P Benn

Central and North West London NHS Foundation Trust, Londinium, England, United Kingdom

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Publications (25)39.39 Total impact

  • Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 07/2014;
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    ABSTRACT: There are currently over 30,000 HIV-positive individuals in London and over 25,000 on anti-retroviral therapy. In 2009/2010, this equated to £170m spent by London's NHS on anti-retroviral drugs. Ways employed to reduce this cost include standardising the drugs patients are on and delivering medication to patients at home. Home delivery (HD) medication is exempt from value-added tax. The savings made from 10 patients using the home delivery service would free up resources to provide anti-retroviral therapy to one further patient. Studies have shown that concerns surrounding potential breaches of confidentiality are a potential barrier to some people using the home delivery service. In order to challenge these concerns, a leaflet was devised highlighting the major benefits to both the patient and the NHS of home delivery and addressing concerns over confidentiality. The leaflet was handed out to patients at the Mortimer Market Centre who were currently on anti-retroviral medication but not on home delivery. They were asked to complete a survey on their views of the service before and after reading the leaflet, whether they had been previously aware of the service and whether their concerns had been addressed. Some 79% felt that the patient information leaflet addressed all of their concerns, and it helped 11% decide whether to consider using home delivery. However, as more patients were opposed to the service after reading the patient information leaflet than those considering it, more work needs to be done to explore patients' concerns and other factors influencing home delivery service uptake.
    International Journal of STD & AIDS 04/2014; · 1.00 Impact Factor
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    ABSTRACT: The incidence of human immunodeficiency virus (HIV) infection continues to rise among core groups and efforts to reduce the numbers of new infections are being redoubled. Post-exposure prophylaxis (PEP) is the use of short-term antiretroviral therapy (ART) to reduce the risk of acquisition of HIV infection following exposure. Current guidelines recommend a 28-day course of ART within 36-72 hours of exposure to HIV. As long as individuals continue to be exposed to HIV there will be a role for PEP in the foreseeable future. Nonoccupational PEP, the vast majority of which is for sexual exposure (PEPSE), has a significant role to play in HIV prevention efforts. Awareness of PEP and its availability for both clinicians and those who are eligible to receive it are crucial to ensure that PEP is used to its full potential in any HIV prevention strategy. In this review, we provide current evidence for the use of PEPSE, assessment of the risk of HIV transmission, indications for PEP, drug regimens, and management of patients started on PEP. We summarize national and international guidelines for the use of PEPSE. We explore the place of PEP within the wider strategy of reducing HIV incidence rates in the era of treatment as prevention and pre-exposure prophylaxis. We also consider the implications of recent data from interventional and observational studies demonstrating significant reductions in the risk of HIV transmission within a serodiscordant relationship if the HIV-positive partner is taking effective ART upon PEP guidelines.
    HIV/AIDS (Auckland, N.Z.). 01/2014; 6:147-58.
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    ABSTRACT: Objective To describe the prevalence of vitamin D deficiency among antiretroviral treatment-naïve, HIV-positive individuals.Methods We reviewed records of consecutive antiretroviral treatment-naïve patients, registering for care for the first time at a London clinic from 01 January 2008 to 31 December 2009. During this period, serum 25-hydroxycholecalciferol was measured routinely for all new patients. 25-hydroxycholecalciferol deficiency and severe deficiency were defined as ≤50 and ≤25 nmol/L, respectively.ResultsAmong 253 patients (82% men, median age 36 years, 64% white ethnicity), 148 (58.5%) were 25-hydroxycholecalciferol-deficient, including 32 (12.6%) who were severely deficient. In all, 73.5% (61/83) patients of non-white ethnicity were 25-hydroxycholecalciferol-deficient compared with 50.7% (76/150) of those reporting white ethnicity (p < 0.001). Seven of eight (87.5%) patients with hypocalcaemia (<2.12 nmol/L) were 25-hydroxycholecalciferol-deficient. The prevalence of 25-hydroxycholecalciferol-deficiency was higher in winter and spring vs. summer and autumn (89/129 [69.0%] vs. 59/124 [47.6%], p < 0.001). Serum 25-hydroxycholecalciferol deficiency was not associated with gender, CD4 count, HIV viral load or clinical stage.Conclusion Serum 25-hydroxycholecalciferol deficiency was common among antiretroviral treatment-naïve patients, with those of non-white ethnicity at highest risk. CD4 count, HIV viral load and HIV clinical staging do not help to identify those at risk, but low serum calcium should prompt investigation of 25-hydroxycholecalciferol levels.
    International Journal of STD & AIDS 12/2013; · 1.00 Impact Factor
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    ABSTRACT: The numbers of individuals living with HIV in the UK continues to increase as a result of the benefits of antiretroviral therapy and continued high incident infection rates. It is estimated that the number of individuals living with HIV in the UK will exceed 100000 by the end of 2012 (Health Protection Agency, 2011).
    British journal of hospital medicine (London, England: 2005) 08/2013; 74(8):465-8. · 0.25 Impact Factor
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    ABSTRACT: There is currently no 'gold standard' for diagnosis of latent tuberculosis infection (LTBI), and both the tuberculin skin test and interferon-gamma release assays (IGRAs) are used for diagnosis; the latter have a higher sensitivity than tuberculin skin test for diagnosis of LTBI in HIV-infected individuals with lower CD4 counts. No evidence-base exists for selection of IGRA methodology to identify LTBI among human immunodeficiency virus-infected patients in the UK. We prospectively evaluated two commercially available IGRA methods (QuantiFERON-TB Gold In Tube (QFG) and T-SPOT.TB) for testing LTBI among HIV-infected patients potentially nosocomially exposed to an HIV-infected patient with 'smear-positive' pulmonary tuberculosis. Among the exposed patients median CD4 count was 550 cells/µL; 105 (90%) of 117 were receiving antiretroviral therapy, of who 104 (99%) had an undetectable plasma HIV load. IGRAs were positive in 12 patients (10.3%); QFG positive in 11 (9.4%) and T-SPOT.TB positive in six (5.1%); both IGRAs were positive in five patients (4.3%). There was one indeterminate QFG and one borderline T-SPOT.TB result. Concordance between the two IGRAs was moderate (κ = 0.56, 95% confidence interval (CI) = 0.27-0.85). IGRAs were positive in only 4 (29%) of 14 patients with previous culture-proven tuberculosis. No patient developed tuberculosis during 20 months of follow-up.
    International Journal of STD & AIDS 07/2013; · 1.00 Impact Factor
  • Clinical Infectious Diseases 03/2013; · 9.37 Impact Factor
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    ABSTRACT: We estimated the burden of HIV-associated neurocognitive disorders (HAND) in a UK clinic. From a random sample, and referrals to specialist services over one year (neurology, clinical psychology, hospital admissions), we determined whether patients were diagnosed with HIV-associated dementia (HAD) and whether they reported symptoms suggesting neurocognitive impairment (NCI). In the first sample, 2/150 (prevalence 1.3%; 95% confidence interval [CI] 0.2-4.7%) had documented HAD. Eleven patients (7.3%; CI 3.7-12.7%) reported recent symptoms suggesting NCI; most of these individuals were diagnosed with a psychiatric or substance-use disorder. Among specialist referrals with symptoms suggesting NCI, 11 were diagnosed with HAD from a clinic population of 3129 individuals (annual incidence 0.4%; CI 0.2-0.6%). No patients with mildly symptomatic or asymptomatic HAND were identified in either sample, suggesting that such patients remain undetected in current clinical practice. Evidence-based screening for HAND in HIV clinics may be needed.
    International Journal of STD & AIDS 03/2013; · 1.00 Impact Factor
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    ABSTRACT: To evaluate the performance and patient acceptability of the PIMA point-of-care (POCT) CD4 test. Parallel POCT and laboratory CD4 testing were performed in newly diagnosed HIV patients and those with chronic infection attending routine or emergency clinics. Demographics, clinical status and time taken for CD4 results to be available were recorded. Patient acceptability was assessed using a five-point Likert scale. POCT and laboratory results were compared. 283 patients underwent POCT and laboratory CD4 testing. Paired laboratory and POCT results were available in 269 patients. After excluding 15 patients tested during the lead-in period, the test comparison was based on 254 results. Most patients were asymptomatic, male and white British reflecting this patient cohort. 236 patients were chronically infected and 47 were newly diagnosed HIV positive. The POCT result was available within 30 min (86%). The laboratory and POCT results were strongly correlated, r=0.93 (p<0.001), but were generally lower for the POCT (201/254 (79%): p<0.001). As a percentage of the laboratory count, the median (95% range) POCT was 87% (57%-126%). The difference between the POCT and laboratory result was greater for those patients attending the emergency clinic. The sensitivity and specificity of the POCT, to identify patients with laboratory CD4 below 350, were 95% (95% CI 88% to 98%) and 88% (95% CI 82% to 93%), respectively. 235 (83%) patients completed the questionnaire and the POCT was highly acceptable. POCT CD4 was highly correlated with laboratory CD4 testing in this cohort, provided immediate results and was highly acceptable to patients.
    Sexually transmitted infections 04/2012; 88(6):413-7. · 2.18 Impact Factor
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    ABSTRACT: Post-exposure prophylaxis (PEP) following sexual exposure to HIV has been recommended as a method of preventing HIV infection in the UK. Men who have sex with men (MSM) are the group most affected by HIV in the UK and their sexual risk taking behaviour is reported to be increasing. One-to-one behavioural interventions, such as motivational interviewing (MI) have been recommended to reduce HIV in high risk groups. The Information, Motivation and Behavioral skills (IMB) model has been shown to provide a good basis for understanding and predicting HIV-relevant health behaviour and health behaviour change, however the IMB has yet to be applied to PEP after risky sexual exposure. The primary aim of this trial is to examine the impact of MI augmented with information provision and behavioural skills building (informed by the IMB Model), over and above usual care, on risky sexual behaviour in MSM prescribed PEP after potential sexual exposure. A secondary aim of this research is to examine the impact of the intervention on adherence to PEP. This study will also provide estimates of the cost-effectiveness of the intervention. A manualised parallel group randomised controlled trial with economic evaluation will be conducted. The primary outcome is the proportion of risky sexual practices. Secondary outcomes include: i) Levels of adherence to PEP treatment; ii) Number of subsequent courses of PEP; iii) Levels of motivation to avoid risky sexual behaviours; iv) Levels of HIV risk-reduction information/knowledge; v) Levels of risk reduction behavioural skills; vi) Diagnosis of anal gonorrhoea, Chlamydia and/or HIV. 250 participants will be asked to self-complete a questionnaire at four time points during the study (at 0,3,6,12 months). The intervention will consist of a two-session, fixed duration, telephone administered augmented MI intervention based on the IMB model. A newly developed treatment manual will guide the selection of persuasive communication strategies as appropriate for each participant and will be based on underlying change mechanisms specified by the IMB theoretical framework. Information provision and skills building will also be included in the intervention package through the use of information leaflets and tailored action plans. Fidelity of intervention delivery will be assessed. The results from this NIHR funded study will identify whether it is appropriate and cost-effective to intervene using one-to-one telephone calls with MSM seeking PEP. If the intervention is effective, further work will be needed on training staff to deliver the intervention competently. TRIAL REGISTRATION NUMBERS: UKCRN ID:11436; ISRCTN00746242.
    BMC Infectious Diseases 03/2012; 12:70. · 3.03 Impact Factor
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    ABSTRACT: We present the updated British Association for Sexual Health and HIV (BASHH) guidelines for post-exposure prophylaxis (PEPSE) to HIV. This document includes a review of the current data to support the use of PEPSE, considers how to calculate the risks of infection after a potential exposure, and provides recommendations on when PEPSE would and would not be considered. We review which agents to use for PEPSE including the potential for drug-drug interactions and make recommendations for monitoring individuals receiving PEPSE. Other areas included are the possible impact on sexual behaviour, cost-effectiveness and issues relating to service provision. Throughout the document, consideration is given to the place of PEPSE within the broader context of HIV prevention strategies and sexual health.
    International Journal of STD & AIDS 12/2011; 22(12):695-708. · 1.00 Impact Factor
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    ABSTRACT: To assess the feasibility and outcomes of recalling men who have sex with men (MSM) diagnosed as having a bacterial sexually transmitted infection (STI) for re-screening. This evaluation was conducted from December 2008 for a 9-month period. MSM diagnosed as having a bacterial STI in that period were offered recall for re-screening 3 months after their diagnosis. Re-screening rates and infection incidence were calculated. Differences in baseline characteristics by re-screening status and factors predictive of infection at re-screening were assessed using the Mann-Whitney test, χ(2) test and logistic regression. Of the 337 MSM diagnosed as having a bacterial STI, 301 were offered recall. Of these, 206 (68.4%) re-screened after 3 months, 30 (10%) declined and the remainder did not re-attend despite giving verbal consent. Compared with those not re-screening, those re-screening were less likely to be HIV positive (p=0.001), but there was no difference in baseline risk behaviours. There were 15 diagnoses of bacterial STIs at re-screening (29 per 100 person-year follow-up (pyfu); 95% CI 14.3 to 43.7) and five new HIV diagnoses of whom three had a negative test at baseline, one tested negative 6 months earlier and one never tested. Among those testing at both time points, the HIV incidence was 8.3 per 100 pyfu (95% CI 0.0 to 17.7). This evaluation demonstrates a 'recall for re-screening' strategy is feasible in terms of high re-screening rates and incidence of new infections diagnosed. Experimental evidence is needed to assess cost-effectiveness and whether it achieves its aim of reducing transmission of STIs and HIV.
    Sexually transmitted infections 09/2011; 87(7):577-82. · 2.18 Impact Factor
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    ABSTRACT: Thymidine nucleoside reverse transcriptase inhibitors (NRTIs) are associated with subcutaneous fat loss. Facial changes cannot be assessed by dual-energy X-ray absorptiometry (DEXA) scans. There are limited objective data on the reversibility of facial lipoatrophy. We performed a facial volume substudy of a randomized thymidine NRTI replacement study carried out in HIV-infected subjects with moderate to severe lipoatrophy. Facial volume changes were assessed using validated 3D laser imaging. Changes in body composition were measured using DEXA scans. The association between changes in facial volume and body composition parameters at 48 weeks was measured using Spearman's rank correlation. Forty-seven individuals (46 male), 11 receiving zidovudine and 36 receiving stavudine, switched to either tenofovir disoproxil fumarate (DF) (n=23) or abacavir (ABC) (n=24). Thirty-nine of these 47 patients (84.8%) reported facial lipoatrophy at baseline. The median volume increase in both cheeks from baseline was 1857.3 mm(3). These volume changes and increases in limb fat at 48 weeks were similar in the two groups and correlated significantly (Spearman's r=0.41, P=0.004). Facial volume in lipoatrophic individuals was found to increase after thymidine NRTI replacement. We demonstrated a significant correlation between improvements in facial and limb fat parameters. Switching from thymidine NRTIs in patients with facial lipoatrophy could potentially reduce the need for cosmetic interventions.
    HIV Medicine 08/2009; 10(6):351-5. · 3.16 Impact Factor
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    Enrique Castro-Sanchez, SG Edwards, J Minton, P Benn
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    ABSTRACT: Background: The availability of Atripla since December 2007 in the UK has afforded HIV+ patients a one pill once a day regimen. We undertook an audit to determine the reasons for and outcomes of individuals switching to Atripla. Methods: From the electronic pharmacy information system (PIMS) we identified HIV + patients who commenced Atripla between 01.02.08 - 30.06.08. Information regarding demographics, disease stage, antiretroviral therapy (ART) and outcomes following the switch was obtained from a retrospective case notes review. Results: A total of 177 patients (157 men, 20 women) were identified. The majority were Caucasian (63%), 18% Black African. At the time of switch the median (range) age was 42 years (24 -69), CD4 count; 435 (170 -1710) and HIV viral load (VL) <50 (<50 – 1200 copies/ml). Patients switched from the following regimens: 83% from truvada and efavirenz (EFV), 10% from EFV and two nucleosides (combivir n=7, kivexa n=11), 4% from a boosted protease inhibitor regimen (rPI). One person switched from trizivir to Atripla. 14/17 who were taking abacavir switched due to concerns regarding cardiovascular risk. Outcomes following switching include continuing Atripla with no side effects (S/E) (86%), continuing Atripla but reporting increased/new S/Es (5%). 7 of 9 had previously received EFV for a median of 10 months, discontinued EFV after experiencing S/Es after a median of 8 weeks (8%). 12 of 14 had previously received EFV for a median of 10 months and one individual stopped due to difficulty swallowing Atripla. Of those individuals reporting S/Es after switching from EFV to Atripla 65% had increased central nervous system S/Es. Viral rebound occurred in one patient which was attributed to pre-exisitng resitance. Discussion: We report a suprisingly high level of discontinuation of Atripla among our patients despite many having previously tolerated both truvada and EFV. Furthermore simplification to Atripla was uncommon in patients stable on a boosted PI regimen.
    BHIVA 2009; 05/2009
  • Paul Benn, Martin Fisher
    Clinical medicine (London, England) 07/2008; 8(3):319-22. · 1.32 Impact Factor
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    ABSTRACT: In July 2004, British Association of Sexual Health and HIV (BASHH) published guidelines for post-exposure prophylaxis following sexual exposure (PEPSE) and the Terence Higgins Trust (THT) launched a campaign promoting PEPSE among men who have sex with men (MSM). We evaluated subsequent changes in PEPSE attendances. Individuals requesting PEPSE in 2004 were identified from clinic databases. Comparisons of clinical data, exposure characteristics and follow-up were made pre and post campaign. Data were available for 197/216 (91%) PEP attendances. The proportion requesting PEP following sexual exposure increased significantly following the campaign. The majority commencing PEPSE were MSM, with the proportion of MSM increasing significantly from 36/46 (78%) pre to 76/80 (95%) following the campaign. Most prescriptions were in high-risk groups and within guidelines. Times to initiation and completion rates were unchanged. Access to PEPSE following the THT campaign and introduction of BASHH guidelines increased. Promotion of earlier initiation of PEPSE and improvement of completion and follow-up is required.
    International Journal of STD & AIDS 05/2008; 19(4):241-2. · 1.00 Impact Factor
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    ABSTRACT: This audit compared sexual histories taken by self-completed questionnaires (SQ) versus the 'gold-standard' of 'traditional' face-to-face interviews by health-care professionals (HP). It compared reporting of symptoms and sexual behaviour and looked at outcomes in terms of diagnoses of sexually transmitted infections. SQ were at least equal to HP and might therefore be a valuable tool in streamlining services.
    International Journal of STD & AIDS 04/2008; 19(3):203-5. · 1.00 Impact Factor
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    ABSTRACT: Lymphogranuloma venereum (LGV) has recently been reported in men who have sex with men. In a case-control study we compared behavioural and clinical features of 32 men with LGV (cases) and 31 men with non-LGV chlamydial proctitis (controls). LGV was associated with rectal discharge (odds ratio [OR] 4.15, 95% confidence interval [CI] 1.42, 12.2), and there was a tendency to association with HIV infection (OR 3.60, CI 0.67-19.4), sexual contact in the UK (OR 3.03, CI 1.02-9.01) and fisting (OR 5.04, CI 0.98-26.1). LGV should be considered a possible diagnosis in men with rectal discharge.
    International Journal of STD & AIDS 08/2007; 18(7):472-5. · 1.00 Impact Factor
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    BHIVA 2007; 05/2007
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    ABSTRACT: Introduction: The success of antiretroviral therapy (ARV) and ongoing incident infection has led to many UK HIV treatment centres experiencing annual increases in cohort size of 10%. In the absence of additional clinical space we describe how an inner London unit safely managed these capacity issues. Methods: With the involvement of the multidisciplinary team and service users we 1) evaluated existing care pathways, 2) modified appointment duration, frequency and method of follow up, and expanded nursing roles, 3) re-evaluated after implementation. Cohort data regarding attendance patterns, CD4 counts, viral load (VL) and ARV use was obtained from clinic databases. Comparison of virological control according to use of service innovations were made. Complaints and user feedback were monitored. Results: Under the existing model of care we estimated that we would exceed capacity by 2006 and our cohort would reach 4100 by 2010. Reducing half of all appointments duration to 20 from 30 minutes could delay reaching capacity until 2008. In a subset of stable patients (on first line ARV with VL<50 for > 12 months, n=415) attending three or less vs four or more times/year, or receiving follow up by a specialist nurse was not associated with virological failure (p=0.9 and p=0.57 respectively) over a 12-month period. Those using alternative methods of follow up (e.g. telephone) were no more likely to experience virological failure. Discussion: HIV services need to evaluate new care pathways to manage increasing demand. We demonstrated major changes in service provision without compromising safety, efficiency or patient acceptability.
    BASHH 2007; 01/2007

Publication Stats

127 Citations
39.39 Total Impact Points

Institutions

  • 2011–2014
    • Central and North West London NHS Foundation Trust
      Londinium, England, United Kingdom
  • 2012
    • East Coast Community Healthcare CIC
      Beccles, England, United Kingdom
  • 2003–2009
    • The Bracton Centre, Oxleas NHS Trust
      Дартфорде, England, United Kingdom
  • 2007
    • University College London Hospitals NHS Foundation Trust
      • Department of Clinical Microbiology
      Londinium, England, United Kingdom
  • 2001
    • Camden and Islington NHS Foundation Trust
      Londinium, England, United Kingdom