Infection control in the setting of the office based clinic, involves the early detection of disease; disease prevention through vaccination as in influenza and pneumococcal vaccinations; and through screening for asymptomatic disease as in tuberculosis. Family physicians play an important role in these aspects within the community. Although influenza vaccination is effective, the take up rate of vaccination locally is low. Annual vaccination with the current vaccines are strongly recommended in high risk populations such as the elderly, the immunocompromised and, those with co-morbidities. The inactivated trivalent vaccine is the most commonly used. Latent Tuberculosis (TB) Infection is asymptomatic and often goes undetected. Prevention of progression to overt TB can be achieved by identifying high risk persons and the early detection by either the tuberculin skin test or interferon gamma release assays (IGRAs). Invasive pneumococcal disease can lead to significant morbidity and mortality in the young and elderly. In the preventive control of this disease, there are two types of pneumococcal vaccines currently available – the polysaccharide vaccine and the conjugate vaccine. Recommendations for the two different vaccines are in accordance with different at risk populations.

INTRODUCTIONHIV-associated neurocognitive disorders (HAND) comprise a wide spectrum of cognitive, motor, and mood abnormalities prevalent in people living with HIV and AIDS (PLWHAs). This field of HIV medicine has gained renewed prominence in recent years with evidence contending that anti-retroviral agents with increased central nervous system (CNS) penetration may improve neurocognitive outcomes in those affected. This review aims at evaluating the available evidence and postulating further study direction in Singapore.

MATERIALS AND METHODSA PubMed search was carried out for original articles and systematic reviews on the subject of HIV-associated neurocognitive disorders, and the results reviewed by the authors.

RESULTSThere is a growing body of evidence that HAND is not uncommon, and the advent of highly active anti-retroviral therapy has increased its prevalence by improving the prognosis of HIV infection, and hence increasing the likelihood of diagnosing of this neurocognitive condition. Screening and diagnosing HAND is important, and requires clinical suspicion as well as validated test batteries for optimal accuracy. The authors recommend strategies for detection in the local context involving stepwise targeted screening. Anti-retroviral agents with good CNS penetration and activity, as well as adjunctive neuro-rehabilitative interventions, may improve the impairments experienced by affected individuals.

CONCLUSIONIncreased awareness of HAND, with earlier diagnosis and targeted, multi-disciplinary management of this challenging condition, may lead to better all-round outcomes for people living with HIV and AIDS in Singapore.

AIDS Dementia Complex ; Anti-HIV Agents ; therapeutic use ; Anti-Retroviral Agents ; therapeutic use ; Antiretroviral Therapy, Highly Active ; HIV Infections ; drug therapy ; Humans ; Neurocognitive Disorders ; Prevalence

COVID-19/diagnosis* ; Coinfection/diagnosis* ; Female ; HIV Infections/diagnosis* ; Humans ; Middle Aged ; Severity of Illness Index

INTRODUCTIONHighly active antiretroviral therapy (HAART) has improved outcomes for individuals infected with human immunodeficiency virus (HIV). This study describes the causes of death in hospitalised HIV-positive patients from 2008 to 2010 in Tan Tock Seng Hospital, the national referral centre for HIV management in Singapore.

MATERIALS AND METHODSData were retrospectively collected from HIV-positive patients who died in Tan Tock Seng Hospital from January 2008 to December 2010.

RESULTSSixty-seven deaths occurred in the study period. A majority of patients died of non-acquired immune deficiency syndrome (AIDS)-defining illnesses (54.7%). The median CD4 count was 39.5 (range, 20.0 to 97.0), and 7 patients had HIV viral loads of <200 copies/mL. There were 27 deaths due to opportunistic infections, 27 due to non AIDS-defining infections, 4 due to non AIDS-associated malignancies. This study also describes 3 deaths due to cardiovascular events, and 1 due to hepatic failure. Patients who had virologic suppression were more likely to die from non AIDS-defining causes.

CONCLUSIONCauses of death in HIV-positive patients have changed in the HAART era. More research is required to further understand and address barriers to testing and treatment to further improve outcomes in HIV/AIDS.

Anti-Retroviral Agents ; therapeutic use ; CD4 Lymphocyte Count ; Cause of Death ; trends ; Female ; HIV Seropositivity ; drug therapy ; epidemiology ; mortality ; Hospital Mortality ; trends ; Hospitalization ; Humans ; Male ; Medical Audit ; Middle Aged ; Retrospective Studies ; Singapore ; epidemiology

Betacoronavirus ; Coronavirus Infections ; epidemiology ; transmission ; Disease Transmission, Infectious ; prevention & control ; Education, Medical, Graduate ; organization & administration ; Humans ; Internship and Residency ; organization & administration ; Pandemics ; Pneumonia, Viral ; epidemiology ; transmission ; Quality Improvement

Humans ; HIV Infections/prevention & control* ; Pre-Exposure Prophylaxis