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15th Annual Conference of the British HIV Associations1-3 April 2009, Liverpool, UK |
Cite as: HIV Med. 2009 April; 10(Suppl 1):page number (abstract no. xx)
Example: HIV Med 2009 April; 10(Suppl 1):1 (abstract no. O1)
| ORAL ABSTRACTS Abstracts O1 to O30, pages 1 through 9 |
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| O1 | ADIPOGENIC GENE VARIANTS IN PATIENTS WITH HIV-ASSOCIATED LIPODYSTROPHY HIV Med. 2009 April; 10(Suppl 1):1 (abstract no. O1) S Pushpakom1, A Owen2, J Vilar3, D Back2 and M Pirmohamed2 Whilst highly active antiretroviral therapy (HAART) has been hugely beneficial in the treatment of HIV, lipodystrophy (LD) associated with HAART is a serious adverse effect, with long term consequences including metabolic disturbances (dyslipidemia, insulin resistance, sometimes leading to diabetes) and an increased risk of ischaemic heart disease. However, LD is clearly related to both the drug regimen and the individual patient and this suggests a role for genetic factors in conferring susceptibility to developing HIV LD. We hypothesised that variation in the genes involved in adipogenesis, and in those implicated in inherited forms of LD, may predispose to the development of LD in HAART-treated patients. |
| O2 | EVALUATION OF PERIPHERAL DUAL ENERGY X-RAY ABSORPTIOMETRY TO DETECT OSTEOPOROSIS IN AN HIV-SEROPOSITIVE MALE POPULATION HIV Med. 2009 April; 10(Suppl 1):1 (abstract no. O2) CS Short1, S Shaw1, M Fisher1, K Walker-Bone2 and Y Gilleece1 This study confirms a high prevalence of low BMD in HIV-infected men independently associated with fracture post diagnosis, underlining the potential requirement for screening. pDXA has a high discriminatory power as a screening tool and could be easily used in routine clinical practice to identify those patients who need DEXA imaging. |
| O3 | FEWER SUBJECTS SWITCHING TO QD ATV/R HAVE LIMB FAT LOSS VERSUS THOSE CONTINUING BID PI/R: 96 WEEK RESULTS OF THE MULTICENTRE, OPEN-LABEL, RANDOMIZED, PROSPECTIVE REAL STUDY FOR THE MANAGEMENT OF LIPODYSTROPHY HIV Med. 2009 April; 10(Suppl 1):1 (abstract no. O3) P Hay1, G Moyle2, Jamie Andrade3, Andrea Antinori4, Patricia Salvato5 and JM Girard6 In this 96 week analysis, patients with lipohypertrophy who switched from BID PI/r to QD ATV/r had no demonstrated benefit on lipohypertrophy but less limb fat loss, while maintaining efficacy and significantly reducing atherogenic lipids. |
| O4 | A PILOT STUDY OF CHANGES IN SURROGATE BIOMARKERS OF CARDIOVASCULAR DISEASE IN INDIVIDUALS INTERRUPTING ANTIRETROVIRAL THERAPY INITIATED IN PRIMARY HIV INFECTION HIV Med. 2009 April; 10(Suppl 1):1 (abstract no. O4) E Hamlyn, M McClure and S Fidler These data suggest that, contrary to chronic HIV infection, levels of IL-6 and D-dimer do not immediately rebound on discontinuing SCART after treatment interruption in PHI. These findings will be further evaluated using the SPARTAC cohort. |
| O5 | CLINICAL EPIDEMIOLOGY OF END-STAGE RENAL FAILURE IN THE UK HIV Med. 2009 April; 10(Suppl 1):2 (abstract no. O5) A Hughes1, L Bansi1, J Connolly2, S Edwards3, N Mackie4, M Fisher5, C Sabin2 and F Post6 The burden of ESRF increased more than six fold during the HAART era. Patients with HIVAN had more advanced renal failure at HIV presentation and a more fulminant course of kidney disease thereafter. Earlier HIV diagnosis in black patients will be an important strategy to stem the increase in number of patients with HIV/ESRF in the UK. |
| O6 | RISK FACTORS FOR VITAMIN D DEFICIENCY IN AN ETHNICALLY DIVERSE URBAN HIV COHORT: WHICH ANTIRETROVIRALS ARE IMPLICATED? HIV Med. 2009 April; 10(Suppl 1):2 (abstract no. O6) T Welz1, K Childs1, F Ibrahim2, M Poulton1 and F Post2 Hypovitaminosis D is almost universal in this cohort. EFZ use was associated with a lower 25(OH)D and TDF with a higher 25(OH)D level, although both drugs were independently associated with ALP elevations. Further studies are required to define the potential mechanisms and clinical implications of this interaction between ART, Vitamin D and bone. |
| O7 | DOES POINT-OF-CARE TESTING IMPROVE ACCEPTANCE OF HIV TESTING? HIV Med. 2009 April; 10(Suppl 1):2 (abstract no. O7) P Khan and S Creighton Overall uptake of HIV testing increased by 6% with the introduction of POCT. POCT resulted in a significant increase in the number diagnosed with HIV infection. The availability of immediate result by POCT appears to be more acceptable to individuals who may be at high risk of HIV infection and reflects the policy of recommending POCT to these individuals. It is conceivable that immediate results may facilitate ongoing access to HIV care and further work will aim to assess this. |
| O8 | A DECADE OF THE SPERM-WASHING PROGRAM: THE EFFECT OF HIV ON SEMEN PARAMETERS AND VIRAL LOAD? HIV Med. 2009 April; 10(Suppl 1):2 (abstract no. O8) JDM Nicopoullos, P Almeida and C Gilling-Smith Our data suggests a negative effect of low CD4 count and the use of HAART on semen. The significant proportion of 'stable' men with undetectable serum viral load but virus in semen confirms the continued importance of such risk-reduction measures. |
| O9 | HIV testing in termination of pregnancy services HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. O9) S Creighton, L Stacey and I Reeves Reducing undiagnosed HIV infection is an urgent public health priority. Women attending TOP had a higher prevalence of HIV than those attending ANC or GUM. Baseline CD4 was higher. This study shows that routine HIV testing at TOP clinics is feasible and may identify women at an earlier stage of HIV than other venues. Initiatives such as this are likely to reduce the excess morbidity and mortality associated with late diagnosis and may reduce onward HIV transmission. |
| O10 | NATIONAL SURVEY OF LACTATION SUPPRESSION IN HIV-POSITIVE PREGNANT WOMEN HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. O10) M Pammi and EM Carlin Avoidance of breastfeeding is universally advised in the UK. Use of single dose cabergoline is a simple effective method to avoid breast engorgement and its associated complications with no major drug interactions. Awareness of its potential for use in HIV positive pregnant women appears to be low. Increasing awareness of cabergoline and its appropriate use will improve the postnatal care of HIV positive mothers. |
| O11 | PREGNANCIES IN HIV-INFECTED ADOLESCENTS: A MULTICENTRE DESCRIPTIVE STUDY HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. O11) A Elgalib1, A Samarawickrama2, S Roedling3, S Tariq4, E Draeger5, A Hegazi6, T Rathnayaka7, A Azwa9, D Hawkins9, M Rodgers6, R Shah10, S Edwards3, J Russell8, H Noble5, M Poulton2, J Anderson4, G Taylor7 and A de Ruiter1 Although most pregnancies were unplanned, obstetric and virological outcomes were favourable. Documentation of contraception use and advice was poor. Nearly a quarter conceived again within 12 months of delivery. Although at high risk for STI, only a third were screened for STI within 6 months of conception. Effective measures to reduce HIV and STI transmission and unplanned pregnancies in HIV-infected adolescents are needed. |
| O12 | DO WE KNOW THE HIV STATUS OF OUR PATIENTS’ CHILDREN AT OUR ADULT HIV UNIT? HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. O12) US Asghar, F Young, A Croucher and C Wood Unfortunately we do not know the HIV status of our patients children and are not protecting them if, their parents decline child testing. Those at greatest risk are children whose mothers are HIV positive yet they remain untested because the majority of these children were born outside the UK. The next at risk group are, children of HIV positive fathers with positive partners. The system has already failed if we don't know the child exists. This audit confirms fears that if practise is not changed, further children may potentially die because they were not diagnosed early enough. As a result, our department is now counselling families with untested children and new local guidelines have been implemented. These should be made nationwide. Adult units need to share responsibilities and be prepared to challenge patients if they decline child testing. |
| O13 | HIGHLY ACTIVE ANTIRETROVIRAL THERAPY AND THE INCIDENCE OF NON-AIDS-DEFINING CANCERS IN PEOPLE WITH HIV INFECTION HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. O13) T Powles1, D Robinson2, J Stebbing3, M Nelson4, S Mandalia4, H Moller2, B Gazzard4 and M Bower4 Since the introduction of HAART there has been a significantly increased risk of NADC, which has now stabilised. A number of factors are associated with this increased risk including, HAART use. There may be an association between the use of NNRTIs and the development of Hodgkin’s lymphoma. |
| O14 | METHYLATION REVERSAL IN HIGH GRADE B LYMPHOMA CELL LINES IDENTIFIES NOVEL EPIGENETIC CHANGES CONSERVED BETWEEN IMMUNOCOMPETENT AND HIV-POSITIVE HOSTS AND OTHERS SPECIFIC TO HIV-ASSOCIATED LYMPHOMA HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. O14) T Crook1, N Syed2, A Papoudou-Bai3, J Stebbing2, K Naresh2, M Nelson1, E Hatzimichael3 and M Bower1 We have identified a number of novel genes subject to transcriptional silencing in high-grade B lymphomas. The similar frequency of methylation observed in immunocompetent and HIV positive patients for a subset of these genes implies that these may be fundamental in suppression of lymphomagenesis. In contrast, other genes are methylated only in HIV-associated cases suggesting important functions in the immunocompromised host. We are currently assessing the potential utility of detection of methylated DNA in these genes as candidate biomarkers of outcome in each patient group. |
| O15 | EXCELLENT IMMUNOLOGICAL RECOVERY FOLLOWING THE INTENSIVE CHEMOTHERAPY CODOX-M/IVAC, AN EFFECTIVE THERAPY FOR HIV-ASSOCIATED BURKITT’S LYMPHOMA HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. O15) J Wilson1, S Montoto2, K Shaw3, C Orkin2, M Johnson1, M Nelson3, M Bower3 and K Cwynarski1 The intensive regimen CODOX-M/IVAC, a feasible and effective chemotherapy, is associated with an excellent immunological recovery in patients with HIV-BL on HAART. |
| O16 | THE ROLE OF THE GUT MUCOSA IN PROTECTION FROM HIV-1 IN HIGHLY EXPOSED PERSISTENTLY SERONEGATIVE INDIVIDUALS (HEPS) HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. O16) J Fox1, C Willberg2, P Ziprin3, R Goldin3, J Weber3, M McClure3, P Klenerman2 and S Fidler3 This is the first study of the rectal tissue of HEPS and although limited by sample size, provides insight into gut HIV pathogenesis. The rectum does not represent a sanctuary site for viral control or harbour HIV-specific immune responses in HEPS. Flow cytometry is required to investigate CD8 and CD16 cell populations further. The trend towards increased CD16 in HEPS with increasing sexual exposure to HIV is intriguing as CD16 is found on the surface of NK cells, monocytes and macrophages which play a vital role in the first line of defence against HIV infection. |
| O17 | IMPACT OF RECOMBINANT HUMAN GROWTH HORMONE ON T-CELL PHENOTYPE AND FUNCTION IN VITRO AND IN VIVO DURING TREATED HIV-1 INFECTION HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. O17) A Herasimtschuk1, M Nelson2, G Moyle2, M Bower2 and N Imami1 These data indicate that beneficial effects of rhGH on T cells in the periphery correlate with reduced activation and exhaustion markers. Daily dosing of rhGH with HAART may reverse some of the T-lymphocyte dysfunction seen in most treated HIV-1+ patients. Thus, immune-based therapeutic approaches may enable the induction of HIV-1 specific CD4+ T cells required to revive the expansion of virus-specific CD8+ T cells. |
| O18 | HIV TRANSMISSION AMONGST MSM: ASSOCIATION WITH ANTIRETROVIRAL THERAPY, INFECTION STAGE, VIRAEMIA AND SEXUALLY TRANSMITTED INFECTIONS (STI) IN A LONGITUDINAL PHYLOGENETIC STUDY HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. O18) M Fisher1, K Nambiar1, A Brown2, S Sudarshi1, D Pao1, N Gill2, C Sabin3 and D Pillay2 Onward transmission of HIV amongst MSM is associated with RI, STI and higher VL, and is reduced by HAART. The majority of new infections, however, appear to occur from individuals whose infection is undiagnosed. Strategies to control the epidemic amongst MSM must consider earlier diagnosis, increased HIV testing, improved STI control, and use of HAART to reduce infectivity. |
| O19 | A COHORT ANALYSIS OF TREATMENT OUTCOMES FROM THE LARGEST PROVIDER OF ANTIRETROVIRAL TREATMENT IN BURMA HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. O19) K Sabapathy1, M Kyaw-Kyaw2 and F Smithuis2 The programme has successfully scaled-up ART provision in Burma and progressively improved outcomes of the most advanced patients. Survival and loss to follow-up data compare favourably with those of other resource-limited settings, despite high levels of severe immuno-suppression and treatment provision entirely at the primary care level. Nonetheless, the unmet need for ART remains high, and requires urgent attention. |
| O20 | LOW-FREQUENCY MUTATIONS STRENGTHEN THE IMPACT OF TRANSMITTED DRUG RESISTANCE (TDR) ON VIROLOGICAL RESPONSES TO FIRST-LINE EFAVIRENZ-OR NEVIRAPINE-BASED ANTIRETROVIRAL THERAPY HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. O20) AL Strang1, JA Johnson2, Z Fox1, CL Booth1, AN Phillips1, JF Li2, W Heneine2 and AM Geretti1 Low-frequency K103N mutants were as prevalent as high-frequency variants in this UK cohort. The detection of low-frequency K103N was significantly associated with virological failure and, albeit not consistently, predicted the failure genotype. |
| O21 | SWITCHING FROM EFAVIRENZ (EFV) TO NEVIRAPINE (NVP): A NOVEL PHARMACOLOGICAL STRATEGY HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. O21) NE Dufty, S Barrett and S Taylor Switching from EFV to NVP is often required in clinical situations but the optimal switch strategy is unknown. Current strategies include switching directly from EFV to NVP 200 mg BD or using a traditional 2 week NVP 200 mg OD lead-in period after stopping EFV. In our unit, typical side effects of rash and hepatitis have been observed in patients despite a low nadir CD4 count. This prompted us to re-evaluate both strategies. We hypothesised that a 2 week cross-over period of EFV with NVP 200 mg OD would provide therapeutic concentrations of EFV during possible sub therapeutic NVP concentrations [NVP] whilst minimising the risk of rash or hepatotoxicity. |
| O22 | IMPACT OF BASELINE (BL) ANTIRETROVIRAL RESISTANCE STATUS ON EFFICACY OUTCOMES AMONG PATIENTS RECEIVING MARAVIROC (MVC) PLUS OPTIMIZED BACKGROUND THERAPY (OBT) IN THE MOTIVATE 1 AND 2 STUDIES HIV Med. 2009 April; 10(Suppl 1):7 (abstract no. O22) A Teague1, M Nelson1, M Fisher2, J Gonzalez-Garcia3 and J Rockstroh4 These data suggest MVC use may be more beneficial in TE patients with R5 virus who do not have triple class-resistant virus than in more heavily treatment-experienced patients. |
| O23 | NUCLEAR RECEPTOR POLYMORPHISMS AND BOOSTED SAQUINAVIR PLASMA CONCENTRATIONS IN HIV-INFECTED SUBJECTS HIV Med. 2009 April; 10(Suppl 1):6 (abstract no. O023) A Chaikan, D Egan, S Gibbons, SH Khoo, A Owen and D Back HNF4alpha (rs1884613G) SNPs may, in part, explain inter-individual variability in SQV concentrations. Further studies are required to confirm the influence of nuclear receptor polymorphisms on other boosted protease inhibitor pharmacokinetics. |
| O24 | DARUNAVIR/RITONAVIR ONCE DAILY: A SINGLE-CENTRE COHORT EXPERIENCE HIV Med. 2009 April; 10(Suppl 1):6 (abstract no. O24) C Scott, A Teague, M Bower, B Gazzard and M Nelson In this cohort of treatment naïve and experienced patients with no background PI resistance, once daily darunavir/ritonavir (900/100 mg) is both effective in terms of virological suppression and well tolerated. |
| O25 | HIV PREVALENCE AND TESTING PRACTICES AMONG TUBERCULOSIS CASES IN LONDON HIV Med. 2009 April; 10(Suppl 1):7 (abstract no. O25) A Rodger1, A Hayward1, Z Fox1 and A Story2 Over half of TB patients in London in 2003/04 were not offered HIV testing. In those offered testing, uptake was high. Patients in higher risk groups were more likely to be offered testing, but even within the very highest risk groups testing was not universally offered. Healthcare staff should promote universal HIV testing in TB patients given the increased morbidity and mortality of co-infection, and identify barriers to acceptance of testing especially in women. |
| O26 | SUCCESSFUL PRIMARY PREVENTION OF CRYPTOCOCCAL DISEASE USING FLUCONAZOLE PROPHYLAXIS IN HIV-INFECTED UGANDAN ADULTS (CRYPTOPRO) HIV Med. 2009 April; 10(Suppl 1):7 (abstract no. O26) R Parkes-Ratanshi1, K Wakeham2, A Kamali2, J Levin2, A Coutinho3, J Whitworth4, H Grosskurth2 and D Lalloo5 Cryptococcal disease remains a significant cause of morbidity and mortality in HIV infected individuals in tropical settings, despite the introduction of antiretroviral therapy (ART). No large trial of fluconazole as primary prophylaxis has been done in Africa. |
| O27 | COGNITIVE FUNCTION AND BRAIN GREY MATTER CHANGE IN HIV-1 YOUNGER AND OLDER POSITIVE ‘MEN WHO HAVE SEX WITH MEN’ IN THE POST-HAART (HIGHLY ACTIVE ANTIRETROVIRAL THERAPY) ERA HIV Med. 2009 April; 10(Suppl 1):7 (abstract no. O27) K Towgood1, M Pitkanen1, R Kulasegaram2, G Barker1, S Soni3, M Fisher3, C Bradbeer2 and M Kopelman1 Whilst there was a slightly increased rate of cognitive impairment in the HIV-1 positive groups, these results were not found to be statistically significant. Results from this study are therefore consistent with existing evidence that suggests that asymptomatic HIV-1 disease does not impair cognitive function. We did however find significant brain grey matter content loss. This may suggest that structural brain changes are present in HIV-1 positive patients despite intact cognitive function and may indeed precede the appearance of detectable cognitive change. |
| O28 | NON-CIRRHOTIC PORTAL HYPERTENSION IN HIV-MONO-INFECTED INDIVIDUALS A Scourfield, LJ Waters, P Holmes, G Panos, K Armenis, J Underwood and M Nelson Non-cirrhotic portal hypertension should be considered in individuals with chronic HIV infection, longstanding ddI therapy, persistently raised ALT or clinical features of portal hypertension. Fibroscan is a useful non-invasive method for the diagnosis and monitoring of these patients. |
| O29 | MULTICENTRE SURVEILLANCE STUDY OF HEPATITIS B VIRUS (HBV) INFECTION IN HIV-INFECTED PATIENTS: EVIDENCE OF TRANSMITTED AND ACQUIRED HBV DRUG RESISTANCE HIV Med. 2009 April; 10(Suppl 1):8 (abstract no. O29) T Doyle HBV co-infection is mostly treated according to guidelines, with good virological responses. A subset of patients is on suboptimal therapy and at risk of HBV viraemia and drug resistance, despite well controlled HIV. A suppressed HIV VL should not be taken as evidence of HBV control. 3TC-resistant HBV is transmissible and pathogenic. There was a great variety of HBV genotypes in this cohort, consistent with its ethnic diversity. |
| O30 | AIDS KAPOSI’S SARCOMA: OUTCOMES IN 254 CONSECUTIVE PATIENTS DIAGNOSED IN MODERN TIMES HIV Med. 2009 April; 10(Suppl 1):8 (abstract no. O30) S Powles, J Weir, N Francis, T Newsom-Davis, T Crook, M Boffito, M Nelson and M Bower A prospective cohort study was performed to evaluate the clinical outcomes of patients with histologically confirmed AIDS related Kaposi's sarcoma (KS) diagnosed since the introduction of highly active antiretroviral therapy (HAART). |
| POSTER ABSTRACTS Abstracts P1 to P150, pages 10 through 50 |
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| P1 | ‘LOST TO FOLLOW-UP’ – WHICH PATIENTS DISENGAGE FROM HIV SERVICES AND WHY? HIV Med. 2009 April; 10(Suppl 1):10 (abstract no. P1) A Osborne and S Kegg Black African patients and those not taking ART are most likely to disengage from services. Loss of contact with services or movement to other centres appears to be largely voluntary and not driven on by dispersal or deportation. A number of patients re-engage with services within 12 months and although this can be encouraged by proactive contact, mobilephonesdo not provide a durable means of contact withthese patients. |
| P2 | ACCESS TO HEALTHCARE: ADDRESSING BARRIERS TO GPS AND PRIMARY CARE SERVICES FOR PEOPLE LIVING WITH HIV HIV Med. 2009 April; 10(Suppl 1):10 (abstract no. P2) A Anderson and E Crafer Research to date suggests that there needs to be dual approach to training for GPs addressing anti-discriminatory and protocols for treating PLHIV, along with cooperative working between GP's and HIV clinics. There may also be scope in supporting PLHIV to act as an 'expert patient' managing the doctor-patient relationship between GPs and HIV specialists. |
| P3 | ASSESSMENT OF THE IMPACT OF A HOME DELIVERY SERVICE ON THE VIROLOGICAL OUTCOME OF PATIENTS WITH THE HUMAN IMMUNODEFICIENCY VIRUS (HIV) HIV Med. 2009 April; 10(Suppl 1):10 (abstract no. P3) H Papineni1, S Castelino2 and C Jones1 The study found that there was no significant difference in the HIV viral load between patients who had their AVR medicines home delivered and patients that were suitable but declined to join the service, indicating they have similar patient outcomes. |
| P4 | CHALLENGES IN ADDRESSING COUNSELLING NEEDS OF MSM IN HIGHLY STIGMATIZED CONTEXTS: RESULTS OF A QUALITATIVE STUDY FROM KENYA HIV Med. 2009 April; 10(Suppl 1):11 (abstract no. P4) M Taegtmeyer1, A Muhaari2, A Davies2, M Mwangome2, EM van der Elst2, SM Graham3 and EJ Sanders4 Counsellor training must challenge judgmental attitudes, as well as improving risk reduction skills, and link to on-going support supervision. On-going exposure, discussion and the presence of counsellors who themselves identified as MSM were powerful promoters of attitudinal change in counsellors which in turn impacted positively on the quality of risk reduction counselling. We will present the findings from this rich data to give a deeper understanding of the breadth and subtly of training and supervisory needs required to provide HIV prevention services to this highly stigmatized group in Africa. |
| P5 | CHANGING PATTERNS IN HIV CARE-OUTCOMES FROM A COMBINED HIV RENAL CLINIC HIV Med. 2009 April; 10(Suppl 1):11 (abstract no. P5) M Rayment, J Levy, M Nelson and R Jones Renal pathology is common in individuals living with HIV. Providers of HIV care should be adept at recognizing those at risk of renal complications and aware of methods to detect, monitor, investigate and treat those affected. Given that the majority of diagnoses made in the combined HIV/renal clinic were unrelated to HIV or antiretroviral exposure, renal management should be provided with the support of an experienced renal physician in a combined clinic where available. |
| P6 | CONFLICTING NEEDS: INVESTIGATING PATIENT PREFERENCES IN THE DESIGN OF A NEW HIV/SEXUAL HEALTH CLINIC SERVING AN ETHNICALLY DIVERSE POPULATION HIV Med. 2009 April; 10(Suppl 1):11 (abstract no. P6) V Harrison, M Fadojutimi, J Anderson and I Reeves Patient preferences were conflicting as they stressed the importance of maintaining confidentiality through environmental design e.g. joint entrances/waiting areas, yet they also wanted to access HIV specific information and talk to other patients within this space. The positive response to the provision of non-clinical services e.g. housing advice and waiting areas separated by gender highlights the social need and diversity of this population, where HIV is only part of a complex of needs. These findings indicate the importance of involving patients and understanding their needs within service design. |
| P7 | CROSSING THE DIVIDE: TRANSITIONAL CARE FOR YOUNG ADULTS WITH HIV – THEIR VIEWS HIV Med. 2009 April; 10(Suppl 1):11 (abstract no. P7) H Bundock1, G Tudor-Williams1, S Fidler1, S McDonald2 and C Foster2 The views of young people living with chronic disease are important in developing transitional care services. This study illustrates that careful transition to a specialized adult service can be a positive event for young people born with HIV. However, the adult ward did not meet some of their healthcare needs and dedicated inpatient services for young people are required. |
| P8 | DISTURBING SYMPTOMS 7: HOW CLINICIANS VIEWED THE STATE OF SEXUAL HEALTH WORK IN 2008–2009 HIV Med. 2009 April; 10(Suppl 1):12 (abstract no. P8) L Power, V Sheard and P Ward Disturbing Symptoms is an annual review, now in its 5th year, analyzing English clinician and commissioner views of how changes in the NHS and in patient load affected sexual health services in the previous year. In 2009 the surveys were extended to cover the whole UK. This paper addresses clinician views across the UK. |
| P9 | HIV-POSITIVE PATIENT RETENTION AT A NORTH LONDON CLINIC: HIGH RATES OF LOSS TO CLINICAL FOLLOW-UP AMONG PREGNANT WOMEN HIV Med. 2009 April; 10(Suppl 1):12 (abstract no. P9) P Stamoulos, TJ Barber and C Wood Our study confirms a high rate of LFU in our HIV+ cohort. Another key finding is the high proportion of pregnant women who are LFU which has not been shown in any other UK study to date. Further analysis is planned to better understand this data, to establish the reasons for LFU in this particular group and to engage better with these patients in the future. |
| P10 | HOUSING AND HIV: THE IMPACT OF HOUSING ON THE HEALTH AND WELL-BEING OF PEOPLE LIVING WITH HIV – AN ANALYSIS HIV Med. 2009 April; 10(Suppl 1):12 (abstract no. P10) Y Azad and J Anderson HIV is an issue that needs to be on the housing agenda and vice versa. NAT and Shelter are using the data from this analysis to develop guidance for housing professionals on HIV and its impact on housing needs. This guidance will be published and disseminated in the first quarter of 2009. |
| P11 | IS BEING HIV-INFECTED A BARRIER TO ACCESSING DENTAL CARE? HIV Med. 2009 April; 10(Suppl 1):12 (abstract no. P11) NM Steedman1 and CJ Cunningham2 Despite MedFASH and GDC guidance HIV-positive individuals still experience significant barriers to accessing dental treatment and many patients remain reluctant to disclose their HIV status. Continued efforts to reduce HIV-associated stigma are essential in order to improve dental care for people living with HIV. |
| P12 | MEETING THE CHALLENGE: SEEING ALL NEW DIAGNOSES WITHIN 2 WEEKS? HIV Med. 2009 April; 10(Suppl 1):13 (abstract no. P12) E Draeger and H Noble Time to first offered appointment has lengthened despite interventions designed to reduce it. Between January and August 2008 a mean of 10 new patients a month presented to the clinic and overall our clinic numbers are increasing. In order to achieve the BHIVA standard more new patient appointments need to be created at our clinic. Further interventions such as a nurse-led stable patient clinic are being implemented but considerable innovation will be required to meet the target. |
| P13 | NEWLY DIAGNOSED HIV INFECTION IN AN INNER LONDON GENITO-URINARY MEDICINE (GUM) CLINIC HIV Med. 2009 April; 10(Suppl 1):13 (abstract no. P13) V Apea1, P Khan1, A De Masi1, M Kall1, T Chadborn2 and I Reeves1 BHIVA standards were met in 93% of our cohort. However, there was significant attrition in attendance for further care, including those with advanced disease. A significant number have not attended other HIV services which may be due to the complex psychosocial difficulties faced by our clinic population. New initiatives are urgently needed to ensure that this complex, at-risk group are fully engaged with HIV services. |
| P14 | PROMOTION OF SEXUAL HEALTH SERVICES TO MEN WHO HAVE SEX WITH MEN, OFFERING HEPATITIS B VACCINATIONS IN KNOWN GAY VENUES HIV Med. 2009 April; 10(Suppl 1):13 (abstract no. P14) S Toomer, J Sweeney and W Wasef This study showed that sexual health promotion could be improved by delivering services in the community especially amongst a high-risk population. |
| P15 | SEXUAL AND REPRODUCTIVE HEALTH OF HIV-POSITIVE WOMEN – SURVEY FROM A PROVINCIAL CENTRE HIV Med. 2009 April; 10(Suppl 1):13 (abstract no. P15) S Moses and J Dhar Further information regarding the SRH of HIV-positive women accessing our service will be discussed. Data highlights differing practices with regard to sexual activity and contraceptive use when compared to the general population. In spite of high awareness of the benefits of HAART in pregnancy, women remain at risk of unplanned pregnancy. Condom use was sub-optimal and an interesting observation was this being sought from non NHS providers. Establishing a dedicated SRH clinic could optimize counselling, contraceptive provision and effective safe sex practices without fear of HIV status disclosure and drug interactions and is likely to be well received locally. |
| P16 | TARGETING HARD-TO-REACH GROUPS: MOVING OUTSIDE THE HIV CLINIC HIV Med. 2009 April; 10(Suppl 1):15 (abstract no. P16) S Creighton The community-based clinics were successful at engaging hard to reach individuals and attracted additional clients. The number of clients appropriately starting ART rose from 13/27 to 27/30, and those lost to follow-up reduced from 22 to 7. Although labour-intensive, it appears that offering a holistic model of care by a multi-disciplinary team including non-HIV specialists may be an effective method of targeting hard-to-reach groups. |
| P17 | THE IMPORTANCE OF PROVIDING VOLUNTARY SECTOR ADVOCACY AND PEER SUPPORT WORKERS IN HIV CLINICS HIV Med. 2009 April; 10(Suppl 1):14 (abstract no. P17) M Muheki1, J Rwami1 and C Wood2 VS and PS workers have greatly added to services that we are able to provide in our clinic. Immediate access to them has improved the quality of service both from the perspective of healthcare providers and patients. They have been particularly invaluable in complex hard to reach cases relating to denial and non-acceptance of HIV diagnosis, disclosure and poor adherence to therapy. We believe that there should be access to these services for all patients attending HIV services in the UK. We recognize that some clinics may not have voluntary sector support locally. However, peer support workers can be developed in any clinic with appropriate prioritization, this issue should be addressed at national level so that funding is readily available. We believe it is time to recognize the invaluable services that voluntary sectors and peer support workers provide to the statutory sector and the statutory sector needs to take some responsibility to ensure, availability, provision and continuity of these services. |
| P18 | THE PROVISION OF HIV HEALTH TRAINER SERVICES IN LONDON – EVALUATION OF THE FIRST YEAR’S EXPERIENCE HIV Med. 2009 April; 10(Suppl 1):14 (abstract no. P18) P Ward, G Brough and L Power Health trainers play an important role in supporting people to make healthier lifestyle choices. In 2007/08 THT opened the first condition-specific service in the UK HIV field. These were funded by London PCTs with the aim of providing health support to people with HIV in HIV outpatient clinics, THT centres, by telephone and at home where applicable. |
| P19 | UNDERSTANDING THE SEXUAL AND REPRODUCTIVE HEALTH NEEDS OF WOMEN LIVING WITH HIV HIV Med. 2009 April; 10(Suppl 1):14 (abstract no. P19) G Cooney1, C Cohen2 and S Day2 While this is a small study results suggest that women would value a comprehensive sexual health service within their HIV outpatients departments. Of note a large number of HIV+ women are considering pregnancies and would welcome preconceptual care. The study also indicates a need to support Health Promotion topics such as cervical smears, condom use, and disclosure. Women's interest in accessing certain services at their GPs would suggest a need to work more collaboratively with level 1 services to support this service. |
| P20 | USER PREFERENCE OF MODELS OF HIV AND NON-HIV CARE DELIVERY HIV Med. 2009 April; 10(Suppl 1):15 (abstract no. P20) S Munir1, SG Edwards1, J Richens2, A Copas2, A Byakwaga1, G Brough3, B George1 and PD Benn1 User preferences of model are influenced by age and previous use of GPs. Further evaluation is warranted to ensure acceptable GP services are available to all. |
| P21 | WHAT DO COURT TRANSCRIPTS REVEAL ABOUT JUDGES’ UNDERSTANDING OF THE MEDICAL IMPACT OF HIV INFECTION AND WHAT ARE THE IMPLICATIONS FOR HEALTHCARE PROFESSIONALS GIVING ADVICE TO THE COURT? HIV Med. 2009 April; 10(Suppl 1):15 (abstract no. P21) R James More must be done to provide judges and courts with balanced and up-to-date information on all aspects of HIV. This can be achieved both through interventions by the Judicial Studies Board but also by careful explanation from healthcare professionals when asked to advise or give evidence in such cases. |
| P22 | WHAT DO PEOPLE WITH HIV REALLY THINK CLINICS AND HIV ORGANIZATIONS ARE GOOD FOR? HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P22) L Power1, P Ward1 and P Weatherburn2 Both clinics and NGOs need to be aware of how PWHIV view them and the needs they can meet. In particular, clinics are identified as having a greater role in managing sex and relationships then they may realize and this impacts upon many current concerns such as prosecutions for transmission. Since clinics and NGOs are very different in the uses made of them, opportunities for joint/collaborative working should be explored. |
| P23 | CASTLE STUDY: 96-WEEK EFFICACY & SAFETY OF ATV/R VERSUS LPV/R IN ANTIRETROVIRAL-NAÏVE HIV-1-INFECTED PATIENTS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P23) M Johnson1 and G Moyle2 on behalf of the CASTLE Study Group Non-inferiority of ATV/r versus LPV/r was confirmed at week 96. In the ITT analysis, ATV/r had higher response rates. This difference in response was driven by discontinuations among subjects on LPV/r. ATV/r continues to demonstrate a better lipid profile and fewer GI AEs versus LPV/r. |
| P24 | CLINICAL EXPERIENCE OF RALTEGRAVIR IN SALVAGE PATIENTS FAILING THERAPY, 48-WEEK DATA HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P24) A Teague, C Scott, M Bower, B Gazzard and M Nelson The use of RGV, a new class of drug, in combination with other active antiretroviral agents, leads to an excellent virological response in highly treatment experienced patients. In our cohort all but one individual achieved an undetectable viral load at week 48, setting a new target for patients in salvage therapy. |
| P25 | CLINICAL EXPERIENCE WITH MARAVIROC (UK 427857 OR CELSENTRI®) WITH AN OPTIMIZED BACKGROUND REGIMEN IN HIGHLY TREATMENT-EXPERIENCED PATIENTS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P25) A Teague, J Underwood, C Scott, M Bower, B Gazzard and M Nelson In those individuals taking MVC, good CD4 count rises were seen in both those with virological failure or suppression at baseline. In individuals failing HAART, who are CCR5 tropic, MVC is an effective antiretroviral when used with other active agents achieving high rates of virological suppression. |
| P26 | ETRAVIRINE USE IN CLINICAL PRACTICE: 48-WEEK DATA FROM A SINGLE-CENTRE COHORT HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P26) C Scott, A Teague, M Bower, B Gazzard and M Nelson ETV + OBR is an effective antiretroviral combination in treatment experienced patients. ETV is a suitable alternative antiretroviral in patients who need to switch therapy. There was no loss of virological control in the subset of individuals who switched therapy to a regimen that included ETV. |
| P27 | EVALUATING HIV-1 CO-RECEPTOR TROPISM IN A DIVERSE CLINIC POPULATION HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P27) M Rogers and I Reeves The majority of these patients were infected with R5 tropic virus. The number of patients with CD4 <200 was small suggesting that the test took low priority in patients with more advanced disease. Patients experiencing treatment failure with VL <1000 are also not represented. Should future data show that tropism does not change whilst patients take effective therapy, pre-treatment tropism testing will expand the choices available to patients wishing to switch due to treatment-related tolerability/toxicity. |
| P28 | EXPERIENCE WITH RITONAVIR/ATAZANAVIR IN HIV-POSITIVE ANTIRETROVIRAL-NAÏVE INDIVIDUALS COMMENCING THERAPY HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P28) J Dunning, J Myers, P Holmes, C Stuart-Buttle, M Bower and M Nelson Boosted atazanavir is a safe and effective PI, with a favourable lipid profile, when used in combination with other antiretrovirals in a treatment-naïve cohort with 89% of individuals achieving an undetectable viral load at week 48 (ITT). |
| P29 | HIGH RISK OF EARLY FAILURE OF ANTI-RETROVIRAL THERAPY WITH TRUVADA/NEVIRAPINE AND ASSOCIATED RESISTANCE MUTATIONS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P29) L Turtle1, H Reynolds2 and SH Khoo2 A high rate of early virological failure on the antiretroviral combination Truvada and nevirapine (Truvada/NVP) has previously been described in controlled clinical trials. We report the occurrence of a number of treatment failures in our cohort of approximately 800 HIV+ patients. |
| P30 | IS THERE A ROLE FOR ETRAVIRINE IN PATIENTS WITH NNRTI RESISTANCE? &NDASH; AN UPDATE USING A WEIGHTED ETV RESISTANCE ASSOCIATED MUTATION SCORE HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P30) C Scott, A Teague, G Kawai, M Bower, B Gazzard and M Nelson Using the ETV RAM weighted score we predict that the majority of patients (90%) in our cohort who have failed on EFV or NVP with NNRTI resistance will be ETV susceptible (WS <4). This value is comparable to the previously predicted majority. |
| P31 | LOPINAVIR/RITONAVIR (LPV/R) COMBINED WITH RALTEGRAVIR (RAL) PROVIDES MORE RAPID VIRAL DECLINE THAN LPV/R COMBINED WITH TENOFOVIR DISOPROXIL FUMARATE/EMTRICITABINE (TDF/FTC) IN TREATMENT-NAÏVE HIV-1-INFECTED SUBJECTS HIV Med. 2009 April; 10(Suppl 1):19 (abstract no. P31) T Podsadecki, M Tian, L Fredrick, A Lawal and B Bernstein Through 8 weeks of treatment, the novel NRTI-sparing regimen of LPV/r+RAL results in a more rapid VL decline and a statistically significantly higher proportion of subjects with VL below the LOQ compared to LPV/r+TDF/FTC. These results are consistent with the rapid rate of decay previously observed with RAL+2 NRTIs, and show that a 2 drug NRTI-sparing regimen can also achieve such rapid HIV-1 RNA suppression. |
| P32 | PATIENT ACCEPTABILITY OF ATAZANAVIR FORMULATIONS: SIZE VERSUS PILL BURDEN HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P32) DA Ogden and ST Sadiq In this mixed cohort, the majority of patients felt size was not an issue in choosing the 300 mg capsule. A minority chose the higher pill burden with 150 mg capsules despite the new formulation being no bigger than the ritonavir capsule. This was an effect seen across age, gender and ethnicities. Potential increased patient acceptability with reduced pill burden regimens may be offset by increases in pill size in some patients. Clinics should be mindful of formulation changes where size increases with lower pill burden. |
| P33 | PATIENT TREATMENT SATISFACTION AFTER SIMPLIFICATION TO A FIXED DOSE COMBINATION OF EFAVIRENZ/EMTRICITABINE/TENOFOVIR HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P33) E Rutland and R Mani The vast majority of patients taking fixed dose Tenofovir/ Emtricitabine and Efavirenz report high treatment satisfaction scores. There was a significant improvement on switching to FDC; however this effect was small overall with a 'ceiling effect' created by the large proportion of patients scoring highly at baseline. The HIVTSQ change demonstrated an improvement in patient treatment satisfaction following switch to FDC Tenofovir/Emtricitabine/Efavirenz. |
| P34 | SIMPLIFYING TO ATRIPLA: NOT ALWAYS SIMPLE? HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P34) E Castro-Sanchez1, SG Edwards1, J Minton2 and PD Benn1 We report a surprisingly high level of discontinuation of Atripla among our patients despite many having previously tolerated both truvada and EFV. Furthermore simplification to Atripla was uncommon in patients stable on a boosted PI regimen. |
| P35 | SWITCHING TO RALTEGRAVIR; A SUCCESSFUL STRATEGY IN TREATMENT-EXPERIENCED PATIENTS WITH TOXICITY? 48-WEEK DATA HIV Med. 2009 April; 10(Suppl 1):19 (abstract no. P35) A Teague, C Scott, T Youngstein, M Bower, B Gazzard and M Nelson In treatment experienced patients, intolerant of a PI/T20, substitution of this agent with RGV is a successful strategy. Our data show sustained virological suppression to week 48. |
| P36 | THE EVOLUTION OF CO-RECEPTOR TROPISM IN PATIENTS INTERRUPTING SUPPRESSIVE HAART HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P36) LJ Waters, AT Scourfield, P Randell, M Marcano, BG Gazzard and MR Nelson Change in tropism during viral suppression is uncommon and or most patients a stored sample Trofile can reliably guide treatment switch. Both patients who demonstrate tropism change were highly treatment-experienced. |
| P37 | USE OF A PRESCRIPTION REFILL-BASED MEASURE OF ANTIRETROVIRAL THERAPY ADHERENCE TO PREDICT SUBSEQUENT VIROLOGICAL REBOUND IN PATIENTS WITH STABLE UNDETECTABLE HIV VIRAL LOADS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P37) V Cambiano1, F Lampe1, A Rodger1, C Smith1, R Lodwick1, J Holloway2, M Johnson2 and A Phillips1 To assess whether a simple, routinely available measure of adherence to antiretroviral therapy (ART) – the proportion of days covered by drug prescriptions in the previous 6 months – predicted viral rebound at the next HIV viral load (VL), in patients who were previously virologically suppressed. |
| P38 | UTILITY OF THERAPEUTIC DRUG MONITORING (TDM) IN A COHORT OF PERINATALLY HIV-INFECTED ADOLESCENTS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P38) V Cambiano1, F Lampe1, A Rodger1, C Smith1, R Lodwick1, J Holloway2, M Johnson2 and A Phillips1 TDM is a useful tool in perinatally HIV-infected adolescents to confirm poor adherence to ARVs and sub-therapeutic ARV dosing. It may also be used to monitor ARV toxicity and ARV levels when drug interactions are suspected. Routine TDM in this group is not indicated. Adult ARV dosing regimens can be used when adolescents' weight is >40 kg. |
| P39 | GENDER AND RACE-BASED EFFICACY AND SAFETY ANALYSES IN ARV-NAÏVE PATIENTS TREATED WITH BOOSTED PROTEASE INHIBITORS (PIS): RESULTS FROM THE CASTLE STUDY HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P39) M Johnson on behalf of the CASTLE Study Group The CASTLE study has shown that ATV/r is non-inferior to LPV/r in antiviral efficacy in treatment-naïve patients, with significantly less elevation of lipids and better GI tolerability. Race and gender-based differences in efficacy and safety have been reported among HIV- infected individuals receiving HAART, however, data from randomized clinical trials are limited. |
| P40 | REAUDIT ON SEXUAL HEALTH AND HEPATITIS SCREEN IN HIV-POSITIVE PATIENTS – COMPLETION OF AUDIT CYCLE HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P40) M Pammi and IH Ahmed Following the initial 2004 audit, clinicians and nurses were educated and awareness about sexual health and hepatitis screening was increased. The reaudit done in 2008 shows significant increase in STI screen, hepatitis B&C screening and hepatitis B vaccination. Increased awareness and an organized protocol will improve the uptake and offering of sexual health and hepatitis screen in HIV patients which might potentially reduce the risk of onward transmission. |
| P41 | SEXUAL TRANSMISSION OF HCV AMONG MEN WHO HAVE SEX WITH MEN IN LONDON AND THE SOUTHEAST HIV Med. 2009 April; 10(Suppl 1):20 (abstract no. P41) Our findings indicate that few MSM with recently acquired HCV had a history of IDU and provides evidence of sexual transmission of HCV among MSM in London and the South East. MSM with recently acquired HCV were almost all HIV infected and the majority had engaged in UAI and/or fisting. Furthermore, these data highlight the need for HCV evaluation for all MSM with abnormal LFTs and as well as routine screening of all HIV-positive MSM. |
| P42 | THE ACCEPTABILITY AND EFFECTIVENESS OF HOME-SAMPLING FOR SEXUALLY TRANSMITTED INFECTIONS IN HIV-POSITIVE MEN WHO HAVE SEX WITH MEN HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P42) N Perry1, M Fisher1, S Wayal2, H Smith2, C Ison3, S Alexander3, J Parry3 and D Richardson1 Home-sampling offers an acceptable alternative to conventional clinic STI testing for some HIV-positive MSM, and significantly increases overall rates of testing for STDs in MSM attending an HIV clinic. A significant proportion were identified with an STI and therefore onward transmission of HIV as well as STDs may be reduced. |
| P43 | AN AUDIT OF CERVICAL SMEARS IN HIV-INFECTED WOMEN ATTENDING AN INFECTIOUS DISEASES UNIT HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P43) L Johnson1, A Jones2, V Cooney1, S Douthwaite1 and A Ustianowski1 These data suggest that smear abnormalities are more likely in those with a low nadir CD4 count, a detectable viral load and in asylum seekers. A high nadir CD4 may be beneficial. Improved communication between the Infectious diseases unit, GP and GUM clinics may help increase smear uptake as well as determine compliance with guidelines. |
| P44 | BURKITT’S NON-HODGKIN LYMPHOMA PRESENTING AS AN ISOLATED BELL’S PALSY IN HIV-POSITIVE PATIENTS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P44) H Woodcock, P Holmes, S Powles, J Dunning, M Bower and M Nelson In HIV-positive patients, Bell's palsy can be the presenting sign of Burkitt's non-Hodgkin lymphoma. A non-resolving weakness should prompt early investigation for NHL since this can result in earlier detection and better prognosis. |
| P45 | COMPARING LIQUID-BASED CERVICAL CYTOLOGY (LBC) AND COLPOSCOPY IN A GROUP OF WOMEN LIVING WITH HIV/AIDS (WLHA) HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P45) T Mathew, R Thomson-Glover and M Wood The majority of liquid-based cytology samples were consistent in their findings compared to colposcopy. Although in those samples which were unmatched there was a trend towards overestimation of the histological grade, a significant proportion of LBC results under graded the colposcopic findings. Further larger studies which include several colposcopy centres are needed to identify if this is a true trend. |
| P46 | DIAGNOSIS, TREATMENT AND OUTCOMES OF MALIGNANCIES IN HIV IN THE POST-HAART ERA HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P46) B Kiely, JD O'Flaherty, S Surah, D O'Donnell, D O'Mahony, C Bergin and F Mulcahy With the advent of HAART, AIDS defining malignancies are becoming less common and outcomes are improving with improved immune function. Poorer outcomes are associated with low CD4 counts and late diagnoses, emphasizing the importance of early diagnosis and treatment with HAART. Non-AIDS defining malignancies are increasing and this highlights the need for prospective surveillance in an ageing HIV population. |
| P47 | GRADE OF CERVICAL INTRAEPITHELIAL NEOPLASIA (CIN) IS NOT RELATED TO THE DEGREE OF IMMUNOSUPPRESSION IN A MULTI-ETHNIC COHORT OF HIV-INFECTED WOMEN UNDERGOING COLPOSCOPY HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P47) M Samuel1, A Bailey1, M Hoey1, L Campbell2 and C Taylor1 In this cohort of HIV infected women undergoing colposcopy, severity of CIN was not associated with CD4 count or CD4 nadir. This may relate to the majority being on antiretroviral therapy. Treatment of CIN was successful in most women but a significant number had recurrence or non-resolution of disease, highlighting the need for careful follow-up. |
| P48 | COMPARISON OF THE CLINICAL AND DEMOGRAPHIC CHARACTERISTICS OF HIV-INFECTED PREGNANT WOMEN WITH HIV-INFECTED NON-PREGNANT WOMEN SEEN FOR CARE IN ENGLAND, WALES AND NORTHERN IRELAND HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P48) S Huntington1, T Chadborn1, J Masters2,P Tookey2 and V Delpech1 At least 5% of women seen for HIV-related care in 2007 in EWNI were pregnant. Although, overall, pregnant HIV-infected women have higher CD4 counts, they are likely to require more complex clinical care during pregnancy. Women living with HIV also require advice and interventions regarding conception. |
| P49 | DISSEMINATED TUBERCULOSIS AND ITS COMPLICATIONS IN THREE HIV-POSITIVE PREGNANT WOMEN HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P49) TJ Barber and C Wood Management of MTB in HIV-positive pregnant women is a challenging clinical problem due to atypical presentations and the frequent need to start MTB therapy/ART simultaneously. All the three cases had significant pyrazinamide toxicity and at least one had an illness consistent with MTB-IRIS. With appropriate management of medical and psychosocial problems affecting our patients, all three cases had positive outcomes for the mothers and their children. |
| P50 | DON’T FORGET THE CHILDREN: THE DANGERS OF UNDIAGNOSED HIV INFECTION IN CHILDREN WITH HIV-POSITIVE PARENTS ATTENDING ADULT HIV SERVICES HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P50) C Wood1, J Daniels1, H Lyall2, P Tookey3 and M Conway4 The number of undiagnosed HIV-positive children in the UK is unknown. This includes undiagnosed HIV-positive children whose parents attend adult HIV services. Most vertically infected HIV-positive children show signs of HIV disease within the first 1–2 years of life, although some may remain asymptomatic for years, and a small number may not be diagnosed until well into their teens. These undiagnosed HIV- positive children are at risk of potentially avoidable HIV-related morbidity and death. We know of one case in 2008 where an undiagnosed HIV- positive 10-year-old boy died within 48 hours of presenting with his first diagnosed HIV-related illness. Both of his parents were HIV-positive and attending adult HIV services for their own HIV care. We believe that this death may have been avoided had his HIV status been known prior to his final illness. We decided to organize a multi-sector conference to increase awareness and knowledge; develop models of best practice and make recommendations to improve clinical standards around the issue. |
| P51 | EXPERIENCE OF MANAGING HIV IN PREGNANCY IN A COHORT OF INTRAVENOUS DRUG USERS (IVDU) FROM A LARGE ETHNICALLY DIVERSE INNER CITY HIV EUROPEAN CENTRE HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P51) S Surah1, F Lyons1, F Mulcahy1, D Ward1, B Png1 and N Al-Assaf2 Management of HIV in pregnancy can reduce mother-tochild transmission (MTCT) to ~1%. Maternal substance abuse in pregnancy poses an additional challenge. We present experience of managing HIV in pregnant IVDUs from a single centre. |
| P52 | GETTING PREGNANT WOMEN ON TO HAART (HIGHLY ACTIVE ANTIRETROVIRAL THERAPY); DEVELOPING A STRATEGY FOR ADVANCED PREVENTION OF MOTHER-TO-CHILD TRANSMISSION OF HIV (PMTCT+) IN RURAL TANZANIA HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P52) S Edmonds1, L Shangalawe1 and J Meadway2 The PMTCT+ protocol led to led to a high uptake of HIV testing by pregnant women, and HAART reaching an increasing number of those needing it. Difficulty in attending clinics when pregnant was the main bar to women accessing treatment. Improvements in testing for babies would allow assessment of the effect of PMTCT+ on HIV transmission. |
| P53 | HIV INFECTION IN CHILDREN AGED 2&NDASH;59 MONTHS WITH NON-SEVERE PNEUMONIA ATTENDING A PAEDIATRIC ASSESSMENT CENTRE IN UGANDA HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P53) JM Kaducu1, G Ndeezi2, A Odiit2, J Meadway3 and JK Tumwine2 Children under 5 years of age attending an assessment centre in Uganda with non-severe pneumonia had an HIV prevalence of 6.3%. The factors independently associated with HIV in this group of children were diarrhoea and splenomegaly. |
| P54 | HOW DO CHILDREN WITH HIV PRESENT TO A REGIONAL NETWORK? HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P54) FAI Riordan1, A Tan2, P McMaster3, R O’Connor4 and N Laycock5 Children with HIV can present at any age. Half are tested because of their mother's HIV status, mostly by HIV paediatricians. Many of these children were asymptomatic; highlighting the importance of testing all children born to HIV-infected women. However 40% of HIV- infected children were the first person diagnosed with HIV in their family. They presented with a variety of clinical features suggesting HIV and were diagnosed in primary, secondary and tertiary care, often by non-HIV specialists. |
| P55 | IMPACT OF DEDICATED MULTIDISCIPLINARY TEAM ON MANAGEMENT OF PREGNANT HIV-POSITIVE WOMEN AT A LARGE UK TEACHING HOSPITAL HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P55) O Navti, U Venkitaraman, V Kalathy, M Nakade, M Jethwa, L Boon, J Qualie, J Dhar and M Khare The multidisciplinary management of HIV pregnant women in our unit involving obstetricians, genito-urinary physicians, dedicated specialist midwives, pharmacists and neonatal team over an 8-year period resulted in a 1.7% MTCT rate with a significant vaginal delivery rate of 42%. |
| P56 | LINKAGE OF THE UK COLLABORATIVE HIV COHORT (CHIC) STUDY AND NATIONAL STUDY OF HIV IN PREGNANCY AND CHILDHOOD (NSHPC) TO ASSESS ART PATTERNS IN PREGNANT WOMEN HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P56) L Bansi1, C Thorne2, P Tookey2 and C Sabin1 This linkage will allow adjustment for pregnancy in future analyses, and will enable investigation of research questions which neither study could investigate independently, such as the impact of pregnancy on HIV disease progression. |
| P57 | MANAGEMENT OF PREGNANCY IN AN HIV ELITE CONTROLLER HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P57) E Rutland and R Mani Management of pregnancy in presumed HIV-1 'elite controllers' presents some dilemmas; the option of combination therapy may provide more reassurance about PMTCT despite potential toxicity issues and the limiting of future treatment options, whereas monotherapy is probably adequate for PMTCT and has an established safety profile in pregnancy. Ruling out STIs which may increase viral load locally is important. Patient preferences regarding mode of delivery remain influential. |
| P58 | PLANNED VAGINAL DELIVERY IN HIV-POSITIVE WOMEN: HOW DO THEY ACTUALLY DELIVER? HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P58) S Allstaff, S Schoeman, A Baugh and E Street In light of the 31% emergency CS rate observed within this cohort, compared to the 10% rate within our trust, these women should be counselled early in pregnancy regarding the risk of emergency CS, particularly in nulliparous women, and the implications that this has on mother-to child-transmission and maternal morbidity. More data regarding pregnancy outcomes are required to allow HIV- positive women making these important choices to give fully informed consent. |
| P59 | PRECONCEPTIONS ABOUT PRE-CONCEPTION? DEVELOPMENT OF A DEDICATED PRE-CONCEPTION CLINIC FOR PEOPLE LIVING WITH HIV HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P59) AN Jayasuriya, S Thomas-Williams and S Taylor There is currently a paucity of knowledge and understanding about preconception and parenting options for PLWH. A dedicated preconception service with standardized protocols and written information for patients addressing issues surrounding conception and the sexual transmission of HIV may serve to dispel some of these misconceptions and provide a meaningful service for those who wish to have children. |
| P60 | ‘TESTING THE CHILDREN’ – ARE WE DIAGNOSING THE UNDIAGNOSED? HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P60) S Schoeman, N Hettarachchai and E Street To diagnose undiagnosed HIV within this high risk and vulnerable group we must first assess parenthood and then implement discussion of HIV testing. If discussed, the majority of parents agreed to have their children tested. We must standardize our care such that these discussions take place with every patient, regardless of their gender and the age or health of their children, as soon as possible after diagnosis. |
| P61 | THE NEXT GENERATION &NDASH; A SHARED CARE EXPERIENCE OF BABIES BORN TO YOUNG WOMEN WITH PERINATALLY ACQUIRED HIV-1 INFECTION HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P61) J Kenny1, J Evans2, H Wankowska3, J Gould3, M Douglas1, H Lyall1, G Taylor1 and C Foster1 Women born with HIV-1 are surviving to have their own uninfected infants. However these early data illustrate the treatment complexity and intensity needed to prevent transmission and long-term follow-up of these first infants is required. |
| P62 | THE VALUE OF PROVIDING AN ANTENATAL AND POSTNATAL SUPPORT GROUP FOR HIV-POSITIVE WOMEN HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P62) J Rwami1, M Muheki1, K Francis2 and C Wood2 Our antenatal support groups have been very successful and popular with the women. We believe that these findings have wide potential applicability and that all HIV antenatal services should strive to provide at least some kind of support groups for HIV-positive pregnant women and mothers. The Voluntary sector and peer-support workers are an integral part of the success of this process and their contribution should be recognized and formally supported by the statutory sector. |
| P63 | DEVELOPING ANTENATAL CLASSES SPECIFICALLY FOR HIV-POSITIVE PREGNANT WOMEN HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P63) C Wood1, K Francis1 J Rwami2, M Muheki2 and A Govind1 Our research has shown a very significant gap in the provision of optimal antenatal care for HIV-positive women. As far as we are aware these are the first antenatal classes developed specifically for HIV-positive pregnant women, at least in the UK. We have now developed a programme of antenatal classes tailored for women with HIV and are currently refining this in an ongoing process of consultation. We hope that this will be useful in other antenatal HIV settings. We would encourage other units to explore the issue in a similar way. |
| P64 | ACUTE HEPATITIS C INFECTION IN HIV-1 SEROPOSITIVE SUBJECTS WITH UNDETECTABLE PLASMA HIV RNA AFFECTS NEUROCOGNITIVE PERFORMANCE HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P64) LJ Garvey, E Thomson, D Yerrakalva, J Main and A Winston Acquisition of acute HCV in subjects with chronic HIV infection adversely impacts the monitoring domain of neurocognitive performance. This may be related to the chronic fatigue and impaired concentration previously described in chronic HCV infection. Clinicians should be aware of early CNS involvement when assessing and treating subjects with acute HCV infection. |
| P65 | HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P65) P Holmes, E Low, M Bower, M Anderson and M Nelson There is an epidemic of acute Hepatitis C, initially described in the UK, and now prevalent throughout Europe and America. Some authors have reported fibrotic changes, on liver biopsy, associated with acute Hepatitis C infection, whilst others have reported changes in fibroscan readings associated with this condition. Aims: To assess fibroscan readings in HIV-positive individuals with proven acute Hepatitis C. |
| P66 | AN OBSERVATIONAL STUDY OF HIV/TB COINFECTION: PRESENTATION AND MANAGEMENT IN AN URBAN NGO CLINIC IN INDIA HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P66) S Soni, B Satish and K Satish HIV/TB patients are presenting late and with more EP disease. There are significant delays in starting ART for reasons which are not always clear. We emphasize the need for strengthening collaboration between TB and AIDS control programmes. |
| P67 | CHARACTERISTICS THAT DISTINGUISH DISSEMINATED MYCOBACTERIUM TUBERCULOSIS (MTB) AND NON-TUBERCULOUS MYCOBACTERIAL INFECTION (NTM) IN HIV-INFECTED PATIENTS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P67) A Samarawickrama1, B Nathan2, AC Bailey1, L Campbell3, F Ibrahim3, M Fisher2, R Barker1 and F Post1,3 Clinical and laboratory characteristics of patients with MTB and NTM overlap, but prior/concomitant AIDS-defining illnesses, recent initiation of HAART, and CD4 <100 cells/lL favour NTM, whilst parenchymal lung changes and positive respiratory AFB smears favour MTB. NTM patients have more advanced HIV infection and higher mortality. A diagnostic and treatment algorithm will be presented at the conference. |
| P68 | DETECTING, PREVENTING AND MONITORING HEPATITIS B INFECTION IN HIV-POSITIVE PATIENTS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P68) S Ramasami Most of our patients were screened in keeping with BHIVA guidelines. A significant proportion remain at risk of HBV infection as a result of failing to respond immunologically to vaccination and should be screened annually for HBV infection. We plan to extend the study to include our entire HIV cohort. Improvements in documentation and vigilance of medical are paramount for effective prevention and detection of HBV infection in HIV- positive patients. |
| P69 | EFFECT OF RALTEGRAVIR ON ALT IN SUBJECTS COINFECTED WITH HIV AND HEPATITIS C HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P69) A Scourfield, LJ Waters, PA Randell, K McCormick, K Armenis, M Bower and M Nelson HIV and HCV coinfected individuals appeared to show improvements in their mean ALT following switch to a raltegravir-based regimen. Although this result was not statistically significant, further investigation in larger cohorts is warranted. |
| P70 | ENTECAVIR SAFETY AND VIROLOGICAL RESPONSE IN LAMIVUDINE AND TENOFOVIR-EXPERIENCED HBV/HIV CO-INFECTED PATIENTS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P70) MD Phillips, L Ratcliffe, A Pennell and FJ Vilar Entecavir (ETV) has been approved for use as first-line treatment in HBV mono-infected patients by NICE since 2008. There has been only one study using ETV with tenofovir (TDF) as a rescue therapy in chronic HBV infected patients with prior treatment failures. ETV has been reported to have anti-HIV activity and there are reports of HIV resistance appearing following ETV usage without ART. We report data using ETV along with anti-retroviral therapy (ART) in HBV/ HIV co-infected patients with previous HBV therapy failure or inadequate suppression. |
| P71 | INTEGRATION OF ROUTINE SYMPTOMATIC TB SCREENING IN RESOURCE-LIMITED HIV CLINIC SETTINGS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P71) P Wekesa and L Otiso Kenya has been ranked as one of the 22 countries that contribute to 80% of the world's TB cases. Intensified case finding was identified as one of the key strategies in the fight against TB and HIV co-infection in Kenya. Liverpool VCT Care and Treatment (LVCT) piloted routine TB screening for all patient visits in 3 outpatient HIV care clinics in Nairobi and Kisumu in Kenya. The objective was to show that screening of all HIV patients during their clinic visits is a simple, practical and effective way to detect TB early and improve treatment outcomes. |
| P72 | INTRODUCING A PROTOCOL FOR DIAGNOSING AND TREATING LATENT TUBERCULOSIS IN NEWLY DIAGNOSED HIV PATIENTS: FEASIBILITY AND COST-EFFECTIVENESS HIV Med. 2009 April; 10(Suppl 1):29 (abstract no. P72) R Brian, C Stewart, U Okpaluba and A Evans Hypovitaminosis D is almost universal in this cohort. EFZ use was associated with a lower 25(OH)D and TDF with a higher 25(OH)D level, although both drugs were independently associated with ALP elevations. Further studies are required to define the potential mechanisms and clinical implications of this interaction between ART, Vitamin D and bone. |
| P73 | TELBIVUDINE (LDT) HAS ACTIVITY AGAINST HIV-1 HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P73) E Low, R Jones, A Cox, M Atkins and M Nelson LdT is a L-nucleoside analogue of thymidine with activity against hepatitis B virus (HBV). Recommendations from the HIV-HBV International Panel state that LdT has no activity against HIV and it is suggested as a treatment option for HBV infection, when HIV does not require therapy. We report the case of a patient with HIV/HBV coinfection in whom LdT therapy suppressed his HIV viral load (VL) to less than 50 copies/mL. |
| P74 | THE FREQUENCY OF HEPATITIS C VIRUS (HCV) PERSISTENCE IN PERIPHERAL BLOOD MONONUCLEAR CELLS (PBMCS) OF PATIENTS WITH PREVIOUS HIV/HEPATITIS C CO-INFECTION HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P74) E Low, R Jones, A Cox, M Atkins and M Nelson The absence of HCV RNA in PBMCs of 25 previously HIV/ HCV co-infected individuals is reassuring. Persistence of HCV RNA in reservoir sites could lead to HCV relapse in immunocompromised patients. The fact that persisting HCV RNA cannot be detected in PBMCs suggests that loss of serum HCV RNA 6 months after therapy can be used as a marker of treatment success. Patients can be reassured that achieving a SVR correlates with viral clearance. In addition the absence of HCV RNA in PBMCs in these individuals adds weight to recent studies suggesting that individuals with subsequent HCV positivity is due to re-infection rather than relapse. (BHIVA Research Award Winner 2007: Study to assess the frequency of persistence of hepatitis C virus in peripheral blood mononuclear cells of patients with previous HIV/hepatitis C co-infection. Emma Low) |
| P75 | THE IMPACT OF HEPATITIS B AND C CO-INFECTION ON ANTIRETROVIRAL OUTCOMES IN MALAWI HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P75) EM Moore1, MBJ Beadsworth2, I Hart2, B Faragher2, NJ Beeching2, EE Zijlstra1 and JJ van Oosterhout1 Among Malawians starting nevirapine, lamivudine and stavudine under routine circumstances, CVH was very common but does not appear to have a significant negative influence on ART outcome and side effects after 1 year. This is likely to be due to the huge impact of other opportunistic infections. In resource poor settings, costly monitoring of CVH appears not a priority. |
| P76 | A DESCRIPTIVE STUDY OF ANTI-RETROVIRAL THERAPY COMBINATIONS IN PATIENTS WITH HIV-RELATED NEUROCOGNITIVE IMPAIRMENT HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P76) R O'Connell1, N Starkey2, A Asghar2 and S Rackstraw2 Despite a decreased incidence of severe HIV-related neurocognitive impairment (HRNCI) due to improved anti-retroviral therapy (ART), late presentation of HIV means that HRNCI remains a significant clinical problem. Further, HRNCI may develop despite ART, and an ageing HIV-positive cohort presents additional risks for other neurocognitive impairment. Evidence is conflicting as to whether ART cerebrospinal fluid (CSF) penetration correlates with improved neurocognitive outcomes in the management of HRNCI. This study explores physician prescribing of ART if HRNCI has been diagnosed. A retrospective descriptive casenotes review of ART prescribed by physicians referring patients to an urban centre for HRNCI rehabilitation. |
| P77 | ANAEMIA IN A RURAL COHORT OF HIV-INFECTED UGANDANS RECEIVING EITHER AZT-OR NON AZT-CONTAINING ANTIRETROVIRAL REGIMENS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P77) R Parkes-Ratanshi1, K Wakeham2, J Levin2, D Katende2, C Nabiryo3, H Grosskurth2, D Lalloo4 and A Kamali2 Although mean Hb increased in participants on all ART regimens, significant anaemia occurred after starting ART in patients who received both AZT or non-AZT containing regimens. Monitoring of Hb should be emphasized in roll out programmes irrespective of ART regimen. |
| P78 | ARE WE ADEQUATELY CONSIDERING DRUG INTERACTIONS WHEN PRESCRIBING STATINS TO PATIENTS ON CART WITH DYSLIPIDAEMIA? HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P78) J Myers, M Rayment, S Sonecha, G Moyle and M Boffito Many patients fail to achieve target lipid parameters. There is evidence of suboptimal dosing of statins in patients on NNRTI-based cART. Seemingly appropriate dosing of patients on PI-based cART does not translate to adequate TC response. Managing hyperlipidaemia in HIV-positive patients on cART is complicated by drug interactions; however other factors such as poor adherence to statins or diabetes may contribute to this complexity. |
| P79 | CARDIOVASCULAR RISK ASSESSMENT AND REDUCTION IN PATIENTS ON ABACAVIR HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P79) NS Bulteel, A Wilson, D Wilks and C Leen The use of abacavir (ABV) may be associated with an increased risk of cardiovascular disease and myocardial infarction in HIV-positive patients. |
| P80 | CARDIOVASCULAR RISK IS DRAMATICALLY INCREASED WHEN FRAMINGHAM RISK IS ADJUSTED FOR ANTI-RETROVIRAL THERAPY IN AN HIV-POSITIVE COHORT HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P80) DE Cousins1, K Eccleston2, C Whitfield1, S Mayes1, M Farazmand1, E Parker1, C Babu1, M Kingston1, O McQuillan1, A Sukthankar1 and V Lee1 Adjusting for antiretroviral drug use in our cohort dramatically increases the estimated CVD risk and may necessitate medical therapy where it was previously not thought to be indicated. These findings were apparent in older, hyperlipidaemic and hypertensive patients, but not smokers. The medical care of HIV-positive patients has to be adapted to the medical needs of the ageing population. |
| P81 | CHANGE IN PLASMA HOMOCYSTEINE NOT A POSSIBLE BIOLOGICAL MECHANISM FOR POTENTIAL INCREASED RISK OF MI SEEN IN PATIENTS TAKING ABACAVIR HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P81) K Manavi, A McDonald, K Flemming and B Cramb Elevated levels of plasma homocysteine, has been implicated as a potential risk factor in the pathogenesis of cardiovascular disease. Recently, use of abacavir has been reported to be associated with a 90% increased risk of myocardial infarction (MI). We postulated that the potential increased risk seen with abacavir might be associated with an increase in plasma homocysteine level and conducted a small pilot study to investigate such association. |
| P82 | NEVIRAPINE HYPERSENSITIVITY IN MALAWI: A PROSPECTIVE COHORT STUDY HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P82) M Chaponda1, SH Khoo1, JV Oosterhout2, J Kumwenda2, D Lalloo3 and M Pirmohamed1 At least 1 million patients need antiretroviral therapy in Malawi. Nevirapine (as part of HAART) is given first line to all patients without prior CD4 count monitoring. Nevirapine hypersensitivity has been observed worldwide, but data on its epidemiology in African countries are lacking. Caucasian patients who have rapid dose escalation, abnormal baseline liver function tests (LFT) or are females with CD4 cell count>250 are at higher risk. |
| P83 | DIDANOSINE-INDUCED LIVER DISEASE: REPORT OF THREE CASES HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P83) S Thomas, L Turtle and S Khoo These cases are consistent with observations linking DDI to liver disease. The time to observed improvement of LFTs after substituting DDI for different ARVs was 2–3 months in these patients, which is shorter than has previously been described. |
| P84 | HIGH RATES OF ASYMPTOMATIC NEUROCOGNITIVE IMPAIRMENT (ANCI) IN HIV-1-INFECTED SUBJECTS RECEIVING STABLE COMBINATION ANTIRETROVIRAL THERAPY (CART) WITH UNDETECTABLE PLASMA HIV RNA HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P84) LJ Garvey, Dharani Yerrakalva and A Winston We have observed high rates of aNCI in a UK cohort of patients stable on CART, particularly in younger individuals. Possible explanations for these findings include an increased susceptibility of younger adults to the effects of HIV on the brain or differing education and socioeconomic status between our cohort and control data. |
| P85 | HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P85) Abstract withdrawn |
| P86 | OPPORTUNISTIC INFECTIONS IN SRI LANKAN HIV PATIENTS AND THEIR RELATIONSHIP TO CD4+ T CELL COUNTS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P86) DDA Wijewickrama, LLDA Maduwanthi, PMIP Bandara, G Udugumkorala, N Gamage, J Perera and SL Seneviratne While the prevalence of TB, OC and PCP among Sri Lankan HIV patients was similar to Thailand there are significant differences in the frequency of some other OIs such as Crypotococcal meningitis and Salmonella septicaemia which were uncommon in the Sri Lankan cohort. Herpes zoster and Kaposi's sarcoma commonly seen in the African cohorts was also uncommon. Understanding the pattern and frequency of OIs among Sri Lankan HIV patients helps us with suspecting, diagnosing and managing our HIV patients. |
| P87 | SAFETY OF USAGE OF HSV PROPHYLAXIS WITH ACICLOVIR (ACL) TOGETHER WITH TENOFOVIR (TDF)-BASED ANTIRETROVIRAL THERAPY (ART) IN HIV PATIENTS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P87) E Walls1, L Ratcliffe2, P Lewthwaite2 and FJ Vilar2 TDF has been part of ART since licence in 2001. TDF is renally excreted by a combination of glomerular filtration (GF) and active tubular secretion. It is reported that <1% of patient using TDF developed impaired renal function. ACL is also eliminated via kidneys by the same combination of mechanisms. Competition for renal tubular secretion by ACL and TDF using organic anion transporter 1 (hOAT1) can cause increased serum concentration of TDF when given concurrently. |
| P88 | THALIDOMIDE USE IN THE TREATMENT OF PERSISTENT HYPERTROPHIC HERPES SIMPLEX VIRUS ULCERATION IN AN HIV-POSITIVE PATIENT HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P88) A Ng and A Tariq Herpes simplex virus (HSV) ulcerations are more common in immunocompromised individuals and in HIV-positive patients are more frequently resistant to conventional treatment regimens. Case report: We report a case of a 36-year-old HIV-positive man who presented with hypertrophic HSV lesions on his penis. |
| P89 | VITAMIN D AND CALCIUM SUPPLEMENTS REVERSE THE SECONDARY HYPERPARATHYROIDISM THAT COMMONLY OCCURS IN HIV PATIENTS ON TDF-CONTAINING HAART HIV Med. 2009 April; 10(Suppl 1):33 (abstract no. P89) K Childs1, C Kadish2, W Branch-Elliman2, S Fishman2, M Mullen2 and AD Branch2 VD3/calcium supplements increased serum 25(OH)D and decreased PTH. Baseline PTH values were influenced by 25(OH)D levels and TDF use; PTH changes were dependent on baseline PTH values. Vitamin D3 and calcium are a safe and effective treatment for HAART- associated hyperparathyroidism. |
| P90 | ACCEPTANCE OF AN OPT-OUT HIV TESTING IN AN URBAN EMERGENCY DEPARTMENT – A REPORT FROM SOUTH INDIA HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P90) D Sureshkumar1, S Supriya2 and P Nadol3 Opt-out HIV testing was feasible in ED, due to high acceptance rate (>90%), high prevalence rate (4.9%). and lack of awareness (95%) of HIV infection status in patients treated in ED. The main limitation of the study was small sample size and delay in getting their HIV test results (average 3 days). |
| P91 | AN AUDIT OF CURRENT HIV TESTING PRACTICES AND AWARENESS OF THE UK NATIONAL GUIDELINES FOR HIV TESTING 2008 AMONG DOCTORS WORKING IN A UK TEACHING HOSPITAL HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P91) L Mitchell, S Bushby and M Chauhan Medical practitioners lack confidence in testing for HIV. The majority questioned underestimated the current scale of the problem in the UK and were unaware of the recently published guidelines. To reduce undiagnosed HIV infection and therefore onward transmission, further education among medical practitioners is vital. |
| P92 | COMPARATIVE EVALUATION OF THE PERFORMANCE OF THE CAVIDI EXAVIR LOAD ASSAY FOR THE MEASUREMENT OF B AND NON-B HIV-1 RNA LOAD IN PLASMA HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P92) G Foster, A Garcia-Diaz, W Labbett, G Clewley, M Johnson and AM Geretti he ExaVir Assay is potentially affordable for viral load monitoring in resource-limited settings. We evaluated the Cavidi ExaVir version 3 assay relative to the Abbott HIV-1 RealTime assay and Roche Ampliprep/COBAS TaqMan using HIV-1 plasma samples and dilutions of the international standard for HIV-1 RNA. |
| P93 | DIAGNOSING THE UNDIAGNOSED &NDASH; THE REAL WORLD EXPERIENCE FROM A NORTHEAST ENGLAND REGIONAL INFECTIOUS DISEASES UNIT HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P93) N Premchand1, K Golds2 and ELC Ong1 The 2006 BHIVA audit found that at least 24% of deaths in HIV-positive adults were related to ineffective treatment due to delayed diagnosis. It is estimated that 1/3 of adults living with HIV are still undiagnosed. The UK National HIV testing guidelines were launched in September 2008 to facilitate an increase in HIV testing in all healthcare settings. |
| P94 | DOCUMENTATION AND TESTING OF EXISTING CHILDREN OF HIV-POSITIVE WOMEN HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P94) NM McDonald, P Anderson, A Winter, R Nandwani, R Fox, A MacConnachie and A Seaton A significant number of children are at risk of undiagnosed HIV infection, a substantial fraction (74%) living outwith the UK. Where possible, children will be followed up. Formal documentation will be encouraged by staff education, provision of a specific area on the HIV-positive patient front-sheet for existing children to be documented, and formal protocols linked with paediatrics for follow-up and counselling if a woman refuses testing of her child. Targets for documentation and testing rates could be implemented, and re-audited. |
| P95 | GENOTYPIC PREDICTION OF VIRAL CO-RECEPTOR TROPISM: CORRELATION WITH ENHANCED TROFILE HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P95) AL Strang, J Cameron, CL Booth, AM Garcia-Diaz and AM Geretti In this pilot evaluation of the Geno2Pheno-coreceptor prediction system, we found excellent correlation with enhanced Trofile predictions, comparable to the correlation that can be observed between different phenotypic assays. While further work is required to expand the validation dataset, these initial findings indicate that genotypic prediction offers a suitable tool for assessing tropism. |
| P96 | HIV STATUS OF FAMILY MEMBERS OF PATIENTS ON ANTIRETROVIRAL THERAPY IN MALAWI HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P96) D Cohen1, M Lungu2 and JJG van Oosterhout1 A large percentage of spouses and very high proportion of children of patients on ART were reportedly not tested for HIV. This may represent a big group who miss out on the benefits of ART and cotrimoxazole prophylaxis. Interventions to improve HIV testing in these individuals need to be designed. |
| P97 | HOW CAN WE DIAGNOSE UNDIAGNOSED HIV? HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P97) V Apea and S Creighton The majority of HIV cases were diagnosed among attenders at GUM and GP. It is unclear how many individuals from any setting already knew themselves to be HIV positive prior to testing, this is particularly relevant in SAU attendees. Newer initiatives diagnosed 14 cases of HIV who may not have accessed traditional HIV testing sites. Increasing the uptake of HIV testing to 100% in GP and GUM might have diagnosed an extra 76 cases. |
| P98 | IMPROVING THE DETECTION AND DIAGNOSIS OF HIV IN NON-HIV SPECIALTIES – HOW USEFUL WAS THE CMO/CNO LETTER? HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P98) A Hughes, R Jones and A Sullivan A recent BHIVA audit showed at least 35% of HIV related deaths occurred in individuals diagnosed too late for effective therapy. In response the Chief Medical Officer(CMO) and Chief Nursing Officer (CNO) wrote to all healthcare providers in an attempt to improve the detection of HIV in non HIV specialties. We designed a survey for general practitioners (GP) to assess the impact of the CMO/CNO letter and to evaluate knowledge of HIV risk factors and clinical presentations. |
| P99 | NEWLY DIAGNOSED HIV IN AN INNER LONDON CLINIC: WHO TESTS WHERE? HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P99) M Kall, P Khan, V Apea, I Reeves and J Anderson In this cohort of largely heterosexual, non UK born patients two thirds of those newly diagnosed with HIV are immediately eligible for antiretroviral therapy. Routine asymptomatic screening identifies those with higher CD4 counts. Those with the lowest CD4 counts at diagnosis are likely to be symptomatic heterosexual men. Health seeking behaviour in this patient population needs to be better understood in designing accessible and appropriate HIV diagnostic services. |
| P100 | POOR UPTAKE OF AN HIV TESTING SERVICE FOR MEN EXPECTING A BABY – THE TOPAN EXPERIENCE HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P100) H Noble1, S Samba-Gomez1, A Fakoya1, C Kalema2 and C Tawana1 Since the success of universal offer of antenatal HIV testing, seroconversion with HIV during pregnancy is an important cause of mother-to-child-transmission (MTCT) in the UK. In this area of the UK HIV is predominantly diagnosed in the African heterosexual community. African men are less likely to know their HIV status than other high-risk groups in the UK and are more likely to present with advanced disease. It was hoped that TOPAN, a programme designed to encourage African men to test for HIV while expecting a baby would reduce rates of late diagnosis in this group and prevent some cases of MTCT. |
| P101 | THE TEST AND WHAT HAPPENED NEXT? HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P101) T Welz, L Hamzah, S Moses, M Sudhanva and C Taylor A significant proportion of patients with newly diagnosed HIV do not receive their results or engage with care. In a small but worrying number of cases, appropriate follow-up was not arranged or results overlooked. HIV results on EPR, centralised follow-up of all Positive results and communication with GPs may reduce these potentially catastrophic losses to follow-up. |
| P102 | SAFE OR SORRY (SOS) SAUNA OUTREACH PROJECT, ARE WE DOING ENOUGH TO DIAGNOSE THE UNDIAGNOSED? HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P102) S Toomer, J Sweeney and W Wasef Ora-Quick HIV testing had 100% sensitivity and specificity in this study and was found to be highly acceptable and convenient in outreach venues. The study highlights the benefit of delivering sexual health service in gay saunas providing the hard to reach, high risk group with easy accessibility. |
| P103 | THE ACCEPTABILITY AND EFFECTIVENESS OF HOME-SAMPLING AS A METHOD OF HIV TESTING IN MEN WHO HAVE SEX WITH MEN HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P103) N Perry1, M Fisher1, S Wayal2, H Smith2, C Ison3, S Alexander3, J Parry3 and D Richardson1 Home-sampling for HIV offers an acceptable alternative to conventional clinic testing for some MSM and may enable testing in those who have never previously tested or facilitate annual re-testing in line with national guidance. However, the lack of detection of HIV in this study suggests that this strategy may be more acceptable to those with lower risk of undiagnosed infection. |
| P104 | CAUSES AND OUTCOMES OF HOSPITALIZATION OF HIV PATIENTS IN FIRST 6 MONTHS OF ANTIRETROVIRAL THERAPY (ART) IN A TEACHING HOSPITAL IN SOUTHWESTERN UGANDA HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P104) O Siraji1, A Rodger2, W Muyindike1, L Pepper1, T Wilson1, M Johnson3 and S Bhagani3 Our study shows that serious infections and death are not uncommon during the first 6 months of antiretroviral therapy in individuals with advanced HIV at start of treatment in resource poor settings. Mortality was high, with TB the commonest cause of death. The rate of TB is suggestive of unmasking. |
| P105 | CHANGING DEMOGRAPHY AND UNIQUE RISK FACTORS FOR HIV INFECTION IN SRI LANKA: ARE WE HEADING FOR A FULL-BLOWN EPIDEMIC? HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P105) DDA Wijewickrama, LLDA Maduwanthi, KADN Marlon, N Gamage, G Udugamkorala, J Perera and SL Seneviratne The association between employment in Middle East and HIV infection of women in Sri Lanka is highly significant. This can have very serious economic and social implications. Three wheel drivers are another possible risk group. The changing male to female ratio and the increasing number of patients who possibly contacted the disease from a local source may be the warning signs of a bigger epidemic in the future. |
| P106 | COST-EFFECTIVENESS OF ATAZANAVIR COMPARED TO LOPINAVIR IN TREATMENT-NAÏVE HIV-1 PATIENTS IN SCOTLAND HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P106) C Leen1, PO Thuresson2, B Hegg2, K Vardeva2, T Gosden3, JZ Yogaratnam3 and B Van Hout1 This analysis suggests that atazanavir has a favorable cost- effectiveness ratio for treatment of treatment naïve HIV patients in Scotland. These results were robust when changing the parameters in the univariate and multivariate sensitivity analyses. |
| P107 | DEMOGRAPHICS OF THE HIV-PATIENT POPULATION IN A MAJOR UK HOSPITAL HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P107) ARA Aiken and AML Lever A much higher number of patients than expected are illegal immigrants. Most of them are African, currently awaiting review of an expired visa, or making application for a visa extension. Some are asylum seekers, and some have already been detained by the authorities or deported. A concerning number are lost to follow-up. Nearly all are from countries where adequate HAART treatment is unavailable. Such data are scarce in the literature, and there is a need for greater awareness and discussion of this bleak situation. |
| P108 | HIV INFECTION IN CENTRAL AND EASTERN EUROPEAN PREGNANT WOMEN LIVING IN THE UK/IRELAND: DATA FROM NATIONAL SURVEILLANCE 1992 – 2007 HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P108) H Haile-Selassie, P Tookey, J Masters and C Townsend Pregnancies in HIV-infected CEE women living in the UK/Ireland have increased significantly since before 2004, with a high proportion of women diagnosed antenatally. Continued monitoring of these pregnancies remains important in view of the increasing number of reports. |
| P109 | IMPROVING THE QUALITY OF DEATH DATA IN THE UK CHIC STUDY HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P109) T Hill1, T Hartney2, T Chadborn2, V Delpech2 and C Sabin1 Death data from a number of sources provide valuable additional information to the UK CHIC database. However, the processes have highlighted limitations in the linking between datasets, and in the timeliness and flow of information relating to deaths from hospital sources to clinic databases. Improvement of the quality of death data is essential to increase the accuracy of data analyses in the UK CHIC Study. |
| P110 | THE SYMPTOM PREVALENCE AND BURDEN IN HIV-1-INFECTED ADULTS IN RURAL UGANDA HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P110) K Wakeham1, R Harding2, R Parkes3, D Bamukama1, J Levin1, G Muzaaya4, A Kamali1 and D Lalloo3 Knowledge of the burden of physical and psychological symptoms in HIV infected individuals in sub-Saharan Africa is sparse. We aim describe the burden prior to antiretroviral therapy (ART) in a population representative of those who initially present to HIV/AIDS care and treatment services. |
| P111 | HIV-1 CLADE A INFECTION AND VIRAL CONTROL: AN IMMUNOLOGICAL PERSPECTIVE ON A CASE OF UNDER-QUANTIFICATION HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P111) SJ Westrop1, A Jackson2, M Nelson2, B Gazzard2 and N Imami1 We emphasize the growing need for awareness of possible limitations of the commonly used viral load assay, which can be relied upon too unreservedly in a clinical setting. Furthermore this study highlights the increasing need for more detailed investigation into both viral genetics and fitness when defining patients as HIV controllers or long-term nonprogressors. |
| P112 | HBV VACCINE RESPONSE OF HIV-INFECTED PATIENTS IMMUNIZED WITH DOUBLE DOSE ENGERIX® COMPARED WITH VACCINATION RESPONSE OF HIV-UNINFECTED PATIENTS VACCINATED WITH STANDARD DOSE OF ENGERIX® HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P112) SJ Westrop1, A Jackson2, M Nelson2, B Gazzard2 and N Imami1 HBV vaccination response of HIV-un-infected patients was significantly higher than HIV infected patients. Even after administration of double dose of Engerix® to HIV infected patients, their vaccination response remained significantly less than that of HIV un-infected patients immunised with standard dose of Engerix® . HBV vaccination response was more likely amongst patients with CD4 count of above 200 cells/mm3. |
| P113 | THE ROLE OF CD8+ T CELL-MEDIATED IMMUNITY IN HIV-1 DISEASE PROGRESSION: RAPID, CHRONIC AND CONTROLLED HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P113) SJ Westrop1, J Pido-Lopez1, N Grageda1, M Nelson2 and N Imami1 Relatively unstable HLA-B*35:peptide complexes may explain the association with rapid progression. In contrast, high representation of HLA-B*27 in HICs may contribute to HIV-1 control. Recognition of HIV-1 CD8 T-cell epitopes by CPs, and modest evidence of cytoxic T-cell-mediated selective pressure, intimates anergy as a decisive cause of HIV-1 disease progression. |
| P114 | A COMPARISON OF MRI VERSUS CT BRAIN IMAGING IN HIV-POSITIVE INPATIENTS PRESENTING WITH NEUROLOGICAL SYMPTOMS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P114) AJ Wilson1, RA Sayer2, SG Edwards2, JD Cartledge2 and RF Miller1 The majority of HIV+ patients with neurological disease imaged at our centre received MRI, which provided an enhanced diagnostic yield irrespective of clinical presentation or level of immunosuppression. Early MRI would avoid unnecessary duplication of scanning modalities, reduce radiation exposure and is more likely to provide the best image for diagnosis and future comparison. Our data reinforce the need for early MRI of patients with neurological disease, and early transfer of patients from centres that do not have rapid access to (or expert interpretation of) MRI scanning, to an appropriate HIV specialist centre which does. |
| P115 | ADHERENCE TO DARUNAVIR/RITONAVIR (DRV/R) AND LOPINAVIR/R (LPV/R) IN TREATMENT-NAÏVE HIV-INFECTED PATIENTS IN ARTEMIS (ANTIRETROVIRAL THERAPY WITH TMC114 EXAMINED IN NAÏVE SUBJECTS): 96-WEEK DATA HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P115) M Nelson1, PM Girard2, R DeMasi3, L Chen3, E Smets4, V Sekar3 and L Lavreys4 Virological response rates were higher in adherent versus non-adherent patients. Non-adherence with DRV/r had a lesser effect on clinical outcomes compared with LPV/r. Non-adherent patients reported more AEs and GI AEs, suggesting that factors other than convenience are also substantial drivers of adherence. |
| P116 | COMPARISON OF ACUTE HOSPITAL PRESENTATIONS OF HIV PATIENTS DURING TWO TIME PERIODS (1983&nash;2001 AND 2005–2007): OPPORTUNITIES FOR EARLY DIAGNOSIS ARE STILL BEING MISSED HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P116) S Thomas1, L Ratcliff1, NJ Beeching1 and M Taegtmeyer2 (1) As elsewhere in the UK, there has been a major demographic shift, and in the recent cohort there are more patients from SSA contributing to the increase in the proportion presenting acutely and with TB. (2) The numbers of clues 'missed' were similar in both cohorts, but in the later cohort were recorded less by non-specialists. (3) The mean time to diagnosis decreased in the second cohort but is still too long. |
| P117 | DIAGNOSTIC YIELD OF PERCUTANEOUS IMAGE-GUIDED NEEDLE BIOPSY OF LYMPH NODES IN THE HAART ERA HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P117) R Adlington1, J Cartledge1, P Shaw2 and A Ramsay2 Even in the HAART era, HIV-positive patients still present with fever and/or lymphadenopathy requiring investigation. Traditional diagnostic techniques have included fine needle aspiration (good for mycobacteria but poor for detecting malignancies) and full excision biopsy. Image-guided needle biopsy of lymph nodes (core biopsy) under local anaesthetic is an alternative. We present a series of 32 sequential cases where this technique was adopted. |
| P118 | HEALTHCARE WORKERS WITH HIV INFECTION: DO THEY REFER THEMSELVES TO OCCUPATIONAL HEALTH? HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P118) M Jones and DR Churchill An HIV-positive healthcare worker (HCW) was admitted to our unit with an acute infection. It became clear that he worked in an area where exposure-prone procedures (EPPs) were performed, but he had never been assessed by Occupational Health (OH). Following investigation, we decided to carry out an audit of all our patients to assess whether 2005 UK guidance HIV+ HCWs was being followed. This guidance makes clear that all HIV+ HCWs should be assessed by an OH physician, and that decisions about risks to others should not be made by the patient themselves. |
| P119 | IMPACT OF TRANSITION TO ADULT SERVICES ON CLINIC ATTENDANCE AND VIROLOGICAL CONTROL IN HIV-INFECTED ADOLESCENTS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P119) S Eisen1, L Barkley1, C Schepers2, K Gurney2, M Clapson3, D Shingadia3 and EMA Jungmann2 The data suggest that adherence and virological control remained consistent post-transition; however, clinic attendance rates declined. This may imply potential long-term negative consequences for disease control, particularly relating to engagement with services, and highlights the need for close and dedicated support as transitioning adolescents take responsibility for independent management of their condition. |
| P120 | INTENSIVE CARE SURVIVAL WITH HIV-INFECTION IS EQUIVALENT TO HIV-NEGATIVE ADMISSIONS: A SINGLE CENTRE IN THE SOUTHEAST HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P120) CS Short, N Brejt, B Patel, N Jackson and Y Gilleece Equivalent ICU and post intubation survival with HIV and non-HIV admissions, inspite of a high burden of PCP (52% of HIV admissions), reflects improved outcomes in the post HAART era and an advance in Intensivist management of HIV disease. |
| P121 | PROFILE OF NONATTENDERS AT AN INNER CITY HIV CLINIC, DISEASE OUTCOMES AND USE OF RESOURCES HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P121) K McFaul1, C Boyle2 and P Mallon1,3 These data suggest less interaction with HIV OPD services by IVDU with associated increases in inpatient admissions. Consideration to providing HIV care through DTC may help improve effective care delivery in cohorts with high IVDU prevalence and improve outcomes in this challenging group. |
| P122 | PROPOSED TREATMENT ALGORITHM FOR TESTOSTERONE REPLACEMENT THERAPY IN HIV-POSITIVE PATIENTS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P122) A Murungi, M Nelson, K Shotliff and J Catalan Testosterone replacement therapy (TST) has been shown to produce a wide range of benefits including improvement in libido, bone density, muscle mass, body composition and mood in patients with low to subnormal levels of circulating testosterone. |
| P123 | THE NEW FACE OF THE EPIDEMIC? SEXUALLY TRANSMITTED HIV AND YOUNG PEOPLE HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P123) A Hughes, B Ward, R Hope, G von Schweitzer, R Jones, N Nwokolo and F Boag The majority of this cohort have acquired HIV sexually with half having had a previous negative test highlighting the need for improved prevention strategies. Current HIV services are not meeting the individual needs of this cohort, with over a third lost to follow up. A specialist <26 clinic has been developed aiming to improve standards of care for this vulnerable group. |
| P124 | TISSUE BIOPSY IN HIV-INFECTED PATIENTS: HOW OFTEN DO SAMPLES GET SENT FOR MICROBIOLOGICAL ANALYSIS? HIV Med. 2009 April; 10(Suppl 1):43 (abstract no. P124) E Elliot, D Churchill, Y Gilleece, M Newport and M Llewelyn Less than a third of tissue samples in HIV patients are sent to microbiology, resulting in many missed or delayed diagnoses. We have presented our results at HIV, surgical and radiology clinical governance meetings, and are developing clearer clinical pathways for tissue biopsy in HIV+ patients to try to eliminate the problem. |
| P125 | UTILIZATION OF TRADITIONAL AND CONVENTIONAL HEALTHCARE IN RURAL SOUTH AFRICAN HAART INITIATORS IN THE PERIOD BEFORE DEATH HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P125) R Hamilton1, C McGoldrick2, RBS Laing2 and P MacPherson3 Although fewer males than females initiated HAART, males were more likely to die at home, perhaps reflecting more advanced immunosuppression at initial presentation. Despite already being on a HAART program, more than half accessed traditional healers during the period of illness leading to death. A number of factors may contribute, including barriers to primary and secondary health care access (e.g. transportation, poverty, stigma) and cultural beliefs regarding the use of traditional medicine. |
| P126 | HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P126) Abstract withdrawn |
| P127 | 'SEX, LOVE AND ONE-NIGHT STANDS: GETTING THE RELATIONSHIP YOU WANT': EVALUATION OF A EUROPEAN SEXUAL HEALTH WORKSHOP FOR HIV-POSITIVE YOUNG PEOPLE HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P127) T Campbell1, H Beer1, R Wilkins2 and N Parrett1 A week long residential conference for HIV+ young people was held in Switzerland in July 2008. Fifty delegates (15 males, 20 females aged 14–19 years: x = 17.25 and 11 males, 4 females aged 20– 29 years: x = 22.5) from 12 European countries attended. They participated in a series of workshops including a 3 hour sexual health workshop aimed at increasing confidence about the negotiation of sexual relationships, increasing skill regarding condom use and strategies about HIV disclosure to sexual partners. |
| P128 | HIGH RATE OF PSYCHIATRIC COMORBIDITY AND LOW RATE OF REHABILITATION REFERRALS IN PATIENTS WITH HIV-RELATED COGNITIVE IMPAIRMENT (HIVCI) HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P128) D Herlihy1, A Samarawickrama2, S Gibson1, D O'Flynn1, C Taylor2 and D Summerfield1 This is a cohort of young patients with HIVCI complicated by high rates of PC, CB and PI who would have difficulty complying with complex treatment regimens. Most had migrated to the UK from abroad and were unemployed. This combination of social disadvantage and HIVCI makes them a very vulnerable group. The rate of referral for neuro-rehabilitation was low. This study highlights the importance of close collaboration between the HIV and psychiatric teams, a low threshold for referral for psychiatric assessment and intervention, and early consideration of neurorehabilitation for all patients with HIVCI. We recommend that clear care and referral pathways are established in order to optimise the long-term management of this group of patients. |
| P129 | MOOD, STIGMA AND ILLNESS PERCEPTION IN HIV-POSITIVE AFRICAN PEOPLE WITH LIPODYSTROPHY SYNDROME (LDS) HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P129) T Campbell, H Beer, P Legemah and M Siane There is a dearth of British literature on the psychosocial impact of LDS in Africans. There were high rates of mood disorder, perceived stigma as a result of HIV and perceived high severity of HIV in this study. Earlier detection of mood disorder in this group may ameliorate some of these symptoms. Physicians should be aware that for this group of patients ARVs may be associated with negative psychological and social consequences. These factors will be explored in more depth in the study. |
| P130 | BRONCHOSCOPY YIELD IN HIV-POSITIVE PATIENTS, TEN YEARS ON FROM THE INTRODUCTION OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P130) EM Hadley HIV patients represent a significant proportion of the workload for the bronchoscopy unit. The commonest findings are bacterial lung infection and PCP, followed by mycobacterial disease of various types then fungal infections. It is clear that fibreoptic bronchoscopy remains a key investigation in HIV patients with symptoms, signs or radiographic evidence of pulmonary disease. In our series we had a yield of 85%. Our audit shows that PCP is still a common diagnosis for which bronchoscopy remains the best diagnostic tool. Since HAART was introduced in the late 1990s, the number of bronchoscopies requested for HIV patients has fallen by 60%. Despite this the indications remain the same. Our results show that for these patients the yield of bronchoscopy is high. |
| P131 | NEW THERAPIES FOR PNEUMOCYSTIS JIROVECII PNEUMONIA: THE ROLE OF ECHINOCANDINS AND NASAL HIGH FLOW GAS THERAPY HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P131) D Armstrong-James, L John, A Murungi and M Nelson Current first line therapies for PCP are associated with a number of adverse effects, and treatment discontinuation is often necessary. Fuirthermore, for patients with severe PCP, invasive ventilation is associated with risk of pneumothorax and death. We present our experience of the use of echinocandin therapy as a component of salvage for PCP and the role of Vapotherm high flow nasal oxygen therapy for respiratory support in patients with PCP and severe type 1 respiratory failure. |
| P132 | HIV-ASSOCIATED MULTICENTRIC CASTLEMAN’S DISEASE (MCD) MAY PRESENT IN THE CONTEXT OF IMMUNE RECONSTITUTION (IR); HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART) ALONE CAN MODIFY CLINICAL RESPONSE AND IS ASSOCIATED WITH RADIOLOGICAL RESPONSE AND SUPPRESSION OF KAPOSI SARCOMA HERPES VIRUS (KSHV) VIRAEMIA HIV Med. 2009 April; 10(Suppl 1):49 (abstract no. P132) DN Chilton1, F Raja2, SM Lee2, J Paul3, A Ramsay4, RF Miller5 and SG Edwards1 MCD may present in the context of IR. HAART alone can lead to clinical resolution of symptoms in HIV-associated MCD and both radiological and KSHV virological responses. These cases illustrate the importance of initiating, optimising and persisting with HAART once a diagnosis of MCD is made. Treatment with HAART alone represents a treatment strategy for those patients without significant organ failure at presentation. |
| P133 | ASSOCIATION BETWEEN ABCB1 3435C>T AND CYP2B6 516G>T AND HIGH-DENSITY LIPOPROTEIN CHOLESTEROL (HDL-C) CHANGES IN ANTIRETROVIRAL-NAÏVE PATIENTS RECEIVING FIRST-LINE EFAVIRENZ (EFV)-BASED REGIMENS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P133) TW Mahungu1, D Nair1, CJ Smith1, M Youle1, MA Johnson1, SH Khoo2, DJ Back2 and A Owen2 In this analysis we have demonstrated the cumulative effect of drug metabolising and drug transport variants on mean HDL-c changes in patients on EFV. These findings need to be validated in independent cohorts. The mechanisms underlying EFV-induced HDL-c increases are yet to be elucidated. |
| P134 | CO-ADMINISTRATION OF FLUCONAZOLE INCREASES NEVIRAPINE CONCENTRATIONS IN HIV-INFECTED UGANDANS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P134) K Wakeham1, R Parkes2, V Watson3, G Abu-Baker1, H Grosskurth1, J Levin1, S Khoo3 and D Lalloo2 We performed a large double blind placebo controlled study of fluconazole (200 mg 3x per week) as prophylaxis for cryptococcal disease (CRYPTOPRO) in patients with CD4 counts <200 in Uganda. Data from retrospective or uncontrolled studies have suggested that there may be an interaction between fluconazole and nevirapine, increasing nevirapine concentrations and potentially leading to hepatotoxicity. |
| P135 | FACTORS INFLUENCING LOPINAVIR (LPV) AND ATAZANAVIR (ATV) PLASMA CONCENTRATION HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P135) W Stöhr1, S Khoo2, D Dunn1, S Gibbons2, T Hill3, A Winston4, C Sabin3 and D Back2 This analysis confirms the effect of NNRTIs on ATV concentration, and there was a negative association of weight and LPV concentration. In contrast to some other studies we did not find an influence of tenofovir on ATV levels. The unexpectedly strong impact of concomitant rifabutin on LPV concentration should be studied further. |
| P136 | HIV-RELATED MEDICATION ERRORS: FREQUENCY, CAUSE AND OUTCOMES IN A SPECIALIST HOSPITAL OUTPATIENT CLINIC HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P136) B Marett, C Naude and R Weston Medication errors are the second most reported patient safety incident and responsible for 6.5% of hospital admissions in the United Kingdom (UK). To date there are no published prospective data of HIV related medication errors in hospital outpatients. We aim to prospectively evaluate HIV related medication errors, causes, actual and potential outcomes in HIV outpatients attending a hospital based outpatient clinic in the UK. |
| P137 | ONCE-DAILY DARUNAVIR (DRV) USED IN ROUTINE CLINICAL CARE PRODUCES TROUGH DRV DRUG CONCENTRATIONS IN EXCESS OF 30X THE PROTEIN CORRECTED (PC) EC50 FOR WILD TYPE (WT) HIV HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P137) NE Dufty, CM Robertson, AN Jayasuriya and S Taylor In clinical practice measured drug concentrations often exhibit significant differences to those published in clinical trials. This can impact on virological efficacy and drug toxicity. The aim of this study is to assess DRV concentrations achieved in a cohort of HIV-positive individuals using a non-standard dose of DRV 900 mg OD with RTV 100 mg OD. |
| P138 | PHYSICIAN AWARENESS OF ANTIRETROVIRAL DRUG INTERACTIONS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P138) LE Cottle1, JG Evans-Jones1 and SH Khoo2 Antiretrovirals (ARVs) have the potential to interact with each other as well as with other medications, herbal preparations and recreational drugs. Lack of awareness of these interactions may result in excessive toxicity or reduced efficacy of treatment. This study aimed to identify all clinically relevant drug interactions in out-patients on ARVs over a four week period in July 2008 and to assess awareness of these amongst HIV practitioners. It intended to highlight frequently occurring drug interactions and improve prescribing practice. |
| P139 | POPULATION PHARMACOKINETICS (PK) OF NEVIRAPINE (NVP) IN HIV-INFECTED ADULTS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P139) A Schipani1, K Wakeham2,3, A Ggayi2, A Kamali2, DG Lalloo3, M Youle4, M Johnson4, S Khoo1, L Dickinson1 and D Back1 The one compartment population model developed to describe the pharmacokinetics of NVP in HIV-infected adult has the potential to predict NVP CL/F from sparse sampling and be a valuable tool in clinical trials. |
| P140 | POPULATION PHARMACOKINETICS (PK) OF RITONAVIR (RTV)BOOSTED ATAZANAVIR (ATV) IN HIV-INFECTED AND HEALTHY INDIVIDUALS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P140) L Dickinson1,3, L Aarons2, D Back3, L Waters4, L Else3, S Khoo3, A Pozniak4 and M Boffito4 We aimed to develop and validate a population PK model to i) describe RTV-boosted ATV concentrations (300/100 mg q.d.) and identify important covariates impacting PK variability, and ii) simulate concentration-time profiles of lower unlicensed ATV doses (150 mg q.d., 200 mg q.d.). |
| P141 | PREVALENCE OF POTENTIAL DRUG&NDASH;DRUG INTERACTIONS IN THE SWISS HIV COHORT STUDY HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P141) C Marzolini1, S Gibbons2, L Elzi1, S Khoo2, B Ledergerber3, M Battegay1 and D Back2 Drug–drug interactions (DDIs) related to HIV therapies continue to expand with new drugs, more complex ART regimens, and increasing age-related comorbidities. The identification, resolution and prevention of DDIs are important determinants for clinical management as it may prevent treatment failure and toxicity. This study investigates the prevalence of DDIs (HIV/HIV drugs and HIV/non-HIV drugs) within Swiss HIV Cohort Study (SHCS) patients. |
| P142 | REVIEW OF THE USE OF THERAPEUTIC DRUG MONITORING FOR ANTIRETROVIRALS AT A LARGE LONDON HOSPITAL HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P142) NJ Marshall, L Swaden and MA Johnson The majority of TDM requests were taken with the BHIVA guidelines. Improvements could be made in documentation and sampling times, although the frequency of errors in this audit was substantially lower than reported at other large centres. |
| P143 | VARIABILITY IN STEADY-STATE RALTEGRAVIR PHARMACOKINETICS – IMPACT OF EZETIMIBE? HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P143) A Jackson1, G Moyle1, V Watson2, D Back2, S Khoo2, K Armenis1, B Gazzard1 and M Boffito1 The integrase inhibitor raltegravir (RAL) and lipid lowering agent ezetimibe (EZE) are metabolised in the liver via glucuronide conjugation involving the UDP-glucuronyltransferase UGT1A1, with subsequent biliary and renal excretion of the conjugates. This common metabolic pathway allows the potential for drug interactions. We have assessed the interaction in healthy volunteers. |
| P144 | ARE WE FAILING OUR MEDICAL STUDENTS? EDUCATION PROVIDED TO UK MEDICAL ELECTIVE STUDENTS REGARDING HIV RISK AND POST EXPOSURE PROPHYLAXIS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P144) K Stacey1, L Sellers1 and S Barrett2 The situation regarding HIV risk education and provision of PEP to elective students has improved since 2002. However, there remains a discrepancy between advice given, supervision of projects and provision of PEP starter packs across UK medical schools. This highlights the need for national guidance provided to all medical schools so our students can undertake their elective without undue risk. |
| P145 | HOW HIGH IS VIRAL LOAD IN HIV SEROCONVERTERS ONCE THEY PRESENT TO A CLINIC? HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P145) V Jones1, K Porter1 and G Hart2 ART intervention in early infection has been suggested for public health benefit. Its impact, however, depends on how early infected individuals present to clinics. We describe HIV viral load (VL) at first clinic presentation, changes over time following seroconversion (SC),and factors associated with a high VL (>5 log10 copies/mL) at presentation using data from persons with known HIV SC dates. |
| P146 | POST EXPOSURE PROPHYLAXIS IN THE DEVELOPED AND DEVELOPING WORLDS: DIFFERENT REASONS FOR POOR ADHERENCE TO GUIDELINES HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P146) J Davies1, M Yong2, G van der Maaten3, NJ Beeching1, EE Zijlstra3, JJ van Oosterhout3 and MBJ Beadsworth1 Despite adequate resources and clear guidelines poor database entry, documentation and follow-up prompted a revision of local and regional guidelines in the UK centre. In Malawi, inadequate follow-up and questionable adherence have necessitated an improved publicity campaign and on-going audit. PEPSE now makes up the vast majority of PEP episodes in this UK centre whereas occupational PEP still predominates in a developing world setting. Good logistic organisation, audit and funding of PEP programmes will help improve uptake of services and data collation, and help to reduce HIV transmission. |
| P147 | PRE-ELECTIVE HIV POST-EXPOSURE PROPHYLAXIS CLINIC FOR MEDICAL STUDENTS: DESIGN, PROTOCOL, UPTAKE AND EFFECTIVENESS HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P147) L Sellers1, K Stacey1 and S Barrett2 Some students are embarking on their electives without adequate preparation. Our innovative 'Pre-elective HIV PEP Clinic' is an acceptable way to help prepare students to undertake a fulfilling elective at their chosen destination without unnecessary risk. |
| P148 | THE EFFECTIVENESS OF A DEDICATED NURSE-LED POST-EXPOSURE PROPHYLAXIS FOR SEXUAL EXPOSURE (PEPSE) CLINIC IN AN INNER LONDON HOSPITAL HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P148) N Ault, S Thomas-William, D Scott and L Sarner The dedicated nurse-led PEPSE clinic showed significant improvement in all aspects of the standard of PEPSE care except 3 month follow up for HIV testing. |
| P149 | UNDERSTANDING HIV-RISK BEHAVIOUR IN HIV-SERODISCORDANT COUPLES – A NOVEL APPROACH HIV Med. 2009 April; 10(Suppl 1):3 (abstract no. P149) J Fox1, A Alsop2, G Elam2, J Green3, J Weber3, H Ward3, M McClure3 and S Fidler3 This study represents the largest investigation of HIVserodiscordant couples undertaken in the UK and provides, for the first time, perspectives from both HIV-negative and HIV-positive individuals within a couple. Differences in perceptions of risk and justifications for risk behaviour within a couple, suggests that tailored couple-counselling to high-risk couples may be beneficial. HIV-positive individuals should communicate their anxieties regarding transmission to partners and HIV- negative individuals need to be educated on the impact HIV has on quality of life. |
| P150 | HIGH-RISK SEXUAL BEHAVIOUR AND HIV-1 SUPERINFECTION: AN INDICATION FOR EARLY INITIATION OF ANTIRETROVIRAL THERAPY? HIV Med. 2009 April; 10(Suppl 1):50 (abstract no. P150) T Doyle1, A Garcia-Diaz1, C Booth1, H Dreja2, A McKnight2, M Johnson1 and AM Geretti1 HIV-1 infected patients who engage in high-risk sexual behaviour are at risk of superinfection both in the early and established phases of the disease, even in the presence of effective immune responses. Targeted screening based upon sexual history and viral load can achieve a high detection rate. There is a case for early HAART initiation in these patients, both as a public health measure and to address the risk of superinfection. |
| P151 | LOW PREVALENCE OF TRANSMITTED DRUG RESISTANCE (TDR) IN AN INNER LONDON GENITO-URINARY MEDICINE (GUM) CLINIC COHORT WITH PREDOMINANTLY HETEROSEXUALLY TRANSMITTED, NON-B-SUBTYPE INFECTION HIV Med. 2009 April; 10(Suppl 1):55 (abstract no. P151) P Khan, V Apea, A DeMasi, M Kall and I Reeves The overall prevalence of TDR in our predominantly non-B subtype cohort was 3.2%. The majority of resistance occurred in subtype B and was confined to a single drug class. Prevalence of TDR in non-B subtype was 1.6%. These findings are in line with recent reported data suggesting reduced TDR amongst non-B subtypes. |
| P152 | SPOT THE DIFFERENCE: HIGH RATES OF MEASLES IGG SERONEGATIVITY IN HIV-POSITIVE ADULTS POST HAART HIV Med. 2009 April; 10(Suppl 1):55 (abstract no. P152) Y Gilleece and J Whetham To our knowledge these are the first UK data post HAART looking at measles IgG serostatus in HIV-positive adults. The data show a seronegative rate >6 times that of the general population, despite good CD4 counts and ARV use. Whether due to effects of HIV on vaccine induced antibodies (as shown in African children) or low rates of measles vaccination and exposure (less likely given cohort studied), these data highlight the importance of screening and support recent BHIVA guidelines. |
| P153 | TROPISM TESTING: REAL-LIFE EXPERIENCE HIV Med. 2009 April; 10(Suppl 1):55 (abstract no. P153) LJ Waters, AT Scourfield, K Gedela, K Armenis, A Jackson, M Marcano and MR Nelson The majority of Trofile assays sent from our cohort were successful and failed results were more likely to be from samples with a viral load less than 1000 copies/mL. Similar proportions with R5 and D/M/X4 tropic virus were treatment-experienced and tropism testing should be considered even in highly treatment-experienced subjects if MVC is an option. |
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