Freedomhealth Blog

Photodynamic Therapy PDT for Skin Cancer

2010-10-28T13:38:00.005+01:00

Some of you may have seen Amanda Platell's article in the Daily Mail on Tuesday about Photodynamic Therapy (PDT for short) and the treatment of skin cancers and skin pre-cancers.

In essence the article described the use of chemicals applied to the skin which then make rapidly growing skin cancer cells very susceptible to the damaging effects of particular light sources. Normal surrounding skin cells are unaffected so collateral damage is very limited. The technique can be used for other tumours in which case the photo-sensitising chemical is either swallowed or injected.

This technique does not involve the use of radiation - it just relies on the increased susceptibility of rapidly growing (jargon = hyperproliferative) skin cancer cells to take up the sensitising chemical and then become much more vulnerable to light.

The British Association of Dermatologists have produced a very good patient information leaflet on PhotoDynamic Therapy and also on Basal Cell Carcinoma's.

The disadvantage of photodynamic therapy is primarily that it can only be used for certain types of skin cancer and pre-cancers and these have to be carefull assessed and pre-determined by taking a very fine biopsy sample for laboratory analysis. The treatable skin cancers are basal cell carcinomas, Bowen's Disease and also actinic keratosis. Anatomical positioning is also important because although collateral damage to normal skin cells is most unlikely and unusual great care has to be used in areas such as the surrounds of the eye.

Malignant melanomas are currently definitely not amenable to treatment with routine photodynamic therapy or PDT at the moment.

What happens when using photodynamic therapy?

Well to begin, a skin biopsy, usually using a device called a punch biopsy is taken to make the diagnosis. This sounds rather horrid but there is no "punching" involved. Following application of a small amount of anaesthetic a tiny 2mm core of tissue is taken from the suspect target skin cancer.

The sample is sent for histology at our laboratory where the exact type of skin cancer or pre-cancer is determined and also very importantly the depth of the tumour. The depth is important because there are some sorts of basal cell skin cancers which do not respond to photodynamic therapy because they are too deep. These need to be surgically removed.

How does PDT - photodynamic therapy, work?

A specially prepared chemical cream called methyl aminolevulinate (MAL) is applied to the target area and then covered with a dressing which keeps out light. This remains on the skin for a variable period - usually a few hours and the patient is free to leave the clinic and return later.

The MAL will cause the production of porphorins in the rapidly growing and dividing cancer cells. By exposing the target area which had previously been covered by the MAL cream to a specific red or blue wavelength light, the porphrins will create oxygen free radicals within the cells which will then kill the cancer cells.

Typically two treatments are needed at a 7 day interval. During application of the cream and also the application of the red or blue light source there is usually no pain.

After the light exposure has finished there can be quite an intense discomfort localised to the target area which a few patients have likened to a hot "fizzing" sensation. This is generally anticipated and controlled by pain killers ahead of the use of the light treatment.

So in summary, the skin cancer is confirmed and identified by the biopsy specimen; the patient returns when the histology result is available; the first application of the cream is used and then three or so hours later the red or blue light is applied for a few minutes. The patient is then free to go home and rest and to return in 7 days for the second treatment.

Ongoing surveillance does need to be carried out over a lifetime. Patients with basal cell carcinoma's tend to be either genetically susceptible eg with Celtic skin colouring and to have been heavily sun exposed and so usually the first basal cell carcinoma is just that - the first, and others can be expected.

The very definite advantage for basal cell cancers, Bowen's Disease or actinic keratoses which fall into this treatment category is that the treatment avoids fairly substantial surgery. With Amanda Platell's skin cancer she had a big surgical excision over her eyebrow with recurrence of the cancer some years later at the same site. Standard surgical treatment on the second time around would likely have resulted in her eyebrow being removed as part of the surgery. This would not be a desirable outcome for anyone.

Lee Garrett RN, BSc is a Specialist Cosmetic Medicine/ Non-Surgical Nurse working at Freedomhealth Limited London

Human Penile Worms

2010-10-14T17:11:00.002+01:00

A lovely little article appeared in this months International Journal of STD and AIDS (July 2010) written by Drs Samuel and Taylor from Kings College Hospital London.

They describe the case of a 56 year old man who had sex with other men and who complained of increased desire to pass urine, irritation in the urethra (the pipe that you wee through) and also pain on passing urine. All standard tests were negative but his symptoms persisted. Being a resourcefull fellow he collected his own urine and took it into clinic where a worm was found.

The "worm" was a 2 mm larva of a drain fly from the family Psychodidae which responded to appropriate treatment after successful identification at the London School of Hygiene and Tropical Medicine Reference Laboratory.

Drs Samuel and Taylor describe the larva as preferring wet, decaying vegetation in drains, sewage plants and cesspools and drains in bathrooms and kitchens to breed and lay eggs. The larvae may rarely contaminate human orifices.

Poor personal hygiene were suggested as perhaps being relevant to the contamination by the worm with the patient apparently mentioning drainage problems in his flat and poor personal attention to cleanliness.

The prize for the most interesting odd article goes to Drs Samuel and Taylor! Patients should beware though that this is incredibly rare and is fascinating precisely because it is so very unusual.

EARLY SYMPTOMS OF HIV

2010-10-08T14:22:00.000+01:00

How Infectious is HIV?

2010-10-08T14:14:00.003+01:00

How Infectious is HIV?

The commonly quoted figure for HIV transmission between heterosexual couples is around one HIV transmission per 1000 sexual contacts or 0.001% chance per episode. The question that many patients ask us at Freedomhealth is that if that figure is true, how come so many people have HIV worldwide? The answer is a complex one reflecting a mix of interacting and often conspiring co-factors, which may enhance or reduce the overall risk.

In an excellent review of the heterosexual infectivity of HIV 1, Powers et al in the Lancet: Infectious Diseases (Vol 8 Sept 2008 pp553 - 563) describe the apparent paradox between the often quoted risk of HIV 1 acquisition of around 0.001% or 1 case per 1000 sexual contacts and the rapid rise of HIV cases worldwide with approximately 33 million people living with HIV in 2008 and a further 2.5 million new infections per year. In short, the apparent low risk of HIV infection compared with the actual numbers of new and existing HIV disease simply do not make sense.

Powers and her colleagues have painstakingly reviewed a whole series of articles and scientific papers to try to get to the bottom of this HIV infection conundrum.

They make several very important points. Infectivity estimation needs an accurate count of the possible "transmission" events - and of course retrospective collection of data detailing sexual contact is difficult to do and to estimate. In addition, they speculate that infectiousness (the likelihood of an infected person passing on HIV) and susceptibility (the likelihood of a non infected person acquiring HIV) will vary with a number of differnet factors including the "direction" of transmission ie male to female or female to male (in heterosexuals); type of sexual act eg oral, vaginal and anal sex; HIV viral load - ie the amount of HIV virus in the HIV positive persons system; male circumcision; vaginal infection; other sexually transmitted diseases and finally the age of the people involved.

Powers found that there were a number of HIV transmission co-factors which heightened the chance of infection with HIV.

She and her coworkers found that genital ulcer disease eg with herpes infection or syphilis would increase the likelihood of onward transmission of HIV from an HIV positive person to an HIV negative person by up to 6 times. Lack of circumcision in susceptible males would increase the chance of HIV transmission by up to 8 times and early infection with HIV would likely increase the HIV transmission rate by a further factor of 2.5 times as against "mid stage HIV".

The overall inescapable conclusion is that whilst the background rate of HIV transmission in otherwise sexually naive individuals with circumcised partners and no accompanying STD's would perhaps be 0.001%, the actual rate in sexually active adults having unprotected sex who may already have an STI, plus or minus genital ulcer disease, plus or minus the misfortune to have unprotected sex with someone who is in the early stage of HIV disease is likely to be potentially much higher.

Bacterial STD's and STI's such as chlamydia etc are regarded by many as bening and easily fixed with antibiotics. Whilst this undoubtedly is the case, co-existence of other STD's in some circumstances may make the transfer of HIV much more efficient.

HIV testing methodologies thankfully have moved on from the early HIV 1 1st generation antibody tests and we now have an armoury of very accurate HIV testing methods which will enable us to test as early as 7 days post HIV possible exposure. The importance of early HIV testing is to firstly identify new HIV infected individuals but also the knowledge that most people, once they now their HIV positive status, will seek to avoid passing the disease on.

Sean Cummings is a doctor with a special interest in HIV and STD testing, treatment and prevention. He owns and runs a large, busy private Clinic, Freedomhealth, in Central London. Freedomhealth offers a full range of expert General Medical Services, Sexual Health and HIV testing and treatments and also Non-Surgical Skin and Cosmetic treatments from very smart, ultra-clean premises in the very heart of London, medical district. Freedomhealth is based at 60 Harley Street London W1G 7HA and is open Mon to Sat. Tel 02076371600 or visit www.freedomhealth.co.uk

Acne and Acne Laser Treatments

2010-10-07T10:41:00.002+01:00

Acne and Acne Laser Treatments

Acne is an extremely common condition affecting probably around 85% of adolescents and adults at some time in their lives. The common wisdom when you're 14 years old with mega eruptions of acne on your face, back, shoulders and chest is that it will fade with time and you'll "grow out of it". Very many people don't and in fact persisting acne into adulthood is common and also traumatic and troublesome. Acne is socially debilitating, depressing and associated with suicide.

Acne patients are generally long suffering and often despondent by the time they seek medical assistance. They need fairly gentle encouraging handling and with combination therapies will achieve good improvements in a short time frame. One of the main determinants of success in my experience is persuading patients to stick with a treatment protocol. Whilst its not true to say that sticking to any treatment is as successful as another, persistence brings better results.

The size of the problem can be gauged partly by looking at how many web searches are made for acne-related terms in any one month. In March 2010 a total of nearly 500,000 searches were made for acne, acne treatment and acne medicine via Yahoo. By anybody's terms this suggests a huge problem. In the USA the estimated cost of acne in the USA is thought to be in excess of $1 billion with $100 million spent on over the counter remedies.

Social and psychological stigma associated with acne and acne scarring is colossal, with very many people withdrawing from social activity such as sports as a result. Men are inhibited from taking off their shirts in public and many of our male patients have withdrawn from high-level athletics, football and swimming as a direct consequence of acne. This generally leaves them regretful and in some instances resentful. One of the most annoying things patients report is that everybody has a solution which they are keen to offer. Drinking Guiness, sunlight, steam rooms, homeopathy, mysterious herbs ordered over the internet are all candidates put forward by well-meaning but irritating friends and relatives.

Acne is quite a complicated condition. Children rarely, if ever develop acne. Rather, it begins as puberty develops, mainly in response to the sudden development of super-doses of testosterone in both boys and girls. Acne is described in the medical literature as a follicular disease6. This means that the individual skin hair follicles become larger, produce more oil and more skin cells and then block. The blockage causes the glands to slowly accumulate oil and miscellaneous skin debris. This then makes the glands larger and eventually they are colonized with a bacteria, Propionibacterium acnes.

Teenagers with their oily skin are ideal breeding grounds for the acne bacteria. Unfortunately so are some adults who seem to be predisposed to continuing acne. Men who use anabolic steroids will often experience dramatic breakouts - effectively going through puberty all over again, each time they use.

The invasion of the acne bacteria starts a fabulous cascade to dermal hell. The immune system recognises the bacteria as foreign and lymphocytes flood into the follicles and peri-follicular area. This results inflammation and the follicle will rupture releasing bacteria, oil (sebum) and skin cell debris into the nearby dermis. The cascade ratchets up a notch with infiltration with neutrophils, lymphocytes and foreign body giant cells producing papules, pustules and nodular swellings7.

Diagnosing acne rarely presents a problem. Patients, their mothers, boyfriends and girlfriends have already correctly identified the disease before they come anywhere near a doctor. They've also usually spent quite a bit on miscellaneous remedies in the pharmacy, though rarely for long enough to make any sustained improvement.

Treatment

Standard treatments haven't changed much in the last thirty years or so quite frankly and they remain mostly unsatisfactory from a patient's point of view.There are though some glimmers of light on the horizon.

The mainstay of treatment remains oral antibiotics which require long term usage over many months. It's estimated though that around 65% plus of acne bacteria in UK patients is resistant to commonly used antibiotics such as tetracyclines (25%) and erythromycin (50%). In addition, such antibiotic usage sometimes will trigger development of resistant commensal organisms which may then superinfect pre-existing acne lesions exacerbating the condition and allowing for paradoxical loss of disease control.

Whilst for some patients the response to oral antibiotics is good, for many it is lacklustre at best. This, coupled with increasing reluctance to take antibiotics long term, common GI side effects and photosensitivity reactions is making oral antibiotic treatment a poor option.

New formulations of antibiotics have successfully removed the "antibacterial" part of the medication whilst retaining the anti-inflammatory part which is thought to be very important. Medications such as lymecycline are highly effective and very well tolerated.

Topical antibiotics are commonly used also but in my experience are poorly effective, active only on the well applied areas and some of the preparations may give a fluorescent glow in ultraviolet light - difficult for young people in nightclubs. There are other preparations like benzoyl peroxide which have a good antibacterial effect but can be extremely irritating to the skin and will bleach coloured items such as clothing. For large hard to reach areas such as the back they are less than practical.

Retinoid creams and gels will act to regulate the follicle function and restore normality. They are useful in active inflammatory acne and also to reduce comedone formation. They will improve the general tone and look of the skin. In darker skins where inflammatory lesions leave dark hyperpigmented areas they will act to reduce the hyperpigmentation. Coupled with "blender" creams containing hydroquinone such as the Obagi Nu-Derm Blender, the dark scarred areas can be reduced markedly. Retinoid creams are prescription only items and a doctors prescription is necessary.

Roaccutane has attracted a great deal of attention recently. It works very well indeed in severe acne, but because of the side effect profile it is limited to prescription by hospital dermatologists and for very severe acne only. It works by attacking all the various pathways that lead to acne formation. It reduces the size of the follicles, reduces the formation of oil and blockages in the skin and effectively kills off the bacteria causing acne. The result is an extremely potent treatment. However, there are possible psychiatric side effects. This is difficult to tease out fully because acne alone is known to cause depression and lack of confidence. Recent evidence seems to suggest that the severity and length of duration of acne is more relevant in suicidal thoughts than the medication used to treat acne.

At Freedomhealth we've started using the Sciton BBL laser. The laser has two effects. The first is that the immediate impact of the laser beam on the acne bacteria is to kill the organisms, an effect similar to that achieved by exposure to sunlight or UV light. This seems to be mediated by an oxygen liberating effect with porphyrin containing organisms subjected to particular wavelengths of light. In addition the laser seems to have a immune modulating effect such that the initial response and the body's cascade reaction to the acne sequence might be reduced leading to long term improvement overall.

Our own results at Freedomhealth have been intensely encouraging with the overwhelming majority of patients treated experiencing significant improvement with one to two treatments. It is common to experience a very immediate improvement probably due to the bacteria killing effect of the laser, followed by a short relapse 7 or so days post treatment and then a sustained improvement thereafter.

Summary

There is no doubt that acne is a demoralizing and depressing condition whether it's on the face or back or both. There are some very basic rules to follow which will minimize the damage, because its not only the red spots which can disfigure but the scars which result from inappropriate picking an squeezing.

Try and keep your fingers away from your spots. If you must squeeze, then restrict it to the spots with yellow heads or blackheads only. Don't squeeze the blind red ones because you'll just double the result. Wash the to-be-squeezed areas well and scrub your finger nails with a brush before attempting the squeeze.

Dietary factors are said to be irrelevant but from personal experience I know that certain foods make my acne worse. Try and identify your own troublemakers and keep them to a minimum.

Seek advice from an interested doctor early rather than late. This will save you months of angst and also a fair amount of money in terms of potions and lotions.

Erectile Dysfunction Treatments Online

2010-10-06T08:54:00.007+01:00

Erectile Dysfunction Treatment On Line

This used to be called impotence until the rather more sensitive erectile dysfunction or “ED” phrase was coined. It actually is a better term because there is a range of ways in which your penis mail fail to live up to expectations, causing embarrassement and disappointment.

Very technically, ED is defined as the inability to develop or keep an erection long enough for the desired sex to occur. This might include masturbation, public sex, penetration and oral sex. It really doesn’t matter why the erection is desired – but if you can’t reliably get one when you need one, then you have ED.

ED is probably the most common sexual problem that a man can experience. Overall, probably around 1 in 4 men have problems. Younger men tend to have more in the psychological problem area with negative embarrassing experiences being reinforced each time the erection fails. Older men have a much higher rate of ED with around 50% plus of men in the 50 to 70 age group in at least one US study reporting it. Remember that ED is a range of conditions – it’s not simply a “dead or alive” condition. Partial erections; erections which start off strong and then fail; erections which are fragile in the sense that it doesn’t take much to make them collapse, are common.

As I say, younger men generally have less physical reason to develop erectile failure. They usually will have strong erections but occasional psychological problems like “performance anxiety” where they worry whether an erection will occur will kick in and cause erectile collapse. Older men, sadly in my age bracket of 40 plus, will tend towards more physical causes with around 5% of us being totally unable to develop an erection of any sort at all.

The reasons for erectile dysfunction have become much clearer over the last 20 years or so. In fact, I’m so old that I can remember the days when as students we were taught that the majority of men with erectile problems had physical disease causing it. We then went almost full circle with the psychological argument taking precedence and suddenly all men with ED had “issues” which you could solve with a jolly good chat with a psychologist.

Luckily things really have changed and mainly with the meteoric arrival of the drug Viagra and then its relatives Cialis and Levitra. These drugs heralded the notion that although there might be a physical or a psychological problem, it was solvable and reliably so, by taking the medications.

The arrival of these medications also opened the box of shame and enabled men to discuss the issues rather more openly. As a GP in NHS practice I would frequently have female patients come to talk to me about their sexual problems and their male partner’s lack of erection.

What finally did become really very clear was that there was a range of interacting physical and psychological elements, all having impact on each other. Physical difficulty caused by disease and or medications would be compounded with realising that once you’d started there had to be the expected outcome which usually involved penetration and ejaculation. Consequently a combined medical and gray-haired psychologist lady approach would often help tease everything out. Unlike women, few men can fake sexual arousal because if the erection isn’t there, well, it’s a difficult one.

There are a number of well-known conditions that will cause or worsen ED. The main ones I’m afraid are self-induced. If you suffer from ED its is worth while having a medical examination and also some blood tests for hormone and sugar levels.

Stress is something that’s often talked about and is a very powerful damper of sexual functioning. It is an awkward one to get around though because its 2010 and life is a blur of work and getting to work and family and responsibility and money etc etc – you know the picture. If you can sort the stress out then its probable that your sexual functioning will return to normal.

Alcohol and recreational drugs are for lots of people the major culprits. I do love a drink but the painful fact is that alcohol, except in very small amounts is very toxic. It’s also very seductive, so that one drink which might just calm the nerves before a potential sexual encounter, will frequently become plenty of drinks, leaving your erection something only to be dreamed of. Depressive illnesses also encourage people to drink far too much alcohol and the combination of the two together really is not a good one.

Recreational drugs – ecstasy, cocaine, crystal meth are widely used. I saw a recent press release saying that cocaine had become the UK drug user’s drug of choice in 2010. The problem with these drugs is that they will often increase sexual desire and feeling of “sexiness” but they equally often will destroy the mechanism so your hydraulics don’t match up with what you’re experiencing in your head. As a result, especially with crystal meth people will become fantastically desperate to achieve firstly an erection and secondly ejaculation. Even if they do, this isn’t enough and as soon as they’re done they’re off on another sexual quest. The result is often unsafe very risky sex, genital injury and sometimes such complete disinhibition that STI’s or STD’s including the blood borne variety HIV and 2010’s new infectious darling, Hepatitis C become a routine.

Diseases such as diabetes, heart disease and high blood pressure also have a marked impact on erectile dysfunction rates. This happens via a combination of routes including the disease process itself and also the medications used to treat the conditions. Very many medications will have an adverse effect on both libido and erectile capability.

Luckily there are now a variety of devices and medications used to treat ED. Although using medications etc is not ideal, it does virtually guarantee an erection.

The medications fall into two main groups – oral and injectable/insertable.

The oral meds began with Viagra or sildenafil. This was the first of a group of drugs called phosphodieterase inhibitors or PD5 inhibitors for short. They work by allowing an increase of blood into the penis and maintaining the erection for longer. It’s a bit like filling a bath – if you turn the taps on full the bath will fill, even though the plug is out. Other drugs like Cialis and Levitra are variations on the same theme but with their own characteristics. Levitra and Viagra are very similar medications being prompt acting with a relatively short duration of action.

Cialis has a longer onset and longer overall effect – in some men up to 3 days. Doctors will try to tailor the medication according to your needs. So for the man who needs an erection in an hours time, Levitra or Viagra are the appropriate drugs. For the man who wants a more normal sexual response over time, then maybe twice weekly Cialis is the way forward.

Other drugs include the injectable Caverject – yep, you have to inject your penis – but the upside is a fantastic stiff erection that you can hang your hat on. Muse is a little pellet which you insert into the urethra – the pipe you pee through – and then massage your penis. Gives a reasonable injection, but stings and burns a little. Also, someone sucking you may end up with a rather medicinal taste…..

Finally, vacuum pumps. These are rigid penis shaped devices slipped over the penis. You vacuum extract the air and suck blood into the penis, then slipped a tight cock ring over the base to keep the blood in. Surprisingly popular, though gives a cold, unattractive blue penis with frequent interruptions to re-inflate it. Not the most magical of moments.

Saturday GUM and STD / HIV clinics

2010-10-04T13:22:00.003+01:00

Saturday GUM and STD / HIV clinics

In a paper in the Journal of STD and AIDS 2010; 21: 273-276, Challenor and Warwick assessed the acceptability and usage of weekend GUM and STD clinics in response to increasing demand and pressure to see mor epatients.

In perhaps an unsurprising finding they discovered that the Saturday GUM clinics were popular and more so than Sunday clinics. This is in keeping with our experience with Saturday GUM Clinics at our London Freedomhealth Clinic. Freedomhealth opens every Saturday between 10.30 am and 3.30 pm and the clinics typically are booked in advance with many "walk-in's" - ie patients without prior booked appointments. Reasons offered are that many of our patients find it difficult to get away from work in the week; attending NHS clinics tends to result in the waste of a good part of the day and patients are able to choose which of our doctors they can see.

Challoner and Warwick's review showed that around 30% of patientswere likley or very likley to use a Saturday NHS GUM Clinic service. They also found that Saturday patients are more likely to attend with symptoms of a http://www.freedomhealth.co.uk/sexual-health/std-sti-test-and-testing-clinic-london/175/. Interestingly many patients attending the Saturday GUM NHS clinic were too embarrassed to reveal to admin staff that they had symptoms.

Our patients on the other hand tend to be very informative about their symptoms and conditions before they arrive at our private GUM clinic.

HIV testing rare subtypes

2010-09-29T17:24:00.002+01:00

Common Questions on the Freedomhealth Sexual Health Forum

HIV testing rare subtypes

Dear dr Sean, I had a sexual encounter with a male sex worker approximately 13 weeks ago, unprotected anal sex, I was receptive
I have almost all symptoms imaginable,
Flu
Aches (that were so severe that I have never experienced before
Rash
Diorehea which I still have
Swollen lymph glands
Pins & needles all the time which are currently present & prevent me from sleeping each night, even sleeping pills are not working
Weight loss (muscle that is, I look skinny as a stick)
Blurred vision / floaters which has been present since week 5
Dry skin
Sore throat/ cough
Fever
But at various times of testing I have tested negative, I used the HIV p24 test.
I tested negative also at 12 weeks using a instant 60 sec test.

My concern is that I'm as the duo test only looks for groups M,N,O
That I may have picked another group eg group E which the the antibody test is not detecting.
What tests can I do to make sure I have not picked up any rare subtype?
As currently with all my symptoms I'm all certain I have HIV & can't take the risk of sleeping with someone even though my 12 week test was negative.
You may think it's anxiety, but that's not the case my health is detoroating at a rapid rate yet the HIV antibody test is showing negative.
I have done various other tests throug my gp which are normal, so doc what test are there to detect rare subtypes,?
Thanks

Doctor's Answer

My concern is that I'm as the duo test only looks for groups M,N,O
That I may have picked another group eg group E which the the antibody test is not detecting. Well, you are right to say that HIV does present a diagnostic challenge and there are many minor variants of HIV whihc may present some difficulty. However, you are fundamentally wrong when it comes to what you describe as Group E - which in fact is not a distinct Group at all but a South East Asia version of Group M, subtype A - what you identify as group E is a criculating recombinant form containing components of subtype A and in actual fact was reclassified as long ago as 1998 as CRF01_AE. So since it is actually a Group M variant - both the INSTI and the HIV DUO will detect it

Aside from the rarity of rare subtypes and the chances then of you acquiring them are rare - you should remember that we don't know if Mr X the sex worker was HIV positive in the first place. If he was then yes, you engaged in a high risk activity and I believe you have escaped unscathed. You can do further tests - but - I believe that the tests you have had already are more than adequate. If you wanted to do all tests possible (and bear in mind that in your situation the results are often not convincing to the patient concerned) then you can do a HIV 1 and 2 RNA PCR which will look for groups M and O - and NOT N; a Western Blot which should accomodate all the other little variants and in addition a CD8/CD4 count which will cast an oblique look at your immune system and check that it remains within the normal range.

As currently with all my symptoms I'm all certain I have HIV & can't take the risk of sleeping with someone even though my 12 week test was negative.
You may think it's anxiety, but that's not the case my health is detoroating at a rapid rate yet the HIV antibody test is showing negative.I'm not aware that I've met you and until I've met you, examined you and decided for myself as a result of those things what the situation is, I can't say its anxiety with certainty. It is possible to be seronegative to HIV antibody tests and to still have HIV - these are incredibly rare and I have not seen a case. Even in those circumstances though, the HIV PCR and also the p24 antigen component of the DUO IS positive so the diagnosis is not in doubt - there is just an odd conundrum with antibodies in a handful of people worldwide.
I have done various other tests throug my gp which are normal, so doc what test are there to detect rare subtypes,? As above

Reducing transmission of sexually transmitted infections and HIV amongst male and female sex workers

2010-09-29T10:07:00.003+01:00

Reducing transmission of sexually transmitted infections and HIV amongst male and female sex workers

Use of male and female sex workers is common throughout the world. Sex workers may be referred to as prostitutes, commercial sex workers, lap dancers, escorts etc but trade of sexual activity for money, food or drugs is the common factor.

A common assumption is that because of the frequency and number of change of sexual partners with commercial sex workers that they will be more exposed to sexually transmitted diseases and HIV and thus more likely to acquire, carry and spread STD/STI’s and HIV. As a clinician working in a clinic where I see many people, male and female, who have used sex workers, the concept of risk is one that generally occurs after the sexual event.

There is good evidence that male and female sex workers and their clients may represent a significant source of new HIV and other sexually transmitted infections. Condoms are very, very effective in reducing spread of STD’s and HIV but often they are not used for penetrative vaginal and or anal sex.

Many STD’s/ STI’s are easily treatable using modern antibiotic therapies. Ease of treatment however may miss the point. We know that gonorrhoea and also Chlamydia will increase the amount of HIV virus which is shed from both the cervix and also in semen of HIV infected men and women. Equally, concurrent infection with herpes 2 virus in the genital tract of either of the individuals will make HIV acquisition much more likely for a previously HIV negative partner.

Gonorrhoea, syphilis, chlamydia and herpes in the previously HIV negative individual engaging in unprotected penetrative sex with an HIV positive individual will markedly increase the chances of new HIV infection. These newly infected HIV positive individuals pose an exceptionally high risk of infecting other sexual partners because they are often unaware of the risks they have taken and unaware of the new HIV infection gaining rapid momentum in their body. New HIV infection will take a few weeks to generate often several million copies of HIV virus per ml of blood or semen making these individuals extremely infectious in the initial phase.

When contemplating exceptionally high background rates of STD and HIV in populations there is a correct tendency to view this as a feature of poverty and also developing societies such as Sub Saharan Africa etc. South Africa has the highest rate of HIV in the world. But there is a catch and that is that in different population pockets around the world, such as Washington DC in the USA, HIV infection rates in some sub-groups exceeds that of the South African HIV rate. Consequently, interventions to reduce the spread of HIV need to be universally applied and the notion that the highest rates are in the poorest countries is part of the picture.

Vickerman etc al, writing in the journal Sexually Transmitted Infections (2010:86:163-168) used mathematical modeling to estimate the impact of periodic presumptive treatment on the transmission of sexually transmitted infections and HIV amongst female sex workers. The female sex workers were of a group taken from Johannesburg.

The article started with the premise that periodic treatment of common STD’s / STI’s using antibiotics without pre-testing could reduce the rates of genital ulcer disease, gonorrhoea, Chlamydia. What was not known was whether reduction of these infections by interval treatments would also consequently reduce the rate of HIV transfer.

The conclusion reached was that whilst possibly optimistic assumptions had been made about the impact of blanket antibiotic use in high risk female sex worker populations in reducing onward HIV transmission, there was reason to believe that antibiotic interventions with good population coverage could noticeably reduce the HIV infection rate amongst female sex workers with previously inadequate STI and STD treatments.

Clearly the use of antibiotics themselves would only impact on the bacterial diseases and have no impact on HIV itself – but, because the bacterial diseases enhance the shedding and availability of HIV in cervical fluid and semen, reduction in bacterial contamination will reduce spread of HIV. This is not a substitute for condom use but as the accompanying Editorial points out, many vulnerable sex workers are often not in a position to enforce condom use.

A further weapon in the identification of early HIV before onward HIV transmission is the use of very early HIV testing methods. Confusion has reigned over the appropriate testing intervals and this has largely occurred because different and more sensitive HIV testing methods have become available over the last 30 years. The confusion has been compounded a little by the advice of government regulatory bodies in different countries who have tailored their advice to what they now about commonly used HIV testing methods on the ground.

In the UK 4th generation HIV testing methods using HIV 1 and 2 antibodies and also p24 antigen ( a core HIV viral protein) have been commonplace for many years and good experience has been gained with these tests.

A further advance has been the development for diagnostic purposes of an HIV 1 and 2 RNA PCR test which will identify extremely early HIV infection often before symptoms of Acute Retroviral Syndrome have appeared. This test can be performed from seven days post possible HIV exposure. The importance of such an early test is that it firstly enables early intervention in terms of medications if desired and secondly it allows for the opportunity to avoid infecting others.

Simultaneous early PCR testing will allow for detection of a host of bacterial and viral STD’s / STI’s such as herpes 1 and 2, trichomonas, gardnerella, Chlamydia, gonorrhoea, ureaplasma, mycoplasma, and hepatitis C and B.

HIV and Aids medication linked to dementia

2010-09-27T09:52:00.002+01:00

HIV and Aids medication linked to dementia

Researchers at the University of California say they have found a link between antiretroviral medication used to treat patients with HIV and brain impairments such as dementia.

Data collected from HIV negative people, HIV positive people and AIDS patients between 1990 and 1995, when antiretroviral treatment was unavailable, was compared with data from different people in the same groups collected between 2000 and 2007 when the medications were available.

The study involved around 1500 people and all were matched for age, educational level, sex, ethnicity, and neuromedical and neuropsychological evaluations.
It was found that 40% of HIV positive patients on antiretroviral treatment showed evidence of brain impairment compared with 33% of HIV positive people in the era before the medication was available.

36% of those with impairments sampled between 2000 and 2007 were just in the early stages of their infection, compared to 25% of those sampled before medication was available.

"This study underscores [the idea] that despite the benefits of modern therapies in terms of decreased mortality, there seem to be persistent neurocognitive deficits" said the University of California’s Dr. Igor Grant who led the research.

Immune system stimulation

It’s thought that the problems could be a result of chronic immune system stimulation which is induced by the treatment to achieve long-term survival.
The antiretroviral therapy means people are living longer, therefore giving the virus more time to cause problems, said Dr Grant.

Dr Victor Valcour described a “Trojan horse effect”, where white blood cells become infected with HIV, cross the blood-brain barrier and disrupt brain function.

Types of brain impairment in HIV patients

Dr Valcour estimated that as many as 50% of all HIV-infected people may have some degree of brain dysfunction, even if it is asymptomatic. Patients from the pre- and post antiretrovirals groups showed different types of impairment. In the groups of people infected and receiving treatment it was noted that there were more problems with memory, and in planning and decision making but fewer problems with certain types of verbal and motor skills.

Smoking and lifestyle of HIV positive people

There was also a warning from Dr. Valcour that other factors could be influencing the brain impairment. He said more attention needed to be paid to the fact that smoking, hypertension, diabetes and high cholesterol are common among HIV positive people.

Should gay men be screened for anal cancer?

2010-09-26T16:35:00.002+01:00

Should gay men be screened for anal cancer?

Cases of anal cancer among gay men who are HIV positive have been on the rise since the advent of antiretroviral treatment for those living with the virus.

Consequently questions are now being asked about whether men who have sex with men should be routinely screened for anal cancer using anal cytology (taking cell samples from the area) and high resolution anoscopy (a tube used to see the lining of the anus).

In an article published in Wolters Kluwer Health journal Dr Paul Fox examines the current evidence and opinion on routine anal cancer screening. Dr Fox is a Consultant Physician at the ChelseFreedomhealth Clinic in London a and Westminster Hospital and also where he runs a private High Resolution Anoscopy Clinic for anal cancer screening.

Current UK guidelines do not recommend routine anal cancer screening and guidelines from outside the UK vary. For example in New York routine anal cytology is recommend for gay men, whereas leading groups in other states including Texas and California say that there is not yet enough research to form any guidelines.

There are a number of reasons why routine anal screening programmes have not been rolled out. The cost, both of setting up and maintaining the programme, is just one of the factors. Balancing the need for screening with any patient anxiety is another factor as well as concerns over the efficacy of screening.

The sensitivity of anal cytology is regarded as poor and so is used in conjunction with high resolution anoscopy, where medical professionals will look for the precursor lesion to anal cancer known as a high grade squamos intraepithelial lesion (HSIL).

A number of studies have been carried out to try and assess how great the risk of anal cancer is to gay men in a bid to identify groups that could benefit from routine anal cancer screening.

Dr Fox makes some criticism of the small number of studies for the way in which patients were recruited; many were not randomly selected meaning there was a potential selection bias.

However Dr Fox highlighted two recent studies which he was sure eliminated selection bias, one by randomly selecting patients and another by using the entire population of an HIV clinic.

The first study screened the 516 patients of an HIV clinic in Paris. It was found that 473 had HSIL, and that men who had sex with men were more than twice as likely to have HPV lesions - which can be potentially cancerous - than heterosexual men or women.

A second study looked at HIV patients on antiretroviral treatment from different demographic groups, evenly divided between MSM, heterosexual men and women. It found what Dr Fox described as “surprisingly little difference” between the groups in terms of the number of patients with HSIL. Around 5% of people in each group had an HSIL – the anal cancer precursor lesion.

The figure matched data from the days before antiretrovirals were available, leading Dr Fox to conclude that there was a possibility that the rising incidence of anal cancer in HIV-positive patients treated with anti-retroviral therapy is due to patients living longer, which gives greater rise to the cancers occurring.

Dr Fox also concluded that patients on antiretroviral treatment must therefore be at greater risk of their HSIL making a malignant transformation into anal cancer.

There were also concerns that treatment was less effective for HIV patients compared to HIV negative people. Dr Fox looked at a number of studies carried out on the treatment of HSIL and anal cancer.

A study by Goldstone et al showed that 65% of HIV positive men who received infrared coagulation treatment treatment for HSIL had new or persistent lesions after a 10 month follow-up, compared to 50% of patients who were HIV negative. A further study, which differed in its methodology by performing a repeat biopsy of the treatment site at 6 months post-treatment found only 10% of HIV positive patients were disease free.

A study on the outcome of two different types of treatment for HIV positive men with HSIL has provisionally shown little difference. It looked at patients who were given a single infrared coagulation treatment and those who applied trichloroacetic acid once monthly for four months. There was an individual clearance of 68% with individual lesions with IRC and 87% in the group treated with trichloroacetic acid.

A further study involved a placebo controlled study of 53 HIV patients using a self-applied imiquimod cream. In the patients using the cream the response rate was 39% compared to those using the placebo cream.

In a further study where participants were offered open-label imiquimod the response rate was 40% with half of those patients having a complete and sustained resolution of their lesions.

It was noted that the benefit of these treatments is that the lesions disappear and although some recur in different locations it is thought that lesions that have not been static for some years will carry only a low risk of malignant transformation.
According to the article it is therefore reasonable to suppose that treatment of HSIL will reduce the likelihood of anal cancer, but this has not yet been proven.

Dr Fox also concluded that anal cytology is a validated means of detecting anal cancer but is best restricted to selected patients.

He recommends that clinics carry out physical, digital examination of the anus to look for abnormalities and that this becomes the standard at HIV clinics.

A study in San Francisco highlights the important of digital examination. The cases of 21 patients who had developed anal cancer were examined and it was found that 19 had presented with palpable mass, an induration or ulcer. The implication was that physical examination could have picked up these lesions at an early stage.

Patients should also be encouraged to self-examine with Dr Fox saying it may be “just as effective as a cytology based approach”.

He says the clinics must play an important role in encouraging patients to self-examine and helping them learn how to carry it out properly. The report suggests clinicians carry out the initial examination to prevent patients becoming concerned by lumps that are either benign or part of their normal anatomy.

HIV warning for over 50s

2010-09-22T14:20:00.001+01:00

HIV warning for over 50s

More over 50s are contracting HIV than ever before and there is a warning that their diagnoses could come too late.

710 over 50s were diagnosed with HIV in 2007, compared to 299 in 2000, according to new figures released by the Health Protection Agency (HPA).

Other sexually transmitted infections have shown a similar increase in the same age group, rising at a faster rate than in younger age groups.

Late HIV diagnosis

Almost half of those diagnosed in 2007 were found to be at an advanced stage of HIV infection, severely limiting the benefits of HIV treatment.

In fact 14% of those diagnosed at an advanced stage in their infections were dead a year later, compared to 1% of older patients who had been diagnosed earlier.

“We have a group of people who don’t get tested because they don’t think they are at risk,” said Dr Valerie Delpech of the Health Protection Agency.

The HPA estimates that half of those diagnosed between 2000 and 2007 were actually infected when they were aged 50 or over.

Older people with HIV were more likely to be gay, white men. But “it wasn’t all gay men”, said Dr Delpech, “In fact, there were a large proportion of heterosexual men and women”.

The charity Terrence Higgins Trust says its own research confirms that over 50s were now the fastest growing group of people with HIV in the UK.

Better sex for older people

Some experts say more divorces and better health might be behind the rise in HIV infection rates, with older people having more sex.

“What this means is that screening is particularly important in people over 50,” said Dr. Anupam B. Jena, who was not involved in this study. “The take home point from this paper is that it always makes sense to be screening younger people for HIV, but that maybe the balance should shift a little bit toward older people.”

A separate study carried out by Dr. Jena found that 60-year-old men taking Viagra had twice the rate of STDs of those not taking the drug.

New four in one HIV pill shows low toxicity and good efficacy

2010-09-20T09:45:00.002+01:00

4 drug HIV pill shows promise

A single pill containing 4 drugs to treat HIV infection has achieved promising results during trials, according to data presented at the 50th Interscience Conference on Antimicrobial Agents and Chemotherapy and reported in the Medscape HIV/AIDS journal.

Quad by Gilead Sciences contains elvitegravir, cobicistat, emtricitabine and tenofovir disoproxil fumarate and was highly effective in suppressing HIV and in helping patients boost their CD4 T cell counts. CD4 T cells are important in the body's response to HIV and tend to be targeted by the HIV virus itself. Boosting CD4 T cell counts is protective against many HIV related cancers and infections. Quad also apparently had better tolerance than the popular single pill 3 drug formulation Atripla.

Atripla has been a very effective and also very convenient way of delivering anti-HIV medications.

The study was carried out over 48 weeks. 71 patients were recruited, 48 given Quad and 23 were given Atripla. All the patients were new to HIV treatment with a HIV viral load of more than 5,000 and CD4 counts greater than 50. (HIV viral load is the amount of free HIV virus circulating in the blood and a normal CD4 count is between 400 and 1200)

At the end of the trial 90% of those taking Quad had HIV viral loads of less than 50compared to 83% of the Atripla group. Those taking Quad also experienced a rise in CD4 cells averaging 240 compared to 162 in those given Atripla.

The incidence of adverse reactions was similar in both groups but those taking Quad experienced fewer problems of the central nervous system.

Doctors welcomed the results of the trials. “These results suggest that Quad could be an important new option for people with HIV,” said lead author Dr Richard Elion from the Whitman Walker Clinic in Washington, DC. “The challenge is to make treatment simple and compress the number of pills that need to be taken. The bottom line is that our study showed that use of an experimental booster [cobicistat] in this regimen that includes an experiment integrase inhibitor [elivitegravir] achieved similar results to Atripla with improved tolerability.”

Dr Elion went on to explain that the experimenta1 booster cobicistat, unlike ritonavir, was amenable to coformulation with other antiretroviral drugs.

A further study on cobicistat involved giving 50 patients cobicistat-boosted atazanavir, emtricitabine, and tenofovir and comparing results to 29 patients who were given the same combination with cobicistat replaced with ritonavir.

The study again showed promise with patients in the cobicistat group experiencing an average rise in CD4 cell counts of around 230 compared to 206 in the ritonavir group. 82% of those taking cobicistat met the primary objective of an HIV viral load less than 50, compared to 86% of the ritonavir group.

Commenting on Quad, Dr Amalio Telenti, Director of the Institute of Microbiology at the University of Lausanne in Switezerland said: “I welcome this single pill that can be taken once a day as an important alternative to the existing single pill now on the market, Atripla, for initial treatment or in cases of toxicity without having to resort to more a complex prescription.”

However the long term safety of the experimental compounds elvitegravir and cobicistat was yet to be established, according to Dr Telenti speaking to Medscape. “The decreased creatinine clearance with cobicistat is relevant and could be compounded by the known association between tenofovir and renal and possibly bone metabolism,” he added. (Creatinine clearance is a guide to kidney health - reduced creatinine clearance may signify deteriorating kidney function and this needs to be monitored in all patients on anti-HIV medications).

London is sex infection capital

2010-09-19T11:57:00.000+01:00

London is sex infection capital

London has been highlighted as the capital of sexually transmitted infections, as new data shows STIs are on the rise across the country.

There were almost half a million cases of STIs – such as gonorrhoea and chlamydia in 2009, an increase of 12,000 from the previous year.

The data from the Health Protection Agency shows under 25s, and gay men are particularly affected, as well as people living in the capital.

In previous years men have accounted for around 50,000 more infections than women, but this latest set of figures show that the gap has narrowed dramatically to around 10,000.

London hotspots

9 of the UK’s top ten ‘STI hotspots’ are in London. Hackney tops the list, followed by Lambeth, Southwark, Hammersmith and Fulham, Islington, Haringey, Wandsworth, Tower Hamlets and Westminster. Brighton and Hove takes the tenth place.

Experts from the HPA say that more people testing for sexually transmitted infections accounted for some of the rise as well as improved tests that are more sensitive to detecting infections. But there was also a warning that unsafe sex was to blame.

“These studies highlight the vulnerability of young women. Many studies have shown that young adults are more likely to have unsafe sex. Often they lack the skills and confidence to negotiate safer sex,” said the HPA’s Dr Gwenda Hughes.

Chlamydia, gonorrhoea and herpes

While sexually transmitted infections overall increased by 3% on the previous year, there were greater increases in the case of some specific infections.

Chlamydia increased by 7%, gonorrhoea by 6% and genital herpes (genital warts) by 5%.

Re-infection is a problem with one in 10 under 25s diagnosed becoming re-infected within a year.

Resistant strains

Experts have also expressed concern that some strains of gonorrhoea are becoming resistant to the most commonly used antibiotics. “We could see gonorrhoea becoming a very difficult infection to treat within the next five years,’ said the HPA’s Professor Cathy Ison.

For now the best advice remains to use a condom and to regularly test for sexually transmitted infections. Left untreated many can lead to serious complications and infertility.

Freedom Health offers a wide range of tests for sexually transmitted infections to suit your circumstances. See the overview of our services here or download a free copy of our sexual health services brochure.

Shingles Vaccine at Freedomhealth London Clinic

2010-09-17T16:01:00.002+01:00

Cost concerns over shingles vaccine

Earlier this year government advisors recommended that a vaccine against shingles be given to Brits aged between 70 and 79, but raised concerns over its cost. Now, as research shows just 10% of eligible patients in America have received the vaccine because of its high price, is there really a hope for Britain’s elderly?

Shingles is the common name for herpes zoster which is caused by the reactivation of the virus which causes chicken pox and then lies dormant in our body.
The virus is called the varicella-zoster virus and is reactivated in around a third of people who have had chicken pox, causing shingles - which is a localised rash commonly with blisters. Unlike chicken pox, shingles is not contagious.

People of any age can develop shingles but it commonly occurs in people aged over 50, this is because of the decline in immunity as people age. For this reason people with suppressed immune systems are also susceptible to shingles, according to Kimberlin and Whitley writing in the New England Journal of Medicine.

They report that a patient over 60 years old is 8 to 10 more times more likely to develop shingles than a younger patient and that shingles will have developed in up to half of people who are 85 years old.

One of the most serious complications of shingles is a condition known as postherpetic neuralgia, a persistent pain which remains in the area of the rash after the rash has gone. It is caused by the virus damaging a nerve and can lead to pain, itchiness, numbness which can last for months or years.

Estimates suggest that around 250,000 people in the UK get shingles every year, and almost 100,000 of them develop postherpetic neuralgia. Patient.co.uk reports that 1 in 4 of those with shingles develops postherpetic neuralgia that lasts more than 30 days.

As Nigel Scott from the Shingles Support Society told the BBC,: “Shingles and postherpetic pain, can make people’s final years a complete misery’.
So you would think there would be widespread relief about the Joint Committee on Vaccination and Immunisation recommending to the British government this January that a vaccine against shingles be given to those aged between 70 and 79.
The vaccine works as a preventative measure given before the reactivation of the varicella-zoster virus. It has been used in America for over four years, where it is available for everybody over 60 years of age.

Just one dose of the vaccine is needed. The vaccine contains the live varicella virus which enables the body to develop enough immunity against it, giving the patient a new ‘immunologic threshold’ above that at which the patient is at risk for shingles.

Kimberlin and Whitley report a study found that the vaccine reduced the likelihood of developing shingles by over 50%. The evaluation was based upon two groups totally around 40,000 people, one who had received the vaccine and another who had received a placebo. The study also found that the incidence of postherpetic neuralgia was 67% lower among those who had received the vaccine.

The study found that around 17 people would need to be vaccinated to prevent one case of shingles and 31 would need to be vaccinated to prevent one case of postherpetic neuralgia.

Side effects appear to be minimal with rashes at the injection site and skin redness being reported. However, the study was carried out less than a year after the shingles vaccine became available to Americans and so it was difficult to study the potential risk of rare adverse effects.

The biggest side effect seems to be the cost. Writing for the New York Times in June this year, Pauline Chen reports that in the two years since the shingles vaccine became available, fewer than 10 percent of all eligible patients have received it.
This is because the shingles vaccine typically costs between $160 and $195 dollars, around 10 times more than other commonly prescribed adult vaccines. Chen reports that even patients with health insurance plans are not having the vaccine because of complicated reimbursement methods relating to it.

The article also describes how American doctors have tried to help patients obtain their vaccines more cheaply. Some have sent their patients to cheap pharmacies to buy the vaccine and then return to the surgery to be injected, or to go to pharmacies which offer immunisations to have the vaccine administered there.
However, Chen reports that the hassles of these methods put patients off.
Now it looks like the cost of the vaccine may prove to be a hurdle with the roll-out of the vaccination programme by the NHS in the UK.

Vaccination against shingles would just be available to people in the UK between the ages of 70 and 79, according to the BBC. This is despite the aforementioned study finding that the vaccine was more effective in preventing shingles among persons aged 60 to 69, than those aged 70 or over.

It also contrasts with the situation in the US, where all over 60s are recommended to be vaccinated against shingles.In January the Department of Health told the BBC the programme was dependent on a "fair price" but that they was confident this could be achieved, given that four million doses would be required.

They also revealed that the programme should start before the end of the year to achieve maximum effectiveness.

New Early HIV Testing Clinic Home Service Launched Across the UK by Freedomhealth, London, UK

2010-08-09T11:10:00.002+01:00

New Early HIV Testing Clinic Home Service Launched Across the UK by Freedomhealth, London, UK

Early HIV testing is readily available in London UK but availability is limited or patchy through the rest of the UK. A new early HIV testing clinic Home Visit Service is now available across the UK provided via clinicians at London’s Private HIV and Sexual Health Clinic, Freedomhealth. A full range of state of the art very early HIV blood testing including the HIV DUO test and HIV 1 and 2 RNA PCR test is offered. Freedomhealth continues to offer a comprehensive, dedicated expert early HIV test and treatment service at its London Clinic

Early HIV testing is readily available in London UK but availability is limited or patchy through the rest of the UK. A new early HIV testing clinic Home Visit Service is now available across the UK provided via clinicians at London’s Private HIV and Sexual Health Clinic, Freedomhealth. A full range of state of the art very early HIV blood testing including the HIV DUO test and HIV 1 and 2 RNA PCR test is offered. Freedomhealth continues to offer a comprehensive, dedicated expert early HIV test and treatment service at its London Private HIV and Sexual Health Clinic.

The HIV testing emphasis in the UK has been passive to date with HIV testing facilities offering antibody testing at a three month interval to the majority of patients who request HIV tests. The arrival of new testing modalities such as the HIV 1 and 2 RNA PCR test and also new logistical approaches to HIV blood sample collection means that Freedomhealth has a truly UK – wide national reach with dedicated, experienced phlebotomists providing a bespoke blood sampling service.

Dr Sean Cummings commented “ This new early HIV testing service with blood sampling in the privacy of a patients home is a further very important step towards making early HIV testing a universal possibility in the UK. Home HIV testing represents a further part of the Freedomhealth continual Sexual Health development strategy”

Lack of privacy, difficulty with appointment times, unhelpful GUM clinic staff, lack of availability or knowledge of the most modern HIV tests make take up rates for HIV testing amongst groups most at risk relatively poor.

How does the early HIV Testing Home Visit Service Work?

Freedomhealth is renowned for its innovative approach in the HIV and STD testing arena. The new service entails a patient making a telephone consultation with one of our expert, friendly and extremely knowledgeable doctors. This appointment is charged at our standard telephone consultation rate. Full details of the possible HIV exposure or risk event are taken and discussed and the doctor will provide a detailed risk assessment. During the telephone consultation the doctor and patient will agree a strategy to go forward with.

Blood testing for HIV and other blood borne viruses is well established to be far superior to oral testing. Oral testing kits are not licensed for use in the EU because the total test process does not meet CE requirements. They are not indicated for HIV diagnosis in the UK or EU.

Smart well-trained and fully insured phlebotomy services.

The agreed strategy between Freedomhealth and the patient may involve testing using a number or even combination of different HIV and STD tests. Blood testing is commonly required and we will arrange for a specialist phlebotomist to attend the patients preferred address at home, office, hotel or airport all over the UK. The phlebotomists are specialists in taking blood samples and are hand selected for their caring, customer centred approach. All phlebotomists are extensively trained, fully insured, fully conversant with infection control and risk minimization procedures and attend by appointment in smart casual attire.

Early testing for HIV infections will allow for reduction of onward transmission of HIV by more than 50%. Plasma HIV RNA PCR testing allows for very early identification of new HIV infection well before HIV antibody tests may become positive. Typically after new HIV infection, antibodies will take 2 to 6 weeks to form and become detectable. The detection of antibodies will vary depending on the individual patient’s immune system but also on the quality of the HIV test and which generation HIV test is used. Modern third generation HIV tests will correctly identify greater than 99% of newly acquired HIV infection by 6 weeks post exposure. By contrast, the HIV 1 and 2 RNA PCR test will correctly identify greater than 99% of new infections at 7 days after exposure.

New Online Impotence Diagnosis and Treatment Clinic Launched by Freedomhealth, London

2010-08-09T10:10:00.003+01:00

A new, remote, online erectile dysfunction (impotence) diagnosis and treatment service has been launched by London’s Private Sexual Health Clinic, Freedomhealth. Freedomhealth has partnered with the UK’s biggest dedicated online registered pharmacy, ChemistDirect to provide this new service.

The alliance between Freedomhealth and ChemistDirect will make it much easier for the majority of the 2.5 million men in the UK who suffer with erectile dysfunction to access good quality medical and sexual health advice. The new online impotence treatment service is run by personnel who are visible UK registered doctors and pharmacists operating from regulated and authorised premises.

Dr Sean Cummings said “The days of people being fleeced by dodgy websites who supply overpriced and counterfeit medications are over. Men are drawn to use the internet to find erectile medications becasue they are embarrassed. That doesn’t mean they should receive a shoddy or dangerous service or product. With our new collaboration with the largest online pharmacy in the UK our patients will receive excellent, prompt and appropriate service with the same friendly efficiency as at our London clinic”.

Freedomhealth has an established reputation for innovation in the field of Sexual Health. Founded in 2003 by Dr Cummings and Lee Garrett, the clinic has grown exponentially since and has expanded the range of services year on year. Dr Cummings added “The key to a successful clinic is to focus on the patient with staff who love what they do. Our London clinic is a calm, safe environment for people with often embarrassing predicaments. We know that we can extend our classic “Freedomhealth feel good factor” into the online space and allow greater access to our patients”

How does the New Online Impotence Diagnosis and Treatment Clinic service work?

Accessing the service is very straightforward and can be done remotely via the web. A patient registers on the Online Impotence Diagnosis and Treatment Clinic site and completes a thorough questionnaire. The patient is then allowed to select a preferred medication option such as viagra, cialis or levitra and makes payment with a credit or debit card. The questionnaire is reviewed promptly by a Freedomhealth doctor and there may be further clarification needed. Additional advice may be provided by the doctor depending on the information supplied. If medication is prescribed it is sent out by first-class next day delivery and signed for mail. Repeat prescriptions are possible by making a further application.

The same service is available for patients who wish to talk to a doctor on the phone. This consultation is charged for but in essence works in the same way.

Erectile Dysfunction in the UK

Approximately 2.5 million men in the UK suffer from erectile dysfunction or “impotence” as it used to be called, according to the Sexual Dysfunction Association. 20% of men felt so embarrassed that they allowed their relationships to break up because of it. 90% of men do not discuss the issue with their GP and a staggering 60% don’t discuss it with their sexual partner either. Data from the USA suggests that around 5% of men between the ages of 40 to 49 years have severe and disabling erectile dysfunction and approximately 17% of this age group have moderately severe problems.

Erectile dysfunction is twice as high amongst smokers as non-smokers and patients should be advised of this when they are consulting about erectile dysfunction issues. In addition and very interestingly, more than two thirds of patients who develop coronary (heart) symptoms related to atherosclerosis (clogging of the arteries) will have had symptoms and signs of erectile dysfunction prior to the onset of heart symptoms.

Early HIV Infection and PEP | Post-exposure Prophylaxis

2010-07-08T09:08:00.005+01:00

Post-exposure Prophylaxis (PEP) for HIV infection

Post-exposure Prophylaxis, often abbreviated to PEP, is a course of medication that can be taken after exposure to HIV that can prevent HIV infection.

Writing in the New England Journal of Medicine, Raphael Landovitz and Judith Currier have outlined current clinical practice and recommendations for the use of PEP.

How can people be at risk of contracting HIV?

When the treatment first became available in the early 1990s it was primarily for medical professionals who had come in to contact with HIV infected blood. This could be through a needlestick injury or being splashed with copious amounts of blood on an area where it could get in to their bloodstream, such as through the eyes, mouth or fresh open cuts.

The treatment still continues to be used for these occupational injuries but has since become widely used to treat people who may have been exposed to HIV through sexual activity.

The journal reports that the risks of transmission through unprotected sex are difficult to quantify but does specify that receptive anal intercourse carries the greatest risk, followed by insertive anal intercourse and receptive vaginal intercourse. Oral sex is considered to pose the lowest risk of HIV transmission though the article acknowledges that some people have infected with HIV and report their only risk factor was receptive oral sex where an HIV positive person ejaculated into their mouth.

When is PEP recommended?

For those who may have come in to contact with HIV in an occupational setting it is easier to determine whether the blood they have come in to contact with is infected with HIV, and often tests will be carried out on the ‘source patient’ to establish their HIV status and inform a decision on whether PEP should be used.

A negative test result may not necessarily mean that PEP is ruled out, because a recent high-risk behaviour could mean the source patient is infected with HIV but infection was so recent that it doesn’t yet show up on tests. In these situations, the ultra sensitive and ultra accurate HIV 1 and 2 RNA PCR test gives exquisitely accurate and very early results.

For people who have had unprotected sex and fear they have been exposed to HIV, it can be harder to establish whether they actually have been exposed to the virus.

In such a situation doctors will carry out a ‘risk assessment’ trying to establish whether the risk of exposure to HIV is great enough to justify the side effects and cost of the treatment.

It will look at the likelihood that the person they had sex could be HIV positive. If they are from an at-risk group where prevalence of HIV is high then treatment should be given. This would include men who have sex with men, commercial sex workers, injection drug users, people who have been in prison, and people from a country where the prevalence of HIV is greater than 1%. Although the article is American, similar principles operate in the UK.

How soon after exposure should it be taken?

PEP should be taken as soon after the exposure or suspected exposure to HIV. The article cites trials on macaques that showed a greater benefit of taking PEP within 36 hours of exposure compared to 72 hours after exposure. Guidelines including those issued by the World Health Organisation say the treatment should be started within 72 hours of exposure; however New York State’s guidelines recommend a 36-hour window. In the UK it is generally given within 72 hours of exposure.

How effective is PEP?

The article concludes that the success rate of PEP is around 80% saying it is not a guarantee of protection. It also says more studies need to be carried out in this area. A number of variables that impact on the success of the treatment are also highlighted, including how soon after exposure treatment was started and adherence to the treatment regime.

It is also not determined exactly what level of adherence is required to get the maximum benefit from PEP treatment but the current recommendation in the UK is a full 28 days.

What exactly are the PEP drugs?

PEP treatment can be made up of a combination of two or three antiretroviral drugs. Ritonavir, Tenofovir and Iamivudine (Combivir) are commonly used. An alternative more palatable but equally effective regime which we use at Freedomhealth is Truvada and Kaletra. The exact combination can depend on other illnesses or conditions that the patient may have and the likely resistance of the HIV to which the patient has been exposed . This can mean that the number of pills taken during the 28-day course of treatment can vary from 1 to 6 depending on the treatment.

What are the side effects of PEP?

The antiretroviral drugs that make up PEP are toxic pills. Side effects can include sickness and diarrhoea, liver problems, renal stones and hepatitis. Many people find it difficult to continue taking the drugs and the article states that adherence to the medication regime is around 70-80%. We will almost invariably add in other medications such as anti-nausea and anti-diarrhoeal medications to control side effects.

Follow-up to PEP treatment

The UK Guidelines on PEP suggest testing 4 to 6 weeks after exposure and again finally 4 months after exposure. There may also be more regular checks to establish what effect the PEP is having on the patient. Although in ordinary circumstances antibody tests can detect HIV up to 3 months after exposure, a 4 month test is needed because of uncertainty over the effect PEP has on HIV antibody production.

Genital Herpes (HSV2) and HIV disease: Why does it matter?

2010-07-02T11:07:00.001+01:00

Genital Herpes (HSV2) and HIV disease: Why does it matter?

There is good evidence from population studies of people infected with both HIV1 and also HSV2 that infection with Herpes Simplex 2 virus will both increase the amount of HIV1 which is shed in gental secretions and also it increases the rate at which HIV 1 is transmitted.

Treatment designed to suppress Herpes simplex 2 (HSV2) is established to reduce the amount of HIV1 RNA in blood and also genital secretions such as semen and vaginal secretions.

The impact of co-infection (having infection with HIV and HSV2) of HIV1 and HSV2 is very significant indeed with HSV2 and HIV1 co-infected individuals having very much more HIV1 RNA (ie the infectiouness of the individual is increased) in their genital secretions and also in their blood. This obviously means that their potential for spreading HIV either through asymptomatic HSV shedding or symptomatic HSV2 lesions is greatly increased. In addition, treatment for the HSV2 part of the co-infection has no effect on the HIV1 directly but does reduce the HIV1 viral load.
HIV viral load increases are associated with an accelerated course towards the development of AIDS defining diagnoses (AIDS is not the same as being HIV positive). The way anti HSV2 medications reduce HIV1 viral load is thought to be through partly interupting the “HIV inducing effect” of HSV2.

Unfortunately, we also know that people with HSV2 genital lesions are much more likely to acquire HIV1 from an HIV infected individual – by a factor of up to six times more likely.

Up to 60% of people living in the “West” with HIV have Herpes Simplex 2 (HSV2) infections whereas in Sub-Saharan Africa the figure is thought to be up to 90%.
A study by Nagot and others published in the NEJM (Nagot N, Ouedraogo A, Foulongne V, et al. Reduction of HIV-1 RNA levels with therapy to suppress herpes simplex virus. N Engl J Med 2007;356:790-9) looked at HIV1 and HSV2 co-infected populations in Sub-Saharan Africa and treated trial subjects with valaciclovir, an anti-HSV2 drug.

HIV1 is shed from HSV2 lesions and most of the shedding (85%) occurs without the actual physical appearance of HSV2 genital ulcers.

The effects were to markedly reduce the re-occurence of HSV2 lesions, and to markedly reduce the amount of HIV1 in both blood and also genital secretions.

The significance of this is that reducing the HIV1 viral load in the genital tract by treating the additional HSV2 infection may reduce the transmissibility of HIV1 infections (and probably HIV2 although this was not within the studied populations).

A further possible scenario is that people with HSV2 but not HIV will be at theoretically reduced risk of HIV acquisition if they suppress the appearance of HSV2 lesions by long term suppressive treatments such as aciclovir or valaciclovir. Aciclovir has the great advantage of being very cheap and very well tolerated.

Laser and Combination Treatment of Ageing Skin

2010-07-01T19:40:00.003+01:00

Recent advances in treatments for photoaging

Photoaging, or photodamage as it is also known, is characterised by features including wrinkles, loss of skin elasticity, redness and a change in skin texture or colour. Photoaging is caused by damage from Ultraviolet (UV) light which comes from exposure to the sun and is one of two main categories in skin ageing; the other being intrinsic ageing which is due to simply getting older.

Thankfully for patients seeking to improve the appearance of their skin there are a number of treatments that are available, many of which are easy to undergo with little risk and rapid recovery.

Treatments include laser treatments, chemical peels, topical agents, injections such as Botox and dermal fillers like Restylane.

Increasingly studies are concluding that combining many treatments for photoaging has beneficial effects beyond simply complementing each other.

Tierney and Hanke, writing for the American Society for Dermatologic Surgery, have reviewed 24 recent studies into the effects of combining treatments for photoaging and conclude that many of the treatments have synergistic benefits, meaning one treatment actually improves the efficacy of the other.

The researchers said the studies’ findings were ‘remarkable’ and highlighted that 10 of the 24 studies into combination treatments showed histologic evidence of the repair of sun damaged skin. This means that not only were patients and doctors reporting better results with the combined treatments but that tests such as ultrasound and biopsies performed on the skin were actually able to prove their success. In some cases it was proven that new collagen was being produced, that skin thickness had changed or that damaged parts had been eradicated.

One such study by Berlin and colleagues looked at the combination of a skin peel (Er: YAG, which stands for erbium-doped yttrium aluminium garnet) and intense pulsed light (IPL). Patients underwent three sequential monthly treatments of the combination. Doctors then studied their skin and skin tissue, finding evidence of new collagen production and eradication of disorganised elastic fibres. IPL is one of three primary nonablative laser systems, meaning it doesn’t remove skin or tissue. IPL devices target the dermis (a deep inner layer of the skin) and target melanin and haemoglobin pigments which are associated with photoaging and sun damage.
The review also found further evidence to support using topical agents in laser and light treatments. Five separate trials were carried out into combining aminolevulinic acid and IPL.

All five found using the acid alongside the light improved the efficacy of the treatment. Crow’s feet were improved by 55% compared to 28% with IPL alone, skin texture improved by 55% vs. 30%, hyperpigmentation (dark patches) improved by 60% vs. 37% and redness by 84% vs. 54%.

Evidence was also found to support the combination of injectable treatments such as Botox and fillers like Restylane.

A study by Carruthers and Carruthers found that combining BTX-A (Botox) with hyaluronic acid (Restylane) doubled the longevity of the Restylane. The study involved treating women with deep wrinkles with the combination and another group with Restylane alone. It found the average time for the wrinkles to return to their pre-treatment state was 18 weeks with the Restylane alone group but 32 weeks for those who had been treated with both Botox and Restylane. It is thought the Botox may have delayed the Restylane deforming.

Another study by Khoury and colleagues aimed to determine whether Botox could also improve the efficacy of intense pulsed light treatments. Doctors treated one group of women with Botox and IPL and another group with saline and IPL and then evaluated their wrinkles, fine lines, redness, hyperpigmentation, pore size, skin texture and overall appearance over 8 weeks. It found a significantly higher proportion of patients treated with Botox and IPL showed improvement with small wrinkles and fine lines – 93% compared to 29% of those treated with saline and IPL. Redness was also more improved with the combination treatment.

Studies also looked at the combination of two laser treatments. Biopsies taken after a combined treatment with a potassium titanyl phosphate laser (KTP) and a neodymium doped laser (Nd: YAG) showed evidence of new collagen formation, in ways that would not have been present had just one of the treatments been used alone. These lasers, like intense pulsed light treatment are non-ablative.

In addition to the studies of combination treatments, the
review also looked at studies carried out with ablative lasers, which involve the removal of some of the skin’s surface. A study by Hedelund and colleagues performed a comparison of a carbon dioxide laser and IPL. The treatment performed with a carbon dioxide laser is often known as C02 laser resurfacing. The study found that skin elasticity increased in both groups and that CO2 laser resurfacing reduced wrinkles better than IPL but induced some side effects. The side effects include redness, dyspigmentation and whiteheads. The study found that consequently a number of patients preferred IPL treatments over carbon dioxide laser resurfacing.
See our pages on laser skin treatments, dermal fillers and chemical peels and resurfacers for more information.

HIV seroconversion syndromes or HIV ARS

2010-06-30T11:09:00.004+01:00

What are the symptoms of HIV?

This is a common question we receive here at Freedom Health.

According to this article on emedicine, it is thought around 70% of people who contract HIV will develop symptoms when they are seroconverting. Seroconversion is the period between exposure to the HIV virus and the completion of the initial response of your immune system. It lasts about two to three months, though the symptoms will last for a shorter period. Seroconversion is also known as acute HIV infection.

The symptoms of an HIV infection are often described as ‘flu-like,’ the most common are fever and chills, swollen glands, a sore throat (with or without ulcers), anaemia and rash, particularly on the upper body. Symptoms can also include headaches, fatigue, night sweats and weight loss and an individual recently infected with HIV may also feel nauseous, experience diarrhoea, have swollen and tender joints or a painful or stiff neck.

Many of the symptoms will disappear without the need for medical treatment.

These symptoms may be the signs of a recently acquired HIV infection, but not all HIV tests will be able to detect whether an individual is HIV positive during the period of acute HIV infection. If you have any of these symptoms and have had a risky sexual exposure you should get tested for HIV.

See our HIV testing page and also our information on novel testing methods for more information.

What happens during seroconversion?

The article also gives a rough timeline of the different stages of HIV infection.
Day 0: A person is infected with the HIV virus.

From day 8: The amount of virus in the blood more than doubles every day and the CD4 cell count begins to drop as the viral load (amount of virus in the body) increases. CD4 cells are the immune cells that the HIV virus depletes over time, eventually resulting in the need for anti-retroviral medication. At this stage of the seroconversion a HIV RNA PCR test would be able to detect HIV, however traditional antibody tests would come back negative.

Week 2 - 4: The viral load peaks and can be as high as millions of copies per microlitre of blood, making the individual their most infectious. Despite the high amount of HIV virus within the body, antibody tests may still return a negative result. For this reason the sooner an HIV infection is diagnosed, the less chance there is of it unwittingly being passed on.

Week 10 – 24: The viral load will drop to its lowest point and traditional HIV antibody tests will become positive for HIV.

What happens after seroconversion?

The immune system continues its battle against the HIV virus but the depletion of CD4cells, or T-cells as they are also known, continues as the virus replicates. This stage is known as chronic HIV infection and can continue for many years without the need for medication until it eventually would develop into AIDS. AIDS (Acquired immunodeficiency syndrome) is defined by a CD4 cell count of less than 200 per microlitre of blood.

The interval between seroconversion and AIDS is an average of ten years, with the CD4count being depleted at an average rate of 50 cells per year. The speed at which the disease progresses relates to the HIV viral load - the higher the viral load the faster the progression.

Many people first become aware they are HIV positive after contracting an opportunistic infection brought on by having a low CD4 T-cell count. A low CD4 cell count leads to a serious state of immunodeficiency which puts the individual at great risk of contracting opportunistic infection, further damaging their immune system. For this reason it is agreed that the earlier a person infected with HIV knows that they are HIV positive, the better it will be for their health.
However, it is not just a weakened immune system that can cause illness; it is possible that the HIV virus itself can have a direct effect on the body, such as causing organ dysfunction.

Some symptoms that may reflect a deteriorating immune system include herpes lesions, shingles and anaemia, caused by the virus damaging the body’s marrow.
Within the chronic infection stage are a number of other stages which are based on the CD4 T-cell count. A count of more than 500 is considered the ‘early stage,’ between 200 – 500 is an ‘intermediate stage’ and a CD4 T-cell count of less than 200 is considered an ‘advanced’ stage of infection.

Reducing HIV Spread

2010-06-29T11:03:00.002+01:00

An interesting boost to the notion that as many people as possible should be tested for HIV so that they can discuss treatment possibilities was presented at the 17th Conference on Retroviruses and Opportunistic Infections (abstract 33).

Researchers form the San Francisco Dept of Public Health have found that increased HIV testing rates and also improved and increased uptake of the use of anti-hiv medications - (anti-retorviral drugs - or ARV's for short) has resulted in a reduction in the "community HIV viral load" on San Francisco. Viral load is the term used to describe the amount of HIV in a persons blood stream and or body fluids. The rationale behind the research is that because so many people with HIV have been correctly identified in the San Francisco area, many more have been offered treatment.

The aim of treatment with ARV's is to reduce an individual's viral load and thus his or her infectiousness. The success of the this public health initiative has resulted in a TOTAL drop of viral load in the community which in turn has benefited the community as a whole by a subsequent decline in new cases of HIV between 2004 and 2008.

This is good news as a whole and does give more credence to the drive to test and treat more people at an earlier stage. This also fits with the concept that interventions with treatment in the very early stages of new HIV disease may limit the infectivity of those persons and thus the inadvertent onward passage of HIV to others.

See our HIV testing page and also our information on novel testing methods for more information.

HPV Wart Virus and cancers: A New Dimension in predicting the risk of cervical cancer

2010-06-28T12:49:00.005+01:00

A New Dimension in predicting the risk of Cervical Cancer.

Expression of specific viral oncoproteins E6 and E7 is required for the development and maintenance of cervical cancer cells. The DNA of specific HPV types has
been found in almost all cervical cancer biopsies.

Links between human papillomaviruses (HPV) and cervical
cancer, anal cancers and also latterly oral cancers are well documented. The very high prevalence of HPV compared with the very low incidence of cervical cancer has since presented a problematic issue when trying to use the presence of HPV as the diagnostic tool to prevent cervical cancer. However by the mid-nineties it became better understood that it was not the entire viral particle that was responsible for the development of cancer. Since then, more than 1400 international publications have
documented that it is not the HPV virions that have an active role in the carcinogenic process, but that abnormal transcription from fragments of HPV DNA giving fulllength E6/E7 oncoproteins are required for initiating the transformation and immortalisation of normal cervical cells into abnormal cells. Production of E6/E7
oncoproteins is required for maintaining the malignant growth of cervical cancer cells.

This wealth of scientific documentation repeatedly confirms that it is not possible to develop HPV related cervical, anal or oral cancer without the presence of full-length E6/E7 oncoproteins in abnormal cells. Normal HPV infection does not produce
full-length oncogene E6/E7 proteins or mRNA. Most HPV infection is transient
and short lived. Therefore, the majority of HPV DNA positive cases are without
oncogene or transforming activity. Testing for HPV-DNA therefore identifies the
presence of an extremely common virus. Looking, instead, for full-length E6/E7
mRNA, has the capability of directly identifying the presence of abnormal cells in
the cervix.

High Risk Subtypes – Coverage Rate

One of the most frequent questions about HPV asks which subtypes are related to
cervical cancer development. Several large international studies have been performed
and a number of HPV subtypes have been identified in biopsies from cervical cancer
patients. Almost 98% of all HPV-positive cervical cancers identify five HPV
subtypes 16, 18, 31, 33 and 45 in Europe and Northern America. In addition, new studies using cervical smears from women with cervical cancer have demonstrated 100%
coverage rate in detecting the presence of E6/E7 mRNA from these five HPV-types
only. Other HPV subtypes found in cervical cancers appear to be passengers, and not
responsible for the development of cervical cancer. The reason for this is that the
underlying fragmented HPV DNA (even with a low copy number) from these five
types may always be present in nearly 100 of the cervical carcinomas producing high
amounts of full-length E6/E7 mRNA and proteins. It would therefore be of little benefit to test for more HPV subtypes because of the dominant position these five
most prevalent HPV subtypes already hold. The HPV virion or HPV DNA with intact
transcriptional control will not take any active part in the development of cervical
cancer. In abnormal cells, the virus does not replicate itself anymore due to integration and reduced differentiation. Because of
HPV integration and loss of regulation causing disruption or fragmentation of
DNA, all available DNA based HPV tests will give a negative result in 4-25% of the
cervical cancer cases. Integration creates deletions in target sequences for HPV DNA
based tests and the loss of viral replication drastically reduces the number of HPV
DNA copies (but not the number of HPV E6/E7 mRNA copies). However, the
expression of full-length E6/E7 is never absent in HPV induced cervical cancer cells.
Therefore, a DNA-based test without target amplification will have a lower sensitivity towards HPV induced cervical cancer than PreTect HPV-Proofer.

Greater understanding of results:

POSITIVE DNA/ NEGATIVE mRN
NEGATIVE DNA/POSITIVE mRNA

Because of the totally different roles of the HPV virus and full-length E6/E7
oncoproteins in relation to the development of cervical, anal and oral cancer, there will be occasions when results will be positive for HPV-DNA
and negative for full-length E6/E7 oncoproteins (mRNA). This is due to the
high prevalence of transient HPV infections in a screening population with no clinical implications for the development of HPV induced cervical cancer. However the very low incidence when an HPV DNA based test is negative and the PreTect HPV-Proofer test is positive for full length E6/E7 oncoporoteins represents those few cases of women with persistent severe abnormalities or invasive cervical carcinoma.

New STD tests and testing

2010-06-28T12:32:00.004+01:00

Selected STD's and STI's testing

Herpes Simplex Virus Type 1 and 2 by PCR

Testing for the virus directly from the skin is useful if genital signs or symptoms are present at the time of examination. A viral (green) or PCR swab need to be taken from a lesion or sore for detection of herpes simplex virus.

PCR tests are the most accurate tests for herpes. PCR techniques make many copies of the viral genetic material (DNA) in a short time so that even tiny amounts of virus are sufficient for a positive test. Positive samples are confirmed as positive for either HSV I or HSV II. Herpes PCR DNA swabs can be ordered directly from Freedomhealth for personal sampling in the convenience of your own home. We would prefer you to have a telephone consultation with us prior to sampling to make sure you need the test, understand the limitations of the test, understand how best to perform the test and we will help you understand the results with a free follow up telephone call. To book a telephone consultation with us please call 02076371600 Monday to Friday bewteen 8.30 am to 6.30 pm.

Trichomonas vaginalis

One of the most common sexually transmitted protozoal infections, T. vaginalis, is associated with signs and symptoms of urethritis, an odorous vaginal discharge and dyspareunia. Pregnant women infected with T. vaginalis are more likely than uninfected women to deliver preterm, or to have a low birth weight infant.

Complications in men include prostatitis, epididymitis, urethral stricture disease, and infertility. T. vaginalis infection is highly associated with the presence of other STDs.

Mycoplasma genitalium

Sexually transmitted pathogen, M. genitalium, is identified in acute and chronic non-gonococcal, non-chlamydial urethritis in men, and urethritis, cervicitis, and pelvic inflammatory disease in women. A high concordance rate is found among sexual partners of M. genitalium infected patients, indicating that the infection is sexually transmitted.

Results of studies have shown that in male patients presenting with persistent or recurrent non chlamydial, non-gonococcal urethritis after treatment with antibiotics, nearly half were infected with M. genitalium. It is an organism that continues to be of interest to clinicians and pathologists. It exceedingly difficult to culture, and accurate detection is dependent on specific PCR assays. Data indicating that M. genitalium is a potential cause of non-gonococcal urethritis have only recently been demonstrated by the use of PCR.

HPV 20 DNA subtypes

More than 100 different types of HPV exist, most of which are harmless. Around 40 types are thought to be spread through sexual contact and are classified as either low risk or high risk. High-risk types of HPV may cause abnormal Pap smear results and could lead to cancers of the cervix, vulva, vagina, anus, or penis. Some types of HPV cause genital warts and are considered low risk types (the most common of which are 6 and 11). Genital warts are contagious. About two-thirds of people who have sexual contact with a partner with genital warts will develop warts, usually within 3 months of contact. Men can unknowingly transmit HPV to their female sex partners. Compared to heterosexual men, women are at higher risk of developing disease from HPV – most notably, cervical cancer. Cervical cancer in women is much more common than anal or penile cancer in men. Anal cancer rates are high in men who have sex with men, women who have already had cervical cancer or cervical cancer pre-changes. HIV positive people have a particularly high risk of anal cancers and pre-cancers.

Persistent High Risk HPV infection is a necessary cause of cervical cancer. Although it has been widely accepted that HPV is sexually transmitted there is limited insight available about the clinical manifestations of HPV infection in men and their contribution to viral spread. Initial studies looking to further the understanding of HPV infection (relevant subtypes, mixed-type, and persistence of infection) in men are taking place with the aim of developing programmes effective for both men and women.

The graph at the top shows he four subtypes being immunised against with the Gardasil HPV vaccine are 6,11 (low risk) and 16, 18 (high risk). HPV20 reports each DNA subtype individually as positive or negative. There is another vaccine, Cervarix, which is active against both the very high risk subtypes 16 and 18.

STD / STI / HIV and Hepatitis B and C testing by text

2010-06-24T17:08:00.004+01:00

Freedomhealth is launching a brand new STD/STI and HIV / Hepatitis B and Hepatitis C testing service across Europe. Patients can text the code for the STD or HIV test of their choice to a dedicated number and an HIV / Hepatitis B / Hepatitis C /STD /STI testing kit will be sent to them by post (arriving the next working day if ordered by 5.00 pm).

Each test is performed by the Doctors Laboratory. the biggest private laboratory in the UK and part of the Sonic Group which is a global provider of diagnostic services. The Doctors Laboratory is a major and sophisticated testing facility.

Freedomhealth works closely with The Doctors Laboratory and also in partnership with ChemistDirect to provide a comprehensive range of Health Solutions.

Freedomhealth is registered with the Care Quality Commission, has a permanent staff of dedicated, very experienced and well trained doctors and also operates a walk-in or appointment service from very comfortable, smart and clean premises at 60 Harley Street London W1G 7HA. If you'd rather visit us then please call us on +44 (0)20 6371600.

We also offer telephone consultations for one to one discussion of your individual circumstances.

This innovative new system is simple and very easy to use.

Decide which test seems the most appropriate for you and then text the special code to 88020 if you live in the UK or +447950080232 if you live in Western Europe.

You will then receive a set of very simple questions and some instructions. The test results will be returned to Freedomhealth Limited and all results will be individually checked by one of our doctors.

The tests currently available are as follows:-

FHPATH1 - this is a very sophisticated combined urine test which will correctly identify genital infection with chlamydia, gonorrhoea, herpes 1 and 2, mycoplasma, ureaplasma, trichomonas, and gardnerella all in one simple test. The test costs £180 and the fee is payable only when you return the testing kit to our laboratory in the pre-paid envelope supplied. To obtain this test kit text FHPATH1 to 88020.

FHPATH2 - an important urine test for chlamydia alone. The test costs £70 and the fee is payable only when you return the testing kit to our laboratory in the pre-paid envelope supplied. To obtain this test kit text FHPATH2 to 88020

FHPATH3 - this is a combined test looking for chlamydia and gonorrhoea. The test costs £85 and is payable only when you return the testing kit to our laboratory in the pre-paid envelope supplied. To obtain this test kit text FHPATH3 to 88020.

FHPATH4 - this is a state of the art HIV DUO BLOOD test kit. The HIV DUO test combines a test looking for HIV 1 and 2 antibodies and also p24 antigen which allows for very early detection of HIV infection. This is an excellent test and very accurate indeed after just 28 days after possible exposure. The test costs £75 and is payable only when you return the testing kit to our laboratory in the pre-paid envelope supplied. To obtain this test kit text FHPATH4 to 88020

FHPATH5 - a superb Early Detection Screen for very early HIV 1 and HIV 2, Hepatitis B and Hepatitis C - testing from as early as 7 days post possible exposure to HIV. This test is superior to the HIV DUO and can be done much earlier. In terms of HIV it detects RNA which is the key viral structure. The test costs £192 and this is payable only when you return the testing kit to our laboratory in the pre-paid envelope supplied. The test takes 5 working days to be processed from the date of receipt. To obtain this test kit text FHPATH5 to 88020

All of these tests are available by simply texting the test code number to the 88020 (or +447950080232 if you live in Western Europe and outside the UK) and answering the simple questions.

You have the option if you live within the London M25 area of requesting a nurse to visit you to collect the blood from you. You can do this by calling us on 020 7637 1600 Monday to Friday 8.30 am to 6.30 pm or Saturday 10.30 am to 3.30 pm and asking for the Freedomhealth Visiting Nurse service. This service will cost a further flat fee of £85 which covers the cost of dispatching the nurse to you, collecting the blood and returning to the laboratory with your samples.

Telephone consultations are available with one of our doctors through the week and into Saturday's. They are pre-paid at the time of booking and we charge £55 for a twenty minute consultation.

Sue Carroll of the Dailly Mirror has a Non Surgical Face Lift at FreedomHealth

2010-05-18T05:03:00.002+01:00

Sue Carroll, Britain's favourite columnist has a non-surgical facelift at Freddomhealth with top Aesthetic Nurse Practitioner Lee Garrett. You can read all about Sue's experience here in the Daily Mirror.

Treating Ageing Hands

2010-05-06T16:48:00.000+01:00

Treatment of the Ageing Hand Using Combined Modalities of BroadBand Light and Dermal Fillers

The general public is now accustomed to the concept of photo-protection of the face and neck in order to slow the onset of visible signs of ageing. High SPF, comfortable and pleasantly fragranced sunscreens have transformed the acceptability of sun-hygiene routines.

In addition, judicious use of dermal fillers such as hyaluronic acids, calcium hydroxyapatite and poly-lactic acid restores volume and lustre. Use of fractional photo-thermolysis and intense pulsed light or Broad Band Light will correct dyschromia, textural changes and wrinkling through collagen stimulation.

Using a combined treatment approach with both rejuvenating intense light sources together with dermal fillers will achieve very substantial improvement in appearance and feel. The response is immediate in terms of volumisation and very rapid in terms of pigment correction.

What the public and practitioners often forget is that the hands are as visible as the face but at least as equally amenable to restoration. The hands are also very often subject to photo-damage without the benefit of a protecting SPF sunscreen. Most people will religiously apply SPF to their faces and may well intend to cover their hands also. The reality though is that the greasy feel of most sunscreens will encourage people to wipe their hands clean or wash their hands after applying to the rest of the body. The result is an enhanced photo-atrition over a truncated time frame, resulting in volume depleted, rough, wrinkled and dyschromic skin.

Despite diligent attention to the face, neck and decolletage the hands will often give the ageing game away.

All is far from lost however. Most practitioners will have the skill and capacity to restore a youthful appearance to the hands quite easily.

Intense Light Sources for Hand Rejuvenation

My approach is to identify which part of the Ageing Hands Syndrome the patient dislikes most and to start with correction of that particular aspect. Intense light sources and fillers of varying descriptions can be used together but the patient needs to understand the time frame between each treatment and also the different effects achieved by the various methods. Preferably light treatments, either fractional photo-thermolysis or broad band light should be used prior to the use of dermal fillers to avoid inadvertent premature destruction of the dermal filler.

I use the Sciton BBL device which allows for speedy throughput of patients whilst delivering effective treatment. The small spot size makes treatments highly efficient and maximises patient comfort. The 515 nm filter deals easily with most hand freckles and age-spots and swiftly restores normal even pigment. However, I prefer to use the 560nm for the first pass and this will effectively promote collagen regrowth and reduce crepiness in the skin. As an aside, several patients have volunteered improvement in the symptoms associated with their Raynaud’s Disease.

The Sciton BBL provides repeatable, reproducible and even results time after time. Unlike very many other systems using standard IPL technology there are no consumables (unless you are unfortunate enough to break a filter) and although the initial cost of the device is slightly greater, it represents excellent value for money.

I tend to use one pass initially with the 560nm filter as described above but with a small spot size followed then with a single further pass with the 515nm filter and again using small spot size. Typically there is no bruising although the letigines will crust and fall off. A maximum total of three treatments at three week intervals is required for optimal effect.

Rejuvenation of the hands using dermal fillers.

Dermal fillers will correct the loss of volume which occurs with the exposure of the hands to sunlight over time. Hands will age due to loss of subcutaneous fat and also because of loss of muscle in the skin layers. The net effect is a wasted hand covered with crepe like skin with visible tendons and blood vessels and also an increased propensity to wrinkle and dry. The “snap test” will often fail dramatically.

Options for volume replacement include fat transfer and dermal fillers of one sort or another. Fat transfer is problematic because it needs to be carefully harvested and carefully placed. It also tends to fade rapidly and in my experience long lasting success is very operator dependent.

Permanent fillers should not be used. History has shown clearly that permanent fillers have a marked propensity to cause wholly unanticipated problems and in my view, cosmetic use is unjustified.

There are two dermal fillers I have had excellent results with. Radiesse and Restylane Vital.

Radiesse is a synthetic calcium hydroxyapatite product comprised of micro spheres suspended in a water based gel carrier. It is 100% biocompatible and occurs naturally in human tissue. It is injected using a fine gauge needle. Typically the wasted areas are obvious and tend to lie between the metacarpal heads. I inject 0.5ml 1% lidocaine plain (no adrenaline) as a bleb and then inject a total of 0.75ml Radiesse into four or five target points. Once placed it forms a fine, cobweb like “scaffold” to support and stimulate the body’s own collagen production. The results are long lasting and extremely satisfying to see. The treatment will give extremely good results after only one treatment, although sometimes a top-up is needed at a six week review appointment. Effects are long lasting at 12 months but importantly are temporary. In my opinion temporary is good. The major adverse effects of dermal fillers and volumisers are almost entirely related to permanent fillers.

Occasionally post-injection oedema may occur but I warn patients regarding this and give post-treatment instructions. For oedema, this amounts to simply sitting on the hands for 5 minutes. All patients are given my mobile phone number and to date there have been no abuses of this.

Restylane Vital is non-animal stabilised hyaluronic acid (NASHA) at 20mg /ml suspended in saline solution. It is colourless and comes as 2ml disposable syringes with an automated “wind up” delivery mechanism. The syringe holder fits comfortably in the hand and makes precise delivery of individual aliquots into the skin very easy. Qmed have recently introduced a new silicone coated needle which has further improved patient comfort. The process is generally well tolerated by patients few of whom require local anaesthetic. Again, if desired local anaesthetic can be applied by smearing a thick layer of EMLA or LM-X cream over the target and allowing 45 minutes for it to take effect. Hyaluronic acids have been shown to have a positive effect on natural pre-existing collagen and to increase both quality and production. Restylane Vital is injected at monthly intervals with an initial treatment schedule of three treatments. A top up is usually required at six months. Vital does require multiple punctures which some patients find unsettling.

I don’t think there is a definite “right or wrong” approach to hand rejuvenation (with the exception of my complete antipathy towards the use of permanent products) and as I said at the outset, I believe most practitioners will be able to effectively achieve renaissance of the ageing hand with a carefully blended use of intense light therapies and dermal fillers. The ultimate effects are quite remarkable with universal patient satisfaction.

Lee Garrett RN; BSc is Aesthetic Nurse Specialist at Freedomhealth. The Freedomhealth Group provides Private General Medical, Non-Surgical Cosmetic and Sexual Health Services. www.freedomhealth.co.uk 60 Harley Street London W1G 7HA. Tel 02076371600

¿Cuál es la mejor prueba de detección del virus VIH?

2010-05-03T16:21:00.000+01:00

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¿Cuál es la mejor prueba de detección del VIH?

La mejor prueba para detectar el VIH es aquella que proporcione un resultado exacto y tranquilizador en el marco de tiempo que más le convenga. Cada persona va a tener una "mejor prueba del VIH" diferente porque las circunstancias serán ligeramente diferentes. Los elementos principales a considerar serían en primer lugar, el momento en el cual uno haya estado posiblemente expuesto al virus VIH y en segundo lugar lo desesperadamente que uno necesite saber la respuesta. El momento de exposición es importante porque nos permite calcular el período ventana del VIH, que es el tiempo desde la infección por el VIH hasta el momento de la posible detección.

Existe una gran confusión respecto a las pruebas del VIH lo que se debe principalmente a los enormes avances en nuestro conocimiento sobre el VIH en el tiempo que ha transcurrido desde que comenzó la epidemia y el progreso de la tecnología para el desarrollo de las distintas pruebas. En consecuencia la respuesta a cuál es la mejor prueba de detección del VIH depende en gran medida de las circunstancias individuales.

Ahora tenemos métodos que nos permiten en realidad identificar la infección por VIH muy pronto. Esto es importante por todo tipo de razones, y no es menos importante el hecho de que así sabemos que el período más importante para la transmisión del VIH a otras personas es en los primeros meses después de la infección, cuando la cantidad de virus en el torrente sanguíneo, el semen o los fluidos vaginales de la persona infectada, es probablemente que sea muy alto. La cantidad de virus VIH en un fluido corporal se conoce como carga viral del VIH y en las primeras etapas es probable que haya muchos cientos de miles o millones de copias del virus en cada mililitro de sangre u otro fluido.

A medida que avanza la infección y el cuerpo de la persona recién infectada comienza a tomar control de la nueva infección por el VIH, la cantidad de virus disminuye y así se convierte en esa persona, pensamos, mucho menos infecciosa. Así, por ejemplo, si yo fuera hoy mismo a convertirme en VIH positivo, entonces en alrededor de aproximadamente 2 semanas mi carga viral - la cantidad de virus en cada ml de sangre o semen - aumentaría rápidamente alcanzando varios millones de copias . En este caso yo sería muy infeccioso para las personas con las que tuviera relaciones sexuales.

La detección temprana de nuevos casos de infección de personas VIH positivas nos permite tener oportunidades para poder influir de una forma positiva en un mejor pronóstico de la enfermedad y en una reducción en la transmisión. Sabemos por estudios que la mayoría de las personas que saben que son VIH positivas estarían dispuestas a tratar de evitar la transmisión del VIH a otras personas.

Entonces, ¿cuál es la mejor prueba de detección del VIH?

- Las pruebas para detectar el VIH una semana después de la exposición

El diagnóstico preliminar del VIH y de la enfermedad de la hepatitis C es ahora posible sólamente 7 días tras la exposición a los virus. Este período de tiempo tan corto no estaba disponible en el pasado, pero la utilización novedosa de una tecnología estándar de rutina nos ha facilitado el diagnóstico temprano. La técnica ha tenido la mayoría de sus aplicaciones hasta ahora en la detección del suministro de sangre humana de donantes de sangre y ha reducido muy considerablemente el número de casos con contaminación inadvertida con el VIH y el virus de la hepatitis C. La técnica también se emplea en la donación de órganos, los cuales para ser donados son examinados con la misma técnica de detección del VIH-1, VIH-2, hepatitis C y virus de la hepatitis B.

Un estrecha colaboración con The Doctors Laboratory (un laboratorio de referencia mundial en Londres), nos ha permitido aplicar esta técnica de detección en sangre, para iniciar el proceso de diagnóstico de las enfermedades mencionadas.

La técnica de diagnóstico ultra-rápido utiliza un sistema completamente automatizado realizado por Roche y el método de ensayo
utiliza la reacción en cadena de la polimerasa (PCR) o NAT (Amplificación de los Acidos Nucleicos) siendo posible detectar cantidades minúsculas de material genético del virus (y la técnica puede aplicarse también a las bacterias).

El proceso funciona de la siguiente manera. Tomamos una cantidad de sangre suficiente para ejecutar las tres pruebas NAT para el VIH-1 y VIH-2, virus de la hepatitis C y el virus de la hepatitis B. También podemos incluir la sífilis IgG e IgM dentro de esa pantalla. La prueba se realiza utilizando la plataforma de Roche y se ejecuta con la técnica de "sample in, results out", lo que reduce las posibilidades de contaminación del producto, etc a cero. En caso de una muestra positiva, toda la muestra se analiza a continuación para identificar exactamente el virus que ha producido el resultado positivo y más pruebas adicionales específicas de confirmación se llevan a cabo.

El resultado es de una alta sensibilidad,y los métodos de detección son de alta precisión. El tiempo de respuesta es rápido, necesitando un máximo de 4 ó 5 días.

– Prueba de los anticuerpos VIH 1 y 2 y del antígeno p24 (VIH DUO o VIH Combi)

Esta prueba del VIH está aprobada en la Unión Europea para su uso 28 días después de una posible exposición. Es, probablemente, mucho mejor que esto y es probable que pueda identificar a la mayoría de las personas VIH positivas infectadas entre los 14 y 21 días. Esta prueba del VIH se conoce como de cuarta generación . Ciertamente en nuestra clínica hemos tenido muchos nuevos diagnósticos de pacientes positivos con esta prueba combinada del VIH DUO tras este periodo de tiempo mencionado de 14 a 21 días.

La prueba del VIH DUO se basa en el principio de que cuando el VIH primero se establece en el cuerpo, empieza a replicarse rápidamente y casi como un subproducto de esta replicación una proteína central - el antígeno p24 del VIH - se produce en grandes cantidades alrededor de los 10 días después de la primera infección y durante el tiempo en que los anticuerpos del VIH se están formando. El antígeno p24 entonces estaría a un nivel muy alto durante los primeros meses después de la infección, seguido de una disminución posterior de acuerdo con la disminución de la carga viral del VIH. Nunca desaparece por completo y se podrá detectar a diferentes niveles durante el curso de la enfermedad.

Así que en general, el antígeno p24 se forma un poco antes de que los anticuerpos aparezcan, lo que nos permite cerrar la brecha entre la infección y el tiempo de detección - el período ventana del VIH. Conforme pasa el tiempo, la mayoría de las personas VIH positivas forman anticuerpos contra el VIH 1 ó 2 después de 28 días. Buscando entonces en combinación tanto al antígeno p24 como a los anticuerpos del VIH 1 y 2 permitiría la detección del VIH mucho antes que si buscamos sólamente los anticuerpos contra el VIH.

- Prueba de anticuerpos VIH 1 y 2

En torno a esta prueba es donde se centra la mayor confusión. Cuando la epidemia comenzó a principios de los años ochenta, nuestros métodos y dispositivos de análisis eran relativamente pobres y con frecuencia producían resultados falsos. Esto fue en gran parte debido a que los investigadores estaban tratando de encontrar en primer lugar, la causa y luego una prueba de detección de una enfermedad nueva y virulenta.

Recuerdo muy bien aquellos primeros días llenos de pánico. Los resultados falsos - tanto los falsos positivos com los falsos negativos nos condujeron en ese momento a tener una gran cautela en la interpretación de los resultados de las pruebas del VIH. Con el tiempo, nuestro mayor y mejor conocimiento de la enfermedad, junto con los avances en los métodos de control han contribuido enormemente en la mejora de las pruebas de detección.

Hemos pasado de las pruebas rudimentarias a principios de los años ochenta, a las pruebas del VIH de tercera y cuarta generación en 2010. Las pruebas de anticuerpos VIH 1 y 2 en uso en el Reino Unido y resto de Europa Occidental son de tercera o cuarta generación. Las modernas pruebas de tercera generación identifican a más del 99% de las personas VIH positivas infectadas 6 semanas después de la exposición a pesar de que tienen licencia sólamente para su uso después de 12 semanas tras una posible exposición.

La mejor prueba del VIH siempre va a ser la que se adapte al periodo de tiempo específico de posible exposición al virus, así como también sería necesario saber el nivel de ansiedad o preocupación en el paciente. Siempre hemos de recordar que si Usted tiene una exposición de alto riesgo, como el sexo sin protección con alguien que se sabe que es VIH positivo, o una ruptura de condón con alguien que se sabe que es VIH positivo, entonces no se debe esperar a hacer la prueba, sino que se debe consultar un médico lo antes posible para considerar la Profilaxis Post Exposición (PEP) al VIH, que se debe comenzar idóneamente antes de 36 a 72 horas después del incidente.

HIV Symptoms

2010-05-03T16:20:00.000+01:00

Many of the questions we answer on the Freedomhealth Sexual Health Forum relate to anxiety about HIV and also possible early HIV symptoms.

One of the main problems in relying on HIV symtoms themselves is that they are notoriously vague and almost all the symptoms may in fact be symptoms of a different disease. The best method always of diagnosing HIV is to have a modern HIV test. Diagnosis may be difficult and uncomfortable but in Western Industrialised countires knowing your HIV status - positive or negative is ALWAYS a good thing. Knowing you are HIV positive and engaging in medical care will preserve your life to a normal lifespan.

It sounds obvious, but in order to acquire HIV there has to be a significant exposure. A significant sexual exposure means unprotected vaginal and or anal (or both) penetrative sex with a person who already has HIV infection.

Dr Martin Fisher of Brighton and Sussex University Hospitals in the UK has looked specifically at HIV sero-conversion illness and has found that it occurs much more commonly than is currently thought.

We knew already that early HIV disease provides a short interval at an early stage in the illness to identify new infections. By identifying new HIV infections early we can do two important things.

Firstly we can dramatically alter the health of the person we have just diagnosed. This is because we are in an informed position where we can prevent that person entering a long period of several years chronic undiagnosed infection which ultimately ends in a crisis catastrophic illness where the diagnosis is made. This long period of slowly deteriorating health can be halted by just knowing a persons HIV status. The crisis point where a previously undiagnosed HIV positive patient becomes critically ill will frequently end their life.

Secondly, we can dramatically alter the onward transfer rate of HIV to other people. Dr Fisher, in his contribution to the UK's National Aids Trust Policy Report "Primary HIV Infection", cites some research published by Marks in the Journal of AIDS 2005 where a 50% reduction in risky behaviour was seen in people who were aware of their HIV diagnosis. There was an even greater reduction in risky behaviour when the HIV positive person was aware that their sexual partner was HIV negative.

The possibilities presented by the second of these points are enormous in terms of reducing spread. Imagine if we could successfully reduce transfer rates by greater than 50% without doing anything special ? We can. We just need more people to be aware of their status.

So what are typical HIV Symptoms?

Dr Fishers team looked at 108 people with HIV and found that 70 per cent of them had three classic symptoms - the HIV "Triad". These are:-

Severe sore throat

High Temperature

A body rash

These three classic symptoms and signs in an adult should suggest a possible HIV infection and should generate a suggestion that that person should have an HIV test.

There are many other symptoms and signs such as severe muscle aches, headaches, night sweats, lymph node enlargement, and joint pains.

All of these are valid but the key three features are as given above - 1) very high temperature 2) very sore throat 3) body rash. These three classical symptoms should point to the need for an HIV test, preferably one or a mix of a 4th generation HIV DUO test and/or an HIV PCR test. Both of these will allow us to make an early diagnosis with the option then of stopping a severe seroconversion illness early and preventing early immune damage and also allowing the newly infected HIV positive patient to limit the accidental further spread of HIV.

¿Cuál es la mejor prueba de detección del virus VIH?

2010-04-21T11:35:00.002+01:00

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La mejor prueba para detectar el VIH es aquella que proporcione un resultado exacto y tranquilizador en el marco de tiempo que más le convenga. Cada persona va a tener una "mejor prueba del VIH" diferente porque las circunstancias serán ligeramente diferentes. Los elementos principales a considerar serían en primer lugar, el momento en el cual uno haya estado posiblemente expuesto al virus VIH y en segundo lugar lo desesperadamente que uno necesite saber la respuesta. El momento de exposición es importante porque nos permite calcular el período ventana del VIH, que es el tiempo desde la infección por el VIH hasta el momento de la posible detección.

Existe una gran confusión respecto a las pruebas del VIH lo que se debe principalmente a los enormes avances en nuestro conocimiento sobre el VIH en el tiempo que ha transcurrido desde que comenzó la epidemia y el progreso de la tecnología para el desarrollo de las distintas pruebas. En consecuencia la respuesta a cuál es la mejor prueba de detección del VIH depende en gran medida de las circunstancias individuales.

Ahora tenemos métodos que nos permiten en realidad identificar la infección por VIH muy pronto. Esto es importante por todo tipo de razones, y no es menos importante el hecho de que así sabemos que el período más importante para la transmisión del VIH a otras personas es en los primeros meses después de la infección, cuando la cantidad de virus en el torrente sanguíneo, el semen o los fluidos vaginales de la persona infectada, es probablemente que sea muy alto. La cantidad de virus VIH en un fluido corporal se conoce como carga viral del VIH y en las primeras etapas es probable que haya muchos cientos de miles o millones de copias del virus en cada mililitro de sangre u otro fluido.

A medida que avanza la infección y el cuerpo de la persona recién infectada comienza a tomar control de la nueva infección por el VIH, la cantidad de virus disminuye y así se convierte en esa persona, pensamos, mucho menos infecciosa. Así, por ejemplo, si yo fuera hoy mismo a convertirme en VIH positivo, entonces en alrededor de aproximadamente 2 semanas mi carga viral - la cantidad de virus en cada ml de sangre o semen - aumentaría rápidamente alcanzando varios millones de copias . En este caso yo sería muy infeccioso para las personas con las que tuviera relaciones sexuales.

La detección temprana de nuevos casos de infección de personas VIH positivas nos permite tener oportunidades para poder influir de una forma positiva en un mejor pronóstico de la enfermedad y en una reducción en la transmisión. Sabemos por estudios que la mayoría de las personas que saben que son VIH positivas estarían dispuestas a tratar de evitar la transmisión del VIH a otras personas.

Entonces, ¿cuál es la mejor prueba de detección del VIH?

- Las pruebas para detectar el VIH una semana después de la exposición

El diagnóstico preliminar del VIH y de la enfermedad de la hepatitis C es ahora posible sólamente 7 días tras la exposición a los virus. Este período de tiempo tan corto no estaba disponible en el pasado, pero la utilización novedosa de una tecnología estándar de rutina nos ha facilitado el diagnóstico temprano. La técnica ha tenido la mayoría de sus aplicaciones hasta ahora en la detección del suministro de sangre humana de donantes de sangre y ha reducido muy considerablemente el número de casos con contaminación inadvertida con el VIH y el virus de la hepatitis C. La técnica también se emplea en la donación de órganos, los cuales para ser donados son examinados con la misma técnica de detección del VIH-1, VIH-2, hepatitis C y virus de la hepatitis B.

Un estrecha colaboración con The Doctors Laboratory (un laboratorio de referencia mundial en Londres), nos ha permitido aplicar esta técnica de detección en sangre, para iniciar el proceso de diagnóstico de las enfermedades mencionadas.

La técnica de diagnóstico ultra-rápido utiliza un sistema completamente automatizado realizado por Roche y el método de ensayo
utiliza la reacción en cadena de la polimerasa (PCR) o NAT (Amplificación de los Acidos Nucleicos) siendo posible detectar cantidades minúsculas de material genético del virus (y la técnica puede aplicarse también a las bacterias).

El proceso funciona de la siguiente manera. Tomamos una cantidad de sangre suficiente para ejecutar las tres pruebas NAT para el VIH-1 y VIH-2, virus de la hepatitis C y el virus de la hepatitis B. También podemos incluir la sífilis IgG e IgM dentro de esa pantalla. La prueba se realiza utilizando la plataforma de Roche y se ejecuta con la técnica de "sample in, results out", lo que reduce las posibilidades de contaminación del producto, etc a cero. En caso de una muestra positiva, toda la muestra se analiza a continuación para identificar exactamente el virus que ha producido el resultado positivo y más pruebas adicionales específicas de confirmación se llevan a cabo.

El resultado es de una alta sensibilidad,y los métodos de detección son de alta precisión. El tiempo de respuesta es rápido, necesitando un máximo de 4 ó 5 días.

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2010-04-04T11:39:00.001+01:00

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Male Models Wanted for Facial Fillers

2010-03-29T07:30:00.003+01:00

Freedomhealth is currently creating a new Cosmetic brochure for men and we need six models who would like to be considered for free treatment using dermal fillers.

To apply could you please send a plain, good quality image of your face and neck together with very brief details about yourself. These should include age, occupation and reasons for wanting dermal fillers. Please send these details to LEE@FREEDOMHEALTH.CO.UK

We need only six models and we anticipate that these places for free treatment will be snapped up. The conditions will be that you will need to agree to let us use the before and after images in our brochure and that you will agree to attend for the photographs.

We look forward to hearing from you.

Lee Garrett

Vacunas VPH: Gardasil y Cervarix

2010-02-25T11:33:00.000Z

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Vacunas VPH: Gardasil y Cervarix
Se han planteado algunas dudas sobre la seguridad de la vacuna Cervarix hace unos meses, tras la trágica muerte de Natalie Morton de 14 años de edad después de haber recibido la inyección en su escuela de Coventry.
Alrededor de 1,4 millones de vacunas Cervarix se han dado a las estudiantes mayores de 12 años como parte de la campaña nacional de los gobiernos para combatir el cáncer de cuello uterino. Junto con la detección a través de las citologías en chicas mayores de 25 años, potencialmente 700 vidas al año podrían salvarse.
El cáncer cervical es el segundo cáncer más común en mujeres menores de treinta cinco años, resultando en 3.000 casos al año, y causando la muerte de 21 mujeres cada semana en el Reino Unido o en torno a 1000 por año. El setenta por ciento de éstos podrían evitarse mediante el uso de una de las vacunas disponibles contra el VPH. El noventa y nueve por ciento de todos los cánceres cervicales son causados por el VPH, o virus del papiloma humano, una familia de virus que afectan a la piel y a las membranas del cuerpo.

¿Qué es el VPH?
A veces llamado el "virus de las verrugas" o "virus de las verrugas genitales, el VPH se transmite por contacto sexual con alguien que lo tiene. Es muy común y más de la mitad de todas las mujeres que tienen relaciones sexuales se infectan con el VPH en algún momento de su vida.
VPH infecta a las células de la superficie del cuello del útero, donde puede permanecer durante muchos años sin ningún síntoma. El virus del VPH puede dañar las células produciendo cambios en su apariencia, y con el tiempo, estos cambios pueden convertirse en cáncer cervical. Lo mismo puede ocurrir en la mucosa del ano produciendo cancer anal, muy común en aquellas personas que practican el sexo anal receptivo.
Hay más de un centenar de tipos del virus VPH, pero sólo trece de ellos son conocidos por causar cáncer. A menudo, el virus no causa ningún daño, y desaparece sin tratamiento.

¿Cómo funciona la vacuna?:
La vacuna contra el VPH protege contra las dos cepas del VPH (16 y 18) que causan cáncer cervical y anal en más del 70% de las mujeres, pero también en el 70% de los hombres homosexuales que practican el sexo anal receptivo. Cervarix protege contra los tipos 16 y 18 y la vacuna Gardasil protege contra los tipos 16 y 18, así como también los tipos 6 y 11 benignos, que producen el 90% de las verrugas o papilomas ano-genitales, que aparecen en vagina, pene y ano. No protegen contra otras infecciones de transmisión sexual o contra el embarazo.

¿Cómo es de segura la vacuna?
Ambas vacunas eficaces contra el cáncer de cuello uterino, Cervarix y Gardasil, han sido sometidas a rigurosas pruebas de seguridad de gran envergadura como parte del proceso de concesión de licencias necesarias para poder administrarlas en el Reino Unido y en otros países europeos (programs de investigación PATRICIA y FUTURA II).
www.cancerhelp.org.uk
Los posibles efectos adversos son generalmente leves e incluyen:
• Dolor de cabeza
• dolores musculares
• enrojecimiento y dolor alrededor del sitio de la inyección
• Fiebre
• Sensación de malestar general
• Dolor de estómago
• Diarrea
• Comezón, erupción de piel
• Mareos

La Medical and Healthcare Products Regulatory Agency (or MHRA – Agencia Reguladora de los Productos Sanitarios y Médicos) monitoriza la seguridad de la vacuna a través del Yellow Card Scheme (Programa de Tarjetas Amarillas) que facilita el poder informar de cualquier efecto no deseado. Un efecto secundario puede ser informado a las autoridades de forma electrónica o por correo.
Una pequeña cantidad de personas han experimentado una reacción idiosincrática o inpredicible, similar a un shock anafiláctico. Reacciones alérgicas severas son raras, pero son efectos secundarios reconocidos en todas las vacunas, cuyos síntomas pueden incluir difultad para poder respirar y colapso.
En el caso de que ocurran efectos no deseados, el profesional sanitario está perfectamente preparado para tratarlos con efectividad. Si Usted o su hijo sufrieran una reacción anafiláctica después de un tratamineto, uno se recuperaría completamnet después de unas horas.

¿Puedo contraer el VIH a través del sexo oral?

2010-02-24T10:25:00.000Z

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¿Puedo contraer el VIH a través del sexo oral? es probablemente una de las preguntas más frecuentes que me preguntan en Freedomhealth ya sea en persona o a través de nuestro Foro de Salud Sexual. La respuesta es sí, posiblemente, pero es extraordinariamente poco probable.

Ha habido un gran interés y numerosos trabajos de investigación escritos sobre los riesgos del VIH asociados con el sexo oral y de manera similar muchos estudios para tratar de determinar por qué el riesgo del sexo oral con una persona VIH positiva puede ser menor que el asociado con penetración vaginal sin protección o el sexo anal.

Romero et al., en su artículo que describe un excelente estudio a largo plazo no pudo identificar ningún riesgo en la transmisión de VIH de una persona VIH positiva a una pareja VIH negativa a través del sexo oral. En total, 19.000 episodios de sexo oral, se documentaron entre 135 parejas heterosexuales de más de diez años y en el 34% de estos episodios el hombre VIH positivo había eyaculado en la boca de las mujeres VIH negativas. (Romero J et al. Evaluación del riesgo de transmisión del VIH por relaciones sexuales sin protección orogential. 16:9:1269-97 SIDA, 2002.)

Baggaley et al., en su artículo de revisión sistemática de las probabilidades de transmisión orogenital del VIH-1 (International Journal of Epidemiology 37: 1255-65, 2008) se han revisado los artículos más importantes hasta la fecha y la conclusión de que los riesgos de transmisión del VIH por sexo oral es extremadamenete bajo.

Para llegar a sus conclusions, llevó a cabo una revisión sistemática de la literatura disponible. Diez estudios de América del Norte y Europa fueron identificados con el cumplimiento de los criterios exigidos.

Los autores señalaron algunas dificultades con la metodología de los estudios tratándose principalmente de las siguientes: --

- La gente rara vez limita su actividad sexual al sexo oral,

- Donde las personas han tenido otro tipo de sexo, incluyendo la penetración anal o vaginal sin protección, se supone que la actividad de alto riesgo es la que les ha infectado con VIH,
– Los detalles exactos de la actividad sexual se han perdido - es decir, no se sabe exactamente si la eyaculación ha tenido lugar o no en la boca, etc

- Estudios donde se sabe que uno de los miembros de la pareja es VIH positivo y el otro VIH negative, los resultados pueden ser un poco sesgados porque la persona VIH positiva es muy probable que esté tomando medicamentos anti-retrovirales y en consecuencia ser probablemente menos infecciosa de todas formas.

La conclusión general fue que: --

- Las posibilidades de contraer el VIH a través del sexo oral con una pareja con infección por VIH son extremadamente bajos. La mayoría de los estudios calculan un riesgo de cero a minúsculo.

- Estudios mucho más extensos y bien controlados serían necesarios para definir exactamente la cuestión.

Los resultados de un estudio que aparecerá próximamente en el SIDA parecen mostrar que en las relaciones de los varones homosexuales VIH negativos en parejas sero-discordantes (una relación donde uno de los miembros es VIH positivo y el otro VIH-negativo) la saliva tiene una capacidad de neutralizar el VIH. En consecuencia, una de las conclusiones es también que la exposición repetida a bajos niveles de VIH puede producir un nivel de resistencia al VIH en esta población.

Publicado por Freedomhealth

Nueva prueba en Londres: ultra-rápida y ultra-precoz detección del ARN de VIH-1, VIH-2 y de la hepatitis C sólamente 7 días tras la exposición

2010-02-24T10:03:00.003Z

Nueva prueba en Londres: ultra-rápida y ultra-precoz detección del ARN de VIH-1, VIH-2 y de la hepatitis C totalmente veraz sólamente 7 días después de la posible exposición de riesgo, con prueba añadida del ADN de la hepatitis B

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Identificación precisa y ultra-rápida del ARN del VIH 1 (Grupo M y Grupo O) y ARN del VIH 2, ARN del virus de la hepatitis C y el ADN del virus de la hepatitis B en el plasma humano tan pronto como sólo 7 días después de la exposición.

Un diagnóstico preliminar muy temprano del VIH y de las enfermedades de la hepatitis B y C es ahora posible después de sólo 7 días tras la possible exposición. Este período de tiempo no era hasta ahora disponible, pero con la utilización de una tecnología novedosa en la rutina clínica habitual facilitará el diagnóstico temprano.

La técnica utiliza un sistema completamente automatizado fabricado por los laboratorios Roche y consiste en un método de ensayo que utiliza la reacción en cadena de la polimerasa (PCR) o NAT (amplificación de ácidos nucleicos) para
detectar minúsculas cantidades del material genético del virus (y la misma técnica puede aplicarse también a las bacterias).

La técnica fue inventada en los años ochenta por el doctor Kary Mullis, quien más tarde ganaría el Premio Nobel por la invención de tal elegante técnica de la biología molecular. Inicialmente, la prueba comenzó siendo bastante engorrosa y requeria intensivas técnicas muy complicadas para poder ejecutarla.

Además, el coste de la prueba, en parte debido al número de personas involucradas, era alto.

La automatización a través del dispositivo de Taq Roche Multiplex ha permitido tener pruebas muy sensibles y muy específicas, que se realizan de forma totalmente automatizada en la sangre humana, permitiendo la detección del VIH-1 y VIH-2 a partir de 6 o 7 días después de la exposición, de la hepatitis C a partir de 6 o 7 días post-exposición y el virus de la hepatitis B, 20 días después de la exposición.

La técnica ha sido principalmente aplicada hasta la fecha en la selección y suministro de sangre humana de donantes de sangre y ha reducido muy considerablemente el número de casos con contaminación accidental por VIH y virus de la hepatitis C. La técnica también se emplea en la donación de órganos , los cuales son examinados para poder detectar el VIH-1, VIH-2, la hepatitis C y hepatitis B.

Todo esto ha sido posible gracias a nuestra estrecha colaboración con The Doctors Laboratory (el laboratorio más importante de referencia mundial en Londres), comenzando a aplicar esta técnica en el proceso diagnóstico para la enfermedades identificadas.

El proceso funciona de la siguiente manera. Tomamos una cantidad de sangre suficiente para ejecutar las tres pruebas del NAT para el VIH-1 y VIH-2, virus de la hepatitis C y el virus de la hepatitis B. También podemos incluir la sífilis IgG e IgM dentro de esta pantalla. La prueba se realiza utilizando la plataforma de Roche y se ejecuta con la técnica “muestra in, resultados out" lo que reduce las posibilidades de contaminación del producto a cero. En el caso de una muestra positive, toda la muestra se analiza hasta identificar el virus que ha producido el resultado positivo y a continuación más pruebas de confirmación se llevan a cabo.

El resultado es una muy sensible metodología de detección de alta precisión para la detección de los virus. El tiempo de respuesta es rápido, necesitando un máximo de 4 días.

Esto tiene un gran potencial en términos de la identificación temprana de los nuevos pacientes infectados por el VIH y también para permitir que aquellos que piensen que pueden haber sido infectados puedan relajarse, disminuyendo considerablemente la anxiedad que esto puede causar en las personas.

La identificación de los pacientes infectados con el VIH es importante porque presenta varias oportunidades intervencionistas. Permite la identificación temprana de nuevos casos de infección de personas VIH positivas, ofreciendo
la oportunidad de anticipar la sero-conversión y si es necesario comenzar con el uso de medicamentos antirretrovirales, así como para mitigar las posibilidades de que la infección se transmita, sin saberlo, a otro individuo; posiblemente para alterar el curso de la enfermedad del VIH, al permitir una intervención muy temprana y limitar el daño del sistema inmunitario que la intervención temprana en la fase muy temprana, lo que ha sido demostrado de ser beneficioso.

En el Simposio de la FDA sobre la Aplicación de Pruebas de Acidos Nucleicos, ya en 1999, un Dr. Busch identificaba a la ya conocida frase, el "período ventana" como de una importancia fundamental entre los términos de identificación y objetivos de pruebas NAAT.

El período ventana para el VIH 1 y el virus de la hepatitis C hasta la fecha ha dependido en gran medida de la sensibilidad de los dispositivos de detección de anticuerpos del VIH 1 y la hepatitis C.

Esto ha sido mejorado en el VIH con la introducción de la detección en paralelo del antigeno p24 reduciendo el intervalo de detección de VIH 1 en una semana aproximadamente. En los individuos sintomáticos, la combinación de VIH 1 y antígeno p24 ha podido identificar con éxito aquellos individuos VIH positivos 12 días después de la infección. Co-infección con la hepatitis C y el VIH ha siempre presentado un dilema de diagnóstico con un posible retraso en la sero-conversión – éste es un grupo al que se le refiere como “inmuno -silencioso".

Estudios realizados en la sangre tomada de forma secuencial y periódica de personas en las fases de la evolución del VIH y las enfermedades de la hepatitis C han dado información valiosa sobre el periodo ventana y sobre qué marcadores aparecen en qué etapa. Dr. Busch acuñó la frase "el período de eclipse", que creo que es una forma muy elegante de describir el tiempo entre la transferencia física de la infección a una persona determinada y el momento en que las metodologías de análisis actuales puedan identificar las enfermedades.

Casi invariablemente, cuando una persona ha estado expuesta al VIH seguido por el tiempo que empiezan a tener síntomas, quiere decir que ya se encuentran en una fase de "viremia", donde hay gran cantidad de virus detectado en la sangre.

Con una gran cantidad de virus también aparecen gran cantidad de proteínas virales fundamentales-denominadas antígeno p24 y por lo que la combinación de los anticuerpos VIH-1 y el antígeno P24 de VIH-1 es casi siempre positiva en el paciente sintomático.

Así que volviendo al Dr. Busch y su "fase de eclipse", éste es el período de tiempo en el que estamos interesados en la detección de los virus en la sangre y de esta forma, los servicios de donación de órganos en toda Europa y EE.UU. han utilizado técnicas de NAT muy sensibles idóneas para identificar la infección temprana y así detener la contaminación del suministro de transfusión de sangre y de los órganos trasplantados.

Con el uso de pruebas de amplificación del ácido nucleico o PCR se reducirá el período ventana, que actualmente figura en la "fase de eclipse", como se describió anteriormente, y así permitir la identificación temprana de nuevos casos de infección con VIH y hepatitis C sólamente 7 días después de haberse infectado. Del mismo modo, la identificación temprana de la hepatitis B será posible con la reducción del período ventana para esta enfermedad a 20 días.

Publicado por Freedomhealth

Wrinkled Chest and Decolletage Treatment.

2010-02-23T15:25:00.004Z

As Amanda Platell observed in the Daily Mail,

" A wrinkled old décolletage begins to be a problem for most women as they pass 40. Too much sun, hardly any SPF on the chest......"

Sounds a little too familiar, doesn't it? Well, luckily, Amanda discovered Lee Garrett who she describes as the "Décolletage King!"

Specialist Laser Nurse Lee was able to reverse much of the sun damage Amanda had suffered through years of sun exposure in her native Australia, using a combination of special broad band light (BBL) laser treatment and prescription creams.

Across the world women spend literally billions of pounds every year fighting the signs of ageing on their faces, ignoring their neck and chest which unfortunately reveal the secret of their true age - lines and wrinkles, sun damaged crepey skin, and for some, early skin cancers.

Correcting these sun related signs of ageing is though, very straightforward indeed. As Amanda found out, Specialist Nurse Lee Garrett is able to eliminate chest wrinkles and lines and restoring the natural skin elasticity by stimulating the rebuilding of collagen.

Why do women (or men!) develop chest wrinkles?

Chest wrinkles or wrinkles overlying the neck and cleavage (decolletage to give it it's proper name) develop because of atmospheric exposure, especially to harmful ultra-violet light from the sun or from sun beds.

Aside from creating a temporary pleasing looking sun tan, ultra-violet sun light damages the skin causing it to thin and cause the underlying collagen fibres to become distorted, broken and to lose their elasticity. The result is an excess of lines and wrinkles on the neck and chest area. The skin of the neck and chest, the decolletage, is thinner and more vulnerable to sun damage than the skin on the face. Chest and neck skin also tends to be overlooked in the skincare moisturising and SPF routine, even on holiday. A wrinkled neck and chest will quickly result.

Is it possible to reverse the chest wrinkling effect?

It is possible to reverse the chest wrinkle effect by using a combination of broad band light (BBL) and also some specialised skin treatment systems which Lee will advise you on. Lee is an expert in the use of the Sciton BBL Laser. He will tailor the strength of the laser treatment so that it will reduce the appearance and feel of chest and neck lines and wrinkles. The effect is a deep one, correcting the damage years of sun exposure has done. The laser energy will penetrate deep into the skin targeting the region responsible for generating new collagen and reversing the causes the chest and neck wrinkles and lines.

The Sciton BBL laser energy causes growth of new collagen which adds firmness and resilience to the skin. The growth of collagen will continue for some time after your treatment and will lead to a gradual improvement in skin tone and texture, eliminating the crepey, wrinkled neck and cleavage in the weeks and months ahead.

How many laser treatments will I need?

It generally takes many years for your chest skin to develop the wrinkles and lines and lose its natural resilience and elasticity. So, naturally, it will take a while before things are corrected. Ideally you should have three or so treatments spaced 4 or so weeks apart to correct the wrinkle/crinkle effect. However, most people will notice a very distinct improvement after just one treatment.

Does the decolletage treatment hurt?

No, the treatment doesn't hurt. It does feel rather link a flicking with an elastic band but it does tend to be gentle and tolerable. The effects on the chest and neck skin and wrinkles is very clear and so the benefits tend to become quicky obvious.

Will I be able to go back to work after the laser treatment?

Yes, absolutely. The skin over the target areas in the neck and chest will be slightly red and there may be some small bruising, but generally most people are able to return to work afterwards.

Are there other treatments I can use to improve my wrinkled chest skin?

Yes there are. At Freedomhealth we recommend the additional use of the Elastiderm Décolletage System from Obagi as a maintenance treatment to continue to revitalise the decolletage skin. This specially formulated regimen will reduce hyperpigmentation ( discolouration ), minimize wrinkles and fine lines, reduce the appearance of age spots, freckles and other signs of visible ageing.

The Elasiderm Decolletage System consists of two creams proven to help restore healthy skin. The range includes the skin lightening complex which is formulated with 4% hydroquinone, a treatment well known for reducing hyperpigmentation and age spots on the skin. The other part of the system is the Wrinkle Reducing Lotion, formulated with Elastiderm Restorative Elasticity Complex which contains a bi-mineral complex designed to help replenish elasticity and build collagen for increased skin strength and resilience.

Can dermal fillers be used for a wrinkly cleavage or neck?

Yes, they can, although the type of dermal filler needs to be selected carefully. At Freedomhealth we use the very fine Restylane Vital or Vital Light for the neck and chest. This delicate filler is ideal for restoring the body's natural hyaluronic acid (something our skin is full of when we are small babies) and helping literally to moisturise from within.

How much does it all cost?

The laser treatment is best done at 4 weekly intervals and most people need around 3 treatments. The cost is £350 per treatment if paid for individually or £945, a saving of 10% if all three sessions are paid for together.

The Elastiderm Decolletage system costs £158 for both items together.

The Restylane Vital requires 2 syringes per session and this will cost £398 per session.

After consultation with Specialist Nurse Lee Garrett many people prefer to purchase the entire treatment programme and a 10% discount will apply to the total cost.

For more information or to book an appointment call Lee Garrett on 020 7637 1600.

What's the best HIV Test?

2010-02-01T18:19:00.001Z

The best HIV test is one that provides you with an accurate and reassuring result in a time frame that suits you best. Everybody will have a different "best HIV test" because their circumstances will be slightly different. The main things to think about are firstly when you were possibly exposed to HIV and secondly how desperately you need to know the answer. The exposure time is important because it allows us to calculate the HIV window period, which is the time from HIV infection to detection.

There is a great deal of confusion regarding HIV testing which results mainly from the enormous leaps in our knowledge about HIV in the time since the epidemic began and the advancement of the technology behind the testing devices.Consequently the question as to which is the best HIV test depends very much on the individual circumstances.

We now have HIV testing methods that will allow us to identify HIV infection very early on indeed. This is important for all sorts of reasons, not least the fact that we know that the key period for passing HIV on to another person is in the first few months after infection, when the amount of virus in the infected person's blood stream, semen or vaginal fluids is likely to be very high. The amount of HIV virus in a body fluid is referred to as HIV viral load and in the early stages is likely to be many hundreds of thousands or millions of copies of virus in each one millitre of blood or fluid.

As the infection proceeds and the newly infected person's body gets a hold on the new HIV infection, the amount of virus falls and that person becomes, we think, much less infectious. So for example, if I were to become HIV positive today, then in around 2 weeks or so my viral load - the amount of virus in each 1ml of my blood or semen - would be rapidly increasing and starting to run into the millions of copies. I would be very infectious to those I had unprotected sex with.

Testing newly infected HIV positive people early allows us lots of opportunities to influence the outcome for the good. We know from studies that most people who are aware they are HIV positive are keen to avoid passing HIV on to others. They certainly do not want a moment of madness on their part to result in their loved ones becoming HIV positive too.

So, what is the best HIV test?

Testing for HIV 7 days after exposure

Preliminary diagnosis of very early HIV and Hepatitis C disease is now possible at
7 days post possible exposure. This time frame was previously unavailable but utilisation of standard routine technology in a novel diagnostic style will facilitate very early diagnosis. The technique has had most application so far in terms of screening the human blood supply from blood donors and has reduced the numbers of inadvertent contamination with HIV and Hepatitis C virus very considerably. The technique is also employed in organ donation settings where organs to be donated are screened for the HIV-1, HIV-2,Hepatitis C and Hepatitis B viruses.

Thinking laterally and working with The Doctors Laboratory ( a major global referral laboratory in London and CPA, UKNEQUAS, WEQAS, ISFG and EMON approved for quality, robustness and high standards), we have collaborated to apply the blood and tissue screening, ultra-high sensitive technique to beginning the diagnostic process for the
diseases identified.

The ultra-fast diagnostic technique utilises a fully automated system made by Roche and the testing method
uses polymerase chain reaction (PCR) or NAT (Nucleic Acid Amplification) to
detect miniscule amounts of viral (and the technique can be applied to bacteria) genetic material.

The process works as follows. We take a measured amount of blood sufficient to run the three NAT tests for HIV-1 and HIV-2; Hepatitis C virus and Hepatitis B virus. We can also include syphilis IgG and IgM within that screen. The test is performed using the Roche platform and runs on the "sample in, results out" technique
which reduces chances of contamination of product etc to zero. Should a positive sample be produced the whole specimen is drilled down to identify the virus producing the positive result and further confirmatory tests are performed.

The outcome is a highly sensitive, highly accurate detection methodology for detection of the identifed viruses. The turnaround time is swift, taking a maximum of 4 days.

HIV 1 and 2 antibodies and p24 antigen test (HIV DUO or HIV Combi test)

This HIV test is licensed in the EU for use after 28 days after a possible exposure. It is probably much better than this and will probably identify the majority of newly infected HIV positive individuals at between 14 and 21 days. This HIV test is referred to as a fourth generation HIV test. Certainly in our clinic we have had many new diagnoses of patients using this HIV DUO test combination in that time frame.

The HIV DUO test relies on the principle that when HIV first establishes itself in the body it will start to replicate rapidly and almost as a by-product of this replication a core protein - the HIV p24 antigen - is produced in huge amounts from around 10 days or so after first infection and before or during the time when antibodies to HIV are being formed. The p24 antigen will then stay at a very high level for the first few months after infection and later decline in line with the decline in HIV viral load as referred to above. It will though never completely disappear and will run a variable course of detection through the rest of the illness.

So in general, p24 antigen is formed slightly before antibodies are forming allowing us to close the gap between infection to detection time - the HIV window period. As time goes on, then the majority of newly infected HIV positive people will form antibodies to HIV 1 or 2 by 28 days. In combination then, looking for both the HIV 1 p24 antigen and also HIV 1 and 2 antibodies will allow for much earlier detection of HIV than looking for HIV antibodies alone.

HIV 1 and 2 antibody test

This test is where the most confusion is centred around. When the epidemic began in the early 1980's our testing methods and devices were relatively poor and frequently produced false results. This was largely because researchers were scrambling to find firstly the cause and then a test for a new and virulent disease.

I remember those panic struck early days very well. The false results - both false negative and false positives led to great caution in terms of interpreting the HIV test results at that time. As time has passed, our understanding of the disease, it's cause, it's likely progress and also the testing methods have improved enormously.

We have moved from rudimentary tests in the early 1980's to modern, accurate, easy to use third and fourth generation HIV testing methods in 2010. HIV 1 and 2 antibody tests in use in the UK will be either third or fourth generation test. Modern third generation tests will identify well over 99% of newly infected HIV positive people at 6 weeks after exposure even though they are licensed for use after 12 weeks after a possible exposure.

The best HIV test is always going to be the one that suits your time frame and also need to know level or anxiety level the best. Always remember though that if you have a high risk exposure such as unprotected sex with someone who is known to be HIV positive, or a condom break with someone who is known to be HIV positive then don't wait to test but talk to a doctor about HIV Post Exposure Prophylaxis (PEP) as soon as possible, ideally within 36 to 72 hours after the event.

Photodynamic Therapy (PDT) for skin cancer

2010-01-30T18:58:00.004Z

Photodynamic therapy or PDT for short is a new way of treating some skin cancers and certain other pre-cancerous skin lesions. These are basal cell carcinoma’s, Bowen’s Disease and also actinic (or solar) keratosis.

PDT is quick, easy, and does not result in scarring. It is now the preferred treatment for many skin cancers in the UK. We now offer photodynamic therapy or PDT for basal cell skin cancers and also the pre-cancerous Bowens Disease and also actinic (or solar) keratoses at Freedomhealth. To make an appointment please ask for either Mr Lee Garrett or Dr Jose Gonzalez-Garcia and they will discuss the procedure with you, answer any questions you may have and if required, help you make the necessary arrangements for this simple and effective, scar free way of treating skin cancers.

Photodynamic therapy is not the preferred treatment for squamous cell skin cancers as these have a high chance of recurrence and we want to be sure that the treatment has succeeded.

Putting it very simply, photodynamic therapy for skin cancers involves applying a special light sensitizing cream to the affected area and a little of the surrounding area and then after a short while shining a bright light onto the treated area. The cells which have absorbed the chemical and are then subject to the bright light will die off leaving fresh normal skin to grow in its place. Normal cells are left relatively undamaged. This is because PDT affects mainly fast growing skin cancer or pre-cancer cells.

Until recently, standard treatments for these particular skin cancers have been either destructive, for example using liquid nitrogen, or surgical. Both of these treatments has its advantages but a major disadvantage of surgical treatments has been the resulting scar left by the surgical cut and stitches. Liquid nitrogen spray or cryotherapy for skin cancer will destroy the tumour cells but is not terribly refined and will destroy other normal tissue also. Photodynamic therapy avoids scars.

Photodynamic therapy (PDT) is available on the UK NHS in some centres but relatively few and for those NHS units there is a long waiting list. The problem is the usual one of funding. NHS units are limited by their funding and so can see limited numbers of patients. Consequently large numbers of patients are sent via the surgical route and get what is now considered to be good but not the best treatment.

PDT can be used for treating other cancers but at Freedomhealth we only treat designated types of skin cancer and pre-malignant or precancerous lesions as recommended by the UK’s National Institute for Clinical Excellence (NICE). We operate under stringent conditions imposed by the Care Quality Commission and are subject to annual re-licensing and approval.

NICE issued Guidance in 2006 saying that there was good evidence to support the use of PDT for treatment of basal cell cancers, Bowen’s Disease and also solar or actinic keratoses. NICE said that photodynamic therapy for skin cancers was of particular use in situations where a person may need a lot of surgery – for example where there was a large and not too deep skin cancer, or where there were multiple cancers. An obvious use of PDT is for skin cancers that are visible on the face or neck and where a surgical scar would be equally disfiguring as the tumour.

Basal cell skin carcinoma’s or cancers are very common indeed with skin cancers as a whole being the most common cancer in the UK and of these around 80% of the skin cancers which are not melanoma’s will be basal cell cancers. Basal cell skin cancers are caused primarily by exposure to sunlight. Australians have the highest rates of basal cell skin cancers in the world. Other risk factors include fair skin, blue eyes, red or blonde hair and intermittent intense exposure to sunlight or artificial ultra-violet radiation such as sun beds. One a person has a basal cell skin cancer then the chances of another appearing will be increased by 10 times compared with the general population.

How is PDT (photodynamic therapy) for skin cancers used?

The type of skin cancer is identified using a special magnifying glass called a dermatoscope. This allows the specially trained clinician to correctly identify the skin lesion as a basal cell cancer or as a pre-malignant skin lesion such as Bowen’s disease or an actinic keratosis.

In addition, the clinician will take either a painless scrape from the lesion or a special very thin sample of tissue called a biopsy which confirms the diagnosis and in the case of the skin biopsy, the depth of the tumour, to make sure that it is the correct diagnosis and also confirms the depth is ideal for treatment. These samples are sent to our laboratory for analysis which takes a few days.

Once the diagnosis is confirmed by the laboratory then treatment with photodynamic therapy for your particular type of skin cancer can begin.

A light-sensitising cream made up of 5-aminolaevulinic acid (ALA) tradename Metvix, is applied to the target after the crusting debris has been gently removed. The area is covered with a dressing for three to six hours and then the area is subjected to a strong light for up to 45 minutes or so. A slight tingling is felt whilst the light is being used. A crusted area will then remain and will slowly fall off during the next week or two, depending on the size of the original lesion.

A second or third treatment is sometimes needed.

If you would like to discuss this further please call us on 02076371600 and ask for an appointment with Mr Lee Garrett, RN, BSc or Dr Jose Gonzalez-Garcia and they will happily discuss the possibility of treatment with you and answer any further questions you may have.

How to get rid of dark circles under your eyes

2009-11-27T17:40:00.000Z

Getting rid of dark circles under the eyes is a preoccupation for many. Dark circles under the eyes cause a considerable degree of unhappiness, make people look and feel tired and contribute to a lcak of self-confidence and self-esteem. Treatments are now available which will reduce and in some cases eliminate the dark discolouration.

Dark circles under the eyes may have many different causes. Obvious ones include lack of sleep over a prolonged period of time; different skin colouration and pigmentation and sometimes an underlying illness. These tend to be relatively obvious and patients will often complain that they don't want to end up looking like their mother or father with their genetically dark under-eyes.

There can be other treatable causes though and I'm going to work through some of these below and the possible causes and treatments.

Loss of elasticity of the skin under the eyes may result in the appearance of dark areas or dark bags. The skin loses its elasticity because of age, sun exposure over time and also very often due to smoking. Sometimes a genetic predisposition will contribute. The loose skin will then sit across the underlying muscles responsible for blinking and closing the eyes. These muscles tend to be dark in colour and without the normal thin layer of reflective fat under the skin and over the muscles there is an optical illuison where the reflection of light off the dark underlying muscle appears as dark bags or circles.

The good news about this sort of condition is that once correctly identified by a specialist aesthetic practitioner a number of treatments can be applied to deal with the issue. Obviously, prior to treatment then sun protection using a good quality high factor sun protection cream is essential, together with good quality UVA/UVB protecting sunglasses. In addition, the patient should stop smoking. Smoking is proven to reduce the delivery of oxygen to the superficial layers of the skin by up to 20%.

The tissue under the eyes and the area referred to as the tear trough (which is roughly a line running from the corner of the eye downwards and across the mid part of the upper cheek) can be supplemented using very careful application of hyaluronic acid fillers such as Restylane or Restylane Vital. It is important that this is done by an expert in non-surgical techniques. As you might imagine, surgeons themselves are often not the best at this sort of technique because operative work is their forte. However, very many surgeons are now using Restylane as a pre-operative skin conditioner prior to surgery as there is good evidence that application of hyaluronic acid some four to six weeks prior to operation has an excellent hydrating effect, enhancing the operative result.

Use of hyaluronic acids in this area will hydrate the skin and plump the skin, moisturising from within and also lift the skin off the underlying orbicularis oculi muscle (the muscle responsible for blinking and contracting the lower lid in this area). The overall effect is to enhance the natural radiant effect of the eye itself, distract attention from the dark circles, condition the skin and reduce or abolish the ageing tear-trough. The technique is simple but is extremely operator-dependent in terms of good aesthetic results. Expert injectors will achieve excellent results which tend to be long lasting.

Restylane and the other members of the Restylane family have an excellent safety record and to date over 10 million doses have been given worldwide.

Hyperpigmentation is another cause of dark circles under the eyes and may occur alone or in combination with loss of skin elasticity. In hyperpigmentation there is a build up of excess melanin in the melanin producing cells (melanocytes) under the eyes. The particular anatomical position of the excess melanin cells and the loss of fat underneath the skin will accentuate a dark, sad, tired and sometimes hung-over look.

Treatment for hyperpigmentation will involve the use of hydroquinone creams to the affected areas to reduce the amount of melanin producting cells and also the combination use of a topical vitamin A product, tretinoin to reduce the amount of melanin produced by the remaining melanocytes.

Again, as with the use of injectable hyaluronic acids into the area immediately benetah the eye and the tear trough, the administration of the hydroquinone and also the tretinoin is best advised by an expert to achieve best results with minimal side effects. Using the two products together then results should become apparent after about 6 weeks or so with peak or maximal effect at 26 weeks after commencement.

As with all treatments in this area, skilled combination treatments by an expert practitioner using both the application of creams and the use of injectable hyaluronic acids like Restylane or Restylane Vital will achieve excellent, natural looking results with minimal downtime.

Combinations of hyperpigmentation and age or sun related loss of skin elasticity are again best treated with combination treatments. The addition of profractional lasers like the Sciton laser in use at Freedomhealth allows for highly accurate targeted destruction of miniscule columns of skin with precise thermal damage to a predetermined depth.

In between the laser targeted areas are multiple columns of normal unaffected skin allowing for easy skin healing and tightening. Great care is taken to protect the eyes themselves from both light and thermal damage. In the UK patients should only have laser treatments in facilities such as Freedomhealth which are Care Quality Commission registered and are specifically identified as laser and intense light treatment facilities. Ideally, again as at Freedomhealth these treatments must be carried out by a highly trained clinician and not a beauty therapist.

As a preliminary conditioning regime, tretinoin and / or hydroquinone may be used to reduce both the amount and activity of the mealanin producing cells in the target area. This may be accompanied a few weeks ahead of the profractional Sciton laser treatment by the injection of hydrating, moisturising and skin conditioning hyaluronic acid products. We know that these will facilitate a swifter more complete healing time.

Commercially available creams such as those available in supermarkets or department stores will create the appearance of soft smooth skin for a short period and are an inexpensive option for those unconvinced or unable to afford more effective, definitive treatments. Many of these products will contain make up which will help disguise the problem areas but will not relieve the underlying problem.

The most effective treatment for dark circles under the eyes is to seek expert advice from an experienced and diligent aesthetic practitioner. A practitioner with a range of skills and a range of different options to suit the needs of an individual client is ideal.

Patients should not be afraid to check the qualifications of the treating practitioner and to enquire how many of the procedures he or she has done in the last year or so. Some practitioners will openly admit that they are just starting out and that they will be supervised by an experienced clinician.

Dermal Fillers for Men and Women in London

2009-11-08T13:44:00.003Z

Dermal Fillers have had a rapid evolution over the last 20 or thirty years. Fat transfer from one part of the body to another remains a popular but very operator dependent technique in terms of survival of the transplanted fat. This opened the door to manufactured compounds particularly hyaluronic acid products such as Restylane, Perlane and Restylane Sub Q. The total numbers of Restylane used world wide now exceeds 10 million, absolutely reinforcing its safety pedigree.

For a non-surgical way of combating wrinkles in facial skin as it ages, people are increasingly turning to dermal fillers as a safe and relatively non-invasive procedure. The popularity of dermal fillers comes partly because of their speed of effect and safety and efficacy record but also due to the modern understanding of how the face in particular, ages.

Aside from the surface damage caused by environmental factors such as sunlight, exposure to the world at large with all its pollutants and also very importantly cigarette smoke, the major factor in causing sagging of the skin and an aged appearance is depletion of the larger fat deposits contained within the layers of the skin and beneath. Lack of moisture within the skin itself and depletion of collagen may also have an adverse effect of the way the skin "shines". Read what Paul Burston has written about Freedomhealth and Dermal Filers in London's TimeOut magazine.

Dermal fillers are used for facial tissue augmentation, and are injected into the skin to plump it up and make it firmer. Effects are instant, resulting in deep lines being smoothed away and the natural volume of the face and its radiance beng replenished. There are a number of different forms of fillers and the common and safest ones are based on a natural component of human skin tissue, hyaluronic acid. In the main there are two major brands, Juvederm and Restylane and each comes in a range of different types which are useful in different areas of the face and body.

Dermal fillers can be used on any area, but are most suitable for :
o Reducing lines or grooves between the nose and mouth, and around the lips.
o Plumping up the lips.
o Volumising cheeks.
o Redefining chin area.
o Improving contour of the bridge of the nose.
o Reducing the appearance of acne pits or scarring.
o Improving the appearance of depressions or pockmarks due to injury or disease, for example, chickenpox blemishes.
o unevenness in the skin after surgery or skin grafting
o supplementing the use of laser treatments to the chest area which is particularly prone to sun damage through the years.

In the 1970’s, dermal fillers contained substances such as silicone and bovine collagen implants, but research has greatly improved the active ingredients. Now Freedomhealth’s Aesthetic Nurse, Lee Garrett, favours the use of one of the most tested and widely-used products.

Restylane is based on hyaluronic acid, a complex sugar which is present in skin and cartilage and exists naturally in the body to carry and bind water. Restylane is a man-made version but almost identical to the human hyaluronic acid, differing by only 1%. Consequently the body accommodates it relatively easily, and no pre-treatment test is usually required.

A recent study reported that fillers like Restylane could actually promote collagen growth without increasing collagen breakdown. The study by Wang in Arch Dermatol 2007 Feb compared injections of restylane and injections of saline into alternate arms of a number of volunteers. The study showed a 100 fold increase in the amount of collagen produced by the restylane injections compared with saline, suggesting that the formation of collagen was not just a stretching effect produced by injection of fluid or the effect of the needle being introduced into the skin but as a direct result of the interaction of the modified hyaluronic acid on the skin texture.

The Procedure – what to expect :

Firstly, the treatment area is numbed with a cream containing local anaesthetic. The dermal filler is then applied via injection directly into the treated skin. The process takes about 30 minutes, and people should expect a little discomfort, especially during deep injections to the cheek area, but not more unpleasant than a mild bee sting. Restylane contains the local anaesthetic lidocaine and after the very first injection will numb up the area quite swiftly. Occasionally a nerve block will be used to ensure the patient’s comfort.

Results are immediate as hyaluronic acid delivers nutrients and hydrates the skin to plump a targeted area and temporarily remove wrinkles.

Possible side effects :

Treatment with injected fillers in most people results in localised redness, slight swelling and minor discomfort, though these should fade away within a few days. Minor bruising may occur. Bruising can be minimised by using arnica tablets for the few days prior and after the procedure. In addition, if patients are taking drugs such as ibuprofen, aspirin, plavix, warfarin etc they should discuss these with their dermal filler injecting clinician. These drugs are not absolute no-no’s in terms of who can be treated but they do carry extra risks of bruising particularly, making it all the more important to have a medically qualified clinician consult with and inject the patient. This always happens at Freedomhealth.

Patients should avoid putting any undue pressure on the area for at least two days to give the injected gel time to set. High heat should also be avoided for a short period, especially excessive sun exposure, sauna’s and steam rooms etc.

People with a history of cold sores may experience a recurrence after treatment, although this can be minimised by the use of antiviral medicines.

Anyone who experiences severe skin allergies may not be suitable for injections, especially those who have ever experienced anaphylactic shock. Anaphylaxis with hyaluronic acid products made by reputable suppliers such as the Restylane company Q-Med aesthetics and also the company making Juvederm is extremely unlikely. Existing problems with allergies of any type should be discussed in depth with a Doctor first.

How long do injectable fillers last?

Injectable fillers will usually last from six months to a year before being broken down inside the body. Semi-permanent fillers can last up to two years, while permanent fillers can last up to ten years or more.

At the end of that time the fillers do not simply disappear but there is a gradual fading of the effect. This is usually apparent to the patient and a further top up can be useful in terms of restoring the original effect.

Specialist Nurse Lee Garrett is expert at injecting both male and female clients. He attends and contributes to many teaching courses for doctors and nurses around the UK and Europe and is used by the Restylane manufacturer to demonstrate best practice injection technique.

Ultra-fast, ultra-early HIV-1, HIV-2, Hepatitis C RNA test/testing London from 7 days post exposure with added Hepatitis B DNA and Syphilis IgG/IgM

2009-10-12T08:18:00.002+01:00

Ultra-fast, accurate identification of HIV 1 (Group M and Group O) RNA, HIV 2 RNA,
Hepatitis C Virus RNA and Hepatitis B Virus DNA in human plasma from as early as 7
days post exposure.

Preliminary diagnosis of very early HIV and Hepatitis C disease is now possible at
7 days post possible exposure. This time frame was previously unavailable but utilisation of standard routine technology in a novel diagnostic style will facilitate very early diagnosis.

The technique utilises a fully automated system made by Roche and the testing method
uses polymerase chain reaction (PCR) or NAT (Nucleic Acid Amplification) to
detect miniscule amounts of viral (and the technique can be applied to bacteria) genetic material.

The technique was invented in the early 1980's by a Dr Kary Mullis, who later won the Nobel Prize for the invetion of such an elegant molecular biological technique.
Initially, the test was cumbersome and required intensive well-trained technicians to run it.

In addition, the cost of running the test, partly because of the numbers of people involved was high.

Automation via the Roche Taq Multiplex device has enabled highly sensitive, highly specific,fully automated testing to be run on human blood with the detection of HIV-1and HIV-2 possible from 6 or 7 days post exposure; detection of Hepatitis C from 6 or 7 days post exposure and Hepatitis B virus from 20 days post exposure.

The technique has had most application so far in terms of screening the human blood supply from blood donors and has reduced the numbers of inadvertent contamination with HIV and Hepatitis C virus very considerably. The technique is also employed in organ donation settings where organs to be donated are screened for the HIV-1, HIV-2,Hepatitis C and Hepatitis B viruses.

Thinking laterally and working with The Doctors Laboratory ( a major global referral laboratory in London and CPA, UKNEQUAS, WEQAS, ISFG and EMON approved for quality, robustness and high standards), we have collaborated to apply the blood and tissue screening, ultra-high sensitive technique to beginning the diagnostic process for the
diseases identified.

The process works as follows. We take a measured amount of blood sufficient to run the three NAT tests for HIV-1 and HIV-2; Hepatitis C virus and Hepatitis B virus. We can also include syphilis IgG and IgM within that screen. The test is performed using the Roche platform and runs on the "sample in, results ou" technique
which reduces chances of contamination of product etc to zero. Should a positive sample be produced the whole specimen is drilled down to identify the virus producing the positive result and further confirmatory tests are performed.

The outcome is a highly sensitive, highly accurate detection methodology for detection of the identifed viruses. The turnaround time is swift, taking a maximum of 4 days.

This has great potential in terms of early identification of newly infected HIV positive patients and also to allow those who think they may have been infected to relax and enjoy considerable peace of mind.

The identification of patients newly infected with HIV is important because it presents several interventional opportunities.It allows for very early identification of newly infected HIV positive people which provides
the opportunity to anticpate and if necessary terminate by the use of anti-retroviral drugs the seroconversion illness; to mitigate the chances of that infection being transmitted unknowingly onwards to another individual; possibly
to alter the course of the HIV illness by allowing a very early intervention to limit immune system damage should early intervention at the very early stage be proved to be beneficial.

In the FDA Workshop on Implementation of Nucleic Acid Testing as long ago as 1999, a Dr Busch identified the well-known phrase, the "window period" as being of critical importance in identifying and targetingin terms of NAAT.

The window period for HIV 1 and Hepatitis C virus has to date depended very largely on the sensitivity of the HIV 1 and Hepatitis C antibody detection devices.

This was improved on for HIV by the introduction of parallel screening with HIV 1 p24antigen which reduces the HIV 1 detection interval by a week or so. In symptomatic individuals the combination of HIV 1 and HIV 1p24 antigen has successfully identified HIV positive individuals at 12 days post infection. Co-infection with
Hepatitis C and HIV has presented a diagnostic conundrum with occasional delayed sero-conversion - a group referred to as "immuno-silent".

Studies on blood taken sequentially and regularly from people in the evolving phases of HIV and Hepatitis C diseases have given valuable information on the window period and which markers appear at what stage. Dr Busch coined the phrase "the eclipse period" which I think is a very elegant way of describing the time between physical transfer of infection to a person and the time when current testing methodologies can identify the illnesses.

Almost invariably when a person has been exposed to
HIV then by the time they have symptoms they are already in a "viraemic" phase where there is lots of virus detected.

With lots of virus comes lots of core viral proteins-referred to as p24 antigen
and so the combined HIV-1 and HIV-1 P24 antigen test is virtually always positive in the symptomatic patient.

So coming back to Dr Busch and his "eclipse phase", this is the time period we are interested in detecting and the blood and organ donation services across Europe and the USA have utilised highly sensitive NAT techniques to identify early infection to halt contamination of the transfusion blood supply and transplanted organs.

Use of Nucleic acid Amplification Testing or PCR will reduce the window period, currently contained in the "eclipse phase" as described above, and allow early identification of newly infected HIV positive and Hepatitis C positive individuals at 7 days post infection. Similarly, early identification of hepatitis B will be possible with reduction of the window period for this illness to 20 days.

GBL related death and injury in the UK

2009-10-11T18:12:00.003+01:00

GBL related deaths and injury in the UK continue to rise exponentially. GBL (short for gamma butyrolactone) is currently a legal drug in the UK although illegal in the USA and Canada.

GBL is a "precursor drug" and is swiftly metabolised in the human body into it's active form, GHB (short for gamma hydroxybutyrate).

GBL is a caustic chemical solvent available in the UK through the Internet in 10 litre containers which come with a neat 2ml pipette.

Just for an indication of scale one litre of fluid is equivalent to 1000 mls. So a ten litre container contains enough for 5000 doses. Its intended use is in the manufacture of plastics and also as for example, an alloy wheel cleaner.

I see patients on a very regular basis with GBL/GHB addiction problems. With the banning of GHB in the UK GBL has taken its place.

Formulae are available on the internet to convert GBL to GHB in the kitchen. This is perceived by many users to be a safer option. It is unlikely to be safer since one of the essential chemicals required in the kitchen to make GHB from GBL is caustic soda.

GHB was originally formulated in the 1960's and was used therapeutically for a brief period as both an anaesthetic agent and in the treatment of alcoholism. However, it swiftly became a problematic club-drug and use,
in the USA was banned.

GBL is problematic because it is metabolised very swiftly into GHB by a naturally occuring human enzyme. It competes for space for naturally occuring GABA receptors in the brain, but it also seems to attach specifically to GHB receptors in the brain. This duality of function and receptor attachment is likely to be responsible for both it's euphoric and disinhibiting effects and also the physical withdrawal syndrome associated with it (Snead et al, Gamma Hydroxybutyric Acid Volume 352:2721-2732 June 30, 2005 Number 26). Snead et al list a range of physiological effects on the body after dosing including low body temperature (hypothermia); flash hypertension (sudden peaks of blood pressure); racing heart beat (tachycardia);
electrical changes in the brain leading to seizure activity.

A careful study from Barcelona (by Miro et al Trends in illicit drug emergencies: the emerging role of gamma-hydroxybutyrate.) documented changes in causes of
emergency admissions to hopsital emergency departments. They noted that since 1989 when they had undertaken a simialr toxicological study there had been a very significant change in type of drug use.

In fact GHB/GBL overdoses became the second most common reason for illicit drug admission. They identified a profile which was of a young person of approximately 23 +/-5 years 64% of whom were male, 73% of whom had drunk alcohol and 86 % of whom had used other illicit drugs at the same time. The only feature which differs from patients presenting to me in my practice is the age range which for me tends to be from late teens to late 50's

Detecting GHB or GBL is difficult and requires great vigilance in the attending medical team as it is swiftly broken down in the body to inert compounds. The half life (the time it takes to lose half its effectiveness) is very short, being only around 20 or so minutes. Plasma levels will reach their peak at around 40 minutes. People who become addicted to GBL/GHB will frequently dose with 1-2 mls every 40 to 60 minutes through the day.

GBL/GHB is a particularly dangerous substance because it has a very steep dose-response curve which means
that it has a very small margin of safety and as the dose increases, by even very small amounts, the move from safe levels to lethal levels is tiny. Mixing GBL/GHB with alcohol will result in a massive alteration of the safe dose of
GBL/GHB and often result in respiratory depression, vomiting, depressed cardiac output, seizure and death.

Combining GBL/GHB with other dance or club drugs will magnify the toxicity of all compounds in an unpredictable way. GBL/GHB is used particularly to cause euphoria and sexual disinhibition and compliance.

In personal correspondence with one physician operating in this field he identifies GBL/GHB use as being used
in the absence of a normal attractive personality.

Snead et al, in the paper referred to above emphasise the point that whilst GBL/GHB induces a deep and unrousable coma, the recovery time is short. This produces a misplaced feeling of security in the patient. This is certainly borne out anecdotally in my patients who are removed to hospital and recover either
en route or in the resus room and then return to the environment they came from. I have had several patients die of GBL/GHB overdose with and without alcohol and other substances and there are numerous reports in the literature from around the world of similar events. A female student at Brighton University died recently in the UK having taken the drug and this has pushed the issue very much into the media. Previously the drug was seen as the preserve of misfits who attended all night raves.

When someone is known to have taken GBL/GHB and there are problems such as aggression, drowsiness, coma, vomiting, etc then an ambulance should be called and the patient admitted to hospital. There is currently no specific antidote but supportive ventilation; airway protection so vomit aspiration is limited; fluid management; control of seizure activity and sedation are all readily available.

GBL/GHB is highly addictive. Those most at risk are people using the drug for sleep on a regular basis, mood enhancement and weight loss Freese et al (The effects and consequences of selected club drugs. J Subst Abuse Treat 2002;23:151-156). There is no particular protocol developed as yet for management of GBL/GHB addiction excpt the usual supportive psychotherapy, Cognitive Behavioural Therapy, selective serotonin reuptake inhibitors or a mix of selective serotonin and noradreanline reuptake inhibitors plus or minus very high doses of benzodiazepines. Given the excess risks these patients have unwittingly taken we commonly require admission to a competent drug-dependance unit or psychiatric hospital under expert nursing and medical supervision. Live in Clinical Nurse Practitioners are useful also.

GBL/GHB withdrawal syndrome is a medical emergency and needs to be addressed aggressively - and almost invariably in an inpatient setting.

Freedomhealth partners with Medhelp.org

2009-10-09T08:22:00.002+01:00

Freedomhealth has partnered with Medhelp.org to provide high quality advice for the UK based International Forums.

You can see more information on the Medhelp site here

and the individual STD Forum here and the HIV Forum here.

HPV vaccinations: Cervarix and Gardasil

2009-09-30T07:45:00.002+01:00

Doubts have been raised over the safety of the Cervarix vaccine this week, following the tragic death of 14-year-old Natalie Morton after being given the jab at her Coventry school.
About 1.4 million Cervarix vaccines have been given to schoolgirls aged 12 and over as part of the Governments’ national campaign to combat cervical cancer. Coupled with screening for over-25’s, potentially 700 lives a year could be saved.
Cervical cancer is the second most common cancer in women under thirty five, resulting in 3,000 cases a year, and causing the death of 21 females each week in the UK or around 1000 per year. Seventy percent of these can be prevented by using one of the HPV vaccines available. Ninety nine percent of all cervical cancers are caused by HPV, or human papillomavirus, a family of viruses that affect the skin and moist membranes lining the body.
What is HPV?
Sometimes called the ‘wart virus’ or ‘genital wart virus’, HPV is passed by sexual contact with someone who has it. It’s very common and over half of all women who have sex will get infected with HPV at some time in their life.
HPV infects the cells of the surface of the cervix where it can stay for many years without any symptoms. The HPV virus can damage these cells leading to changes in their appearance, and over time, these changes can develop into cervical cancer.
There are over a hundred types of the HPV virus, but only thirteen of them are known to cause cancer. Often the virus causes no harm, and goes away without treatment.
How the vaccine works :
The HPV vaccine protects against the two strains of HPV (16 and 18) that cause cervical cancer in over 70% of women. Cervarix protects against types 16 and 18 and the rival vaccine Gardasil protects against types 16 and 18 and also the benign types 6 and 11. It does not protect against any other sexually transmitted infections or against pregnancy.
How safe is the vaccine?
Both major anti-cervical cancer vaccines, Cervarix and Gardasil, have undergone rigorous safety testing as part of the licensing process required in the UK and other European countries (PATRICIA and FUTURE II research). www.cancerhelp.org.uk
Possible side effects :
The side effects are usually mild and include :
• Headache
• Aching muscles
• Redness and soreness around the site of the injection
• Fever
• Feeling and being sick
• Stomach pain
• Diarrhoea
• Itching, rash
• Dizziness
The Medical and Healthcare Products Regulatory Agency (or MHRA) monitors vaccine safety via the Yellow Card Scheme which encourages the reporting of suspected side effects. You can report adverse reactions online or by post.

A small number of people experience an idiosyncratic or unpredictable reaction, similar to an anaphylactic shock. Extreme allergic reactions are a rare but recognised side effects of most vaccines, and symptoms include difficulty breathing and collapse.
When side effects do occur, the health professional giving the vaccine will have been fully trained in how to effectively deal with it. If you or your child has an anaphylactic reaction, following treatment, they will usually fully recover within a few hours.

Dermal Fillers:Restylane SubQ

2009-09-27T15:16:00.003+01:00

Restylane SubQ is a useful addition to the Restylane family and is particularly good in plumping out the ageing mid-face.

As we age, we lose volume (plumpness) in the skin and also the overlying loose skin tends to drag South with gravity. The result is a depleted mid-face where our lovely cheeks used to be and jowls.

The preferred treatment used to be a tight (often very tight!) facelift to pull the canvass taught over the underlying structures and create an appearance of youthfullness. Unfortunately it often also created a rather startled appearance.

Restylane is a man-made hyaluronic acid. It is almost identical with usual human hyaluronic acid, differing by only 1%. Consequently the body accomodates the injected Restylane easily.

There are an increasing number of members in the Restylane family. Restylane SubQ is one of the newer additions and is comprised of larger particles making it suitable for injection into the mid-face to enhance volume and replace on a long-lasting temporary basis the "malar fat pad" which gives most of us our cheek size.

The procedure is simple and safe. Restylane products have an exemplary safety record and have been used and tested in literally millions of patients worldwide by a myriad of different injectors. In fact, around 11 million doses of the Restylane base product have been used worldwide.

Some practitioners will avoid the use of anaesthetic agents. At Freedomhealth we believe that an individual patient's comfort is paramount.

Lee Garrett, our Aesthetic Nurse Practitioner starts the procedure with careful examination, photography and then ensuring the patient has understood both the procedure and expected outcome.

Lee will then thoroughly cleanse the overlying skin with antibacterial scrub. All the items we use are individual to the patient, single use and sent for incineration after the procedure. Freedomhealth is registered with the Care Quality Commission.

A small amount of local anaesthetic may be injected into the target area. This will numb the area and make the whole procedure very comfortable.

Following this the Restylane SubQ is introduced into the target area and injected to achieve the desired result. The results are instant, immediately visible and there is very little post-procedure reduction after the patient has left.

Lee demonstrated the preferred injection technique at a Q-Med Restylane Conference in Reading in 2009. His victim was his boss, Dr Sean Cummings, Medical Director of Freedomhealth.

"The whole procedure was comfortable" says Sean. "Obviously I know Lee very well (actually, I trained him originally!) so I was very comfortable with the entire set up despite being injected in front of a few hundred delegates". He went on to say "I use Restylane SubQ in my everyday practice as well and I was pleased to have experienced the process. It did make a decided difference to my mid-face. I'd been exercising heavily and had lost quite a bit of weight - ten kilo's in fact. I think after that amount of weight loss then inevitably at 40 plus then there is significant loss from the face".

More information about Restylane SubQ is available here and here.

HIV through fingering a Vagina

2009-06-29T10:28:00.002+01:00

HIV transmission through fingering - inserting a finger into a vagina seems to cause a lot of anxiety worldwide.

Fingering is a zero risk activity as far as we are aware. There are no reported cases worldwide of people becoming HIV positive after fingering a woman with HIV.

People are generally very concerrned about the presence of tiny cuts on their fingers or around their finger-nails which they fear may pose an extra risk by being so called open wounds. An open wound is a cut which is freshly made and freshly actively bleeding. This does not mean an old healed paper cut for example. It does have to be 1) fresh and 2) open and bleeding. Even in this scenario, there is no evidence that it poses a risk with no reported cases worldwide.

The vastly most common routes for transfer of HIV are by unprotected vaginal or anal sex and then by sharing needles for injecting drugs and mother to child transmission during birth or breast feeding.

HIV transmission by fingering is not a risk.

However, it would be polite and very much more comfortable for the person to be fingered (the "fingeree") if the fingerer cut his or her nails and also used some lubricating fluid to make the entire excericse enjoyable for all concerned and less likely to injure the fingeree.

Remember that if you think you might have exposed yourself to HIV then the best approach is to test as soon as you are able. We know that testing and identifying new HIV positive people is very important in terms of their own health but also in reducing the chances of HIV spread to others. The biggest risk of HIV infection is through having unprotected sex with someone who has just become HIV positive.

If you do think you have been exposed then you should obtain medical advice regarding the use of Post Exposure Prophylaxis to reduce your chances of acquiring the infection. The earlier you do this the better.

Sun, sun damage and sun beds

2009-06-21T19:35:00.002+01:00

On holiday recently, it finally dawned on me that I was getting old. Or, to be more precise, I realised my skin was getting older. Underneath I remained the age I always thought I was.

My partner and I were on a snorkelling safari along with some others. I had been staring at a younger man with improbably muscular legs pulled into an equally impossibly small pair of shorts when his wife gave me a funny look. Obviously I'd actually been looking at his skin, not his legs.

I had been slapping on the SPF 30 and they had been happily applying some home mix of olive oil and butter. They were badly burned and I was translucent. Both very attractive looks.

There is no doubt that a nice even sun tan is very attractive. It helps radiate good health, which is a little perverse given that acquiring it results in a deep burn to the skin and tissue destruction.

Most of us like a sun tan and many of us, like me, over the years, have spent hours developing it, either in natural sunlight or in tanning booths. Both I'm afraid are bad. The trouble is you do not generally care about that until you get to my age when you start noticing that younger men have better skin. They have better skin because they've had less time frolicking about in the sun. So although they look lovely and sun-kissed, part of the reason they are so attractive is because they still have a nice, thick, sexy collagen layer underneath their youthful elastic skin.

Modern sunbeds are up to 15 times more intense than the sun at 12 in the afternoon in the Mediterranean. Professor Alex Elliott, Chairman of the UK Committee on Medical Aspects of Radiation in the Environment. People who think they are saving their skin by just using sunbeds are actually using a gigantic magnifying glass. The particular importance is that this intense electric beach causes huge damage to the skin and also an increase in malignant melanoma rates.

Visible ageing is not just due to the passage of time. It's due to sun exposure, particularly exposure to UVA rays, which are as strong in the UK as they are in Australia. Sun-worshippers benefit from exposure to UVB which will tan their skin, but the UVA will penetrate deeply into the tissue layers destroying natural elastic components. People like my PA, Judy, who avoid the sun, have facial skin like babies.

Sunlight will soak deeply into skin causing deep dermal damage and possibly even beneath into fat layers. On the surface there will be pigment changes so freckles and sun-spots become more common. Small but deeply unattractive blood vessels will appear in the top layers of the skin and more lines, particularly around the eyes and mouth will form and deepen. All this has its origin in the early years. So when I was cavorting around Greece in my early twenties, happily burning like my new snorkelling friend, I was setting the scene for now.

Of course we all know about skin cancers but again, relatively few of us care until too late. One of my plastic surgeon chums speaks of "that healthy pasty look so common amongst my malignant melanoma patients". The point, obviously is that people seem to need a malignant melanoma to change their behaviour and stop burning.

The good news is that it is never too late to change your sun strategy and reverse some of the changes, becoming young and plump skinned again. It is established that regular use of high SPF even in skins which have been repeatedly damaged over several years can both protect it from further damage and also reverse some of the more obvious effects of too much sun like excess and irregular pigmentation. Smoking will double the collagen damage and make you look even older and more wrinkled, so stop that too.

Using high factors goes against the grain for lots of us but surprisingly it will give a more even and longer lasting tan whilst making some attempt to both moisturise and protect your skin. By high SPF I mean at least factor 15 and preferably 25. Remember that even in the UK the ageing rays are very powerful so using a sun protection cream you like the feel and smell of all the time as a moisturiser is a good idea. Guys with thinning hair or bald heads should be extra careful to apply to the top of the head or risk a melanoma only someone taller than you can see.

For those of us who have spent a little too long in the sun over the years can repair a lot of damage by combinations of a high SPF sunscreen, using a good retinoid (Vitamin A) cream such as Obagi and also doing as I do and using the Sciton Broadband Light laser to destroy as much of the sun damage as possible. Yes, you do look gruesome when you've just been zapped but the youthful effects soon kick in and you can't wait to get the next lot of BBL and Obagi on the go.

Age is a fascinating subject, but what you really need to know is that sunlight causes most of the visible effects.

Labels: ageing, beach, Obagi, Sciton, Sciton BBL, sun, sun damage, sunlight, UVA, UVB

Anabolic Steroids For Summer?

2009-06-18T19:32:00.002+01:00

Anabolic Steroids - Friend or Foe?

Anabolic steroids have it seems, become man’s best friend. The use of these drugs throughout the UK has mushroomed with more and more men, and some women, using them to enhance their appearance. Worldwide, the beauty industry has spawned a myriad of different techniques to augment what nature has given. Plastic surgery, botox, facial fillers are all de rigueur. Steroids seemingly have joined the pack, although very illicitly.

Estimates as to usage are very vague ranging from maybe 50,000 to 150,000 people across the UK. Steroid use is probably more undergound than other forms of injecting drug use. The reasons are fairly straightforward. Most steroid users would not see themselves as injecting drug users, big muscle size and gym use being associated with a positive health image. Steroid users have a controlled use of their drug or drugs of choice and the chaos surrounding say heroin or cocaine addiction is not present. Steroid users rarely break into your car to steal your radio to fund their habit. So the mind set is completely different.

Anabolic steroids act by causing firstly the growth of muscle tissue and also secondly to a varying extent cause “virilisation” – the development or heightening of male characteristics like deep voice, increased libido and increased beard growth. Most of the commonly used steroids have a degree of both of these actions. Efforts have been made to refine the effects, though not terribly effectively.

Steroids are popular because they will give a swift bulking up and increase in strength. If used carefully with heavy exercise and a good lean diet, they will produce a taut lean muscular body which is so sought after. Using them without careful attention to diet etc will result in indiscriminate weight gain and a bloated, fat effect. Little information is available on what drives people to use. My own practice has seen several thousand users over the years. As a group the guys are usually in their mid to late thirties and have become discouraged by failing to make progress in the gym; there is usually a certain “biological clock” effect with more men in their late thirties feeling “now or never”; they have usually explored / researched the area over several years with increasing interest; they know, from observation of friends and others in their gyms that the side effects are small and they feel a risk worth taking; finally they almost invariably say “I’m just going to try it once” – several months later they are still using but ever more sophisticated regimes.

There are broadly two types of steroid. The first is taken orally as a tablet or capsule and the second as an injection. Oral forms are usually Dianabol, Anavar and Winstrol. Injections are usually Deca-durabolin, Testaviron, Sustanon or Winstrol. There are “fashions” in steroid use as in much of the rest of life. There will be sudden changes in pattern of use depending on which particular steroid is in vogue with the trend setters of the moment. In addition, steroids are commonly used in “stacks” ie in combination with each other. A popular stack may be Deca-durabolin and Sustanon ampoules on a weekly basis for eight weeks.

They are usually obtained from gyms or personal trainers, though in much of Europe they are freely available for sale over the counter in pharmacies. They are illegal to supply in the UK without a prescription but they are legal to possess for personal use.

There is a great deal of myth surrounding use both on the part of users and doctors. There is a view that swallowing a tablet must be less harmful than injecting the drug. There is little truth in this. Tablets contain steroids which in the main have had some chemical tinkering to slow the removal by the liver – the result, paradoxically for many is decreased effect and increased side effect. It is true that injection of steroids carries certain hazards, but these are more to do with the injection technique rather than the drug. Injection hazards include sharing HIV or Hepatitis C and B with your best mate who’s just used the same works or worse, sticking the needle into something rather important like a vein or artery. Occasionally direct injection into say, a calf muscle is done to increase the size of that muscle alone – extremely hazardous.

Benefits include a psychological boost, achieved both from witnessing the sudden real growth, but also as a drug effect as well. People commonly feel better and more confident. They will with careful training cause muscle growth. With increased size comes more attention from others. This adds to the increasing self-confidence.

Disadvantages include the potential to inject the drug into a vital structure, possibility of infection, adverse psychological changes including anger and uncontrolled libido and finally a side effect of the drug itself. Drug side effects include greasy skin, acne, shrunken testicles and increased indiscriminate appetite. These are usually reversible with stopping the drug, but the side effects may continue beyond. Some effects like increased cholesterol level, breast development and rarely a chemical hepatitis can be more serious. Breast development occurs because paradoxically, excess testosterone is turned into the female hormone oestrogen.

There are some basic rules to make steroid use as safe as possible, though in reality this falls into “harm minimisation” rather than making use completely safe. I would suggest seeing a doctor or nurse who is experienced in the area. Basic blood checks on liver, kidneys and blood count should be considered. Being taught the “safest” areas for injection will avoid you pranging something important. Identifying other factors in your life like diabetes, heavy smoking, positive family history for heart disease may alter the course of steroids you plan. The other advantage is that as with many of my patients, it might be obvious to the doctor that the current exercise regime would never achieve the result desired. Altering the regime may well produce a much nicer, much more enduring effect.

How does HIV Spread in Heterosexuals?

2009-05-20T17:02:00.005+01:00

We receive many enquiries on our Sexual Health Forum about the mechanism of spread of HIV in heterosexuals.

People sending in queries are often panic-stricken about minor sexual activities and the risk of possible spread of HIV from an infected individual to them. The risk of spread of HIV from an HIV-infected individual to another in the absence of unprotected penetrative (vaginal and /or anal) is exceedingly low to almost impossible.

A study reported in the New England Journal of Medicine (Viral Load and Heterosexual Transmission of Human Immunodeficiency Virus Type 1; Quinn et al; Vol 342:921-929; March 30, 2000, Number 13) examined the relationship between risk and rate of transfer of HIV depending on "viral load". Viral load is the term used to describe the amount of virus detectable in a particular body fluid and is usually referred to as particles per ml of blood.

The article identified the other factors which might influence how HIV was spread and these were:-

Frequency of unprotected sexual activity
Types of sexual contact
use or otherwise of condoms
circumcision in males
the presence or otherwise of other Sexually Transmitted Infections or Diseases

The study identified 415 heterosexual couples where one was HIV positive and the other HIV negative (HIV discordant couples). 55% of the males were HIV positive and 45% of the females were HIV positive. The study went on for 30 months. 22% of the originally HIV negative people then became HIV positive during this time. The spread rate was the same between HIV positive men and HIV negative women as between HIV negative men and HIV positive women.

Peak rates of spread were observed in younger individuals between 15 and 19 years old.

The study found that the main determinant of whether an HIV positive person would spread HIV and infect another person with whom they had sex was the amount of virus they had in their system at the time - the amount of their viral load. The study found that in people with undetectable viral loads there were no seroconversions in the previously HIV negative people studied. In addition, the cut off point seems to be around 1500 or so copies per ml.

What does this mean?

It seems to suggest that HIV infection occurs most commonly when people who already have HIV have a high viral load - a high amount of virus particles in their system. This is important because:-

It makes the need to have regular HIV test very important if you are having unprotected sex with others because in the early stages of HIV, viral load tends to be very high and this seems to be the time when most new infections might be passed on.
In addition, it is reassuring that because large amounts of virus are required to cause infections in others it is likely that activities we call low risk such as oral sex will be likely to be virtually no-risk in people on successful treatment which aims to reduce the amount of virus to undetectable levels.

Can saliva in a wound cause HIV

2009-05-17T15:41:00.003+01:00

The very short answer to this question is a firm "no". HIV will not spread through saliva unless there is visible blood within it. Visible means you can see it - clearly, not just imagine that it might have been there!

Certainly HIV antibodies can be found in saliva - and we use this to test for HIV in some circumstances. In addition, HIV antibodies will be found in urine - but not the virus. Again, we can use HIV in urine to test for HIV. Antibodies are very different to HIV virus. HIV antibodies are formed by a human body immune system in response to HIV infection.

There are lots of scary stories on the net of people catching HIV through kissing; snogging; deep-French kissing; saliva on genitals; saliva on or in wounds; sharing water and drinks with HIV positive people; sharing knives and forks as cooking utensils with HIV positive people. These are all complete and utter rubbish, perpetrated by people who are either very ignorant or who want deliberately to ostracise HIV positive people.

More information about HIV and HIV testing can be found on our HIV testing page.

Call us on 020 7637 1600 if you think you'd like an HIV test.

HIV infection through medical equipment

2009-04-20T10:12:00.005+01:00

HIV infection through medical devices, blood products and procedures is thankfully very rare in the Western World.

A number of countries including most of Europe and the UK did have problems with an HIV and then Hepatitis C contaminated blood and blood product supply chain some 20 years ago but elaborate screening of donors and also screening of blood products has now eliminated this in the UK.

Yesterday saw the release of information from the Department of Veteran Affairs in the USA confirming the contamination of three patients in different facilities around the USA with HIV after inadequate sterilisation of re-useable medical equipment.

There have been a number of episodes worldwide where devices which have been resterilised have resulted in infection with Hepatitis B, C or HIV. These are really fantastically rare episodes, particularly if you count the number of procedures performed each year.

On the Freedomhealth Forum we receive many hundreds of questions asking about safety of medical procedures in the UK and particularly whether items used at our clinic and also other clinics in the UK are re-used.

We can re-assure everyone that ALL our equipment is sterile single use equipment and it is all disposed of after each single patient contact. Nothing is re-used. If you as a patient are concerned about the possibility of contamination then please ask to see all items and inspect all packaging prior to use. We're very happy to help allay all your fears with regard to this.

Can I get HIV through oral sex?

2009-02-16T09:47:00.002Z

Can I get HIV through oral sex? is probably one of the most frequent questions we get asked at Freedomhealth either in person or via our Sexual Health Forum. The answer is yes, possibly, but it is exceptionally unlikely.

There has been a great deal of interest and many research papers written about the HIV risks associated with oral sex and similarly many studies to try to determine why the risk of oral sex with an HIV positive person might be less than that associated with unprotected penetrative vaginal or anal sex.

Romero and others, in their article describing an excellent and diligent long term study failed to identify any risk at all in transfer of HIV from an HIV positive to an HIV negative partner through oral sex. In total 19000 episodes of oral sex were documented amongst 135 heterosexual couples over ten years and in 34% of these episodes the HIV positive male ejaculated into the HIV negative females' mouth. (Romero J et al. Evaluating the risk of HIV transmission through unprotected orogential sex. AIDS 16:9:1269-97, 2002.)

Baggaley and others, in their article Systematic review of orogenital HIV-1 transmission probabilities. International Journal of Epidemiology 37 : 1255-65, 2008 have reviewed the major articles to date and conclude that the risks of HIV transmission via oral sex are low.

To reach their conclusions they conducted a systematic review of the available literature. Ten studies from North America and Europe were identified as meeting the required criteria.

The authors noted some difficulties with the methodology of the studies. These were mainly the common ones of:-

- People rarely confining their sexual activity to oral sex alone

- where people have had other sorts of sex including unprotected anal or vaginal penetration it is assumed that the higher risk activity will have given them HIV

- exact details of the sexual activity have been missed out - ie whether or not ejaculation into the mouth etc

- Studies where one partner is known to be HIV positive and the other HIV negative are likely to be slightly skewed because the HIV positive person is likely to be on anti-retroviral medications and consequently probably less infectious anyway.

The overall conclusion was that:-

- Chances of acquiring HIV through oral sex with an HIV infected partner are very low. The majority of the studies reporting zero to miniscule risk.

- Very large, very expensive, well controlled studies would be needed to define the question exactly.

The results of a study due to appear shortly in AIDS seem to show that HIV negative gay males in sero-discordant ( a relationship where one of the partners is HIV positive and the other HIV negative) relationships have saliva which has an HIV neutralising capacity. Consequently one of the conclusions drawn is that repeated exposure to low levels of HIV may produce a level of resistance to HIV in this population.

For further information on HIV testing click here

Modern Sexual Health Testing and Screening

2009-02-02T09:38:00.000Z

Modern Sexual Health Screening has become much more rapid and much more accurate that even only a few years ago.

The common sexually transmitted diseases have obviously remained the same but the testing methods and treatments for each are simply hugely faster and much more effective than ever previously. At Freedomhealth we've published an on-line Guide to Common Std's and Treatment.

One of the best and major advances in Sexual Health Screening has been the advent of the combined PCR test which will test for seven different common sexually transmitted diseases on either urine or a simple painless swab.

This combined test will identify Neisseria Gonnorhoea; Chlamydia; Ureaplasma; Mycoplasma; Herpes I and II, Trichomonas and finally Gardneralla all on a simple urine test or swab. It has the further advantage that both of these sampling methods can be done at home and sent in to our laboratory in a pre-paid pack. The test results will be returned within 4-5 working days. It allows for post-sexual event screening for peace of mind and also allows for people in distant parts of the UK to use our services at www.Freedomhealth.co.uk

Treatment for any conditions which we identify is usually straightforward involving a course of anti-biotics - or in the case of herpes, some appropriate antiviral medication.

There is a free interactive Sexual Health Forum available at http://www.freedomhealth.co.uk/forum/

Oral Cancer and Human Papilloma Virus (HPV)

2009-02-02T09:36:00.000Z

There's an interesting article in the New York Times today relating to Oral Cancer, its relationship with the Human Papilloma Virus and also its increasing detection.

Oral cancers have been mainly linked to smoking and excess alcohol consumption, or chewing of certain tobacco products. Genetics has also played a part with some people being more susceptible than others.

The developing story relating to Human Papilloma Virus (HPV) is a fascinating one. We know already that particular subtypes cause cervical and other anogenital cancers and it seems that oral sex is a risk factor for spread of HPV into the oral cavity. Some researchers have postulated that four or five oral sexual exposures with different partners might lead to an increase in risk of oral cancer.

A new device involving the use of a special blue oral rinse and also a visual detection system is said by the manufacturers of the device to be 1) beneficial in terms of detecting oral cancers and 2) lead to a reduction in both death and destructive surgery. This is postulated on the basis that early detection is always better.

An alternative view is that the number of HPV associated tumours is low, much much lower for example than prostate cancer or breast cancer and that very oftne, these tumours are found at the very back of the throat just beneath the tonsil area where they are very difficult to see. Consequently the use of the light device may not actually assist in diagnosis.

It appears that the same HPV viruses as cause cervical cancer and anogenital cancers also cause cancers of the mouth and throat where HPV is implicated. In that case a more rational approach may be to use one of the Human Papilloma Virus vaccines, eg Gardasil or Cervarix to reduce the chances of contamination with HPV 16 or 18 and thus reduce the overall risk.

I don't think the public health implications of a mass immunisation program with HPV vaccines has been fully thought through yet.

For more information on HPV and vaccination have a look at our main site pages on HPV.

There is an excellent review published by the CDC in the US which you can read here which gives a great deal of detail and also leads to other links.

Testing for HIV and STI's amongst gay men who engage in group sex

2009-02-02T09:33:00.000Z

An article by Prestage and others in Sexually Transmitted Infections 2009;85:70-74 reports the results of a survey of sexual habits of a group of 436 gay males who engage in group sex.

The results showed that among the 436 gay men who engaged in group sex within the previous one month 32.5% reported unprotected anal intercourse(UAI) with non-regular, mostly HIV unknown status partners at their recent group sex encounter. The article also reports other sexual practices which are risk factors for for STI's other than HIV.

The article concludes that gay men who have a doctor with whom they were able to openly discuss their group sex activities had received a broader (and by implication, better) range of STI (sexually transmitted infection) checks.

A further conclusion was that sexual practices that risk the transmission of STI's/STD's were common within the high risk group surveyed whereas awareness of risk and need for testing was high but not universal.

The moral of the article may be that patients who can constructively engage in discussion about their sexual habits and practices with an individual they trust not to be judgement may do better than those without that relationship.

A pdf Guide to HIV and STD testing is available here

Sexual Health Update

2008-06-11T09:40:00.000+01:00

The New York Times today reports on the rise of TB and especially multiresistant TB in the HIV infected population around the world. The NYT notes that TB is the most important complication in HIV positive patients globally.http://www.nytimes.com/2008/06/10/health/10tb.html?_r=1&adxnnl=1&oref=slogin&ref=health&adxnnlx=1213182007-Bk+ztFEND7cYa21ym55Vcg

The UK Times Newspaper has a great article on Hepatitis C http://www.timesonline.co.uk/tol/life_and_style/health/article3990791.ece

Early Symptoms of HIV

2008-06-11T09:20:00.000+01:00

One of the commonest recurring questions put to us at Freedomhealth, either on our Sexual Health Forum or in person at our clinic is to do with the very early symptoms of HIV following an often minor sexual indiscretion.

Early HIV symptoms are very like those of any other infectious illness, making it extremely difficult, if not impossible, to identify an early infection with HIV symptoms alone. The commonest symptoms are vague and comprise of headache, rash, fever, sweats, sore throat, abdominal pain, nausea, vomiting, and swollen glands in neck, armpits and groins.

These symptoms will appear in approximately - and it is a very rough approximation - 50-80% of newly HIV infected people. Very many of these will experience mild or almost non existent symptoms, with the remainder having severe illness requiring medical attention. Most of the people we see at Freedomhealth have had an innocuous sexual exposure with no realistic possibility at all of acquiring HIV from it. Despite that, the level of anxiety and distress caused is often massively disproportionate.

Early HIV infection is always best tackled by having one of a range of HIV tests now commonly available. There are now very compelling reasons to have an HIV test as early as possible. Firstly, simply knowing your HIV status will allow you to make adjustments to your lifestyle to protect yourself against further complications. For example, getting plenty of good quality rest, taking vitamin supplements, drinking less alcohol, eating a healthy diet, stopping or reducing recreational drug use are all some of the immediate measures an individual can take to help preserve health and strength. Secondly, knowing your HIV statues early allows, if HIV positive to measure where exactly your immune status is through baseline HIV monitoring tests. Mnay people fear the early introduction of medications, but in fact medications are not need in the short or even medium term for many people. Thirdly, knowing you are HIV positive allows you to take decisions to protect yourself from further infections which might reduce your immunity further and also to protect others you might care about.

HIV testing has become very sophisticated and allows for very early diagnosis. When I first started in practice in the mid 1980's, HIV tests were rudimentary and often took a long time to be processed and would commonly yield false negative and false positive results.

Using an appropriate mix of HIV tests will allow for reliable diagnosis within the first few weeks of possible infection.

HIV PCR testing will allow for diagnosis of HIV 1 from around ten days post exposure. There are some downsides associated with the test. These include a) the cost as it is not a routine test b) the fact that it looks for HIV 1 only. This in itself is not too much of a problem in most countries as HIV1 is by far the most common type c) it may take a few days to return to the doctor requesting - meaning that although the test can be done at 10 days it may take up to 5 working days to be returned d) it has an overall "accuracy" of around 96-99% with false positives and negatives occuring.
HIV DUO testing allows for reliable diagnosis of HIV 1 and 2 from 28 after a possible exposure. The test detects HIV 1 and 2 and also a core protein of HIV 1, the p24 antigen. This will give an accurate result after 28 days with an overall accuracy of 99.89%. The advantages are that it is quick, easy to perform, and the return times form the laboratory should be short - of the order of 4 hours or so.
HIV Antibody testing is still the standard testing method worldwide, the Sexual Health testing sector being relatively slow to embrace new methodologies. Modern 4th generation antibody tests are very sensitive and will allow often for reliable results after approximately 6 weeks or so, although most of these tests remain licensed for use after three months.
Western Blot HIV testing. This is a commonly used test to confirm an initial indeterminate or positive test result from eg an HIV DUO test or an HIV antibody test