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Catriona S. Bradshaw - One of the best experts on this subject based on the ideXlab platform.

  • provision of hiv test results by telephone is both safe and efficient for men who have sex with men
    International Journal of Std & Aids, 2017
    Co-Authors: Catriona S. Bradshaw, Marcus Y Chen, Eric P F Chow, Melanie Bissessor, Christopher K Fairley
    Abstract:

    The aim of this study was to assess the impact of delivering HIV test results by telephone on HIV testing and subsequent risk behaviour of men, as well as saving on Clinic consultation time. It was conducted at the Melbourne Sexual Health Centre, the main public Sexual Health Clinic servicing Victoria, Australia. In 2013, a policy change was introduced so men could obtain their HIV test result via telephone. We compared the proportion of men testing for HIV and receiving results in the 24 months before (2011-2012) and the 24 months after (2013-2014) the policy change. There was a modest increase in the proportion of men having a HIV test of 3.2% ( p < 0.001) after the policy change. The provision of HIV results by telephone more than halved the number of men re-attending (74.4% vs. 33.1%) which freed up 516 hours of Clinic time and had no adverse outcome on subsequent risk behaviour, nor changed the proportion of men who obtained their HIV results ( p = 0.058), or the period of time between testing and obtaining results for HIV-negative ( p = 0.007) and HIV-positive results ( p = 0.198). Telephone notification of HIV test results is a useful option given the potential beneficial effects shown.

  • substantial increases in chlamydia and gonorrhea positivity unexplained by changes in individual level Sexual behaviors among men who have sex with men in an australian Sexual Health service from 2007 to 2013
    Sexually Transmitted Diseases, 2015
    Co-Authors: Eric P F Chow, Glenda Fehler, Jane Tomnay, Ian Denham, David M. Whiley, Catriona S. Bradshaw, Marcus Y Chen
    Abstract:

    To determine the risk-adjusted temporal trend of gonorrhea and chlamydia positivity and associated risk behaviors among men who have sex with men (MSM) attending a Sexual Health Clinic in Melbourne in Australia. METHODS: Gonorrhea and chlamydia positivity by anatomical site adjusted for year of test, age, number of Sexual partners, and condom use among MSM attending Melbourne Sexual Health Centre from 2007 to 2013 were calculated using generalized estimating equation regression models. RESULTS: A total of 12,873 MSM were included with a median age of 30.0 years. The proportion with pharyngeal, urethral, and anal gonorrhea was 1.7%, 2.3%, and 2.9%, respectively. The adjusted odds of gonorrhea positivity increased by 9% (95% confidence interval [CI], 3%-15%), 11% (95% CI, 6%-17%), and 12% (95% CI, 7%-17%) per year, respectively. The proportion of MSM who were infected with anal chlamydia was 5.6%, with an average increase of 6% (95% CI, 3%-10%) per year; however, no significant change was observed in urethral chlamydia positivity (adjusted odds ratio, 1.02; 95% CI, 0.98-1.06). Increases in gonorrhea and chlamydia positivity were primarily restricted to MSM who reported more than 10 partners in 12 months. The number of partners in the last 12 months fell from 16.6 to 10.5, whereas consistent condom use with casual partners decreased from 64.6% to 58.9% over the study period. CONCLUSIONS: Gonorrhea and chlamydia have increased among MSM despite the decrease in the number of Sexual partners and are occurring primarily in MSM with high numbers of partners and persist after adjusting for known risk factors, suggesting that unmeasured factors (e.g., more assortative mixing patterns) may explain the observed changes.

  • transmission and selection of macrolide resistant mycoplasma genitalium infections detected by rapid high resolution melt analysis
    PLOS ONE, 2012
    Co-Authors: Jimmy Twin, Catriona S. Bradshaw, Christopher K Fairley, Jorgen Skov Jensen, Suzanne M Garland, Limyi Min, Sepehr N Tabrizi
    Abstract:

    Background Mycoplasma genitalium (MG) causes urethritis, cervicitis and pelvic inflammatory disease. The MG treatment failure rate using 1 g azithromycin at an Australian Sexual Health Clinic in 2007–9 was 31% (95%CI 23–40%). We developed a rapid high resolution melt analysis (HRMA) assay targeting resistance mutations in the MG 23S rRNA gene, and validated it against DNA sequencing by examining pre- and post-treatment archived samples from MG-infected patients. Methodology/Principal Findings Available MG-positive pre-treatment (n = 82) and post-treatment samples from individuals with Clinical treatment failure (n = 20) were screened for 23S rRNA gene mutations. Sixteen (20%) pre-treatment samples possessed resistance mutations (A2058G, A2059G, A2059C), which were significantly more common in patients with symptomatic azithromycin-treatment failure (12/26; 44%) than in those Clinically cured (4/56; 7%), p<0.001. All 20 patients experiencing azithromycin-failure had detectable mutations in their post-treatment samples. In 9 of these cases, the same mutational types were present in both pre- and post-treatment samples indicating transmitted resistance, whilst in 11 of these cases (55%), mutations were absent in pre-treatment samples indicating likely selection of resistant isolates have occurred. HRMA was able to detect all mutational changes determined in this study by DNA sequencing. An additional HRMA assay incorporating an unlabelled probe was also developed to detect type 4 single-nucleotide polymorphisms found in other populations, with a slightly lower sensitivity of 90%. Conclusions/Significance Treatment failure is associated with the detection of macrolide resistance mutations, which appear to be almost equally due to selection of resistant isolates following exposure to 1 g azithromycin and pre-existing transmitted resistance. The application of a rapid molecular assay to detect resistance at the time of initial detection of infection allows Clinicians to shorten the time to initiate effective second line treatment. This has the potential to reduce transmission of resistant strains and to avoid sequelae associated with persistent untreated infection.

  • trends in chlamydia and gonorrhea positivity among heteroSexual men and men who have sex with men attending a large urban Sexual Health service in australia 2002 2009
    BMC Infectious Diseases, 2011
    Co-Authors: Lenka A. Vodstrcil, Glenda Fehler, David E Leslie, Jennifer Walker, Catriona S. Bradshaw, Jane S Hocking
    Abstract:

    To determine whether chlamydia positivity among heteroSexual men (MSW) and chlamydia and gonorrhea positivity among men who have sex with men (MSM), are changing. Computerized records for men attending a large Sexual Health Clinic between 2002 and 2009 were analyzed. Chlamydia and gonorrhea positivity were calculated and logistic regression used to assess changes over time. 17769 MSW and 8328 MSM tested for chlamydia and 7133 MSM tested for gonorrhea. In MSW, 7.37% (95% CI: 6.99-7.77) were chlamydia positive; the odds of chlamydia positivity increased by 4% per year (OR = 1.04; 95% CI: 1.01-1.07; p = 0.02) after main risk factors were adjusted for. In MSM, 3.70% (95% CI: 3.30-4.14) were urethral chlamydia positive and 5.36% (95% CI: 4.82-5.96) were anal chlamydia positive; positivity could not be shown to have changed over time. In MSM, 3.05% (95% CI: 2.63-3.53) tested anal gonorrhea positive and 1.83% (95% CI: 1.53-2.18) tested pharyngeal gonorrhea positive. Univariate analysis found the odds of anal gonorrhea positivity had decreased (OR = 0.93; 95% CI: 0.87-1.00; p = 0.05), but adjusting for main risk factors resulted in no change. Urethral gonorrhea cases in MSM as a percentage of all MSM tested for gonorrhea also fell (p < 0.001). These data suggest that chlamydia prevalence in MSW is rising and chlamydia and gonorrhea prevalence among MSM is stable or declining. High STI testing rates among MSM in Australia may explain differences in STI trends between MSM and MSW.

  • computer assisted self interviewing in a Sexual Health Clinic as part of routine Clinical care impact on service and patient and Clinician views
    PLOS ONE, 2011
    Co-Authors: Lenka A. Vodstrcil, Jane S Hocking, Catriona S. Bradshaw, Marcus Y Chen, Rosey Cummings, Tim R H Read, Jun K Sze, Christopher K Fairley
    Abstract:

    Background Computer assisted self interviewing (CASI) has been used at the Melbourne Sexual Health Centre (MSHC) in Victoria, Australia since June 2008, to obtain a pre-consultation Sexual risk history. We aimed to evaluate the impact of CASI on consultation times, STI testing rates, patient response rates to CASI questions, and obtain patient and Clinician views on CASI. Methods The proportion of patients who declined to answer questions using CASI since 2008 was calculated. We then used the same 12 week period (Feb to May) over three years (2008 pre-CASI), (2009 CASI period), and (2010 non-CASI period-due to a computer theft) to assess consultation times and STI-testing rates. We carried out surveys of Clinicians and patients to determine their experience and the acceptability of CASI as part of routine Clinical practice. Results 14 190 patients completed CASI during the audit period. Men were more likely than women to decline questions about the number of partners they had of the opposite sex (4.4% v 3.6%, p=0.05) and same sex (8.9% v 0%, p Conclusions This is the first evaluation of CASI operating routinely in a Sexual Health Clinic. We have demonstrated that CASI is acceptable to most patients and Clinicians in a Sexual Health setting and does not adversely affect various measures of Clinical output. The true value of CASI is most likely to be realised when it is integrated with further innovations in Clinical care such as the development of express Clinical services, decision support software and detailed behavioural surveillance system.

David J Templeton - One of the best experts on this subject based on the ideXlab platform.

  • enhanced surveillance of a lymphogranuloma venereum outbreak in sydney 2010 2012
    Australian and New Zealand Journal of Public Health, 2016
    Co-Authors: David J Templeton, Kellyanne Ressler, Kirsty Hope, Isobel Mary Poynten
    Abstract:

    Objectives: To investigate an increase in lymphogranuloma venereum (LGV) notifications in New South Wales (NSW). Methods: Enhanced surveillance of notified LGV cases in NSW between May 2010 and April 2012 using doctor and patient questionnaires. Results: Thirty-seven doctors who had diagnosed 67 (76%) of 88 notified anorectal LGV infections were interviewed. The majority (n=33, 89%) of treating doctors were formally trained and accredited in HIV management and prescribing, and most (n=32, 86%) worked in a public Sexual Health Clinic or a general practice with a high caseload of men who have sex with men (MSM). All 67 cases were MSM who resided in inner-city Sydney and all were serovar L2b. Anal symptoms had been present in 64 cases (96%, 95%CI 87–99%) for a median of 8 days (range 2–1,825) prior to presentation. Almost one-third (n=20) had another concurrent STI diagnosed. Most (82%) of the 22 interviewed patients reported being HIV positive and having other STIs diagnosed over the past year. In the preceding month, all 22 men reported condomless anal sex and the median number of casual Sexual partners was 5 (range 0–100). Conclusions: Characteristics of LGV cases in NSW are similar to those described worldwide, suggesting that a Sexually adventurous subgroup of MSM are at particular risk of infection. Implications: Education of non-Sexual-Health Clinicians on LGV risk factors, presentation, testing and management may allow more timely diagnosis and notification of contacts to reduce LGV transmission in the community.

  • efficacy and acceptability of an intervention for tobacco smoking cessation in hiv positive individuals at a public Sexual Health Clinic
    Sexually Transmitted Infections, 2015
    Co-Authors: Loretta Healey, David J Templeton, C Michaels, Renee Bittoun
    Abstract:

    The negative Health impacts of cigarette smoking have particular relevance for HIV-positive individuals who have high rates of smoking1 and elevated risks of cardiovascular disease and some malignancies.2 Counselling and nicotine replacement therapy have been shown to be effective in smoking cessation.3 These interventions were offered free to HIV-positive individuals at a publically funded Sexual Health Clinic in Sydney in an effort to curb the comorbidities associated with smoking. Between January 2010 and November 2011, 41 HIV-positive male smokers were enrolled in a smoking cessation programme at RPA Sexual Health. Participants were asked to return at 6 and 12 months post-treatment for …

Rejean Thomas - One of the best experts on this subject based on the ideXlab platform.

  • cohort profile l actuel pre exposure prophylaxis prep cohort study in montreal canada
    BMJ Open, 2019
    Co-Authors: Zoe R Greenwald, Michel Boissonnault, Jason Szabo, Mathieu Maheugiroux, Judith Robin, Vinhkim Nguyen, Rejean Thomas
    Abstract:

    Purpose The l’Actuel PrEP Cohort was established to monitor the uptake, effectiveness, safety and changes in Sexual risk behaviours among individuals receiving pre-exposure prophylaxis (PrEP) for the prevention of HIV. This prospective dynamic cohort is based at Clinique medicale l’Actuel, a large Sexual Health Clinic located in Montreal, Canada. Participants Since the cohort inception in January of 2013 through June 2018, 2156 individuals consulted for PrEP as participants in the l’Actuel PrEP Cohort. Median age was 35 years (IQR: 29–44 years) and the majority (96%) were men who have sex with men. Among 1551 individuals who initiated PrEP care, the median duration of follow-up was 9.2 months (IQR: 3.7–19.6), with substantial variation based on year of cohort entry. The l’Actuel PrEP Cohort contains both daily and intermittent ‘on-demand’ PrEP users and has the largest reported population of intermittent PrEP users (n=406) in North America. Findings to date No incident HIV infections have occurred among individuals using PrEP over 1637 person-years of follow-up. However, retention in PrEP care is essential as three individuals who discontinued PrEP subsequently acquired HIV, translating to an HIV incidence of 3.9 cases per 100 person-years (95% CI: 1.3 to 12.1). Among a sample of participants with 1 year of follow-up before and after PrEP initiation (n=109), a moderate increase in Sexually transmitted infections was observed following PrEP start. Future plans The l’Actuel PrEP Cohort continues to grow with new participants starting PrEP monthly and extended follow-up for existing users. The cohort data will be used for ongoing monitoring of PrEP and for population-level modelling of the impact of PrEP on HIV incidence in Montreal.

  • p3 189 recurrence of human papillomavirus external genital wart infection among high risk adults in montreal quebec
    Sexually Transmitted Infections, 2017
    Co-Authors: Rejean Thomas, Marc Steben, Zoe R Greenwald, Melissa Stutz, Caroline Rodier, Fern Deangelis, Emmanouil Rampakakis
    Abstract:

    Introduction External genital warts (EGW) are associated with high psychosocial burden and Health care costs, may be difficult to treat, and recur frequently. However, the incidence of recurrent EGW is not well characterised; this is especially true in a post-human papilloma virus (HPV) vaccination era. The objectives of this study were to assess the incidence of subsequent HPV-related EGW in high-risk male and female adults, as well as ascertain patient profile and disease characteristics, in a real-world Canadian Clinical setting. Methods A retrospective chart review study was conducted at Clinique medicale l’Actuel, a Sexual Health Clinic in Montreal, Quebec, Canada. Eligible patients were 18–45 years of age with a first diagnosis of EGW between July 1, 2006 and June 30, 2012. Results A total of 400 first-episode EGW cases were identified. Up to 6 subsequent episodes were documented, with 194 (48.5%) patients reporting at least 1 subsequent EGW episode. Median time to 1st subsequent EGW episode was 3.97 years, and the incidence density rate for all subsequent episodes was 0.18/100 patient-years. Over 90% of patients reported clearance of the first subsequent episode, with median time to clearance of 0.30 years. Regardless of subsequent episode number, >95% of patients received treatment, primarily cryotherapy, with high-risk Sexual behaviour reducing as number of episodes increased. Conclusion Overall, a high rate of subsequent EGW episodes was observed in this high-risk population despite high treatment rates and improvement in high-risk Sexual behaviour with increasing number of subsequent episodes. This is the first assessment of the rate of EGW recurrence in a Canadian Clinical setting, in addition to proving information related to risk factors, Clinical manifestations, and interventions. These data, assessed in a pre-vaccination Quebec Healthcare system, may be compared to future EGW rates in order to evaluate the impact of a governmentally-funded HPV vaccination program. Support: R. Thomas has received consulting fees from AbbVie, Gilead, Merck, and ViiV; M. Steben has received speaker honoraria or participated in Advisory Boards for Merck, Paladin, Valeant and Inovio; M. Stutz and E. Rampakakis are both employees of JSS Medical Research; C. Rodier and F. DeAngelis are both employees of Merck Canada Inc.

A K Sullivan - One of the best experts on this subject based on the ideXlab platform.

  • texting decreases the time to treatment for genital chlamydia trachomatis infection
    Sexually Transmitted Infections, 2006
    Co-Authors: Anatole Menonjohansson, F Mcnaught, Sundhiya Mandalia, A K Sullivan
    Abstract:

    OBJECTIVE: To assess the effectiveness of a text message result service within an inner London Sexual Health Clinic. METHOD: Demographic data, diagnoses, and time to diagnosis and treatment were collected over a 6 month period for patients receiving text messages and a matched standard recall group. Data on messages sent, staff time, and cost in relation to result provision were collected. RESULTS: Over a 6 month period 952 text messages were sent. In the final month of analysis, 33.9% of all Clinic results were provided by text, resulting in a saving of 46 hours of staff time per month. 49 messages requested that the patient return for treatment, 28 of these patients had untreated genital Chlamydia trachomatis (CT) infection. The mean number of days (SD) to diagnosis was significantly shorter in the text message group (TG) v the standard recall group (SG) (7.9 (3.6) v 11.2 (4.7), p <0.001). The median time to treatment was 8.5 days (range 4-27 days) for the TG group v 15.0 (range 7-35) for SG, p = 0.005. CONCLUSION: Patients with genital CT infection are diagnosed and receive treatment sooner since the introduction of a text message result service. The introduction of this service has resulted in a significant saving in staff time.

  • texting decreases the time to treatment for genital chlamydia trachomatis infection
    Sexually Transmitted Infections, 2006
    Co-Authors: Anatole Menonjohansson, F Mcnaught, Sundhiya Mandalia, A K Sullivan
    Abstract:

    Objective: To assess the effectiveness of a text message result service within an inner London Sexual Health Clinic. Method: Demographic data, diagnoses, and time to diagnosis and treatment were collected over a 6 month period for patients receiving text messages and a matched standard recall group. Data on messages sent, staff time, and cost in relation to result provision were collected. Results: Over a 6 month period 952 text messages were sent. In the final month of analysis, 33.9% of all Clinic results were provided by text, resulting in a saving of 46 hours of staff time per month. 49 messages requested that the patient return for treatment, 28 of these patients had untreated genital Chlamydia trachomatis (CT) infection. The mean number of days (SD) to diagnosis was significantly shorter in the text message group (TG) v the standard recall group (SG) (7.9 (3.6) v 11.2 (4.7), p v 15.0 (range 7–35) for SG, p  =  0.005. Conclusion: Patients with genital CT infection are diagnosed and receive treatment sooner since the introduction of a text message result service. The introduction of this service has resulted in a significant saving in staff time.

Zoe R Greenwald - One of the best experts on this subject based on the ideXlab platform.

  • pre exposure prophylaxis uptake among users of non occupational post exposure prophylaxis a longitudinal analysis of attendees at a large Sexual Health Clinic in montreal
    medRxiv, 2020
    Co-Authors: Yiqing Xia, Zoe R Greenwald, Rachael M Milwid, Claire Trottier, Michel Boissonnault, Neil Gaul, Louise Charest, Gabrielle Landry, Navid Zahedi, Jason Szabo
    Abstract:

    Abstract Background Reducing HIV transmission using pre-exposure prophylaxis (PrEP) requires targeting individuals at high acquisition risk, such as men who have sex with men (MSM) with a history of non-occupational post-exposure prophylaxis (nPEP). This study aims to characterize longitudinal trends in PrEP uptake and its determinants among nPEP users in Montreal. Methods Eligible attendees at Clinique medicale l’Actuel were recruited prospectively starting in October 2000 (nPEP) and January 2013 (PrEP). Linking these cohorts, we characterized the PEP-to-PrEP cascade, examined the determinants of PrEP uptake after nPEP consultation using a Cox proportional-hazard model, and assessed whether PrEP persistence differed by nPEP history using Kaplan-Meier curves. Results As of August 2019, 31% of 2,682 MSM nPEP cohort participants had two or more nPEP consultations. Subsequent PrEP consultations occurred among 36% of nPEP users, of which 17% sought nPEP again afterwards. Among 2,718 PrEP cohort participants, 46% reported previous nPEP use. Among nPEP users, those aged 25-49 years (Hazard Ratio (HR)=1.3, 95% confidence interval (CI): 1.1-1.7), with more nPEP episodes (HR=1.4, 95%CI: 1.3-1.5), reported chemsex (HR=1.3, 95%CI: 1.1-1.7), with a STI history (HR=1.5; 95%CI: 1.3-1.7), and who returned for their first nPEP follow-up visit (HR=3.4, 95%CI: 2.7-4.2) had higher rates of PrEP linkage. There was no difference in PrEP persistence between PEP-to-PrEP and PrEP only participants. Conclusion Over one-third of nPEP users were subsequently prescribed PrEP. However, the large proportion of men who repeatedly use nPEP calls for more efficient PrEP-linkage services and, among those that use PrEP, improved persistence should be encouraged.

  • cohort profile l actuel pre exposure prophylaxis prep cohort study in montreal canada
    BMJ Open, 2019
    Co-Authors: Zoe R Greenwald, Michel Boissonnault, Jason Szabo, Mathieu Maheugiroux, Judith Robin, Vinhkim Nguyen, Rejean Thomas
    Abstract:

    Purpose The l’Actuel PrEP Cohort was established to monitor the uptake, effectiveness, safety and changes in Sexual risk behaviours among individuals receiving pre-exposure prophylaxis (PrEP) for the prevention of HIV. This prospective dynamic cohort is based at Clinique medicale l’Actuel, a large Sexual Health Clinic located in Montreal, Canada. Participants Since the cohort inception in January of 2013 through June 2018, 2156 individuals consulted for PrEP as participants in the l’Actuel PrEP Cohort. Median age was 35 years (IQR: 29–44 years) and the majority (96%) were men who have sex with men. Among 1551 individuals who initiated PrEP care, the median duration of follow-up was 9.2 months (IQR: 3.7–19.6), with substantial variation based on year of cohort entry. The l’Actuel PrEP Cohort contains both daily and intermittent ‘on-demand’ PrEP users and has the largest reported population of intermittent PrEP users (n=406) in North America. Findings to date No incident HIV infections have occurred among individuals using PrEP over 1637 person-years of follow-up. However, retention in PrEP care is essential as three individuals who discontinued PrEP subsequently acquired HIV, translating to an HIV incidence of 3.9 cases per 100 person-years (95% CI: 1.3 to 12.1). Among a sample of participants with 1 year of follow-up before and after PrEP initiation (n=109), a moderate increase in Sexually transmitted infections was observed following PrEP start. Future plans The l’Actuel PrEP Cohort continues to grow with new participants starting PrEP monthly and extended follow-up for existing users. The cohort data will be used for ongoing monitoring of PrEP and for population-level modelling of the impact of PrEP on HIV incidence in Montreal.

  • p3 189 recurrence of human papillomavirus external genital wart infection among high risk adults in montreal quebec
    Sexually Transmitted Infections, 2017
    Co-Authors: Rejean Thomas, Marc Steben, Zoe R Greenwald, Melissa Stutz, Caroline Rodier, Fern Deangelis, Emmanouil Rampakakis
    Abstract:

    Introduction External genital warts (EGW) are associated with high psychosocial burden and Health care costs, may be difficult to treat, and recur frequently. However, the incidence of recurrent EGW is not well characterised; this is especially true in a post-human papilloma virus (HPV) vaccination era. The objectives of this study were to assess the incidence of subsequent HPV-related EGW in high-risk male and female adults, as well as ascertain patient profile and disease characteristics, in a real-world Canadian Clinical setting. Methods A retrospective chart review study was conducted at Clinique medicale l’Actuel, a Sexual Health Clinic in Montreal, Quebec, Canada. Eligible patients were 18–45 years of age with a first diagnosis of EGW between July 1, 2006 and June 30, 2012. Results A total of 400 first-episode EGW cases were identified. Up to 6 subsequent episodes were documented, with 194 (48.5%) patients reporting at least 1 subsequent EGW episode. Median time to 1st subsequent EGW episode was 3.97 years, and the incidence density rate for all subsequent episodes was 0.18/100 patient-years. Over 90% of patients reported clearance of the first subsequent episode, with median time to clearance of 0.30 years. Regardless of subsequent episode number, >95% of patients received treatment, primarily cryotherapy, with high-risk Sexual behaviour reducing as number of episodes increased. Conclusion Overall, a high rate of subsequent EGW episodes was observed in this high-risk population despite high treatment rates and improvement in high-risk Sexual behaviour with increasing number of subsequent episodes. This is the first assessment of the rate of EGW recurrence in a Canadian Clinical setting, in addition to proving information related to risk factors, Clinical manifestations, and interventions. These data, assessed in a pre-vaccination Quebec Healthcare system, may be compared to future EGW rates in order to evaluate the impact of a governmentally-funded HPV vaccination program. Support: R. Thomas has received consulting fees from AbbVie, Gilead, Merck, and ViiV; M. Steben has received speaker honoraria or participated in Advisory Boards for Merck, Paladin, Valeant and Inovio; M. Stutz and E. Rampakakis are both employees of JSS Medical Research; C. Rodier and F. DeAngelis are both employees of Merck Canada Inc.