11th Annual Conference of the British HIV Association

20–23 April 2005, Burlington Hotel·Dublin·Ireland


Cite as BHIVA Conf 2005 Apr 20-23;11:xxx
where "xxx" is the abstract number.

Oral Abstracts

O1 A DECADE OF CHLAMYDIA IN LEEDS: COMPARATIVE ANALYSIS OF DEMOGRAPHIC AND GEOSPATIAL RISK FACTORS AT THE ONSET OF CHLAMYDIA SCREENING
BHIVA Conf 2005 Apr 20-23;11:O1
AL Evans1, D Merrick2, EF Monteiro1, MH Wilcox1, CJN Lacey3
Chlamydia continues to show a wide geospatial distribution with increased risk in under-25s and black ethnic groups. Women are now diagnosed mostly in community settings and efforts will need to be concentrated on partner notification to reduce transmission.
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O2 FREE AVAILABILITY OF POSTAL TESTING KITS FOR CHLAMYDIA IN COLLEGES OF FURTHER EDUCATION AS AN ALTERNATIVE TO NURSE-LED CLINICS: A PROSPECTIVE CROSSOVER INTERVENTION TRIAL
BHIVA Conf 2005 Apr 20-23;11:O2
DJ Clutterbuck, K Carrick-Anderson, K Allison, GR Scott, L McKay
Free distribution of postal testing kits generated a lower percentage return rate than supervised distribution (15% (157/891) vs 25% (38/152), χ2=9.07; P=0.026) but results in a greater number of students being tested. Although all methods were successful in accessing men for testing, postal testing kits carried no additional advantage over clinics. Free distribution of postal testing kits detects a greater number of infections than alternative models with comparable outcomes but reduced manpower requirements.
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O3 THE MANAGEMENT OF CHLAMYDIA TRACHOMATIS IN GENITOURINARY MEDICINE CLINICS: A NATIONAL AUDIT IN 2004
BHIVA Conf 2005 Apr 20-23;11:O3
R Challenor1, S Pinsent1, S Chandramani2, N Theobald3, D Daniels4
GUM clinics are delivering high quality care and evidence based national outcome standards are being met.
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O4 COMPLIANCE WITH NOVEL ‘PARTNER INTERVENTIONS’ AMONGST MALE SEXUAL PARTNERS OF WOMEN WITH CHLAMYDIA TRACHOMATIS
BHIVA Conf 2005 Apr 20-23;11:O4
A Johnstone, S Cameron, A Glasier, H Young, GR Scott
These preliminary results suggest that postal testing and PDPM may be similar to standard contact tracing in terms of proportion of sexual partners known to be tested/treated.
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O5 COMPARISON OF VIRUS CULTURE AND TaqMAN REAL-TIME POLYMERASE CHAIN REACTION (PCR) FOR DETECTION OF GENITAL HERPES SIMPLEX VIRUS (HSV) INFECTION
BHIVA Conf 2005 Apr 20-23;11:O5
MK Malu1, R Cunningham2, J Northwood2, S Shaw3, JR Willcox2
The PCR is significantly more sensitive in detecting HSV (more sensitive for type 2 than type 1 virus) compared to culture.
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O6 DO PEOPLE WITH GENITAL HERPES TELL THEIR SEXUAL PARTNERS? THE INFLUENCE OF STIGMA
BHIVA Conf 2005 Apr 20-23;11:O6
J Bickford, SE Barton, S Mandalia
The reaction to a diagnosis of genital herpes and the decision to disclose or not is influenced by cultural understanding of the infection as well the value of the relationship in which the disclosure may occur. Our study demonstrated that stigma is a barrier to disclosure of genital herpes diagnosis. Management strategies aimed at encouraging disclosure to sexual partners must address stigma.
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O7 HAS YOUNG PEOPLE'S KNOWLEDGE AND USE OF CONTRACEPTIVE SERVICES INCREASED SINCE THE INTRODUCTION OF THE TEENAGE PREGNANCY STRATEGY? FINDINGS FROM THE TEENAGE PREGNANCY STRATEGY EVALUATION
BHIVA Conf 2005 Apr 20-23;11:O7
RS French1, CH Mercer1, R Kane2, P Kingori1, JM Stephenson1, K Lachowycz2, P Wilkinson2, K Wellings2
There has been some success in increasing knowledge and use of services, but it may be too early to observe any positive changes in outcomes.
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O8 CORRELATION OF ERECTILE DYSFUNCTION (ED) SEVERITY AS PERCEIVED BY UK HEALTHCARE PROFESSIONAL COMPARED TO THE INTERNATIONAL INDEX OF ERECTILE FUNCTION SCORE (IIEF): RESULTS FROM THE ERECTILE DYSFUNCTION OBSERVATIONAL STUDY (EDOS)
BHIVA Conf 2005 Apr 20-23;11:O8
P Kell1, J Arellano2, M Noone2, A Riley3, S Kontodimas2
Actual numbers of men with severe ED may be under-reported without the use of tools such as the IIEF questionnaire. *IIEF-EF domain score categories: Normal (26–30), Mild (17–25), Moderate (11–16), Severe (1–10).
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O9 ANTIRETROVIRAL THERAPY IN A NEW PUBLIC SECTOR ANTIRETROVIRAL TREATMENT CENTRE IN GHANA: PATIENTS' PRESENTATION AND RESPONSE
BHIVA Conf 2005 Apr 20-23;11:O9
P Collini1, M Adjei1, K Torpey2, R Amenyah2, D Chadwick3, G Bedu-Addo1
Effective and safe ART is achievable when scaling up.
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O10 TARGETING POINTS FOR FURTHER INTERVENTION: A REVIEW HIV INFECTED INFANTS BORN IN IRELAND IN THE 5 YEARS FOLLOWING INTRODUCTION OF ANTENATAL SCREENING
BHIVA Conf 2005 Apr 20-23;11:O10
W Ferguson2, K Butler1,2,3, A Menon3 , M Goode1, L Barrett1, A Walsh1, M Cafferkey2,3
There remain identifiable targets for intervention (pre-conceptual screening, early booking, repeat tests for at-risk women, adherence support). The problem of early in-utero transmission remains.
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O11 EVALUATION OF NELFINAVIR-BASED MOTHER-TO-CHILD TRANSMISSION REGIMENS
BHIVA Conf 2005 Apr 20-23;11:O11
S O’Dea1, F Mulcahy1, F Lyons1, H McDermott1, C Bergin1, S Coughlan2
At standard nelfinavir dosing almost half the cohort failed to achieve virological suppression <50cpm, suggesting that routine TDM should be considered. Despite this, the absence of PI mutations after treatment cessation suggests that short-term nelfinavir use may not be detrimental to future maternal ART options.
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O12 INCREASED PSYCHOSIS IN HIV-1-INFECTED SUB-SAHARAN AFRICAN IMMIGRANTS
BHIVA Conf 2005 Apr 20-23;11:O12
A Holmes, S O’Dea, A O’Dwyer, F Mulcahy
This study confirms the hypothesis that SSA immigrants are at increased risk of psychological morbidity. The incidence of psychotic illness was notably high. We believe that cultural beliefs and the influence of immigration are important factors in both the rate and type of psychological morbidity.
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O12A SEXUAL BEHAVIOUR AND RISK OF ONGOING TRANSMISSION IN SYMPTOMATIC PATIENTS ATTENDING GENITOURINARY MEDICINE CLINICS
BHIVA Conf 2005 Apr 20-23;11:O12A
JA Cassell, CH Mercer, L Sutcliffe, MG Brook, E Jungmann, J Ross, G Kinghorn, J Stephenson, A M Johnson on behalf of the PATSI collaboration
Our data reinforce the need for rapid access to diagnostic and treatment services, for all patients and not just ‘high risk’ groups. Health promotion should emphasize the need for individuals to seek rapid care and cease sexual activity when an STI is suspected.
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O13 OVERSEAS TRAVEL, HIGH-RISK SEXUAL BEHAVIOUR AND STI TRANSMISSION RISK AMONG BRITISH ADULTS: RESULTS OF A NATIONAL PROBABILITY SURVEY OF SEXUAL ATTITUDES AND LIFESTYLES
BHIVA Conf 2005 Apr 20-23;11:O13
KA Fenton, CH Mercer, AM Johnson, AJ Copas, B Erens, K Wellings
Although travellers who have sex abroad select partners from their own geographic regions, their higher prevalence of sexual risk behaviours at home and abroad place them at greater risk and in need of targeted sexual health promotion.
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O14 HIGH-RISK SEXUAL BEHAVIOUR AMONG LONDON GAY MEN: NO LONGER INCREASING?
BHIVA Conf 2005 Apr 20-23;11:O14
J Elford, G Bolding, M Davis, L Sherr1, G Hart2
The percentage of London gay men reporting high risk sexual behaviour with a casual partner has remained stable since 2001, although it increased significantly between 1998–2001. Addressing this elevated level of risk will present a challenge for sexual health promotion.
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O15 RISK FACTORS FOR THE ACQUISITION OF HIV IN INDIVIDUALS KNOWN TO HAVE RECENTLY SEROCONVERTED
BHIVA Conf 2005 Apr 20-23;11:O15
J Fox, M McClure, J Weber, H Ward, S Fidler
High-risk sexual activity is highly linked to those diagnosed with incident HIV. Without immediate behaviour change onward transmission in such individuals is likely.
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O16 A PROSPECTIVE STUDY OF POST-EXPOSURE PROPHYLAXIS (PEP) FOLLOWING NON-OCCUPATIONAL EXPOSURE TO HIV IN THE UK
BHIVA Conf 2005 Apr 20-23;11:O16
JE Blackham1, V Delpech1, P Benn2, BG Evans1 on behalf of the NONOPEP project collaborative group.
The demand for NONOPEP is increasing, particularly in London and among MSM. The reasons for low follow-up rates are unclear and need to be addressed.
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O17 TRENDS IN TRANSMITTED GENOTYPIC ANTIRETROVIRAL RESISTANCE IN PRIMARY VERSUS LONGSTANDING HIV INFECTION
BHIVA Conf 2005 Apr 20-23;11:O17
D Pao1, K Aderogba1, G Dean1, P Cane2, E Smit3, D Pillay4 and M Fisher1
TAR remains of significant clinical importance despite high levels of effective viral suppression. We demonstrate that rates remain stable and furthermore are comparable in individuals diagnosed at non-PHI as well as PHI. All new HIV diagnoses should have baseline resistance testing performed irrespective of time since infection.
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O18 THE LONGEVITY OF HIV-SPECIFIC CD4 T-HELPER RESPONSES AND CLINICAL OUTCOME FOLLOWING SHORT COURSE ANTIRETROVIRAL THERAPY IN PRIMARY HIV INFECTION
BHIVA Conf 2005 Apr 20-23;11:O18
J Fox, T Scriba, A Oxenius, R Phillips, M McClure, K Porter, J Weber, S Fidler
Despite the preservation of HIV-specific CD4 T-helper responses in 50% of treated seroconverters no correlation with CD4 count or clinical progression was observed.
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O19 LATE DIAGNOSIS AND CONSEQUENT SHORT-TERM MORTALITY OF INDIVIDUALS SEXUALLY INFECTED WITH HIV: ENGLAND AND WALES, 2002
BHIVA Conf 2005 Apr 20-23;11:O19
TR Chadborn, VC Delpech, K Sinka, BD Rice, BG Evans
Continued late diagnosis, particularly of older and heterosexual individuals, means missed opportunities to start therapy early and to prevent further transmission, and an approximate 10 times higher risk of death within a year of diagnosis.
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O20 THERAPEUTIC VACCINATION WITH HIV-1 WHOLE KILLED VACCINE IS ASSOCIATED WITH IMMUNE MODULATION IN HAART-NAÏVE, ASYMPTOMATIC HIV-INFECTED INDIVIDUALS
BHIVA Conf 2005 Apr 20-23;11:O20
A Gori1, D Trabattoni1, G Rizzardini2, R Maserati3, F Mazzotta4, G Theofan5, DH Bray6, M Clerici1, G Marchetti
Immunotherapy with REMUNE® may be associated with changes in circulating lymphocytes phenotype and reduction of type 2 cytokines. Data from larger cohorts of patients is required to assess clinical significance.
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O21 DISCORDANT RESPONSES TO HAART IN ARV-NAÏVE HIV INFECTED INDIVIDUALS
BHIVA Conf 2005 Apr 20-23;11:O21
MY Tung, AK Sullivan, S Mandalia, MR Nelson, BG Gazzard
24.9% experience DR at 12 months, affected by age, CD4 count, VL and rate of CD4 decline. DIR and DVR have a good treatment outcome at 24 months. <50 CD4 rise is more predictive of DP than a positive VL.
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O22 DISCORDANT CD4 AND VIRAL LOAD RESPONSES IN PATIENTS STARTING HAART IN THE UK COLLABORATIVE HIV COHORT (CHIC) STUDY
BHIVA Conf 2005 Apr 20-23;11:O22
A Rider1, RJC Gilson1, A Copas1 and CA Sabin2, on behalf of the UK CHIC Steering Committee
Many patients have sub-optimal increases in CD4 count after starting HAART. Discordant responses at 12 and possibly 8 months may be associated with poorer outcome, although few deaths were reported in this cohort study.
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O23 THE EFFECT OF YEAR OF TREATMENT AND NA BACKBONE ON DURABILITY OF NNRTI-BASED REGIMENS
BHIVA Conf 2005 Apr 20-23;11:O23
NT Annan, S Mandalia, M Bower, M Nelson, B Gazzard
We have shown in a large NNRTI-experienced cohort, that although in univariate analysis efavirenz appears to have a higher success rate, this is explained by differences in backbone and year. This may explain differences between reported cohort studies and the 2NN study.
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O24 THERAPEUTIC DRUG MONITORING (TDM) OF EFAVIRENZ (EFV): A TOOL TO PREDICT VIROLOGIC OUTCOME IN HIV-PATIENTS ON FIRST LINE ONCE DAILY (OD) ANTIRETROVIRAL (ARV) THERAPY?
BHIVA Conf 2005 Apr 20-23;11:O24
D Maitland1, M Boffito1, S Mandalia1, S Gibbons2, D Back2, M Nelson1, B Gazzard1, G Moyle1
Our prospective analysis confirms the association between EFV-[C] and virologic response but with wide variability in EFV-[C], suggesting a role for EFV TDM in naïve patients.
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O24A PREDICTORS OF CURRENT CD4+ T-CELL RESPONSE AMONG PATIENTS RECEIVING SUBCUTANEOUS RECOMBINANT INTERLEUKIN-2 (RIL-2) IN ESPRIT (EVALUATION OF SUBCUTANEOUS PROLEUKIN® IN A RANDOMIZED INTERNATIONAL TRIAL)
BHIVA Conf 2005 Apr 20-23;11:O24A
H Nuwagaba-Biribonwoha1, BJ Angus1,2, J Bebchuk3, A Babiker1, B Cordwell1, F van Hooff1, L Hack1, Y Moraes1, B Gazzard4, J Darbyshire1 on behalf of the ESPRIT Research Group
More rIL-2 cycles and undetectable viral load at baseline were associated with a better CD4+ response.
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O25 EVIDENCE FOR SEXUAL TRANSMISSION OF HCV IN RECENT EPIDEMIC IN HIV-INFECTED MEN IN SOUTH-EAST ENGLAND
BHIVA Conf 2005 Apr 20-23;11:O25
M Danta1, D Brown1, O Pybus6, M Nelson4, M Fisher5, C Sabin3, S Bhagani2 for the HIV and Acute HCV (HAAC) group.
Mucosally traumatic sexual factors are significantly associated with the recent transmission of HCV.
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O26 IS THE TREATMENT OF ACUTE HEPATITIS C IN HIV-POSITIVE INDIVIDUALS EFFECTIVE?
BHIVA Conf 2005 Apr 20-23;11:O26
RE Browne, YC Gilleece, D Asboe, M Atkins, S Mandalia, M Bower, BG Gazzard and MR Nelson
SVR rates in HIV positive patients treated acutely for hepatitis C are lower than in HIV negative subjects. A high percentage of individuals seroconvert spontaneously.
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O27 DOES NADIR CD4 COUNT IN HIV-HCV CO-INFECTED PATIENTS PREDICT HCV TREATMENT RESPONSE TO PEGYLATED INTERFERON (P-IFN) AND RIBAVIRIN (RBV)?
BHIVA Conf 2005 Apr 20-23;11:O27
J Turner1, S Hopkins2, T Mahungu2, R Johnstone1, RM Lascar1,3, S Bhagani2, G Dusheiko, MA Johnson2, I Williams1,3, RJC Gilson1,3
This analysis demonstrates SVRs comparable to controlled studies in HIV-HCV co-infected patients. In addition to genotype, nadir CD4 predicted response to HCV therapy. This merits investigation in larger datasets.
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O28 HEPATITIS C INFECTION IS NOT ASSOCIATED WITH SYSTEMIC HIV-ASSOCIATED NON-HODGKIN'S LYMPHOMA: A COHORT STUDY
BHIVA Conf 2005 Apr 20-23;11:O28
L Waters, J Stebbing, S Mandalia, AM Young, M Nelson, BG Gazzard, M Bower
In this immunocompromised patient population, there was no association between HCV infection and an increased risk of lymphoma.
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O29 INHIBITION OF HEPATITIS B VIRUS REPLICATION BY SMALL INTERFERING RNA EXPRESSED FROM VIRAL VECTORS
BHIVA Conf 2005 Apr 20-23;11:O29
M McClure1, MD Moore1, MJ McGarvey2, RA Russell1, BR Cullen3
This work is the first to demonstrate that delivery of RNAi by viral vectors has therapeutic potential for chronic HBV infection and establishes the ground work for the use of such vectors in vivo.
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O30 IS THERE A RELATIONSHIP BETWEEN FAMILIAL MEDITERRANEAN FEVER (FMF) HOST POLYMORPHISMS AND PARADOXICAL REACTIONS (PR) IN TUBERCULOSIS (TB)?
BHIVA Conf 2005 Apr 20-23;11:O30
A Dunleavy1, RAM Breen1, A Bybee2, S Hopkins1, PN Hawkins2, M Lipman1
In our cohort PR appeared to be more strongly associated with Q148 polymorphisms than HIV status. This requires confirmation in a larger study.
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O31 IDENTIFYING THE KEY BELIEFS INFLUENCING UPTAKE AND ADHERENCE TO HAART: FINAL RESULTS OF A 12-MONTH PROSPECTIVE, FOLLOW-UP STUDY
BHIVA Conf 2005 Apr 20-23;11:O31
R Horne, V Cooper, G Gellaitry, M Fisher
Switching from a thymidine analogue to tenofovir achieves similar resolution of lipoatrophy, better reduction in lipids, and fewer treatment discontinuations than switching to abacavir.
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O32 STOPPING COMBINATION THERAPY WHILST TRAVELLING: IS THERE A REASON FOR GREAT CONCERN?
BHIVA Conf 2005 Apr 20-23;11:O32
MA Schuhwerk1, J Richens2, M Prestage1, K Jones1, N De Esteban1, RH Behrens3
A significant proportion stop HAART at low CD4 counts and are at greatly increased risk of developing medical problems. Development of drug resistance is a real concern.
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O33 SWITCHING FROM A THYMIDINE ANALOGUE TO TENOFOVIR (TDF) ACHIEVES SIMILAR RESOLUTION OF LIPOATROPHY AND BETTER REDUCTION IN LIPIDS THAN SWITCHING TO ABACAVIR (ABC). RESULTS OF THE RAVE STUDY, A UK MULTI-CENTRE OPEN-LABEL RANDOMISED CONTROLLED TRIAL
BHIVA Conf 2005 Apr 20-23;11:O33
JD Cartledge, G Moyle, C Sabin, M Johnson, E Wilkins, D Churchill, P Hay, A Fakoya, M Murphy, G Scullard, C Leen, G Reilly (RAVE study group)
Switching from a thymidine analogue to tenofovir achieves similar resolution of lipoatrophy, better reduction in lipids, and fewer treatment discontinuations than switching to abacavir.
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O34 3-DIMENSIONAL SURFACE LASER SCANNING AND PSYCHOLOGICAL ASSESSMENT: OBJECTIVE EVIDENCE FOR THE USE OF POLYLACTIC ACID IMPLANTS IN HIV-ASSOCIATED FACIAL LIPOATROPHY
BHIVA Conf 2005 Apr 20-23;11:O34
J Ong, A Clarke, M Johnson, S Withey, P Butler
PLA implants improve the physical changes of HIV-associated facial lipodystrophy. Physical and psychological measures show objective improvements with treatment which persist for a year following treatment.
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O35 WHAT IS THE COST OF SWITCHING AN ANTI-RETROVIRAL THERAPY (ART) FROM AN HIV-CENTRE PERSPECTIVE?
BHIVA Conf 2005 Apr 20-23;11:O35
T Toward1,M Fisher2,G Scullard3,C De Souza3, P Hay4, A Adebiyi4, F Pang1
This is the first study to estimate the cost of switching ART in the UK, a frequently overlooked element in costing HAART strategies. This resource utilisation model provides a methodological framework for HIV units to determine the cost impact of switching patients.
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O36 EXTENT OF UNDERDOSAGE OF ANTIRETROVIRAL THERAPY IN HIV-INFECTED CHILDREN
BHIVA Conf 2005 Apr 20-23;11:O36
EN Menson, AS Walker, T Duong, K Doerholt, C Wells, M Sharland, DM Gibb
Largely unwittingly, we have greatly underdosed HIV-infected children on ART over the past 7 years.
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O37 ENHANCED SURVEILLANCE FOR LYMPHOGRANULOMA VENEREUM (LGV) IN ENGLAND
BHIVA Conf 2005 Apr 20-23;11:O37
CA Ison, N Macdonald, IMC Martin, S Alexander, KA Fenton, C Lowndes, H Ward on behalf of the LGV Incident Team
The HPA alert, Terence Higgins Trust publicity campaign, and improved diagnostic tests, have increased community and professional awareness about LGV, case ascertainment, and confirmed in-country transmission of this rare disease.
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O38 AN OUTBREAK OF LYMPHOGRANULOMA VENEREUM IN LONDON IN 2004
BHIVA Conf 2005 Apr 20-23;11:O38
M Hamill1, C Ison2, C Carder3, P Benn1, E Jungmann1, N MacDonald2, P French1
Up to 18th January 2005 there were 23 confirmed cases of LGV in the UK including 10 from our centre. Retrospective testing has shown its presence in the UK since April 2004. Clinicians should be aware of LGV in the UK population particularly its presentation as proctitis among HIV positive MSM.
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O39 SYPHILIS OUTBREAK IN COMMERCIAL STREET SEX WORKERS IN EAST LONDON
BHIVA Conf 2005 Apr 20-23;11:O39
N Lomax, H Anderson, H Wheeler, B Goh
Outbreak management in this population is challenging: an MDT approach is crucial in identifying/treating syphilis to prevent onward transmission. High prevalence of syphilis was detected. Azithromycin was preferred by SCSWs; possible resistance problems were minimised by addition of doxycycline. As contact tracing is difficult, public awareness was heightened through local newspaper articles. Real-time rapid syphilis tests (Abbotts) were introduced to screen at source for SCSWs who decline attending GUM clinics.
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O40 SYPHILIS PCR USE FOR DIAGNOSIS OF EARLY SYPHILIS AUDITED AGAINST ROUTINE SEROLOGICAL TESTING
BHIVA Conf 2005 Apr 20-23;11:040
P Lewthwaite1, M Guiver2, A Turner2
In 2 samples which were PCR positive, syphilis serology was positive but not felt to be consistent with recent or active infection. Of the PCR negative samples 5 had serology consistent with active or recent syphilis infection. Sensitivity was 70.1% and specificity for both PCRs to be positive was 97.8%. Given problems with conventional serological testing for syphilis PCR provides a useful addition.
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O41 OPA-TYPING CAN SUBDIVIDE NG-MAST SEQUENCE TYPES OF NEISSERIA GONORRHOEAE INTO EPIDEMIOLOGICAL RELEVANT GROUPS
BHIVA Conf 2005 Apr 20-23;11:O41
AK Morris, HM Palmer, H Young
Opa-typing can subdivide NG-MAST clusters into subgroups, some of which are supported by epidemiological data.
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O42 HIV-1 ANTIBODY AVIDITY TESTING TO IDENTIFY RECENT HIV SEROCONVERTERS
BHIVA Conf 2005 Apr 20-23;11:O42
A Chawla, M Mirfenderesky, C Donnelly, M Raza, M Johnson, AM Geretti
A HIV-1 avidity index =0.60 reliably identified HIV-1 infection acquired within the previous 30 days and was more sensitive in identifying a recent infection than a low reactivity in the screening EIA test.
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O43 NO RECENT INCREASE IN MORTALITY AMONG HIV-DIAGNOSED INDIVIDUALS WITH LONG EXPOSURE TO THERAPY: UK 1987–2004
BHIVA Conf 2005 Apr 20-23;11:O43
TR Chadborn, VC Delpech, K Sinka, BG Evans
HAART dramatically cut mortality rates in 1996 and continues to postpone death in individuals who were diagnosed with HIV in the early 1990s and those newly diagnosed since 1996.
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O44 HOW SALVAGEABLE ARE THE K65R AND L74V MUTATIONS?
BHIVA Conf 2005 Apr 20-23;11:O44
L Waters, S Mandalia, M Nelson, M Bower, BG Gazzard
The K65R mutation appears to be highly salvageable with a PI-based regimen, whether or not the backbone includes TFV, and less so with non-PI HAART. There is a trend for less success salvaging the L74V whether or not this includes a PI.
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O45 TRIPLE CLASS ANTIRETROVIRAL AGENT RESISTANCE IN A LARGE UK COHORT – PREVALENCE AND RISK FACTORS FOR ACQUISITION
BHIVA Conf 2005 Apr 20-23;11:O45
R Jones, S Mandalia, M Bower, M Nelson, B Gazzard
The need for salvage therapy is best prevented by limiting acquisition of triple class resistance.Three class resistance exists at a low level in our population. 73.6% of individuals received incompletely suppressive therapy in the pre-HAART era. Non-adherence, unstructured treatment interruption, side-effects eliciting non-adherence, concurrent illness and acquisition of resistant virus were all implicated in the development of multi-drug resistance.
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O46 VIROLOGICAL AND CLINICAL OUTCOMES IN PATIENTS WITH MULTI (THREE)-CLASS DRUG RESISTANT (MDR) HIV IN THE UK
BHIVA Conf 2005 Apr 20-23;11:O46
D Grover1, L Allen3, D Pillay1,3,4, H Green2, A Copas3, S Forsyth1, SG Edwards1 on behalf of the UK Collaborative Group on HIV Drug Resistance and UK Collaborative HIV Cohort Study (UK CHIC)
Active management of patients with MDR HIV-1 is associated with delayed time to death, and resistance test guided therapy confers virological benefit.
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O47 CD4 COUNTS AND THE RISK OF LYMPHOMA IN INDIVIDUALS WITH HIV IN THE UK
BHIVA Conf 2005 Apr 20-23;11:O47
I Reeves, M Fisher, T Hill, C Sabin, on behalf of the UK Collaborative HIV Cohort (CHIC) Steering Committee
The risk of lymphoma is increased at low CD4 counts, although the nadir CD4 does not contribute further to this risk.
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O48 A PROGNOSTIC MODEL TO PREDICT SURVIVAL IN SYSTEMIC AIDS RELATED NON-HODGKIN'S LYMPHOMA
BHIVA Conf 2005 Apr 20-23;11:O48
AM Young, J Stebbing, T Dhillon, T Newsom-Davis, C Thirlwell, T Powles, S Mandalia, M Nelson, B Gazzard, M Bower
For patients with ARL in the era of HAART, an accurate prognostic score can be established by combining the IPI with CD4 count. As patients presenting with ARL and a low CD4 count have a poor prognosis, this can be used to guide therapeutic options.
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Posters

P1 IMPROVING ACCESS AND MANAGING PATIENT FLOW IN A BUSY INNER CITY, SEXUAL HEALTH CLINIC
BHIVA Conf 2005 Apr 20-23;11:P1
M Brady1, D Crates1, G Miflin2
Improvements to service have been measurable. We have established that better analysis and management techniques can have as large an impact as simply spending resources on more of the same. Continued work to reduce waiting and transit times will further improve service quality with the ultimate aim of reducing local sexual ill-health.
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P2 TURNING THE TIDE – EFFECTIVELY MANAGING INCREASING DEMAND FOR GU SERVICES
BHIVA Conf 2005 Apr 20-23;11:P2
M Ottewill, G Dean, E Collins, D Williams
By reconfiguring services the need for follow-up appointments declined, whilst maintaining access for symptomatic patients. Patient and staff satisfaction improved, with reduced waiting times and predictable workload. These modernisation efforts increased efficiency without compromising quality of care, although additional resources are required to address asymptomatic disease.
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P2A RELEASING CAPACITY THROUGH REDUCTION IN FOLLOW-UPS
BHIVA Conf 2005 Apr 20-23;11:P2A
V Griffiths, I Ahmed-Jushuf
The follow-up:new ratio can be significantly reduced thus releasing much needed capacity. The six-sigma management tool ensures that patient processes, which contribute to the ratio, are properly evaluated and opportunities for improvement identified. It also ensures that effective controls are in place to ensure that the quality of care is not compromised. The completion date for the project is March 2005. Final data will be available at the conference.
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P3 EXPERIENCE WITH THE TEST NOT TALK (TNT) CLINIC FOR ASYMPTOMATIC MEN
BHIVA Conf 2005 Apr 20-23;11:P3
D Martin, J Barter, R Pittrof
Screening by receptionists identified patients suitable for a high volume, and low cost screening.
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P4 DO GUM PATIENTS WANT CHAPERONES?
BHIVA Conf 2005 Apr 20-23;11:P4
M Osmond1, C Newey1, D Mercey2, E Jungmann3, S Edwards1
This study shows the majority of patients do not want a chaperone, but if offered one, this should be during the consultation.
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P5 FINDING OUT WHAT PRIMARY CARE WANTS FROM GUM AND DELIVERING IT
BHIVA Conf 2005 Apr 20-23;11:P5
DJ Clutterbuck, M Sutherland, N Harrison, C Thomson, J Donald, Edinburgh GUM CLIP team, Edinburgh GUM GP Liaison Group
The protocol directed GPs to a helpline that was incorporated into the existing nurse triage service. Other findings are guiding the further development of STI services.
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P6 HIV WORKLOAD AND PATIENT COMPLEXITY RATINGS
BHIVA Conf 2005 Apr 20-23;11:P6
HR Gumley, N Rees, CA Sabin, D Ransom, M Youle, MA Johnson
Rising patient numbers have led to a huge increase in workload. Activity/casemix trends among Trusts must be monitored on a regular and comparable basis so that we can be better prepared for future growth and diversity as well as the changing commissioning needs of Trusts for the particular cohort of patients for whom they provide care.
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P7 HIV ADMISSIONS IN A SOUTH LONDON TEACHING HOSPITAL
BHIVA Conf 2005 Apr 20-23;11:P7
M Aboud, S Hussain, L Collins, N Larbalastier, B Peters, R Kulasegaram
Our study showed that a significant proportion of HIV admissions are late presenters with preventable morbidity. Improved testing and public awareness remain a priority.
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P8 ARE WE A HAPPY LOT? EVALUATION OF A WALK-IN GU SERVICE
BHIVA Conf 2005 Apr 20-23;11:P8
J Dhar, J Watt, A Needham
Increase in demand with no corresponding growth in resources has precipitated a considerable decrease in the satisfaction levels for both staff and patients, and will be discussed. Walk in STI service, though a viable option, needs adequate long-term resources.
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P9 DOES A CLOSED APPOINTMENT SYSTEM IMPROVE ACCESS?
BHIVA Conf 2005 Apr 20-23;11:P9
S Bhaduri, C Minton, M Mann
Call analysis correlated with the HPA survey results suggesting the closed 48 hour booking system may genuinely improve access although further research is required in this area.
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P9A RECOGNISING THE POTENTIAL OF NON-REGISTERED NURSES TO INCREASE CAPACITY – ANOTHER PHASE IN MODERNISING GUM SERVICES
BHIVA Conf 2005 Apr 20-23;11:P9A
V Griffiths, S Butler, I Ahmed-Jushuf
Rapid STI screening is feasible within GUM for asymptomatic patients. This service is comparable to the chlamydia-screening programme – indeed more value added as patients get offered tests for syphilis and HIV. Rapid screening services improve the ‘patients process’, and releases capacity of registered clinicians to see symptomatic patients.
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P10 I’m OK
BHIVA Conf 2005 Apr 20-23;11:P10
P Handy, J Richards
Popular with patients. Encourages attendance. Enables rapid detection of asymptomatic infection.
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P11 IMPROVING ACCESS – BLUSH AND CREATE A NEW WEBSITE (WWW.GUMNEWCASTLE.NHS.UK)
BHIVA Conf 2005 Apr 20-23;11:P11
RS Pattman and R Hackett
The site was launched in October by Newcastle Falcons Rugby Football Club and was supported by representation from the Sexual Health Unit, DoH amid local publicity. Further detail and information on feedback/usage will be presented.
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P12 TIME TO USE TEXT APPOINTMENT REMINDERS IN GENITOURINARY MEDICINE (GUM) CLINICS
BHIVA Conf 2005 Apr 20-23;11:P12
CE Cohen, S Mandalia, AM Waters, AK Sullivan
Our clinic patients favoured reminder-texts to mobile phones, 2–3 days before appointments. Pilots in other specialties reduced did not attend (DNA) rates by 38%. We plan to pilot this service for chronic problem clinics, to reduce the high non-attendance rate.
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P13 RESULTS BY TEXT – PREFERRED BY PATIENTS, TRANSFORMING WORK PATTERNS
BHIVA Conf 2005 Apr 20-23;11:P13
J Clarke1, Y Taylor1, PJR Harkin2
A review of the impact at December 2004 revealed over 250 texts sent per month. A reduction of over 60% in nurse-led telephone clinics workload freed clinical staff to develop new screening services. Secretaries saw an 85% reduction in results letter requests. The text messaging results service was acceptable to patients, released nursing time into clinic, and has modernised the approach to patient care.
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P14 MOBILE PHONE TEXT MESSAGING TO GIVE RESULTS TO PATIENTS IN A DISTRICT GENERAL HOSPITAL GENITOURINARY MEDICINE CLINIC
BHIVA Conf 2005 Apr 20-23;11:P14
O McQuillan, R Hewart, E Morgan
Text messages are a safe way to give results and deliver a high level of patient and staff satisfaction.
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P15 THE NATIONAL SEXUAL HEALTH STRATEGY AND THE NEW GENERAL PRACTITIONERS' CONTRACT: POLES APART OR RECONCILABLE?
BHIVA Conf 2005 Apr 20-23;11:P15
FEA Keane1, S Gray2, J Tilbury3, N Saulsbury1
This is the first time, to our knowledge, that such a formal agreement has been reached, allowing real progress to be made in implementation of the National Sexual Health Strategy in Cornwall.
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P16 THE NEED OF MEN’S HEALTH CLINICS
BHIVA Conf 2005 Apr 20-23;11:P16
C O'Connor1, M O'Connor2, J Byrne2, H Myles2, S O'Connor2, S O’Shea2
76% desired a male specific health clinic. Death rates are higher here than internationally (8% v 2%). Outside of GP, STI clinics are the preference site for consultation. In view of HIV being an increased risk factor for TC it seems appropriate that Sexual Health Clinics should add Men's Clinics.
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P17 OVERCOMING THE BARRIERS TO GP INVOLVEMENT IN THE DIAGNOSIS AND MANAGEMENT OF HIV INFECTION
BHIVA Conf 2005 Apr 20-23;11:P17
A Bailey1, M Fisher1, R Barker2, G Dean1
A primary care focused course can enhance the role of GPs in co-management and may help reduce levels of undiagnosed HIV.
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P18 ISSUES IMPACTING ON HIV SERVICE UPTAKE BY AFRICANS IN THE UK
BHIVA Conf 2005 Apr 20-23;11:P18
F Burns1, A M Johnson2, J Nazroo3, KA Fenton1,4
HIV remains a much feared and stigmatised disease in African communities in the UK. More involvement from the African communities in the planning and implementation of health services is needed.
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P19 THE USE OF GENERAL PRACTITIONERS AMONGST HIV-POSITIVE PATIENTS
BHIVA Conf 2005 Apr 20-23;11:P19
D Robertson-Bell, S Madge, CJ Smith, MA Johnson and Nursing and Medical Staff of the Ian Charleson Day Centre
Although many HIV-positive patients have GPs, a proportion remains unaware of their patient's HIV status.
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P20 A TREATMENT ADVICE CLINIC (TAC) FOR PATIENTS ATTENDING AN HIV OUTPATIENT CLINIC: HOW DOES IT OPERATE AND WHAT DO PATIENTS THINK?
BHIVA Conf 2005 Apr 20-23;11:P20
C Griffiths1, K Miles1,2, D Aldam2, D Cornforth2, J Minton3, S Edwards2, I Williams1,2
Although evidence that TAC improves clinical outcomes is unavailable, there are clear benefits at the individual level suggesting investment in TAC is worthwhile.
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P21 THE ROLE OF THE SEXUAL HEALTH ADVISOR (SHA) IN A HOSPITAL-BASED HIV SERVICE
BHIVA Conf 2005 Apr 20-23;11:P21
P Anderson, M Murcie, A Winter, R Fox
SHA has increased uptake of STI tests and GUM attendance, yielding a significant number of diagnosis of STIs on this positive population. On going Audit to identify reasons for clients not seeing SHA.
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P22 BRASH: ASSESSING THE FIRST YEAR OF A NEW SERVICE
BHIVA Conf 2005 Apr 20-23;11:P22
C Ashton, E Stephens, H Mitchell
There was a good uptake of a new service specifically designed to meet the reproductive and sexual health needs of an HIV-positive individuals attending their treatment centre.
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P23 CD4 CELL COUNT AND STARTING ART: TRENDS IN SIX UK CENTRES 1997-2002
BHIVA Conf 2005 Apr 20-23;11:P23
W Stöhr1, D Dunn1, K Porter1, C Sabin2 on behalf of UK CHIC Study
There was a trend of deferring ART, which reflected changing BHIVA and other treatment guidelines. Further analyses are planned to examine the role of viral load and selected demographic factors on the initiation of HAART.
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P24 WHAT IS THE CLINICAL SIGNIFICANCE OF SUSTAINED LOW-LEVEL VIRAEMIA (SLLV) IN PATIENTS ON HAART?
BHIVA Conf 2005 Apr 20-23;11:P24
P Easterbrook1, L Bansi2, CA Sabin2, T Welz on behalf of the UK Collaborative HIV Cohort (CHIC) Study
A small proportion of patients on HAART have SLLV with no adverse immunological or virological consequences. The impact on the development of drug resistance need to be further evaluated.
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P25 LONG AND STRONG: EXPERIENCE OF FIRST LINE THERAPY WITH NEVIRAPINE (NVP) IN A COHORT OF ANTIRETROVIRAL (ART) NAÏVE HIV-POSITIVE PATIENTS
BHIVA Conf 2005 Apr 20-23;11:P25
AA Benzie1, NE Mackie1, CA Sabin2, RJ Weston1, J Walsh1
This is the first cohort study providing long term durability and tolerability data in ART-naïve patients commenced on NVP. Beyond the first six weeks, there was no significant hepatotoxicity related to NVP.
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P26 THE IMPACT OF FOSAMPRENAVIR AND LOPINAVIR/R DRUG LEVELS ON VIROLOGICAL OUTCOME IN PATIENTS ON THESE DRUGS IN COMBINATION
BHIVA Conf 2005 Apr 20-23;11:P26
C Slater1, S Castelino2, S McCormick2, C Tong3, R Kulasegaram1
Greater virological failure is associated with low drug levels, but this did not reach statistical significance and will be compounded by adherence. From this small review, we would recommend T1. Lopinavir levels appear key in determining response.
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P27 DOUBLE-BOOSTED PROTEASE TREATMENT USING ATAZANAVIR AND LOPINAVIR/RITONAVIR
BHIVA Conf 2005 Apr 20-23;11:P27
J Ballinger, L Swaden, S Bhagani, M Tyrer, M Youle, MA Johnson
Treatment with this double-boosted PI combination is effective in patients pre-treated with multiple combinations.
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P28 SAFETY AND EFFICACY OF ATAZANAVIR WITH LOW DOSE RITONAVIR IN A CLINIC POPULATION
BHIVA Conf 2005 Apr 20-23;11:P28
SF Forsyth1, DM Mullan1,2, MA Schuhwerk1, A Copas2, SG Edwards1, IG Williams1,2
ATZ/r was well tolerated in this clinic population and associated with significant falls in plasma cholesterol, resolution of diarrhoea in patients switching therapy. Severe mood change was seen in some patients.
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P29 THE EFFECT OF PROTON PUMP INHIBITORS ON PROTEASE INHIBITOR PLASMA CONCENTRATIONS IN THE CLINICAL SETTING
BHIVA Conf 2005 Apr 20-23;11:P29
SE Gibbons, DJ Back, SH Khoo
These data highlight the limitations of a pre-selected, diverse cohort for investigating potential drug interactions. Only carefully designed pharmacokinetic studies can address these issues.
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P30 TIPRANAVIR (TIP)/T-20 CONTAINING SALVAGE REGIME IN HIGHLY TREATMENT EXPERIENCED HIV-INFECTED PATIENTS
BHIVA Conf 2005 Apr 20-23;11:P30
U Kalidindi, M Lechelt, C Skinner, M Murphy, Y Gilleece, G Baily, C Loveday, C Orkin
Tipranavir/T20 containing regimes with optimised nucleoside/nucleotide backbone is successful in highly treatment experienced HIV-infected patients. It is acceptable and well tolerated.
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P31 T20 USE IN THE UK: IS IT OPTIMAL?
BHIVA Conf 2005 Apr 20-23;11:P31
N Perry on behalf of the T20 National audit Group
Despite the majority of patients initiating T20 in an unfavourable setting, reasonable responses were seen and T20 was well tolerated. T20 may perform better if use is optimised.
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P32 NATURAL KILLER CELL FUNCTION AND KIR RECEPTOR EXPRESSION IN HIV LONG TERM NON-PROGRESSION
BHIVA Conf 2005 Apr 20-23;11:P32
A Holmes1, G O’Connor2, F Mulcahy1, C Gardiner2
LTNPs maintain NK cytotoxicity relative to HIV regular progressors, suggesting a role for NK cells in HIV control.
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P33 EFAVIRENZ CONCENTRATIONS RESULTING FROM CO-ADMINISTRATION OF RIFAMPICIN WITH EITHER 600 OR 800 MG EFAVIRENZ
BHIVA Conf 2005 Apr 20-23;11:P33
S Gibbons, L Almond, D Back, S Khoo
There was marked interpatient variability and the datasets were unequal. However, efavirenz concentrations were comparable irrespective of dose given.
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P34 CLINICAL EXPERIENCE WITH ATAZANAVIR
BHIVA Conf 2005 Apr 20-23;11:P34
P Holmes, M Tung, M Nelson, M Bower, BG Gazzard
ATZ may be successfully utilized on PI naïve and PI experienced individuals requiring switch of antiviral agents.
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P35 SINGLE AGENT SWITCHING TO TENOFOVIR – A RETROSPECTIVE ANALYSIS
BHIVA Conf 2005 Apr 20-23;11:P35
TJ Barber, BC De Souza
Data in our cohort suggests that switching to Tenofovir is clinically beneficial in the management/stabilisation of patients with lipodystrophy. Longer follow up would be valuable. This audit was made possible thanks to an unrestricted educational grant from Gilead Sciences.
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P36 BOOSTED ATAZANAVIR USE IN AN INTRAVENOUS DRUG USER COHORT
BHIVA Conf 2005 Apr 20-23;11:P36
S Chew, J Kieran, C Bergin, F Mulcahy
There were a total of 67 patients who received ATV during the specified period. Of these, 45/67 (67.1%) were IVDU. 11/45 were on their first ART regimen, 14/45 had received more than 2 previous ART regimes. After 3 months, only 33/45 (73.3%) were still compliant with the boosted ATV containing ART regimen. The rest were either lost to follow up or still attending the clinic, but non-compliant with treatment.
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P37 THE USE OF ATAZANAVIR/RITONAVIR AS PART OF A ONCE DAILY ANTIRETROVIRAL THERAPY REGIME IN INTRAVENOUS DRUG USERS
BHIVA Conf 2005 Apr 20-23;11:P37
N Chew
Atazanavir is a favourable option in an ART regime for an IVDU to facilitate once daily directly observed therapy.
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P38 CLINICAL EXPERIENCE WITH ATAZANAVIR
BHIVA Conf 2005 Apr 20-23;11:P38
M Natha1, M Pakianathan1,2, T Sadiq1, B Marett1
ATZ/r was well tolerated and there were no discontinuations. Expected elevations in serum bilirubin were observed. Most patients commencing an ATZ/r containing regimen achieved viral suppression to <400 copies/ml at 48 weeks follow-up.
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P39 AUDIT OF CONCOMITANT PROTEASE INHIBITOR AND PROTON PUMP INHIBITOR USE
BHIVA Conf 2005 Apr 20-23;11:P39
ML Schmid, MC Bailey, MH Snow
No patient was on potentially dangerous ATV and omeprazole. However patients on ATV or ATVr/lansoprazole combination did not have reduced ATV levels. Patients on boosted or unboosted ATV requiring acid suppression may be safer to use PPIs with limited interaction like lansoprazole.
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40 ATAZANAVIR AND ACID SUPPRESSANTS – ARE DOCTORS AND PATIENTS AWARE?
BHIVA Conf 2005 Apr 20-23;11:P40
E Davies, K McCormick, C Ruddy, Y Mullens, M Bower, B Gazzard, M Nelson
Despite the fact that all patients attending our clinic are counselled regarding drug interaction issues and issued with written information when initiating atazanavir, this survey demonstrates that repeated reinforcement of such information is required at each visit. Conversely, only 1 patient had received their PPI/H2 antagonist via prescription which suggests that clinicians/HIV pharmacists seem to be well informed of the data.
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P41 EFFECTIVENESS OF TIPRANAVIR IN A CLINIC COHORT
BHIVA Conf 2005 Apr 20-23;11:P41
A Abbara, A Bhuya, L Davies, M Bower, R Popat, M Nelson, BG Gazzard
Tipranavir when used as very late therapy with no other agents is a non-successful therapeutic approach. Individuals with other active agents available respond.
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P41A A SENSITIVE CASE
BHIVA Conf 2005 Apr 20-23;11:P41A
B Killingley, MA Johnson
Specific treatment options are limited, although intravenous immunoglobulin has been used with some success. This case highlights the importance of drug toxicity in HIV disease.
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P42 PREVALENCE OF GENITAL INFECTIONS IN A COHORT OF HIV-POSITIVE PREGNANT WOMEN
BHIVA Conf 2005 Apr 20-23;11:P42
C Brookings, R Browne, P Ratcliffe, W Khan, DA Hawkins
Genital infections in pregnant women are associated with adverse pregnancy outcomes (miscarriage, preterm delivery and infant infections). The prevalence of genital infections was 52 per 100 women. We recommend that all HIV positive pregnant women should be routinely screened.
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P43 POTENTIAL CLINICAL IMPORTANCE OF ALTERED NELFINAVIR PHARMACOKINETICS IN PREGNANCY
BHIVA Conf 2005 Apr 20-23;11:P43
C Bell1, C Slater2, A DeRuiter2, H Noble3, G Taylor1
Although the study's small, retrospective and limited by relatively late first on-treatment viral load sampling the reduced rate of viral decay in pregnant women taking a nelfinavir-containing regimen suggest that the PK data are of clinical importance.
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P44 KALETRA IN PREGNANCY – EXPERIENCE OF A NORTH LONDON TEACHING HOSPITAL
BHIVA Conf 2005 Apr 20-23;11:P44
U Harrisson, S Shah, H Montgomery, S Madge, S Kinloch, M Tyrer, H Evans, Johnson M
Kaletra is a viable choice for HIV+ve pregnant women but additional monitoring during the 3rd trimester is recommended.
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P45 OUTCOMES OF PLANNED VAGINAL DELIVERY OF HIV-POSITIVE WOMEN MANAGED IN A MULTI-DISCIPLINARY SETTING
BHIVA Conf 2005 Apr 20-23;11:P45
R Browne1, EGH Lyall1,2, Z Penn1, W Khan1, DA Hawkins1
Women with viral loads of <50 copies/ml at 36 weeks should be offered the option of a planned vaginal delivery with optimal intra-partum care and senior review in labour.
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P46 HIV INFECTION RESULTS IN BODY FAT REDISTRIBUTION
BHIVA Conf 2005 Apr 20-23;11:P46
M Boothby, G Gilleran, N Crabtree, H Jaleel, M Shahmanesh
Compared to control subject, HIV infected patients who are not on antiretroviral treatment have approximately 2.5 kg (28%) loss of limb fat compared to HIV negative controls.
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P47 DECREASED INCIDENCE OF LIPOATROPHY IN A GROUP OF HIV-POSITIVE PEOPLE TAKING HAART (HIGHLY ACTIVE ANTIRETROVIRAL THERAPY) WITHOUT STAVUDINE ASSESSED BY ANTHROPOMETRY MEASUREMENTS AND REPORTED SELF–PERCEPTIONS OF BODY SHAPE CHANGES
BHIVA Conf 2005 Apr 20-23;11:P47
C Taylor, V Pribram, C Hodgson, R Goncalves, P Easterbrook
Unlike stavudine containing HAART regimes, these results demonstrate an absence of lipoatrophy but high incidence of increased abdominal girth despite very limited PI use. Increased waist size may largely be due to substantial weight gain on HAART in this population.
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P48 EXPERIENCE OF THE USE OF STATINS AND FIBRATES IN PATIENTS RECEIVING HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART) IN THE EDINBURGH HIV COHORT
BHIVA Conf 2005 Apr 20-23;11:P48
WI Beadles, CLS Leen, X Recabarron, R Lessells
The threshold for commencing patients in this cohort on a lipid lowering agent maybe lower than in the general population. Statins and fibrates were well tolerated. Further guidance is needed to help in the management of those patients who have poor response to these agents.
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P49 LONG-TERM EFFICACY AND SAFETY OF INJECTABLE POLY-L-LACTIC ACID FOR THE CORRECTION OF FACIAL LIPOATROPHY
BHIVA Conf 2005 Apr 20-23;11:P49
SE Barton, GJ Moyle, L Lysakova, S Brown
Physical and psychological benefits of PLLA are sustained over at least 18 months. Delayed AEs are neither serious nor severe and include mild nodularity at the treatment site.
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P50 NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTI)-RELATED HEPATIC FIBROSIS AND DECOMPENSATED PORTAL HYPERTENSION
BHIVA Conf 2005 Apr 20-23;11:P50
JA Garcia-Garcia, S Bhagani1, A Quaglia, M Tyrer, MA Johnson, G Slapak
Prolonged NRTI therapy may lead to progressive hepatic fibrosis, probably as a result of mitochondrial toxicity and non-alcoholic steatohepatitis. Clinicians should be aware of the risk of significant liver disease in patients with lipodystrophy, prolonged current or previous NRTI-use and even a moderate transaminitis. These patients should be offered early evaluation for fibrosis and portal hypertension.
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P51 THYROID DYSFUNCTION AMONGST HIV-INFECTED PATIENTS: HIV OR HAART?
BHIVA Conf 2005 Apr 20-23;11:P51
S. Pren, A Scourfield, J Smythe, M Stefanovic, R Jones, S Mandalia, AK Sullivan, MR Nelson, BG Gazzard
K65R is driven mainly by TFV/ddI ±ABC (particularly with NRTI -only regimens). PIs appear to be protective. L74V is predominantly driven by ddI/ABC or ddI/TFV; although numbers are small, PIs don't appear to confer protection.
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P52 THE PREVALENCE OF CANONICAL RESISTANCE MUTATIONS IN NAÏVE HIV-1 INFECTED PATIENTS IS LOW AND DID NOT INCREASE OVER THE TIME PERIOD OF 2000 TO 2003
BHIVA Conf 2005 Apr 20-23;11:P52
H Price, R Jones, S Mandalia, M Bower, M Nelson, B Gazzard
Acquisition of drug resistant HIV-1 has been constant over the last four years.
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P53 HOW COMMON IS THE K65R MUTATION IN CLINICAL PRACTICE?
BHIVA Conf 2005 Apr 20-23;11:P53
E Harte, P Tilston, E Wilkins, A Bonington, J Vilar, E Dunbar, S Clarke
These data demonstrate that the emergence of the K65R mutation is not as common as perhaps thought from the clinical trial setting. The data also provides further evidence of the negative correlation between K65R and the presence of TAMs.
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P54 WHICH ANTIRETROVIRAL REGIMENS DRIVE THE K65R AND L74V MUTATIONS?
BHIVA Conf 2005 Apr 20-23;11:P54
L Waters, S Mandalia, M Nelson, M Bower, BG Gazzard
K65R is driven mainly by TFV/ddI +/-ABC (particularly with NRTI -only regimens). PIs appear to be protective. L74V is predominantly driven by ddI/ABC or ddI/TFV; although numbers are small, PIs don't appear to confer protection.
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P55 DO THE MUTATIONS M046I AND I047A CONFER RESISTANCE TO KALETRA?
BHIVA Conf 2005 Apr 20-23;11:P55
M Stevanovic, H Price, R Jones, S Mandalia, M Bower, M Nelson, B Gazzard
Prior exposure to Kaletra is not required in the development of the mutations M046I and I047A. Presence of these mutations does not adversely affect virological response to Kaletra therapy as part of an HAART regimen.
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P56 THE PRESENCE OF A SINGLE CANONICAL NNRTI RESISTANCE MUTATION IN NAÏVE HIV-1 INFECTED PATIENTS REDUCES THE PROPORTION ACHIEVING VIROLOGICAL SUCCESS WHEN STARTING NNRTI-BASED REGIMENS
BHIVA Conf 2005 Apr 20-23;11:P56
H Price, R Jones, S Mandalia, M Bower, M Nelson, B Gazzard
More than half the patients treated with NNRTI regimens responded despite pre-existing resistance although response to a PI containing regimen was better.
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P57 NEVIRAPINE USE IN PREGNANT HIV-POSITIVE WOMEN – IS IT THE END? (EXPERIENCE OF A PROVINCIAL CENTRE)
BHIVA Conf 2005 Apr 20-23;11:P57
C Chapman, J Dhar
During this period the total number of pregnancies documented were 90, which included 5 miscarriages, 2 terminations and 1 stillbirth. Of the 82 pregnancies the majority were of Black African origin. 51 (57%) patients received NVP as combination therapy. 4 (7%) in this group developed side effects requiring hospitalisation, including a case of toxic epidermal necrolysis. Data will be presented indicating a shift from the recommended guidelines for the management of pregnant HIV positive women in our area post February 2004.
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P58 EXPERIENCE OF DELIVERING WOMEN WITH HIV IN AN INNER CITY LONDON HOSPITAL 1994–2002
BHIVA Conf 2005 Apr 20-23;11:P58
M Parisaei1, J Anderson2, KJ Erskine1
Based on our observations there is room for optimism about the obstetric course and outcome of pregnancy in women with HIV in a multidisciplinary setting.
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P59 HAART TO HEART. WHERE DO DHIVA DIETS FIT INTO BHIVA GUIDELINES?
BHIVA Conf 2005 Apr 20-23;11:P59
A Culkin1, C Stradling2, on behalf of DHIVA3
Clinics are measuring baseline bloods to identify patients who may be at risk of lipodystrophy. In most cases, referrals to dieticians are made and the assessment of CHD risk factors may warrant further dietetic input.
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P60 TENOFOVIR-ASSOCIATED RENAL DYSFUNCTION – CAN WE PREDICT IT?
BHIVA Conf 2005 Apr 20-23;11:P60
E Devitt, E Wallace, M Bryne, WG Powderly, G Sheehan
The contribution of tenofovir to renal dysfunction is controversial. Although elevated creatinine was not seen in clinical trials, TDF has been linked with renal tubular dysfunction in several case reports. Our cases highlight the possibility of developing renal dysfunction while on TDF, but also indicate the potential contribution of other co-morbidities.
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P61 TOXIC LEVELS OF EFAVIRENZ (EFV) TWO WEEKS AFTER STOPPING THERAPY
BHIVA Conf 2005 Apr 20-23;11:P61
G Crowe1, SH Khoo2
EFV levels rose to toxic concentrations despite co-administration with Rifampicin which is known to increase EFV metabolism. Levels fell slowly and were still in the toxic range more than two weeks after stopping therapy. Neurological toxicity was not noted until levels above 27,000 ng/ml were reached. TDM was vital to enable correct management. Further genetic investigations to sequence the CYP2B6 gene are being undertaken.
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P62 THE SNAIL'S PROGRESS: A CASE REPORT OF SCHISTOSOMIASIS IN THE ERA OF HAART
BHIVA Conf 2005 Apr 20-23;11:P62
S de Silva1, J Walsh2, M Brown3
This patient probably acquired S. mansoni many years previously, but only experienced symptoms following initiation of HAART. This immune reconstitution appears to have resulted in an acute inflammatory response to his chronic infection. This phenomenon is likely to take on further significance with the increasing availability of antiretroviral medication in the tropics.
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P63 HAART IMPROVES OUTCOME FROM HIV-ASSOCIATED TTP
BHIVA Conf 2005 Apr 20-23;11:P63
S Roedling, RF Miller, M Scully, H Cohen, R Starke, SJ Machin, SG Edwards
We highlight the importance of HIV testing all patients presenting with TTP. Treatment with plasma exchange and HAART is associated with a high rate of complete remission. Relapse occurs if HAART is stopped.
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P64 OPSOCLONUS-MYOCLONUS SYNDROME FOLLOWING THE INITIATION OF HAART
BHIVA Conf 2005 Apr 20-23;11:P64
J Hutchinson1,3, AS Pym1, RWH Walker2, PA Brex2, S El Gadi3
Nevertheless she made a gradual and eventually almost full recovery over two months. OMS is thought to be immune mediated. The appearance of the condition following a rapid and steep rise in CD4 count suggests OMS could be a rare manifestation of Immune Reconstitution Inflammatory Syndrome (IRIS).
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P65 PLASTIC SPECULA: CAN WE EASE THE PASSAGE?
BHIVA Conf 2005 Apr 20-23;11:P65
L Kozakis, J Vuddamalay, P Munday
We feel that the clinician should now feel more confident that if a difficult examination requires the use of a lubricant, the test results will not be compromised.
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P66
BHIVA Conf 2005 Apr 20-23;11:P66

Abstract: withdrawn as requested
P67 A COMPARISON OF SELF-TAKEN VULVO-VAGINAL AND CERVICAL SAMPLES FOR THE DIAGNOSIS OF CHLAMYDIA TRACHOMATIS INFECTION BY PCR
BHIVA Conf 2005 Apr 20-23;11:P67
R Bendall1, FEA Keane2, N Saulsbury2, L Haddon2
Self-taken vulvo-vaginal samples are an acceptable alternative to cervical samples for C. trachomatis diagnosis.
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P68 COMPARISON OF THE SENSITIVITY AND ACCEPTABILITY OF MEATAL SWABS WITH ENDOURETHRAL SWABS FOR CHLAMYDIA TRACHOMATIS NAAT TESTING IN MEN
BHIVA Conf 2005 Apr 20-23;11:P68
B Elawad, KN Sankar and CF Dickson
Meatal swabs are more acceptable to men than endourethral swabs. Meatal swabs achieved high sensitivity, but the low lower 95% C.I. makes it unsatisfactory alternative to endourethral sampling. Meatal swabs may have place when endourethral swab is not tolerated and urine specimen unavailable. Design of a specific meatal swab may improve sensitivity. Additional assessment examining acceptability of self-collected swabs would be of value.
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P69 WHY WE DO NOT REVIEW NGU MORE THAN ONCE?
BHIVA Conf 2005 Apr 20-23;11:P69
T Theobald1, C O'Connor2, F Berkt3
Increasing workloads in GUM clinics necessitates re-evaluation of work practices. A recent articlei states that 34% of clinics in UK do not require male patients with NSU re-attend. A review of literature showed paucity of evidence for either practice. Traditional practice was evaluated.
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P70 PREVALENCE OF GENITAL INFECTION IN WOMEN ATTENDING PRIOR TO TERMINATION OF PREGNANCY (TOP)
BHIVA Conf 2005 Apr 20-23;11:P70
G Crowe, F Chhibber, S Amin
Women seeking TOP will accept screening for STIs and HIV, and have a high prevalence (9.9%) of these infections. Follow-up of positive patients is assisted by the screening process being carried out within DOSH but despite this only 75% of those requiring follow-up, attended. We intend to pilot a dedicated telephone followup clinic within the TOP service to try and address this need.
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P71 HOW MOLECULAR TESTS FOR GONORRHOEA INFECTION FIT INTO A MODERNISED GENITOURINARY MEDICINE SERVICE
BHIVA Conf 2005 Apr 20-23;11:P71
C Ryan, G Kudesia, GR Kinghorn
Gonorrhoea screening by SDA alone, using the chlamydia screening sample, is feasible for the majority of asymptomatic GUM patients. Assessment of specific risk factors in the routine patient history identifies those in whom additional tests for microscopy and culture should be taken. Only a few women missed by risk factor assessment require repeat examination and additional culture tests prior to treatment.
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P72 OUTBREAK OF GONORRHOEA LINKED TO INTERNET USE AMONG MEN WHO HAVE SEX WITH MEN
BHIVA Conf 2005 Apr 20-23;11:P72
CA Ison1, A Rea2, SA Collins2, IMC Martin1, N Bilek3, BG Spratt3
Acquisition of gonorrhoea and onward transmission within a rural town occurred through contact initiated via the internet or cruising, which has public health implications since they involve a high frequency of anonymous sexual contact and mixing of individuals from a wide geographical area.
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P73 GETTING IT RIGHT THE FIRST TIME: AN AUDIT OF GONORRHOEA MANAGEMENT IN A HIGH PREVALENCE AREA
BHIVA Conf 2005 Apr 20-23;11:P73
I Reeves, M Tenant-Flowers
This audit supports doubt over the utility of TOC and highlights the importance of appropriate initial therapy and sensitivity testing. Attempts to address the issues raised in this audit include: targeted patient information, maintaining open-access clinics and educating local GPs.
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P74 CHANGE FROM MICROSCOPY AND CULTURE TO GONORRHOEA STRAND DISPLACEMENT ASSAY – IS THERE AN IMPACT ON CLINICAL CARE?
BHIVA Conf 2005 Apr 20-23;11:P74
C Slater3, M Hawkins3, D Lewis3, E Fox1, J Klein2
Use of SDA with selective microscopy and culture has not compromised patient care. The impact of false positive tests is difficult to quantify and positive gonorrhoea SDA results should always be confirmed by culture.
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P75 SYPHILIS OUTBREAK IN WALSALL: EPIDEMIOLOGY AND LESSONS FOR CONTROL AND PREVENTION
BHIVA Conf 2005 Apr 20-23;11:P75
A Joseph1, M Pallan2, S Chandramani1, I Morrall1
Syphilis outbreak was occurring in two separate settings. Targeted multifaceted outreach programmes to include community venues and CSW's are necessary to combat further spread.
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P76 THE SYPHILIS OUTBREAK IN NORTHERN IRELAND
BHIVA Conf 2005 Apr 20-23;11:P76
C Emerson, A Lynch, S Gray, C Cunningham, RD Maw
Initially the contacts were mostly from Dublin, as the outbreak gained momentum syphilis was contracted within Northern Ireland. The cohort was not generally associated with high number of sexual contacts, multiple anonymous partners or specific locations. The challenge is to educate both patients and health care professionals as to sexual health issues, specifically the risk associated with casual oral sex by MSM.
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P77 SYPHILIS IN NOTTINGHAM - PREDOMINANTLY A HETEROSEXUAL DISEASE
BHIVA Conf 2005 Apr 20-23;11:P77
K Ponnusamy, P Goold, C J Bignell, C A Bowman
Heterosexual transmission accounted for 83.5% of the cases in this local outbreak. Diagnosis relied heavily on serology despite the high prevalence of clinical signs. Close collaboration with local prostitute outreach project (POW) resulted in enhanced screening of CSWs.
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P78 UK NATIONAL AUDIT OF EARLY SYPHILIS MANAGEMENT
BHIVA Conf 2005 Apr 20-23;11:P78
H McClean, D Daniels, C Carne, P Bunting, R Miller on behalf of the
A national audit of 781 early syphilis cases presenting during 2002–03 in UK genitourinary medicine clinics was conducted in late 2004, organised through the Regional Audit Groups. Data were aggregated by Region, allowing practice in Regions to be compared to the UK national guidelines and national averages.
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P79 WOMEN AND MEN WITH HERPES SIMPLEX (HSV) – TELLING A NEW PARTNER AND THE IMPACT ON SEXUAL RELATIONSHIPS
BHIVA Conf 2005 Apr 20-23;11:P79
M Nicholson1, L Waters2, S Barton2
Most individuals with genital HSV infection divulge this information to new partners and the majority experienced positive responses. There is a trend for non-disclosure amongst the recently diagnosed.
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P80 TOPICAL 5% IMIQUIMOD CREAM IN THE MANAGEMENT OF ANOGENITAL WARTS UNRESPONSIVE TO FOUR WEEKS OF STANDARD TREATMENT
BHIVA Conf 2005 Apr 20-23;11:P80
K Aderogba, I Fernie, I Samuel
5% imiquimod cream demonstrated good efficacy and was well tolerated. Complete responses were better in females with no ethnic differences observed.
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P81 SHOULD ALL CONFIRMED CASES OF CHLAMYDIA TRACHOMATIS BE REFERRED TO A GENITOURINARY MEDICINE (GUM) CLINIC?
BHIVA Conf 2005 Apr 20-23;11:P81
A Davies, A Chiganze, H Birley
The majority of cases of chlamydia infection can be adequately managed in primary care and routine referral to GUM may therefore not be justified.
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P81a TEST > TEXT > TREATMENT: TEXT MESSAGING SERVICE (TMS) IMPROVES THE TIME TO TREATMENT OF CHLAMYDIA TRACHOMATIS INFECTION AND REDUCES THE COST OF RESULT PROVISION
BHIVA Conf 2005 Apr 20-23;11:P81
AS Menon-Johansson, F McNaught, S Mandalia, AK Sullivan
Patients with genital CT infection are diagnosed and receive treatment sooner since the introduction of TMS. Significant savings in costs and staff time were seen following the introduction of this service.
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P82 PREVALENCE OF CHLAMYDIA IN PATIENTS ATTENDING FOR TERMINATION OF PREGNANCY
BHIVA Conf 2005 Apr 20-23;11:P82
S Bhaduri, C Minton, M Mann
In view of the lower incidence of chlamydia in TOP attendees, particularly in attendees over 30 years of age, further work is required to look at the cost effectiveness of chlamydia screening in TOP in this older age group.
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P83 CHLAMYDIAL CONJUNCTIVITIS RESULTING FROM DIRECT EJACULATION INTO THE EYE
BHIVA Conf 2005 Apr 20-23;11:P83
S Rackstraw, ND Viswalingam, BT Goh
Chlamydial conjunctivitis can result from direct ejaculation into the eyes. This mode of transmission may underestimated as a history of ejaculation into the conjunctiva is not normally asked for.
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P84 MICROSCOPIC CERVICITIS, WILL YOU TREAT?
BHIVA Conf 2005 Apr 20-23;11:P84
R Moussa
105 female patients were treated for microscopic cervicitis from a total of 437 patients examined, i.e. 24% of female clinic attenders. In this study, chlamydia was diagnosed nearly 3 time as often in patients with cervicitis (17), as those without (6). With the increase in GUM attenders and the increased number of STIs diagnosed, how should we manage cervicitis? Is treating and contact tracing a waste of resources, or is it an opportunity for preventing PID and tubal infertility?
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P85 LYMPHOGRANULOMA VENERUM IN HIV-POSITIVE HOMOSEXUAL MEN: IS AN OUTBREAK EMERGING IN LONDON?
BHIVA Conf 2005 Apr 20-23;11:P85
NT Annan1, J Dunning1, NA Smith1, K McLean1, B Azadian1, N MacDonald2, C Ison2, M Nelson1
Given the outbreaks in Western Europe and the number of cases presenting to our clinic in recent months we conclude that increased awareness among clinicians is essential to facilitate early diagnosis, treatment and prevent onward transmission of both LGV and HIV. Close collaboration between clinic staff and those in microbiology has been vital.
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P86