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Objectives: As HIV‐positive people age, diagnosis and management of comorbidities associated with ageing are of increasing concern. In this study, we aimed to compare the self‐reported prevalences of heart disease, stroke, thrombosis and diabetes in older Australian HIV‐positive and HIV‐negative gay and bisexual men (GBM). Methods: We analysed data from the Australian Positive & Peers Longevity Evaluation Study (APPLES), a study of a prospectively recruited cross‐sectional sample of 228 (51.1%) HIV‐positive and 218 (48.9%) HIV‐negative GBM, aged ≥ 55 years. Regression methods were used to assess the association of HIV status with self‐reported comorbidities. Results: Of 446 patients, 389 [200 (51.4%) HIV‐positive] reported their disease history. The reported prevalence of comorbidities was higher in the HIV‐positive group than in the HIV‐negative group: heart disease, 19.5 versus 12.2%; stroke, 7.5 versus 4.2%; thrombosis, 10.5 versus 4.2%; and diabetes, 15.0 versus 9.0%, respectively. In adjusted analyses, HIV‐positive GBM had significantly increased odds of reporting heart disease [adjusted odds ratio (aOR) 1.99; P = 0.03] and thrombosis (aOR 2.87; P = 0.01). In our analysis, HIV status was not significantly associated with either age at diagnosis of heart disease (median 53 years for HIV‐positive GBM versus 55 years for HIV‐negative GBM; P = 0.64) or 5‐year cardiovascular disease (CVD) risk estimated using the Framingham risk score. Conclusions: HIV‐positive GBM more commonly reported heart disease and thrombosis compared with their HIV‐negative peers. These results further highlight the need to understand the impact of HIV on age‐related comorbidities in GBM, to guide optimal screening and treatment strategies to reduce the risk of these comorbidities among the HIV‐positive population. [ABSTRACT FROM AUTHOR]

Objectives We established a subcohort of HIV-positive individuals from 10 sexual health clinics within the Australian HIV Observational Database ( AHOD). The aim of this study was to assess demographic and other factors that might be associated with an incident sexually transmitted infection ( STI). Methods The cohort follow-up was from March 2010 to March 2013, and included patients screened at least once for an STI. We used survival methods to determine time to first new and confirmed incident STI infection (chlamydia, gonorrhoea, syphilis or genital warts). Factors evaluated included sex, age, mode of HIV exposure, year of AHOD enrolment, hepatitis B or C coinfection, time-updated CD4 cell count, time-updated HIV RNA viral load, and prior STI diagnosis. Results There were 110 first incident STI diagnoses observed over 1015 person-years of follow-up, a crude rate of 10.8 [95% confidence interval ( CI) 9.0-13.0] per 100 person-years. Factors independently associated with increased risk of incident STI included younger age [≥ 50 vs. 30-39 years old, adjusted hazards ratio ( aHR) 0.4; 95% CI 0.2-0.8; P < 0.0001]; prior STI infection ( aHR 2.5; 95% CI 1.6-3.8; P < 0.001), and heterosexual vs. men who have sex with men ( MSM) as the likely route of exposure ( aHR 0.2; 95% CI 0.1-0.6; P < 0.001). Conclusions In this cohort of individualsbeing treated with antiretroviral drugs, those who were MSM, who were 30-39 years old, and who had a prior history of STI, were at highest risk of a further STI diagnosis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Men who have sex with men (MSM) are at greatly increased risk of human papillomavirus (HPV)-associated anal cancer. Screening for the presumed cancer precursor, high-grade anal intraepithelial neoplasia (AIN), followed by treatment in a manner analogous to cervical screening, has been proposed. We aimed to assess available data for anal HPV disease that can inform pre-cancer screening programmes. METHODS: We searched PubMed, OVID Medline, and Embase for all studies published before Nov 1, 2011, that reported prevalence and incidence of anal HPV detection, AIN, and anal cancer in MSM. We calculated summary estimates using random-effects meta-analysis. FINDINGS: 53 studies met the inclusion criteria, including 31 estimates of HPV prevalence, 19 estimates of cytological abnormalities, eight estimates of histological abnormalities, and nine estimates of anal cancer incidence. Data for incident HPV and high-grade AIN were scarce. In HIV-positive men, the pooled prevalence of anal HPV-16 was 35·4% (95% CI 32·9-37·9). In the only published estimate, incidence of anal HPV-16 was 13·0% (9·6-17·6), and clearance occurred in 14·6% (10·2-21·2) of men per year. The pooled prevalence of histological high-grade AIN was 29·1% (22·8-35·4) with incidences of 8·5% (6·9-10·4) and 15·4% (11·8-19·8) per year in two estimates. The pooled anal cancer incidence was 45·9 per 100000 men (31·2-60·3). In HIV-negative men, the pooled prevalence of anal HPV-16 was 12·5% (9·8-15·4). Incidence of HPV-16 was 11·8% (9·2-14·9) and 5·8% (1·9-13·5) of men per year in two estimates. The pooled prevalence of histological high-grade AIN was 21·5% (13·7-29·3), with incidence of 3·3% (2·2-4·7) and 6·0% (4·2-8·1) per year in two estimates. Anal cancer incidence was 5·1 per 100000 men (0-11·5; based on two estimates). There were no published estimates of high-grade AIN regression. INTERPRETATION: Anal HPV and anal cancer precursors were very common in MSM. However, on the basis of restricted data, rates of progression to cancer seem to be substantially lower than they are for cervical pre-cancerous lesions. Large, good-quality prospective studies are needed to inform the development of anal cancer screening guidelines for MSM. FUNDING: Australian Government Department of Health and Ageing. [ABSTRACT FROM AUTHOR]