Department of Genitourinary Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
Sex Transm Dis. 2011 Dec;38(12):1107-9. doi: 10.1097/OLQ.0b013e31822e6136.
BACKGROUND: Despite antiretroviral therapy (ART), incident human immunodeficiency virus (HIV) continues to rise, and sexually transmitted infections (STI) are well known for their part in HIV transmission. National guidelines recommend routine STI screening in HIV-positive individuals, but despite this, reported uptake remains low. METHODS: We implemented a nurse-led self-screening program for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in asymptomatic HIV patients. Self-collected samples were tested for CT and GC using the GenProbe Aptima Combo 2 assay. Clinical records were reviewed for ART history, CD4 T-cell count, and plasma viral load. A screening service evaluation questionnaire was handed out. RESULTS: During an 8-month period, 976 screens were performed. In all, 143 infections were detected which would have been missed without the screening program. Overall prevalence of infection among men who have sex with men was 17.4%: rectal CT and GC, 9.8% (56/571) and 4.2% (24/571), respectively; urethal CT and GC, 2.6% (16/605) and 1.3% (8/605), respectively; and pharyngeal CT and GC, 1.7% (10/589) and 3.9% (23/589), respectively. Among heterosexual men and women, the rates of CT were 2.1% (3/141) and 1.5% (3/201), and there was no GC. Transient viremia was observed at the time of STI diagnosis in 6 patients on ART. All men who have sex with men and most women found self-swabbing acceptable, and most patients indicated that they would like to be offered testing in future. CONCLUSION: These findings highlight the need for the introduction of similar screening approaches in HIV clinics. Self-collected specimens using sensitive and specific GC and CT nucleic acid amplification tests are a convenient and acceptable way of testing, and it may address some of the barriers to screening in this population.
背景:尽管有抗逆转录病毒疗法(ART),但艾滋病毒(HIV)的新发病例仍在持续增加,性传播感染(STI)是众所周知的 HIV 传播途径。国家指南建议对 HIV 阳性个体进行常规 STI 筛查,但尽管如此,报告的接受率仍然很低。
方法:我们在无症状 HIV 患者中实施了一项由护士主导的沙眼衣原体(CT)和淋病奈瑟菌(GC)自我筛查计划。使用 GenProbe Aptima Combo 2 检测试剂盒对自我采集的样本进行 CT 和 GC 检测。临床记录回顾了 ART 史、CD4 T 细胞计数和血浆病毒载量。发放了筛查服务评估问卷。
结果:在 8 个月期间,共进行了 976 次筛查。共发现 143 例感染,如果没有筛查计划,这些感染将被遗漏。男男性行为者的总体感染率为 17.4%:直肠 CT 和 GC,分别为 9.8%(56/571)和 4.2%(24/571);尿道 CT 和 GC,分别为 2.6%(16/605)和 1.3%(8/605);和咽 CT 和 GC,分别为 1.7%(10/589)和 3.9%(23/589)。在异性恋男性和女性中,CT 的发生率分别为 2.1%(3/141)和 1.5%(3/201),GC 则没有。6 名正在接受 ART 的患者在 STI 诊断时出现一过性病毒血症。所有男男性行为者和大多数女性都认为自我采样可接受,大多数患者表示希望在未来接受检测。
结论:这些发现强调了在 HIV 诊所引入类似筛查方法的必要性。使用敏感和特异的 GC 和 CT 核酸扩增检测进行自我采集标本是一种方便和可接受的检测方法,可能解决该人群筛查的一些障碍。
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