Swine flu information for people living with HIV.

The dreaded flu season is upon us and you’re probably aware that flu vaccines are available, and offered for free to certain groups on the NHS.  Here’s some information, relative to people who are living with HIV.

!! IMPORTANT. The following information should not be interpreted as medical advice.  We are simply presenting facts and you should always speak with your doctor or medical team when discussing a change or supplementing your health care.

While a bad cold can include aching limbs, headaches and general exhaustion too, the difference with flu is it’s more severe, you’ll probably struggle to get out of bed and there’s often a fever as well.

How Serious is the flu when you’re HIV positive?

If you’re in overall good health, you’ll usually recover naturally from flu after a week or so and some sensible rest; pain-killers, plenty of fluids and keeping warm all help. However, flu can be very serious for those less able to fight off or cope with the virus.

Complications can arise, including a worsening of any pre-existing health conditions such as asthma and diabetes, and flu also leads to a number of deaths each year, particularly in the elderly. HIV infection reduces CD4 levels and function which means the bodies of individuals with a low CD4 count have to work harder to fight the flu. However, even with HIV, the human immune system can still fight the swine flu virus to a degree. Data so far does not show that people living with HIV are at a higher risk of catching swine flu virus than the rest of the population.

That being said, if you are infected (with the flu), Swine flu illness may develop at a higher rate amongst people living with HIV with a CD4 count of less than 250 cells/mm3 and not on antiretroviral therapy. Patients with CD4 count of less than 250 cells/mm3 need to contact their HIV department to start anti HIV treatment as soon as possible.

Should People Living with HIV receive the Swine flu (H1N1) vaccination ?

“No one likes getting the flu, but while most people (including people living with HIV) are able to shake it off, people living with HIV are considered to be an at-risk group and are eligible for a free annual flu vaccination.

The influenza vaccine (flu jab) protects against different strains of flu. Unlike a cold, flu can have serious symptoms such as fever and painful limbs. It can lead to complications These can include chest infections such as bronchitis or pneumonia.

It is recommended that people Living with HIV receive the flu vaccination, as they may be at higher risk of developing serious flu and related complications. Flu vaccination should be repeated every year, as the strain of seasonal influenza infecting people changes every year.

People living with with HIV should receive the flu shot rather than the nasal spray. The shot does not contain live flu virus whereas the nasal spray contains flu virus that is alive but weakened. It is not recommended that HIV-infected people (particularly those with CD4 (T-cell) counts <250 cells/mm3) receive the nasal spray, since people with vulnerable immune systems may have a higher risk of complications from the nasal spray. You cannot get the flu from the flu shot.

You should tell your doctor if you are allergic to eggs or have had a bad reaction to other vaccinations in the past before you receive the flu shot.

Pneumococcal vaccination

People living with HIV are also recommended to have a pneumococcal vaccination (known as a ‘pneumo jab’). This will protect you against infections such as pneumonia, meningitis and septicaemia.

You may only need one vaccination or it might need to be repeated after five years. You will be able to get the vaccination from your GP, so you could have it at the same time as your flu jab.  If your GP doesn’t know about your HIV status please speak to someone at your HIV clinic about where to get vaccinated.

I had a vaccination last year, do I really need another one?

Yes – because flu viruses are constantly mutating, so new vaccines are developed each season.  With many illnesses, one jab will keep you immunised for the rest of your life.  Unfortunately, just like HIV, the flu virus is very clever and constantly changes to build up a resistance to the vaccines we produce.

That’s why you need to have a new flu jab every year and stay one step ahead.

It’s also important to be aware that there are lots of flu viruses, and while the vaccines are the best form of protection currently available, they won’t provide 100% protection against flu, so you’d still need to seek medical advice if you experienced symptoms at any point.

It’s best to try at get it done at the start of the season if possible.

Can I catch flu from a flu jab?

No – technically, this isn’t possible, as there are no ‘active viruses’ in the vaccine when administered intravenously.  The NHS points out that you may experience some mild aches and a mild fever for a couple of days afterwards, but serious side-effects are deemed very rare. As with everything we come into contact with, allergic reactions can occur. If you did experience any warning signs, seek urgent medical advice.

What about interactions/side effects between antiretroviral agents & anti-novel H1N1 drugs?

There are two agents active against novel H1N1 virus; tamiflu® (taken as tablets) and relenza® (administered via inhalers). There is little data available on the interaction between anti HIV treatment and these agents. It is likely that protease inhibitors (kaletra, atazanavir, darunavir) may interact with tamiflu® and increase the rate of side effects associated with tamiflu®.

The current advice is to take the drugs and inform your doctor if you developed any side effects. The most significant side effects include neurological and those reducing kidney function. Relenza® is believed to be safe with anti HIV treatment regimes.

What should I do before receiving my vaccination?

The information presented here is not medical advice nor should it be interpreted as medical advice.  You should always speak with your doctor or medical team when discussing a change or supplementing your health care.

What can I do to protect myself from Swine Flu?

Make good hygiene a habit for yourself and your children by following the information below:

  • If you are not currently on HIV treatment, speak with your doctor, particularly if your CD4 count is low (around 250 cells/mm3)
  • Wash your hands frequently with soap and water (Especially after using public transport or being in public spaces).
  • Use a paper towel to dry your hands and if you use cloth towels, wash them daily
  • Avoid touching your eyes, nose or mouth with your hands. Virus spread this way
  • Cover your mouth and nose with tissue when coughing or sneezing
  • Dispose of used tissue in the bin
  • Cough or sneeze into your upper sleeve if you don’t have a tissue
  • Wash your hands after coughing or sneezing
  • Clean hard surfaces, like door handles frequently using normal cleaning products
  • Stay at home if you are sick
  • Stop smoking, smoking suppresses the natural immunity in your lungs
  • Eat a balanced diet; including plenty of vegetables, fruits and whole grain products. Also include low fat diary products, lean meats, poultry, fish and beans
  • Drink lots of water
  • Reduce your salt, sugar and alcohol intake
  • Avoid contact with sick people
  • Take your anti-retroviral drugs fully and regularly

In addition to providing this information when ‘flu season’ hits, we ask our staff and volunteers to receive a vaccination.  We do this to prevent ourselves from catching the flu, so there is less chance for our clients and service users to catch it from us.

Want more information?

Visit the NHS choices page on the Flu Jab for more infomration: http://www.nhs.uk/conditions/vaccinations/pages/flu-influenza-vaccine.aspx

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We have the ability to end HIV in our lifetime!

Image by NIAID (CC BY 2.0)

London’s largest sexual health clinic, Dean Street is on track to record a huge drop in new HIV cases for a second successive year. In light of this, Dean Street has set itself a target of zero new infections after  witnessing a two-thirds fall in the number of new diagnoses since 2015.

So what’s happened? – PrEP has happened.  PrEP is a HIV prevention, once a day pill which you take regularly, or semi regular (depending on your circumstances).  For more information on PrEP please visit Prepster or The Terrence Higgins Trust

The reduction in new HIV diagnosis attributed to intensive testing of high-risk gay men, quick access to antiretroviral therapy and trials of PrEP which will be offered free on the NHS to 10,000 people from next month.

Dean Street diagnosed 136 people with HIV between January and July, putting it on course for a total of 233 by the end of the year.  If achieved, this would be the second successive fall in excess of 40 per cent, down from 679 in 2015 and 393 last year, when clinicians first raised the possibility of defeating HIV.

Dean Street’s figures are notable as it is also the largest HIV clinic in Europe and typically accounts for one in nine of all new cases in the UK.

Lead clinician Dr Alan McOwan said the latest figures were “great but not good enough” and told the Standard: “It’s a very exciting time. Everyone is so motivated to make this work. In 2015 we were diagnosing about 60 to 70 people positive a month. It dropped dramatically last year, and it’s still dropping. Over the last few months it’s between 15 to 20 people a month.”

Public Health England figures show that the total number of HIV diagnoses in London has fallen steadily from more than 3,000 in 2006 to 2,603 in 2015. It has risen within the highest-risk group of “men who have sex with men”, who now account for more than half the cases. One in seven gay and bisexual men in the capital has HIV.

Figures published earlier this summer for London’s five busiest clinics, including Dean Street and Mortimer Market, also in Soho, showed a 32 per cent fall in new HIV cases, from 880 to 595, in the year to last September.

Dr McOwan said the initial fall in infections diagnosed at Dean Street since 2015 had been concentrated among “very well-informed, assertive people” who bought PrEP online and followed medical advice.

The clinic’s Plan Zero initiative, unveiled this week, will provide tailored advice online to “harder to reach” gay and bisexual men on how to reduce the risk of contracting HIV, and preventing onward transmission. “Shockingly, there are still groups of people who have very, very little awareness of even the basics of HIV,” Dr McOwan said. Participants are asked to answer five questions about their lifestyle, adapting the answers depending on whether they are HIV positive or negative, have sex with multiple partners, use condoms, or take PrEP.

“We finally have the tools to end HIV,” Dr McOwan said. “Plan Zero brings them together into one package. We will beat HIV if we all act together.”

Dean Street, part of the Chelsea and Westminster Hospital NHS trust, will be among the first London clinics to offer PrEP before it becomes available country-wide by next April.

The drug, previously available to about 1,000 gay men via the Proud clinical trial, cuts the risk of contracting HIV from unprotected sex by about 86 per cent.

NHS England decided to make it available under a £10 million three-year trial after being told by the Court of Appeal last year that funding PrEP fell within the health service’s remit. The trial will be the biggest of its kind in the world.

It is not yet known how Leicester & Leicestershire will be involved in the trial.

The introduction of anti-retroviral therapy two decades ago was credited with transforming HIV from a fatal infection into a chronic manageable condition. However, there were 594 deaths of people with HIV in the UK last year.

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Gallery

Photographs from Leicester Pride 2017

This gallery contains 77 photos.

Originally posted on tjrfoto:
Leicester Pride is attended by more 10,000 people each year with more than 2,000 taking part in the parade through the city, starting at The Curve and ending at Victoria Park.  Leicester Pride celebrates equality and diversity…

New Integrated Sexual Health Services, we need your opinion!

We invite you to consult and provide your opinion on ‘integrated sexual health services’. This includes contraceptive services and prevention, HIV & STI testing and treatment for sexually transmitted infections. These services can be used by people no matter where they live. (Please note, this survey does not include the HIV Treatment and care services which are provided by University Hospitals of Leicester).

We would like your views to help determine what the new services should offer and how they will work. In addition we also want to highlight future sexual health services available in Leicester, Leicestershire and Rutland and how people will be able to access them.

We need to understand how people might be affected by any proposed changes to how we run our sexual health services. This is why we are asking members of the public, services users, staff and partner organisations to comment on the proposed changes.

The proposed changes will be described in more detail in each section of this consultation. A summary of the proposed changes is also available on the first summary page of the questionnaire.

To give your views, please follow the link to the online survey and please feel free to share this survey with your friends and networks.
https://consultations.leicester.gov.uk/communications/sexual-health-services-review/

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Jenny Hand – LASS CEO due to retire from LASS next week.

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Jenny Hand LASS CEO since 2008

Jenny Hand has been the CEO at LASS, Leicestershire’s HIV specialist charity for almost 10 years and will retire in June this year . With Jenny at the helm, LASS has moved forward with the changes in HIV medication and support, advice, information, prevention and awareness needs. In 2013 LASS was recognised best 10 health charities in the country with a £30,000 Impact Award from GSK with the Kings Fund. LASS continues to benefit from being a member of the Impact Award alumni attending Kings Fund training with other Award winners and taking part in research and reviews.

LASS was among the first charities in the Country to introduce free instant result HIV community testing, demonstrating huge savings for the health service through enabling people to know their HIV status and be referred for appropriate support and medical treatment through a fast track arrangement.

LASS also set up a social enterprise – trading as Well for Living and through this has worked in partnership with other small local HIV services in the region to provide enhanced awareness and prevention services. Most recently the regional partnership has delivered a public health England funded innovation project promoting HIV testing in the workplace. A full report on this pioneering work is due to be released this spring. Jenny says ‘the findings are very encouraging not only for HIV but for other workplace health awareness developments.’

Patrick Bowe, Chair of the trustees at LASS, is immensely proud of the work achieved at LASS over the past 10 years and while he would have hoped Jenny might stay for a few more years sees this as an opportunity for LASS to recruit a new CEO  who will be able to lead both LASS and Well for Living into the future.  ‘LASS will enter its 30th year in June and there is still a huge amount of work to do before people living with HIV can live without stigma and discrimination and to ensure late diagnosis is prevented. The CEO’s role will be critical in taking forward the organisation.’

Jenny is looking forward to continuing some part time work focussing on partnerships and in supporting organisations through bid writing.  She will have more time with her family and for holidays and travel.  She enjoys playing cello in local orchestras, walking, and playing bridge.  You may even find her volunteering in the local community when she retires.

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Leicester City CCG: highest ever diagnosis of Dementia

A 12 month drive has seen Leicester GP practices diagnose a significantly higher number of dementia patients than the UK national average, exceeding the local target and beating its own diagnosis rates from last year.

The news means more patients living in Leicester have benefited from a timely diagnosis thanks to a continued commitment from Leicester City CCG over the past year.  Each year all CCGs in the country are set a target, based on their patient population, by NHS England to improve diagnosis rates for people with dementia aged 65 and over.  This was as a result of national data collected which showed that only 48% of the estimated number of people with dementia had a formal diagnosis.

Between 1 April 2016 and 31 March 2017, Leicester City CCG was given a target of
diagnosing 67.6% (1,821) of their expected number of patients aged over 65 with dementia. In total, the CCG diagnosed 2,457 patients in the age category – which means 91.2% of the estimated number of people with dementia now have a diagnosis.  This also means the CCG has diagnosed 24% more dementia patients than the national average and the second highest number of patients within the East Midlands region, as well as increasing diagnosis locally by 3%.

Dr Sulaxni Nainani, Leicester City CCG Board member and GP lead for older people and dementia, said: “We are delighted to be achieving such positive results for our patients year after year. However, we will continue the drive on diagnosis. We will continue to work closely with our local health and social care partners to improve awareness and remind people of the importance and benefits of a timely diagnosis. It means patients and their family members or
carers can receive the support they need earlier to help live independently for as long as possible.”


Over the last 12 months Leicester City CCG has continued to work ever closer with GP practices to understand their dementia register list each month, so they were able to keep track of how well they were diagnosing and flag any targets that were not being met. Care Navigators, who support Leicester City patients to remain in their own home, have also received fantastic dementia training, so for the last 12 months they have been able to perform mini memory tests if they or the GP has any concerns about the patient’s memory.


Dr Sulaxni Nainani continued: “Once someone has a confirmed diagnosis of dementia there are services to support both the patient and those around them. These include the Alzheimer’s Hospital Liaison Service at the Leicester Royal Infirmary, Leicester City Council 
Dementia Care Advisors, Age UK, Alzheimer’s Society and the Care Homes Mental Health inreach team. Community memory clinics, tea and coffee mornings and singing cafes are also provided by Leicester City Council.”

The word dementia describes a set of symptoms that may include gradual memory loss and difficulties with thinking, problem-solving or language. These symptoms occur when the brain is damaged by certain diseases, including Alzheimer’s and stroke. However, these symptoms could also be caused by a number of other health conditions such as another illness, reaction to medication or experiencing a stressful time, so it is extremely important to make an appointment to see a GP.

HIV-related cognitive impairment

Alzheimer’s disease is the most common cause of dementia, but there are many rarer diseases and conditions that can lead to dementia, dementia-like symptoms or mild cognitive impairment. Rarer forms of dementia account for only around 5 per cent of all dementia cases in the UK.

Learn more about HIV-related cognitive impairment

HIV-associated neurocognitive disorder (HAND)

HIV causes an infection that weakens the immune system, making it harder for the body to fight infections and disease. HIV infection can cause a number of different problems in the brain, which affect up to half of people with HIV. This is known as HIV-associated neurocognitive disorder (HAND).

Difficulties with memory, thinking and reasoning (aspects of cognition) are common with HIV, but they are usually mild and dementia is much rarer. Before the use of antiretroviral drugs (medication that helps to control HIV), around 20-30 per cent of people with advanced HIV infection previously developed dementia. This figure has now decreased to around 2 per cent.

Neurocognitive disorders in people with HIV may be caused by the virus directly damaging the brain. They may also be the result of a weakened immune system enabling infections and cancers to attack the brain.

Symptoms may include problems with short-term memory, learning, speed of thinking, difficulties with concentration and decision making, unsteadiness and mood changes. People may also have problems with their sense of smell.

Some people with HIV may experience only a few very mild symptoms, such as a decline in the ability to think quickly or clearly. These mild impairments do not amount to dementia.

HIV is easily overlooked as a possible cause of dementia. Even when someone is known to have HIV infection, cognitive impairment can sometimes be difficult to diagnose. This is because the symptoms are similar to those of other conditions, such as depression.

Treatment with a combination of at least three antiretroviral drugs often prevents cognitive impairments worsening and, for many people, can reverse the cognitive damage caused by HIV. Rehabilitation programmes may also help people with HAND to re-learn skills.

To find out more information visit the CCG webpage about dementia at http://ow.ly/BUea3. Alternatively visit http://www.alzheimers.org.uk/ for advice on living well with dementia.

There’s currently an outbreak of Hepatitis A affecting gay and bisexual men.

Hepatitis A outbreak in England under investigation

Public Health England is investigating a hepatitis A outbreak predominantly affecting men who have sex with men. Between July 2016 and 2 April 2017, 266 cases associated with the outbreak had been identified in England. At least 74% of these were among MSM, and 63% of cases were in London. There is evidence that there have been some cases in the wider population linked to the outbreak.

A high proportion of cases likely acquired the infection abroad at the beginning of the outbreak, but transmission now mainly occurs in England. The outbreak comprises three concurrently-circulating genotype Ia strains, previously not seen in England. Hepatitis A outbreaks caused by the same strains are concurrently occurring in 12 European countries and elsewhere in the UK outside of England [1,2].

As part of the outbreak response, PHE together with the British Association for Sexual health and HIV have recommended that MSM with one or more new or casual partner in the last three months are opportunistically vaccinated in GUM clinics at their next appointment. In addition, pop-up vaccination clinics have been set up around gay venues in London. PHE is considering wider vaccination strategies to respond this outbreak, which is occurring in the context of a global shortage of hepatitis A vaccine.

See the PDF version of this report for the epidemiological curve depicting the outbreak.

References:

  1. ECDC (December 2016). Rapid risk assessment: hepatitis A outbreaks in the EU/EEA mostly affecting men who have sex with men.
  2. Beebeejaun K, Degala S, Balogun K, Simms I, Woodhall SC, Heinsbroek E, et al (2017). Outbreak of hepatitis A associated with men who have sex with men (MSM), England, July 2016 to January 2017. Euro. Surveill. 22(5), 2 February.

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