Ray Fox - Academia.edu (original) (raw)

Papers by Ray Fox

Research paper thumbnail of Expansion of HCV treatment access to people who have injected drugs through effective translation of research into public health policy: Scotland's experience

International Journal of Drug Policy, 2015

Seven years have elapsed since the Scottish Government launched its Hepatitis C Action Plan-a Pla... more Seven years have elapsed since the Scottish Government launched its Hepatitis C Action Plan-a Plan to improve services to prevent transmission of infection, particularly among people who inject drugs (PWID), identify those infected and ensure those infected receive optimal treatment. The Plan was underpinned by industrial scale funding (around £100 million, in addition to the general NHS funding, will have been invested by 2015), and a web of accountable national and local multidisciplinary multiagency networks responsible for the planning, development and delivery of services. Initiatives ranged from the introduction of testing in specialist drug services through finger-prick blood sampling by nonclinical staff, to the setting of government targets to ensure rapid scale-up of antiviral therapy. The Plan was informed by comprehensive national monitoring systems, indicating the extent of the problem not just in terms of numbers infected, diagnosed and treated but also the more penetrative data on the number advancing to end-stage liver disease and death, and also through compelling modelling work demonstrating the potential beneficial impact of scaling-up therapy and the mounting cost of not acting. Achievements include around 50% increase in the proportion of the infected population diagnosed (38% to 55%); a sustained near two-and-a-half fold increase in the annual number of people initiated onto therapy (470 to 1050) with more pronounced increases among PWID (300 to 840) and prisoners (20 to 140); and reversing of an upward trend in the overall number of people living with chronic infection. The Action Plan has demonstrated that a Government-backed, coordinated and invested approach can transform services and rapidly improve the lives of thousands. Cited as ''an impressive example of a national strategy'' by the Global Commission on Drug Policy, the Scottish Plan has also provided fundamental insights of international relevance into the management of HCV among PWID.

Research paper thumbnail of Early Bactericidal and Sterilizing Activities of Ciprofloxacin in Pulmonary Tuberculosis

American Review of Respiratory Disease, 1993

The early bactericidal and sterilizing activities of ciprofloxacin were evaluated in the treatmen... more The early bactericidal and sterilizing activities of ciprofloxacin were evaluated in the treatment of adult patients with smear positive pulmonary tuberculosis. Two randomized prospective studies were performed in Northern Tanzania. In study 1, ten patients received either 750 mg ciprofloxacin or 300 ng isoniazid daily for 7 days. Counts of colony-forming units (cfu) of Mycobacterium tuberculosis in early morning sputum were performed. In study 2, twenty patients received either a standard regimen of rifampin (R), isoniazid (H), pyrazinamide (Z), and ethambutol (E) (regimen HRZE) or a trial regimen of ciprofloxacin (C), isoniazid (H), and rifampin (R) (regimen HRC). Sputum colony counts were performed for 8 wk. Patients were tested for antibodies to human immunodeficiency virus (HIV)-1. The results demonstrate that ciprofloxacin alone has useful early bactericidal activity, resulting in a mean daily fall of 0.20 log10cfu/ml/day during 7 days compared with 0.25 log10cfu/ml/day for isoniazid. When HRZE and HRC regimens were compared, the HRC regimen appeared to be inferior in its sterilizing ability, with a culture conversion rate of 67% at 2 months compared with 100% for HRZE. The difference in outcome was most marked in HIV-1 positive patients. The role of ciprofloxacin in combination regimens may be as a bactericidal rather than a sterilizing agent.

Research paper thumbnail of Hepatitis C antibody detection in dried blood spots

Journal of Viral Hepatitis, 1999

In the UK, there have been few studies of the seroprevalence of antibodies to hepatitis C virus (... more In the UK, there have been few studies of the seroprevalence of antibodies to hepatitis C virus (anti‐HCV). As part of an ongoing prevalence study of HCV in injecting drug users, we have developed a technique for detecting anti‐HCV in blood spots dried on filter paper using a commercially available assay. Subjects with and without serum anti‐HCV were studied. The manufacturer’s recommended cut‐off (CO) for a positive anti‐HCV result is kit‐dependent, and therefore a ratio of test result (T) to kit CO was used to standardize results. T/CO values greater than 0.99 had a sensitivity of 100% and a specificity of 87.5% for anti‐HCV detection. T/CO values greater than 1.99 had a sensitivity of 97.2% and a specificity of 100%. Hence, testing dried blood spots may be useful for detecting anti‐HCV in epidemiological studies and as a diagnostic test in patients with poor peripheral venous access.

Research paper thumbnail of Cooperative medical management of drug misusers in Liverpool, U.K

Journal of Infection, 1994

Research paper thumbnail of Elbasvir/Grazoprevir and Sofosbuvir for HCV Genotype 3 Infection With Compensated Cirrhosis: A Randomized Trial

Hepatology (Baltimore, Md.), Jun 23, 2018

Many direct-acting antiviral regimens have reduced activity in people with hepatitis C virus (HCV... more Many direct-acting antiviral regimens have reduced activity in people with hepatitis C virus (HCV) genotype (GT)3 infection and cirrhosis. The C-ISLE study assessed the efficacy and safety of elbasvir/grazoprevir (EBR/GZR) plus sofosbuvir (SOF) with and without ribavirin (RBV) in compensated cirrhotic participants with GT3 infection. This was a phase 2, randomized, open-label study. Treatment-naive participants received EBR/GZR + SOF + RBV for 8 weeks or EBR/GZR + SOF for 12 weeks and peginterferon/RBV treatment-experienced participants received EBR/GZR + SOF ± RBV for 12 weeks or EBR/GZR + SOF for 16 weeks. The primary end point was HCV RNA <15 IU/mL 12 weeks after end of treatment (SVR12). Among treatment-naive participants, SVR12 was 91% (21/23) in those treated with RBV for 8 weeks and 96% (23/24) in those treated for 12 weeks. Among treatment-experienced participants, SVR12 was 94% (17/18) and 100% (17/17) in the 12-week arm, with and without RBV, respectively, and 94% (17/1...

Research paper thumbnail of Successful late treatment of venous air embolism with hyperbaric oxygen

Postgraduate Medical Journal

Research paper thumbnail of Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population

Journal of hepatology, Jan 18, 2016

The number of people living with previous hepatitis-C infection that have attained a sustained vi... more The number of people living with previous hepatitis-C infection that have attained a sustained viral response (SVR) is expected to grow rapidly. So far, the prognosis of this group relative to the general population is unclear. Individuals attaining SVR in Scotland in 1996-2011 were identified using a national database. Through record-linkage, we obtained cause-specific mortality data complete to Dec 2013. We calculated standardised-mortality-ratios (SMRs) to compare the frequency of mortality in SVR patients to the general population. In a parallel analysis, we used Cox regression to identify modifiable patient characteristics associated with post-SVR mortality. We identified 1824 patients, followed on average for 5.2 years after SVR. In total, 78 deaths were observed. Overall, all-cause mortality was 1.9 times more frequent for SVR patients than the general population (SMR: 1.86; 95% CI:1.49-2.32). Significant cause-specific elevations were seen for death due to primary liver canc...

Research paper thumbnail of Isolation of A Human GM-CSF Antibody with Potent Neutralizing Activity from a Subject with Idiopathic Pulmonary Alveolar Proteinosis

The Journal of Immunology, Apr 1, 2010

Research paper thumbnail of Hepatitis C reinfection following treatment induced viral clearance among people who have injected drugs

Drug and Alcohol Dependence, 2016

Hepatitis C reinfection following treatment induced viral clearance among people who have injecte... more Hepatitis C reinfection following treatment induced viral clearance among people who have injected drugs.

Research paper thumbnail of Recombinant human antibodies to IFN-{alpha} from the immune repertoires of MG/thymoma donors

The Journal of Immunology, Apr 1, 2010

Research paper thumbnail of A strategy to identify human monoclonal antibodies that neutralize a broad spectrum of influenza A subtypes

The Journal of Immunology, Apr 1, 2010

Research paper thumbnail of Tailoring response-based treatment for hepatitis C

The recommended treatment for chronic infection with hepatitis C virus (HCV) is a combination of ... more The recommended treatment for chronic infection with hepatitis C virus (HCV) is a combination of pegylated interferon (pegIFN) alfa and ribavirin (RBV). Treatment duration is determined by HCV genotype: in genotype 1 (G1) infection, treatment usually lasts for 48 weeks, whereas in genotypes 2 and 3 (G2, G3), therapy for 24 weeks has been found to have equivalent efficacy.1,2 Host factors such as age, ethnicity, body mass index and degree of hepatic fibrosis can influence the likelihood of viral clearance. Evidence suggests that the pretreatment viral load and the virological response during early therapy are the most important factors in determining the outcome of treatment.

Research paper thumbnail of The impact of highly active antiretroviral combination therapy in HIV infected patients in Glasgow

Health bulletin, 2000

To assess the impact of treatment with highly active antiretroviral therapy on morbidity and mort... more To assess the impact of treatment with highly active antiretroviral therapy on morbidity and mortality in the HIV infected population in Glasgow. Retrospective analysis of the HIV clinical and pharmacy databases in a Department of Infectious Diseases, the major provider of HIV treatment and care in Glasgow. The study population comprised all HIV infected individuals who attended the Department of Infectious Diseases as inpatients or outpatients from April 1994 to March 1999. The main outcome measures were the number of deaths; the number of new AIDS diagnoses; expenditure on drugs for the treatment or prevention of opportunistic infections; hospital admissions of HIV patients; and occupied bed days. The number of patients attending in each year was 215 in 1994-95, rising to 242 in 1998-99. During the same time period there was a 75% reduction in the number of deaths (36 in 1994-95 falling to 10 in 1998-99) and the number of AIDS diagnoses (28 to 7), and a 50% reduction in occupied b...

Research paper thumbnail of Factors associated with spontaneous clearance of hepatitis C virus in Chinese population

BioMed research international, 2014

Hepatitis C virus (HCV) infections spontaneously clear in approximately 15-45% of infected indivi... more Hepatitis C virus (HCV) infections spontaneously clear in approximately 15-45% of infected individuals. Factors which influence spontaneous HCV clearance remain to be identified. The purpose of the present study was to identify variables associated with spontaneous HCV clearance in a referred population of Chinese patients. The prevalence of host, viral, and environmental factors known to influence the outcome of HCV infections was compared in 92 HCV spontaneous clearance subjects and 318 HCV persistent infection subjects. Univariate and multivariate analyses were performed to identify those factors associated with spontaneous HCV clearance. In univariate analysis, female gender, a history of icteric hepatitis, serologic evidence of concurrent HBV infection, and rs12979860 CC genotype were positively associated with spontaneous HCV clearance, while alcohol consumption was negatively associated with clearance. In multivariate analysis, female gender, a history of icteric hepatitis, c...

Research paper thumbnail of Uptake of hepatitis C specialist services and treatment following diagnosis by dried blood spot in Scotland

Journal of Clinical Virology, 2014

Research paper thumbnail of Missed opportunities for HIV diagnosis: a three-year audit in the West of Scotland

Scottish Medical Journal, 2013

National specialty guidelines for HIV testing aim to increase diagnosis and reduce late presentat... more National specialty guidelines for HIV testing aim to increase diagnosis and reduce late presentation. An audit of new HIV diagnoses in Glasgow was performed to assess local performance against these guidelines and estimate the proportion of patients presenting who had previous missed opportunities for diagnosis. A retrospective case note review of 339 patients diagnosed from September 2008 to September 2011 was performed. Documented past medical history was assessed for HIV clinical indicator conditions prior to HIV diagnosis and prior review by medical services. Ninety (26%) individuals had at least one documented clinical indicator condition prior to HIV diagnosis, of whom 80 had prior contact with at least one speciality. This group also had a lower mean nadir CD4 count (258 cells/cmm versus 393 cells/cmm, p = &lt;0.005) and were more likely to be severely immunocompromised at diagnosis, with a CD4 count below 50 cells/cmm (31% versus 9%, p = &lt;0.005). AIDS-defining illnesses were also more common (31% versus 8%, p ≤ 0.005) as was HIV-related mortality (p ≤ 0.005). Additional support and training are required to increase adherence to HIV-testing guidelines within primary and secondary care in order to prevent ongoing late presentation with both individual clinical and public health implications.

Research paper thumbnail of The Changing Face of Hepatitis B in Greater Glasgow: epidemiological trends 1993-2007

Scottish Medical Journal, 2010

Research paper thumbnail of Regular audit can lead to changes in practice and better outcomes for pregnant women with HIV

Journal of the International AIDS Society, 2008

Research paper thumbnail of The use of enfuvirtide-based HAART regimens in HIV patients undergoing chemotherapy for lymphoma

Journal of the International AIDS Society, 2008

To evaluate the use of enfuvirtide-based HAART regimens in patients receiving chemotherapy for ly... more To evaluate the use of enfuvirtide-based HAART regimens in patients receiving chemotherapy for lymphoma, where the concomitant use of antineoplastic agents with PI-or NNRTI-based regimens is difficult due to P450 enzyme and p-glycoprotein induction and inhibition. Methods This was a retrospective analysis of five HIV patients treated with an enfuvirtide-based HAART regimen while receiving chemotherapy for lymphoma. Data were gathered from their case notes and information regarding potential drug interactions was obtained from the HIV specialist pharmacist and literature review.

Research paper thumbnail of Managing HIV in pregnancy in Glasgow

Journal of the International AIDS Society, 2008

The number of pregnant patients with HIV in Glasgow has increased over the past 3 years but is in... more The number of pregnant patients with HIV in Glasgow has increased over the past 3 years but is insufficient to justify a dedicated HIV/antenatal clinic. Instead we enhanced a multidisciplinary team approach to the care of HIV-positive pregnant women. We report our outcomes and key learning from this experience.

Research paper thumbnail of Expansion of HCV treatment access to people who have injected drugs through effective translation of research into public health policy: Scotland's experience

International Journal of Drug Policy, 2015

Seven years have elapsed since the Scottish Government launched its Hepatitis C Action Plan-a Pla... more Seven years have elapsed since the Scottish Government launched its Hepatitis C Action Plan-a Plan to improve services to prevent transmission of infection, particularly among people who inject drugs (PWID), identify those infected and ensure those infected receive optimal treatment. The Plan was underpinned by industrial scale funding (around £100 million, in addition to the general NHS funding, will have been invested by 2015), and a web of accountable national and local multidisciplinary multiagency networks responsible for the planning, development and delivery of services. Initiatives ranged from the introduction of testing in specialist drug services through finger-prick blood sampling by nonclinical staff, to the setting of government targets to ensure rapid scale-up of antiviral therapy. The Plan was informed by comprehensive national monitoring systems, indicating the extent of the problem not just in terms of numbers infected, diagnosed and treated but also the more penetrative data on the number advancing to end-stage liver disease and death, and also through compelling modelling work demonstrating the potential beneficial impact of scaling-up therapy and the mounting cost of not acting. Achievements include around 50% increase in the proportion of the infected population diagnosed (38% to 55%); a sustained near two-and-a-half fold increase in the annual number of people initiated onto therapy (470 to 1050) with more pronounced increases among PWID (300 to 840) and prisoners (20 to 140); and reversing of an upward trend in the overall number of people living with chronic infection. The Action Plan has demonstrated that a Government-backed, coordinated and invested approach can transform services and rapidly improve the lives of thousands. Cited as ''an impressive example of a national strategy'' by the Global Commission on Drug Policy, the Scottish Plan has also provided fundamental insights of international relevance into the management of HCV among PWID.

Research paper thumbnail of Early Bactericidal and Sterilizing Activities of Ciprofloxacin in Pulmonary Tuberculosis

American Review of Respiratory Disease, 1993

The early bactericidal and sterilizing activities of ciprofloxacin were evaluated in the treatmen... more The early bactericidal and sterilizing activities of ciprofloxacin were evaluated in the treatment of adult patients with smear positive pulmonary tuberculosis. Two randomized prospective studies were performed in Northern Tanzania. In study 1, ten patients received either 750 mg ciprofloxacin or 300 ng isoniazid daily for 7 days. Counts of colony-forming units (cfu) of Mycobacterium tuberculosis in early morning sputum were performed. In study 2, twenty patients received either a standard regimen of rifampin (R), isoniazid (H), pyrazinamide (Z), and ethambutol (E) (regimen HRZE) or a trial regimen of ciprofloxacin (C), isoniazid (H), and rifampin (R) (regimen HRC). Sputum colony counts were performed for 8 wk. Patients were tested for antibodies to human immunodeficiency virus (HIV)-1. The results demonstrate that ciprofloxacin alone has useful early bactericidal activity, resulting in a mean daily fall of 0.20 log10cfu/ml/day during 7 days compared with 0.25 log10cfu/ml/day for isoniazid. When HRZE and HRC regimens were compared, the HRC regimen appeared to be inferior in its sterilizing ability, with a culture conversion rate of 67% at 2 months compared with 100% for HRZE. The difference in outcome was most marked in HIV-1 positive patients. The role of ciprofloxacin in combination regimens may be as a bactericidal rather than a sterilizing agent.

Research paper thumbnail of Hepatitis C antibody detection in dried blood spots

Journal of Viral Hepatitis, 1999

In the UK, there have been few studies of the seroprevalence of antibodies to hepatitis C virus (... more In the UK, there have been few studies of the seroprevalence of antibodies to hepatitis C virus (anti‐HCV). As part of an ongoing prevalence study of HCV in injecting drug users, we have developed a technique for detecting anti‐HCV in blood spots dried on filter paper using a commercially available assay. Subjects with and without serum anti‐HCV were studied. The manufacturer’s recommended cut‐off (CO) for a positive anti‐HCV result is kit‐dependent, and therefore a ratio of test result (T) to kit CO was used to standardize results. T/CO values greater than 0.99 had a sensitivity of 100% and a specificity of 87.5% for anti‐HCV detection. T/CO values greater than 1.99 had a sensitivity of 97.2% and a specificity of 100%. Hence, testing dried blood spots may be useful for detecting anti‐HCV in epidemiological studies and as a diagnostic test in patients with poor peripheral venous access.

Research paper thumbnail of Cooperative medical management of drug misusers in Liverpool, U.K

Journal of Infection, 1994

Research paper thumbnail of Elbasvir/Grazoprevir and Sofosbuvir for HCV Genotype 3 Infection With Compensated Cirrhosis: A Randomized Trial

Hepatology (Baltimore, Md.), Jun 23, 2018

Many direct-acting antiviral regimens have reduced activity in people with hepatitis C virus (HCV... more Many direct-acting antiviral regimens have reduced activity in people with hepatitis C virus (HCV) genotype (GT)3 infection and cirrhosis. The C-ISLE study assessed the efficacy and safety of elbasvir/grazoprevir (EBR/GZR) plus sofosbuvir (SOF) with and without ribavirin (RBV) in compensated cirrhotic participants with GT3 infection. This was a phase 2, randomized, open-label study. Treatment-naive participants received EBR/GZR + SOF + RBV for 8 weeks or EBR/GZR + SOF for 12 weeks and peginterferon/RBV treatment-experienced participants received EBR/GZR + SOF ± RBV for 12 weeks or EBR/GZR + SOF for 16 weeks. The primary end point was HCV RNA <15 IU/mL 12 weeks after end of treatment (SVR12). Among treatment-naive participants, SVR12 was 91% (21/23) in those treated with RBV for 8 weeks and 96% (23/24) in those treated for 12 weeks. Among treatment-experienced participants, SVR12 was 94% (17/18) and 100% (17/17) in the 12-week arm, with and without RBV, respectively, and 94% (17/1...

Research paper thumbnail of Successful late treatment of venous air embolism with hyperbaric oxygen

Postgraduate Medical Journal

Research paper thumbnail of Mortality in hepatitis C patients who achieve a sustained viral response compared to the general population

Journal of hepatology, Jan 18, 2016

The number of people living with previous hepatitis-C infection that have attained a sustained vi... more The number of people living with previous hepatitis-C infection that have attained a sustained viral response (SVR) is expected to grow rapidly. So far, the prognosis of this group relative to the general population is unclear. Individuals attaining SVR in Scotland in 1996-2011 were identified using a national database. Through record-linkage, we obtained cause-specific mortality data complete to Dec 2013. We calculated standardised-mortality-ratios (SMRs) to compare the frequency of mortality in SVR patients to the general population. In a parallel analysis, we used Cox regression to identify modifiable patient characteristics associated with post-SVR mortality. We identified 1824 patients, followed on average for 5.2 years after SVR. In total, 78 deaths were observed. Overall, all-cause mortality was 1.9 times more frequent for SVR patients than the general population (SMR: 1.86; 95% CI:1.49-2.32). Significant cause-specific elevations were seen for death due to primary liver canc...

Research paper thumbnail of Isolation of A Human GM-CSF Antibody with Potent Neutralizing Activity from a Subject with Idiopathic Pulmonary Alveolar Proteinosis

The Journal of Immunology, Apr 1, 2010

Research paper thumbnail of Hepatitis C reinfection following treatment induced viral clearance among people who have injected drugs

Drug and Alcohol Dependence, 2016

Hepatitis C reinfection following treatment induced viral clearance among people who have injecte... more Hepatitis C reinfection following treatment induced viral clearance among people who have injected drugs.

Research paper thumbnail of Recombinant human antibodies to IFN-{alpha} from the immune repertoires of MG/thymoma donors

The Journal of Immunology, Apr 1, 2010

Research paper thumbnail of A strategy to identify human monoclonal antibodies that neutralize a broad spectrum of influenza A subtypes

The Journal of Immunology, Apr 1, 2010

Research paper thumbnail of Tailoring response-based treatment for hepatitis C

The recommended treatment for chronic infection with hepatitis C virus (HCV) is a combination of ... more The recommended treatment for chronic infection with hepatitis C virus (HCV) is a combination of pegylated interferon (pegIFN) alfa and ribavirin (RBV). Treatment duration is determined by HCV genotype: in genotype 1 (G1) infection, treatment usually lasts for 48 weeks, whereas in genotypes 2 and 3 (G2, G3), therapy for 24 weeks has been found to have equivalent efficacy.1,2 Host factors such as age, ethnicity, body mass index and degree of hepatic fibrosis can influence the likelihood of viral clearance. Evidence suggests that the pretreatment viral load and the virological response during early therapy are the most important factors in determining the outcome of treatment.

Research paper thumbnail of The impact of highly active antiretroviral combination therapy in HIV infected patients in Glasgow

Health bulletin, 2000

To assess the impact of treatment with highly active antiretroviral therapy on morbidity and mort... more To assess the impact of treatment with highly active antiretroviral therapy on morbidity and mortality in the HIV infected population in Glasgow. Retrospective analysis of the HIV clinical and pharmacy databases in a Department of Infectious Diseases, the major provider of HIV treatment and care in Glasgow. The study population comprised all HIV infected individuals who attended the Department of Infectious Diseases as inpatients or outpatients from April 1994 to March 1999. The main outcome measures were the number of deaths; the number of new AIDS diagnoses; expenditure on drugs for the treatment or prevention of opportunistic infections; hospital admissions of HIV patients; and occupied bed days. The number of patients attending in each year was 215 in 1994-95, rising to 242 in 1998-99. During the same time period there was a 75% reduction in the number of deaths (36 in 1994-95 falling to 10 in 1998-99) and the number of AIDS diagnoses (28 to 7), and a 50% reduction in occupied b...

Research paper thumbnail of Factors associated with spontaneous clearance of hepatitis C virus in Chinese population

BioMed research international, 2014

Hepatitis C virus (HCV) infections spontaneously clear in approximately 15-45% of infected indivi... more Hepatitis C virus (HCV) infections spontaneously clear in approximately 15-45% of infected individuals. Factors which influence spontaneous HCV clearance remain to be identified. The purpose of the present study was to identify variables associated with spontaneous HCV clearance in a referred population of Chinese patients. The prevalence of host, viral, and environmental factors known to influence the outcome of HCV infections was compared in 92 HCV spontaneous clearance subjects and 318 HCV persistent infection subjects. Univariate and multivariate analyses were performed to identify those factors associated with spontaneous HCV clearance. In univariate analysis, female gender, a history of icteric hepatitis, serologic evidence of concurrent HBV infection, and rs12979860 CC genotype were positively associated with spontaneous HCV clearance, while alcohol consumption was negatively associated with clearance. In multivariate analysis, female gender, a history of icteric hepatitis, c...

Research paper thumbnail of Uptake of hepatitis C specialist services and treatment following diagnosis by dried blood spot in Scotland

Journal of Clinical Virology, 2014

Research paper thumbnail of Missed opportunities for HIV diagnosis: a three-year audit in the West of Scotland

Scottish Medical Journal, 2013

National specialty guidelines for HIV testing aim to increase diagnosis and reduce late presentat... more National specialty guidelines for HIV testing aim to increase diagnosis and reduce late presentation. An audit of new HIV diagnoses in Glasgow was performed to assess local performance against these guidelines and estimate the proportion of patients presenting who had previous missed opportunities for diagnosis. A retrospective case note review of 339 patients diagnosed from September 2008 to September 2011 was performed. Documented past medical history was assessed for HIV clinical indicator conditions prior to HIV diagnosis and prior review by medical services. Ninety (26%) individuals had at least one documented clinical indicator condition prior to HIV diagnosis, of whom 80 had prior contact with at least one speciality. This group also had a lower mean nadir CD4 count (258 cells/cmm versus 393 cells/cmm, p = &lt;0.005) and were more likely to be severely immunocompromised at diagnosis, with a CD4 count below 50 cells/cmm (31% versus 9%, p = &lt;0.005). AIDS-defining illnesses were also more common (31% versus 8%, p ≤ 0.005) as was HIV-related mortality (p ≤ 0.005). Additional support and training are required to increase adherence to HIV-testing guidelines within primary and secondary care in order to prevent ongoing late presentation with both individual clinical and public health implications.

Research paper thumbnail of The Changing Face of Hepatitis B in Greater Glasgow: epidemiological trends 1993-2007

Scottish Medical Journal, 2010

Research paper thumbnail of Regular audit can lead to changes in practice and better outcomes for pregnant women with HIV

Journal of the International AIDS Society, 2008

Research paper thumbnail of The use of enfuvirtide-based HAART regimens in HIV patients undergoing chemotherapy for lymphoma

Journal of the International AIDS Society, 2008

To evaluate the use of enfuvirtide-based HAART regimens in patients receiving chemotherapy for ly... more To evaluate the use of enfuvirtide-based HAART regimens in patients receiving chemotherapy for lymphoma, where the concomitant use of antineoplastic agents with PI-or NNRTI-based regimens is difficult due to P450 enzyme and p-glycoprotein induction and inhibition. Methods This was a retrospective analysis of five HIV patients treated with an enfuvirtide-based HAART regimen while receiving chemotherapy for lymphoma. Data were gathered from their case notes and information regarding potential drug interactions was obtained from the HIV specialist pharmacist and literature review.

Research paper thumbnail of Managing HIV in pregnancy in Glasgow

Journal of the International AIDS Society, 2008

The number of pregnant patients with HIV in Glasgow has increased over the past 3 years but is in... more The number of pregnant patients with HIV in Glasgow has increased over the past 3 years but is insufficient to justify a dedicated HIV/antenatal clinic. Instead we enhanced a multidisciplinary team approach to the care of HIV-positive pregnant women. We report our outcomes and key learning from this experience.