Jennifer McGowan

Effects of age on symptom burden, mental health and quality of life amongst people with HIV in the UK

The evolving HIV epidemic, coupled with advances in HIV treatment, has resulted in an ageing HIV‐diagnosed population. It has been suggested that adverse physical and psychological effects of HIV may be higher among older people. However, few studies have examined the effect of older age on well‐being for people with HIV.

Age, time living with diagnosed HIV infection, and self-rated health.

An increasing proportion of people living with HIV are older adults, who may require specialized care. Adverse physical and psychological effects of HIV infection may be greatest among older people or those who have lived longer with HIV.

Prescribing tamoxifen in primary care for the prevention of breast cancer: a national online survey of GPs' attitudes.

Background The cancer strategy for England (2015–2020) recommends GPs prescribe tamoxifen for breast cancer primary prevention among women at increased risk. Aim To investigate GPs’ attitudes towards prescribing tamoxifen. Design and setting In an online survey, GPs in England, Northern Ireland, and Wales (n = 928) were randomised using a 2 × 2 between-subjects design to read one of four vignettes describing a healthy patient seeking a tamoxifen prescription. Method In the vignette, the hypothetical patient’s breast cancer risk (moderate versus high) and the clinician initiating the prescription (GP prescriber versus secondary care clinician [SCC] prescriber) were manipulated in a 1:1:1:1 ratio. Outcomes were willingness to prescribe, comfort discussing harms and benefits, comfort managing the patient, factors affecting the prescribing decision, and awareness of tamoxifen and the National Institute for Health and Care Excellence (NICE) guideline CG164. Results Half (51.7%) of the GPs knew tamoxifen can reduce breast cancer risk, and one-quarter (24.1%) were aware of NICE guideline CG164. Responders asked to initiate prescribing (GP prescriber) were less willing to prescribe tamoxifen than those continuing a prescription initiated in secondary care (SCC prescriber) (68.9% versus 84.6%, P<0.001). The GP prescribers reported less comfort discussing tamoxifen (53.4% versus 62.5%, P = 0.01). GPs willing to prescribe were more likely to be aware of the NICE guideline (P = 0.039) and to have acknowledged the benefits of tamoxifen (P<0.001), and were less likely to have considered its off-licence status (P<0.001). Conclusion Initiating tamoxifen prescriptions for preventive therapy in secondary care before asking GPs to continue the patient’s care may overcome some prescribing barriers.

Respiratory health status is impaired in UK HIV-positive adults with virologically suppressed HIV infection

We sought to evaluate whether people living with HIV (PLWH) using effective antiretroviral therapy (ART) have worse respiratory health status than similar HIV‐negative individuals.

Prevalence of beliefs about actual and mythical causes of cancer and their association with socio-demographic and health-related characteristics: findings from a cross-sectional survey in England

Background Literature on population awareness about actual causes of cancer is growing but comparatively little is known about the prevalence of peoples belief concerning mythical causes of cancer. This study aimed to estimate the prevalence of these beliefs and their association with socio-demographic characteristics and health behaviours. Methods A survey containing validated measures of beliefs about actual and mythical cancer causes and health behaviours (smoking, alcohol consumption, physical activity, fruit and vegetable consumption, overweight) was administered to a representative English population sample (N = 1330). Results Awareness of actual causes of cancer (52% accurately identified; 95% confidence interval [CI] 51–54) was greater than awareness of mythical cancer causes (36% accurately identified; 95% CI 34–37; P < 0.01). The most commonly endorsed mythical cancer causes were exposure to stress (43%; 95% CI 40–45), food additives (42%; 95% CI 39–44) and non-ionizing electromagnetic frequencies (35%; 95% CI 33–38). In adjusted analysis, greater awareness of actual and mythical cancer causes was independently associated with younger age, higher social grade, being white and having post-16 qualifications. Awareness of actual but not mythical cancer causes was associated with not smoking and eating sufficient fruit and vegetables. Conclusions Awareness of actual and mythical cancer causes is poor in the general population. Only knowledge of established risk factors is associated with adherence to behavioural recommendations for reducing cancer risk.

Characterising the nicotine metabolite ratio and its association with treatment choice: A cross sectional analysis of Stop Smoking Services in England

Pharmacotherapy provision based on Nicotine Metabolite Ratio (NMR) status (slow/normal metabolism) may improve smoking cessation rates. However, it is unclear whether NMR status is consistent across patient characteristics and current treatment choice. Data come from 1,826 participants attending Stop Smoking Services (SSS) across England in 2012/13. Sociodemographic, mental/physical health, smoking and treatment characteristics (nicotine replacement therapy vs. other pharmacotherapy; group vs. one-to-one behavioural support) were assessed. Salivary nicotine metabolites were measured and NMR (3-hydroxycotinine/cotinine) computed, characterising smokers as slow (NMR < 0.31) or normal (NMR ≥ 0.31) metabolisers. Normal metabolisers were older than slow metabolisers (Odds Ratio (OR) = 1.49, 95% Confidence Interval (CI) = 1.32–1.69) but no other characteristics were associated with NMR status. Overall, predictors accounted for only 7.3% of NMR variance. In adjusted analysis, pharmacotherapy type was not associated with NMR status, but normal metabolisers were less likely to use group support (OR = 0.67, 95% CI = 0.51–0.89). NMR status does not vary substantially across sociodemographic characteristics. Given its impact on pharmacotherapy efficacy, the lack of an association with pharmacotherapy choice suggests there is scope to use NMR status to optimise the selection and efficacy of smoking cessation pharmacotherapy. The unexpected association of NMR status with behavioural support should be explored further.

Psychological Aspects of Tobacco Control

World-wide, tobacco use is a leading cause of morbidity and mortality. However, the health effects of smoking are reversible, making smoking cessation an important target for public health policy. ‘Tobacco control’ is a field of public health science which is dedicated to reducing tobacco use, and thereby reducing cigarette-related morbidity and mortality. In order for tobacco control to be effective, it is necessary for policy-makers to understand the personal and interpersonal factors which encourage people to smoke, factors which motivate smokers to quit (e.g. health, social pressure, cost), and the personal and population-level methods which are most effective at encouraging and prolonging quit attempts. Research has identified that social norms, mental health, and individual personality factors are most associated with smoking uptake and so interventions which reduce social smoking (e.g. smoking bans, plain packaging) would be most effective at preventing uptake. Conversely, the use of cigarettes is maintained by nicotine addiction and quit attempts are often motivated by health concerns, social pressure and the cost of tobacco products. As such, interventions which address physiological and behavioural addiction inherent in tobacco product use (such as nicotine replacement therapy combined with counselling), create social pressure to stop (such as mass media campaigns), or increase the cost of tobacco products, are most likely to be effective at encouraging quit attempts.

P226 Impaired respiratory health status in the UK HIV infected population despite the use of antiretroviral therapy

Background The widespread use of antiretroviral therapy (ART) has led to a reduction in HIV related opportunistic infections. An increase in chronic non-HIV related co-morbidities has been observed in stable HIV positive individuals receiving ART. The extent to which HIV infection remains an independent risk factor for respiratory disease despite the use of antiretroviral therapy is uncertain and few studies have systematically evaluated respiratory disease in HIV-infected populations with access to antiretroviral therapy. Aims We sought to evaluate the frequency of (a) smoking and (b) respiratory symptoms and (c) spirometric impairment in the ambulatory UK adult HIV infected population, compared to HIV uninfected controls. Methods HIV-positive participants were recruited from a large HIV care service, HIV uninfected participants were recruited from Sexual Health services (where recruitment was stratified by age to approximate that of the HIV positive subjects). Participants completed a questionnaire which included questions on smoking history and respiratory health status using the St George’s Respiratory Questionnaire (SGRQ), and undertook spirometry without bronchodilation. Results 249 participants were recruited between April and July 2015 (Table 1). 28% of HIV positive and 33% of HIV negative participants were current smokers (p = 0.22). 9% of HIV positive and 7% of HIV negative participants had an FEV1/FVC of <0.7 (p = 0.38). 92% of HIV positive participants were using antiretroviral therapy, 86% had an undetectable plasma HIV viral load and mean CD4 count was 684 cells/µL.Abstract P226 Table 1 HIV positive (N = 181) HIV negative (N = 68) Age [years] 50 (43–56) 44 (38–52) P = 0.006 Using antiretroviral therapy 92% CD4 count [cells/µL] 617 (458–839) Male 79% 68% P = 0.065 Current smoker 28% 33% P = 0.22 FEV1 3.43 (0.86)* 3.20 (0.78)* P = 0.08 FVC 4.24 (1.06)* 3.87 (0.98)* P = 0.02 FEV1/FVC <0.7 9% 7% P = 0.55 SGRQ Total score 12 (6–29) 8 (3–18) P = 0.032 Values median (IQR) or% unless otherwise stated. *mean (SD). Significantly higher SGRQ scores were observed in HIV positive participants than HIV-negative participants with a median total SGRQ score of 12 for those with HIV infection and 8 for the HIV negative participants (p = 0.03). In a linear regression (log scale) model, HIV infection was associated with a 62% increase (95% CI 1.19–2.21, p < 0.01) in SGRQ in unadjusted analysis and 48% increase (1.08–2.02, p = 0.01) in a multivariable analysis adjusting for age, gender and smoking status. Conclusions Despite widespread use of ART, HIV infection is independently associated with impaired respiratory health status. This does not appear to result from current smoking or obstructive lung disease.