Anal Intraepithelial Neoplasia in People Assigned Female at Birth

The experience of treating and/or losing a patient to anal cancer is deeply upsetting. Therefore, the early detection and treatment of precursors are of utmost importance to patients and clinicians. People with HIV have a higher prevalence and incidence of Human Papilloma Virus infection, an oncogenic virus, which may cause intraepithelial neoplasia, the precursor of squamous cell carcinomas in the anal canal. Though encouraging progress has been made to support gay and bisexual men and transgender women with HIV from developing anal cancer, research and health policies do not offer specific prevention strategies against anal cancer in people assigned female at birth. In this podcast Dr Tamzin Cuming outlines progress made so far and areas of research and health care that need further attention.   Links: https://iansoc.org/Board-of-Directors   Host: Ass. Prof./Dr. Fabiola Martin, BMJ STI Podcast Editor, Sexual Health and HIV Specialist, Clinical Associate Professor, Australian National University, Canberra, Australia Guest: Dr Tamzin Cuming, Consultant Colorectal Surgeon, President of International Anal Neoplasia Society, Homerton Hospital, in London, UK  

Previously we reported on the Rise of Syphilis world wide. Today we focus on the devastating effects of syphilis on parents and their children. Hand in hand with an increase in syphilis incidence in adults the rates of congenital syphilis are rising and missed opportunities to test and treat birthing parents, their partners and babies are preventable contributing factors. Congenital syphilis is caused by Treponema pallidum transmission to the foetus during pregnancy and birth, resulting in diverse clinical presentations. Congenital syphilis in a foetus may be associated with a full-term, seemingly healthy infant, but it can also cause multi-organ dysfunction, prematurity, and/or stillbirth. Routine screening and early treatment of pregnant people affected by syphilis is the hallmark of effective intervention to decrease infant morbidity and mortality. Host: Ass Prof/Dr Fabiola Martin, Canberra Sexual Health Centre and Australian National University, Canberra, Australia Guests: - Professor Clare Nourse, Member of the Order of Australia, a paediatric infection specialist at the Queensland Children’s Hospital and clinical professor of paediatrics at the University of Queensland - Dr Justin Penner, Consultant in paediatric infectious diseases at Imperial College NHS Healthcare Trust, London, UK and Honorary Senior Lecturer, Imperial College London

Continuing on the search for innovative strategies to shape the future of HIV cure research in the second part of this series, Dr Jillian Lau discusses how anti–PD1 immunotherapies and carefully designed treatment interruption studies are helping clinicians and scientists to better understand pathways to durable HIV remission. Dr Ming Lee then breaks down the results of the RIO study, highlighting the promising potential of broadly neutralising antibodies (bNAbs) in sustaining viral control without ongoing therapy. Together, they offer a forward-looking perspective on the scientific breakthroughs moving us closer to an HIV cure. Listen to part 1 of this podcast: Apple: https://podcasts.apple.com/us/podcast/world-aids-day-pt-1-progress-towards-an-hiv-cure/id356342980?i=1000739054089&uo=4 Spotify: https://open.spotify.com/episode/73LY8Eie8EQ7I5FKF6F0SM Web: https://stibmj.podbean.com/e/world-aids-day-pt-1-progress-towards-an-hiv-cure/  Links: Sustained HIV-1 remission after heterozygous CCR5Δ32 stem cell transplantation Host: Dr Ming Lee, Sexual Health Specialist, Canberra Sexual Health Centre, ACT, Australia; Honorary Clinical Senior Lecturer, Imperial College London, London, UK   Guests:  - Professor Christian Gaebler, Professor, Charité Universitätsmedizin Berlin, Berlin, Germany - Professor Beatriz Mothe, Group Leader and Senior Research Scientist, IrsiCaixa, Barcelona, Spain - Dr Jillian Lau, Infectious Disease Physician and Post doctoral Research Fellow, Department of Infectious Diseases, University of Melbourne and the Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia  

In the first of this two-part series, we explore the latest advances in the search for an HIV cure. Professor Christian Gaebler shares insights from the remarkable case of the second Berlin patient —an individual cured of HIV following a stem cell transplant—and reflects on what similar cases mean for the future of curative strategies. We’re also joined by Professor Beatriz Mothe, who discusses the promise of therapeutic vaccines and their role in long-term HIV remission, and the results of the AELIX003 study.  Links: Sustained HIV-1 remission after heterozygous CCR5Δ32 stem cell transplantation Host: Dr Ming Lee, Sexual Health Specialist, Canberra Sexual Health Centre, ACT, Australia; Honorary Clinical Senior Lecturer, Imperial College London, London, UK   Guests:  - Professor Christian Gaebler, Professor, Charité Universitätsmedizin Berlin, Berlin, Germany - Professor Beatriz Mothe, Group Leader and Senior Research Scientist, IrsiCaixa, Barcelona, Spain - Dr Jillian Lau, Infectious Disease Physician and Post doctoral Research Fellow, Department of Infectious Diseases, University of Melbourne and the Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia

Over the last decade we have seen an exponential surge in research and peer reviewed publications about the sexual health of trans and gender diverse people. We now know that sexually transmitted infections are highly prevalent in this key population and there is an urgent need for concentrated efforts made by patient advocates, health care providers, public health policy developers and governments to improve health and prevent harm in this underserved population. Today we discuss with Prof Jade Ghosn, his team's latest publication in STI BMJ titled: "Pre-exposure prophylaxis (PrEP) uptake and retention in care in a group of transgender women at high risk of HIV: a French cohort of follow-up" and with Alisha Goburdhun, her team's work in supporting and advocating for trans clients at Accpetess-T.   Host: Ass Prof/Dr Fabiola Martin, Sexual health Specialist, Canberra Sexual Health Centre, Australian National University ‌ Guests: Alisha Goburdhun, Heath Mediator at Acceptess-T, Paris, France Prof Jade Ghosn, Infectious Diseases Specialist at the Sexual Health Clinic in Bichat University Hospital in Paris, France

Most people requiring HIV pre-exposure prophylaxis (PrEP) are offered a daily or event driven oral tablet which contains two HIV antiretroviral drugs combined. Oral medication, however, may not be a feasible and/or effective PrEP option for some. FDA has approved two long-acting injectable HIV anti-viral drugs: Cabotegravir, an HIV integrase inhibitor (2 monthly injections) and Lenacapavir an HIV capsid inhibitor (6 monthly injections) as safe and efficacious HIV PrEP. Today we will discuss the efficacy of and access to long-acting HIV PrEP with Prof Sinead Delany-Moretlwe and Dr Claire Dewsnap.   STI has published extensively on the topic, here are a few examples of recent articles: Pre-exposure prophylaxis (PrEP) uptake and retention in care in a group of transgender women at high risk of HIV: a French cohort of follow-up Association between HIV risk perception, knowledge of biomedical prevention and sexual behaviour among sub-Saharan African immigrants living in a precarious situation in France Preferences for pre-exposure prophylaxis service package among men who have sex with men in Australia: a discrete choice experiment Estimating the number of people who could benefit from HIV pre-exposure prophylaxis (PrEP) in England and the unmet need Regression-based risk scores using sociodemographic and sexual behaviour data do not predict asymptomatic sexually transmitted infections among HIV PrEP users   Host: Ass Prof/Dr Fabiola Martin, Sexual Health Specialist, Associate Professor at Australian National University Guests: Prof Sinead Delany-Moretlwe, Professor of Global Health and Infectious Diseases at the University of the Witwatersrand, Johannesburg Dr Claire Dewsnap, President of the British HIV Association for HIV & Sexual Health (BASHH) and Consultant in Genitourinary Medicine, Sheffield Teaching Hospital, Sheffield, UK

Worldwide the prevalence of sexually transmitted infections is increasing. Today we will discuss innovative ways of testing and treating large number of patients with STIs that are equitable, reliable and potentially cost-effective. We will discuss the eSexual Health Clinic (eSHC) research published in The Lancet Public Health in 2017 and NIHR funded  SEQUENCE Digital research program based in UK as well as the multi-site co-designed EmERGE research program based in UK, Croatia and Zambia. Host: Ass Prof/Dr Fabiola Martin, Sexual Health Specialist, Associate Professor at Australian National University Guests: Professor Claudia Estcourt, Professor of Sexual Health & HIV in Glasgow, Scotland and in London and a sexual health clinician Dr Mary Darking, Principal Lecturer in Social Policy and Innovation at Brighton University Lancet paper: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(17)30034-8/fulltext 

Today we will discuss the evolution and efficacy of antenatal testing for blood borne pathogens as a strategy to improve pregnancy outcomes and prevent parent to child transmission. Over the last 40 years the number of infections tested for in the antenatal setting has expanded which has been followed closely by treatment guidelines for each infection. However, there are stark regional differences in the infections routinely tested for. Brazil has recently added Human T Leukaemia Virus (HTLV) to its antenatal testing and is planning to test 2.5 million pregnancies yearly. Pregnant people who test positive for HTLV are advised to avoid breast feeding and are provided with formula milk free of charge. Health care providers are being offered upskilling in HTLV care provision. This way Brazil aims to "Take HTLV out of Invisibility" and ultimately eliminate HTLV in Brazil. Host: Ass Prof/Dr Fabiola Martin, Sexual Health Specialist, Associate Professor at Australian National University Guests: Professor Graham Taylor, Head of Section of Virology at Imperial College London and a founder of the National Centre for Human Retrovirology at St. Mary’s Hospital – the UK’s clinical service for people living with Human T Leukaemia Virus (HTLV) infection. Dr Pâmela Cristina Gaspar, General Coordinator of Sexually Transmitted Infections Surveillance at Ministry of Health of Brazil, Brasilia, Brazil Host: Ass Prof/Dr Fabiola Martin, Sexual health, HIV and HTLV Specialist, Canberra, Australia and Australian National University   Brazil HTLV ANC testing: - National guide: https://www.gov.br/aids/pt-br/central-de-conteudo/publicacoes/2022/guia_htlv_internet_24-11-21-2_3.pdf/view   - Folder HTLV for general population: https://www.gov.br/aids/pt-br/assuntos/ist/materiais-informativos/folder-htlv-final-grafica.pdf  - Distance Learning Course for HTLV: https://campusvirtual.fiocruz.br/gestordecursos/hotsite/htlv    NACCHO-ASHM, Australia, HTLV testing guidelines: https://htlv1.guidelines.org.au/ 

Today we will discuss different types of HIV and Syphilis antibody testing performed at home by the patient or consumer. Home testing for HIV and Syphilis empower people, especially pregnant women who live in remote areas or are marginalised and hard to reach, to screen themselves for these two serious and communicable infections at home and seek additional confirmitory testing, treatment and support if their screening test is reactive. We will discuss what these tests are, how they can be used as well as review their merits and potential risks. Host: Dr Fabiola Martin, Sexual Health Specialist, Associate Professor at Australian National University Guest: Dr Bobbie Van Der Pol, Professor of Medicine and Public Health at the University of Alabama at Birmingham, the Director of the UAB STD Diagnostics Laboratory and President of the International Society for STD Research.

Today we will discuss if screening asymptomatic Men who have sex with Men, also referred to as MSM, who are receiving HIV pre-exposure anti-retroviral medication, called HIV PrEP, routinely for bacterial STIs, gonorrhoea and chlamydia through pharyngeal, urine and rectal PCR testing every three months- also referred to as 3x3 testing is indeed of benefit or may cause harm. This year, in Lancet HIV, the Gonoscreen trial, a randomised controlled trial, of 500 MSM on PrEP in each arm followed up for 12 months reported that 3x 3 testing does not reduce the incidence of gonorrhoea and chlamydia infections in this specific cohort. In Belgium, this trial has led to a change in clinic practice through the Belgium HIV PrEP guidelines where patients will be screened less frequently and intensely. Lancet ID on the other hand published an opinion piece by Raccagni et al where concerns about transmission and morbidity risk of untreated infection and implications of using poor quality screening tools are voiced. We will discuss today the merit of the Gonoscreen trial and other studies that support a decrease in screening & treating asymptomatic bacterial STIs and exercising stricter antimicrobial stewardship versus the risks associated with leaving asymptomatic infections untreated and risking morbidity and transmission. Relevant links: Effect of screening for Neisseria gonorrhoeae and Chlamydia trachomatis on incidence of these infections in men who have sex with men and transgender women taking HIV pre-exposure prophylaxis (the Gonoscreen study): results from a randomised, multicentre, controlled trial Primum non-nocere: Is it time to stop screening for Neisseria gonorrhoeae and Chlamydia trachomatis in men who have sex with men taking HIV pre-exposure prophylaxis? The arrested immunity hypothesis in an immunoepidemiological model of Chlamydia transmission Gonorrhoea and chlamydia screening for asymptomatic people with HIV and HIV PrEP users: open issues Host: Dr Fabiola Martin, Sexual Health Specialist and Associate Professor, Australian National University, Canberra, Australia Dr Thibaut Vanbaelen, physician and post-doctoral researcher at The Institute of Tropical Medicine in Antwerp, Belgium Dr Angelo Roberto Raccagni, physician at Vita-Salute San Raffaele University in Milan, Italy