Aim:
To explore the association of chronic HIV infection with co-morbid cardiovascular disease (CVD) in one high case-load inner Sydney general practice, in part to reconnect with normal clinical practice post Covid pandemic restrictions.
Rationale:
The proportion of people infected with HIV older than 50 is increasing across first world countries; non-AIDS defining disease is now a more common cause of morbidity and mortality than AIDS. Some older antiretroviral treatments increased the risk of ischaemic heart disease, largely mediated by dysregulated lipids, but people now live longer with the associated increased risks of CVD, Type 2 Diabetes (T2DM), central adiposity, chronic kidney disease and poly pharmacy with the potential for drug-drug interactions.
The increased risk of CVD is thought to approximate that of co-incident T2DM.
Methods:
Electronic medical records of patients with chronic HIV infection seen at East Sydney Doctors since updated computer software was introduced in 2000 were reviewed. Co-morbid diagnoses of acute myocardial infarction (both ST elevation or STEMI and non-ST elevation or NSTEMI), peripheral vascular disease and heart failure.
Summary:
1055 HIV infected people were seen: 13 female (age range 18-72) and 3 male-to-female trans-gender.
Tools used:
The Cardiac Society of Australia and New Zealand refers to management guidelines produced by the European Society of Cardiology. There are guidelines for heart failure (HF 2021), STEMI (AMI.STEMI 2017), NSTEMI (NSTE 2020) and peripheral vascular disease (PAD 2017).
Management of these conditions in this population will be assessed against these guidelines.
Study limitations:
As in all real-life settings, data depends on the quality of information recorded by the consulting doctor.
References:
European Society of Cardiology htpps://escardio.org
Learning objective:
Identify the increased risk of CVD in HIV positive patients.

1. HIV infection is associated with an increased risk of cardiovascular disease. 2. Review of care against guidelines can inform future practice

Context. The medical care of trans(gender) people is currently under scrutiny in France with the publication in 2022 of the Report on the health and care pathways of trans people. Access to health care for the trans population is marked by stigmatisation. Their relationship with health care providers is under-investigated.

Aim. To explore trans people’s experiences in relation to all health care providers, whether within or outside the transition process, in order to highlight the positive and negative qualitative factors impacting their relationship with healthcare providers.

Method. Qualitative study by semi-structured individual interviews with people self-identifying as trans from April 2021 to July 2022. The interviews were double coded and analyzed by themes.

Results. All 20 participants reported having experienced violence from health care providers. On the other hand, some reported what they considered to be good practice. They described strategies they had developed to deal with the violence they had experienced or anticipated. The involvement in their care was present on an individual level but also for some on a community level. Finally, they shared their expectations regarding health care providers.

Conclusion. This study describes the violence suffered by trans people in their patient-provider relationships, but also the good practices implemented by health care providers. It also identifies the strategies developed in response to violence, and reinforces the status of trans people as expert patients. The recognition of these strategies and this status by health care providers can lead to an improvement in the patient-provider relationship with trans people.

1. communication skills
2. consent request
3. call name firstname in waiting room (no mention of gender)

Background:
Availability of effective antiretroviral therapy (ART) has improved survival and older adults (≥ 50 years old) constitute approximately 10% of the world’s Human Immunodeficiency Virus (HIV) population. However, data on this peculiar population is lacking, especially in sub-Saharan Africa.

Aim:
To profile older adults with HIV infection receiving ART and identify the factors associated with their treatment outcomes.

Methods:
A retrospective cross-sectional study involving HIV patients ≥50 years, registered at a University Hospital in Kumasi, Ghana from January, 2010 to July, 2020. All study participants had been on ARTs for ≥ 12 months. Data was analysed using STATA® and multivariate logistic regression was done to determine association between variables.

Results:
132 study participants were recruited with a mean age of 58.1 years (±6.8). Non-communicable diseases (NCD) comprised the commonest comorbidity (67.4%; n=89) and hypertension was the most prevalent (47.2%). The mean duration of ART was 63.2 months (±32.0) and approximately 84.1% (n = 111) achieved viral suppression (≤50 copies/ml). After adjustment, factors independently associated with viral suppression were widow(ed) (aOR = 0.23; 95% CI = 0.07 – 0.72) and good ART adherence (aOR = 3.51; 95% CI = 1.03 – 11.99).

Conclusion:
Hypertension is prevalent among this cohort of HIV patients. Approximately 84% of elderly patients on ARTs achieve viral suppression, influenced by widowhood and good drug adherence.

Takeaways:
Given the increasing number of elderly patients with HIV coupled with the associated challenges of aging, HIV care providers, researchers and policy makers should channel essential resources and attention to this population.

1. There is an increasing number of older adults living with HIV globally
2. Comorbidities, particularly hypertension and other diseases of aging, are common among older adults with HIV
3. With effective treatment and drug adherence, viral suppression can be achieved

Introduction:
It has been pointed out that not only the sex of the patient but also the gender of the physician may affect various patient outcomes. In the prevention of atherosclerotic diseases, gender differences may play a role in modifying risk factors, but the extent of this effect remains unclear. This study aims to investigate whether there is an interaction between the gender of the patient and the gender of the physician in relation to the achievement of systolic blood pressure (SBP) control targets.
Methods:
This cross-sectional study utilised electronic medical records from an urban clinic in Japan. Participants were aged 40-79 years and had a history of coronary artery disease or non-cardioembolic stroke. Multivariable logistic regression models were employed to evaluate the associations between the patient's sex, the physician's gender and the proportion of patients achieving the SBP targets. The interaction between the patient's sex and the physician's gender was also considered in this model. Relevant covariates were patient sex, physician gender, age, body mass index, and smoking history.
Results:
A total of 232 participants were included in this study (28.7% were women). Regarding the patient's sex, the proportion of SBP target achievement was 61.0% for men and 65.6% for women. Male physicians were less likely to achieve SBP goals (53.8% of male physicians vs 72.0% of female physicians). After adjusting for covariates, female physicians were more likely to achieve SBP targets (adjusted odds ratio: 2.39, 95% CI: 1.28-4.46). There was no apparent interaction between the patient's sex and the physician's gender.
Conclusions:
There was no apparent interaction between the patient's sex and the physician's gender. Male physicians were less likely to achieve SBP targets compared to female physicians. Quality improvement interventions aimed at improving this situation are warranted.

1. The consideration of gender in practice enhances comprehension of diseases.
2. Gender impacts the physician-patient dynamic.
3. Physician gender may also play a role in managing comorbidities.