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BackgroundRegenerating islet-derived protein 3α (REG3α) is an antimicrobial peptide secreted by intestinal Paneth cells. Circulating REG3α has been identified as a gut damage marker in inflammatory bowel diseases. People living with human immunodeficiency virus (PWH) on antiretroviral therapy (ART) present with an abnormal intestinal landscape leading to microbial translocation, persistent inflammation, and development of non-AIDS comorbidities. Herein, we assessed REG3α as a marker of gut damage in PWH.MethodsPlasma from 169 adult PWH, including 30 elite controllers (ECs), and 30 human immunodeficiency virus (HIV)–uninfected controls were assessed. REG3α plasma levels were compared with HIV disease progression, epithelial gut damage, microbial translocation, and immune activation markers.ResultsCross-sectionally, REG3α levels were elevated in untreated and ART-treated PWH compared with controls. ECs also had elevated REG3α levels compared to controls. Longitudinally, REG3α levels increased in PWH without ART and decreased in those who initiated ART. REG3α levels were inversely associated with CD4 T-cell count and CD4:CD8 ratio, while positively correlated with HIV viral load in untreated participants, and with fungal product translocation and inflammatory markers in all PWH.ConclusionsPlasma REG3α levels were elevated in PWH, including ECs. The gut inflammatory marker REG3α may be used to evaluate therapeutic interventions and predict non-AIDS comorbidity risks in PWH.

An expert workshop focusing on per- and poly-fluoroalkyl substances (PFAS) was held in Adelaide, South Australia, Australia in September 2019 following the 8th International Contaminated Site Remediation Conference — CleanUp 2019. The workshop was organised by the Cooperative Research Centre for Contamination and Remediation of the Environment (CRC CARE) and was chaired by Professor Ravi Naidu, CEO and Managing Director of CRC CARE and Director of the Global Centre for Environmental Remediation at the University of Newcastle, NSW. The purpose of the workshop, which was attended by more than 50 experts in the field of contaminated land assessment and management, was to discuss the current state of play and research needs relating to PFAS contaminated sites. This paper provides a summary of the discussions and conclusions and lists actions and needs that the expert group identified as critical for pursuing successful PFAS management and remedy approaches. This paper is intended to capture the shared information, comments, and current thinking related to PFAS challenges and research needs as identified by the group of expert participants; the write up is not intended to be a complete dissertation on the science and work that has been carried out. With a fast-evolving subject and increased government and public attention on PFAS presence in the environment, the group was convened with the objective of providing value in contributing to solutions to the PFAS challenges that are faced both in Australia and internationally. The text contained herein provides references to observations and methods that the experts drew on in their discussions and in support of their commentary; documentation of the original references was not provided, and the reader should consult the scientific literature if further information and confirmation of observations is required. Following a brief on the background to PFAS challenges, the paper focusses on research gaps identified by experts with focus on Australian soils and groundwater including climatic patterns, an overview of PFAS research in Australia with emphasis on: • Regulatory • Analytical considerations • Ecological and Human Health Risks • Fate and Transport • Remediation and Risk Management.

Background It was estimated in 2005 that 13% of men who have sex with men (MSM) in Montreal were HIV-positive, and that 23% of these were not aware of their diagnosis. Clinique l9Actuel introduced a pilot rapid HIV testing program using the MedMira kit in 2008. The objective of this study was to describe the sensitivity and specificity of rapid HIV tests in a community based, high HIV risk setting. Methods An advertising campaign encouraged MSM and others at risk for HIV to undergo testing through dedicated clinics offering rapid HIV tests. Patients calling for testing deemed at high risk were given appointments within 2 weeks, where they filled out a short questionnaire, received medical consultation routine STI screening, pre- and post- test counselling and their HIV test results within the hour. Those consenting received with a MedMira or and INSTI rapid test and regular HIV screening. Any positive result was confirmed by Western blot. Results 2500 individuals were tested: 98% men with a median age of 34 (IQR: 26–41). For the MedMira test there were 43 true positives, 2295 true negatives, 13 false positives and four false negatives. 145 patients received the finger-prick INSTI test giving two true positives and 143 true negatives. For MedMira, sensitivity was 91.5% and specificity 99.5% while both figures were 100% for INSTI. The four false negatives were also negative by standard ELISA but positive for P24 antigen. Patients testing positive for HIV had significantly more history of previous STI than those testing negative (p=0.041). Conclusion In this setting sensitivity and specificity of the rapid tests used was comparable to standard testing. Acute seroconversion likely explains the four false negatives. As with conventional testing, rapid testing requires adequate counselling about the possibilities of a false negative test. In high-risk populations, routine STI screening should always be performed together with HIV screening.

Background In Quebec it is estimated that 1/3 of those infected do not know their HIV status, that HIV is diagnosed late in 41%, and that sex during primary infection is an important driver of the epidemic. In late 2008 Clinique l9Actuel launched a testing campaign tailored to MSM in Montreal using free rapid tests with the goal of increasing early diagnosis of HIV. In this study we evaluated the feasibility of and potential impact of facilitated access to rapid HIV-testing. Methods Rapid HIV-tests offered through dedicated clinics were widely advertised in Montreal9s MSM community. Patients calling for testing deemed at high risk were given appointments within 2 weeks, where they filled out a short questionnaire, received medical consultation routine STI screening, pre- and post-test counselling and their HIV test results within the hour. Ongoing support, care, and treatment were offered to those testing positive. Results Over 9 months 2500 received HIV testing. 98% were men and median age was 34 (IQR=26–41). Of these patients, 42% were new to the clinic, 10% had never been tested previously, and 29% had not been tested within the past 2 years. 93% reported they were more likely to undergo repeat screening because of rapid testing. 2% were found to be HIV positive. Of these, 60% cited the rapid test as the primary reason for undergoing screening. 33% of those testing positive were in primary infection, as compared to 18% the previous year at Clinique l9Actuel (p=0.062) and 11% in Quebec. Conclusion Facilitated access to rapid HIV testing can increase uptake in high-risk patients. This may increase early HIV diagnosis and intervention to decrease transmission.

Background Often STIs are not diagnosed and not treated because people don9t have access to appropriate healthcare screening facilities and to care. At Clinique l9Actuel (Montreal, Canada) we developed Gay Screen Clinic (GSC) as a new concept giving rapid access to men who have sex with men (MSM) to an appointment for STI screening. We then assessed the extend and risk factors of STIs in a population of men having sex with men (MSM) attending the GSC. Methods We did a retrospective analysis of the last 1000 attendees to the GSC at Clinique l9Actuel in 2009−2010. Multivariable analyses were conducted to identify the factors associated with history of STIs. Results Participants were all MSM with a mean age of 32 years (ranged from 18 to 70 y). In total, 50% (n=506) of them self reported history of STIs and 236(24%) of them had a positive sexual health screen at this visit. STI diagnoses included genital herpes (n=105, 14 %), condylomes (n=79, 8%), syphilis (n=43, 5%), chlamydia infection (n=32, 3%), HIV (n=10, 1%), Gonorrhoea (n=9, 1%) and HCV (n=5, 1%). 32% of the attendees had sexual relations in bath houses and 43% with anonymous contacts. In multivariate analyses, past history of STI was significantly associated with higher age (OR=1.02, p=0.001), higher number of sexual partners in the last 12 months (OR=1.02, p=0.015), having sexual contact in bath houses (OR=1.46, p=0.021) and with unknown partners met through internet or in backrooms (OR=1.53, p=0.004), using recreational drugs (OR=2.01, p=0.001) and having only male partners (OR=1.60, p=0.023) rather than male and female sexual partners. Conclusions STIs were common among non HIV MSM attending the GSC in Montreal. Even after many years of prevention campaign MSM still have high risk sexual behaviour. Physician should routinely enquire about drug use of their patients in order to prevent new STIs. Targeting specific sexual networks is needed to be more effective.

Few cases of sexually transmitted Hepatitis C infection (HCV) in men who have sex with men (MSM) had been reported in the literature. Background The incidence of genital infection from non-L Chlamydia trachomatis (CT) is increasing in the province of Quebec. Traditionally it was more prevalent in young women. In the last few years, CT infection has emerged in men who have sex with men (MSM) group. The objective of this study was to describe anal non-L CT infection in MSM in an HIV-STI clinic in a large urban setting. Methods Retrospective study of anal non-L CT cases diagnosed at Clinique l9Actuel in 2010. We collected information on age at diagnosis, HIV status, CT serovars, symptoms, mode of transmission and concomitant presence of CT in urine. An anal swab specimen was collected with a TAAN test (BD Probe Tec TM). Results From 2006 to 2009, we diagnosed respectively 42, 58, 82 and 118 anal non-L CT infection in MSM. In 2010, we diagnosed 154 different anal non-L CT infections in 152 MSM. Patient9s age at diagnosis was 33 years (IQR—25−38) from 18 to 70 years. 28% were HIV+ at time of diagnosis. Anal infection was primarily caused by serovars J (35%), G (31%), D (23%), E (10%), F (1%) and C (1%). Among HIV patients the serovars was predominantly J (46%), D (30%) and G (24%). But this difference was not statistically significant. Anal non-L CT infection was detected in asymptomatic patients while screening in 54% of case. 7% of MSM had no symptom but consulted because they were notified by a sexual partner. 39% had symptoms—proctitis (26%), urethritis (11%) or symptom of other STI including syphilis and HIV primary infection (2%). Mode of transmission for the anal infection was not specifically specified in the file of the patients, but 88% reported anal unprotected penetration in the past year, 12 % did not report anal penetration but had mouth to anus contact (rimming) or friction from penis to anus. One patient reports sharing anal toys. Urine CT was positive in 18% of MSM, so those MSM had two infected sites. Conclusion Given the high rate of positive results, MSM should be screen with a TAAN test for anal CT infection. This screening should be included in the regular follow-up of HIV patients. MSM community should be aware of this emerging infection. Public health authority should focus on developing and promoting new guidelines of screening, access to validated test with identification of serovars.

Methods A retrospective analysis of the clients who attend the “Gay Screening Clinic” (GSC) at Clinique medical l9Actuel (Montreal, Canada) between May 2009 and April 2010 was conducted. Results Among the 1010 patients included in the analyses we found five cases of new HCV infection which seems to be acquired by sexual transmission. All of them were male and MSM, none of the cases had previous history of IDU, but three reported having had sexual relation with IDU partners. All of them were previously vaccinated for Hepatitis A and B and screened for HIV. None of them were coinfected with HIV, but one was coinfected with Syphilis and one with Gonorrhoea. Patients infected with HCV were older than non HCV patients (37 years vs 32 years) and had a higher number of sexual partners during the last 12 months (16 part. vs 9 for the non HCV patients). One of the HCV cases reported not having anal intercourse, two reported having had occasional unprotected anal intercourse and two reported always using condom for anal intercourse. Conclusions As in other urban centers, cases of sexually transmitted HCV had also been found in Montreal. This prevalence of 0.5% is very low compared to our HIV population in which the prevalence of sexually transmitted HCV is 3%. The particularity of MSM with recently acquired HCV by sexual transmission seems to be related to their engagement in sexual relation with high number of concurrent partners.

During a 5.5-year retrospective study (1979-84) 170 children with blunt abdominal trauma were investigated with intravenous urography (IVU), ultrasound (US) and scintigraphy. For the investigation of the last 71 children (after 1982) a 4th generation CT scanner was available in the same department. The results of radiologic investigations were compared with clinical outcome in 157 and results at laparotomy in 13 children. During the study period, real time US became the first line screening tool, and was combined with IVU in suspected renal trauma. In spite of permanent accessibility of CT since November 1982, the latter was used only in complex diagnostic problems or in children with multiple injuries (8% of the series). There were no deaths resulting from abdominal trauma. During the study, the incidence of splenectomy and exploratory laparotomy decreased, and no diagnostic peritoneal lavage were performed after 1980.