Sundhiya Mandalia | Imperial College London (original) (raw)

Papers by Sundhiya Mandalia

Research paper thumbnail of Evaluation of Filter Paper Transfer of Whole-Blood and Plasma Samples for Quantifying HIV RNA In Subjects on Antiretroviral Therapy In Uganda

JAIDS Journal of …, 2007

Background: Most HIV-infected subjects on antiretroviral therapy (ART) in resource-limited settin... more Background: Most HIV-infected subjects on antiretroviral therapy (ART) in resource-limited settings do not undergo virologic monitoring. There is an urgent need for cheap, accessible HIV RNA assays for early diagnosis of virologic failure. We investigated filter paper transfer (FPT) of ...

Research paper thumbnail of A comparison of the CD4 response to antiretroviral regimens in patients commencing therapy with low CD4 counts

Journal of Antimicrobial Chemotherapy, 2004

Objective: To compare the immunological response to highly active antiretroviral therapy (HAART) ... more Objective: To compare the immunological response to highly active antiretroviral therapy (HAART) in treatment-naive patients with a baseline CD4 count of <200 cells/mm 3 .

Research paper thumbnail of Impact of antiretroviral choice on hypercholesterolaemia events: the role of the nucleoside reverse transcriptase inhibitor backbone

Hiv Medicine, 2005

BackgroundThe use of highly active antiretroviral therapy (HAART) has profoundly altered the life... more BackgroundThe use of highly active antiretroviral therapy (HAART) has profoundly altered the life expectancy of individuals infected with HIV. Metabolic abnormalities associated with antiretrovirals and cumulative exposure to combination antiretroviral therapy, including dyslipidaemia and insulin resistance, have been linked to an increased risk of myocardial infarction.The use of highly active antiretroviral therapy (HAART) has profoundly altered the life expectancy of individuals infected with HIV. Metabolic abnormalities associated with antiretrovirals and cumulative exposure to combination antiretroviral therapy, including dyslipidaemia and insulin resistance, have been linked to an increased risk of myocardial infarction.MethodsLongitudinal data from a large prospectively collected clinical database were analysed. All patients who commenced first antiretroviral therapy (ART) [two nucleoside reverse transcriptase inhibitors (NRTIs)+one nonnucleoside reverse transcriptase inhibitor (NNRTI) or one active protease inhibitor (PI)] since 1996 were identified. Patients with elevated cholesterol levels [>5.5 mmol/L (215 mg/dL)] prior to therapy initiation were excluded. Quantitative data were categorized into quartiles and presented stratified by individuals developing abnormal levels of cholesterol during first-line HAART. Event time was defined as time from commencing first-line ART to either development of cholesterol level >6.5 mmol/L (254 mg/dL) or switch of first-line therapy. The Kaplan–Meier product limit survival method was used to estimate time to abnormal cholesterol level, and the χ2 test was used for comparisons between drug classes. Cox's proportional hazards regression analysis was used to identify factors predicting a likelihood of raised cholesterol level.Longitudinal data from a large prospectively collected clinical database were analysed. All patients who commenced first antiretroviral therapy (ART) [two nucleoside reverse transcriptase inhibitors (NRTIs)+one nonnucleoside reverse transcriptase inhibitor (NNRTI) or one active protease inhibitor (PI)] since 1996 were identified. Patients with elevated cholesterol levels [>5.5 mmol/L (215 mg/dL)] prior to therapy initiation were excluded. Quantitative data were categorized into quartiles and presented stratified by individuals developing abnormal levels of cholesterol during first-line HAART. Event time was defined as time from commencing first-line ART to either development of cholesterol level >6.5 mmol/L (254 mg/dL) or switch of first-line therapy. The Kaplan–Meier product limit survival method was used to estimate time to abnormal cholesterol level, and the χ2 test was used for comparisons between drug classes. Cox's proportional hazards regression analysis was used to identify factors predicting a likelihood of raised cholesterol level.ResultsA total of 1664 patients were included in the study: 57.1% on two NRTIs+one NNRTI, 38.4% on two NRTIs+one PI, and 4.4% on two NRTIs+a boosted PI regimen. Regimens containing stavudine or PIs were associated with a significantly higher event risk and earlier time to event. No differences between efavirenz and nevirapine or between didanosine and lamivudine were observed. In 28 patients exposed to the combination of tenofovir+lamivudine+efavirenz, there were no episodes of elevated cholesterol level.A total of 1664 patients were included in the study: 57.1% on two NRTIs+one NNRTI, 38.4% on two NRTIs+one PI, and 4.4% on two NRTIs+a boosted PI regimen. Regimens containing stavudine or PIs were associated with a significantly higher event risk and earlier time to event. No differences between efavirenz and nevirapine or between didanosine and lamivudine were observed. In 28 patients exposed to the combination of tenofovir+lamivudine+efavirenz, there were no episodes of elevated cholesterol level.ConclusionDyslipidaemia has emerged as an important issue in HIV-infected individuals receiving antiretroviral therapy. This study demonstrates that age at start of therapy, baseline cholesterol level, stavudine use and PI use are all associated with increased risk of hypercholesterolemia on initial therapy. Both NRTI and NNRTI/PI choice influence risk of hypercholesterolaemia.Dyslipidaemia has emerged as an important issue in HIV-infected individuals receiving antiretroviral therapy. This study demonstrates that age at start of therapy, baseline cholesterol level, stavudine use and PI use are all associated with increased risk of hypercholesterolemia on initial therapy. Both NRTI and NNRTI/PI choice influence risk of hypercholesterolaemia.

Research paper thumbnail of Use and Cost of Hospital and Community Service Provision for Children with HIV Infection at an English HIV Referral Centre

PharmacoEconomics, 2000

To describe the use of hospital and community services for children infected with HIV and estimat... more To describe the use of hospital and community services for children infected with HIV and estimate the cost per patient-year by stage of HIV infection during the era of antiretroviral monotherapy. Data on the use of hospital services were collected from case notes; the use of statutory and nonstatutory community services was recorded through diaries and interviews. Total cost estimates were calculated from unit costs from relevant hospital departments and community organisations. Children managed at St. Mary&#39;s Hospital (London, England) between 1 January 1986 and 31 December 1994, some of whom used statutory and nonstatutory community services in South East England between 1 November 1994 and 31 May 1996. 118 children with positive HIV antibody status. Mean inpatient days, outpatient visits, tests and procedures performed, drugs prescribed, community services used, associated unit costs and average cost estimates per patient-year by stage of HIV infection (1995/1996 values), and lifetime costs. Service provision during the study period was predominantly hospital-based. The use of services increased for different stages of HIV infection and increased with increasing severity of HIV infection. A shift from an inpatient-based to an outpatient-based service was seen between the periods 1986 to 1991 and 1992 to 1994. As symptoms evolved, children used more hospital inpatient services, with an accompanying shift in the use of community services from general services, such as schooling, to increased use of nurses, social care and home help. The estimated total cost of hospital and community care was 18,600 Pounds per symptomatic non-AIDS patient per year and 46,600 Pounds per AIDS patient per year. Similar estimates for children with indeterminate HIV infection and asymptomatic infection amounted to 8300 Pounds and 4800 Pounds per patient-year, respectively. Nondiscounted lifetime costs for hospital care amounted to 152,400 Pounds (44,300 Pounds to 266,800 Pounds) compared with discounted lifetime costs of 122,700 Pounds (42,000 Pounds to 182,200 Pounds); nondiscounted lifetime costs for community care amounted to 24,300 Pounds (7900 Pounds to 41,600 Pounds) compared with discounted lifetime costs of 21,000 Pounds (6800 Pounds to 32,000 Pounds). The continued emphasis on the use of hospital services may be due to the small number of children infected with HIV, most of whom lived in the London metropolitan area where specialist care was concentrated in a few centres. A shift from an inpatient- to an outpatient-based service was observed over time; the advent of the use of combination antiretroviral therapy in this population may further facilitate a shift in service provision and promote shared care between specialist centres, local hospital and community-based services.

Research paper thumbnail of Moyle G, Higgs C, Teague A, Mandalia S, Nelson M, Johnson M, et al. An open-label, randomized comparative pilot study of a single-class quadruple therapy regimen versus a 2-class triple therapy regimen for individuals initiating antiretroviral therapy

Antiviral therapy

ABSTRACT

Research paper thumbnail of Qualifications: MBChB, MMed (Internal Medicine)

Research paper thumbnail of Comparison of attendance and emergency admission patterns at accident and emergency departments in and out of London

British Medical Journal, 1993

OBJECTIVE--To compare the sociodemographic characteristics, diagnoses, and mode of referral of pe... more OBJECTIVE--To compare the sociodemographic characteristics, diagnoses, and mode of referral of people and emergency admissions between an accident and emergency department in inner London and one in a town outside London. DESIGN--Standardised questionnaire completed prospectively over two weeks by field-workers in each accident and emergency department. SETTING--Accident and emergency departments in an inner London teaching hospital and an associated teaching

Research paper thumbnail of Patients who consult with tiredness: frequency of consultation, perceived causes of tiredness and its association with psychological distress

British Journal of General Practice

ideas and explanations when patients complain of being 'tired all the time'.

Research paper thumbnail of How 'gold' is the standard? Interobservers' variation on venograms

International angiology: a journal of the International Union of Angiology

The aim of this study was to determine the degree of agreement between radiologists having differ... more The aim of this study was to determine the degree of agreement between radiologists having different levels of experience, in reporting 151 venograms independently. It was also aimed to assess whether the degree of disagreement would have influenced the final outcome of a thromboprophylactic study and the decision to anticoagulate the patients. Seventy-eight patients undergoing total hip replacement had bilateral venography on postoperative days 8-12. Patients were allocated to receive either a low molecular weight heparin (enoxaparin) with or without TED stockings or a placebo Each of the 151 venograms obtained has been reported on four times. The overall incidence of deep venous thrombosis was 42% (33 of 78 patients). The range of the Kappa value of each radiologist versus the others was 0.568 to 0.669. There was a significant decrease in the incidence of deep venous thrombosis in the treatment versus the placebo groups. On an intention to treat all diagnosed thrombi, a difference of up to 16% was demonstrated between the report of individual radiologists and the panel. This difference was reduced to 8% when only thrombi proximal to the calf were considered clinically significant. These differences reflect the radiologist&amp;amp;#39;s experience and frequency of reporting on venograms and should be taken into account when studies for thromboprophylaxis are planned.

Research paper thumbnail of brjgenprac00028-0035

Research paper thumbnail of Young people's views on provision of sexual health services

Sexually Transmitted Infections, 2002

Objectives: To identify the sexual health needs of young people in order to establish a service s... more Objectives: To identify the sexual health needs of young people in order to establish a service suited to these needs. Methods: A peer designed questionnaire piloted to a small group of young people was followed by a more widely distributed, amended questionnaire. The questionnaire survey was delivered to 744 pupils aged 11-18 years in six secondary schools and a pupil exclusion unit in central London. Factors encouraging or discouraging the use of young people's sexual health services were measured. Results: Several findings challenged existing models of care for young people's sexual health services. Notably, pupils wanted clinics to run more frequently than the usual once a week; the staff attributes that were most important were attitudinal rather than to do with sex, age, or physical appearance; and they did not mind if the waiting room contained older people. Many findings, however, agreed with existing data-young people wanted the clinic to be open after school; girls preferred to attend with a friend; a confidential, walk-in service was preferred. Conclusions: Large financial outlays are not necessary for the establishment of effective sexual health services for young people. Existing facilities and staff may be utilised with training of these staff to be sensitive to, and aware of, the needs of young people. Clinic opening times should coincide with school closing times. Although pupils stated a preference for female staff, this was not a high priority. More important was feeling that staff would listen to them and take their problems seriously, and that confidentiality would be maintained.

Research paper thumbnail of Survival and treatment of AIDS patients 1984-1993: experience of a smaller east London HIV centre

Sexually Transmitted Infections, 1997

Objective: To assess changes in survival from diagnosis of AIDS for patients managed in a small E... more Objective: To assess changes in survival from diagnosis of AIDS for patients managed in a small East London HIV clinic and the impact of therapeutic interventions on these survival patterns.

Research paper thumbnail of Tiredness as a ticket of entry: The role of patients' beliefs and psychological symptoms in explaining frequent attendance

Scandinavian Journal of Primary Health Care, 1999

To test when patients presented with fatigue whether their beliefs about its cause was related to... more To test when patients presented with fatigue whether their beliefs about its cause was related to their frequency of attending; and to measure the association between their fatigue and psychological symptoms and their frequency of attendance during the study year. A cohort study. Primary health care. Patients presenting with fatigue as their main symptom. A fatigue questionnaire, the general health questionnaire (GHQ), an attribution scale, and measurement of consulting frequency during the 6 months before and after the patient presented. Patients who believed their fatigue was due to a physical or costly physical cause consult for any reason significantly more frequently than patients who reported that psychological as well as physical problems might have caused their fatigue. Patients&#39; psychological distress measured with the GHQ was more closely associated with frequent attendance than their level of fatigue was. When patients present with fatigue it is important to inquire about their beliefs and psychological symptoms; these factors may be more important than the fatigue itself in explaining their help-seeking behaviour.

Research paper thumbnail of Serum sialic acid as an indicator of change in coronary artery disease

Metabolism, 1995

We measured serum levels of total sialic acid (TSA) by an enzymatic method in 74 men who complete... more We measured serum levels of total sialic acid (TSA) by an enzymatic method in 74 men who completed the St Thomas&#39; Atherosclerosis Regression Study (STARS). Coronary artery disease (CAD) was assessed as the change (delta) in mean absolute width of coronary segments (MAWS) over 3 years by a computerized technique. Delta TSA was significantly correlated with delta MAWS (r = -.50, P &lt; .001) after adjusting for age, blood pressure, smoking status, and plasma low-density lipoprotein (LDL) cholesterol. The relative risk of progression of CAD for a delta TSA exceeding 10 mg/dL as compared with a delta TSA not exceeding 10 mg/dL was 4.6 (95% confidence interval, 2.4 to 8.7). We conclude that serial measurement of serum TSA levels may be a useful indicator of the progression of CAD.

Research paper thumbnail of A survey of patients’ willingness to switch from a single-tablet regimen to 2 pills once a day as a cost-saving strategy

Journal of the International AIDS Society, 2012

ABSTRACT

Research paper thumbnail of Highly Active Antiretroviral Therapy and Human Immunodeficiency Virus-Associated Primary Cerebral Lymphoma

JNCI Journal of the National Cancer Institute, 2006

From a cohort of 9621 human immunodeficiency virus type 1-infected individuals, we identified 61 ... more From a cohort of 9621 human immunodeficiency virus type 1-infected individuals, we identified 61 patients with primary central nervous system lymphoma (PCL) who had a median survival of 1.3 months. We compared clinicopathologic variables of patients who were treated in the pre-highly active antiretroviral therapy (HAART) and HAART eras and investigated whether exposure to antiretroviral agents with differing cerebrospinal fluid penetrations was associated with risk for PCL. All statistical tests were two-sided. Incidence of PCL was lower in the HAART era (1.2 cases per 1000 patient-years, 95% confidence interval [CI] = 0.8 to 1.9) than in the pre-HAART era (three cases per 1000 years, 95% CI = 2.1 to 4.0; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001), and overall survival was longer (median survival = 32 days, range = 5-315 days, versus 48 days, range = 15-1136 days; log rank P = .03). In the HAART era, fewer patients had prior acquired immunodeficiency syndrome-defining illnesses than in the pre-HAART era (64% versus 90%; P = .013), and patients were more likely to have the diagnosis of PCL confirmed histologically or by polymerase chain reaction (77% versus 26%; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001). Exposure to specific antiretroviral agents was not associated with risk for PCL.

Research paper thumbnail of How common is the non-nucleoside reverse transcriptase inhibitor mutation E138K in clinical practice?

Journal of Infection, 2011

1. J Infect. 2011 Jun 12. [Epub ahead of print] How common is the non-nucleoside reverse transcri... more 1. J Infect. 2011 Jun 12. [Epub ahead of print] How common is the non-nucleoside reverse transcriptase inhibitor mutation E138k in clinical practice? Bradshaw D, Mandalia S, Nelson M. Chelsea and Westminster Hospital, London SW10 9NH, UK. ...

Research paper thumbnail of The Safety and Tolerability of Switching from a Non-failing Antiretroviral Regimen to Lopinavir

Journal of Infection, 2003

Research paper thumbnail of Burkitt's Lymphoma and Previous AIDS-Defining Illnesses Are Not Prognostic Factors in AIDS-Related Non-Hodgkin's Lymphoma

Journal of Clinical Oncology, 2005

REFERENCES 1. Clark OAC, Lyman GH, Castro AA, et al: Colony stimulating factors for chemotherapy ... more REFERENCES 1. Clark OAC, Lyman GH, Castro AA, et al: Colony stimulating factors for chemotherapy induced febrile neutropenia: A meta-analysis of randomized controlled trials. J Clin Oncol 23:4198-4214, 2005 2. Sprott DA: Normal likelihoods and their relation to large sample theory of estimation.

Research paper thumbnail of Absence of Association Between Individual Thymidine Analogues or Nonnucleoside Analogues and Lipid Abnormalities in HIV-1–Infected Persons on Initial Therapy

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2000

Changes in levels of triglycerides and cholesterol during antiretroviral therapy raise concerns r... more Changes in levels of triglycerides and cholesterol during antiretroviral therapy raise concerns regarding an increased future risk of atherogenic disease and may precede the appearance of fat redistribution. Hypotheses regarding the impact of nucleoside analogues on adipocytes provide a possible explanation for metabolic and clinical fat disturbances. It is unclear whether the choice of nucleoside analogue combination or coadministration of nonnucleoside agents influences change in lipids. We performed a cross-sectional analysis of 135 persons receiving their first nucleoside analogue plus nonnucleoside-based combination antiretroviral regimen for at least 1 month and for whom cholesterol and triglyceride values were available on therapy. Univariate and multivariate regression models were used to explore the relation between cholesterol and triglycerides, as continuous variables with other variables. Both significant and nonsignificant variables from univariate analyses were evaluated in multivariate models to limit possible confounders. No association with drug choice was observed, either when comparing thymidine analogues (stavudine or zidovudine), all nucleoside analogue combinations or choice of either efavirenz or nevirapine as nonnucleoside. Age and triglyceride levels were found in a multivariate analysis to be associated with higher cholesterol. Only higher cholesterol was associated with higher triglyceride levels. In conclusion, no differences were observed between choice of drug or combination on cholesterol or triglyceride values during therapy. Older individuals may be more likely to have elevated cholesterol values.

Research paper thumbnail of Evaluation of Filter Paper Transfer of Whole-Blood and Plasma Samples for Quantifying HIV RNA In Subjects on Antiretroviral Therapy In Uganda

JAIDS Journal of …, 2007

Background: Most HIV-infected subjects on antiretroviral therapy (ART) in resource-limited settin... more Background: Most HIV-infected subjects on antiretroviral therapy (ART) in resource-limited settings do not undergo virologic monitoring. There is an urgent need for cheap, accessible HIV RNA assays for early diagnosis of virologic failure. We investigated filter paper transfer (FPT) of ...

Research paper thumbnail of A comparison of the CD4 response to antiretroviral regimens in patients commencing therapy with low CD4 counts

Journal of Antimicrobial Chemotherapy, 2004

Objective: To compare the immunological response to highly active antiretroviral therapy (HAART) ... more Objective: To compare the immunological response to highly active antiretroviral therapy (HAART) in treatment-naive patients with a baseline CD4 count of <200 cells/mm 3 .

Research paper thumbnail of Impact of antiretroviral choice on hypercholesterolaemia events: the role of the nucleoside reverse transcriptase inhibitor backbone

Hiv Medicine, 2005

BackgroundThe use of highly active antiretroviral therapy (HAART) has profoundly altered the life... more BackgroundThe use of highly active antiretroviral therapy (HAART) has profoundly altered the life expectancy of individuals infected with HIV. Metabolic abnormalities associated with antiretrovirals and cumulative exposure to combination antiretroviral therapy, including dyslipidaemia and insulin resistance, have been linked to an increased risk of myocardial infarction.The use of highly active antiretroviral therapy (HAART) has profoundly altered the life expectancy of individuals infected with HIV. Metabolic abnormalities associated with antiretrovirals and cumulative exposure to combination antiretroviral therapy, including dyslipidaemia and insulin resistance, have been linked to an increased risk of myocardial infarction.MethodsLongitudinal data from a large prospectively collected clinical database were analysed. All patients who commenced first antiretroviral therapy (ART) [two nucleoside reverse transcriptase inhibitors (NRTIs)+one nonnucleoside reverse transcriptase inhibitor (NNRTI) or one active protease inhibitor (PI)] since 1996 were identified. Patients with elevated cholesterol levels [>5.5 mmol/L (215 mg/dL)] prior to therapy initiation were excluded. Quantitative data were categorized into quartiles and presented stratified by individuals developing abnormal levels of cholesterol during first-line HAART. Event time was defined as time from commencing first-line ART to either development of cholesterol level >6.5 mmol/L (254 mg/dL) or switch of first-line therapy. The Kaplan–Meier product limit survival method was used to estimate time to abnormal cholesterol level, and the χ2 test was used for comparisons between drug classes. Cox's proportional hazards regression analysis was used to identify factors predicting a likelihood of raised cholesterol level.Longitudinal data from a large prospectively collected clinical database were analysed. All patients who commenced first antiretroviral therapy (ART) [two nucleoside reverse transcriptase inhibitors (NRTIs)+one nonnucleoside reverse transcriptase inhibitor (NNRTI) or one active protease inhibitor (PI)] since 1996 were identified. Patients with elevated cholesterol levels [>5.5 mmol/L (215 mg/dL)] prior to therapy initiation were excluded. Quantitative data were categorized into quartiles and presented stratified by individuals developing abnormal levels of cholesterol during first-line HAART. Event time was defined as time from commencing first-line ART to either development of cholesterol level >6.5 mmol/L (254 mg/dL) or switch of first-line therapy. The Kaplan–Meier product limit survival method was used to estimate time to abnormal cholesterol level, and the χ2 test was used for comparisons between drug classes. Cox's proportional hazards regression analysis was used to identify factors predicting a likelihood of raised cholesterol level.ResultsA total of 1664 patients were included in the study: 57.1% on two NRTIs+one NNRTI, 38.4% on two NRTIs+one PI, and 4.4% on two NRTIs+a boosted PI regimen. Regimens containing stavudine or PIs were associated with a significantly higher event risk and earlier time to event. No differences between efavirenz and nevirapine or between didanosine and lamivudine were observed. In 28 patients exposed to the combination of tenofovir+lamivudine+efavirenz, there were no episodes of elevated cholesterol level.A total of 1664 patients were included in the study: 57.1% on two NRTIs+one NNRTI, 38.4% on two NRTIs+one PI, and 4.4% on two NRTIs+a boosted PI regimen. Regimens containing stavudine or PIs were associated with a significantly higher event risk and earlier time to event. No differences between efavirenz and nevirapine or between didanosine and lamivudine were observed. In 28 patients exposed to the combination of tenofovir+lamivudine+efavirenz, there were no episodes of elevated cholesterol level.ConclusionDyslipidaemia has emerged as an important issue in HIV-infected individuals receiving antiretroviral therapy. This study demonstrates that age at start of therapy, baseline cholesterol level, stavudine use and PI use are all associated with increased risk of hypercholesterolemia on initial therapy. Both NRTI and NNRTI/PI choice influence risk of hypercholesterolaemia.Dyslipidaemia has emerged as an important issue in HIV-infected individuals receiving antiretroviral therapy. This study demonstrates that age at start of therapy, baseline cholesterol level, stavudine use and PI use are all associated with increased risk of hypercholesterolemia on initial therapy. Both NRTI and NNRTI/PI choice influence risk of hypercholesterolaemia.

Research paper thumbnail of Use and Cost of Hospital and Community Service Provision for Children with HIV Infection at an English HIV Referral Centre

PharmacoEconomics, 2000

To describe the use of hospital and community services for children infected with HIV and estimat... more To describe the use of hospital and community services for children infected with HIV and estimate the cost per patient-year by stage of HIV infection during the era of antiretroviral monotherapy. Data on the use of hospital services were collected from case notes; the use of statutory and nonstatutory community services was recorded through diaries and interviews. Total cost estimates were calculated from unit costs from relevant hospital departments and community organisations. Children managed at St. Mary&#39;s Hospital (London, England) between 1 January 1986 and 31 December 1994, some of whom used statutory and nonstatutory community services in South East England between 1 November 1994 and 31 May 1996. 118 children with positive HIV antibody status. Mean inpatient days, outpatient visits, tests and procedures performed, drugs prescribed, community services used, associated unit costs and average cost estimates per patient-year by stage of HIV infection (1995/1996 values), and lifetime costs. Service provision during the study period was predominantly hospital-based. The use of services increased for different stages of HIV infection and increased with increasing severity of HIV infection. A shift from an inpatient-based to an outpatient-based service was seen between the periods 1986 to 1991 and 1992 to 1994. As symptoms evolved, children used more hospital inpatient services, with an accompanying shift in the use of community services from general services, such as schooling, to increased use of nurses, social care and home help. The estimated total cost of hospital and community care was 18,600 Pounds per symptomatic non-AIDS patient per year and 46,600 Pounds per AIDS patient per year. Similar estimates for children with indeterminate HIV infection and asymptomatic infection amounted to 8300 Pounds and 4800 Pounds per patient-year, respectively. Nondiscounted lifetime costs for hospital care amounted to 152,400 Pounds (44,300 Pounds to 266,800 Pounds) compared with discounted lifetime costs of 122,700 Pounds (42,000 Pounds to 182,200 Pounds); nondiscounted lifetime costs for community care amounted to 24,300 Pounds (7900 Pounds to 41,600 Pounds) compared with discounted lifetime costs of 21,000 Pounds (6800 Pounds to 32,000 Pounds). The continued emphasis on the use of hospital services may be due to the small number of children infected with HIV, most of whom lived in the London metropolitan area where specialist care was concentrated in a few centres. A shift from an inpatient- to an outpatient-based service was observed over time; the advent of the use of combination antiretroviral therapy in this population may further facilitate a shift in service provision and promote shared care between specialist centres, local hospital and community-based services.

Research paper thumbnail of Moyle G, Higgs C, Teague A, Mandalia S, Nelson M, Johnson M, et al. An open-label, randomized comparative pilot study of a single-class quadruple therapy regimen versus a 2-class triple therapy regimen for individuals initiating antiretroviral therapy

Antiviral therapy

ABSTRACT

Research paper thumbnail of Qualifications: MBChB, MMed (Internal Medicine)

Research paper thumbnail of Comparison of attendance and emergency admission patterns at accident and emergency departments in and out of London

British Medical Journal, 1993

OBJECTIVE--To compare the sociodemographic characteristics, diagnoses, and mode of referral of pe... more OBJECTIVE--To compare the sociodemographic characteristics, diagnoses, and mode of referral of people and emergency admissions between an accident and emergency department in inner London and one in a town outside London. DESIGN--Standardised questionnaire completed prospectively over two weeks by field-workers in each accident and emergency department. SETTING--Accident and emergency departments in an inner London teaching hospital and an associated teaching

Research paper thumbnail of Patients who consult with tiredness: frequency of consultation, perceived causes of tiredness and its association with psychological distress

British Journal of General Practice

ideas and explanations when patients complain of being 'tired all the time'.

Research paper thumbnail of How 'gold' is the standard? Interobservers' variation on venograms

International angiology: a journal of the International Union of Angiology

The aim of this study was to determine the degree of agreement between radiologists having differ... more The aim of this study was to determine the degree of agreement between radiologists having different levels of experience, in reporting 151 venograms independently. It was also aimed to assess whether the degree of disagreement would have influenced the final outcome of a thromboprophylactic study and the decision to anticoagulate the patients. Seventy-eight patients undergoing total hip replacement had bilateral venography on postoperative days 8-12. Patients were allocated to receive either a low molecular weight heparin (enoxaparin) with or without TED stockings or a placebo Each of the 151 venograms obtained has been reported on four times. The overall incidence of deep venous thrombosis was 42% (33 of 78 patients). The range of the Kappa value of each radiologist versus the others was 0.568 to 0.669. There was a significant decrease in the incidence of deep venous thrombosis in the treatment versus the placebo groups. On an intention to treat all diagnosed thrombi, a difference of up to 16% was demonstrated between the report of individual radiologists and the panel. This difference was reduced to 8% when only thrombi proximal to the calf were considered clinically significant. These differences reflect the radiologist&amp;amp;#39;s experience and frequency of reporting on venograms and should be taken into account when studies for thromboprophylaxis are planned.

Research paper thumbnail of brjgenprac00028-0035

Research paper thumbnail of Young people's views on provision of sexual health services

Sexually Transmitted Infections, 2002

Objectives: To identify the sexual health needs of young people in order to establish a service s... more Objectives: To identify the sexual health needs of young people in order to establish a service suited to these needs. Methods: A peer designed questionnaire piloted to a small group of young people was followed by a more widely distributed, amended questionnaire. The questionnaire survey was delivered to 744 pupils aged 11-18 years in six secondary schools and a pupil exclusion unit in central London. Factors encouraging or discouraging the use of young people's sexual health services were measured. Results: Several findings challenged existing models of care for young people's sexual health services. Notably, pupils wanted clinics to run more frequently than the usual once a week; the staff attributes that were most important were attitudinal rather than to do with sex, age, or physical appearance; and they did not mind if the waiting room contained older people. Many findings, however, agreed with existing data-young people wanted the clinic to be open after school; girls preferred to attend with a friend; a confidential, walk-in service was preferred. Conclusions: Large financial outlays are not necessary for the establishment of effective sexual health services for young people. Existing facilities and staff may be utilised with training of these staff to be sensitive to, and aware of, the needs of young people. Clinic opening times should coincide with school closing times. Although pupils stated a preference for female staff, this was not a high priority. More important was feeling that staff would listen to them and take their problems seriously, and that confidentiality would be maintained.

Research paper thumbnail of Survival and treatment of AIDS patients 1984-1993: experience of a smaller east London HIV centre

Sexually Transmitted Infections, 1997

Objective: To assess changes in survival from diagnosis of AIDS for patients managed in a small E... more Objective: To assess changes in survival from diagnosis of AIDS for patients managed in a small East London HIV clinic and the impact of therapeutic interventions on these survival patterns.

Research paper thumbnail of Tiredness as a ticket of entry: The role of patients' beliefs and psychological symptoms in explaining frequent attendance

Scandinavian Journal of Primary Health Care, 1999

To test when patients presented with fatigue whether their beliefs about its cause was related to... more To test when patients presented with fatigue whether their beliefs about its cause was related to their frequency of attending; and to measure the association between their fatigue and psychological symptoms and their frequency of attendance during the study year. A cohort study. Primary health care. Patients presenting with fatigue as their main symptom. A fatigue questionnaire, the general health questionnaire (GHQ), an attribution scale, and measurement of consulting frequency during the 6 months before and after the patient presented. Patients who believed their fatigue was due to a physical or costly physical cause consult for any reason significantly more frequently than patients who reported that psychological as well as physical problems might have caused their fatigue. Patients&#39; psychological distress measured with the GHQ was more closely associated with frequent attendance than their level of fatigue was. When patients present with fatigue it is important to inquire about their beliefs and psychological symptoms; these factors may be more important than the fatigue itself in explaining their help-seeking behaviour.

Research paper thumbnail of Serum sialic acid as an indicator of change in coronary artery disease

Metabolism, 1995

We measured serum levels of total sialic acid (TSA) by an enzymatic method in 74 men who complete... more We measured serum levels of total sialic acid (TSA) by an enzymatic method in 74 men who completed the St Thomas&#39; Atherosclerosis Regression Study (STARS). Coronary artery disease (CAD) was assessed as the change (delta) in mean absolute width of coronary segments (MAWS) over 3 years by a computerized technique. Delta TSA was significantly correlated with delta MAWS (r = -.50, P &lt; .001) after adjusting for age, blood pressure, smoking status, and plasma low-density lipoprotein (LDL) cholesterol. The relative risk of progression of CAD for a delta TSA exceeding 10 mg/dL as compared with a delta TSA not exceeding 10 mg/dL was 4.6 (95% confidence interval, 2.4 to 8.7). We conclude that serial measurement of serum TSA levels may be a useful indicator of the progression of CAD.

Research paper thumbnail of A survey of patients’ willingness to switch from a single-tablet regimen to 2 pills once a day as a cost-saving strategy

Journal of the International AIDS Society, 2012

ABSTRACT

Research paper thumbnail of Highly Active Antiretroviral Therapy and Human Immunodeficiency Virus-Associated Primary Cerebral Lymphoma

JNCI Journal of the National Cancer Institute, 2006

From a cohort of 9621 human immunodeficiency virus type 1-infected individuals, we identified 61 ... more From a cohort of 9621 human immunodeficiency virus type 1-infected individuals, we identified 61 patients with primary central nervous system lymphoma (PCL) who had a median survival of 1.3 months. We compared clinicopathologic variables of patients who were treated in the pre-highly active antiretroviral therapy (HAART) and HAART eras and investigated whether exposure to antiretroviral agents with differing cerebrospinal fluid penetrations was associated with risk for PCL. All statistical tests were two-sided. Incidence of PCL was lower in the HAART era (1.2 cases per 1000 patient-years, 95% confidence interval [CI] = 0.8 to 1.9) than in the pre-HAART era (three cases per 1000 years, 95% CI = 2.1 to 4.0; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001), and overall survival was longer (median survival = 32 days, range = 5-315 days, versus 48 days, range = 15-1136 days; log rank P = .03). In the HAART era, fewer patients had prior acquired immunodeficiency syndrome-defining illnesses than in the pre-HAART era (64% versus 90%; P = .013), and patients were more likely to have the diagnosis of PCL confirmed histologically or by polymerase chain reaction (77% versus 26%; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001). Exposure to specific antiretroviral agents was not associated with risk for PCL.

Research paper thumbnail of How common is the non-nucleoside reverse transcriptase inhibitor mutation E138K in clinical practice?

Journal of Infection, 2011

1. J Infect. 2011 Jun 12. [Epub ahead of print] How common is the non-nucleoside reverse transcri... more 1. J Infect. 2011 Jun 12. [Epub ahead of print] How common is the non-nucleoside reverse transcriptase inhibitor mutation E138k in clinical practice? Bradshaw D, Mandalia S, Nelson M. Chelsea and Westminster Hospital, London SW10 9NH, UK. ...

Research paper thumbnail of The Safety and Tolerability of Switching from a Non-failing Antiretroviral Regimen to Lopinavir

Journal of Infection, 2003

Research paper thumbnail of Burkitt's Lymphoma and Previous AIDS-Defining Illnesses Are Not Prognostic Factors in AIDS-Related Non-Hodgkin's Lymphoma

Journal of Clinical Oncology, 2005

REFERENCES 1. Clark OAC, Lyman GH, Castro AA, et al: Colony stimulating factors for chemotherapy ... more REFERENCES 1. Clark OAC, Lyman GH, Castro AA, et al: Colony stimulating factors for chemotherapy induced febrile neutropenia: A meta-analysis of randomized controlled trials. J Clin Oncol 23:4198-4214, 2005 2. Sprott DA: Normal likelihoods and their relation to large sample theory of estimation.

Research paper thumbnail of Absence of Association Between Individual Thymidine Analogues or Nonnucleoside Analogues and Lipid Abnormalities in HIV-1–Infected Persons on Initial Therapy

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2000

Changes in levels of triglycerides and cholesterol during antiretroviral therapy raise concerns r... more Changes in levels of triglycerides and cholesterol during antiretroviral therapy raise concerns regarding an increased future risk of atherogenic disease and may precede the appearance of fat redistribution. Hypotheses regarding the impact of nucleoside analogues on adipocytes provide a possible explanation for metabolic and clinical fat disturbances. It is unclear whether the choice of nucleoside analogue combination or coadministration of nonnucleoside agents influences change in lipids. We performed a cross-sectional analysis of 135 persons receiving their first nucleoside analogue plus nonnucleoside-based combination antiretroviral regimen for at least 1 month and for whom cholesterol and triglyceride values were available on therapy. Univariate and multivariate regression models were used to explore the relation between cholesterol and triglycerides, as continuous variables with other variables. Both significant and nonsignificant variables from univariate analyses were evaluated in multivariate models to limit possible confounders. No association with drug choice was observed, either when comparing thymidine analogues (stavudine or zidovudine), all nucleoside analogue combinations or choice of either efavirenz or nevirapine as nonnucleoside. Age and triglyceride levels were found in a multivariate analysis to be associated with higher cholesterol. Only higher cholesterol was associated with higher triglyceride levels. In conclusion, no differences were observed between choice of drug or combination on cholesterol or triglyceride values during therapy. Older individuals may be more likely to have elevated cholesterol values.