictly prioritise people with a high risk of STI. The biggest increase was seen in heterosexual men (from 16.1 in 2015 to 18.0 percent in 2016). In women, the percentage of chlamydia diagnoses increased from 14.2 to 15.4. In MSM, the percentage has been stable around 10 percent for years. Gonorrhoea The number of gonorrhoea diagnoses at the STI clinics has risen in the past year with 13 percent, to 6,092 infections. The percentage of positive tests in heterosexual men (1.7 percent) and women (1.4 percent) remained stable, compared to previous years. In MSM, the percentage has increased from 10.7 percent in 2015 to 11.3 percent in 2016. The STI clinics have not yet found cases of gonorrhoea resistant to the first option antibiotic, Ceftriaxone. The number of gonorrhoea infections diagnosed by general practitioners in 2015 saw a slight decline among women, but an increase among men of 20 percent compared to 2014. Syphilis In 2016, the number of syphilis diagnoses increased by 30 percent compared to 2015, totalling 1,223 infections. This increase is mainly caused by an increase in the number of diagnoses in MSM, both those with and without HIV. Out of all syphilis infections, 95 percent was diagnosed in MSM. The percentage of positive diagnoses in heterosexual men and women remains very low; 0.19 and 0.07 percent of all consultations that tested for syphilis, respectively. HIV In 2016, 285 new HIV diagnoses were detected at the STI clinics, approximately the same number as in 2015 (288); 93 percent was detected in MSM. The percentage of HIV diagnoses in MSM decreased, from 2.8 percent in 2007 to 0.8 percent in 2016. The number of HIV patients that had their 'first care' encounter at a Dutch HIV treatment centre decreased again, from 1,033 cases in 2015 to 976 in 2016. Out of these people, 666 received their diagnosis in 2016Het aantal mensen dat zich bij een Centrum Seksuele Gezondheid (CSG) heeft laten testen op een seksueel overdraagbare aandoening (soa) is, na een daling in 2015, in 2016 weer toegenomen. Het percentage bij wie een soa werd vastgesteld is ook gestegen, tot 18,4 procent in 2016. Naar schatting is het aantal soa-consulten bij huisartsen licht gedaald. Chlamydia blijft de meest voorkomende soa onder heteroseksuelen. Onder mannen die seks hebben met mannen (MSM) werd vaker gonorroe dan chlamydia gevonden. De CSG's bieden hoog-risicogroepen de mogelijkheid om zich gratis te laten testen op soa's. In totaal zijn er in 2016 143.139 consulten geregistreerd bij de CSG's, een stijging van 5 procent ten opzichte van 2015. Het percentage gevonden soa's varieerde tussen de GGD-en; van 12,8 tot 20,9. De meeste soa's zijn gevonden bij mensen met hiv, gevolgd door mensen die waren gewaarschuwd voor een soa. Chlamydia In 2016 had 14,5 procent van de CSG-bezoekers een chlamydia-infectie (20.698 diagnoses; een toename van 11 procent ten opzichte van het jaar ervoor). Deze stijging is mogelijk deels te verklaren doordat GGD-en sinds 2015 eerder voorrang verlenen aan personen met hoog risico op soa. De grootste toename was te zien bij heteroseksuele mannen (van 16,1 in 2015 naar 18,0 procent in 2016). Bij vrouwen nam het percentage vastgestelde chlamydia toe van 14,2 naar 15,4. Onder MSM ligt dit percentage al jaren rond 10 procent. Gonorroe Het aantal gonorroe-diagnoses bij de CSG is het afgelopen jaar met 13 procent toegenomen tot 6.092 infecties. Het percentage positieven onder heteroseksuele mannen (1,7 procent) en vrouwen (1,4 procent) bleef stabiel ten opzichte van voorgaande jaren. Onder MSM is het percentage toegenomen van 10,7 procent in 2015 naar 11,3 procent in 2016. Bij CSG-bezoekers is nog steeds geen gonorroe resistent gevonden tegen het 'eerstekeus' antibioticum ceftriaxon. Het aantal gonorroe-infecties gediagnosticeerd door huisartsen in 2015 nam licht af onder vrouwen, maar steeg onder mannen met 20 procent ten opzichte van 2014. Syfilis In 2016 is het aantal diagnoses van syfilis met 30 procent gestegen ten opzichte van 2015, tot 1.223 infecties. Deze stijging komt voornamelijk door een toename in het aantal diagnoses onder MSM, zowel met als zonder hiv. Van alle syfilis-infecties werd 95 procent bij MSM vastgesteld. Het percentage positieve diagnoses onder heteroseksuele mannen en vrouwen blijft zeer laag; respectievelijk 0,19 en 0,07 procent van alle consulten waarin getest werd op syfilis. Hiv In 2016 zijn 285 nieuwe diagnoses van hiv gesteld bij de CSG, vrijwel evenveel als in 2015 (288). Drieënnegentig procent daarvan werd bij MSM vastgesteld. Het percentage hiv-diagnoses bij MSM is gedaald van 2,8 procent in 2007 tot 0,8 procent in 2016. Het aantal hiv-patiënten dat voor het eerst 'in zorg' was bij de Nederlandse hiv-behandelcentra daalde opnieuw, van 1.033 gevallen in 2015 tot 976 in 2016. Van hen hadden 666 personen de diagnose in 2016 gekregenMinisterie van VW

Gender Difference in 2-Year Mortality and Immunological Response to ART in an HIV-Infected Chinese Population, 2006–2008

Since it was initiated in 2002, the China Free Antiretroviral Treatment (ART) Program has been progressing from an emergency response to a standardized treatment and care system. As of December 31, 2009, a total of 81,880 patients in 31 provinces, autonomous regions, and special municipalities received free ART. Gender differences, however, in mortality and immunological response to ART in this cohort have never been described.To understand whether women and men who enrolled in the China National Free ART Program responded equally well to the treatment.A retrospective analysis of the national free ART databases from June 2006-December 2008 was performed. HIV-infected subjects who were 18 years or older, ART naïve at baseline, and on a 3TC regimen enrolled in the program from June 1 to December 31, 2006, were included in this study, then followed up to 2 years.Among 3457 enrolled subjects who met the inclusion criteria, 59.2% were male and 40.8% female. The majority of the subjects were 19-44 years old (77%) and married (72%). Over the full 24 months of follow-up, the mortality rate was 19.0% in males and 11.4% in females (p = 0.0014). Males on therapy for 3-24 months were more likely to die than females (HR = 1.46, 95% CI: 1.04-2.06, p = 0.0307) after adjusting for baseline characteristics. Compared to men, women had higher CD4+ counts over time after initiating ART (p<0.0001).Our study showed that women had an overall lower mortality and higher CD4+ counts than men in response to ART treatment, which may be attributed to adherence, biological factors, social, cultural and economic reasons. Further study is needed to explore these factors that might contribute to the gender differences in mortality and immunological response to ART

Maior sobrevida em pacientes com marcadores imunogenéticos de rápida progressão para a AIDS: subsídios para a assistência de enfermagem

This study sought subsidies for improving nursing care programs for AIDS patients and aimed to verify the influence of changes in sexual behavior, including the adoption of safe sex practices, associated with the survival of AIDS patients with immunogenetic markers of rapid disease progression. 27 AIDS patients were interviewed, with genetic predisposition to rapid progression to AIDS. Genes were typified through the polymerase chain reaction. In spite of the presence of immunogenetic factors, associated with individual predisposition to a rapid evolution of the disease, changes in sexual behavior, including safe sex practices and antiretroviral therapy, may be related to greater survival. This suggests that counseling, detection of risk attitudes and health education, focusing on positive health behavior, are tools nursing must use with HIV-positive patients, with a view to better quality of life and greater survival among these individuals, even among those with genetic predisposition to rapid disease progression.Los autores buscan apoyo para el perfeccionamiento de programas de enfermería, orientados a pacientes con SIDA. La finalidad de este estudio fue la de verificar la influencia del comportamiento sexual en la supervivencia de pacientes con SIDA, portadores de genes asociados a la rápida progresión de la enfermedad. Fueron estudiados 27 pacientes con SIDA. Las tipificaciones de genes fueron realizadas por la reacción en cadena de la polimerasa. No obstante la presencia de factores inmunogenéticos, asociados a la predisposición individual a la rápida evolución de la enfermedad, cambios en el comportamiento sexual, con prácticas sexuales seguras y el uso de terapia antiretroviral, pueden estar relacionados con mayor supervivencia. La orientación, la detección de actitudes de riesgo y la educación de salud con enfoque en el comportamiento positivo de salud son herramientas que la enfermería debe utilizar con portadores del VIH, buscando la mejor calidad de vida y mayor supervivencia de esos individuos, incluso en aquellos que tienen predisposición genética a la rápida progresión de la enfermedad.Com enfoque em subsídios para o aperfeiçoamento de programas de enfermagem, direcionados a pacientes com aids, o presente estudo foi realizado com o objetivo de verificar a influência do comportamento sexual na sobrevida de pacientes com aids, portadores de genes associados à rápida progressão da doença. Foram entrevistados 27 pacientes com aids, geneticamente predispostos à rápida progressão da doença. As tipificações dos genes foram realizadas pela reação em cadeia da polimerase. Os resultados sugerem que, apesar da presença de fatores imunogenéticos, associados à predisposição individual para rápida evolução da doença, as mudanças do comportamento sexual, com adoção de práticas de sexo seguro, junto ao uso da terapia anti-retroviral, podem estar relacionadas com maior sobrevida. O aconselhamento, a detecção de atitudes de risco e a educação para saúde, enfocando o comportamento positivo de saúde, são ferramentas que a enfermagem deve utilizar a portadores do HIV, visando à melhor qualidade de vida e maior sobrevida desses indivíduos, mesmo naqueles geneticamente predispostos à rápida progressão da doença

Physicians are a key to encouraging cessation of smoking among people living with HIV/AIDS: a cross-sectional study in the Kathmandu Valley, Nepal

BackgroundHIV care providers may be optimally positioned to promote smoking behaviour change in their patients, among whom smoking is both highly prevalent and uniquely harmful. Yet research on this front is scant, particularly in the developing country context. Hence, this study describes smoking behaviour among people living with HIV/AIDS (PLWHA) in the Kathmandu Valley of Nepal, and assesses the association between experience of physician-delivered smoking status assessment and readiness to quit among HIV-positive smokers.MethodsWe conducted a cross-sectional survey of PLWHA residing in the Kathmandu Valley, Nepal. Data from 321 adult PLWHA were analyzed using multiple logistic regression for correlates of current smoking and, among current smokers, of motivational readiness to quit based on the transtheoretical model (TTM) of behaviour change.ResultsOverall, 47% of participants were current smokers, with significantly higher rates among men (72%), ever- injecting drug users (IDUs), recent (30-day) alcohol consumers, those without any formal education, and those with higher HIV symptom burdens. Of 151 current smokers, 34% were thinking seriously of quitting within the next 6 months (contemplation or preparation stage of behaviour change). Adjusting for potential confounders, experience of physician-delivered smoking status assessment during any visit to a hospital or clinic in the past 12 months was associated with greater readiness to quit smoking (AOR = 3.34; 95% CI = 1.05,10.61).ConclusionsRoughly one-third of HIV-positive smokers residing in the Kathmandu Valley, Nepal, are at the contemplation or preparation stage of smoking behaviour change, with rates significantly higher among those whose physicians have asked about their smoking status during any clinical interaction over the past year. Systematic screening for smoking by physicians during routine HIV care may help to reduce the heavy burden of smoking and smoking-related morbidity and mortality within HIV-positive populations in Nepal and similar settings

Height and timing of growth spurt during puberty in young people living with vertically acquired HIV in Europe and Thailand

Objective: The aim of this study was to describe growth during puberty in young people with vertically acquired HIV. Design: Pooled data from 12 paediatric HIV cohorts in Europe and Thailand. Methods: One thousand and ninety-four children initiating a nonnucleoside reverse transcriptase inhibitor or boosted protease inhibitor based regimen aged 1-10 years were included. Super Imposition by Translation And Rotation (SITAR) models described growth from age 8 years using three parameters (average height, timing and shape of the growth spurt), dependent on age and height-for-age z-score (HAZ) (WHO references) at antiretroviral therapy (ART) initiation. Multivariate regression explored characteristics associated with these three parameters. Results: At ART initiation, median age and HAZ was 6.4 [interquartile range (IQR): 2.8, 9.0] years and -1.2 (IQR: -2.3 to -0.2), respectively. Median follow-up was 9.1 (IQR: 6.9, 11.4) years. In girls, older age and lower HAZ at ART initiation were independently associated with a growth spurt which occurred 0.41 (95% confidence interval 0.20-0.62) years later in children starting ART age 6 to 10 years compared with 1 to 2 years and 1.50 (1.21-1.78) years later in those starting with HAZ less than -3 compared with HAZ at least -1. Later growth spurts in girls resulted in continued height growth into later adolescence. In boys starting ART with HAZ less than -1, growth spurts were later in children starting ART in the oldest age group, but for HAZ at least -1, there was no association with age. Girls and boys who initiated ART with HAZ at least -1 maintained a similar height to the WHO reference mean. Conclusion: Stunting at ART initiation was associated with later growth spurts in girls. Children with HAZ at least -1 at ART initiation grew in height at the level expected in HIV negative children of a comparable age