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ABSTRACTS 11th Annual Conference of the British HIV Association [BHIVA] with the British Association for Sexual Health and HIV [BASHH] 20–23 April 2005 Burlington Hotel · Dublin · Ireland www.bhiva.org Conference Secretariat Mediscript Ltd 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD Tel: +44 (0)20 8369 5380 Fax: +44 (0)20 8446 9194 www.bashh.org MAJOR SPONSORS Health Care 3M Health Care Ltd 3M House, Morley Street Loughborough Leicester LE11 1EP EXHIBITORS Actelion Pharmaceuticals Blithe Systems Abbott Laboratories Limited Abbott House, Norden Road Maidenhead Berkshire SL6 4XE Boehringer Ingelheim Limited Ellesfield Avenue Bracknell Berkshire RG12 8YS BMJ Journals Caradata Ltd Bristol-Myers Squibb Pharmaceuticals Limited 141–149 Staines Road Hounslow Middlesex TW3 3JA Delphic Europe Eli Lilly and Company Limited Lilly House, Priestley Road Basingstoke Hampshire RG24 9NL Durex Gilead Sciences Limited Granta Park Great Abington Cambridgeshire CB1 6GP Gen-Probe Inc GlaxoSmithKline UK Limited Stockley Park West Uxbridge Middlesex UB11 1BT Mill Systems / Text Tools Roche Products Limited PO Box 8 Welwyn Garden City Hertfordshire AL7 3AY RSM Press Ltd Roche Products Limited PO Box 8 ROCHE DIAGNOSTICS Welwyn Garden City Hertfordshire AL7 3AY Stiefel Mediscript Medical Publishers Conference Secretariat: Mediscript Ltd Published by the BHIVA Organising Secretariat 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD Tel: +44 (0)20 8369 5380 Fax: +44 (0)20 8446 9194 E-mail: [email protected] Registered Charity No: 1056354 CONTENTS BHIVA and BASHH Committees ………………………………………………………………………………… ………………………………………………………………………… iii ……………………………………………………………………………………………………………………… 1 Research Presentations: Summary Oral Abstracts Poster Abstracts …………………………………………………………………………………………………………………… 14 ………………………………………………………………………………………………………………… 57 ………………………………………………………………………………………………………………………… 61 Printed Abstracts Author Index ii Abstract selection The number of high-quality abstracts submitted for presentation at the Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV was overwhelming which made selection a most difficult task. Thanks are due to the Joint BHIVA and BASHH Committees (see page ii) for all the time and effort they put into this selection process. Unfortunately, due to time and space constraints, it has been necessary to disappoint some potential presenters. The Committees hope this will not deter anyone from submitting abstracts for future meetings. Abstract citations All abstracts accepted for both oral and poster presentation including printed abstracts will be published in the supplement to the May issue of HIV Medicine, the BHIVA peer-reviewed journal. All published citations of abstracts should be made to HIV Medicine and not to this conference book. Prizes / Scholarships There will be a conference prize for the best oral presentation and one for the best poster presentation. Bristol-Myers Squibb Scholarships will be awarded to the five best abstract presentations. To qualify for a scholarship, applicants must be of Junior Grade or under 35 years of age. Each scholarship is worth £1000. BHIVA Science Scholarships are awarded to up to ten scientists studying for a PhD or MD. For those whose abstracts are accepted for presentation (oral or poster), all registration fees, a contribution of a maximum of £100 towards travel expenses and accommodation costs (maximum three nights at £60 per night) will be paid for by BHIVA. The Maggie Godley Memorial Prize will be awarded to the best abstract presented by a doctor who has consultant status and who works in a district general/non teaching hospital in the UK. i BHIVA AND BASHH COMMITTEES JOINT BHIVA/BASHH CONFERENCE COMMITTEE Prof Brian Gazzard Chair of Joint Committee Dr Jane Anderson BHIVA Honorary Secretary Dr Jan Clarke BASHH Treasurer Dr Anna Maria Geretti BHIVA Executive Committee Member Dr Margaret Johnson BHIVA Chair Prof Fiona Mulcahy BHIVA Invited Local Representative Dr Rajul Patel BASHH Education Committee Chair Dr Anton Pozniak BHIVA Executive Committee Member/ BASHH Board Member Dr Angela Robinson BASHH President Prof Lorraine Sherr BHIVA Invited Representative Dr Helen Ward BASHH Invited Representative Dr Ian Williams BHIVA Executive Commitee Member Dr Janet Wilson BASHH Conferences and Communications Secretary ORAL RESEARCH JUDGING PANEL Dr Keith Aizen Bristol-Myers Squibb Representative POSTER RESEARCH JUDGING PANEL Dr Colm Bergin BHIVA Invited Representative Dr Andrew Freedman BHIVA Executive Committee Member Dr Gary Brook BHIVA Executive Committee Member Ms Vanessa Griffiths BASHH Elected Representative Dr Rachel Challenor BASHH Elected Representative Dr Ian Hitchcock Bristol-Myers Squibb Representative Dr Claudia Estcourt BASHH Board Member Dr Cathy Ison BASHH Invited Representative Dr Ade Fakoya BHIVA Executive Committee Dr Frances Keane BASHH Board Member Dr Mark Pakianathan BASHH Board Member Dr Adrian Palfreeman BHIVA Co-opted Representative Prof Jonathan Ross BASHH Invited Representative Dr Alan Tang Dr Ann Sullivan BHIVA Invited Representative BHIVA Executive Committee Member BHIVA COMMITTEE Officers Chair Dr MA Johnson (Royal Free Hospital, London) Hon Treasurer Dr EL Wilkins (North Manchester General Hospital) Hon Secretary Dr J Anderson (Homerton University Hospital, London) Executive members Dr S Ash Dr MG Brook Dr A Fakoya Dr M Fisher Dr AR Freedman Prof BG Gazzard Dr AM Geretti Dr C Leen Dr NE Mackie Dr AL Pozniak Mrs D Robertson-Bell Prof JD Ross Dr C Skinner Dr A Tang Dr IG Williams (Ealing Hospital, London) (Central Middlesex Hospital, London) (Newham General Hospital, London) (Royal Sussex County Hospital, Brighton) (Cardiff University School of Medicine) (Chelsea and Westminster Hospital, London) (Royal Free Hospital, London) (Western General Hospital, Edinburgh) (St Mary’s Hospital, London) (Chelsea and Westminster Hospital, London) (Royal Free Hospital, London) (Whittall Street Clinic, Birmingham) (Royal London Hospital, London) (Royal Berkshire Hospital, Reading) (Royal Free and UCMS, London) Co-opted members Prof S Lucas Prof L Sherr (Guy’s and St Thomas’ Hospital, London) (Royal Free Hospital, London) Co-opted representatives Mr K Alcorn (NAM) Mr S Collins (HIV i-Base) Mr D Edmondson (DHIVA) Dr A Palfreeman (MRC) Ms N Perry (NHIVNA) Dr A Robinson (BASHH) Dr TG Tudor-Williams (CHIVA) Mr BC West (HIV Scotland) Ms R Weston (HIVPA) ii BASHH BOARD Elected Officers and Representatives Dr Angela Robinson President Dr Simon Barton Vice President Dr Jan Clarke Treasurer Dr Keith Radcliffe General Secretary Dr Janet Wilson Conferences and Communications Secretary Dr Immy Ahmed Chair, Clinical Governance Committee Dr Raj Patel Chair, Education Committee Dr Colm O’Mahony Past Chairman of AGUM Dr Rachel Challenor Non-Consultant Career Grade Representative Ms Vanessa Griffiths Nurse/Health Advisor Representative Dr Penny Goold Doctors in Training Representative Members Dr George Kinghorn Dr Stephen Dawson Dr Mark Pakianathan Dr Claudia Estcourt Dr Francis Keane Dr Phillip Kell Sheffield Slough St George’s Hospital, London St Bartholomew’s Hospital, London Royal Cornwall Hospital, Truro Archway Sexual Health Clinic, London Co-opted Members Dr Mark FitzGerald Chair of the Trustees Dr Margaret Johnson BHIVA Dr Alison Bigrigg FFPRHC RESEARCH PRESENTATIONS THURSDAY 21 APRIL 0930–1030 Oral Research Presentations: Session 1 Epidemiology and partner management – chlamydia and herpes Chairs: Dr Raj Patel Royal South Hampshire Hospital, Southampton, UK Dr Celia Skinner Royal London Hospital, UK 0930–0940 Abstract 1 A decade of chlamydia in Leeds: comparative analysis of demographic and geospatial risk factors at the onset of chlamydia screening AL Evans, Leeds General Infirmary, UK 0940–0950 Abstract 2 Free availability of postal testing kits for chlamydia in colleges of further education as an alternative to nurse-led clinics: a prospective crossover intervention trial DJ Clutterbuck, Lothian Health Board, UK 0950–1000 Abstract 3 The management of Chlamydia trachomatis in genitourinary medicine clinics: a national audit in 2004 R Challenor, Derriford and Torbay Hospitals, Plymouth, UK 1000–1010 Abstract 4 Compliance with novel ‘partner interventions’ amongst male sexual partners of women with Chlamydia trachomatis GR Scott, University of Edinburgh, UK 1010–1020 Abstract 5 Comparison of virus culture and TaqMan real-time polymerase chain reaction (PCR) for detection of genital herpes simplex virus (HSV) infection MK Malu, Whittall Street Clinic, Birmingham, UK 1020–1030 Abstract 6 Do people with genital herpes tell their sexual partners? The influence of stigma J Bickford, Chelsea and Westminster Hospital, London, UK 1500–1600 Oral Research Presentations: Session 2 Service delivery/women and children Chairs: Dr Jane Anderson Homerton University Hospital, London, UK Dr Janet Wilson Leeds General Infirmary, UK 1500–1510 Abstract 7 Has young people's knowledge and use of contraceptive services increased since the introduction of the Teenage Pregnancy Strategy? Findings from the Teenage Pregnancy Strategy Evaluation RS French, Centre for Sexual Health and HIV Research, Royal Free and UCMS, London, UK 1510–1520 Abstract 8 Correlation of erectile dysfunction (ED) severity as perceived by UK healthcare professionals compared to the International Index of Erectile Function score (IIEF): results from the Erectile Dysfunction Observational Study (EDOS) P Kell, Archway Sexual Health Clinic, London, UK 1520–1530 Abstract 9 Antiretroviral therapy in a new public sector antiretroviral treatment centre in Ghana: patients' presentation and response P Collini, Komfo Anokye Teaching Hospital HIV/AIDS Clinic, Kumasi, Ghana 1530–1540 Abstract 10 Targeting points for further intervention: a review of HIV-infected infants born in Ireland in the 5 years following introduction of antenatal screening W Ferguson, The Rotunda Hospital, Dublin, Ireland 1540–1550 Abstract 11 Evaluation of nelfinavir based mother-to-child transmission regimens S O’Dea, St James’ Hospital, Dublin, Ireland 1550–1600 Abstract 12 Increased psychosis in HIV-1-infected sub-Saharan African immigrants A Holmes, St. James’s Hospital, Dublin, Ireland 1620–1830 Oral Research Presentations: Session 3 New infections, risk factors and early treatment Chairs: Dr Keith Radcliffe Birmingham University Medical School, UK Dr Ian Williams Royal Free and UCMS, London, UK 1620–1630 Abstract 12a Sexual behaviour and risk of ongoing transmission in symptomatic patients attending genitourinary medicine clinics CH Mercer, Centre for Sexual Health and HIV Research, Royal Free and UCMS, London, UK 1630–1640 Abstract 13 Overseas travel, high-risk sexual behaviour and STI transmission risk among British adults: Results of a national probability survey of sexual attitudes and lifestyles CH Mercer, Centre for Sexual Health and HIV Research, Royal Free and UCMS, London, UK 1640–1650 Abstract 14 High risk sexual behaviour among London gay men: no longer increasing? J Elford, City University London, UK iii RESEARCH PRESENTATIONS THURSDAY 21 APRIL 1650–1700 Abstract 15 Risk factors for the acquisition of HIV in individuals known to have recently seroconverted J Fox, Imperial College, London, UK 1750–1800 Abstract 21 Discordant responses to HAART in ARV naïve HIV infected individuals MY Tung, Chelsea and Westminster Hospital, London, UK 1700–1710 Abstract 16 A prospective study of post-exposure prophylaxis (PEP) following non-occupational exposure to HIV in the UK JE Blackham, Health Protection Agency Centre for Infections, London, UK 1800–1810 Abstract 22 Discordant CD4 and viral load responses in patients starting HAART in the UK Collaborative HIV Cohort (CHIC) Study RJC Gilson, Centre for Sexual Health and HIV Research, Royal Free and UCMS, UK 1710–1720 Abstract 17 Trends in transmitted genotypic antiretroviral resistance in primary versus longstanding HIV infection K Aderogba, Brighton and Sussex University Hospitals, UK 1720–1730 Abstract 18 The longevity of HIV-specific CD4 T-helper responses and clinical outcome following short course antiretroviral therapy in primary HIV infection J Fox, Imperial College, London, UK 1730–1740 Abstract 19 Late diagnosis and consequent short-term mortality of individuals sexually infected with HIV: England and Wales, 2002 TR Chadborn, Health Protection Agency Centre for Infections, London, UK 1740–1750 Abstract 20 Therapeutic vaccination with HIV-1 whole killed vaccine is associated with immune modulation in HAART-naïve, asymptomatic HIV-infected individuals G Marchetti, University Milano, Italy iv 1810–1820 Abstract 23 The effect of year of treatment and NA backbone on durability of NNRTI based regimens NT Annan, Chelsea and Westminster Hospital, London, UK 1820–1830 Abstract 24 Therapeutic drug monitoring (TDM) of efavirenz (EFV): a tool to predict virologic outcome in HIV-patients on first line once daily (OD) antiretroviral (ARV) therapy? D Maitland, Chelsea and Westminster Hospital, London, UK 1830–1840 Abstract 24a Predictors of current CD4+ T-cell response among patients receiving subcutaneous recombinant interleukin-2 in ESPRIT H Nuwagaba-Birbonwoha, ESPRIT Research Group RESEARCH PRESENTATIONS FRIDAY 22 APRIL 0930–1030 Oral Research Presentations: Session 4 Co-infections Chairs: Dr Immy Ahmed Nottingham City Hospital, UK Dr Clifford Leen Western General Hospital, Edinburgh, UK 0930–0940 Abstract 25 Evidence for sexual transmission of HCV in recent epidemic in HIV-infected men in South-East England M Danta, Royal Free and UCMS, London, UK 0940–0950 Abstract 26 Is the treatment of acute hepatitis C in HIV positive individuals effective? YC Gilleece, Chelsea and Westminster Hospital, London, UK 0950–1000 Abstract 27 Does nadir CD4 count in HIV-HCV co-infected patients predict HCV treatment response to pegylated interferon (p-IFN) and ribavirin (RBV)? S Hopkins, Centre for Sexual Health and HIV Research, Royal Free and UCMS, London, UK 1000–1010 Abstract 28 Hepatitis C infection is not associated with systemic HIV-associated non-Hodgkin's lymphoma: a cohort study L Waters, Chelsea and Westminster Hospital, London, UK 1010–1020 Abstract 29 Inhibition of hepatitis B virus replication by small interfering RNA expressed from viral vectors M McClure, Imperial College London, UK 1020–1030 Abstract 30 Is there a relationship between Familial Mediterranean Fever (FMF) host polymorphisms and paradoxical reactions (PR) in tuberculosis (TB)? A Dunleavy, Royal Brompton Hospital, London, UK 1050–1150 Oral Research Presentations: Session 5 Management issues in HIV Chairs: Dr Jan Clarke Leeds General Infirmary, UK Dr Ed Wilkins North Manchester General Hospital, UK 1050–1100 Abstract 31 Identifying the key beliefs influencing uptake and adherence to HAART: Final results of a 12-month prospective, follow-up study R Horne, University of Brighton and Royal Sussex County Hospital, UK 1100–1110 Abstract 32 Stopping combination therapy whilst travelling: is there a reason for great concern? MA Schuhwerk, Mortimer Market Centre, London, UK 1110–1120 Abstract 33 Switching from a thymidine analogue to tenofovir (TDF) achieves similar resolution of lipoatrophy and better reduction in lipids than switching to abacavir (ABC). Results of the RAVE study, a UK multi-centre open-label randomised controlled trial JD Cartledge, Mortimer Market Centre, London, UK 1120–1130 Abstract 34 3-dimensional surface laser scanning and psychological assessment: objective evidence for the use of polylactic acid implants in HIV-associated facial lipoatrophy J Ong, Royal Free Hospital, London, UK 1130–1140 Abstract 35 What is the cost of switching an anti-retroviral therapy (ART) from an HIV-centre perspective? T Toward, Abbott Laboratories, UK, 1140–1150 Abstract 36 Extent of underdosage of antiretroviral therapy in HIV-infected children EN Menson, MRC Clinical Trials Unit, London, UK 1400–1500 Oral Research Presentations: Session 6 New technologies and surveillance Chairs: Dr Martin Fisher Royal Sussex County Hospital, Brighton, UK Dr Helen Ward Imperial College School of Medicine, London, UK 1400–1410 Abstract 37 Enhanced surveillance for lymphogranuloma venereum (LGV) in England CA Ison, Health Protection Agency Centre for Infections, London, UK 1410–1420 Abstract 38 An outbreak of lymphogranuloma venereum in London in 2004 M Hamill, Mortimer Market Centre, London, UK 1420–1430 Abstract 39 Syphilis outbreak in commercial street sex workers in east London N Lomax, Barts and The London NHS Trust, London, UK 1430–1440 Abstract 40 Syphilis PCR use for diagnosis of early syphilis audited against routine serological testing P Lewthwaite, North Manchester General Hospital, UK 1440–1450 Abstract 41 Opa-typing can subdivide NG-MAST sequence types of Neisseria gonorrhoeae into epidemiological relevant groups AK Morris, Royal Infirmary of Edinburgh, UK 1450–1500 Abstract 42 HIV-1 antibody avidity testing to identify recent HIV seroconverters A Chawla, Royal Free and UCMS, London, UK v RESEARCH PRESENTATIONS FRIDAY 22 APRIL 1620–1720 Oral Research Presentations: Session 7 Late HIV infection Chairs: Dr Rob Miller Royal Free and UCMS, London, UK Dr Anton Pozniak Chelsea and Westminster Hospital, London, UK 1620–1630 Abstract 43 No recent increase in mortality among HIV-diagnosed individuals with long exposure to therapy: UK 1987–2004 TR Chadborn, Health Protection Agency Centre for Infections, London, UK 1630–1640 Abstract 44 How salvageable are the K65R and L74V mutations? L Waters, Chelsea and Westminster Hospital, London, UK vi 1640–1650 Abstract 45 Triple class antiretroviral agent resistance in a large UK cohort – prevalence and risk factors for acquisition R Jones, Chelsea and Westminster Hospital, London, UK 1650–1700 Abstract 46 Virological and clinical outcomes in patients with multi (three)-class drug resistant (MDR) HIV in the UK D Grover, Mortimer Market Centre, London, UK 1700–1710 Abstract 47 CD4 counts and the risk of lymphoma in individuals with HIV in the UK I Reeves, Brighton and Sussex University Hospitals, UK 1710–1720 Abstract 48 A prognostic model to predict survival in systemic AIDS related non-Hodgkin's lymphoma AM Young, Chelsea and Westminster Hospital, London, UK 11th Oral Abstracts O1 O3 A decade of chlamydia in Leeds: comparative analysis of demographic and geospatial risk factors at the onset of chlamydia screening The management of Chlamydia trachomatis in genitourinary medicine clinics: a national audit in 2004 AL Evans1, D Merrick2, EF Monteiro1, MH Wilcox1, CJN Lacey3 R Challenor1, S Pinsent1, S Chandramani2, N Theobald3, D Daniels4 1Leeds General Infirmary, 2Yorkshire and Humber Public Health 1GUM Department, Derriford Hospital, Plymouth, 2GUM Department, Observatory, 3Hull York Medical School, University of York, UK Objective: To compare the demographics of chlamydia in Leeds in 2003–2004 with 1994–1995. Methods: Laboratory data for all chlamydia diagnoses in Leeds in 2003-2004 were compared to 1994–1995. Results: For persons aged 15 to 54, total annualised positivity rates increased 4-fold from 159.0/106 in 1994/5 by ELISA (95% CI 150.4 to 167.9) to 644.8/106 in 2003/4 by SDA (95% CI 627.4 to 662.5). This increase was the same for both sexes; peak age groups remained 15–19 for women and 20–24 for men. Ethnicity data (Genitourinary Medicine (GUM) diagnoses only) showed a persistent relative risk of 10 for black as opposed to white ethnic groups. In 2003/4, GUM diagnosed 42% of chlamydia positives compared with 80% in 1994/95. 51% were diagnosed in the community: General Practice (39%), Contraceptive services (7%) and Chlamydia Screening Project (5%). A positive female was 4.5 times more likely than a positive male to be diagnosed in a non-GUM setting. Analyses of setting-specific positivity rates and geospatial distribution are underway. Conclusions: Chlamydia continues to show a wide geospatial distribution with increased risk in under-25s and black ethnic groups. Women are now diagnosed mostly in community settings and efforts will need to be concentrated on partner notification to reduce transmission. Manor Hospital, Walsall, 3John Hunter Clinic, Chelsea and Westminster Hospital, London, 4Sexual Health Clinic, West Middlesex Hospital, UK Aim: To undertake the first national audit of the management of Chlamydia trachomatis in genitourinary medicine (GUM) clinics in the UK. Methods: A retrospective case note review. Non-Consultant Career Grade Doctors working in GUM clinics were each asked to complete ten data collection forms. Results: One thousand six hundred and seventy forms were completed (from 830 males and 840 females with chlamydia) during the audit period of January to March 2004. Ninety nine per cent (1647) were treated appropriately. Seventy six per cent (1261) were followed up, of which 12% (154) required re-treatment. Seventy one per cent (1186) were managed appropriately within four weeks and 942 partners (0.56 per index case) were managed satisfactorily within four weeks of the initial partner notification interview. Partner notification outcomes were significantly more successful when the index patient was followed up (P <0.0001). Outcome standards were not associated with age, gender or sexuality, but were significantly associated with ethnicity (P <0.004). Conclusion: GUM clinics are delivering high quality care and evidence based national outcome standards are being met. O2 O4 Free availability of postal testing kits for chlamydia in colleges of further education as an alternative to nurse-led clinics: a prospective crossover intervention trial Compliance with novel ‘partner interventions’ amongst male sexual partners of women with Chlamydia trachomatis DJ Clutterbuck, K Carrick-Anderson, K Allison, GR Scott, L McKay Healthy Respect, Lothian Health Board, Lothian, UK Three models of testing and treatment for chlamydial infection in students attending four FE colleges in Lothian, SE Scotland were compared in a prospective crossover intervention trial as part of the 'Healthy Respect' health demonstrator project. Part-time nurse-led clinics were compared over two consecutive academic years with the use of postal testing kits, distributed either under supervision by trained non-healthcare staff or freely available from distribution points. 316 tests for chlamydia were carried out, 65% in women and 35% in men. Chlamydia prevalence in those tested on site was the same as that detected by postal testing (11.6% (14/121) vs 12.3% (24/195), χ2=0.04; P>0.05). Treatment rate was 100% and contact details were obtained in all cases. Free distribution of postal testing kits generated a lower percentage return rate than supervised distribution (15% (157/891) vs 25% (38/152), χ2=9.07; P =0.026) but results in a greater number of students being tested. Although all methods were successful in accessing men for testing, postal testing kits carried no additional advantage over clinics. Free distribution of postal testing kits detects a greater number of infections than alternative models with comparable outcomes but reduced manpower requirements. A Johnstone, S Cameron, A Glasier, H Young, GR Scott University of Edinburgh, Little France Drive, Edinburgh, UK Aim: To explore novel approaches to partner notification and treatment in view of suboptimal rates of contact tracing for chlamydia (~25%) reported by Scottish GUM clinics. Methods: Women diagnosed chlamydia-positive at either a hospital gynaecology clinic (termination of unwanted pregnancy) or a community family planning clinic, or a GUM clinic in Edinburgh, were randomised to one of three strategies of partner intervention: (i) contact tracing by a GUM health Adviser (ii) postal testing kit for partner(s) to post urine sample for chlamydia testing, or (iii) patient delivered partner medication (PDPM) whereby woman is given 1G of azithromycin to give to sexual partner(s). Ethical Committee approval was obtained. Results: Thus far, 101 women have been recruited and randomised to: 33 contact tracing (33 partners), 33 postal testing (36 partners) and 35 PDPM (38 partners). There was no significant difference between groups in terms of the percentage of partners known to have complied with the intervention: 28% contact tracing, 28% postal testing and 32% PDPM. Discussion: These preliminary results suggest that postal testing and PDPM may be similar to standard contact tracing in terms of proportion of sexual partners known to be tested/treated. 1 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV O5 O7 Comparison of virus culture and TaqMan real-time polymerase chain reaction (PCR) for detection of genital herpes simplex virus (HSV) infection Has young people's knowledge and use of contraceptive services increased since the introduction of the Teenage Pregnancy Strategy? Findings from the Teenage Pregnancy Strategy Evaluation MK Malu1, R Cunningham2, J Northwood2, S Shaw3, JR Willcox2 1Whittall Street Clinic, Birmingham, 2Plymouth Hospitals NHS Trust, Plymouth, 3Department of Statistics, University of Plymouth, Plymouth, UK Aim: To compare the detection rates of HSV with virus culture and TaqMan PCR. Methods: 134 patients with lesions suggestive of genital herpes attending the GUM clinic in Plymouth were recruited in the study. Two swabs were taken simultaneously by holding them together and sent for virus culture and PCR. Results: Table: HSV detection by virus culture and PCR Culture (n=134) PCR (n =134) HSV 1 29 (21.64%) 37 (27.61%) HSV 2 25 (18.65%) 49 (36.56%) Negative 74 (55.22%) 48 (35.82%) Unable to perform test 6 (4.47%) 0 (0.0%) Overall 40.29% and 64.17% of the specimens were positive for either HSV 1 or 2 by culture and PCR respectively. Notably the yield was higher with virus type 2 than type 1. There was no discrepancy in virus type as determined by culture and PCR. There was no patient with PCR negative but culture positive for the virus. There were 6 patients where culture could not be done due to contamination, of which 2 were HSV type 1, 2 were HSV type 2 and 2 were negative by PCR. Conclusion: The PCR is significantly more sensitive in detecting HSV (more sensitive for type 2 than type 1 virus) compared to culture. RS French1, CH Mercer1, R Kane2, P Kingori1, JM Stephenson1, K Lachowycz2, P Wilkinson2, K Wellings2 1Centre for Sexual Health and HIV Research, The Royal Free and University College Medical School, London, 2London School of Hygiene and Tropical Medicine, London, UK Aim: To investigate young people’s knowledge and use of contraceptive services over four years of the Teenage Pregnancy Strategy. Methods: Random location sample of young people aged 13–21 years (n=8877) were surveyed using Computer Assisted Personal Interviews between October 2000 and June 2004. Results: 82% of young women and 69% of young men knew a place they could visit for information about sex. Knowledge that contraception is freely available has increased. However, the proportion reporting they had obtained contraceptive advice prior first sexual intercourse has declined over the last four years. The service most frequently cited by young women for accessing supplies was general practice (54%) and for young men was the commercial sector (54%), but young men’s use of general practice and specialist contraceptive services has increased. This was particularly evident in local authorities rated as ‘high quality’ in terms of effort put into sexual health services (Teenage Pregnancy Unit data). Young people living in more deprived areas and those under 16 were more likely to use designated young people’s services. Conclusion: There has been some success in increasing knowledge and use of services, but it may be too early to observe any positive changes in outcomes. O6 O8 Do people with genital herpes tell their sexual partners? The influence of stigma Correlation of erectile dysfunction (ED) severity as perceived by UK healthcare professional compared to the International Index of Erectile Function score (IIEF): results from the Erectile Dysfunction Observational Study (EDOS) J Bickford, SE Barton, S Mandalia Chelsea and Westminster Hospital, London, UK Objectives: To assess the nature and effect of stigma on disclosure of genital herpes diagnosis to sexual partners. Methodology: Quantitative data regarding disclosure were collected using a questionnaire survey which included the hospital anxiety and depression scale captured on likert scales. In addition qualitative data were collected on 10% of these subjects using semi-structured interviews. Results: Seventy-one patients responded to the questionnaire and the in clinic response rate was 91%. The point prevalence of moderate to severe anxiety in this sample was 32%. 54% discussed genital herpes with all their sexual partners and 44% did so before first sexual contact. Qualitative interview identified herpes related stigma associated with non-disclosure of diagnosis to sexual partners. Disclosure of diagnosis to sexual partners tended to occur within the context of established relationships. Conclusion: The reaction to a diagnosis of genital herpes and the decision to disclose or not is influenced by cultural understanding of the infection as well the value of the relationship in which the disclosure may occur. Our study demonstrated that stigma is a barrier to disclosure of genital herpes diagnosis. Management strategies aimed at encouraging disclosure to sexual partners must address stigma. 2 P Kell1, J Arellano2, M Noone2, A Riley3, S Kontodimas2 1Archway Sexual Health Clinic, London, 2Eli Lilly, UK, 3University of Central Lancashire, Preston, UK Introduction: EDOS is a pan-European, observational study assessing effectiveness, satisfaction and treatment patterns of ED therapies. Design and method: Patients initiating and changing treatment for ED were recruited. All types of ED treatments were allowed. ED severity was assessed using the IIEF-erectile function (EF) domain score and physician's perception of severity according to the clinical history. Results: In the UK 93 investigators enrolled 1,362 patients. Investigators were GPs (84.4%) but also Urologists (4.4%), Andrologist (2.2%), Sexual therapists (1%) and others (7.8%). The mean age was 57.2 years (range 18-86). 58% (n =782) of men had symptoms of ED between 1 and 5 years. ED aetiology: organic -37%; psychogenic –16%; mixed – 47%. Investigators rating of ED severity: 34% severe, 57% moderate, 8% mild. According to the IIEF-EF domain score*, 42% of men had severe ED, 26% had moderate and 24 % had mild ED. Moderate ED was the commonest categorisation of ED severity when severity was assessed by investigators however within that category patients with both severe and mild ED existed according to the IIEF score. Conclusion: Actual numbers of men with severe ED may be under-reported without the use of tools such as the IIEF questionnaire. *IIEF-EF domain score categories: Normal (26–30), Mild (17–25), Moderate (11–16), Severe (1–10). 11th Oral Abstracts O9 O11 Antiretroviral therapy in a new public sector antiretroviral treatment centre in Ghana: patients' presentation and response Evaluation of nelfinavir-based mother-to-child transmission regimens P Collini1, M Adjei1, K Torpey2, R Amenyah2, D Chadwick3, G Bedu-Addo1 1Komfo Anokye Teaching Hospital HIV/AIDS Clinic, Kumasi, Ghana, 2Family Health International, Accra, Ghana, 3James Cook University Hospital, Middlesbrough, UK Objective: To review presentation of 200 patients and their response after 6 months of antiretroviral therapy (ART) attending the new ARV clinic in Komfo Anokye Teaching Hospital. Methods: Prospective observational study of first 200 ART patients. Results: Family Health International's START program in partnership with the National AIDS Control Program / Ministry of Health and DFID have scaled up the delivery of ART in Ghana. In its first year this clinic enrolled 1738 patients and started over 600 on treatment. All received 2NRTI+1NNRTI except one (2NRTI+1PI). 188 were ART naïve. 128 had a regime containing AZT (M=58), 21 later switched to d4T because of anaemia. 71(M=25) started on d4T. Efavirenz was given to 101(M=71), nevirapine to 95(M=11). No cases of nevirapine induced hepatitis were recorded. 8 were switched from nevirapine to efavirenz on developing tuberculosis. Mean (median) CD4 count increased by 166(158) from 125(123) cells/mm3 and weight increased from 50.7(50) to 58.0(58) Kg. 4 deaths were recorded. 15 patients defaulted follow up by more than 3 months. More than 80% of patients reported greater than 95% adherence on every follow up visit over the period. Further data on this cohort will be presented. Conclusion: Effective and safe ART is achievable when scaling up. S O’Dea1, F Mulcahy1, F Lyons1, H McDermott1, C Bergin1, S Coughlan2 1GUIDE Clinic, St James Hospital, Dublin, 2National Virus Reference Laboratory, University College Dublin, Ireland Background: Sub-therapeutic levels of nelfinavir in pregnancy, at standard dosing, have been reported. This study examines viral response, resistance and outcome in a cohort of women receiving combivir/nelfinavir(standard doses) in pregnancy. Methods: 47 pregnant women with a pre-treatment CD4> 300×106/l were prescribed combivir/nelfinavir in the 3rd trimester. All received at least 6 weeks treatment (range 6–12, mean 11 weeks) and discontinued post-partum. All women returned for genotypic resistance testing after treatment cessation. Results: Viral load at 36 weeks: 26/47[55%] <50cpm; 18/47[38%] >50<1000cpm (mean 154cpm) and 3/47[6%] >1000cpm (mean 2160cpm). Mean pre-treatment VL 3,761cpm in <50 group versus 39,535cpm in >50 group. Adherence issues were identified in 4/26(15%) with 36 week VL<50cpm; 1/18(5.5%) with VL>50<1000cpm and 1/3(33%) with VL> 1000cpm. No drug A/Es were reported. No primary PI resistance mutations were identified after treatment cessation. 1 baby acquired HIV (maternal VL<50cpm, membranes ruptured >24hrs). Conclusion: At standard nelfinavir dosing almost half the cohort failed to achieve virological suppression <50cpm, suggesting that routine TDM should be considered. Despite this, the absence of PI mutations after treatment cessation suggests that short-term nelfinavir use may not be detrimental to future maternal ART options. O10 O12 Targeting points for further intervention: a review of HIV infected infants born in Ireland in the 5 years following introduction of antenatal screening Increased psychosis in HIV-1-infected sub-Saharan African immigrants W Ferguson2, K Butler1,2,3, A Menon3 , M Goode1, L Barrett1, A Walsh1, M Cafferkey2,3 1The Rainbow Clinic, National Centre for HIV Medicine in Children, Our Lady’s Hospital for Sick Children, 3The Children's University Hospital and 2The Rotunda Hospital, Dublin, Ireland Aim: 'Opt-out' AN screening, in Ireland since Jan.'99, has 95%–99% uptake. Vertical transmission rates are <2%. We sought to identify intervention targets to reduce ongoing transmission. Methods: HIV+ pregnant women are referred to the paediatric service. Maternal and infant data are prospectively gathered. Results: From 01/1999–12/2004, 11 infected infants were born. There were 527 HIV+ pregnancies and 2 postnatal diagnoses. 2/11 infants were born to the women diagnosed postnatally (1 pregnancy seroconversion, 1 missed screening). Of the remaining 9, 4/9 women who booked at (36 weeks received ≤3 weeks ART. 5/9 booked <36 weeks; 1 received <1 week ART & delivered at 33 weeks. 4 received >4 weeks ART (3 cART, 1 ZDV); adherence was poor in 1 (delivery VL >10,000 copies/ml), 1 with undetectable VL had 24 hours ROM, in the remaining 2 (1 ZDV monotherapy & delivery viral load <400 copies/ml, 1 cART from 20/40 & delivery VL 53 copies/ml), infant HIV-PCRs were positive ≤5 days suggesting in-utero transmission. All 9 women & infants received IP-ZDV and postnatal ART respectively (6 triple, 3 monotherapy). Conclusion: There remain identifiable targets for intervention (pre-conceptual screening, early booking, repeat tests for at-risk women, adherence support). The problem of early in-utero transmission remains. A Holmes, S O’Dea, A O’Dwyer, F Mulcahy St. James’s Hospital, Dublin, Ireland Background: Psychiatric morbidity in HIV has been well documented in western populations, but not in sub-Saharan African [SSA] immigrants. Aim: To assess psychological morbidity in HIV positive SSAs, and evaluate illness-related variables on presentation. Method: Retrospective review of patient notes. Results: Of a cohort of 324 [229 female, 95 male], 24 patients were referred to the Department of Psychological Medicine. This referral rate is 7.4%, compared to 5.9% [67/1138] in the non-SSA cohort. Diagnosis of depression was associated with increasing HIV disease progression and was made in 12 [50%] of patients, predominantly in females [75%, 18/24]. Psychosis was diagnosed in 5 [25%]; cases occurring within three months of HIV diagnosis. 3 of these patients [60%] had an AIDS defining illness. Anxiety and adjustment disorders accounted for 7 [29%]. Some cases were related to violence/sexual assault that had resulted in HIV acquisition. Organic brain disease accounted for 2 referrals. Conclusion: This study confirms the hypothesis that SSA immigrants are at increased risk of psychological morbidity. The incidence of psychotic illness was notably high. We believe that cultural beliefs and the influence of immigration are important factors in both the rate and type of psychological morbidity. 3 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV O12a O14 Sexual behaviour and risk of ongoing transmission in symptomatic patients attending genitourinary medicine clinics High-risk sexual behaviour among London gay men: no longer increasing? JA Cassell, CH Mercer, L Sutcliffe, MG Brook, E Jungmann, J Ross, G Kinghorn, J Stephenson, A M Johnson on behalf of the PATSI collaboration Centre for Sexual Health and HIV Research, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London, London, UK Background: Delayed access to services and sexual contact while symptomatic may increase STI transmission. Aim: To determine the extent of ongoing sexual contact in symptomatic patients, whether symptoms influence sexual behaviour at this time, and the impact of symptom resolution on health care seeking. Methods: A questionnaire was administered to approximately 8000 patients in 8 sexual health clinics and linked to preliminary clinical data. Results: 38.8% of men and 42.9% of women with acute symptomatic STI continued sexual intercourse after symptoms began, by contrast with 46.3% of men and 61.2% of women with no acute STI. Among symptomatics, 7.7% of men and 0.7% of women had had more than one sexual partner. Symptom duration was (7 days at clinic visit in 64.3% of men and 66.7% of women with an STI, of whom 22. 4% of men, and 42.9% of women had self-treated. 22.4% of men and 36.7% of women with STI would no longer seek care if symptoms resolved. Conclusions: Our data reinforce the need for rapid access to diagnostic and treatment services, for all patients and not just ‘high risk’ groups. Health promotion should emphasize the need for individuals to seek rapid care and cease sexual activity when an STI is suspected. 1City University London, 2Royal Free and University College Medical School London, 3MRC Social and Public Health Sciences Unit, Glasgow, UK Aim: To examine changes in sexual behaviour among London gay men between 1998–2004. Methods: Nearly 5000 gay men using gyms in central London were surveyed annually between 1998-2004 (range 498–834 per year, response rate 50–60%). Information was collected on HIV status and unprotected anal intercourse (UAI) in the previous 3 months. High risk sexual behaviour was defined as UAI with a casual partner of unknown or discordant HIV status. Results: Of the 4934 men, 774 (15.7%) were HIV positive, 3099 (62.8%) were HIV negative, 1061 (21.5%) had never been tested for HIV. Median age was 35 years. Between 1998–2001 the overall percentage of men reporting high risk sexual behaviour with a casual partner increased from 6.7% to 15.2% (P <0.001). Between 2001–2004, however, the percentage of men reporting high risk sexual behaviour with a casual partner remained stable (annual figures, 15.2%, 15.5%, 16.1%, 14.7%, P =0.8). A similar pattern was seen for HIV positive, negative and never-tested men when examined separately. Conclusion: The percentage of London gay men reporting high risk sexual behaviour with a casual partner has remained stable since 2001, although it increased significantly between 1998–2001. Addressing this elevated level of risk will present a challenge for sexual health promotion. O13 O15 Overseas travel, high-risk sexual behaviour and STI transmission risk among British adults: results of a national probability survey of sexual attitudes and lifestyles Risk factors for the acquisition of HIV in individuals known to have recently seroconverted KA Fenton, CH Mercer, AM Johnson, AJ Copas, B Erens, K Wellings Centre for Sexual Health and HIV Research Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London, Mortimer Market Centre, London, UK Aim: To identify factors associated with acquiring new sexual partners while overseas. Methods: National probability survey of 12,110 men and women aged 16–44 years, resident in Britain in 2000. Sociodemographic, health-related, travel, sexual behaviour and attitudinal data collected by computer-assisted-self-interviewing. Results: 14.7% of men and 7.8% of women reported new sexual partner(s) while abroad in the past 5 years. The mean (standard deviation) number of new partnerships while abroad in this period was significantly greater for men: 3.7 (12.8), than women: 2.0 (4.8). 49.5% of new partners originated from the UK; 37.2% from other European countries. Mixing was also assortative by country of birth, with partners tending to be from the UK or, if not UK born, their own birth region, than elsewhere. Reporting new partnerships abroad was significantly associated with a range of demographic and risk behaviours including younger age, non-married status, greater partner numbers, paying for sex, same-sex partnerships, and unsafe sex in the past 4 weeks. Conclusion: Although travellers who have sex abroad select partners from their own geographic regions, their higher prevalence of sexual risk behaviours at home and abroad place them at greater risk and in need of targeted sexual health promotion. 4 J Elford, G Bolding, M Davis, L Sherr1, G Hart2 J Fox, M McClure, J Weber, H Ward, S Fidler Department of Medicine, Imperial College, London, UK Background: People who have recently acquired HIV could play a key role in onward transmission if they have unprotected sexual intercourse (UPSI) with multiple partners whilst having a high viral load and/or other sexually transmitted infections (STI). Aims: To describe recent sexual behaviour in people who have recently acquired HIV. Methods: Cross sectional survey, 2002–4. Incident HIV was defined as an evolving HIV antibody response, HIV PCR-DNA positive/ antibody negative, and/or HIV antibody positive with a negative test within 6 months. A detailed sexual behaviour questionnaire was completed at diagnosis. Results: Five women and 50 men were recruited. Two of the women reported casual sex in the previous 3 months, neither used condoms consistently. 49 men were MSM; 19 reported sex for money; and 17 had UPSI with >10 casual partners in the preceding 3 months. Condom use was inconsistent in 91% receptive and 93% insertive anal intercourse with casual partners. High levels of recreational drug use occurred. 2/55 viruses appeared phylogenetically related, (i.e. not a sexual network). 14 had a concomitant STI at seroconversion. Discussion: High-risk sexual activity is highly linked to those diagnosed with incident HIV. Without immediate behaviour change onward transmission in such individuals is likely. 11th Oral Abstracts O16 O18 A prospective study of post-exposure prophylaxis (PEP) following non-occupational exposure to HIV in the UK The longevity of HIV-specific CD4 T-helper responses and clinical outcome following short course antiretroviral therapy in primary HIV infection JE Blackham1, V Delpech1, P Benn2, BG Evans1 on behalf of the NONOPEP project collaborative group. 1HIV and Sexually Transmitted Infections Department, Health Protection Agency Centre for Infections, London, UK, 2Department of Genitourinary Medicine, Mortimer Market Centre, Camden PCT, London, UK Aim: To describe recent trends in PEP use for non-occupational exposures to HIV (NONOPEP), across 10 UK GUM/HIV clinics. Methods: Individuals attending 10 GUM/HIV clinics receiving NONOPEP between 11/2002 and 11/2004 were prospectively recruited. Demographic, behavioural and clinical data were collected at baseline, 4–6 weeks, 3 and 6 months. Results: 212 individuals have been recruited: 89% male, 74% men who have sex with men (MSM), 79% of white ethnicity, average age 32 years (range 18-64). 91% received PEP following high-risk sexual exposures, 22% with regular partners. 42/156 (27%) MSM and 13/22 (60%) women receiving PEP reported unprotected intercourse (anal/vaginal respectively) with an HIV positive partner. All cases received PEP in accordance with BASHH guidelines. Follow-up rates to date are low: 4–6 weeks (57%); 3 months (35%); 6 months (28%). Of the 128 followed-up: 86% completed the 4-week PEP course, 75% adhered fully and 56% experienced mild-moderate side effects. During the study period numbers prescribed NONOPEP increased by 98% (range 60%–1400%); with the greatest increase occurring in London (172%) in the later part of 2004. Conclusions: The demand for NONOPEP is increasing, particularly in London and among MSM. The reasons for low follow-up rates are unclear and need to be addressed. J Fox, T Scriba, A Oxenius, R Phillips, M McClure, K Porter, J Weber, S Fidler Department of Medicine, Imperial College, London, UK Background: Antiretroviral treatment at HIV seroconversion has been associated with the preservation of HIV-specific CD4+ T-cell responses ordinarily lost without intervention. The longevity and clinical relevance of this is unknown. Aims: To compare the immunological outcome of receiving short course ART (SCART) at Primary HIV (PHI) with rate of decline in CD4 count and this with a natural history cohort (CASCADE). Methods: Seroconversion was identified by an evolving HIV antibody response, HIV PCR-DNA positive/ antibody negative or HIV antibody positive with negative test within 6 months. Patients were offered SCART and followed monthly. HIV-specific CD4 T-cell frequencies were determined by interferon-γ ELISPOT analysis. Results: Of 105 subjects followed prospectively for 3 years, 90 chose SCART at PHI. Longitudinal data on 16/105 subjects over 4 years, showed 7/14 receiving SCART had maintained HIV-specific CD4+ T-helper responses compared to 1/2 who did not receive SCART. All were CCR5 delta 32 negative. There was no relationship between T-helper responses, CD4 count, and pVL. We report a more rapid decline in CD4 count compared with CASCADE. Discussion: Despite the preservation of HIV-specific CD4 T-helper responses in 50% of treated seroconverters no correlation with CD4 count or clinical progression was observed. O17 O19 Trends in transmitted genotypic antiretroviral resistance in primary versus longstanding HIV infection Late diagnosis and consequent short-term mortality of individuals sexually infected with HIV: England and Wales, 2002 D Pao1, K Aderogba1, G Dean1, P Cane2, E Smit3, D Pillay4 and M Fisher1 1Dept of GU Medicine, Brighton and Sussex University Hospitals, UK, 2Health Protection Agency, Porton Down, UK, 3Health Protection Agency, Birmingham, UK, 4Health Protection Agency, Colindale, UK Background: It is well recognised that a significant minority of individuals with primary HIV infection (PHI) harbour transmitted antiretroviral resistance (TAR). Whilst most clinicians perform resistance testing in individuals diagnosed with PHI, only 6% diagnosed with non-PHI were tested pre-treatment in the 2002/3 BHIVA audit, despite guidelines to the contrary. Objectives: To compare trends in prevalence of genotypic TAR among individuals diagnosed at PHI and non-PHI. Methods: Analysis of TAR (including only major, significant mutations) in 450 treatment-naïve individuals, classified as PHI or non-PHI by year of diagnosis, from 2000–2004. Results: Genotype results were available in 147/149 (99%) and 127/301 (42%) of the PHI and non-PHI group respectively. To account for possible testing bias in non-PHI, re-analysis assuming no resistance in those untested (58%) is shown(1). 2000 2001 2002 2003 2004 PHI 17% 21% 12% 15% 7% Non-PHI (max) 14% 17% 9% 8% 15% Non-PHI (min)(1) 12% 4% 3% 5% 10% Conclusion: TAR remains of significant clinical importance despite high levels of effective viral suppression. We demonstrate that rates remain stable and furthermore are comparable in individuals diagnosed at non-PHI as well as PHI. All new HIV diagnoses should have baseline resistance testing performed irrespective of time since infection. TR Chadborn, VC Delpech, K Sinka, BD Rice, BG Evans HIV/STI Department, Health Protection Agency's Centre for Infections, London, UK Aims: To determine factors associated with late diagnosis of individuals, sexually infected with HIV, and the impact this had on short-term mortality. Methods: Analysis of national HIV/AIDS case reports of new diagnoses linked to CD4 cell counts from the CD4 Surveillance Scheme. Outcomes were late diagnosis (CD4 <200 cells / mm3) and short-term mortality (death within a year of diagnosis). Results: 38% of 3,596 individuals sexually infected with HIV (with CD4 counts at diagnosis) were diagnosed late. Late diagnosis affected 26% of homosexual men, 49% of heterosexual men and 40% of heterosexual women (22% where diagnosis was antenatal). Late diagnosis increased with age. Black Africans were diagnosed later than white individuals (although not evident after stratifying by other factors). There were 137 (2.6% of 5,200) deaths within a year of HIV diagnosis. Short-term mortality was 6.2% for individuals diagnosed late and 0.5% for others (excluding pregnant women for whom it was 0.4% overall). Early diagnosis could have markedly reduced short-term mortality and all mortality in 2002. Conclusions: Continued late diagnosis, particularly of older and heterosexual individuals, means missed opportunities to start therapy early and to prevent further transmission, and an approximate 10 times higher risk of death within a year of diagnosis.s 5 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV O20 O22 Therapeutic vaccination with HIV-1 whole killed vaccine is associated with immune modulation in HAART-naïve, asymptomatic HIV-infected individuals Discordant CD4 and viral load responses in patients starting HAART in the UK Collaborative HIV Cohort (CHIC) Study A Gori1, D Trabattoni1, G Rizzardini2, R Maserati3, F Mazzotta4, G Theofan5, DH Bray6, M Clerici1, G Marchetti 1University Milano, Milano, Italy, 2H di Circolo, Busto Arsizio, Italy, 3H S Matteo, Pavia, Italy, 4H SS Annunziata, Firenze, Italy, 5The Immune Response Corp, Carlsbad, CA, United States, 6MRC, London, UK Background: Use of agents increasing natural immune response to HIV to delay initiation of antiretroviral therapy is being considered. Immunogenicity of REMUNE®, a gp120-depleted, whole-killed HIV-1 vaccine consisting of HIV antigen in Incomplete Freund's Adjuvant (IFA), was assessed in antiretroviral-naive HIV-1 infected subjects. Methods: HAART-naïve asymptomatic subjects with HIV-1 RNA 10,000-40,000 copies/mL and CD4 400-800 cells/ul received three injections of REMUNE® (N=19) IFA (n=11), or saline (n=10) at weeks 0, 12, and 24. Results: Median absolute CD4 counts remained stable through week 28 in REMUNE(r) patients (baseline=534 cells/ul; week 28=560 cells/ul) but declined in both saline (baseline=497 cells/ul; week 28=388 cells/ul) and IFA (baseline=549 cells/ul; week 28=431 cells/ul) treated subjects. Possible effect of REMUNE® on thymopoiesis was evidenced by increases in naïve (CCR7+/RA+), central memory (CCR7+/RA-) CD4 T cells, serum IL-7 and decrease in effector memory (CCR7-/RA-) CD4 T cells in the REMUNE® group. These changes were not observed in saline or IFA subjects. HIV specific CD8+ IL10-producing T cells (ICC) were diminished at week 28 in REMUNE® patients. Conclusions: Immunotherapy with REMUNE® may be associated with changes in circulating lymphocytes phenotype and reduction of type 2 cytokines. Data from larger cohorts of patients is required to assess clinical significance. A Rider1, RJC Gilson1, A Copas1 and CA Sabin2, on behalf of the UK CHIC Steering Committee 1Centre for Sexual Health and HIV Research, 2Department of Primary Care and Population Sciences, Royal Free and University College Medical School , University College London, London, UK Objectives: To examine the impact on survival and disease progression of a discordant CD4:viral load (VL) response at 8 and 12 months after starting HAART in the UK CHIC Study. Methods: Patients with VL<50 copies/ml at 8m and 12m were divided into those with a rise in CD4 from baseline of <100 (discordant response) or >100cells/mm3 (non-discordant response). Incidence rate ratios (IRR) for the effect of a discordant response on mortality and AIDS were calculated using multiple Poisson regression. Results: 6120 ART-naïve patients started HAART of whom 1205 had baseline and follow-up CD4/VL data and VL<50 at 8m, and 1089 at 12m, of whom 494 (41%) and 351 (32%) had discordant responses respectively. Discordant responses were associated with an increased risk of death at 8m (6 deaths in the discordant group, 4 in the non-discordant; IRR=2.23; 95% CI [0.63,7.89]) and 12m (7 vs. 4; IRR=3.94 [1.15,13.46]), but a discordant response had little effect on the incidence of AIDS (312 and 282 events from 8m and 12m respectively). Discussion: Many patients have sub-optimal increases in CD4 count after starting HAART. Discordant responses at 12 and possibly 8 months may be associated with poorer outcome, although few deaths were reported in this cohort study. O21 O23 Discordant responses to HAART in ARV-naïve HIV infected individuals The effect of year of treatment and NA backbone on durability of NNRTI-based regimens MY Tung, AK Sullivan, S Mandalia, MR Nelson, BG Gazzard St Stephen's Centre, Chelsea and Westminster Hospital, London, UK Aim: Evaluate virological and immunological responses to HAART. Methods: 12 month treatment outcome was defined as successful (TS=VLBLD+>50CD4 cell rise), discordant immunological response(DIR=VLBLD+<50CD4 cell rise), discordant virological response(DVR=+VL+ >50CD4 cell rise) and failing (TF=+VL+<50CD4 cell rise). 24 month data and disease progression were obtained. Results: NT Annan, S Mandalia, M Bower, M Nelson, B Gazzard Chelsea and Westminster Hospital, London, UK Introduction: Several cohort studies have suggested increased potency of efavirenz when compared with nevirapine but the 2NN study failed to show this difference. Two possible confounding factors are year of treatment and NA backbone. We evaluate the effect of these factors on NNRTI based regimen success in a large prospectively collected cohort. Methods: ART naïve individuals starting NNRTI with dual NA backbone were identified between 1/1/1998–1/7/2004. Treatment failure was defined as switch/discontinuation of NNRTI or documented virological failure (2× VL>500 copies/ml). Results: 994 patients were identified, 72.7% efavirenz and 27.3% nevirapine. There were no significant differences in gender, age, baseline VL or CD4 count. In univariate analysis, efavirenz was associated with significantly greater virological success (p <0.001). Multivariate analysis showed DDI/TFV(HR6.57, 95%CI 3.88–11.13) and DDI/D4T (HR1.49, 95%CI 1.00–2.22) to be significant independent predictors of failure. Univariate analyses showed the likelihood of success to be almost two fold increase per year (HR1.96, 95%CI 1.81–2.13) since 1998. When controlling for NA backbone and stratifying by year of therapy, there was no significant difference between treatment with nevirapine or efavirenz. Conclusion: We have shown in a large NNRTI-experienced cohort, that although in univariate analysis efavirenz appears to have a higher success rate, this is explained by differences in backbone and year. This may explain differences between reported cohort studies and the 2NN study. Number(%) Baseline CD4(cells/µL) VL(copies/ml) Rate of CD4 decline preHAART (cells/mL/month[95%CI]) 24 month outcome N(%) Disease Progression(%) All 1141 175 71,138 TS 757(66.4) 157 88,792 9.7 [9.1–10.3] DIR 186(16.3) 264 29,791 4.8 [3.7–6.0] DVR 98(8.6) 151 101,818 9.5 [7.9–11.0] TF 100(8.8) 225 67,091 4.7 [3.3–6.2] 755 6.3 548(72.6)* 4.6* 85(11.3) 8.9* 65(8.6) 4.2 57(7.5) 9.4 P= <0.001 <0.001 <0.001 *<0.05 *0.02 Conclusions: 24.9% experience DR at 12 months, affected by age, CD4 count, VL and rate of CD4 decline. DIR and DVR have a good treatment outcome at 24 months. <50 CD4 rise is more predictive of DP than a positive VL. 6 11th Oral Abstracts O24 O25 Therapeutic drug monitoring (TDM) of efavirenz (EFV): a tool to predict virologic outcome in HIV-patients on first line once daily (OD) antiretroviral (ARV) therapy? Evidence for sexual transmission of HCV in recent epidemic in HIV-infected men in South-East England D Maitland1, M Boffito1, S Mandalia1, S Gibbons2, D Back2, M Nelson1, B Gazzard1, G Moyle1 1Chelsea and Westminster Hospital, London, 2University of Liverpool, UK Aim: To investigate the usefulness of TDM of EFV in ARV-naïve patients starting an OD regimen containing ddI/EFV and tenofovir (TDF) or 3TC. Methods: EFV TDM was performed prospectively following ARV initiation with blood samples collected at weeks 4 and 12. Concentrations of EFV were determined by HPLC in plasma, samples collected 10–15h post-evening-EFV dose. For samples >15h, concentrations were back extrapolated to 12h by linear regression. Results: Samples from 66 patients (9 females, median age 37years, baseline median CD4+ and mean viral load 174cells/mm3 and 5.01log10-copies/ml) were analysed (n =132). Median EFV-[C] were 1569 (range 354-11611) and 1705 (466-13351)ng/ml week 4 and 12. Among responders, 17 had at least one EFV-[C] lower than the suggested effective-[C] (MEC) of 1000ng/ml. Of the 5 non-responders, 3 had EFV-[C]<1000ng/ml (despite 100% adherence assessed by MEMSCAPS). Coefficient of variation in EFV-[C] was 90% at week 4 and 12. Subjects with higher (>1100ng/ml) EFV-[C] at week 4 and 12 were more likely to show virologic response (<50 copies/ml) at week 12 (p <0.001, ROC method). Conclusion: Our prospective analysis confirms the association between EFV-[C] and virologic response but with wide variability in EFV-[C], suggesting a role for EFV TDM in naïve patients. M Danta1, D Brown1, O Pybus6, M Nelson4, M Fisher5, C Sabin3, S Bhagani2 for the HIV and Acute HCV (HAAC) group. 1Centre for Hepatology, 2Dept of HIV Medicine, 3Dept of Primary Care and Population Sciences, Royal Free and University College Medical School, 4Dept of HIV Medicine, Chelsea and Westminster Hospitals, London, 5Dept of HIV Medicine, Brighton and Sussex University Hospitals Trust, Brighton, 6Dept of Zoology, Oxford University, Oxford, UK Aims: To characterise the mode of acute HCV transmission in HIV-infected individuals using linked molecular and clinical epidemiological analysis. Methods: Patients enrolled had a seroconversion to anti-HCV + and positive HCV PCR within 9 months. The E1/E2 region of the HCV genome from each patient's serum was amplified with RT-PCR and sequenced. Using PAUP* software, a phylogenetic tree was constructed from the amplified sequences, comparing them with unrelated E1/E2 sequences. A case-control study using a questionnaire instrument to determine transmission factors was performed using HIV mono-infected controls from each clinic's database, matching for age, length of HIV infection and HAART. Results: 90 HIV-positive homosexual males (mean age 36 yrs) with acute HCV have been identified. Phylogenetic analysis of 55 E1/E2 sequences reveals multiple monophyletic clades signifying that several independent HCV lineages (clades) are co-circulating in this population. The largest clade involves 21 patients. Preliminary factors identified more commonly in cases (n =23) vs controls (n=48) are: unprotected receptive and insertive anal intercourse (P <0.001), mucosally traumatic practices including fisting (P <0.001) and use of sex toys (P<0.001), group sex (87% Vs 52.3%, P=0.01), and sexual activity while feeling the effects of drugs (100% Vs 64%, P<0.003). Conclusions: Mucosally traumatic sexual factors are significantly associated with the recent transmission of HCV. O24a O26 Predictors of current CD4+ T-cell response among patients receiving subcutaneous recombinant interleukin-2 (RIL-2) in ESPRIT (evaluation of subcutaneous Proleukin(r) in a randomized international trial) Is the treatment of acute hepatitis C in HIV-positive individuals effective? H Nuwagaba-Biribonwoha1, BJ Angus1,2, J Bebchuk3, A Babiker1, B Cordwell1, F van Hooff1, L Hack1, Y Moraes1, B Gazzard4, J Darbyshire1 on behalf of the ESPRIT Research Group 1Medical Research Council Clinical Trials Unit, London, UK, 2Nuffield Department of Medicine, Oxford University, Oxford, UK, 3Division of Biostatistics/CCBR, School of Public Health, University of Minnesota, Minneapolis, USA, 4Chelsea and Westminster Hospital, London, UK Aim: To examine predictors of current CD4+ response in patients on the rIL-2 arm of ESPRIT. Background: ESPRIT is an international, phase III, open-label, randomized trial comparing the effects of subcutaneous rIL-2 and no rIL-2 on disease progression and death in HIV-1 patients with absolute CD4+ counts ≥300/µl at baseline who are taking combination antiretroviral therapy (ART). Methods: Baseline and rIL-2 cycling characteristics of patients randomized to rIL-2 were analysed. Logistic regression determined the independent predictors of CD4+ increase >200/µl above baseline at 35 median months of follow-up. Results: Analysis was based on 1,977/1,998 (99%) of patients receiving rIL-2. At their most recent follow-up examination, 876 (44%) had CD4+ increase >200/µl while 1,101 (56%) had CD4+ increase ≤200/µl from a median baseline CD4+ of 470/µl and 460/µl respectively. More patients with CD4+ increase >200/µl had baseline viral load <50 copies/ml (83% versus 77%; OR=1.8, 95%CI 1.4–2.3, p <0.001); and had completed (4 cycles of rIL-2 (67% versus 48%; OR=2.2, 95%CI 1.8–2.7, p<0.001). Age, duration of ART, nadir CD4+, baseline CD4+, gender, and stage of HIV disease at baseline were not significantly associated with CD4+ increase >200/µl above baseline. The results were similar for the UK subset of patients. Conclusion: More rIL-2 cycles and undetectable viral load at baseline were associated with a better CD4+ response. RE Browne, YC Gilleece, D Asboe, M Atkins, S Mandalia, M Bower, BG Gazzard and MR Nelson St Stephen’s Centre, Chelsea and Westminster Hospital, London, UK Objective: To evaluate the effectiveness of treatment of acute hepatitis C infection in HIV-1 positive individuals. Design: Open label, prospective study. Methods: Patients diagnosed with acute hepatitis C by positive HCV antibody test had sequential HCV RNA levels measured at 0, 4, 12, 24, 32 and 48 weeks. If HCV RNA positive at 12 weeks patients were offered pegylated interferon alpha-2b 1.5µg/Kg/week + weight adjusted ribavirin for 24 weeks. Patients with increasing HCV RNA VL were offered treatment earlier. Results: 50 male homosexuals, mean age 37yrs, were identified: 44 via newly abnormal LFT’s, 4 from sexual contact with HCV positive partner and 2 at HIV seroconversion. 12 individuals became HCV RNA -ve spontaneously. This was significantly associated with a high baseline median CD4+ lymphocyte count (P =0.029), CD4+ lymphocyte count >500 (P =0.017) and lower HCV RNA VL (P =0.017). 27 patients accepted treatment, 16 (59%) of whom had a sustained virological response (SVR). This was associated with a higher peak mean ALT (P <0.001) but not with genotype. Conclusions: SVR rates in HIV positive patients treated acutely for hepatitis C are lower than in HIV negative subjects. A high percentage of individuals seroconvert spontaneously. 7 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV 8 O27 O29 Does nadir CD4 count in HIV-HCV co-infected patients predict HCV treatment response to pegylated interferon (p-IFN) and ribavirin (RBV)? Inhibition of hepatitis B virus replication by small interfering RNA expressed from viral vectors J Turner1, S Hopkins2, T Mahungu2, R Johnstone1, RM Lascar1,3, S Bhagani2, G Dusheiko, MA Johnson2, I Williams1,3, RJC Gilson1,3 1Centre for Sexual Health and HIV Research, Royal Free and University College Medical School, 2Department of HIV Medicine, Royal Free Hospital, 3Camden PCT, Mortimer Market Centre, London, UK, Centre for Hepatology, Royal Free Hospital, London, UK Introduction: Response rates of 26–46% have been reported to p-IFN and RBV in HIV-HCV in published studies. None of these studies have investigated the role of nadir CD4 count in predicting response. Aim: to evaluate treatment outcomes and predictors of response, particularly nadir CD4 counts Methods: All HIV-HCV patients (n=59) who commenced treatment for chronic HCV at two centres were included in this analysis. Baseline demographics, HCV and HIV related factors were collated. Data was entered and analysed on SPSSv10.0. Results: Patients were predominantly male (86%), Caucasian (87%), and on antiretrovirals (ARV) (69%). 32% were IVDU and 39% were MSM. 44% were genotype 2/3. Median age was 40yrs, baseline CD4 count was 468x106/l and nadir CD4 count was 220×106/l. Median baseline HCV-VL was 1.5X106IU/l. 56% had an end-of-treatmentresponse (Genotype (G) 1/4:33% & G2/3:86%) and 42% had a SVR (G1/4:24%&G2/3:65%). Predictors of response were nadir CD4 count (P =0.04) and genotype(P=0.008). No other factors predicted response including age, sex, type of p-IFN (2A/2B) or duration of HCV therapy. 19% discontinued therapy. Conclusion: This analysis demonstrates SVRs comparable to controlled studies in HIV-HCV co-infected patients. In addition to genotype, nadir CD4 predicted response to HCV therapy. This merits investigation in larger datasets. 1Jefferiss Trust Laboratories, Wright-Fleming Institute, Imperial College O28 O30 Hepatitis C infection is not associated with systemic HIV-associated non-Hodgkin's lymphoma: a cohort study Is there a relationship between Familial Mediterranean Fever (FMF) host polymorphisms and paradoxical reactions (PR) in tuberculosis (TB)? L Waters, J Stebbing, S Mandalia, AM Young, M Nelson, BG Gazzard, M Bower Departments of HIV Medicine and Oncology, The Chelsea and Westminster Hospital, London, UK Aim: HIV-associated immunosuppression increases the risk of non-Hodgkin’s lymphoma (NHL). The hepatitis C virus (HCV) has been implicated in the development of B cell lymphomas, and HCV is common in HIV-infected individuals, we compared the incidence of systemic NHL during HIV infection compared with HIV and HCV co-infection. Methods: Data were extracted from a prospectively collected database for all patients entering our cohort in the HAART era. To compare lymphoma risk in HIV mono-infected and co-infected individuals, person years at risk (PYAR) was estimated from cohort entry to i) end of study period, ii) NHL development, iii) last recorded visit or iv) date of death. Data were analysed using the Genmod with loge link and Poisson error distributions; all P values are two-sided. All NHL cases were biopsy-proven and primary CNS lymphomas were excluded. Results: Out of 5,832 individuals studied during the era of highly active anti-retroviral therapy (HAART), 102 patients were diagnosed with systemic NHL. The incidence of systemic NHL was 6.9/104 patient years in co-infected individuals compared with 7.1/104 patient years if HIV mono-infected (P =0.9). Conclusion: In this immunocompromised patient population, there was no association between HCV infection and an increased risk of lymphoma. A Dunleavy1, RAM Breen1, A Bybee2, S Hopkins1, PN Hawkins2, M Lipman1 1Royal Free Hospital, London, 2The National Amyloid Centre, Royal Free Hospital, London, UK Aims: The inflammatory condition FMF is associated with polymorphisms in the human pyrin gene. Its expression is upregulated by cytokines similar to those implicated in TB related PR. We sought to ascertain if patients with these polymorphisms are at an increased risk of PR compared to HIV + subjects (known risk factor for PR). Methods: MEFV exon 2 restriction length polymorphism for Q148 was analysed in blood from subjects with active TB enrolled in a prospective study of PR. Analysis was performed using SPSS 10.0. Results: 42 subjects were assessed – 17 (41%) HIV+. (24%) experienced PR. 9/42 (21%) expressed the Q148 mutation of which 4/10 (40%) had PR. 5/32 (16%) without PR were Q148 mutation+ (P =0.18). PR occurred in 5/17 (29%) HIV= and 5/25 (20%) HIV-subjects (P=0.71). The odds ratio (OR) for developing PR with Q148 was 3.6 (95%CI 0.40-7.0;P =0.48). Conclusion: In our cohort PR appeared to be more strongly associated with Q148 polymorphisms than HIV status. This requires confirmation in a larger study. M McClure1, MD Moore1, MJ McGarvey2, RA Russell1, BR Cullen3 London, UK, 2Hepatology, QEQM, Imperial College London, UK, 3Howard Hughes Medical Institute and Department of Molecular Genetics and Microbiology, Duke University Medical Centre, Durham, USA Aim: To investigate the potential of RNA interference (RNAi) for the treatment of Hepatitis B virus (HBV) infection. Methods: An RNAi sequence active against the HBV surface antigen (HBsAg) was expressed from a polymerase III expression cassette. Therapeutic use of RNAi demands a suitable delivery system. Hence, the expression cassette was inserted into two vector systems, one based on the Prototype Foamy Virus (PFV), the other, Adeno-Associated Virus (AAV). Both are non-pathogenic and capable of integration into cellular DNA. The vectors containing the HBV targeted RNAi molecule were introduced into a cell line stably expressing HBsAg (293T.HBs) and one which secreted infectious HBV virions (HepG2.2.15). Results: We identified an RNAi sequence active against HBsAg. Further, we demonstrated knockdown of HBsAg by approximately 90%, compared with controls in 293T.HBs cells transduced by shRNA-encoding PFV and AAV vectors. This reduction has been observed up to 5 months post-transduction in single cell clones. Both vectors successfully inhibited HBsAg expression from HepG2.2.15 cells, even in the presence of HBV replication. Conclusions: This work is the first to demonstrate that delivery of RNAi by viral vectors has therapeutic potential for chronic HBV infection and establishes the ground work for the use of such vectors in vivo. 11th Oral Abstracts O31 O33 Identifying the key beliefs influencing uptake and adherence to HAART: final results of a 12-month prospective, follow-up study Switching from a thymidine analogue to tenofovir (TDF) achieves similar resolution of lipoatrophy and better reduction in lipids than switching to abacavir (ABC). Results of the RAVE study, a UK multi-centre open-label randomised controlled trial R Horne, V Cooper, G Gellaitry, M Fisher Centre for Health Care Research, University of Brighton and Royal Sussex County Hospital, Brighton, UK Objective: To examine the utility of a necessity-concerns framework in explaining uptake and adherence to HAART. Methods: Patients attending Brighton clinics from 2000–2003 who were not taking HAART were referred to this study by their HIV doctor. Of 322 patients recruited, 153 were recommended HAART. Validated questionnaires investigating beliefs about personal necessity of HAART and concerns about adverse effects were completed following a treatment offer. Those who subsequently accepted HAART (n =120) were followed up after 1, 3, 6 and 12 months of treatment. Results: Necessity (odds ratio (OR), 6.7; 95% Confidence Interval (CI), 2.5–18.0) and concerns (OR, 0.12; 95% CI, 0.03- 0.42) predicted uptake independently of clinical variables. Adherence was initially high but tailed off significantly by six months (P <0.001), and low adherence was predicted by changes in beliefs about HAART over time. Further analyses revealed how patients' perceptions of need and concerns about HAART derived from their interpretation of symptoms and personal beliefs about HIV that may conflict with the medical view. Conclusion: This study has identified the key factors influencing patients’ decisions about HAART and can inform the design of evidence-based interventions to facilitate informed patient choice in relation to HAART, with implications for clinical care. JD Cartledge, G Moyle, C Sabin, M Johnson, E Wilkins, D Churchill, P Hay, A Fakoya, M Murphy, G Scullard, C Leen, G Reilly (RAVE study group) Mortimer Market Centre, London, UK Methods: 105 HIV+ adults with moderate/severe lipoatrophy and HIVRNA <50 on HAART containing d4T (n =71) or AZT (n=34) were randomised to switch the thymidine analogue to open label ABC 300mg bd (n =52) or TDF 300mg od(n =53). Patients had to have no documented resistance to ABC or TDF and/or no treatment history suggestive of such resistance. Analyses were performed on an intentto-treat basis ignoring treatment changes Results: Limb fat by DEXA was similar for the two groups at baseline. Comparisons of results at baseline and at 48 weeks are given below. Limb fat increased significantly in both groups (P <0.01) but with no difference between the groups (P=0.36). CT scan showed reductions in visceral fat and increases in subcutaneous fat that were similar for both groups (P =0.32 & P=0.78 respectively). Viral load suppression was similarly maintained by ABC and TDF(P =0.16). Ten patients discontinued study drug, 1 on TDF, 9 on ABC (3 with hypersensitivity reactions). Changes in cholesterol and LDL significantly favoured TDF (P =0.01 & 0.05 respectively). A pre-planned subanalysis of response according to thymidine analogue will be presented. Conclusions: Switching from a thymidine analogue to tenofovir achieves similar resolution of lipoatrophy, better reduction in lipids, and fewer treatment discontinuations than switching to abacavir. O32 O34 Stopping combination therapy whilst travelling: is there a reason for great concern? 3-dimensional surface laser scanning and psychological assessment: objective evidence for the use of polylactic acid implants in HIV-associated facial lipoatrophy MA Schuhwerk1, J Richens2, M Prestage1, K Jones1, N De Esteban1, RH Behrens3 1Mortimer Market Centre, Camden Primary Care Trust, 2Centre for Sexual Health, University College Hospital, 3Hospital for Tropical Diseases, University College Hospital, London, UK Aim: To investigate whether stopping HAART during travelling is of concern. Methods: Questionnaire based survey of HIV positive individuals attending the HIV outpatient clinic detailing history of travel. Results: 12% (26/216) of individuals had stopped HAART whilst travelling. 35% had a CD4 count of 200 or less. The regular HIV physician was informed in 46% and only 30% had HIV inclusive travel insurance. At the time of stopping 19 % were on a triple nucleoside, 44% a PI and 38% an NNRTI regimen. Individuals were twice more likely to stop a PI regimen than an NNRTI regimen, 15% versus 7%. 65% had prior drug resistance. 50% reported ‘entering a country with HIV restrictions’ as the main reason for stopping, 39 % ‘fear of being found out’ and 23 % side-effects from tablets. Stopping had a clear relationship to ethnic background: white 11%, Black 30%, Asian 0%. 31 % had to end their journey prematurely (versus 7 % who continued HAART), 50% had to see a doctor abroad (versus 18 %) and 62% needed to see a doctor on return (versus 27%). Conclusion: A significant proportion stop HAART at low CD4 counts and are at greatly increased risk of developing medical problems. Development of drug resistance is a real concern. J Ong, A Clarke, M Johnson, S Withey, P Butler Departments of Plastic and Reconstructive Surgery, Clinical Psychology and Infectious and HIV Medicine, The Royal Free Hospital Hampstead NHS Trust, London, UK HIV-associated lipoatrophy is a physical condition which is associated with significant psychosocial morbidity. This study shows aesthetic and psychological improvement with facial injections of Polylactic acid (PLA) (NewFill(R)). Methods: 50 patients with HIV-associated facial lipoatrophy had PLA implants into their cheeks. All patients were assessed with 3 dimensional (3D) facial laser scanning, psychological questionnaires (Derriford Appearance scale, HADS, Rosenberg self esteem scale) and clinical photography and examination prior to treatment. All patients received 4 or 5 sets of treatment. The first 30 patients had 3D scans and clinical photographs before each treatment. All assessment measures were repeated every 6 months until 1 year after treatment. Results: Pre-treatment 3D laser scans were used as baseline (0mm). Mean surface projection improvements were 0.8mm after 1 treatment, 1.4mm after 2 treatments, 1.8mm after 3 treatments, 2.3mm after 4 treatments and 2.6mm after 5 treatments. Post treatments scans at 6 months (2.8mm) and 12 months (2.8mm) showed persisting changes. There were significant improvements in all Psychological and clinical measures. Conclusion: PLA implants improve the physical changes of HIV-associated facial lipodystrophy. Physical and psychological measures show objective improvements with treatment which persist for a year following treatment. 9 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV 10 O35 O37 What is the cost of switching an anti-retroviral therapy (ART) from an HIV-centre perspective? Enhanced surveillance for lymphogranuloma venereum (LGV) in England T Toward1,M Fisher2,G Scullard3,C De Souza3, P Hay4, A Adebiyi4, F Pang1 1HE&OR, Medical Division, Abbott Laboratories, UK, 2Brighton & Sussex University Hospitals, Brighton, 3St Mary's Hospital, London UK, 4St Georges' Hospital, London, UK Aim: To estimate costs associated with switching an ART for reasons of Virological-Failure or Modification (non Virological-Failure: i.e. toxicity, non-adherence) in the UK setting. Methods: Treatment-resource pathways associated with (i) maintaining (VL<50copies/ml), or (ii) switching ART, were developed from surveying staff at three HIV-centres (2 London, 1 outside London). Direct resource costs for HIV-centre medical personnel (e.g. physician, nurse, pharmacist, dietician) and laboratory tests (e.g. viral-load, CD4, biochemistry, genotype, TDM) were included from an NHS perspective. Total costs for each scenario (i and ii) were calculated from valuating the resources consumed using representative NHS unit-costs. The difference between these total costs was the cost of switching ART. Further analyses investigated the impact of centre-specific costing and costs over a one-year period. Costs for overheads, capital, lost ARTs, concomitant treatment/investigations for Virological-Failure- or Modification-related adverse events (e.g. diarrhoea, rash) were excluded. Results: The mean (lower-upper range) costs across 3 centres of switching ART for Virological-Failure or Modification were £787(£730–£889) or £534(£367–£618), respectively. Conclusion: This is the first study to estimate the cost of switching ART in the UK, a frequently overlooked element in costing HAART strategies. This resource utilisation model provides a methodological framework for HIV units to determine the cost impact of switching patients. CA Ison, N Macdonald, IMC Martin, S Alexander, KA Fenton, C Lowndes, H Ward on behalf of the LGV Incident Team Health Protection Agency Centre for Infections, London, UK Aim: To raise awareness and improve the diagnosis and surveillance of LGV in England. Methods: In October 2004 the Health Protection Agency (HPA) launched an enhanced surveillance alert following outbreaks of LGV among men who have sex with men (MSM) presenting with proctitis in western Europe. Case definition is confirmation of C. trachomatis by RT PCR in a rectal or urethral specimen and presence of an LGV serovar, L1, L2 or L3 by genotyping. Clinicians provide additional clinical and behavioural data on confirmed cases. Results: By end Jan 2005, 29 cases of LGV were confirmed: 22 (76%) from London and the remainder from major towns across the UK. Epidemiological data for 19 cases confirmed: All 29 are MSM; 17 (89%) HIV positive; 18 reported anorectal symptoms; seven had systemic symptoms; and two inguinal LGV symptoms. Concurrent STIs were reported for 8/19(42%) patients and 4(21%) of whom were hepatitis C antibody positive. Probable country of acquisition was reported for 15 men, five identified mainland European countries, and 10 within the UK. Conclusion: The HPA alert, Terence Higgins Trust publicity campaign, and improved diagnostic tests, have increased community and professional awareness about LGV, case ascertainment, and confirmed in-country transmission of this rare disease. O36 O38 Extent of underdosage of antiretroviral therapy in HIV-infected children An outbreak of lymphogranuloma venereum in London in 2004 EN Menson, AS Walker, T Duong, K Doerholt, C Wells, M Sharland, DM Gibb MRC Clinical Trials Unit, London, UK Aims: To explore the extent of, and contributing factors to, underdosing of antiretroviral therapy (ART) drugs in children with HIV infection in the UK and Ireland. Methods: We evaluated ART doses prescribed to children aged 2–12 years in the Collaborative HIV Paediatric Study (CHIPS) (January 1997–December 2003, to be updated to November 2004). Underdosing was defined relative to current recommended doses (CRD) in 2004 Paediatric European Network for the Treatment of AIDS (PENTA) guidelines in order to evaluate ‘dosage-adequacy’ based on current best evidence. Results: The CHIPS cohort included 78% (757) of diagnosed HIV-1-infected children; 73% had received ART drug(s). Children were underdosed for 40.5% of their time on ART. Most commonly underdosed ART drugs were efavirenz and nelfinavir. Prevalence of underdosing reduced over calendar time, particularly for nelfinavir and nevirapine, concordant with changes in prescription guidelines. Accordingly, newer drugs such as kaletra were underdosed least. Reasons for underdosing included failure to increase doses with growth; limitations of drug formulations; rounding-down calculated doses; and, for certain drugs, dosing using weight-bands or mg/kg for dose calculations, rather than as recommended in prescription guidelines. Conclusions: Largely unwittingly, we have greatly underdosed HIV-infected children on ART over the past 7 years. M Hamill1, C Ison2, C Carder3, P Benn1, E Jungmann1, N MacDonald2, P French1 1Department of Genitourinary Medicine, Mortimer Market Centre/ Archway Sexual Health Centre, Camden PCT, London, 2Sexually Transmitted Bacteria Reference Laboratory, Health Protection Agency, Centre for infections, Colindale, 3Department of Microbiology, University College London Hospitals NHS Trust, London, UK Introduction: Lymphogranuloma venereum (LGV), [Chlamydia trachomatis (CT) – serovars L1–3] is rare in the UK. There has been a recent resurgence of LGV (serovar L2) in Western Europe, with outbreaks in several European cities among homosexual men (MSM); who are predominantly HIV positive and many also co-infected with hepatitis C (HCV). Methods: All CT positive rectal samples identified by culture and polymerase chain reaction (PCR) at UCLH during 2004 were genotyped for presence of an LGV serovar and a clinical notes review was undertaken. Results: 20 CT positive samples were identified. So far, 10/15 samples typed have been identified as LGV (L2). The earliest case of LGV identified is from April 2004. All those with LGV were MSM, 9/10 lived in London, age range 24–47 years, 9/10 were HIV positive, 2/10 co-infected with HCV and 9/10 had symptomatic proctitis. 1/10 had inguinal lymphadenopathy and 1/10 reported constitutional symptoms at diagnosis. Discussion: Up to 18th January 2005 there were 23 confirmed cases of LGV in the UK including 10 from our centre. Retrospective testing has shown its presence in the UK since April 2004. Clinicians should be aware of LGV in the UK population particularly its presentation as proctitis among HIV positive MSM. 11th Oral Abstracts O39 O41 Syphilis outbreak in commercial street sex workers in east London Opa-typing can subdivide NG-MAST sequence types of Neisseria gonorrhoeae into epidemiological relevant groups N Lomax, H Anderson, H Wheeler, B Goh Barts and The London NHS Trust, London, UK Background: An outbreak of infectious syphilis was identified in street commercial sex workers (SCSWs) in Hackney, East London in early 2004. Objective: To describe the epidemiology of the outbreak and measures taken from April–December 2004. Methods: A multidisciplinary team (MDT) based around an existing outreach service provided a targeted service for STI screening and treatment. SCSWs were identified at outreach or during drop-in sessions. Meals were provided as an incentive for attending the GU clinic with outreach workers. Results: Of 24 SCSWs identified, 14 (58%) were found to have positive treponemal serology (4 secondary, 6 early latent and 4 late latent syphilis) Treatment was with either Benzathine penicillin (4), azithromycin (3), doxycycline (2) or azithromycin and doxycycline (4). Coexistent STIs were identified in 10 (42%). 92% used crack or heroin. Discussion and Conclusions: Outbreak management in this population is challenging: an MDT approach is crucial in identifying/treating syphilis to prevent onward transmission. High prevalence of syphilis was detected. Azithromycin was preferred by SCSWs; possible resistance problems were minimised by addition of doxycycline. As contact tracing is difficult, public awareness was heightened through local newspaper articles. Real-time rapid syphilis tests (Abbotts) were introduced to screen at source for SCSWs who decline attending GUM clinics. AK Morris, HM Palmer, H Young Scottish Neisseria gonorrhoeae Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK Aims: To opa-type all ciprofloxacin resistant (MIC≥ 1mg/l) and intermediate resistant (MIC≥ 0.05 <1mg/l) isolates submitted to SNGRL in 2002 that had a non-unique sequence type by NG-MAST. To assess the concordance between opa and NG-MAST sequence types. To determine if epidemiological information supports any subdivision of NG-MAST sequence types resulting from opa-typing. Methods: 74 isolates were opa-typed and the results compared with NG-MAST sequence type and epidemiological data. These 74 isolates were selected on the basis of NG-MAST sequence typing of 106 isolates with reduced susceptibility to ciprofloxacin (89 resistant and 17 intermediate resistant) submitted to SNGRL in 2002: there were 12 clusters containing 2–32 isolates each (74 isolates in total) and 32 unique sequence types. Results: The 74 isolates were divided into 20 opa-types. Seven of the NG-MAST sequence types were concordant with single opa-types, but the remaining five sequence types (ST147, ST314, ST304, ST203, ST211) were subdivided into 2–5 opa types. The largest NG-MAST cluster, ST147, containing 32 isolates, could be subdivided into five opa-types. Differences in patient sexual preference, and geographical location were apparent for some of the opa-type subgroups. Conclusions: Opa-typing can subdivide NG-MAST clusters into subgroups, some of which are supported by epidemiological data. O40 O42 Syphilis PCR use for diagnosis of early syphilis audited against routine serological testing HIV-1 antibody avidity testing to identify recent HIV seroconverters P Lewthwaite1, M Guiver2, A Turner2 1Infectious Diseases Unit North Manchester General Hospital, 2Manchester Medical Microbiol Partnership, Dept Clin Virology, Manchester Royal Infirmary, Manchester, UK The incidence of syphilis in the UK is increasing. Real-time Polymerase Chain Reaction (PCR) assays were designed using gene targets used with previously published PCR assays for the detection of syphilis we audited the use of the PCR against routine serological testing. Swabs taken from ano-genital or oral ulcers where either herpes or syphilis was suspected and tested by syphilis PCR using both the Light Cycler and Taqman assays. Samples were initially refrigerated at 4 degrees centigrade and transferred to sterile 1.5ml tubes for storage at -80 degrees centigrade. Batches of samples were then tested. DNA was extracted by Qiagen DNA extraction method. 135 samples from 111 patients were analyzed from July 2003–December 2004. In the statistical analysis only one sample was analyzed per patient. 14 samples were PCR positive by both methods, 1 sample positive only by Light cycler and 1 by Taqman assay only. In 2 samples which were PCR positive, syphilis serology was positive but not felt to be consistent with recent or active infection. Of the PCR negative samples 5 had serology consistent with active or recent syphilis infection. Sensitivity was 70.1% and specificity for both PCRs to be positive was 97.8%. Given problems with conventional serological testing for syphilis PCR provides a useful addition. A Chawla, M Mirfenderesky, C Donnelly, M Raza, M Johnson, AM Geretti Royal Free Hospital and Royal Free and University College Medical School, London, UK Objective: Antibody avidity, a measure of the tightness of antigenantibody fit, is low in early infection and increases as IgG responses mature. Our aim was to determine whether the avidity index for HIV antibodies can be used as a new serological marker to identify recent seroconversion among newly diagnosed HIV-positive persons. Methods: Serum samples were tested for HIV antibodies by manual EIA (Ortho Diagnostics). Two aliquots were tested in parallel and in duplicate or triplicate wells following either the standard EIA protocol (=reference) or a modified protocol requiring an additional wash with 8M urea in PBS to dissociate low avidity antibodies (=test). The avidity index was calculated by dividing the averaged reference optical density (OD) value by the test averaged OD value. Results: Among newly diagnosed HIV-positive persons, 17 patients had a clinical history suggestive of a recent infection. Their median baseline CD4 cell count was 620 cells/µL (range 520–1000). The serum samples collected at the time of diagnosis showed an avidity index consistently ≤0.60 (median 0.40, range 0.2–0.60). Among the 17 patients, 9/17 showed reference OD values increasing from low to high in follow-up samples, consistent with a recent infection; the remaining 8/17 had a strongly positive reference EIA but were confirmed as recently infected by Western blot. All 17 patients had detuned EIA result (STARHS) consistent with infection acquired within the previous 5–6 months. The avidity index was monitored in follow-up samples collected at various time points after HIV diagnosis. Avidity increased over time and was 1.0 by day 30. Conclusions: A HIV-1 avidity index =0.60 reliably identified HIV-1 infection acquired within the previous 30 days and was more sensitive in identifying a recent infection than a low reactivity in the screening EIA test. 11 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV O43 O45 No recent increase in mortality among HIV-diagnosed individuals with long exposure to therapy: UK 1987–2004 Triple class antiretroviral agent resistance in a large UK cohort – prevalence and risk factors for acquisition TR Chadborn, VC Delpech, K Sinka, BG Evans HIV/STI Department, Health Protection Agency's Centre for Infections, London, UK Aim: To determine whether mortality rates have increased in cohorts of HIV infected individuals with long treatment exposure. Methods: Analysis of national HIV surveillance data to examine all-cause mortality rates of HIV-infected cohorts – grouped by year of diagnosis. Mortality rates were calculated as the percentage of HIV-diagnosed individuals that died within 0,1,2,etc. years of diagnosis – approximated to calendar years. Results: The number of deaths fell from 1,530 in 1995 to 409 in 2001 but is likely to exceed 500 for the first time since 1997 in 2003. Mortality rates of cohorts diagnosed between 1987 and 1995 fell from an average of 7.5% per year before 1996 to 2.1% in 1997 and then continued to decline to 0.9% in 2002. Cohorts diagnosed between 1996 and 2002 experienced an average drop of 82% in mortality rates from the year of diagnosis to the following year, and then a slow but continued decline. There was no evidence of an increase in mortality rates in recent years in any of the ‘year of diagnosis’ cohorts. Conclusions: HAART dramatically cut mortality rates in 1996 and continues to postpone death in individuals who were diagnosed with HIV in the early 1990s and those newly diagnosed since 1996. R Jones, S Mandalia, M Bower, M Nelson, B Gazzard Department of HIV and GU Medicine, The Chelsea and Westminster Hospital, London, UK Introduction: Individuals harbouring triple class resistant virus constitute one of the major treatment challenges of the HAART era. This study examines the prevalence of triple class resistance and factors influencing its acquisition Methods: Patients with genotypic tests demonstrating resistance to the three main antiretroviral classes were identified from a large clinical database. Data were scrutinised to identify risk factors for acquisition of triple class resistance. Results: 7715 resistance tests from 3476 patients have been collected. 231(6.7%) individuals had triple class resistance defined as ≥3 mutations, constituting ≥1 mutation from NRTI, NNRTI and PI class at any time point.170 (73.6%) had exposure to mono or dual agent antiretroviral therapy in the pre-HAART era.16 patients (6.9%) had documented non-adherence.14(5.6%) experienced adverse side-effects.5 patients(2.2%) underwent unstructured treatment interruption.1(0.4%) had concurrent illness and 1 treatment naïve individual (0.4%) had acquired a multi-resistant virus at the time of seroconversion. Conclusion: The need for salvage therapy is best prevented by limiting acquisition of triple class resistance.Three class resistance exists at a low level in our population. 73.6% of individuals received incompletely suppressive therapy in the pre-HAART era.Non-adherence, unstructured treatment interruption, side-effects eliciting non-adherence, concurrent illness and acquisition of resistant virus were all implicated in the development of multi-drug resistance. O44 O46 How salvageable are the K65R and L74V mutations? Virological and clinical outcomes in patients with multi (three)-class drug resistant (MDR) HIV in the UK L Waters, S Mandalia, M Nelson, M Bower, BG Gazzard Department of HIV Medicine, The Chelsea and Westminster Hospital, London, UK Aim: To investigate subsequent virological response to HAART in patients with a K65R or L74V mutation. Methods: Data were extracted for all patients entering our cohort since January 2000. We identified all those with either mutation, analysed subsequent HAART regimens and calculated % chance of viral suppression (<50 copies/ml). Results are divided according to whether subsequent therapy included ddI/ABC or TFV/3TC for individuals with L74V/K65R respectively and whether or not therapy included a PI. Results: 52 and 91 patients with K65R/L74V respectively had >6/12 follow-up. The numbers and percentage achieving undetectability with first subsequent therapy are illustrated below. NRTIs PI-regimen Non-PI L74V ABC 13/20 (65%) 11/21 (52.4%) ddI 8/11 (72.7%) 2/7 (28.6%) ABC/ddI 1/3 (33.3%) 0/4 No ABC or ddI 14/19 (73.7%) 1/6 (16.7%) K65R TFV 7/7 (100%) 1/3 (33.3%) TFV/3TC 3/4 (75%) No TFV 25/30 (83.3%) 4/8 (50%) Conclusion: The K65R mutation appears to be highly salvageable with a PI-based regimen, whether or not the backbone includes TFV, and less so with non-PI HAART. There is a trend for less success salvaging the L74V whether or not this includes a PI. 12 D Grover1, L Allen3, D Pillay1,3,4, H Green2, A Copas3, S Forsyth1, SG Edwards1 on behalf of the UK Collaborative Group on HIV Drug Resistance and UK Collaborative HIV Cohort Study (UK CHIC) 1Mortimer Market Centre, 3UCL, 4HPA, 2Medical Research Council Clinical Trials Unit, London, UK Aim: To evaluate predictors of survival and virological response in patients with MDR HIV in the UK HIV Drug Resistance Database. Methods: Poisson and linear regression were used to determine factors associated with survival and HIV viral load (VL) response 24-48 weeks after MDR diagnosis. Results: 628 patients; 85.3% males; median age 43 years; median CD4 and VL at MDR diagnosis 238 cells/mm3 and 4.15 log10 copies/ml; median number of any inactive drugs 12; median time on ART 4.5 years. There were 54 deaths after MDR diagnosis (median follow-up 23.9 months). Estimated probability of death was 3%, 8% and 13% by 12, 24 and 36 months respectively. 250 patients changed regimen after MDR diagnosis. In adjusted analysis, higher VL and lower CD4 at MDR diagnosis were significantly associated with increased risk of death (P =0.03, <0.001). Change in regimen and lower number of inactive drugs were significantly (P <0.01) associated with a decreased risk of death. In patients changing therapy after MDR, genotypic sensitivity score of the new regimen was significantly associated with decrease in VL after 24 weeks, (P =0.02) but not the risk of death (P =0.11). Conclusion: Active management of patients with MDR HIV-1 is associated with delayed time to death, and resistance test guided therapy confers virological benefit. 11th Oral Abstracts O47 O48 CD4 counts and the risk of lymphoma in individuals with HIV in the UK A prognostic model to predict survival in systemic aids related non-Hodgkin's lymphoma I Reeves1, M Fisher, T Hill, C Sabin, on behalf of the UK Collaborative HIV Cohort (CHIC) Steering Committee 1Brighton and Sussex University Hospitals, Brighton, UK Aim: To describe the incidence of and risk factors for lymphoma in the HAART era in the UK CHIC Study. Method: Poisson regression analyses determined the associations between lymphoma and the following variables: sex, exposure, ethnicity, viral load, current and nadir CD4 count, receipt of HAART. Results: 106/13729 (0.8%) patients had lymphoma (59 NHL, Burketts, immunoblastic or equivalent, 23 primary cerebral and 24 type unknown). At lymphoma diagnosis, patients were aged from 25–73 (median 38) years, had a median CD4 count of 169 cells/mm3, and 52 (49.1%) had received HAART. 80 (75%) were homo/bisexual with 76 (72%) white and 13 (12%) black African. Compared to individuals with a CD4>500 cells/mm3, the rate was highest in those with a current CD4<50 cells/mm3 (relative rate 9.46, 95% CI: 3.4, 26.1, P =0.0001) and decreased as the CD4 count increased. The trend with nadir CD4 count was similar. There were no significant relationships with sex, exposure, ethnicity, age or previous HAART. After adjusting for the most recent CD4 count, the nadir count was not significantly associated with the risk of lymphoma. Conclusion: The risk of lymphoma is increased at low CD4 counts, although the nadir CD4 does not contribute further to this risk. AM Young, J Stebbing, T Dhillon, T Newsom-Davis, C Thirlwell, T Powles, S Mandalia, M Nelson, B Gazzard, M Bower The Chelsea and Westminster Hospital, London, UK Background: The established International Prognostic Index (IPI) for lymphomas has not included patients with systemic AIDS-related non Hodgkin's lymphoma (ARL). As this remains an important cause of morbidity and mortality in individuals infected with the human immunodeficiency virus (HIV), we wished to establish the most appropriate prognostic index for use in these patients. Methods: Multivariate analyses of 215 patients with ARL were used to examine criteria for survival. Cox's proportional hazards regression analysis determined the prognostic significance of clinico-pathological variables. Results: In multivariate analyses of the entire cohort, CD4 count, prior AIDS diagnosis, Burkitt’s lymphoma and IPI risk group were significant variables. Regression modelling for patients diagnosed in the era of HAART reveals 2 independent predictors of mortality: IPI risk group and CD4 count. These identified four risk strata with one year survivals of 82%, 47%, 20% and 15%. Conclusions: For patients with ARL in the era of HAART, an accurate prognostic score can be established by combining the IPI with CD4 count. As patients presenting with ARL and a low CD4 count have a poor prognosis, this can be used to guide therapeutic options. 13 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P1 ■ Improving access and managing patient flow in a busy inner city, sexual health clinic ■ V Griffiths, I Ahmed-Jushuf Presenting on behalf of the Six-Sigma Group: S Barton, S Bhaduri, C Bowman, E Carlin, S Dawson, P Greenhouse, TC Harry, M Kingston, E Morgan, C O’Mahony, J Ross, M Weir Background: Patients wishing to access GUM clinics have endured long waiting times due to excess demand. Follow-up:new case ratio has dropped from 2.2:1 in 1990 to 1.3:1 in 2003. Method: 12 Centres formed a project team to challenge current practice and seek ways of reducing the ratio. Using the six-sigma management tool, the team identified opportunities for reducing the ratio. Six-sigma uses a 5-stage process ‘DMAIC‘: Define-MeasureAnalyse-Improve-Control. All follow-up patients attending the 12 centres during 19–23.04.2004 were analysed against a set proforma. Results: Group base line ratio was 0.7:1 (p <0.02). 3 main reasons were identified where further reduction was deemed possible: results policy, Chlamydia/non-gonococcal urethritis and warts. Aim was to reduce by 80% in each of the three areas; a potential group mean of 0.47 was identified as a target to work towards. Groups mean ratio was 0.5:1–(31.12.2004) Conclusion: The follow-up:new ratio can be significantly reduced thus releasing much needed capacity. The six-sigma management tool ensures that patient processes, which contribute to the ratio, are properly evaluated and opportunities for improvement identified. It also ensures that effective controls are in place to ensure that the quality of care is not compromised. The completion date for the project is March 2005. Final data will be available at the conference. P3 ■ Turning the tide – effectively managing increasing demand for GU services Experience with the Test not Talk (TNT) clinic for asymptomatic men M Ottewill, G Dean, E Collins, D Williams Department of GU Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK Background: Since the late 1990s GUM services have witnessed unprecedented increases in demand due to rising STI rates, changes in sexual behaviour and greater public awareness. The situation has been exacerbated by attempts to meet Sexual Health Strategy targets within constrained resources. Without compromising quality of clinical care, we modernised services within existing resources. Methods: Following multidisciplinary consultation, service provision changes were implemented: redesign of appointment system, using an advanced access model, prioritising symptomatic patients; improving laboratory/clinic IT links to facilitate ‘no-news is good-news’ results system (including HIV results); introducing telephone follow-up for NSU/chlamydia; increased use of text-messaging for results/recall/appointment reminders. Results: There was a reduction in follow-up to new-episode ratio from 2.11 in 2001 to 0.86 in 2004. Between 2001 and 2004 chlamydia diagnoses increased by 89%, and syphilis by 455%. HIV testing rates improved: 93% patients offered a test in 2004 with uptake of 65%, compared to 76% and 48% respectively in 2001. Conclusion: By reconfiguring services the need for follow-up appointments declined, whilst maintaining access for symptomatic patients. Patient and staff satisfaction improved, with reduced waiting times and predictable workload. These modernisation efforts increased efficiency without compromising quality of care, although additional resources are required to address asymptomatic disease. D Martin, J Barter, R Pittrof Department of Reproductive and Sexual Health GUM, Town Clinic, Enfield Primary Care Trust, Enfield, UK Aim: Evaluation of a screening clinic for asymptomatic men. Methods: Audit of the first year of TNT services. Process: The receptionists asked male patients calling for an appointment: ‘Do you just want a check up or do you have symptoms’. Check up only patients were offered a TNT appointment. In the clinic patients received written information, a symptom/risk self-assessment questionnaire saw a nurse and were offered first void urine (gonorrhoea-culture, chlamydia-SDA) and blood tests (syphilis-EIA, HIV-EIA). Symptomatic, high risk patients or patients who want to talk were referred to the next GUM clinic. Results were communicated by letter or phone. Results: 39 clinic sessions were offered and 337 of 468 possible appointments were made. Of the 303 men who attended (median age of 23) 264 were new to our service, 161 classified themselves as white UK and 257 as asymptomatic. Symptoms and risk factors acknowledged were: genital pain:10, dysuria:10, urethral discharge:0, skin problems:18, MSM:10, IVDU:2, >1 partner in the last 3 months:118. 248 underwent full STI/HIV screening and 22 new STI diagnoses were (chlamydia:20, gonorrhoea:1, late latent syphilis:1). All patients with STIs were effectively treated. Conclusion: Screening by receptionists identified patients suitable for a high volume, and low cost screening. Large Poster 14 ■ Releasing capacity through reduction in follow-ups M Brady1, D Crates1, G Miflin2 1Caldecot Centre, King’s College Hospital, London, 2South East London Strategic Health Authority, London, UK Background: Rates of STIs and GUM attendances continue to rise. Novel ways of improving access and quality are needed. We report the impact of changes to service delivery on patient flow and transit times. Methods: Detailed demand and capacity analyses were performed. We undertook process mapping to better understand our system with a view to improving patient flow. We designed a ‘Slot System’ to spread demand throughout the day. The service remains ‘walk-in’ but each day is divided into hourly slots and a fixed number of patients are seen each hour. Activity and patient transit times were recorded throughout. Data was analysed using run (SPC) charts and control (I or xMR) charts. Results: Patient attendances have remained stable. Mean transit time decreased from 1hr 38 minutes (upper control limit (UCL) 3hrs 48 minutes) to 1 hr 13 minutes (UCL 2hrs 56). The proportion of patients waiting more than 4 hours reduced by 90%. Conclusion: Improvements to service have been measurable. We have established that better analysis and management techniques can have as large an impact as simply spending resources on more of the same. Continued work to reduce waiting and transit times will further improve service quality with the ultimate aim of reducing local sexual ill-health. P2 P2a ■ Standard Poster ● 11th P4 Poster Abstracts ■ P6 ■ Do GUM patients want chaperones? HIV workload and patient complexity ratings M Osmond1, C Newey1, D Mercey2, E Jungmann3, S Edwards1 1Mortimer Market Centre, Camden PCT, 2Centre for Sexual Health and HIV Research UCL, 3Archway Sexual Health Clinic, Camden PCT, London, UK Background: The GMC and Royal Colleges recommend that we offer chaperones to all patients for intimate examinations. Only 10% of genitourinary medicine (GUM) clinics have a policy regarding chaperones. The policy in the 2 clinics studied is to offer each patient a chaperone before their examination. Little data is available from the patient perspective. Aim: To identify patients’ wishes concerning offer and provision of chaperones in a GUM clinic. Methods: Anonymous questionnaire given to patients after their examination at two GUM clinics in London. Results: 600 questionnaires were completed. Results of 336 showed: mean age 29 (range 16–61), M:F 51%:49%. 158 (47%) were offered a chaperone at this visit, of whom 20 (12%) said yes, 128 (80%) declined (8% no response). 167 (50%) weren’t offered a chaperone, of whom 143 (80%) didn't want to be offered one. 12% (40) of respondents said they would like a chaperone at their next visit. The patients preferred method of being offered a chaperone was to be asked during the consultation (48%,55/114). Full results will be presented at the conference. Conclusion: This study shows the majority of patients do not want a chaperone, but if offered one, this should be during the consultation. HR Gumley, N Rees, CA Sabin, D Ransom, M Youle, MA Johnson Royal Free Hospital, Royal Free and UCL Medical School, London, UK Aim: To investigate changes in HIV activity between 2000 and 2003 and introduce a patient complexity model to monitor HIV casemix and outcomes. Methods: Identified patients seen at a single centre between 1/1/2000 and 31/12/2003. Results: The number of patients increased by 35% from 1524 in 2000, to 2057 in 2003. Total outpatient visits increased by 53% from 13,637 in 2000, to 20,808 in 2003 and the mean number of visits per patient increased from 8.95 to 10.12. Day case visits decreased by 6% while inpatient visits increased by 19%. Plotting actual data against predictions from the 1999 York report indicated that actual patient population and outpatient activity are much increased on previous expectations. Non-complex patients increased by 47% from 1146 in 2000, to 1682 in 2003 and patients of varying complexity increased by 15% from 338 in 2000, to 389 in 2003. Conclusion: Rising patient numbers have led to a huge increase in workload. Activity/casemix trends among Trusts must be monitored on a regular and comparable basis so that we can be better prepared for future growth and diversity as well as the changing commissioning needs of Trusts for the particular cohort of patients for whom they provide care. P5 P7 ■ Finding out what primary care wants from GUM and delivering it DJ Clutterbuck, M Sutherland, N Harrison, C Thomson, J Donald, Edinburgh GUM CLIP team, Edinburgh GUM GP Liaison Group Lothian University Hospitals, Edinburgh, UK Aim: To support primary care delivery of STI services according to GPs’ requirements. Methods: Questionnaire survey to prioritise interventions deliverable with existing resources. Results: A brief questionnaire was sent to each of 709 GP principals and practice nurses (PNs) in 127 practices in Lothian in October 2003. Overall return rate was 58%. At least one questionnaire was returned from 95 practices (75%). To improve STI care 42% prioritised improving existing services, 36% developing peripheral services and 18% improving support for GPs. Changes that GPs and PNs thought would most help them to manage STIs and refer appropriately were an STI management protocol, a telephone helpline, and a website. A GP liaison group was formed and developed and published an STI management protocol as its first priority, with a navigable web-based version launched in November 2004. The protocol directed GPs to a helpline that was incorporated into the existing nurse triage service. Other findings are guiding the further development of STI services. ■ HIV admissions in a south London teaching hospital M Aboud, S Hussain, L Collins, N Larbalastier, B Peters, R Kulasegaram Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK Introduction: The incidence of HIV is rising in the UK with 63,000 cases reported by the end of 2003. About 14,300 cases are estimated to be unaware of their diagnosis. Despite improved testing and effective treatment, new and known HIV patients still present with advanced disease or AIDS-defining illnesses (ADI’s). We aim to describe the admission demographics at our inner city unit. Methods: We conducted a retrospective analysis of 140 admissions at St Thomas’ Hospital from September 2003 to September 2004. Data on age, sex, ethnicity, length of stay, new versus old diagnosis, CD4 count, viral load (VL), ADI's and bacterial infections were collected and analysed on Microsoft Access. Results: 70% of all patients were male, 39% white, 39% black (91% of these African). 30% of all patients were new HIV diagnoses. Of these, 80% had a CD4 Count <200, 40% a CD4 count <50, 52% a VL >100000, 64% an ADI. 52% of all cases were already on HAART. Of these, 52% had a detectable VL, 43% a CD4 <200, and 25% an ADI. Discussion: Our study showed that a significant proportion of HIV admissions are late presenters with preventable morbidity. Improved testing and public awareness remain a priority. 15 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P8 ● Are we a happy lot? Evaluation of a walk-in GU service J Dhar, J Watt, A Needham Department of GU Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK Background: GU clinics nationally have experienced dramatic increases in clinic attendances and strategies for managing demand and access are constantly being explored. Prior to March 2003 the clinic offered a walk in service in the mornings and appointments only in the afternoon, but this had to be reviewed in view of perceived imbalance between a.m./p.m. sessions, high DNA rates in the afternoon, loss of lunchtime educational and training opportunities by over-running a.m. sessions. In April 2003 walk in service was extended to the afternoons with appointments late morning and in the late afternoon. Discussion: A pre and post-implementation patient and staff satisfaction exercise was undertaken in March 2003 and in June 2003, which indicated that the new system benefited staff and patients. Satisfaction rates were up by 15–20% for both groups. Details of this will be presented. However, since 2003 an increase of 5% has been observed. The impact of this further increase on patient and staff satisfaction has been evaluated. Conclusion: Increase in demand with no corresponding growth in resources has precipitated a considerable decrease in the satisfaction levels for both staff and patients, and will be discussed. Walk in STI service, though a viable option, needs adequate long-term resources. P9 16 ● P9a ● Recognising the potential of non-registered nurses to increase capacity – another phase in modernising GUM Services V Griffiths, S Butler, I Ahmed-Jushuf Department of GU Medicine, Nottingham City Hospital, Nottingham, UK Aim: To identify a ‘New’ way of screening for asymptomatic men. To evaluate the feasibility of using non-registered clinicians to deliver a fast-track ‘mini-screening’ service. Method: All male ‘walk-in’ patients between August-October 2004 were given a leaflet explaining suitability for ‘mini-screen’, as well as information regarding tests and procedures. Mini-screen comprised of a first catch urine for chlamydia (BD-Probetest) and serological tests for syphilis and HIV. Screening was undertaken by trained non-registered nurses using a standard proforma. All positive diagnoses followed-up as per clinic policy. Results: 58 patients opted for ‘mini-screen’, (49%) had previously attended. 51 eligible, 7 referred back to clinician. 49/51(96%) consented for syphilis and HIV serology, all negative. 8 (16%) chlamydia positive, all successfully recalled, and one contact per index case treated. All documentation had been completed correctly. Mini-screen patients spend less time in the clinic as compared to other walk-ins (38:140min). Conclusion: Rapid STI screening is feasible within GUM for asymptomatic patients. This service is comparable to the chlamydia-screening programme – indeed more value added as patients get offered tests for syphilis and HIV. Rapid screening services improve the ‘patients process’, and releases capacity of registered clinicians to see symptomatic patients. P10 ● Does a closed appointment system improve access? I’m OK S Bhaduri, C Minton, M Mann Sexual Health Service, South Worcestershire Primary Care Trust, UK Introduction: Patients attending all GU clinics were recently asked to complete a HPA survey regarding time taken to obtain an appointment. In North Worcestershire (where routine appointments can only be made 48 hours in advance), the result was 43% of patients could obtain an appointment within 48 hours (West Midlands average was 28%). Is this figure anomalous or does it reflect genuine access? Methods: Telephone calls were logged over a 3 month period recording whether a routine appointment was offered or not available. Results: On average 143 calls regarding appointments were logged per week (range 113–166). 47% (range 38–57%) of callers/week were able to make routine appointments, 44% (range 27-59%) were unable to book and were asked to ring again (20% of these were male). 9% were offered appointments but declined attendance at time offered. Conclusion: Call analysis correlated with the HPA survey results suggesting the closed 48 hour booking system may genuinely improve access although further research is required in this area. P Handy, J Richards Dept of Genito-Urinary Medicine, Newcastle General Hospital, Newcastle, UK Objective: To provide earlier access to asymptomatic patients for sexual health screening Method: Currently those who are asymptomatic but wish to check their sexual health may have to wait for up to 3 weeks for an appointment. An audit of attendees at our clinic found that about 50% were asymptomatic patients. Whilst a triage system is in place for those who are symptomatic or have been in contact with an infection, we recognised that nothing existed for the asymptomatic worried as well. A weekly ‘I’m OK’ nurse led clinic designed to see only asymptomatic patients was funded by the PCT allowing 35 walk in slots. Tests for chlamydia, gonorrhoea, HIV, syphilis were taken, no microscopy was performed. Signs or symptoms of infection resulted in the patient being referred to a normal clinic session. Results were available by phone after 1 week. Those found to have an infection are asked to return to a normal clinic. Results: Over initial two-month period overall asymptomatic chlamydia infection rate of 10%. Other infections found include HIV, syphilis, gonorrhoea. Conclusion: Popular with patients. Encourages attendance. Enables rapid detection of asymptomatic infection. 11th P11 Poster Abstracts ● P13 ● Improving access – Blush and create a new website (www.gumnewcastle.nhs.uk) Results by text – preferred by patients, transforming work patterns RS Pattman and R Hackett Department of Genitourinary Medicine, Newcastle upon Tyne, UK Aim: To use non-recurrent Department of Health (DoH) funding to improve service access. Methods: Commercial website redesign to provide information on: infections both by condition and symptoms (novel ‘self-diagnosis’ format) supported by graphic images; 'normal' genital variants; prevention – top ten tips, condom use, importance of partner notification; local UK clinics (via a link - www.playingsafely.co.uk). Also interaction with questions and answer section, guidelines/information leaflets for general practitioners, a fun section (games and e-cards linked to the site), staff section, password protected (with image and PowerPoint libraries). The site had to be: easy to update and monitor; compliant with NHS guidance and also attractive to the casual browser; accessible to the disabled. Results: The site was built using Curo. A cartoon figure, ‘Blush’, and ‘Sex is – …’ rotating banner headlines were produced to promote the site and our service. Clinic staff produced the information for the site and ‘Mates’ provided the condom use images. The site was launched in October by Newcastle Falcons Rugby Football Club and was supported by representation from the Sexual Health Unit, DoH amid local publicity. Further detail and information on feedback/usage will be presented. J Clarke1, Y Taylor1, PJR Harkin2 1Leeds General Infirmary, 2Leeds University School of Medicine, Leeds, UK A city centre GU Medicine clinic changed the methods of sending results to patients following an initial patient questionnaire indicating that 85% of attenders had access to a text phone. Patients were encouraged to book a text message for results. One of two standard messages were sent: a negative text or a request to call the clinic. Options for results by letter, in person or by ringing a nurse telephone clinic were also available. The text service started in August 2004. A further patient questionnaire was performed to assess the acceptability of texting and other methods. 278 out of 300 questionnaires (93% response rate) were completed by new and rebook attenders. 80% of respondents agreed that results by text were acceptable, and 91% wanted contact for all results, positive or negative. Method available Considered best way of contact Text patient 44% Ring into nurse clinic 32% Letter home 26% Face to face with staff 25% A review of the impact at December 2004 revealed over 250 texts sent per month. A reduction of over 60% in nurse-led telephone clinics workload freed clinical staff to develop new screening services. Secretaries saw an 85% reduction in results letter requests. The text messaging results service was acceptable to patients, released nursing time into clinic, and has modernised the approach to patient care. P12 P14 ● Time to use text appointment reminders in genitourinary medicine (GUM) clinics CE Cohen, S Mandalia, AM Waters, AK Sullivan John Hunter Clinic, Chelsea and Westminster Hospital, London, UK Aim: To determine patient preferences for GUM appointment reminders. Methods: 350 questionnaires were distributed to consecutive GUM attendees. Results: The response rate was 87%, 156 (52%) were female and the median age was 27 years (range 14–73). 268 (88%) patients considered appointment reminders a good idea. Reminders via text message were the most preferred option [203 (67%)] followed by phone call [105 (35%)], e-mail [81 (27%)] and letter [72 (24%)]. There was no association with age or gender. 254 (84%) considered automated voicemail reminders to mobiles as acceptable. Younger patients were significantly more accepting of voicemail reminders to their mobiles compared to either home or work (p =0.026)*. 301 (99%) preferred reminders 1–7 days in advance, 2–3 days being most popular [119 (39%)]. 99 (33%) patients preferred morning reminders, 52 (17%) afternoon, 48 (16%) evening, and 20% did not mind. 208 (68%) were accepting of reminders at weekends and 178 (59%) on public holidays. No association with age or gender was found. Conclusion: Our clinic patients favoured reminder-texts to mobile phones, 2–3 days before appointments. Pilots in other specialties reduced DNA rates by 38%. We plan to pilot this service for chronic problem clinics, to reduce the high non-attendance rate. *χ2 test DNA-did not attend ● Mobile phone text messaging to give results to patients in a district general hospital genitourinary medicine clinic O McQuillan, R Hewart, E Morgan Bolton Centre for Sexual Health, Bolton, UK Aim: To assess efficiency of and patient satisfaction with giving results by text message in the setting of a busy DGH GUM clinic. No formal assessment of text messaging results service has been carried out before. Methods: For one month patients who received results by text message were asked to give a score out of 5 for level of satisfaction. Results: 373 results were text messaged to patients who were assessed as low risk of having an STI who had attended our GUM clinic. 329(88.3%) results were negative which were texted in an average time of 9.78 days so these patients did not need to phone or attend the clinic again. 125(37.9%) of these texted back and gave an average satisfaction score of 4.63/5. 44(11.7%) results were positive (C4a/ B1/ C10a/A4/E1A) and appointments were sent out in an average of 9.75 days, out of which 23(52%) attended the department. 18(78.2%) of these gave an average satisfaction score as 4.62/5. 1 negative result went to the wrong phone number due to this being recorded incorrectly in the notes. Conclusion: Text messages are a safe way to give results and deliver a high level of patient and staff satisfaction. 17 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P15 ● FEA Keane1, S Gray2, J Tilbury3, N Saulsbury1 1Department of Genito-urinary medicine, Royal Cornwall Hospital, Truro, 2Lowe Lemon Street Surgery, Truro, 3The Health Centre, Haye Road, Callington, Cornwall, UK The National Strategy for Sexual Health describes services for patients at their General practice (level 1, essential) in enhanced community-delivered services (level 2) and in specialised services (level 3). General Practitioners have subsequently disputed that all level 1 services described in the Department of Health Sexual Health Commissioning Toolkit (CT) document are essential. The New GMS Contract is inconsistent with the National Strategy, designating Sexual Health as a National Enhanced Service. To date, the discrepancies between the National strategy and GMS contract have not been resolved at national level. This has contributed to delayed strategy implementation. In order to overcome this impasse locally, GPs and GU consultants met to scrutinize each service element described in the CT and agree its assignment to essential, additional, enhanced or specialised level. This document, subsequently endorsed by the Local Medical Committee, will be displayed. It has enabled the local Sexual Health Advisory Board to place business plans before the Primary Care Trusts’ Professional Executive Committees towards development of enhanced Sexual Health Services. This is the first time, to our knowledge, that such a formal agreement has been reached, allowing real progress to be made in implementation of the National Sexual Health Strategy in Cornwall. ● The need of men’s health clinics C O'Connor1, M O'Connor2, J Byrne2, H Myles2, S O'Connor2, S O’Shea2 1GU/STD clinics Regional Hospital, Limerick, Ireland, 2Medical School, University College, Cork, Ireland Introduction: Men’s health issues include the commonest cancer (testicular) (TC) in young men (15–40 years). It has doubled in the last 20 years. Mortality =8%. The project investigates the need for services. Methods: A cross-sectional self-administered anonymous questionnaire survey on 400 consecutive men >18 at a Regional Hospital (OPD) and a university campus (Unit) was done. Consent was obtained and information and contact details were given. Results: Response rate 336/400 (84%) Table: Some findings of study OPD Unit Total (200) (200) (400) Mean age 48 22 34 Aware age category TC (%) 31% 49% 41% Examined by Dr for TC (%) 19% 15% 17% Knew someone with TC 23% 30% 28% Who would consult with lump: GP (%) 91% 89% 90% STI clinic (%) 6% 7% 6% Attended an GU/STD clinic (%) 7% 13% 9% Treated for STI 8% 3% 5% Men’s Health Clinic wanted (%) 84% 70% 76% Conclusion: 76% desired a male specific health clinic. Death rates are higher here than internationally (8% v 2%). Outside of GP, STI clinics are the preference site for consultation. In view of HIV being an increased risk factor for TC it seems appropriate that Sexual Health Clinics should add Men's Clinics. 18 ● Overcoming the barriers to GP involvement in the diagnosis and management of HIV infection The National Sexual Health Strategy and the New General Practitioners' contract: poles apart or reconcilable? P16 P17 A Bailey1, M Fisher1, R Barker2, G Dean1 1Brighton and Sussex University Hospitals Trust, 2Brighton University, Brighton, UK Background: As HIV care becomes more complex and encompasses cardiovascular and metabolic disorders, GPs need to play an increasing role in co-management. In conjunction with local GPs we established a primary care focused interactive two day course based upon the STIF model. Methods: Attendees completed questionnaires before and after to assess current involvement in HIV care and confidence in co-management. Additionally, quantitative assessment of effect using laboratory data on numbers of HIV tests was performed. Results: Of 46 participants, 16 were GPs of whom 7 had >20 HIV+ patients. Barriers to HIV testing identified most frequently were lacking knowledge about HIV and support services. After the course, all reported increased confidence in managing non-HIV related issues and HIV testing, with 13/16 more confident in managing HIV-related problems. Although HIV testing rates were unchanged after the course, some individuals did increase their testing rates with 3 new positive diagnoses made post-course. Conclusions: A primary care focused course can enhance the role of GPs in co-management and may help reduce levels of undiagnosed HIV. P18 ● Issues impacting on HIV service uptake by Africans in the UK F Burns1, A M Johnson2, J Nazroo3, KA Fenton1,4 1Centre for Sexually Health and HIV Research, Mortimer Market Centre, UCL, 2Department of Primary Care and Population Sciences, Royal Free and University College Medical School, 3Department of Epidemiology and Public Health, UCL, 4Health Protection Agency, London, UK Background: In Britain Africans with HIV access health services late in the course of their HIV disease compared to non-Africans. The factors behind late presentation are not yet fully understood. We wanted to identify the key issues affecting utilisation of HIV services in order to develop a questionnaire and topic guide for future research on this topic. Aim: To identify key issues affecting the utilisation of HIV services by Africans in Britain. Methods: Semi-structured interviews were conducted with key informants with extensive experience working with African communities, HIV and sexual health. Results: Eleven interviews were conducted. Respondents felt there was high HIV awareness within African communities in the UK but this did not translate into perception of individual risk. Rumour, myth and the media perpetuate fear and misunderstanding about transmission and health services. Health is a low priority, and preventive medicine an alien concept for many Africans. Ignorance around entitlement to care and unfamiliarity with the NHS hinder access. Health services have not yet effectively engaged with African men. Conclusions: HIV remains a much feared and stigmatised disease in African communities in the UK. More involvement from the African communities in the planning and implementation of health services is needed. 11th P19 Poster Abstracts ● P21 ● The use of general practitioners amongst HIV-positive patients The role of the sexual health advisor (SHA) in a hospital-based HIV service D Robertson-Bell, S Madge, CJ Smith, MA Johnson and Nursing and Medical Staff of the Ian Charleson Day Centre Royal Free Hospital and Medical School, London, UK Background: With the introduction of HAART, the care of HIV patients has moved from acute care to the management of a chronic condition. The Royal Free operates an emergency clinic which caters for a variety of conditions, including non-HIV-related. Method: 149 patients at the emergency clinic and 93 who attended out-patient’s clinic completed a self-administered questionnaire on GP use. Results: 186 (77%) were male, 50 (21%) Black African and 161 (67%) White. The median age was 38 years. 200/242 (83%) had GPs. Women were more likely to have a GP (96% of women, 79% men;p=0.0019), but there were no differences according to ethnicity, age, or routine appointment. 32/42 (76%) of those who did not have a GP felt the Royal Free met their health needs, and 20 (48%) felt their GP could not meet their health needs. Of those with a GP, 128/200 (64%) have informed their GP of their HIV status. 137/200 (69%) had seen their GP in the last year. 40/70 (57%) who have not told their GP they are HIV-positive were worried about confidentiality in the practice Conclusions: Although many HIV-positive patients have GPs, a proportion remains unaware of their patient's HIV status. P Anderson, M Murcie, A Winter, R Fox The Infection Tropical Medicine and Counselling Service, The Brownlee Centre, Gartnavel General Hospital, Glasgow, UK Problem: No routine sexual health screening done in our HIV clinic; cohort of 587 HIV positive clients seen regularly between Genitourinary Medicine (GUM) and Infectious Disease (ID). Rise in local syphilis numbers. Unknown partner notification outcomes for HIV. Intervention: SHA employed in January 2003, to assess sexual health needs of our clients. Aim is to review all patients at least annually by Sexual Health Advisor (SHA) within their routine outpatient clinic appointment for HIV, 71% of PN outcomes for April–June 03 were verifiable. Syphilis testing offered quarterly, data to 31st December 2004 Outcomes Sexual Health Assessment 483 (82%) of cohort Referred to GUM for STI screening 223(46% of assessed) Seen at GUM for STI screening 193 (86% of referred) STI testing at HIV unit 19 (4%) STI's diagnosed (n =52) 69 (11% of 483 assessed) (27% of 193 who tested) STI Diagnosis: 69 chlamydia 20 (29%), gonorrhoea 10 (15%), HSV 14 (20%), PID 1 (1%), genital warts 24 (35%). Syphilis: 17 (routine testing). Conclusion: SHA has increased uptake of STI tests and GUM attendance, yielding a significant number of diagnosis of STIs on this positive population. On going Audit to identify reasons for clients not seeing SHA. P20 P22 ● A treatment advice clinic (TAC) for patients attending an HIV outpatient clinic: how does it operate and what do patients think? C Griffiths1, K Miles1,2, D Aldam2, D Cornforth2, J Minton3, S Edwards2, I Williams1,2 1Centre for Sexual Health and HIV Research, UCL, 2Mortimer Market Centre, Camden PCT, 3University College London Hospitals NHS Foundation Trust, London, UK Background: Mortimer Market Centre provides care for over 1300 patients on HAART and approximately 20 patients start therapy each month. TAC offers appointments to patients advised to start/change therapy. Anecdotal evidence suggests TAC is beneficial. We evaluated the practicalities, performance and outcomes of the TAC service to determine patient benefit. Methods: Qualitative and quantitative data were collected through 20 consultation observations, 20 patient interviews, database analyses and 100 retrospective case note reviews. Results: Patients referred to TAC from their routine doctor will see one of two research nurses, two consultants or a pharmacist, for a onehour booked session. Care pathway analysis revealed that though sessions were similar across treatment advisors, follow-up care varied depending on the approach and capacity of the advisor. It was felt that follow-up should be standardised and routinely offered to all patients initiating therapy. Patients outlined many benefits: appointment length, observing tablets to describe options, tailoring regimen to lifestyle, and telephone follow-up/support. Patients felt these factors helped improve adherence. Differences in clinical outcomes between TAC and non-TAC patients could not be determined. Conclusions: Although evidence that TAC improves clinical outcomes is unavailable, there are clear benefits at the individual level suggesting investment in TAC is worthwhile. ● BRASH: assessing the first year of a new service C Ashton, E Stephens, H Mitchell Mortimer Market Centre, London, UK Aim: To review the first year of the BRASH (Bloomsbury Reproductive and Sexual Health) Service for HIV-positive individuals attending a central London HIV treatment centre Background: The BRASH service was set up in response to a demonstrated need for one-stop provision of sexual and reproductive healthcare for HIV-positive individuals in their treatment centre. Methods: Retrospective computer and notes review of all BRASH clinic attendances. Results: 36 clinics ran in the first year of the service, with a total of 180 appointments available of which 106 were booked. There was a 13% DNA rate, leaving 93 visits. 82 sets of notes were reviewed, 53 were new patients and 29 follow-ups. Equal numbers attended for advice on contraception (32%) as did for pregnancy planning (30%). 4 patients attended for advice on unplanned pregnancy, 1 opted to continue and 3 requested referral for termination. 6% attended for infertility and 4% to discuss sperm washing. Conclusions: There was a good uptake of a new service specifically designed to meet the reproductive and sexual health needs of an HIV-positive individuals attending their treatment centre. 19 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P23 ■ CD4 cell count and starting ART: trends in six UK centres 1997-2002 W Stöhr1, D Dunn1, K Porter1, C Sabin2 on behalf of UK CHIC Study 1MRC Clinical Trials Unit, 2Department of Primary Care and Population Sciences, Royal Free and UC Medical School, London, UK Aim: BHIVA and other treatment guidelines have become progressively more conservative in their recommendations on when to initiate antiretroviral therapy (ART). We examined the extent to which this has been followed in routine clinical practice in the six centres participating in the UK Collaborative HIV Cohort (UK CHIC) Study, which covers around one-third of all patients in the UK. Methods: Each CD4 measurement between 1997 and 2002 was classified as resulting or not resulting in ART initiation, defined as within 3 months of sampling and before the next measurement. The probability of initiating ART was then estimated for each combination of individual calendar year and CD4 level (<200, 200–350, 351–500, >500 cells/mm3). Results: 6277 patients were included, of whom 3004 (48%) started ART. Between 1997 and 2002, the probability of starting ART following a CD4 count between 200–350 cells/mm3 gradually decreased from 34% to 16%, and from 15% to 4% at counts of 351–500 cells/mm3. Preliminary analyses using longitudinal methods confirmed this trend. Conclusion: There was a trend of deferring ART, which reflected changing BHIVA and other treatment guidelines. Further analyses are planned to examine the role of viral load and selected demographic factors on the initiation of HAART. P24 ■ What is the clinical significance of sustained low-level viraemia (SLLV) in patients on HAART? P Easterbrook1, L Bansi2, CA Sabin2, T Welz on behalf of the UK Collaborative HIV Cohort (CHIC) Study 1GKT School of Medicine, London, 2Royal Free and University College Medical School, London, UK Background: The clinical significance and management implications of sustained low-level viraemia (SLLV) in patients on HAART remain poorly defined. We aimed to determine the incidence, virological- and immunological consequences of SLLV in a large cohort of patients receiving HAART. Methods: The UK CHIC is an observational cohort of 16,593 HIV-infected individuals from 6 clinical centres in the UK. SLLV was defined as a viral load (VL) between 500–10,000 copies/ml for =6 months in patients who initially attained an undetectable VL (=500 copies/ml) on 2 consecutive occasions following initiation of HAART (n=6509). Results: 270/6509 (4%) patients developed SLLV which was sustained for a median of 10.3 months (IQR=7.5, 15.5). Treatment was changed in 45% of cases. The median CD4 count at start of SLLV was 355 copies/ml (220, 500) with no significant change during SLLV. In 116 patients (43%) the VL increased to >10, 000; 127 patients (47%) regained an undetectable VL; and 27 patients (10%) had ongoing SLLV at the end of follow-up [median duration: 13.0 months (9.6, 18.0)]. 3 patients developed an AIDS event Conclusion: A small proportion of patients on HAART have SLLV with no adverse immunological or virological consequences. The impact on the development of drug resistance need to be further evaluated. 20 P25 ■ Long and strong: experience of first line therapy with nevirapine (NVP) in a cohort of antiretroviral (ART) naive HIV-positive patients AA Benzie1, NE Mackie1, CA Sabin2, RJ Weston1, J Walsh1 1Jefferiss Wing, St Mary’s Hospital, 2Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK Background: Concerns about potency and hepatotoxicity continue to influence prescribing of Nevirapine (NVP). We re-analysed and updated durability and tolerability data from a previous cohort analysis in HAART-naive patients who commenced a NVP-containing regimen. Methods: Case note review. Kaplan-Meier methods were used to assess time to virological failure (viral loads >500 copies/mL on two consecutive occasions) and time to significant liver abnormality. Patients who stopped NVP and lost to follow up were considered as failures, but not those who switched an NRTI backbone for toxicity. Results: 287 patients were included in the analysis. The median (range) baseline CD4 count and HIV-1 RNA were 200 (0–821) cells/µL and 54,494 (202–500,000) copies/mL. The median (range) follow up was 39 (1–76) months. 49 patients were lost to follow up. 34/287 (12%) experienced virological failure, 24/287 (8%) discontinued due to toxicity, hepatotoxicity occurred in only 4/287 (1.4%). 25/287 (9%) of patients chose to discontinue therapy. Conclusion: This is the first cohort study providing long term durability and tolerability data in ART-naive patients commenced on NVP. Beyond the first six weeks, there was no significant hepatotoxicity related to NVP. P26 ■ The impact of fosamprenavir and lopinavir/r drug levels on virological outcome in patients on these drugs in combination C Slater1, S Castelino2, S McCormick2, C Tong3, R Kulasegaram1 1Department of Genitourinary Medicine, 2Department of Pharmacy, 3Department of Virology, St Thomas’ Hospital, London, UK Background: Fosamprenavir and lopinavir/r interact producing reduced drug levels compared to single PI therapy. We reviewed our cohort on this combination to see if their drug level had an impact on virological outcome. Method: Case notes were reviewed. Data was collected on sex, age, ethnicity, CDC stage, antiretroviral history, drug history, CD4, viral load (VL) and trough concentration (Ctrough) results from therapeutic drug monitoring (TDM) for patients on fosamprenavir 700mg bd + lopinavir/r 3bd + ritonavir 100mg bd (T1, N=20) and those on fosamprenavir 1400mg bd + lopinavir/r 3bd (T2, N=12). Results: 85% on T1 had TDM, 17.6% had Ctrough< estimated minimum Ctrough (EMCtrough); 66.6% with Ctrough<EMCtrough responded virologically vs. 85.7% with Ctrough >EMCtrough. 83.3% on T2 had TDM, 20% with Ctrough<EMCtrough; 50% Ctrough <EMCtrough responded virologically vs. 62.5% with Ctrough >EMCtrough. All virological failures in both treatment groups had low lopinavir levels but adequate fosamprenavir levels. 82.4% on T1 responded virologically vs. 60% on T2. (p>0.05 for all comparisons.) Discussion: Greater virological failure is associated with low drug levels, but this did not reach statistical significance and will be compounded by adherence. From this small review, we would recommend T1. Lopinavir levels appear key in determining response. 11th P27 Poster Abstracts ■ P29 ■ Double-boosted protease treatment using atazanavir and lopinavir/ritonavir The effect of proton pump inhibitors on protease inhibitor plasma concentrations in the clinical setting J Ballinger, L Swaden, S Bhagani, M Tyrer, M Youle, MA Johnson Royal Free Centre for HIV Medicine, London, UK Background: Atazanavir (ATV) is a relatively new protease inhibitor (PI) drug and there is little data on its use combined with other PIs. We wanted to examine the efficacy of using it in combination with lopinavir/ritonavir (LOP/r) in treatment-experienced patients. Methods and Results: From our database we identified 23 patients who received HAART containing ATV and LOP/r. Most recent viral load (VL) and CD4 count and those at time of first receiving this combination were noted. Median CD4 count at start of this combination was 494. Most recent median CD4 count was 522. 15/23 (65%) patients had a VL <50copies/ml on starting the combination and 22/23 (97%) had a VL <50copies/ml at end of study. The patient group were generally heavily pre-treated with 16/23 (70%) having received greater than 4 previous treatment combinations. Therapeutic drug monitoring was performed on 7 occasions for ATV and 3 occasions for LOP/r. All TDM results were within the therapeutic range for both drugs. Conclusion: Treatment with this double-boosted PI combination is effective in patients pre-treated with multiple combinations. SE Gibbons, DJ Back, SH Khoo Department of Pharmacology and Therapeutics, University of Liverpool, UK Background: Recent reports indicate that coadministration of proton pump inhibitors (PPI) with atazanavir (BMS, Dear Healthcare Provider Letter, December 2004) or fosamprenavir (Ford SL et al, Antimicrob Agents Chemother, 2004, 49, 467–469) can decrease protease inhibitor plasma concentrations. The PPI interaction in the clinical setting was examined using requests received by the Liverpool TDM Service. Methods: A retrospective analysis was performed on trough samples from adults receiving lansoprazole or omeprazole in ritonavir-boosted, twice-daily amprenavir/fosamprenavir (APV) or once-daily atazanavir (ATV) containing regimens. Plasma concentrations were compared to samples obtained during a similar time period from patients reported as not receiving a PPI. Results: No difference in median plasma concentrations of either APV or ATV was noted in patients receiving a PPI. The proportion below target (APV 400 ng/ml, ATV 100 ng/ml) was not different between the groups for either drug. Conclusions: These data highlight the limitations of a pre-selected, diverse cohort for investigating potential drug interactions. Only carefully designed pharmacokinetic studies can address these issues. P28 ■ P30 ■ Safety and efficacy of atazanavir with low dose ritonavir in a clinic population Tipranavir (Tip)/T-20 containing salvage regime in highly treatment experienced HIV-infected patients SF Forsyth1, DM Mullan1,2, MA Schuhwerk1, A Copas2, SG Edwards1, IG Williams1,2 1Mortimer Market Centre, Camden PCT, 2Centre for Sexual Health and HIV Research, Royal Free and University College London Medical School, London, UK Aim: To describe the use and outcome of Atazanavir/ritonavir (ATZ/r) in a HIV clinic population. Methods: Retrospective case series of all patients starting ATZ/r between 26/01/04 and 31/10/04, follow-up to be extended. Data collected using a standardised proforma. Results: 102 patients identified, 88 male: median (range) age 42 (20,73) years. Median prior antiretroviral therapy (ART): 6.4 (0–15.3) years. 6 were ART naive, 23 PI naive, 28 single PI, 51 multiple PI-experienced. Median follow-up: 135 (0,331) days. 12 (11.8%) discontinued ATZ/r: 4 jaundice, 5 depressed mood, 4 other. Of those with a detectable viral load at baseline (N=35), 19 (54%) had VL<50 at 12 weeks, median CD4 count rise 100×106/l (-140,830). Of those starting ATV/r with VL<50 copies/ml, none experienced viralogical failure. 14 (19%) had total cholesterol (TC) >6.5 mmol/l at baseline and 5 (8%) at week 12. Mean fall (95%CI) in TC in patients switching therapy :-0.43(–0.76,–0.09)mmol/l at 3 months, p =0.012. Median (range) total bilirubin at baseline: 9 (2,71) umol/l, rise by 12 weeks: 15 (–18,98) p <0.001. 61% patients with ART associated diarrhoea at baseline reported improvement. Conclusions: ATZ/r was well tolerated in this clinic population and associated with significant falls in plasma cholesterol, resolution of diarrhoea in patients switching therapy. Severe mood change was seen in some patients. U Kalidindi, M Lechelt, C Skinner, M Murphy, Y Gilleece, G Baily, C Loveday, C Orkin Barts and The London NHS Trust, London, UK Aim: to assess efficacy, safety and tolerability of Tipranavir/T-20 containing regimes in a clinic cohort. Methods: Review of triple drug class experienced clinic patients who had failed previous Protease Inhibitor (PI) containing regimes and were receiving Tipranavir/T-20 with optimised nucleoside analogue (NA) backbone for a minimum of 3 months. Results: 10 patients (9 male, 1 female) were identified. Median age 48 (range 35–61). 6 Caucasian and 4 Black African. Median time since diagnosis was 13 years (range 3–19), nadir CD4 16 (1–146) and the median number of prior ARV combinations 11 (6-13). 9 patients showed triple class resistance. Median exposure to Tipranavir/T-20 was 7 months (4–15). Pre Tip/T-20 3 months 6 months 9 months (N=9) CD4 (median) 45 101 (N=9 91 (N=8) 127 (N=3) VL log (median) 5.05 2.90 (N=8) 2.48 (N=6) 70 (N=1) 1 log ↓ 66% (6/9) 83% (5/6) VL<400 44% (4/9) 83% (5/6) 67% (2/3) No grade 3/4 toxicities for lipids or LFTs were observed during the study time. All patients continue on therapy. Conclusion: Tipranavir/T20 containing regimes with optimised nucleoside/nucleotide backbone is successful in highly treatment experienced HIV-infected patients. It is acceptable and well tolerated. 21 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P31 ■ T20 use in the UK: is it optimal? N Perry on behalf of the T20 National audit Group Department of HIV/GUM, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK Aim: To compare UK prescribing of T20 and response with known predictive factors for treatment success in the TORO studies. Method: UK wide audit of patients receiving T20. Results: 61 patients from 11 centres. Median time on ARVs was 85 months (range 15–152) with 12 (3–29) prior agents. At starting T20 (‘baseline’) median CD4 was 84 (range 4–456) and viral load 4.7log (0–6log). 24 patients had a baseline CD4 count >100cells; 30 had a viral load ≤5log, and 20 had ≤10 previous ARVs at baseline. Only 7 patients met all 3 predictive factors for success. Resistance data and genotypic sensitivity score will be presented. The median CD4 count rise and viral load drop in the whole group was 40 cells and 1.4 log respectively. The probability of achieving either a VL<400 copies was greater in those with all 3 predictive values (86% vs 0%; p=0.0001) with a trend for <50 copies (14% vs 0%; ns). 10 (16%) patients discontinued. 46% of patients reported no injection site reactions. Conclusion: Despite the majority of patients initiating T20 in an unfavourable setting, reasonable responses were seen and T20 was well tolerated. T20 may perform better if use is optimised. P32 ■ Natural killer cell function and KIR receptor expression in HIV long term non-progression A Holmes1, G O’Connor2, F Mulcahy1, C Gardiner2 1St James Hospital Dublin, Ireland, 2Trinity College Dublin, Dublin, Ireland Aim: Investigation of NK cell function and KIR receptor expression in HIV long-term non-progressors (LTNP). Method: NK cell cytotoxicity of 8 control, 6 HIV-infected and 10 HIV LTNP (defined by viral load and CD4+ count) individuals was measured using a standard 4-hour 51Cr release assay. PBMCs were stained with anti-CD16, anti-CD56 and anti-CD3 antibodies to identify NK cell subsets. NK cell receptor expression was examined by flow cytometry. Results: NK cell cytotoxicity was decreased in all HIV patients relative to controls [previously reported]. Cytotoxicity was increased in HIV LTNPs relative to HIV progressors (P=0.01), although it did not reach control levels. Whilst the percentage of NK cells (CD56+ and/or CD16+ lymphocytes) was similar in all groups, expansion of CD16+CD56-, a subset that shows poor cytotoxicity, was increased in both HIV groups. The percentage of NK cells expressing KIR receptors was decreased in HIV progressors; levels on NK cells of HIV LTNP patients were similar to control values. KIR expression on T-cells was increased in HIV patients relative to controls, especially in LTNPs, possibly reflecting chronic activation of a T-cell subset. Conclusion: LTNPs maintain NK cytotoxicity relative to HIV regular progressors, suggesting a role for NK cells in HIV control. 22 P33 ■ Efavirenz concentrations resulting from co-administration of rifampicin with either 600 or 800 mg efavirenz S Gibbons, L Almond, D Back, S Khoo University of Liverpool, Liverpool, UK Aims: Current guidelines recommend increasing the efavirenz dose from 600 to 800 mg q.d. when co-administering with rifampicin. However, recent studies suggest that the standard efavirenz dose is adequate when given with rifampicin (Pedral-Sampio et al., 2004; Patel et al. 2004). This retrospective survey of the Liverpool TDM dataset (1999–2004) compared efavirenz plasma concentrations in adult patients taking rifampicin with either 600 or 800 mg efavirenz. Methods: Data from samples taken between 8–16 hours post-dose were analysed. Patients considered to be non-adherent (concentrations <100ng/ml) were excluded. Data were analysed using Mann Whitney-U and Fisher’s Exact statistical tests. Results: There was no difference in efavirenz concentrations between patients taking 600 (n=20) or 800 mg (n=125) efavirenz (median 2543 vs. 2698 ng/ml; p=0.78). The percentage of patients taking 600 mg efavirenz with concentrations below the considered minimum effective concentration (1000 ng/ml) was not different from those taking 800 mg [4.8% vs. 10.0%; OR=0.45 (95%CI 0.07-4.97) p=0.30]. Likewise, there was no difference in the proportion of patients with high (>4000 ng/ml) efavirenz concentrations [30.4% vs. 40.0%; OR=0.66 (95% CI 0.23–2.01), p=0.40]. Conclusion: There was marked interpatient variability and the datasets were unequal. However, efavirenz concentrations were comparable irrespective of dose given. P34 ■ Clinical experience with atazanavir P Holmes, M Tung, M Nelson, M Bower, BG Gazzard Chelsea and Westminster Hospital, London, UK Methods: A prospective review describing the results of treatment with atazanavir (ATZ) at 6 months of therapy Results: As of 1/6/04, 241 individuals received ATZ, 231 ritonavir boosted, 10 ATZ alone. 89 protease inhibitor (PI) naive, 47 single PI experienced and 105 multiple (PI) experienced. Reason for utilization were virological failure (126) and switch, VL <50 (115). Reasons for switch, adverse drug reaction (78), adherence (9), end of trial (28). ATZ was switched for Kaletra (34), saquinavir/ritonavir (22), other PI (14), NRTIs (3), efavirenz (38), nevirapine (2). In patient switching therapy, at week 24 89% VL<50, 94%<500 by ITT and 94%<50, 99%<500 by OT. CD4 increment 98 cells. In virologically failing individuals, mean VL decrease -1.94 log in PI experienced, -2.12 log in PI naive. PI Naive PI Experienced OTT ITT OTT ITT <500 92% 76% 93% 79% <50 84% 69% 72% 64% CD4↑ +165 – +124 – Hypercholesterolaemia rate (>6.5 mmol/L) decreased from 15% to 9%. Mean bilirubin rise was 24 mmol/L. 4 individuals stopped therapy due to jaundice. 6 individuals with virological failure in whom pre/post therapy resistance tests were available, showed no new protease mutations. Conclusions: ATZ may be successfully utilized on PI naive and PI experienced individuals requiring switch of antiviral agents. 11th P35 Poster Abstracts ● Single agent switching to tenofovir – a retrospective analysis TJ Barber, BC De Souza Imperial College of Science, Technology and Medicine, St Mary’s Hospital, London, UK Aim: To audit single agent switching to Tenofovir in combination therapy in HIV patients. Methods: We identified patients prescribed Tenofovir (1/10/2003–31/03/2004), through our database. Naive prescriptions/switching following virological failure were excluded. Results: Of 27 eligible patients, 1 was excluded due to virological failure (switched back to Stavudine). 26 patients remained – 20 (77%) male. Agents switched: Zidovudine (17; 65%), Stavudine (7), Abacavir (1), Didanosine (1). Reasons for switch: lipodystrophy/fat loss (17), nail discolouration (1), raised serum lipids (1), lipodystrophy concern (1), peripheral neuropathy (1), neutropaenia (1). No reason for switch recorded: 4 patients. Regime simplification was not cited as a reason for switch in this sample. Mean serum Hb at baseline was 14.01g/dL. Mean serum haemoglobin and random cholesterol six-month post switch were not significantly different to baseline (p=0.43 and p=0.36). Six months after switching, 8/17 lipodystrophy patients showed subjective improvement (7/8 objective); 9/17 no worsening. The patient with raised serum lipids improved (t0 T Chol = 11.20mmol/L; t6 T Chol = 6.23mmol/L). The patient with peripheral neuropathy also improved subjectively. Conclusions: Data in our cohort suggests that switching to Tenofovir is clinically beneficial in the management/stabilisation of patients with lipodystrophy. Longer follow up would be valuable. This audit was made possible thanks to an unrestricted educational grant from Gilead Sciences. P36 ● Boosted atazanavir use in an intravenous drug user cohort S Chew, J Kieran, C Bergin, F Mulcahy Department of Genitourinary Medicine and Infectious Diseases, St. James's Hospital, Dublin, Ireland Introduction: Atazanavir (ATZ) is the first once-daily (OD) protease inhibitor for the treatment of human immunodeficiency virus type 1 infection and was first prescribed at our service in September 2003, soon after it received FDA approval. Due to its OD dosing, it is favoured when choosing an ART regime for an intravenous drug user (IVDU) to maximize compliance. Aims: The aim of this audit is to analyse HIV positive IVDU attending our clinic to determine: The proportion receiving a boosted ATV containing regimen as their first ART regimen versus salvage regimen; Compliance at the end of the follow up period; The effect of boosted ATV containing ART regimen on CD4 and HIV viral load (VL); The frequency of hyperbilirubinemia due to ATV and its severity. Method: A retrospective chart analysis of patients attending our HIV clinic and receiving a boosted ATV containing ART regime from September 2003 to October 2004. These patients were followed up for 3 months from the date of ATV commencement. Data was also cross-referenced with pharmacy records. Results: There were a total of 67 patients who received ATV during the specified period. Of these, 45/67 (67.1%) were IVDU. 11/45 were on their first ART regimen, 14/45 had received more than 2 previous ART regimes. After 3 months, only 33/45 (73.3%) were still compliant with the boosted ATV containing ART regimen. The rest were either lost to follow up or still attending the clinic, but non-compliant with treatment. P37 ● The use of atazanavir/ritonavir as part of a once daily antiretroviral therapy regime in intravenous drug users N Chew St James’s Hospital, Dublin, Ireland Aim: The aim of this study is to evaluate efficacy, adherence, tolerability and hyperbilirubinemia in an atazanavir (ATV) containing antiretroviral (ART) regimen. Methods: All patients who commenced an ATV containing ART regimen between October 2003 to October 2004 were included in this prospective study. Adherence was measured by cross-referencing with pharmacy records. Symptoms of methadone withdrawal were monitored regularly by the drug treatment centre and at each HIV clinic visit. Week 12 data is presented. Results: 45 patients were included in this study. 33/45 (73.3%) were fully adherent to ART. On the basis of on treatment analysis, the mean increase in CD4 count was 101.2 cells/mm3 and 19/33 (57.6%) had VL<50 cpm. Of the remaining 14 patients who still had detectable VL, 13/14 had a 2 to 4 log reduction in VL. On intention to treat analysis, 42.2% of patients had VL<50 cpm. There were no cases of methadone withdrawal clinically. 10/33 (30.3%) of patients developed hyperbilirubinemia, none requiring discontinuation of ATV. Conclusion: Atazanavir is a favourable option in an ART regime for an IVDU to facilitate once daily directly observed therapy. P38 ● Clinical experience with atazanavir M Natha1, M Pakianathan1,2, T Sadiq1, B Marett1 1South West London HIV and GUM Clinical Services Network Heath Clinic, Mayday University Hospital, 2Courtyard Clinic, St Georges Hospital, London, UK Purpose of study: Boosted Atazanavir (ATZ/r) has been licensed in Europe since 2004 for the management of treatment experienced HIV positive patients. In the 045 study which demonstrated similar efficacy between ATV/r and boosted lopinavir, the number of patients assigned to the boosted atazanavir was relatively small (n=120). Additional data on the outcomes of patients taking boosted atazanavir will aid in informing future clinical practice. Methods: Ongoing, prospective, observational study on patients receiving ATV/RTV 300/100 mg daily as part of combination antiretroviral therapy (CART). Parameters assessed include HIV RNA, CD4 cell count, and safety (including lipids). Results: Available to 48 weeks. Table 1 describes the demographic and clinical baseline characteristics of patients. Baseline characteristics n =40 (at starting or switching to Atazanavir/r) Median age 38 Ethnicity % White 30 Black African 65 Other 5 Proportion treatment experienced 40 (100%) Median CD4 (cells/mm3 229 Baseline viral load <50 copies/ml 17 (43%) Median bilirubin change µmol/L +32 Conclusions: ATZ/r was well tolerated and there were no discontinuations. Expected elevations in serum bilirubin were observed. Most patients commencing an ATZ/r containing regimen achieved viral suppression to <400 copies/ml at 48 weeks follow-up. 23 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P39 ● Audit of concomitant protease inhibitor and proton pump inhibitor use ML Schmid, MC Bailey, MH Snow Department of Infection and Tropical Medicine, Newcastle General Hospital, Newcastle, UK Aim: Following recent interaction warning of atazanavir (ATV) and omeprazole we audited our cohort to identify if concomitant protease inhibitor (PI) and proton pump inhibitor (PPI) use had a negative effect on HIV +ve patients. Methods: Retrospective case note review and prospective PI therapeutic drug monitoring (TDM) in a regional North-East HIV cohort. Results: 11 episodes of longer-term concurrent PI/PPI treatment in 10/450 HIV+ve were identified: 9 episodes used lansoprazole, 2 omeprazole whilst on various PI regimens. No concurrent ATV or ATVr/omeprazole prescription was identified. 1 patient had viral load increase whilst on omeprazole/SQVandRTV which was attributed to viral resistance development. Rest of patients did not have any negative change in their viral loads. Patients on current PI/PPI treatment had TDM requested. Of those 2 patients on ATV or ATVr and PPI (lansoprazole) had TDM which were within therapeutic levels. Conclusion: No patient was on potentially dangerous ATV and omeprazole. However patients on ATV or ATVr/lansoprazole combination did not have reduced ATV levels. Patients on boosted or unboosted ATV requiring acid suppression may be safer to use PPIs with limited interaction like lansoprazole. P40 ● Atazanavir and acid suppressants – are doctors and patients aware? E Davies, K McCormick, C Ruddy, Y Mullens, M Bower, B Gazzard, M Nelson Chelsea and Westminster Hospital, London, UK Aim: To investigate the incidence of co-administration of atazanavir and proton pump inhibitors or H2 antagonists in a clinic cohort. Methods: A prospective survey of patients who consecutively attended the clinic pharmacy, established on atazanavir. Patients were questioned as to whether they were currently taking a PPI/H2 antagonist, whether it was prescribed by their doctor, purchased over the counter (OTC) and if they were aware of the potential problem with co-administration of these medications and atazanavir. Results: 68 patients were surveyed. 15 were currently taking PPIs or H2 antagonists. 14 of these (93%) had purchased the drug OTC. Only 53% of patients stated that they were aware of any guidance on the co-administration of these agents with atazanavir. Conclusion: Despite the fact that all patients attending our clinic are counselled regarding drug interaction issues and issued with written information when initiating atazanavir, this survey demonstrates that repeated reinforcement of such information is required at each visit. Conversely, only 1 patient had received their PPI/H2 antagonist via prescription which suggests that clinicians/HIV pharmacists seem to be well informed of the data. 24 P41 ● Effectiveness of tipranavir in a clinic cohort A Abbara, A Bhuya, L Davies, M Bower, R Popat, M Nelson, BG Gazzard Chelsea and Westminster Hospital, London, UK Aim: Tipranavir is the first non-peptidic protease inhibitor, and is active against both wildtype and multiple PI resistant HIV-1. It’s position in the HIV armamentarium remains unclear, with many physicians utilizing this drug only in late stage salvage. Methods: Retrospective note review Results: Ritonavir boosted tipranavir has been utilized in 10 patients at our unit. 8 male and 2 female. 8 patients received this drug following virological failure of protease inhibitor therapy, one for intensification, one had HIV-2. Patients were extensively pre-treated having received a mean of 5.4 NRTIs, 1.4 NNRTIs and 2.9 PIs. 4 received T20. In 8 individuals with virological failure, 7 had 5–8 PI mutations, one greater than 8 PI mutations. Of 8 individuals with a viral load quantifiable above 500 copies, 2 individuals achieved a viral load fall greater than 1 log within 6 months of therapy, and one individual a viral load below 500 copies. In both individuals who achieved a viral load fall greater than 1 log, the number of active drugs other than tipranavir in the regimen was 2, compared with no other active drugs in all 6 individuals who did not achieve this endpoint. Conclusion: Tipranavir when used as very late therapy with no other agents is a non-successful therapeutic approach. Individuals with other active agents available respond. P41a ● A sensitive case B Killingley, MA Johnson Royal Free Centre for HIV Medicine, London, UK A 34 year old Afro-Caribbean lady was diagnosed with HIV in June 2004, CD4 = 231 (26%). On 16/07/04, in Zambia, she was commenced on Trimune bd (Stavudine 30mg, Lamivudine 150mg and Nevirapine 200mg) after a lead in period with nevirapine alone. She presented to our centre on 18/08/04 with fever, abdominal pain and diarrhoea and 3 days later facial oedema and a maculopapular rash were seen. This progressed to a bullous and then blistering rash with involvement of mucous membranes. A diagnosis of Toxic Epidermal Necrolysis was confirmed on skin biopsy and in association with an acute hepatitis, a hypersensitivity reaction to Nevirapine was presumed. Drugs were withdrawn, she received human immunoglobulin and had a long and complicated recovery. The pathogenesis of Nevirapine hypersensitivity is probably immune mediated. There is a spectrum of severity, the incidence of Stevens Johnson syndrome is 0.3-1%. Risk is multifactorial and has been linked to female sex, CD4 count >250, Afro-Caribbean race and an HLA association. Toxicogenomic studies are underway and may identify other markers. Specific treatment options are limited, although intravenous immunoglobulin has been used with some success. This case highlights the importance of drug toxicity in HIV disease. 11th P42 Poster Abstracts ■ P44 ■ Prevalence of genital infections in a cohort of HIV-positive pregnant women Kaletra in pregnancy – experience of a north London teaching hospital C Brookings, R Browne, P Ratcliffe, W Khan, DA Hawkins Chelsea and Westminster Hospital, London, UK Aim: To investigate the prevalence of genital infections in a cohort of HIV positive pregnant women. Methods: All HIV positive pregnant women are offered a vaginal examination and screen for infections at 16–18 weeks and at 32 weeks. The screens are predominantly done in the 'Splash' clinic; a service based in the HIV clinic, run by a specialist GUM nurse. Retrospective clinical data from this service was analysed. Results: 42 out of 55 women agreed to screening between May 2003 and December 2004. Median age was 33 (range 19–41) and median CD4 was 318 (range 86–713). 8 were newly diagnosed with HIV. 19 women had two screens and the rest one. 22 women had infections detected; candida (8), bacterial vaginosis (7), chlamydia (1), B-haemolytic streptococcus (1), genital warts (1), bacterial vaginosis and candida (1), HSV and candida (1), genital warts and HSV (1). One woman had bacterial vaginosis and candida initially and candida alone on second screen. Conclusion: Genital infections in pregnant women are associated with adverse pregnancy outcomes (miscarriage, preterm delivery and infant infections). The prevalence of genital infections was 52 per 100 women. We recommend that all HIV positive pregnant women should be routinely screened. U Harrisson, S Shah, H Montgomery, S Madge, S Kinloch, M Tyrer, H Evans, Johnson M Royal Free Hospital Hampstead NHS Trust, Ian Charleson Day Centre, London, UK Introduction: HAART may increase the risk of premature delivery. Kaletra is often used during pregnancy, yet little is known of its effects on pregnancy complications. Methods: We retrospectively investigated pregnancy outcome, HIV factors and routine blood results of women receiving Kaletra during pregnancy between 2002–2004. Results: Of 35 HIV+ve women, 11(31%) used Kaletra during pregnancy, 6 received it prior to conception and 9 were black-African. Pre-pregnancy median CD4 counts and viral loads in patients commencing Kaletra during pregnancy and those using Kaletra prior to pregnancy were 478cells/mm3 and 6050copies/ml, and 499cells/mm3 and <50copies/ml respectively. 9/11 were admitted prior to planned caesarean section (CS), 4 were in labour, 3 had SROM, 2 suffered placental abruptions and 1 had HELLP. Additionally, 8 had emergency CS, 1 had spontaneous vaginal delivery and 2 had elective CS. Median gestation at delivery was 37+2 (excluding 1 emergency CS at 27wks). Median ALT was 13IU/l and AST 20IU/l. Viral loads <50copies/ml were seen in 9 women at delivery. Mean birth weight was 2765.5g (excluding 1 born at 27wks); 3 were admitted to neonatal ICU. All babies remain HIV-negative with no abnormalities. Conclusion: Kaletra is a viable choice for HIV+ve pregnant women but additional monitoring during the 3rd trimester is recommended. P43 P45 ■ ■ Potential clinical importance of altered nelfinavir pharmacokinetics in pregnancy Outcomes of planned vaginal delivery of HIV-positive women managed in a multi-disciplinary setting C Bell1, C Slater2, A DeRuiter2, H Noble3, G Taylor1 1St Mary’s Hospital, 2Guys and St Thomas’s, 3Newham General Hospital, London, UK Aim: Nelfinavir is widely prescribed in pregnancy but PK studies have shown reduced nelfinavir and M8 concentrations in pregnant women. We sought to determine whether these changes might impact on the antiviral effect of nelfinavir-containing HAART, using the initial rate of viral decay in treatment naive patients as a surrogate marker. Method: Pregnant and non-pregnant women commencing either nelfinavir or nevirapine, with AZT/3TC were identified retrospectively. The crude rate of viral decay was determined from pre-treatment and temporally comparable first on-treatment viral loads and compared for significance using t-test. Results: 39 pregnant (nevirapine n=17, nelfinavir n=22) and 27 non-pregnant women (22 and 5) were identified. Viral t1⁄2 in pregnant women taking nelfinavir was prolonged compared with non-pregnant women (4.15 v 2.94 days p 0.03). No significant difference was seen by pregnant state with nevirapine (2.1 v 1.75 days p 0.18). HIV decay at 2 weeks was significantly prolonged in the pregnant nelfinavir group compared with nevirapine (3.02 v 1.94 days p = 0.004). Conclusion: Although the study's small, retrospective and limited by relatively late first on-treatment viral load sampling the reduced rate of viral decay in pregnant women taking a nelfinavir-containing regimen suggest that the PK data are of clinical importance. R Browne1, EGH Lyall1,2, Z Penn1, W Khan1, DA Hawkins1 1Chelsea and Westminster Hospital, 2St Mary’s Hospital, London, UK Aim: To investigate the management and outcomes of HIV positive women having planned vaginal deliveries. Methods: Women with or expected to have viral loads of <50 copies/ml at 36 weeks are offered the option of a vaginal delivery provided there are no obstetric contraindications. Analysis of case notes and computerised data on this cohort was performed. Results: Between January 1999 and December 2004, 24 women (total 141) planned to deliver vaginally had 32 infants; 7 had >1 pregnancy. The proportion of the total infants born vaginally statistically significantly increased. With HAART all women achieved viral load <50 copies/ml =6 weeks prior to labour. Five women had an emergency caesarean section after the onset of labour due to failure to progress and one woman had a planned caesarean section after a rebound in viral load just prior to delivery. The median length of labour in the rest was 5 hours and 23 minutes. The median infant gestational age and birth weight was 39 weeks (IQR 37–39), and 2.9kg (IQR 2.6–3.2) respectively. There has been no HIV transmission to date. Conclusion: Women with viral loads of <50 copies/ml at 36 weeks should be offered the option of a planned vaginal delivery with optimal intra-partum care and senior review in labour. 25 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P46 ■ HIV infection results in body fat redistribution M Boothby, G Gilleran, N Crabtree, H Jaleel, M Shahmanesh University Hospitals Birmingham Foundation Trust, Birmingham, UK Background: Lipodystrophy is seen in some HIV infected patients receiving antiretroviral therapy. Peripheral lipoatrophy has been reported in some HIV treatment naive patients. To our knowledge there have not been any comparisons with HIV negative controls. Aims: Cross sectional study to measure body fat distribution by DEXA scan in HIV infected treatment naive patients and HIV negative controls Methods: Whole-body DEXA scans and fasting plasma lipids and glucose were performed in 25 HIV infected treatment naive patients (20 male) and 15 control subjects (8 male). Peripheral fat (arms plus legs), trunk fat and lean mass were expressed as g/height (cm). Ethical committee approval was obtained. Comparison between groups was by Chi-Squared test and Man Whitney test. Results: There were no differences in age, sex and ethnicity, LDL cholesterol, triglyceride, and glucose between the groups. Serum HDL cholesterol was significantly lower in the HIV infected persons (table 1) as was total cholesterol. While BMI and lean mass was similar between the two groups, HIV infected patients had a greater lean mass/height and a significantly reduced limb fat/height but not total fat/height or trunk fat/height (table 1). Controls HIV treatment Naive P value Age 32 (23–40) 34 (29–38) 0.41 Total cholesterol 5.10 (4.20–5.50) 4.30 (3.38–4.78) 0.012 LDL cholesterol 2.41 (2.20–3.48) 2.53 (1.92–2.92) 0.62 HDL cholesterol mmol/l 1.7 (1.5–2.2 1.0 (0.9–1.2) <0.001 BMI kgm2 24.1 (20–27.2) 23.8 (21.4–25.2) 0.62 Median +/– interquartile range Conclusion: Compared to control subject, HIV infected patients who are not on antiretroviral treatment have approximately 2.5 kg (28%) loss of limb fat compared to HIV negative controls. P47 ■ Decreased incidence of lipoatrophy in a group of HIV-positive people taking HAART (highly active antiretroviral therapy) without stavudine assessed by anthropometry measurements and reported self–perceptions of body shape changes C Taylor, V Pribram, C Hodgson, R Goncalves, P Easterbrook King’s College Hospital, London, UK Aim: To assess fat redistribution occurrence in the current therapeutic era. Method: An observational study comparing morphological changes before HAART and 12–36 months post HAART using anthropometry and standardised questionnaire. Results: This treatment naive group (n=74) enrolled 6/2000-11/2002 consisted of 42% women, 51% black Africans, 19% black Caribbeans, 30% Caucasians, with mean age 37.5 (SD=/–8.3) mean nadir CD4 173.2 (SD+/-139). Ninety-three percent of nucleoside analogues used were zidovudine, lamivudine, emtricitabine, abacavir; non-nucleosides used consisted of efavirenz (83%), nevirapine (17%). Four percent of prescribed drugs were protease inhibitors (PIs). Anthropometry, consistent with reported patient perceptions, showed statistically significant increases in weight (p=.000), waist circumference (p=. 018), suprailiac (p=.047) indicating increased subcutaneous adipose tissue, mid-upper arm (p=.008), and hip circumference (p=.023). This trend was strongest among women, black Africans and with CD4 nadir <200. Improvements were reported for facial wasting from pre-treatment levels, particularly among over 35s (p=.034). There were no statistically significant increases in LDL cholesterol, reported thinning of legs, buttocks, or increased vein prominence. Conclusion: Unlike stavudine containing HAART regimes, these results demonstrate an absence of lipoatrophy but high incidence of increased abdominal girth despite very limited PI use. Increased waist size may largely be due to substantial weight gain on HAART in this population. 26 P48 ■ Experience of the use of statins and fibrates in patients receiving highly active antiretroviral therapy (HAART) in the Edinburgh HIV Cohort WI Beadles, CLS Leen, X Recabarron, R Lessells Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK Background: Our objective was to assess the indications for commencing lipid lowering agents and their efficacy and tolerability. Methods: Medical notes were reviewed for patients on HAART and a lipid lowering agents. Results: There were 330 patients on HAART, of whom 29 were on a statin, 2 a fibrate and 2 both. 7 patients had diabetes, 7 ischaemic heart disease, 5 peripheral vascular disease and 2 cerebral vascular disease. 10 year risk of a major coronary event was calculated for patients at time of commencing statin/ fibrate: 6= <10%, 8= 10–20%, 8= >20%, 1= >30%, 8= insufficient data. 1 patient had a possible statin related rash; there were no cases of myositis or hepatotoxicity. 26% of patients had >30% decrease in cholesterol at 6 months. Of patients <30% change in cholesterol, 43% (10/23) had their statin increased or a fibrate added and of these 20% (2/10) had >30% decrease in cholesterol at 6 months. Conclusions: The threshold for commencing patients in this cohort on a lipid lowering agent maybe lower than in the general population. Statins and fibrates were well tolerated. Further guidance is needed to help in the management of those patients who have poor response to these agents. P49 ■ Long-term efficacy and safety of injectable poly-Llactic acid for the correction of facial lipoatrophy SE Barton, GJ Moyle, L Lysakova, S Brown Department of HIV Medicine, Chelsea and Westminster Hospital, London, UK Objective: To evaluate the long-term safety and efficacy of injectable poly-L-lactic acid (PLLA) for the correction of HIV-associated facial lipoatrophy (LA). Methods: This was a randomised, open-label, comparative, single-centre study of Immediate (Weeks 0, 2 and 4) or Delayed (Weeks 12, 14 and 16) PLLA treatment, administered as three sessions of bilateral injections into the deep dermis above the buccal fat pad. Efficacy was evaluated at the Recall Visit (12–18 months post final study assessment) using visual analogue scales (VAS) to record patient satisfaction, and by the Hospital Anxiety and Depression Scale (HADS). All adverse events (AEs) were recorded. Results: Twenty-seven of 30 patients returned for the Recall Visit. Significant improvements over baseline in VAS scores for facial appearance were sustained to the Recall Visit in both groups (p<0.05 and p<0.001). Improving trends in HADS scores were also noted. One case of injection-site induration and 9 cases of injection-site nodules were noted the Recall Visit, none of which were serious or severe. Conclusions: Physical and psychological benefits of PLLA are sustained over at least 18 months. Delayed AEs are neither serious nor severe and include mild nodularity at the treatment site. 11th P50 Poster Abstracts ■ P52 ■ Nucleoside reverse transcriptase inhibitors (NRTI)-related hepatic fibrosis and decompensated portal hypertension The prevalence of canonical resistance mutations in naive HIV-1 infected patients is low and did not increase over the time period of 2000 to 2003 JA Garcia-Garcia, S Bhagani1, A Quaglia, M Tyrer, MA Johnson, G Slapak Royal Free Hospital, London, UK, 1Hospital Universitario de Valme, Seville, Spain Aim: We report three cases of advanced hepatic fibrosis in HIV-positive patients on highly active antiretroviral therapy without any other aetiology of liver disease. Results: Three patients presented to our centre with variceal bleeding. Prolonged previous therapy with stavudine and didanosine were involved in all cases (median 5.6 years). Two patients had also taken hydroxyurea. Mild transaminitis and lipodystrophy was previously noted in all the patients. Other recognisable aetiologies of liver disease were not seen on liver biopsies or evident from laboratory tests or past medical histories. All denied alcohol intake. They had well-controlled HIV disease (CD4 count higher than 250 cells/mm3 and viral load less than 1000 copies/mL in all the cases). Variceal bleeding were treated initially with band-ligation and then prophylactic banding as well as nonselective betablockade. Antiretrovirals were changed to nucleoside sparing regimens. Liver transplantation is being considered. Conclusion: Prolonged NRTI therapy may lead to progressive hepatic fibrosis, probably as a result of mitochondrial toxicity and non-alcoholic steatohepatitis. Clinicians should be aware of the risk of significant liver disease in patients with lipodystrophy, prolonged current or previous NRTI-use and even a moderate transaminitis. These patients should be offered early evaluation for fibrosis and portal hypertension. H Price, R Jones, S Mandalia, M Bower, M Nelson, B Gazzard Department of HIV Medicine, Chelsea and Westminster Hospital, London, UK Background: Recent studies have suggested that the transmission of drug resistant virus following primary HIV infection is increasing. This study examines the prevalence of mutations in an ARV naive population from 2000–2003 at the Chelsea and Westminster Hospital. Methods: Since 2000 all patients naive to therapy have had a resistance test performed on the first stored blood sample available. Significant mutations were identified using IAS criteria. Individuals with VL<500 were excluded from the analysis. Results: The prevalence of mutations in each of the 3 classes of ARVs has been 10% over each of the last four years. (χ2 for trend analysis p=0.5. P51 P53 ■ Conclusion: Acquisition of drug resistant HIV-1 has been constant over the last four years. ■ Thyroid dysfunction amongst HIV-infected patients: HIV or HAART? How common is the K65R mutation in clinical practice? S. Pren, A Scourfield, J Smythe, M Stefanovic, R Jones, S Mandalia, AK Sullivan, MR Nelson, BG Gazzard Chelsea and Westminster Hospital, London, UK Aim: To evaluate the prevalence of thyroid disease in our HIV cohort and to assess the possible role of HAART. Methods: We reviewed the case notes of all patients prescribed thyroid medication between April 1995–June 2004. Patients with known thyroid disease were excluded Routine screening of thyroid function was subsequently performed from August–November 2004. Results: Of 35 patients, 3 had thyroid disease pre-HAART. 72% were male, 84% White Caucasian and mean age was 43.1 years. Median (IQR) CD4: 228(156-325) incidence/10000 patient years (95%CI). E Harte, P Tilston, E Wilkins, A Bonington, J Vilar, E Dunbar, S Clarke North Manchester General Hospital, Manchester, UK Background: There is little data on the emergence of K65R in routine clinical settings, where there is widespread prescribing of Tenofovir (TDF) to both ART naive and experienced patients. Methods: A retrospective review was carried out on patients who acquired the K65R mutation over a 6 year period. Results: Since the availability of TDF, 350 patients have received this medication, with 27 patients developing the K65R mutation. Twenty-five patients (93%) were ART experienced with a mean of four prior combinations, including prior exposure to thymidine analogues (TA). Two patients were ART naive. At the time of the emergence of K65R, twenty-five patients were not receiving any TA. Both patients who were receiving a TA were poorly compliant. In addition to K65R, other mutations included: 7 × M184V, 11 × Y181C, 11 × K103N, 4 × Y115F, 2 × K219E, 3 × D67N. Twenty-four patients (88%) had no TAMs, and two patients had a single TAM, one patient with two TAMs. Conclusion: These data demonstrate that the emergence of the K65R mutation is not as common as perhaps thought from the clinical trial setting. The data also provides further evidence of the negative correlation between K65R and the presence of TAMs. Conclusion: The results indicate a significant prevalence of thyroid disease in HIV positive patients on HAART. Thyroid antibody production in some patients suggests an association with immune restoration following HAART. Thyroid disease was not linked to any class of ART. 27 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P54 ■ Which antiretroviral regimens drive the K65R and L74V mutations? L Waters, S Mandalia, M Nelson, M Bower, BG Gazzard Department of HIV Medicine, The Chelsea and Westminster Hospital, London, UK Aim: To investigate which antiretrovirals drive the K65R and L74V mutations. Methods: Data were extracted for all patients entering our cohort since January 2000. We identified all those with either mutation, analysed preceding HAART regimens and calculated risk per 100PY of exposure to various combinations of TFV, ddI and ABC. Results: 81 and 129 patients with available drug history developed K65R/L74V respectively. The numbers of patients (rate per 100PY) are expressed below. Conclusion: K65R is driven mainly by TFV/ddI +/-ABC (particularly with NRTI -only regimens). PIs appear to be protective. L74V is predominantly driven by ddI/ABC or ddI/TFV; although numbers are small, PIs don't appear to confer protection. P55 28 ■ P56 ■ The presence of a single canonical NNRTI resistance mutation in naive HIV-1 infected patients reduces the proportion achieving virological success when starting NNRTI-based regimens H Price, R Jones, S Mandalia, M Bower, M Nelson, B Gazzard Department of HIV Medicine, Chelsea and Westminster Hospital, London, UK Aim: There is a 10% prevalence of resistance mutations in plasma samples from antiretroviral (ARV) naive patients. This study examines whether this influences the result of treatment. Methods: Between 2000 and 2003, 808 patients had a resistance test retrospectively performed on a stored sample taken prior to initiating therapy with either a PI-based regimen, an NNRTI-based regimen or nucleoside analogues only. The proportion of patients who were virologically undetectable within six months was assessed. Results: N Rx PI Rx NN Rx NA only PI mutation 28 5 ex 6 17 ex 19 2 ex 3 NNRTI mutation 49 13 ex 15 19 ex 31 2 ex 3 Multiple mutations 27 4 ex 9 8 ex 14 3 ex 4 No mutations 704 98 ex 155 397 ex 506 29 ex 43 Conclusion: More than half the patients treated with NNRTI regimens responded despite pre-existing resistance although response to a PI containing regimen was better. P57 ● Do the mutations M046I and I047A confer resistance to Kaletra? Nevirapine use in pregnant HIV-positive women – is it the end? (Experience of a provincial centre) M Stevanovic, H Price, R Jones, S Mandalia, M Bower, M Nelson, B Gazzard Department of HIV and GU Medicine, The Chelsea and Westminster Hospital, London, UK Introduction: In HAART experienced patients, protease inhibitor (PI) resistance constitutes a major treatment challenge. Kaletra, the formulation of lopinavir and ritonavir, has significant antiretroviral potency often maintaining antiviral activity where other PI regimens have failed. Recent data have suggested that the mutations M046I and I047A may confer resistance to Kaletra. Methods: All individuals with genotypic resistance tests demonstrating M046I and I047A were identified from a large, prospectively collected clinical database. Data were scrutinised to identify treatment history and immunological outcomes in each of the individuals. Results: A total of 7715 resistance tests pertaining to 3476 patients have been collected at this institution. 104 individuals harboured M046I, I047A or both. Of these, 7 (6.7%) individuals had previous exposure to Kaletra as part of their antiretroviral regimen. 52 individuals were exposed to Kaletra following resistance testing. Of these, 33 (63.5%) maintained an undetectable viral load whilst prescribed a Kaletra containing HAART regimen. Conclusion: Prior exposure to Kaletra is not required in the development of the mutations M046I and I047A. Presence of these mutations does not adversely affect virological response to Kaletra therapy as part of an HAART regimen. C Chapman, J Dhar Department of GU Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK Background: Since 1997 Nevirapine (NVP) has been used as monotherapy and combination in HAART to prevent mother to child transmission in HIV disease. Concerns about its use in patients with a relatively intact CD4 count prompted a ‘Dear Doctors’ letter in February 2004. Aim: To review the use of NVP in pregnant females, and assess the incidence of adverse events in our cohort. To explore the impact, if any, on the prescribing practices post February 2004. Method: The case notes of all HIV positive pregnant women between January 2000–December 2004 were reviewed. Results: During this period the total number of pregnancies documented were 90, which included 5 miscarriages, 2 terminations and 1 stillbirth. Of the 82 pregnancies the majority were of Black African origin. 51 (57%) patients received NVP as combination therapy. 4 (7%) in this group developed side effects requiring hospitalisation, including a case of toxic epidermal necrolysis. Data will be presented indicating a shift from the recommended guidelines for the management of pregnant HIV positive women in our area post February 2004. 11th P58 Poster Abstracts ● P60 ● Experience of delivering women with HIV in an inner city London hospital 1994–2002 Tenofovir-associated renal dysfunction – can we predict it? M Parisaei1, J Anderson2, KJ Erskine1 E Devitt, E Wallace, M Bryne, WG Powderly, G Sheehan Department of Infectious Diseases, Mater Misericordiae Hospital, Dublin, Ireland Aim: To review cases of tenofovir (TDF) associated renal dysfunction within our cohort and to see if there are any predictors of this adverse outcome. Methods: A review of all patients attending an urban HIV unit who have received TDF as part of combination antiretroviral therapy. Cases that have developed renal dysfunction (creatinine clearance <50ml/min) were identified and further evaluated. Results: 101 patients have been prescribed TDF. Three cases of renal dysfunction were identified. Mean CD4 starting TDF was 171. Elevation in serum creatinine from baseline occurred in all cases. Hypophosphataemia occurred in one. The cases had a baseline creatinine clearance of 120, 71 and 85 ml/min. The latter two had significant co-morbidities including diabetes mellitus, hypertension and liver disease. 2/3 cases required hospitalisation and discontinuation of TDF with return towards baseline of renal parameters. 2/3 cases died, neither death was felt to be solely due to renal dysfunction. Conclusion: The contribution of tenofovir to renal dysfunction is controversial. Although elevated creatinine was not seen in clinical trials, TDF has been linked with renal tubular dysfunction in several case reports. Our cases highlight the possibility of developing renal dysfunction while on TDF, but also indicate the potential contribution of other co-morbidities. 1Department of Obstetrics and 2Sexual Health, Homerton University Hospital NHS Foundation Trust, London, UK Objective: To compare pregnancy outcomes of women with and without HIV. Design: Retrospective review of pregnancy and outcomes 1994-2002. Setting: Inner City London Hospital, UK (Homerton University Hospital) Results: A total of 82 deliveries were studied in 88 women with HIV. Compared to the general antenatal population these women were more likely to be black African with inadequate housing and only 65% spoke English as a first language. However there were few intercurrent medical or antenatal complications except previous history of depression. 81% were delivered by caesarean section. There was one vertical transmission in this period. 95 % of the women with HIV had an uneventful postnatal period. Conclusion: Based on our observations there is room for optimism about the obstetric course and outcome of pregnancy in women with HIV in a multidisciplinary setting. P59 ● P61 ● HAART to heart. Where do DHIVA diets fit into BHIVA guidelines? Toxic levels of efavirenz (EFV) two weeks after stopping therapy A Culkin1, C Stradling2, on behalf of DHIVA3 1Northwick Park Hospital, Harrow, 2Birmingham Heartlands Hospital, 3Dietitians in HIV/AIDS Group of the British Dietetic Association, UK Background: The BHIVA Treatment Guidelines for HIV infected adults (2003) state that all newly diagnosed patients should have baseline bloods including a lipid profile and glucose level. The aim was to audit the guidelines and subsequent action taken on abnormal levels. Methods: An audit form was devised and the case notes of 70 patients, diagnosed with HIV since 2003, from 7 centres in England were reviewed. Results: Baseline cholesterol, triglyceride and glucose were recorded in 68 (97%), 67(96%) and 61(87%) respectively, of patients studied. 23(34%) cholesterol, 20 (30%) triglyceride and 8 (13%) glucose levels were raised. Only 9 patients with raised levels were repeated fasting. 18 (25%) patients were referred to the dietician, of whom 6 were given appropriate lipid advice (Mediterranean diet, omega 3 fats, fruit and vegetables, increased activity levels), and a further 6 were found to have normal levels when repeated fasting. 6 patients were appropriately referred for other reasons including PEG feeding, nephrotic syndrome and weight reduction. None of the patients were prescribed lipid lowering medication. Conclusion: Clinics are measuring baseline bloods to identify patients who may be at risk of lipodystrophy. In most cases, referrals to dieticians are made and the assessment of CHD risk factors may warrant further dietetic input. G Crowe1, SH Khoo2 1Princess Alexandra Hospital, Harlow, Essex, 2University of Liverpool, Liverpool, UK Introduction: We present a 40 year old HIV positive African woman who developed toxic levels of EFV which persisted for more than 2 weeks after stopping therapy. Case Report: A 40 year old Zambian woman was diagnosed HIV positive in June 2004. Baseline viral load (VL) and CD4 were 22,121 copies per ml and 34 × 106 per litre respectively. Antiretroviral therapy was commenced with Zidovudine, Lamivudine and EFV along with Septrin for PCP prophylaxis. Two months later she complained of weakness, nausea, vomiting and shortness of breath, and further investigations revealed pulmonary tuberculosis. She was commenced on Rifampicin, Isoniazid, Ethambutol, Pyrazinamide and Pyridoxine, and her EFV was increased from 600 mgs to 800 mgs daily. Two weeks later therapeutic drug monitoring (TDM) was carried out which revealed an EFV trough level of 27,499 ng/ml. There were no neurological symptoms or signs at this stage. Her EFV was decreased to 600 mgs per day and a further TDM was carried out two weeks later. This showed a level of 44,463 ng/ml and EFV was stopped. At this stage she appeared vague, confused, was unsteady on her feet, walked with a broad based gait and exhibited dysdiadokokinesis. An MRI of brain was normal. Repeat TDM levels over the following two weeks showed a slow decrease in levels. Conclusions: EFV levels rose to toxic concentrations despite co-administration with Rifampicin which is known to increase EFV metabolism. Levels fell slowly and were still in the toxic range more than two weeks after stopping therapy. Neurological toxicity was not noted until levels above 27,000 ng/ml were reached. TDM was vital to enable correct management. Further genetic investigations to sequence the CYP2B6 gene are being undertaken. 29 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P62 30 ● P64 ● The snail’s progress: a case report of schistosomiasis in the era of HAART Opsoclonus-myoclonus syndrome following the initiation of HAART S de Silva1, J Walsh2, M Brown3 1Mortimer Market Centre, Camden Primary Care Trust, 2St Mary’s Hospital, London, 3London School of Hygiene and Tropical Medicine, London, UK We describe a 36 year old man from South Africa, diagnosed with HIV infection in 1990. Following initiation of HAART in November 2002, his CD4 count increased from 190 × 106/l to 230 × 106/l in 4 weeks. At 6 weeks he presented with vomiting, abdominal pain and diarrhoea. Attributing these symptoms to his medication, he stopped his HAART, with prompt symptomatic improvement. The gastrointestinal symptoms recurred 3 weeks after re-initiation of HAART. During the following 2 years his symptoms forced him to stop treatment on 5 occasions – each time demonstrating the temporal association between HAART and these GI symptoms. Following extensive investigations, colonic histology demonstrated numerous granulomas containing ova of Schistosoma mansoni. Schistosoma antibody ELISA was positive at level 4. He was successfully treated with praziquantel. Schistosomiasis is the second most prevalent tropical disease, with approximately 120 million people worldwide symptomatic and 600 million at risk. Schistosoma eggs are highly immunogenic. Granuloma formation leads to fibrosis causing long-term damage. This patient probably acquired S. mansoni many years previously, but only experienced symptoms following initiation of HAART. This immune reconstitution appears to have resulted in an acute inflammatory response to his chronic infection. This phenomenon is likely to take on further significance with the increasing availability of antiretroviral medication in the tropics. J Hutchinson1,3, AS Pym1, RWH Walker2, PA Brex2, S El Gadi3 1Departments of Infection and Immunity and 2Neurology, St Bartholomews and the Royal London Hospitals, and 3Departments of Sexual Health, Homerton University Hospital, London, UK Opsoclonus-mycoclonus syndrome (OMS) is a rare neuro-ophthalmological disorder usually considered to be either a paraneoplastic or post-infectious condition. We report a case of OMS in a 36-year-old HIV positive Caucasian woman. She presented with a week's history of dizziness progressing to an unsteady gait, shaking and vomiting. On neurological examination she was found to have opsoclonus, myoclonus of the arms and neck and truncal ataxia, the 3 hallmarks of OMS. Her CD4 count at presentation was 193 having risen from a nadir of 1 five months previously when she had reinitiated HAART after a three-year interruption. During this time she had been treated for Pneumocystis carinii pneumonia, salmonella septicaemia and cytomegalovirus infection. Extensive investigation failed to identify an associated neoplasm or precipitating infection. Her condition was not initially improved by clonazepam, sodium valproate or a 5-day course of intravenous immunoglobulin. Nevertheless she made a gradual and eventually almost full recovery over two months. OMS is thought to be immune mediated. The appearance of the condition following a rapid and steep rise in CD4 count suggests OMS could be a rare manifestation of Immune Reconstitution Inflammatory Syndrome (IRIS). P63 P65 ● ■ HAART improves outcome from HIV-associated TTP Plastic specula: can we ease the passage? S Roedling, RF Miller, M Scully, H Cohen, R Starke, SJ Machin, SG Edwards Department of Genitourinary Medicine, Mortimer Market Centre, Department of Haematology, University College Hospital, Royal Free and University College Medical School, UCL, London, UK Introduction: TTP is a rare cause of thrombocytopenia in HIV infection but incidence is up to 40 times higher than in the general population. It is due to deficiency of von Willebrand factor –cleaving protease (vWF-cp) activity. Standard treatment is plasma exchange (PE). Pre-HAART TTP appeared to be more common in those with advanced disease and had a poor prognosis. Aim: Describe clinical presentation, laboratory data, treatment and outcome in the era of HAART. Methods: Case note review. Results: 9 patients identified, 5 not known HIV+. All black African heterosexuals, 8 female. HAART was started in the first week of (PE) treatment of TTP and reduced the number of PE needed. 8/9 alive, all survived acute TTP. Longest survival 51⁄2 years to date. Relapse occurred in 2/2 patients who stopped HAART compared to 0/7 who continued. Both recovered following re-initiation of PE and HAART. vWF-cp levels were low at diagnosis in all patients and, in 4, increased as CD4 improved and HIV viral load fell. Conclusions: We highlight the importance of HIV testing all patients presenting with TTP. Treatment with plasma exchange and HAART is associated with a high rate of complete remission. Relapse occurs if HAART is stopped. L Kozakis, J Vuddamalay, P Munday Watford General Hospital, Vicarage Road, Watford, UK Aim: To investigate the effects of lubricating gel on the culture of Neisseria gonorrhoeae, and on Chlamydia trachomatis Strand Displacement Assay (SDA). Introduction: With the increased use of disposable plastic specula, a common problem is friction on insertion. The perceived wisdom is that specula should be used without lubrication other than water; however this does not appear to be robustly evidence based. Method: We looked at the effect of Aquagel on the culture of N. gonorrhoeae on 3 standard laboratory media. Varying dilutions of N. gonorrhoeae were created by taking different numbers of colonies and emulsifying them in 30 microliters of gel. They were then plated and incubated in the standard way and read after 48 hours. We also added 100 microliters of gel to the Chlamydia trachomaits SDA positive and negative controls, and ran the test as normal. Results: There was found to be no inhibition of growth of N. gonorrhoeae by Aquagel at any concentration. The positive and negative chlamydia controls were also unaffected by the addition of gel. Conclusion: We feel that the clinician should now feel more confident that if a difficult examination requires the use of a lubricant, the test results will not be compromised. 11th Poster Abstracts P66 P68 Withdrawn as requested. Comparison of the sensitivity and acceptability of meatal swabs with endourethral swabs for Chlamydia trachomatis NAAT testing in men ■ B Elawad, KN Sankar and CF Dickson Department of Genitourinary Medicine, Newcastle upon Tyne, UK Aim: Accuracy and patient acceptability of meatal swabs compared to endourethral swabs for detecting Chlamydia trachomatis. Method: 100 symptomatic men or chlamydia contacts recruited. Using standard urethral swabs meatal and endourethral swabs were collected and tested using Roche PCR C. trachomatis assay. Men completed questionnaire indicating swab causing least discomfort and time last urinated. C. trachomatis is diagnosed if both or either swabs tested positive Results: 36 men had positive meatal and urethral chlamydia swabs and 4 had positive urethral swabs only. Both methods scored 100% specificity. The sensitivity of meatal swab was 90.0% (95% CI 80.7%–100%) and urethral swabs 100%. 93% of men considered meatal sampling caused the least discomfort. No difference between the sensitivity of meatal swabs in symptomatic and asymptomatic chlamydia positive men. No relationship between the time of last urination and meatal swab sensitivity. Conclusion: Meatal swabs are more acceptable to men than endourethral swabs. Meatal swabs achieved high sensitivity, but the low lower 95% C.I. makes it unsatisfactory alternative to endourethral sampling. Meatal swabs may have place when endourethral swab is not tolerated and urine specimen unavailable. Design of a specific meatal swab may improve sensitivity. Additional assessment examining acceptability of self-collected swabs would be of value. P67 ■ A comparison of self-taken vulvo-vaginal and cervical samples for the diagnosis of Chlamydia trachomatis infection by PCR R Bendall1, FEA Keane2, N Saulsbury2, L Haddon2 1Department of Medical Microbiology, Royal Cornwall Hospital Trust, Truro, 2Department of Genito-urinary Medicine, RCHT, Truro, UK Background: The National Chlamydia Screening programme commenced in Cornwall in April 03 for under 25 year olds in Genito-urinary Medicine (GUM) and community venues, using Roche COBAS PCR diagnostics. Initially, urine samples were obtained in community sites and endocervical samples in GUM clinics. However, the rate of inhibitory results from female urines was unacceptably high (8%) and the positivity rate lower than from other anatomical sites. In January 04 self-taken vulvo-vaginal swabs became the preferred community collection specimen. We compared self-taken vulvo-vaginal and cervical samples for the diagnosis of C. trachomatis in GUM. Methods: Women under the age of 25 were invited to obtain their own vulvo-vaginal sample initially, an endocervial sample was obtained during examination and the results compared. Results. 333 women participated. The positivity rates for the 2 sampling sites are shown below. Vulvo/vag positive Vulvo/vag negative Cervical positive 51 2 53 (91.4%) Cervical negative 5 275 280 56 (96.6%) 277 15.3% of samples tested were positive at both sites, 15.9% from the cervical site were positive compared to 16.8% vulvo-vaginal samples. There is no significant difference between positivity rates in cervical and vulvo-vaginal samples. Conclusion: Self-taken vulvo-vaginal samples are an acceptable alternative to cervical samples for C. trachomatis diagnosis. P69 ■ Why we do not review NGU more than once? T Theobald1, C O'Connor2, F Berkt3 1Medicine Rostock Medical School, Germany, 2GU/STD clinics Regional Hospital, Limerick Ireland, 3Frankfurt Medical School, Germany Background: Increasing workloads in GUM clinics necessitates re-evaluation of work practices. A recent articlei states that 34% of clinics in UK do not require male patients with NSU re-attend. A review of literature showed paucity of evidence for either practice. Traditional practice was evaluated. Methods: Retrospective analysis of 1010 patients was done by reviewing files of men with non-gonococccal urethritis (NGU). Evaluated were: causative agents (chlamydia, anaerobes), cure rate at each review, sexual intercourse following treatment. Treatment policy is per UK guidelines. Retesting was done 3 weeks after therapy2. Results: 1010/1922 (52.5%) had NGU. Age range was 16.5-63 years. (mean=27.7). 25% had chlamydia (mean age=26.4) while 27% grew anaerobes. Table 1: Reviews Conclusions: 1. Between 50% and 65% resolved at each review. 2. Chlamydia trachomatis was present in 25% and anaerobes in 27%. 3. Significant differences in cure rate was found between those who had and had not sexual intercourse following treatment (p<.0005). 31 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P70 ■ Prevalence of genital infection in women attending prior to termination of pregnancy (TOP) 32 ■ Outbreak of gonorrhoea linked to internet use among men who have sex with men G Crowe, F Chhibber, S Amin Princess Alexandra Hospital NHS Trust, Essex, UK Background: Pelvic inflammatory disease occurs in up to 10% of women undergoing TOP and it is recommended that these women are screened for sexually transmitted infections (STIs) or given prophylactic antibiotics. In our area all patients are seen within the Department of Sexual Health (DOSH), offered a full STI screen including HIV, given prophylactic antibiotics and followed up if positive. We examine the prevalence of genital infections and HIV in this group. Methods: The notes of women attending for TOP between 1st January 2004 and 31st December 2004 were analysed. Results: Of 370 women who attended, 7 deferred their TOP and therefore 363 were offered screening, of whom 351 (96.7%) accepted. One hundred and sixty one infections were detected including 28 chlamydia infections, 6 cases of genital warts, and 1 molluscum contagiosum (MC). Of 355 women who accepted screening for HIV, 1 was positive. STIs were commonest in those aged 16–25 of whom 12% had chlamydia and 2.8% had warts or MC. All 28 patients with chlamydia were treated and recalled; 21 reattended of whom 1 required retreatment. Nine brought partners of whom 2 were also positive, and 7 others were known to have been treated elsewhere. Conclusions: Women seeking TOP will accept screening for STIs and HIV, and have a high prevalence (9.9%) of these infections. Follow-up of positive patients is assisted by the screening process being carried out within DOSH but despite this only 75% of those requiring follow-up, attended. We intend to pilot a dedicated telephone followup clinic within the TOP service to try and address this need. P71 P72 ■ CA Ison1, A Rea2, SA Collins2, IMC Martin1, N Bilek3, BG Spratt3 1Health Protection Agency Centre for Infections, Colindale, London, 2Department of Genitourinary Medicine, Lincoln County Hospital, 3Department of Infectious Disease Epidemiology, Imperial College London, London, UK Aim: To investigate an increase in numbers of cases of gonorrhoea among men who have sex with men (MSM) where sexual contact had been arranged through internet chat rooms or cruising in a rural part of England between July and September 2000. Methods: Case notes for all gonococcal diagnoses were reviewed using KC60 coding. Standard clinic operating procedures were followed to guide contact tracing and partner notification activity and contact network maps were constructed. A molecular method (NG-MAST) was used to genotype all available gonococcal isolates. Results: Epidemiological data were available for 41 patients, and typing results for 38. Seven clusters of linked patients, predominately among MSMs, were identified. Each cluster included multiple sexual partners many of whom were unidentified or untraceable. Molecular typing confirmed all known epidemiological links. There was evidence of contact through internet chat rooms in two of these clusters, (the largest cluster of 18) and of cruising in an additional two clusters. Conclusion: Acquisition of gonorrhoea and onward transmission within a rural town occurred through contact initiated via the internet or cruising, which has public health implications since they involve a high frequency of anonymous sexual contact and mixing of individuals from a wide geographical area. P73 ■ How molecular tests for gonorrhoea infection fit into a modernised genitourinary medicine service Getting it right the first time: an audit of gonorrhoea management in a high prevalence area C Ryan, G Kudesia, GR Kinghorn Sheffield Teaching Hospitals Trust, Sheffield, UK Background: The BD ProbeTec ET Strand Displacement Assay (SDA) test for gonorrhoea (and chlamydia) is reliable, acceptable, and increases laboratory efficiency. However it neither provides immediate results nor antimicrobial sensitivity data. Method: To establish a clinical protocol for optimal test use, a retrospective audit was performed in 1587 consecutive patients (736 males, 851 females) attending the GUM clinic in Sheffield. The case records of 54 patients who tested positive for gonorrhoea (27 males, 27 females) were further reviewed to determine the presence of risk factors for gonorrhoea. Results: All 27 positive males and 23 (85%) of 27 positive females had at least one risk factor for gonorrhoea. The 4 females without risk factors represented 15% of the gonorrhoea positive group, but only 0.47% of the tested women. Symptoms were the commonest risk factor and occurred in 93% males and 55% females. Discussion: Gonorrhoea screening by SDA alone, using the chlamydia screening sample, is feasible for the majority of asymptomatic GUM patients. Assessment of specific risk factors in the routine patient history identifies those in whom additional tests for microscopy and culture should be taken. Only a few women missed by risk factor assessment require repeat examination and additional culture tests prior to treatment. I Reeves, M Tenant-Flowers King’s College Hospital, London, UK Aim: To audit the management of gonorrhoea in an area of high prevalence in light of the current revision of guidelines and rising anti-microbial resistance. Method: A retrospective audit of all gonorrhoea diagnoses over a three-month period. Case notes were reviewed and data collected regarding demographics, site of infection, antibiotic sensitivity, treatment and outcome. Results: There were 144 diagnoses: 93 men and 51 women. Black patients accounted for 69% of infections. All women and 92% men were heterosexual. Thirteen infections were resistant to initial antibiotic treatment. In three of these cases, patients (all male) did not re-attend despite being recalled, effectively receiving azithromycin only. Two men receiving azithromycin for NSU did not re-attend for gonorrhoea treatment. Test of cure (TOC) was done in 67% cases. DNA rates for TOC were 35% men and 19% women. There were 6 positive TOC’s: 5 had evidence/high clinical suspicion of re-infection. Treatment of contacts was 0.24 per male patient and 0.52 per female. Conclusions: This audit supports doubt over the utility of TOC and highlights the importance of appropriate initial therapy and sensitivity testing. Attempts to address the issues raised in this audit include: targeted patient information, maintaining open-access clinics and educating local GPs. 11th P74 Poster Abstracts ■ ■ The syphilis outbreak in Northern Ireland Change from microscopy and culture to gonorrhoea strand displacement assay – is there an impact on clinical care? C Slater3, M Hawkins3, D Lewis3, E Fox1, J Klein2 1Department of GUM, 2Department of Microbiology, 3St Thomas’ Hospital, London, UK, St Thomas’ Hospital, London, UK Aim: Strand displacement assay (SDA) is now our screening test for gonorrhoea, with microscopy reserved for cases of high gonorrhoea probability and culture as confirmation. We assessed the impact of this change on clinical care. Methods: Case note review of 249 patients with gonorrhoea pre (OP, n=141) and post protocol change (NP, n=108). Data collected: sex, age, ethnicity, sexuality, symptoms, gonorrhoea SDA, microscopy and culture results, time to treatment and complications. Gold standard = positive gonorrhoea culture (gonorrhoea contacts presumed true positive SDA). Results: Men – SDA sensitivity 98%, positive predictive value (PPV) 100%. Percentage treated on day 1 was no different (75.5% NP vs OP 76%). Women – SDA sensitivity 100%, PPV 91.5%, false positive SDA 9.3%. SDA 100% PPV in higher risk women (SDA, microscopy and culture at presentation). Women treated day 1: NP vs OP – 41.8% vs 45.4% overall, 59% vs 60.9% asymptomatic; median time to treatment 25 vs 20 days; delayed treatment and subsequent PID 0% vs 5.6%. p>0.05 for all comparisons. Discussion: Use of SDA with selective microscopy and culture has not compromised patient care. The impact of false positive tests is difficult to quantify and positive gonorrhoea SDA results should always be confirmed by culture. P75 P76 ■ C Emerson, A Lynch, S Gray, C Cunningham, RD Maw Royal Victoria Hospital, Belfast, Ireland Background: The resurgence of syphilis has been well reported, with notable outbreaks in Brighton, Manchester, London and Dublin, predominately among men who have sex with men (MSM). We report here a similar outbreak in Northern Ireland. Methods: Case notes were reviewed from 1st July 2000 to 31 March 2004 of all GUM clinic attendees to identify those who met the agreed criteria for primary, secondary or early latent syphilis. An outbreak control team was established to improve surveillance and partner notification. Results: 96 individuals were diagnosed with syphilis, 83 were MSM. 16 indicated a contact in Dublin as likely source. 20 were identified through contact tracing. 4 had more than 1 episode of infection. Most (64) had 1 or 2 partners in the previous 3 months. 10 cases were HIV positive (8 aware of status). Conclusion: Initially the contacts were mostly from Dublin, as the outbreak gained momentum syphilis was contracted within Northern Ireland. The cohort was not generally associated with high number of sexual contacts, multiple anonymous partners or specific locations. The challenge is to educate both patients and health care professionals as to sexual health issues, specifically the risk associated with casual oral sex by MSM. P77 ■ Syphilis outbreak in Walsall: epidemiology and lessons for control and prevention Syphilis in Nottingham - predominantly a heterosexual disease A Joseph1, M Pallan2, S Chandramani1, I Morrall1 1Department of Genitourinary Medicine, Manor Hospital, Walsall, 2Directorate of Public Health, Primary Care Trust, Walsall, UK Aim: Review the epidemiology of the recent outbreak of syphilis and assess the risk taking behaviour among men who have sex with men (MSM). Methods: Syphilis cases diagnosed at the department of genitourinary medicine (GUM) and at outreach screening at a sauna and a public house during a 12 month period beginning September 2003 were reviewed. Risk taking behaviour was assessed using a standardised questionnaire among men attending the sauna. Results: Fifty IgM positive cases were diagnosed. Of the 39 males, 27 had acquired syphilis through heterosexual contact. Four cases were referred through outreach screening. Twenty-nine men and 4 women had primary syphilis while 11 patients were asymptomatic. Four heterosexual men reported commercial sex workers (CSW) as contacts. Six patients were HIV antibody positive of whom 2 seroconverted subsequently. Questionnaires were completed by 163 men, of whom 76% described themselves as MSM. Half the men reported having 2–5 sexual partners in the past month and 12% over 10 partners. Unprotected anal sex and oral sex was reported by 64% and 98% respectively in the past month. GUM services have never been used by 35% but 73% said they would use a service in the community such as the sauna. While 37% assumed that they were HIV negative, 53% assumed that their last sexual partner was HIV negative. Conclusion: Syphilis outbreak was occurring in two separate settings. Targeted multifaceted outreach programmes to include community venues and CSW's are necessary to combat further spread. K Ponnusamy, P Goold, C J Bignell, C A Bowman Department of Genitourinary medicine, Nottingham City Hospital, Nottingham, UK Aim: To describe the epidemiology and clinical features of the ongoing outbreak of infectious syphilis. Method: Case-note review of all patients diagnosed with infectious syphilis between December 2002 and December 2004. Enhanced partner notification was implemented to identify network connections. Results: Ninety-seven cases of infectious syphilis were diagnosed. Sixty-two cases were in men, of whom 46 (74.2%) were heterosexual. 3 gay men were HIV positive. Twelve men reported paying for sex. 9 of the 35 (25.7%) women were commercial sex workers (CSW). Six women were pregnant. A genital lesion was present in 70 cases (72.%) at presentation. Skin signs were present in eighty-four (86.5 %). 21 of 68 (30.8 %) genital ulcers were painful or tender. Inguinal lymphadenopathy was prominent in 38 male cases. 24 of the 38 dark-ground (DG) examinations performed were positive. 5 men were DG positive VDRL negative at presentation. In 67 cases (69 %) the diagnosis of syphilis was only established on receipt of serology results. Conclusions: Heterosexual transmission accounted for 83.5% of the cases in this local outbreak. Diagnosis relied heavily on serology despite the high prevalence of clinical signs. Close collaboration with local prostitute outreach project (POW) resulted in enhanced screening of CSWs. 33 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P78 ■ UK national audit of early syphilis management H McClean, D Daniels, C Carne, P Bunting, R Miller on behalf of the National Audit Group of British Association for Sexual Health And HIV, Royal Society of Medicine, London, UK A national audit of 781 early syphilis cases presenting during 2002–03 in UK genitourinary medicine clinics was conducted in late 2004, organised through the Regional Audit Groups. Data were aggregated by Region, allowing practice in Regions to be compared to the UK national guidelines and national averages. An EIA test was used to diagnose 89% of cases (regional range 18–100%) with highly variable use of other tests. A pre-treatment non-treponemal test (NTT) was obtained for 94% (50–100%). Uptake of HIV testing was 77% (69-94%). Overall, 67% of treatments were injected, with equal use of benzathine (50%, 0-97%) and procaine penicillin G (50%, 3–100%). Doxycycline comprised 85% (0–100%) of oral treatments. About 4% were not, or not known to be, treated. Treatment completion was recorded for 88% (71–100), resolution of lesions for 74% (40-96%), and a fourfold decline in NTT for 54% (37–70%). Only 35% (12–56%) had a negative NTT recorded at one year, mainly explained by non-attendance and other reasons. Contact tracing was provided for 87% (57–97%), and identified 997 traceable contacts of whom 511 (ratio 0.51, 0.26–0.70) were seen, and 215 (42% 3–73%) had syphilis. Individual NHS Trust data aggregated by Regions were provided to Chairs of Regional Audit Groups. P79 ■ ■ Topical 5% imiquimod cream in the management of anogenital warts unresponsive to four weeks of standard treatment K Aderogba, I Fernie, I Samuel Caldecot Centre, Kings College Hospital, London, UK Aim: To investigate the efficacy of topical 5% imiquimod cream in treating anogenital warts in cases non-responsive to 4 weeks of cryotherapy and /or topical podophyllotoxin solution. Method: A prospective study using self applied topical 5% imiquimod cream 3 times weekly for 16 weeks, or resolution, whichever was sooner. Partial response assessed as equal or >50% reduction in wart area, poor response <50%. Results: 61 patients recruited, 42 males and 19 females of which 16/42 and 11/19 were Afro-Caribbean respectively. Mean age 33. 8/42 males and 4/19 females were HIV positive. Amongst the males 18/42 (43%) had perianal warts alone. In the women 10/19 (52%) had vulval warts alone. Complete clearance rates were 34/61 (56%) of which 20/42 (48%) was male and 14/19 (74%) female. Median time to complete response was 4 weeks (range 1–18). 11/61 (18%) showed partial clearance with a median of 16 weeks use (range 8-26). 16/61 (26%) a poor response with a median 16 weeks use (range 4–22). Adverse events were observed in 11/61 (18%) and most commonly mild. One male experienced a severe reaction. Conclusion: 5% imiquimod cream demonstrated good efficacy and was well tolerated. Complete responses were better in females with no ethnic differences observed. P81 ● Women and men with herpes simplex (HSV) – telling a new partner and the impact on sexual relationships Should all confirmed cases of Chlamydia trachomatis be referred to a genitourinary medicine (GUM) clinic? M Nicholson1, L Waters2, S Barton2 A Davies, A Chiganze, H Birley Department of Genitourinary Medicine, Cardiff Royal Infirmary, Cardiff, UK Aim: To assess the initial management of patients with confirmed chlamydia infection subsequently referred to GUM and to identify any benefits of referral. Methods: Notes of 100 consecutive cases of Chlamydia trachomatis referred in from elsewhere (mainly general practice) in 2003 were hand searched. Treatment and contact tracing prior to referral, additional diagnoses made in GUM and number of further contacts identified, notified and treated as a result of referral were noted. Results: Prior to referral 67% received appropriate treatment, 4% received inappropriate treatment and 24% received no treatment. 57% had at least one contact notified and 32% had at least one contact treated. In GUM clinic 53 additional contacts were identified. 34% of the clients referred had further contacts notified and 16% had further contacts treated. On referral 68% were already chlamydia –ve. 7% had an additional STI and 36% an additional non-STI diagnosis made. Conclusions: The majority of cases of chlamydia infection can be adequately managed in primary care and routine referral to GUM may therefore not be justified. 1Herpes Viruses Association, London, 2Department of GU Medicine, Chelsea and Westminster Hospital, London, UK Aim: To assess the experiences of females and males with genital HSV when telling new partners and the outcomes of divulging this information. Method: The Herpes Viruses Association (HVA) sent a postal questionnaire to all their members, including questions on their experience of the impact of HSV on their relationships and their partners' attitude. Results: 200 individuals, 148 women, 52 men, responded. 39 females reported 39 rejections in 116 experiences when divulging their HSV status, 1/2.9 episodes. 12 men experienced rejection (19 times in 61), 1/3.2 divulgences. 107 people had never been rejected when telling 169 partners (52% and 55% of women and men respectively). Non-disclosure was reported by 14 women and 8 men, a non-significant difference. Non-disclosing men tend to be more recently infected. Most individuals reported having sex since their diagnosis and positive attitudes from their partners with a small proportion experiencing denial, judgemental or punitive attitudes. When asked if herpes simplex is more of a physical or emotional problem, both sexes find it more of an emotional problem. Conclusion: Most individuals with genital HSV infection divulge this information to new partners and the majority experienced positive responses. There is a trend for non-disclosure amongst the recently diagnosed. 34 P80 11th P81a Poster Abstracts ● Test > Text > Treatment: text messaging service (TMS) improves the time to treatment of Chlamydia trachomatis infection and reduces the cost of result provision P83 ● Chlamydial conjunctivitis resulting from direct ejaculation into the eye AS Menon-Johansson, F McNaught, S Mandalia, AK Sullivan John Hunter Clinic, Chelsea and Westminster Hospital, London, UK Aim: To assess the impact of TMS on time to treatment for genital Chlamydia trachomatis (CT) infection and result provision. Methods: Time from testing to diagnosis and treatment for patients with CT infection receiving results via text message (TG) was compared to a sex and age matched standard recall group (SG, n=21) over a six month period. Providing results in person, by phone and by text message were calculated to take 12, 4 and 1.5 minutes respectively. Economic calculations were based on a staff rate of £13/hr. Results: Of 952 text messages sent, 28 were for untreated CT. The mean number of days (standard deviation) to diagnosis was significantly shorter in TG vs SG; 7.9 (3.6) vs 11.2 (4.7), p < 0.001. The median time to treatment was 8.5 days (range 4–27 days) for TG vs 15.0 (range 7–35) for SG, p = 0.005. By month 6, 46.9 less hours were required to provide equivalent result numbers (69.0hrs vs 115.9hrs for month 1) with a saving of £609/month. Conclusions: Patients with genital CT infection are diagnosed and receive treatment sooner since the introduction of TMS. Significant savings in costs and staff time were seen following the introduction of this service. S Rackstraw, ND Viswalingam, BT Goh Diagnostic Clinic, Moorfields Eye Hospital, London, UK Background: The majority of cases of chlamydial conjunctivitis are thought to result from autoinoculation by the patient of infected genital secretions from themselves or their sexual partners. We noted that some patients had developed symptoms following direct ejaculation into the affected eye. Methods: Retrospective casenote review of chlamydial conjunctivitis seen at the Diagnostic Clinic from 1995–2004, looking for a history of direct ejaculation into the eye. Results: 4 cases of chlamydial conjunctivitis following ejaculation of semen directly into the eye were identified. The duration of onset of the eye symptoms was from 1 to 4 weeks, compared to experimental models where symptoms developed 2–19 days following inoculation of the organism. In only one case was chlamydia detected in the genital tract. In 3 cases, there was no evidence of genital chlamydial infection; the sources of the eye infection being either from infected genital material of their sexual partners transferred by hands to the eyes, or more likely from direct ejaculate inoculation. Conclusion: Chlamydial conjunctivitis can result from direct ejaculation into the eyes. This mode of transmission may underestimated as a history of ejaculation into the conjunctiva is not normally asked for. P82 P84 ● Prevalence of chlamydia in patients attending for termination of pregnancy S Bhaduri, C Minton, M Mann Sexual Health Service, South Worcestershire Primary Care Trust, UK Introduction: Patients undergoing a Termination of Pregnancy (TOP) are routinely screened and prophylactically treated for chlamydia pre-operatively to prevent post operative salpingitis. Is the prevalence of chlamydia in this population higher than those attending GU clinics? Methods: GU and TOP case notes were analysed retrospectively over 1 year for diagnoses of chlamydia (via PCR) with respect to age of attendees. Results: 2540 tests were done in GUM, 14.3% were positive. 369 tests were done pre TOP, 8.13% were positive. Age specific incidences were similar apart from 2 groups– a) patients less than age16 (GUM 9/55 were positive for chlamydia compared to TOP where 3/113 were positive, p<0.01) and b) those aged 30 and over (GUM 50/746 were positive compared to TOP 0/103, p<0.01), where a higher incidence was seen in GUM patients in both age groups. Conclusion: In view of the lower incidence of chlamydia in TOP attendees, particularly in attendees over 30 years of age, further work is required to look at the cost effectiveness of chlamydia screening in TOP in this older age group. ● Microscopic cervicitis, will you treat? R Moussa Ipswich Hospital, Ipswich, Suffolk, UK Background: Microscopic cervicitis is a controversial topic in GUM diagnosis and management. Objective: To evaluate the clinical significance of microscopic cervicitis in the diagnosis of STIs. Methods: 437 female patients attended the GUM clinic 1/5/04-30/6/04 and were examined. Of these, 105 were diagnosed as cervicitis as they had 10+ pus cells/HPF on cervical microscopy. Results: Of these 105 patients, 88 were coded as C4H and 17 as C4A when laboratory results available. [5 of those coded ac C4A were contacts of chlamydia (2), Gonorrhoea (1) and NSU (2)]. Another 6 were chlamydia positive with no cervicitis. Results of contacts of all female C4H patients will be shown. Also, details of co-existing infections. Conclusion: 105 female patients were treated for microscopic cervicitis from a total of 437 patients examined, i.e. 24% of female clinic attenders. In this study, chlamydia was diagnosed nearly 3 time as often in patients with cervicitis (17), as those without (6). With the increase in GUM attenders and the increased number of STIs diagnosed, how should we manage cervicitis? Is treating and contact tracing a waste of resources, or is it an opportunity for preventing PID and tubal infertility? 35 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P85 ● Lymphogranuloma venerum in HIV-positive homosexual men: is an outbreak emerging in London? ● MK Malu, KW Radcliffe Whittall Street Clinic, Birmingham, UK Aim: To compare the outcome of management of gonorrhoea by test of cure with telephonic follow-up. Methods: Data was collected from the case notes of patients with gonorrhoea managed between April and September 2003 using test of cure, and cases managed between April and September 2004 by telephonic follow-up. Results: Patients was similar in terms of age, sex, sexual orientation in both the groups, but ethnic mix was different. There were more whites (30.3% vs 19.8%, p=0.004), less blacks (43.9% vs 56.5%, p= 0.003) and less other ethnic groups (12.9% vs 21.6%, p=0.007) in the telephonic follow-up phase than the test of cure phase. Conclusion: Outcome of management of cases of gonorrhoea with telephonic follow-up is satisfactory and a step in right direction towards the modernization of GUM services. P88 ● The demography of gonorrhoea in Wales – an analysis from the GRASP study Gonorrhoea treatment response after change to treatment guidelines CM Davies1, D Thomas2, M Lyons2, H Birley3, R Das4, E Rudd5, C Ison6 M Tung1, A Kingston1, L Low1, T Annan1, B Azadian2, AK Sullivan1 1Department of Genitourinary Medicine, 2Department of Microbiology, Chelsea and Westminster Hospital, London, UK Aim: To assess the clinical and microbiological response to treatment of gonorrhoea following the change in national treatment guidelines for first line antibiotic therapy to cefixime or ceftriaxone, and to identify any cases of cephalosporin resistance. Methods: Antibiotic sensitivities and clinical data were collected for all culture positive gonorrhoea infections identified over a four month period in three genitourinary medicine clinics. Results: 198 cases were identified. Patients’ mean age was 31.2 years, 174 (88%) were men, 112 (64%) were MSM. 83 cases (42%) were treated with cefixime, 78 (39%) with ceftriaxone, and 28 (14%) with ciprofloxacin. The incidence of chlamydia co-infection was 12%; 18 (75%) cases in men, 10 (56%) heterosexual. No isolates demonstrated resistance to cephalosporins, 11% were ciprofloxacin resistant, 6% penicillin resistant and 4% resistant to both penicillin and quinolones. 140 patients (70%) returned for follow-up, 134 (96%) were successfully treated becoming asymptomatic with a negative test of cure. 3 cases (2%) had positive gonococcal cultures following treatment, with no evidence of antibiotic resistance. Cause for treatment failure was unprotected intercourse with an untreated partner. Conclusion: The use of cefixime or ceftriaxone for uncomplicated gonorrhoea infection is effective clinically and microbiologically with no cases of treatment failure. 1Cardiff Royal Infirmary, Wales, 2NPHS CDSC Wales, 3Cardiff Royal Infirmary, Wales, 4Royal Gwent Hospital, Wales, 5Communicable Disease Surveillance Centre, 6Centre for Infections, Health Protection Agency, London, UK Introduction: New cases of uncomplicated gonorrhoea seen at GUM clinics in England (reported on form KC60) decreased by 5% between 2002 and 2003. In Wales the number of cases diagnosed by GUM clinics increased by 29%. Welsh laboratory reports from Cardiff and Newport indicate a further increase in 2004. This report examines the increase in gonorrhoea seen in Wales (2000-2003) using data from GRASP (the sentinel surveillance system for gonococcal resistance to antimicrobials). Data from Cardiff GUM clinic includes 2004. Results: The figures confirm a rise in the number of cases of gonorrhoea in Wales since 2001. The number of patients diagnosed with gonorrhoea from ethnic minorities in Wales (7% in 2003) is remarkably low when compared to data from all centres across England and Wales. Data from Cardiff demonstrate a 55% increase in the number of cases of gonorrhoea from 2003 to 2004. The increase occurs in all groups, the largest increase being in heterosexual males. The distribution of diagnosis in homosexual males (40% and 38% in Cardiff in 2003 and 2004 respectively) is notably high. Conclusion: Gonorrhoea cases have continued to increase in contrast to national data, highlighting the necessity of local surveillance to inform public health. 36 ● Telephonic follow-up of gonorrhoea: a step in the right direction NT Annan1, J Dunning1, NA Smith1, K McLean1, B Azadian1, N MacDonald2, C Ison2, M Nelson1 1Chelsea and Westminster Hospital, London, 2Health Protection Agency, Colindale, UK Introduction: Recent outbreaks of Chlamydia trachomatis L2 genotype have been reported amongst gay men in Western Europe. Lymphogranuloma venerum (LGV) is associated with transmission of HIV infection. Case report: We report the cases of five HIV positive men presenting to our clinics between November 2004 and January 2005. All presented with proctitis and 40% with perianal ulceration following unprotected passive anal sex. Four had sexual contacts outside the UK (Italy, Germany and Madeira). Three patients were antiretroviral (ART) naive and two were ART experienced with viral loads <50 copies/Molalla cases had positive rectal chlamydia nucleic acid amplification tests for Chlamydia trachomatis of the L2 genotype. All cases were successively treated with doxycycline. Three cases had concurrent rectal gonorrhoea and were treated with Ceftriaxone. Conclusion: Given the outbreaks in Western Europe and the number of cases presenting to our clinic in recent months we conclude that increased awareness among clinicians is essential to facilitate early diagnosis, treatment and prevent onward transmission of both LGV and HIV. Close collaboration between clinic staff and those in microbiology has been vital. P86 P87 11th P89 Poster Abstracts ● High rates of Neisseria gonorrhoea contacts abroad reduced partner notification P91 ● Men with herpes simplex (HSV) - treatment and information satisfaction survey M Nicholson1, L Waters2, S Barton2 R Buckley, P O’Grady, A Wyer, F Mulcahy GUIDE Clinic, St James’s Hospital, Ireland Background: National guidelines for gonorrhoea recommend that at least 0.6 sexual partners should be verified as having been satisfactorily managed within four weeks. Previous studies carried out at this clinic have shown that partner notification for heterosexuals is significantly higher than for MSM. Method: A prospective study was undertaken comparing the effectiveness of partner notification of casual partners of heterosexuals and MSM. Results: 42 index patients with GC had casual partners. (19 MSM, 20 heterosexual males and 3 heterosexual females) Heterosexuals documented 42 casual partners over the previous three-month. MSM documented 34 partners but 18% of MSM failed to quantify the number of partners. Partner notification for casual partners was (0.24) and (0.04) for heterosexuals and MSM respectively. 76% (32/42) of heterosexual casual partners were non-contactable. Analysis of the barriers to partner notification indicated 86% (26/32) of non-contactable partners of heterosexuals were abroad, 77% (20/26) Asia. 14% of casual partners in Ireland were uncontactable. MSM who indicated their casual partners were uncontactable met their partner in Ireland. Conclusion: This review concurs with previous findings, however more recently partner notification in heterosexuals is reduced secondary to significant sexual contact outside country of residence. Chelsea and Westminster Hospital, London, UK Aim: To assess levels of patient satisfaction with the management of their first episode of genital HSV. Method: The Herpes Viruses Association (HVA) performed a detailed postal questionnaire of all their male members. Individuals were asked to detail their waiting time, first-episode management, treatment success and satisfaction with the information provided. Results: 51 men responded (mean age 46.4, mean time since diagnosis 11.6 years). 41 were diagnosed in a GU clinic with an average delay (within the last 3 years) of 2.6 days, a figure that has not changed significantly over time. The majority received aciclovir tablets or no specific therapy; oral therapy yielded the highest satisfaction scores. The levels of satisfaction regarding information varied with a trend for patients to be less satisfied with information from their GP as opposed to GU clinic staff. 10/15 received no written information from their GP compared with 2/26 in a GU clinic. Conclusion: Male patients attending GU services with a first episode of genital HSV are seen within 3 days. Oral aciclovir, the commonest therapy, led to high satisfaction scores. Even within specialist services a number remain unsatisfied with the information supplied and the provision of written information by GP services was poor. P90 P92 ● Syphilis causes eye disease – a case series M Gupta1, R Ellks1, S Al Alabri2, C Murphy3, D Edrisinghe4, Al Pearce3, M Bradley1, NJ Beeching2 1Department of Genitourinary Medicine, 2Tropical and Infection Diseases, 3Ophthalmology, Royal Liverpool University Hospital and 4Department of GUM Countess of Chester Hospital, Cheshire, UK Introduction: Co-infection with HIV alters the course, clinical presentation and serological findings of syphilis. A rapidly progressing ocular problem may be the presenting feature of either. We present a series of 5 cases of ocular syphilis seen in 2004. Findings: All patients were male. Four were homosexuals. All presented with blurring of vision and were referred after there had been no response to standard ophthalmological treatment for uveitis. All had strongly positive syphilis serology. Three subsequently tested positive for HIV. The clinical presentation ranged from retinitis to anterior uveitis and will be illustrated. They responded to high dose intravenous penicillin/ceftriaxone/doxycycline, with steroid cover for first 48 hours to prevent Jarisch-Herxheimer reaction. Discussion: Syphilis is becoming more common and ophthalmic involvement would be expected in 5–10% of patients. There are no pathognomic ocular findings of syphilis. A differential diagnosis includes infection, granulomatous and autoimmune disease. Ophthalmic involvement of syphilis should be considered as neurosyphilis and treated early with high dose intravenous penicillin. Conclusion: Ocular manifestations of syphilis are likely to become more common and may be severe. Syphilis should be considered in the differential diagnoses of ocular inflammation, as delay in treatment can lead to permanent visual loss. 1Herpes Viruses Association, London, 2Department of GU Medicine, ● A 5-year study of the trends in incidence and management of Trichomonas vaginalis A Ezeokoli, M Nathan Department of Sexual Health, Homerton University Hospital NHS Foundation Trust, London, UK Aim: To identify the incidence and management trends of trichomoniasis in a busy inner city clinic over a 5-year period. Results: Over a five year period, the incidence of Trichomonas vaginalis was 40.4–55.8 per 1000 new women attending. The majority of cases were in the 21–30 age group. The predominant symptom was vaginal discharge (59.7-68%) and 20-25% of patients were asymptomatic and diagnosed through screening. Wet film microscopy within the department enabled the diagnosis in 76.2–87.2%. Culture alone enabled the diagnosis in further 10-14%. 25% of patients had a concomitant sexually transmitted disease (gonorrhoea 2.7%, chlamydia 14.7%, syphilis 4%). Most patients (92–96.6%) were treated with a single dose (2g) or a five day course (400mg bid) of metronidazole. In 1999, 51% of patients attended for follow-up appointments compared to 56% in 2003. 44.4-52% of patients had a negative test at follow up.10–16% had recurrence within a year. Contact tracing was initiated at the time of diagnosis in 77.3%. Information regarding partner treatment was available for 18.7–23.6% of patients. Conclusion: Trichomonas vaginalis remains a significant sexually transmitted disease in our locality which also has a high prevalence of HIV infection. 37 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P93 ● The changing face of STIs in pregnancy in Limerick, Ireland over 15 years C O’Connor, J Clancy GU/STD Clinic, Regional Hospital, Limerick, Ireland Background: Regional meeting of clinicians requested ‘STIs in pregnancy’ be discussed at next meeting. Methods: Files of pregnant women and post partum to 6 weeks were manually searched (1987–2002) and audited. Findings: 5%(217) were pregnant of which 21%(47) attended immediately post partum. 102/217(47%) were seen 2000–2002 of which 38(37%) were non nationals. Attendance: Conclusion: A large increase in foreign nationals is noted. Even in the most distal clinics increased clinical awareness of less common diagnoses and co-operation is essential to help prevent congenital transmission of preventable diseases. P94 38 ■ P95 ■ Similar high frequency of detection of PPD-specific CD4+ lymphocytes in broncho-alveolar lavage in HIV positive and negative patients with active TB RAM Breen, K Dheda, JP Dilworth, I Cropley, M Beckles, MA Johnson, G Janossy, MCI Lipman Departments of Thoracic and HIV Medicine, Royal Free Hospital, London, UK Introduction: In HIV-infected individuals diagnostic difficulties frequently lead to delays in TB treatment. Lung-derived CD4+ lymphocytes producing interferon-gamma (IFN-γ) in response to PPD have been demonstrated at high frequencies in HIV negative TB patients. This assay may have diagnostic utility. We sought to investigate its performance in HIV-infected individuals. Methods: Broncho-alveolar lavage (BAL) was performed on patients with various respiratory conditions. BAL was incubated overnight with PPD or no antigen and CD4 lymphocytes producing IFN-γ measured by flow cytometry. Results: BAL from 33 HIV positive individuals with a median blood CD4 count of 131 cells/µl (6-661 cells/µl) was analysed and compared to BAL from 64 HIV negative individuals. Median frequency of PPD response for culture-confirmed TB were: HIV+ 7.13% (n=15; 0.00–67.11%) versus HIV- 13.94% (n=19; 0.12-79.32%). Median TB culture negative response: HIV+ 0.01% (n=18; 0.00-16.12%); HIV0.67% (n=45; 0.00–45.66%). Frequency of PPD response was similar at high and low blood CD4 counts in the HIV-infected population. Conclusion: A similar high frequency of CD4+ lung lymphocyte responses to PPD are demonstrated in HIV positive and negative subjects, even in the presence of marked CD4 lymphopenia. This lungorientated, rapid immunological technique may have diagnostic utility in all patients with TB. P96 ■ Immune reconstitution inflammatory syndrome (IRIS)-associated Kaposi sarcoma Hepatitis B vaccine service: staying on top of the audit cycle C Thirlwell, AM Young, T Newsom-Davis, T Dhillon, T Powles, S Mandalia, M Nelson, B Gazzard, M Bower The Chelsea and Westminster Hospital, London, UK Background: Starting HAART occasionally reactivates indolent infections, a phenomenon known as immune reconstitution inflammatory syndrome (IRIS). We have identified a similar paradoxical deterioration in Kaposi sarcoma (KS) on starting HAART. Methods: Since 1996, 300 patients were diagnosed for the first time with KS; 239 patients were HAART naive, and 150 were treated with HAART alone. We examined the clincopathological details and clinical course of these patients. Results: Ten of the 150 naive patients developed rapid clinical progression of KS within 2 months of starting HAART. All 10 patients developed new KS lesions and progression of established lesions. Moreover, the rate of progression of KS accelerated during this period compared to prior to starting HAART. There were no differences in KS stage or visceral involvement between the 10 who developed IRIS KS and the 140 who did not. Patients who developed IRIS KS had a higher CD4 count at start of HAART (median 335/mm3 vs 121/mm3 : p=0.028) but no difference in HIV viral load (median 295K/mm3 vs 171K/mm3 : p=0.35). Conclusion: Patients with KS who start HAART may be at risk of IRIS progression of KS AS Menon-Johansson, K Coyne, A Rajkumar, P Randell, A McOwan Chelsea and Westminster Healthcare, London, UK Aim: To assess the impact of audit recommendations on the Hepatitis B vaccine (HepBvax) service. Methods: The delivery of the first and third dose of HepBvax to all eligible MSM was audited across four clinics on four occasions. Recommendations were made and implemented after each audit. The Sexual Health Strategy targets of 80% and 50% for the 1st and 3rd HepBvax dose became effective at the end of 2004. Results: In 2004, 27% of eligible MSM requested to wait for serology results prior to vaccination. However, almost half of these individuals did not return. Conclusions: Clear audit recommendations to modernizing service delivery have improved vaccine uptake over three audit cycles. Introducing POCT could capture those patients who currently defer vaccine until their serology result is known. 11th P97 Poster Abstracts ■ Does hepatitis B ultra-rapid vaccination work in HIVpositive people? A comparative study of HIV-positive and HIV-negative vaccine recipients L Rubinstein, G King, MG Brook Central Middlesex Hospital, London, UK Aim: To assess ultra-rapid hepatitis B vaccination in HIV+ and HIV-patients. Methods: A retrospective analysis of individuals prescribed the ultra-rapid vaccination regimen (0,1,3 weeks) in 2004 who had post-vaccine antibody levels. Results: 22 HIV+ and 34 HIV- individuals met the entry criteria. There was an excess of women (13/22, 59% vs 9/34, 26% p= 0.02) and black people (16/22,73% vs 5/34,15% p<0.001) in the HIV+ vaccinees. Response rate (anti-HBs >10iu/l) was lower in the HIV+ individuals (11/22, 50% vs 30/34, 88% p=0.004) although this response is similar to longer vaccination schedules. Approximately equal numbers of patients actually received three injections either during >2 months (‘rapid’) or <2 months (-ultra-rapid’). The differences between HIV+ and HIV- remained for ultra-rapid (8/12, 67% vs 16/17 94% n.s.) and rapid recipients (3/10, 30% vs 14/17, 82% p=0.01). Ultra-rapid achieved better results than rapid vaccination in the HIV+ (8/12, 67% vs 3/10, 30% n.s). This difference is explained by CD4 count: 7/8 (88%) and 3/3 (100%) ultra-rapid and rapid responders but only 1/4 (25%) and 3/7 (43%) non-responders had a CD4 count >350 cells/mm3. Conclusion: Ultra-rapid vaccination of HIV+ people seems to be as effective as longer schedules in terms of early antibody response. P98 ■ Comparison of two accelerated hepatitis B vaccination schedules – completion and immune response RK Ellks, H Sugunendran Royal Liverpool University Hospital, Liverpool, UK Introduction: It is accepted that the two accelerated vaccination schedules for hepatitis B are equally efficacious. This study was designed to compare vaccinations at 0,7,21 days (schedule-A) and 0,1,2 months (schedule-B) examining completion rate of course and the development of adequate immunity i.e. hepatitis B surface antibody (anti-HBs) >10IU/L at two months after the third vaccine. Method: A retrospective analysis of 264 patient records. Results: Schedule-A 140 patients, (86males). Schedule-B 124 patients, (87 males). The groups were equally matched for age, immune status and indication for vaccination. 73% of schedule-A completed vaccination compared with 64% schedule-B (not significant (NS)). Anti-HBs was checked in 61% of schedule-A compared with 70% schedule-B (NS). Schedule-A had 60% anti-HBs >10IU/L compared with 76% in schedule-B (significant p=0.055). Conclusion: This study shows that the two schedules have no significant difference in completion rates, and no significant difference in attendance for antibody check. The anti-HBs response is significantly lower with the 0,7,21 vaccine. The widespread use of this schedule should now be reconsidered. P99 ■ Prevalence of hepatitis C in urban sexually transmitted infections (STI) clinic for men who have sex with men (MSM): is screening necessary and is it cost effective? G Courtney1, L Jones2, M Crean2, S Keating1 1Gay Men’s Health Project, Dublin, 2Virus Reference Laboratory, UCD, Dublin, Ireland Background: Outbreaks of HepC in MSM, especially those with HIV co-infection have recently been reported. This study reports the prevalence of HepC in a community based screening programme and evaluates its cost-effectiveness. Methods: From Jan–Dec 04 all MSM attending a community based MSM Sexual Health Clinic were screened for Hepatitis C Abs by Ortho EIA assay. Positive tests were confirmed by RIBA. Results: 1258 MSM were screened, 1389 tests performed. 28 men tested positive for HIV. 2 men screened + for HepC; 1 positive by Ortho EIA, but not confirmed on RIBA3, was reported negative. The only confirmed positive case was in a man who had a previous sexual partner who was an IVDU. HepC PCR was +, HIV1/2 ab negative. The prevalence rate was 0.07%. The cost of screening for the year was 19,737 euro, personnel costs not included. Conclusion: The prevalence of Hepatitis C in HIV negative MSM is low even in the context of a recent local syphilis epidemic and rising rate of HIV in this population. Generalised screening is not cost effective in this population however targeted testing in those with a sexual history identifying increased risk (IVDU/ partner IVDU) and in HIV+ cases remains important. P100 ■ Treatment and outcomes of HCV treatment in HIV-HCV co-infected patients 2001–2004 J Lambourne, G Farrell, H McDermott, S Woods, C Bergin, F Mulcahy GUIDE department, St James’s Hospital, Dublin, Ireland Background: With the use of HAART increasing morbidity/mortality from HCV mediated end stage liver disease in HIV populations is recognised. Pegylated interferon and ribavirin (PEG/RBV) use has been associated with an increased sustained virological response (SVR). Objective: To identify primary and secondary treatment outcomes of HCV treatment. Results: Demographics: 89% male, 63% IVDU, 27% haemophiliac, 42% genotype 1/4, 58% genotype 2/3, 55% on HAART, mean CD4 507×10^6/l. 62 patients commenced PEG/RBV. 54 completed treatment with an end of treatment response of 37/54 (69%) [genotype 1/4=6/19 (32%) and genotype 2/3= 31/35 (89%)]. 46 reached 6/12 post treatment. SVR seen in 28/46 (61%) [genotype 1/4=4/16 (25%) and genotype 2/3=24/30 (80%)]. OT analysis: SVR seen in 27/42 (64%) (genotype 1/4=4/15 (27%) and genotype 2/3= 23/27 (85%). 11/62 discontinued treatment because of psychiatric morbidity (n=4), sustained significant CD4 decline (n=1), non-treatment related death (n=2). Two patients required dose reduction, 14 received haematological support (erythropoetin 9, transfusion 2, GC-SF 6). Conclusions: SVR rates compare favourably to mono-infected data. Increased awareness of HCV treatment toxicities, use of supportive growth factors to enable use of full dose HCV therapies and knowledge of HAART interactions enable favourable therapeutic outcomes. 39 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P101 ■ Treatment outcomes of hepatitis C intervention with pegylated interferon and ribavirin in hepatitis C/HIV co-infected haemophiliacs J Kieran, J Lambourne, G Farrell, S Chew, C Bergin, F Mulcahy, B White, B Nolan St James’ Hospital, Dublin, Ireland Aim: To examine the primary and secondary outcomes of hepatitis C treatment in co-infected haemophiliacs. Method: In 2001 an open-label treatment study was commenced. All patients were initially treated with 24 weeks of pegylated interferon and ribavirin; those with genotype 1/4 infection received a further 24 weeks of treatment providing they were HCV-PCR negative. Primary endpoints were HCV-PCR negative at the end of treatment (EOT) and at 6 months post completion of treatment i.e. sustained viral response (SVR). Secondary outcomes were discontinuation or dose reduction due to adverse drug reactions, need for haematological support and interactions with HAART. 62 patients have received treatment, 17 of whom are haemophiliac. Results: Of 17 patients, 10 had genotype 1/4 disease and 7 had genotype 2/3. 83% were HCV-PCR negative at EOT (100% genotype 2/3, 60% of genotype 1/4). Overall SVR is 53% (genotype 2/3;86%). 18% were non-responders, all genotype 1. No patient required dose reduction or had interactions with their HAART. There was one case of thyroiditis and 17% required haematological support to maintain full dose therapy. Conclusion: Pegylated interferon and ribavirin is an effective and well tolerated treatment in co-infected haemophiliacs. P102 ■ Use of pegylated interferon-alpha (peg-IFN) with or without ribavirin in the treatment of acute HCV in HIV-positive individuals M Danta1*, JM Turner2*, R Johnstone2, RM Lascar2,3, MA Johnson4 GM Dusheiko1, IG Williams2,3, RJC Gilson2,3, S Bhagani4 1Centre for Hepatology, Royal Free Hospital, London, 2Centre for Sexual Health and HIV Research, Royal Free and University College Medical School, 3Camden Primary Care Trust, The Mortimer Market Centre, London, 4Department of HIV Medicine, Royal Free Hospital, London, UK *Joint first authors Aims: To describe the virological outcomes of two different treatment strategies for acute HCV infection in HIV infected individuals. Method: HIV-positive individuals presenting with acute HCV infection at two centres were offered treatment but with different standard regimens. At centre 1 all individuals persistently positive for HCV RNA by reverse transcriptase polymerase chain reaction (PCR) 12 weeks after presentation were offered peg-IFN alpha 2b (1.5 µg/kg) and ribavirin (>10.6 mg/kg) for 48 weeks. At centre 2 individuals were offered immediate treatment with peg-IFN alpha 2a or 2b for 24 weeks. Ribavirin (800mg/d) was added in individuals still positive for HCV RNA at week 12. Results: Baseline characteristics were similar in individuals at centre 1 (n=24) and centre 2 (n=15); mean age (35.7 Vs 36.3 years), CD4 count (583 Vs 515 cells/ml), HIV viral loads (30% Vs 20% <50copies), HCV genotype 1 or 4 (83% Vs 87%), and ALT (177 Vs 362IU/ml). Sustained clearance rates were available in 23 patients and were significantly better at centre 1 (60%) than centre 2 (8%) p<0.001. Side effect profiles were similar. Conclusions: The optimal treatment schedule for acute HCV in HIV co-infection is not known but our experience suggests that peg-IFN alone has poor efficacy. 40 P103 ■ HCV-specific T-cell responses of acutely HCV infected individuals with and without HIV M Danta1*, N Semmo3*, J Northfield3, D Brown1, G Dusheiko1, P Fabris4, S Bhagani2, P Klenerman3 1Centre for Hepatology, 2Department of HIV Medicine, Royal Free and University College Medical School, London, 3Nuffield Department of Clinical Medicine, Peter Medawar Building, University of Oxford, Oxford, UK, 4Department of Infectious Diseases and Tropical Medicine, S Bortolo Hospital, Vicenza, Italy *Joint first authors Aims: To assess HCV-specific T-cell responses and serum cytokines in HIV-positive and HIV-negative individuals with acute HCV infection. Methods: Frozen PBMCs and serum from multiple time points in the acute phase of HCV infection from a cohort of HIV-positive individuals in London and an Italian cohort of HCV mono-infected individuals were used. HCV-specific T-cell responses were assessed using an IFN-γ ELISpot for HCV core derived peptides (20mers overlapping by 10aa) and HCV recombinant non-structural proteins (NS3-5). Serum cytokines were analysed using cytokine bead array and FACS analysis. Results: HIV-positive individuals (n=12, all male, mean age 33, mean CD4 714 cells/ml) were compared with 10 HCV mono-infected (n=10, 6 male, mean age 40) individuals. Comparison of IFN-( ELISpots for NS3-5 proteins revealed significantly reduced responses in HIV-positive vs. HIV-negative individuals (1/10 vs. 5/7, p=0.034). No difference was seen for the core peptides (3/10 vs. 5/7, p=ns). In HIV-positive individuals cytokines (pg/ml) compared at peak ALT and >2 months post-peak ALT revealed significant late increases in: INF-γ (108.9±34.5 vs. 154.5±32.7, p<0.01), TNF (7.7±2.9 vs. 10.9±2.3, p<0.01) and IL-2 (3.3±0.4 vs. 3.6±0.4, p<0.01). Conclusions: Failure of early immunological control of HCV in HIV-positive individuals is supported by the lack of breadth of the CD4 responses to the non-structural proteins and late elevation of cytokines. P104 ● Hepatitis C (HCV) screening: what should genitourinary medicine be doing? PM Williams, A Edwards Harrison Department, Radcliffe Infirmary, Oxford Department of GUM, UK Objective: To improve the effectiveness of HCV screening in GUM. Method: The indications for tests requested over a six month period were audited against national guidelines. Reasons for inappropriate testing, and risk factors for all diagnosed HCV cases were determined. Risk factors for all HCV cases over four years were also collected. The guidelines were modified to limit testing to: All IDU; Long-term sexual contacts of known HCV positive individuals; All HIV positive patients at initial diagnosis. This was implemented and the audit repeated. Results: 174 tests for HCV were requested over the initial six months. 62% complied with national guidelines. 50% of inappropriate tests were sexual contacts of IDU. We identified 10 new cases, 8 were IDU and 1 HIV positive. No patient who is thought to have acquired HIV heterosexually from someone of WHO pattern 2 origin and who denied intravenous drug use (29 patients) was co-infected with HCV. 90% of cases of HCV diagnosed over four years were IDU. Implementing modified guidelines resulted in 50% fewer requests, 9 new cases, all IDU. Conclusion: Using our modified guidelines we would not miss cases of HCV and we reduced unnecessary requests by 50%. 11th P105 Poster Abstracts ● P107 ● HIV-associated T-cell non-Hodgkin lymphoma Pulmonary Kaposi sarcoma in era of HAART T Powles, T Dhillon, AM Young, C Thirlwell, T Newsom-Davis, M Nelson, B Gazzard, M Bower Chelsea and Westminster Hospital, London, UK Background: T-cell non-Hodgkin’s lymphoma (T-NHL) accounts for <10% NHL and has only recently been found to have an increased incidence in HIV+ people. The management of HIV-associated T-NHL is uncertain. Methods: Since 1986 we have managed 317 HIV+ patients with lymphoma including 62 primary cerebral NHL, 24 Hodgkin's disease, and 231 systemic NHL. We compared the clinicopathological features and outcomes of patients with systemic T-NHL and B-NHL. Results: We identified 10 patients with T-NHL. There were no significant differences in gender (χ2 p=0.57), age (MW p=0.16), prior AIDS defining illness (χ2 p=0.43), NHL stage (χ2 p=0.28), CD4 cell count (MW p=0.25) or HIV-1 viral load (MW p=0.62) at NHL diagnosis. Aggressive NHL is classified using the International Prognostic Index; there was no difference in the distribution of IPI scores (χ2 p=0.33). There is no difference in overall survival (log rank p=0.40). The 2 year overall survival is 32% (95%CI: 27-39%0 for B-cell NHL and 46% (95%CI: 14-78%) for T-cell NHL. Conclusion: There were no differences in immunological parameters or survival duration between patients with T-NHL and B-NHL. We suggest that aggressive T-NHL could be included as an AIDS defining malignancy along with high grade B-NHL. T Newsom-Davis, T Dhillon, AM Young, T Powles, C Thirlwell, M Nelson, M Bower Chelsea and Westminster Hospital, London, UK Background: The survival following a diagnosis of Kaposi sarcoma (KS) has improved dramatically since the introduction of HAART. Methods: Since 1996, 301 patients have been diagnosed for the first time with KS, including 26 with pulmonary KS (pKS). The clinicopathological features and outcome of patients with pKS are compared with those without pulmonary involvement. Results: Patients with pKS were more often female (all black Africans) (15% vs 4% χ2 p=0.006) and were younger (mean age 36 vs 39 MW p=0.02). They had lower CD4 cell counts (median 33/mm3 vs 128/mm3 MW p=0.009) but similar HIV plasma viral loads (MW p=0.8). All patients were treated with chemotherapy and HAART. The 5 year overall survival for patients with pKS is 49% (95%CI: 24–74%) compared to 82% (95%CI: 77–87%) for KS patients without pulmonary involvement (log rank p<0.0001). Conclusion: The median survival for pKS is 1.6 years in this cohort which compares favourably with quoted rates of 3–10 months from the pre-HAART era. However, the prognosis of pKS remains poor and is significantly worse than for KS without lung involvement. P106 P108 ● ● Hodgkin’s disease in the era of HAART – single institution experience No cardiotoxicity observed with liposomal anthracyclines for Kaposi sarcoma T Powles, C Thirlwell, AM Young, T Newsom-Davis, T Dhillon, S Holmes, P Nelson, B Gazzard, M Bower The Chelsea and Westminster Hospital, London, UK Background: Although not AIDS defining, Hodgkin's disease (HD) occurs at increased frequency in the HIV+ population and was previously associated with a poor outcome. Methods: We reviewed our experience of HD since 1996 when HAART was introduced into routine clinical care. Results: We have treated 17 patients (16 male) for HIV associated HD. The mean age is 42 years and 4 (24%) had a prior AIDS defining illness. At diagnosis, the median CD4 count was 175/mm3 (range 49–661) and 11 (65%) were on HAART of whom 7 (64%) had an undetectable HIV viral load. Most had advanced HD at presentation: 10 (59%) had stage IV disease, 14 (82%) had B symptoms and 8 (47%) had bone marrow involvement. This compares to values of 15%, 40% and <5% in the general population with HD. All patients were treated with combination chemotherapy. One patient was treated at relapse with high dose chemotherapy and autologous stem cell transplantation. The actuarial 2 year survival is 79% (95%CI: 58–100%). Four patients have died, 2 from HD and 2 from other causes. Conclusion: Even in the HAART era, patients with HD present with advanced stage disease, however the survival for these patients is improving with aggressive therapeutic strategies. T Dhillon, AM Young, C Thirlwell, T Newsom-Davis, R Jones, MR Nelson, BG Gazzard, M Bower Chelsea and Westminster Hospital, London, UK Background: Anthracyclines are associated with cumulative cardiotoxicity due to free radical peroxidation of cardiolipids in myocytes. Cardiotoxicity is characterised by dilated cardiomyopathy. The recommended maximum lifetime cumulative dosages of non-liposomal anthracyclines are 450 mg/m2 for doxorubicin and 600 mg/m2 for daunorubicin. Method: We measured the lifetime cumulative dosages of liposomal anthracyclines delivered to patients with AIDS-Kaposi sarcoma (AIDS-KS) and the incidence of clinically significant cardiac failure. Results: We have treated 93 patients with AIDS-KS (90 male, 2 female, 1 gender reassignment) whose mean age is 39 years (range 24–62) with liposomal anthracyclines. Liposomal anthracyclines were the first line systemic chemotherapy for 78 (84%). Fifty eight patients were treated with liposomal daunorubicin (Daunoxome), 30 with pegylated liposomal doxorubicin (Caelyx) and 5 with both. The median cumulative doses received were 120mg/m2 (range 20–520) for liposomal daunorubicin and 240mg/m2 (range 80-760) for pegylated liposomal doxorubicin. The maximum cumulative dosage delivered to a single patient was 640 mg/m2 liposomal daunorubicin plus 160 mg/m2 pegylated liposomal doxorubicin. The actuarial 5 year survival from commencing liposomal anthracycline chemotherapy is 73% (95% confidence interval: 61-85%). Conclusion: We have observed no clinically significant episodes of cardiotoxicity amongst this cohort of patients despite high cumulative dosages of liposomal anthracyclines. 41 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P109 ● Clinicopathological features of 12 cases of HIV-associated multicentric Castleman's disease H Dharmana, A Roy, AM Young, S Cox, M Nelson, BG Gazzard, M Bower Chelsea and Westminster Hospital, London, UK Background: The diagnosis of HIV-associated multicentric Castleman’s disease (MCD) is often delayed due to non-specific clinical findings. Methods: We examined the clinical features of 12 patients with MCD diagnosed or treated at our institution. Results: The mean age was 39 years (range 31-49) and 11 were male. Five (42%) had prior AIDS defining illness and 8 (67%) had cutaneous KS. All had lymphadenopathy and PUO and 10 /11 splenomegally (1 prior splenectomy for ITP). Two (17%) had effusions and 5 (42%) pulmonary infiltrates. The median symptom duration was 5 months (range 2–24). At presentation 11 (92%) were anaemic (Hb<10g/dl), 8 (67%) thrombocytopenic (Plt<100×109/l). 9/10 had polyclonal gammaglobulinaemia (median IgG 29 g/l, range 5–59, normal range 5–16) and all had low albumin (<35g/l). The median CD4 count was 197/mm3 (range 65–1429), CD8 was 881/mm3 (range 310–5661) and CD19 was 228/mm3 (range 8-554). Only 2 had undetectable HIV-1 viraemia, although 8 were on HAART at MCD diagnosis. Three (25%) also had plasmablastic microlymphoma associated with MCD. Seven patients have died and the median survival is 6 months. Conclusion: The rather non-specific clinicopathological features at presentation may account for the prolonged duration of symptoms prior to diagnosis of MCD. P110 ● Under-reporting of tuberculosis among HIV-infected individuals diagnosed in the UK V Delpech1, J Forde1, M Lipman2, D Antoine3, B Evans1 1HIV/STI and 3Respiratory Departments, CDSC, Centre for Infection, Health Protection Agency, London, 2Department of Respiratory Medicine, Royal Free Hospital, London, UK Background: HIV is fuelling the TB epidemic in high HIV prevalence populations. Both infections are on the increase in the UK with over 6000 new diagnoses of each reported per year. We reviewed national trends and matched cases of AIDS with TB at diagnosis to the national TB database to assess under-reporting. Results: The proportion (and number) of AIDS cases with TB at initial diagnosis increased from <5% (59/1577) in 1992 to 30% (233/766) in 2003. TB has drawn level with PCP as the most common initial AIDS defining illness. 88% of black-Africans diagnosed with AIDS presented with tuberculosis in 2003 (compared to 2.3% of MSM). Almost 40% of AIDS cases with TB at initial diagnosis reported (1998-2001) could not be matched to the TB surveillance system, ranging from 36% in 1998 to 42% in 2001. Conclusions: TB is now a leading cause of HIV related morbidity in the UK. High co-infections among black-African individuals reflect the high prevalence of HIV and TB in their country of origin. Although estimates are subject to matching limitations, the high proportion of under-reporting of tuberculosis among HIV individuals is concerning and warrants further investigation. 42 P111 ● Virological outcome for individuals with HIV/tuberculosis co-infection receiving highly active antiretroviral therapy RAM Breen1, RF Miller2, T Gorsuch3, A Schwenk3, J Ballinger1, l Swaden1, CJ Smith2, MA Johnson1, MCI Lipman1 1Departments of Thoracic and HIV Medicine, Royal Free Hospital, 2Department of Primary Care and Population Sciences, Royal Free and University College Medical School, 3Department of HIV Medicine, North Middlesex Hospital, London, UK Aim: To describe the virological response to HAART in TB/HIV patients. Methods: Retrospective case-note review of 115 consecutive individuals with HIV/TB co-infection. Results: At TB diagnosis, patients had a median CD4 count 132 cells/uL (3–1200); viral load 365,000 copies/mL (50–750,000). TB treatment was rifamycin-based in 113/115. 84/115 (73%) patients received HAART during TB treatment (1/3 were on this at TB diagnosis). Time from anti-TB therapy to starting HAART if HAART naive: <2 weeks=12/59 subjects (20%); 3–4 weeks=7/59 (12%); 5–8 weeks=22/59 (37%); 9-16 weeks=12/59 (20%); 17-24 weeks=6/59 (10%). 18 different HAART regimens were prescribed: PI containing n=26; NNRTI containing n=45; triple NRTI n=13. 69/84 (82%) achieved a viral load <50 copies/ml by the end of TB treatment, similar to our non-TB HAART treated individuals. Viral load response was not related to specific regimen type. 5/15 who did not achieve <50 copies/ml had a >2 log fall in HIV load and were felt to be responding slowly; giving a total response of 74/84 (88%). 10/15 had a <1 log fall in HIV load. Conclusions: Good virological responses are seen in the majority of our cohort, demonstrating that anti-tuberculosis and anti-retroviral therapy can be successfully combined. P112 ● Intravenous pentamidine is inferior to trimethoprimsulphamethoxazole for treatment of Pneumocystis jirovecii pneumonia (PCP) J Helweg-Larsen, T Benfield, C Atzori, RF Miller University College London, London, UK Background: Trimethoprim-sulphamethoxazole (TMP-SMX) is first-line treatment for (PCP). Few data are available to guide choice of second-line treatment for patients who fail or who are intolerant of first-line therapy. Methods: Treatment data and outcome from 1145 episodes of HIV-associated PCP (1035 patients) presenting between January 1989 and June 2004 were analysed to identify if specific treatment was associated with 3-month mortality. Patients were from Copenhagen (555), London (375) and Milan (215). Results: First-line therapy was TMP-SMX in 928, IV pentamidine (PENT) in 82, clindamycin/primaquine (C+P) in 67 and ‘Other‘ (dapsone/TMP), atovaquone or inhaled PENT) in 65. Outcomes for first-line treatment [response rate/treatment switch for toxicity/switch for treatment failure/mortality at 3 months] were TMP-SMX: 78%, 17%, 5%, 14%; IV PENT: 53%, 27%, 20%, 19%; C+P: 56%, 26%, 18%, 16%: 'Other' 57%, 12%, 31%, 3%. For patients receiving second-line treatment multivariate Cox regression analysis of risk of death (95% CI) at 3 months was IV PENT = 3.2 (2.2-4.6), C+P = 1.1 (0.6-1.8), ‘Other’ = 0.7 (0.3–1.4). Conclusion: Compared to TMP-SMX treatment of PCP with IV PENT has a 3.2-fold risk of death at 3 months, which is due to its inferior efficacy as first and second-line therapy. 11th P112a Poster Abstracts ● Simultaneous pulmonary and extrapulmonary infection with multiple strains of Mycobacterium tuberculosis in an immunocompromised patient: a case report ● Contact tracing by HIV genotypic resistance test results J Lambourne1, N Gibbons2, J Keane3, C Bergin1 1Department of Genitourinary Medicine and Infectious Diseases, 2Department of Medical Microbiology, 3Department of Respiratory Medicine St James’s Hospital, Dublin, Ireland We present a case of disseminated Mycobacterium tuberculosis (MTB) infection involving multiple MTB strains in a 28-year-old Vietnamese patient co-infected with HIV and hepatitis C. The patient presented with cough, sputum and constitutional upset. Pan-sensitive MTB was isolated from blood, urine, pleural and cerebrospinal fluid. Bronchioalveolar lavage fluid grew both pan-sensitive and Isoniazid-resistant MTB indicating mixed infection with multiple strains within a single anatomic compartment. Three months following presentation, while on treatment with rifampicin, ethambutol and pyrazinamide, the patient began to complain of increasing headache, nausea and vomiting and recurrent falls. Examination revealed marked ataxa and sustained nystagmus on both left and right gaze. Neuroimaging revealed leptomeningeal tuberculous disease and multiple parenchymatous tuberculomas with obstructive hydrocephalus. MTB isolated from CSF at this time was resistant to rifampicin. Genetic analysis identified this isolate as identical to the original pan-sensitive isolates implying the development of rifampicin resistance while on therapy. Cases of mixed infection are increasingly recognised and it appears that co-infecting strains of MTB are not necessarily equally distributed between pulmonary and extra-pulmonary sites. This highlights the importance of culture and sensitivity testing and isolate identification of all samples obtained from distinct sites in patients with MTB infection. P112b P112c ● C Kamutasa, OE Williams, S McAndrew, H Bailey Ysbyty Glan Clwyd Hospital, North Wales, UK Introduction: Genotypic resistance testing is now recommended before starting HAART in HIV disease. The results can accurately identify the source of infection when more than one contact exists. Case summary: A 38-year-old Caucasian heterosexual male tested positive with multi-drug resistant HIV clade C. His current partner is a married HIV-positive African woman with wild-type clade C virus, undetectable on Trizivir since 2002. Genotyping prompted revelation of former partner, another African female who died of AIDS in 2001 while on third HAART regime of d4T/ddl/Kaletra. HIV genotypes were closely related for the index patient deceased female and her ex-husband, strongly suggesting the same source. RT mutations D67N, T215S/F, G190S, A98G and PR mutation M63I were common to the female and index patients while the two males shared the RT mutations: G109S/G/A, K101/3E/K/R, V35T, E36A, T39E, K173E, Q174R, D177E, Q207E and R211K and PR mutations: M36I, I93L, L93L. A conscious decision was made not to reveal the link. Discussion: HIV genotyping allows the correct choice of HAART. Using the results for contact tracing is debatable, particularly with the recent criminalisation of non-disclosure of HIV status. Conclusion: Genotypic resistance test results enabled accurate contact tracing in a seemingly unrelated cluster. P112d ● A case of prolonged immune reconstitution inflammatory syndrome Case report: HIV and seronegative arthropathy and role of methotrexate EJ Morris, EF Monteiro Leeds General Infirmary, Leeds, UK IRIS is a common complication of the treatment of HIV and TB. Symptomatic treatment with steroids is suggested. Leukotriene receptor anatagonists exert broad anti-inflammatory effects and may benefit in refractory cases. Case report: A 41 year old Kenyan man presented with gross cervical lymphadenopathy. He was HIV positive with a CD4 of 18. Lymph node biopsy confirmed tuberculosis fully sensitive to antimicrobials. Quadruple therapy with pyridoxine was commenced. ART was started two weeks after TB treatment. He continued to have intermittent pyrexia, increasing lymphadenopathy and persistently raised inflammatory markers. High dose prednisolone and later intravenous hydrocortisone showed no clinical benefit. He required weekly cervical lymph node aspiration and later developed fistulae. Aspirate fluid remained culture negative. Adherence to all therapy was excellent. CD4 count was 59 @ four months. Montelukast was trailed at this stage. Two weeks later, lymphadenopathy had improved and CRP had decreased significantly. He required no further drainage. However, he deteriorated five weeks later with leg pain and restricted movement. Massive psoas and abdominal abscesses were found and over 1 litre of pus drained (culture negative). Since drainage of the abscesses he has continued to improve. IRIS can be prolonged and difficult to manage. Montelukast may have a role in its management. RAM Varma, M Nathan Homerton Hospital, London, UK Introduction: The effects of methotrexate on patients with HIV are not well known. We report a case of a man with a relatively high CD4 count, not requiring treatment with HAART, displaying evidence of immune failure while on methotrexate. Case presentation: We describe the case of a 48 year old British Caucasian gay man who presented with a 2 year history of lower limb synovitis requiring recurrent steroid injections; he became progressively more debilitated. Initially tested negative for HIV. He also complained of early morning back pain for a number of years and HLA B27 confirmed clinical suspicion of Ankylosing Spondylitis (AS). Repeated HIV testing 2 years after initial presentation confirmed HIV with CD4 count 622 cells/µl (25%) and 41,400 viral load HIV-1 RNA copies/ml. Initial results suggested that HAART should be withheld. Escalating doses of methotrexate have coincided with evidence of impaired T cell function manifest as widespread Molluscum and violatious lesions on his 1st MTP joint. Biopsy confirmed Kaposis sarcoma (KS). His arthropathy remains difficult to control; however he now has an AIDS illness requiring treatment with HAART. Discussion: The effects of steroid use in patients with HIV is established as a risk for the development of opportunistic infection and KS. The effects of methotrexate are not as clear and there is very little literature of the interaction between HIV and AS. 43 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P112e ● A case of optic perineuritis A Checkley, P Hay St George’s Hospital, London, UK A 46-year-old man presented with a 2-month history of headaches, visual obscurations and night sweats. On examination he had widespread lymphadenopathy, a maculo-papular rash and optic disc oedema. Visual acuity and fields were normal. CT brain was also normal, and lumbar puncture revealed a normal opening pressure, with protein 1.3g/l, 94 white cells/(µl (100% lymphocytes) and glucose 2.7/5.6 mmol/l (CSF/plasma). HIV serology was positive, with a CD4 count of 260 x109/l. Syphilis serology was also positive, with the following titres: RPR 1 in 2 and TPPA >1/1280 (plasma), and TPPA 1/320 and a positive RPR (CSF). A diagnosis was made of meningovascular syphilis with optic perineuritis. Syphilitic optic perineuritis is characterised by optic disc oedema with normal visual acuity, pupillary responses and intracranial pressures, and normal visual fields except for an enlarged blind spot. It is a rare manifestation of neurosyphilis, thought to represent an extension of basal meningeal inflammation to the optic nerve sheaths. It is differentiated from papilloedema by a normal CSF opening pressure, and from papillitis by normal visual acuity and pupillary responses. It has also been described in meningococcal meningitis, viral meningoencephalitis, rickettsial infections and sarcoidosis. P113 ■ Expedited partner therapy (ExPT): is it feasible and acceptable to sexual health clinic attenders in the UK? L Sutcliffe1, J Cassell1, C S Estcourt1,2, JL Chapman2, G Brook3 1Department of Primary Care and Population Sciences, Royal Free and University Medical School, University College London, 2Centre for Infectious Disease, ICMS, Queen Mary University of London, 3Patrick Clements Sexual Health Clinic, Central Middlesex Hospital, London, UK Aim: To explore acceptability and feasibility of a range of options for rapid treatment of sexual partners of clinic attenders diagnosed with acute sexually transmitted infections (STIs), including treatment without clinic attendance (ExPT). Methods: Exploratory, qualitative, cross-sectional pilot study, using semi-structured, audiotaped interviews, which were thematically analysed. Participants: Purposive sample of 41 patients representing a range of demographic variables and risk factors within an outer London sexual health clinic. Results: Preliminary analysis suggests that clinic users find ExPT a highly acceptable method of partner notification. Both patient-delivered therapy and collection of therapy from community pharmacies are feasible and acceptable options. Users perceived a high degree of motivation to attend clinic for subsequent HIV testing after ExPT. Further detailed analysis will include: preferred methods of communication with partners; communication with partners by mobile phone whilst index is attending, and issues surrounding primary and non-primary partners. Conclusion: Many sexual health services are unable to meet current targets for partner notification for acute STIs. We believe that innovative models of partner management including patient delivered therapy, using modern communication technology, should be evaluated. We present detailed patient consultation data addressing feasibility and acceptability of expedited partner therapy in a high risk population. 44 P113a ■ What potential do patients presenting to primary care hold for effective STI control interventions? JA Cassell, L Sutcliffe, C H Mercer, MG Brook, E Jungmann, J Ross, GR Kinghorn, J Stephenson, A M Johnson on behalf of the PATSI collaboration. Centre for Sexual Health Research, Department of Primary Care and Population Sciences, University College London, London, UK Background: There is evidence that up to 40% of new patients in genitourinary medicine clinics seek care in general practice first. This may have an impact on transmission and cure rates. Aims: To compare sexual behaviour, health care seeking behaviour and extent of symptoms between clinic attenders who did, and did not, approach primary care first. Methods: A questionnaire was administered to approximately 8000 patients in 8 sexual health clinics and linked to clinical data. Results: 22.5% of males and 48.0% of females with an STI had first sought care elsewhere, of which 76.0% of males and 76.5% of females had approached primary care. Males first approaching primary care were more likely to report 2 or more partners while symptomatic than those attending clinic directly (P=0.03). Symptom duration was ≥7 days in 85.1% of those first approaching primary care, and 62.8% in others (P0.01) – the association held for males and females. Conclusions: Patients with high risk sexual behaviour often refer themselves to primary care, rather than to specialist sexual health services. Expedited treatment is required for such patients, since attendance at primary care delays definitive treatment, and some patients may fall ‘through the net’ between services. P114 ■ Yeah but, no but, yeah but … What information are young Britons getting about sexual health? V Lee, K Walsh, E Foley Department of GU Medicine, Southampton University Hospitals NHS Trust, Southampton, UK Background: The numbers of sexually transmitted infections (STI's) diagnosed in the UK continues to increase, with the highest reported rates in young sexually active persons. Many young women rely on the media including womens’ magazines for information about sexual health, and is a commonly cited reason why a young woman presents for STI screening. Aims: To determine the quantity and quality of information about sex and sexual health, in particular STI's in young womens’ magazines sold in the UK. Method: This is a prospective study since November 2004. Womens’ magazines which target 14–21 year-olds were reviewed for articles concerning sex and sexual health. This study examined the article type, the authors’ professional qualifications, and the accuracy of the content. Results: Of the 77 journals reviewed to date, 90% carried articles about sex but only 14% had articles on STI's. In all cases the factual content was correct. The types of infections reviewed, article type authorship will be discussed. Conclusion: Although information about sexual health is common in young womens' magazines, there is far less information about STI’s. With the increasing awareness for asymptomatic screening magazines may provide a good vehicle in which to disseminate more information about STI’s. 11th P115 Poster Abstracts ■ Designed by young people for young people: description and review of a specialist sexual health clinic in Hammersmith and Fulham ■ A description of the sexual risk behaviours of college students when they travel abroad CE Cohen, NA Smith, S Bennett, J Marshall, S Mandalia, KA McLean Chelsea and Westminster Healthcare NHS Trust, West London Centre for Sexual Health, London, UK Aims: To determine the rates of sexually transmitted infections (STIs) and pregnancy in young people attending a specialised sexual health clinic, ‘Cont@ct 2’, at the WLCSH, from its inauguration in June 2001–December 2003. To describe this unique service designed by young people. Methods: Data was collected prospectively for all Cont@ct 2 attendees, and was analysed using SAS statistical package. Results: There were 1312 attendances from 734 patients, aged 13.6–21.5 years (mean, 17.7). Most were female [572 (77.9%)], 263 (35.8%) were white, and 335 (45.6%) of varying Black ethnicities. The rate of infection with chlamydia was 16.7% (95/572) amongst females, and 17.3% (28/162) amongst males. The rate of infection with gonorrhoea was 5.4% (31/572) and 7.4% (12/162) respectively. There were 378 attendances for contraception. The pregnancy rate was 7.5% (43/572), 25 (57.8%) amongst girls of Black ethnicities. Eight (18.6%) had concurrent STIs at diagnosis. Thirty termination of pregnancy referrals were made for 29 girls. Conclusion: This open-access clinic, operating after school hours, with different registration facilities in a separate clinic area, has found high rates of STIs and teenage pregnancy. The increasing numbers of yearly attendances, testifies to the success of our approach and necessity to expand this service. P116 P117 ■ A review of a nurse-led sexually transmitted infection screening service, including laboratory provision, in a young person's clinic after 9 months K Jones, B Beeching, C Jones, M Devine, J Davies, P Roberts, C Bates Royal Liverpool and Broadgreen University Hospital, Liverpool Brook Centre, Liverpool, UK Aim: To review the outcome and acceptability of sexually transmitted infection (STI) screening in the setting of a young persons contraceptive service. Methods: Records of all clients who attended a GUM clinic at Liverpool Brook Centre were reviewed. Results: During the first nine months of this new service 666 appointments were attended; 576 (86.5%) were first attendee’s, 10 (1.5%) were re-registered clients and 80 attended for follow up. 544 (92.8%) clients received a full screen which in 222 (37.9%) was negative. HIV testing was offered to 560 (95.6%) clients of whom 213 (37.2%) accepted. A partner notification audit of clients seen during the first six months was carried out; 60.7% of known contacts attended for testing and/or treatment. 61 (93.8%) clients from a random sample of 65 completed a client satisfaction questionnaire. A high degree of satisfaction was expressed regarding both premises and staff attitudes. Conclusion: A nurse led STI screening service, including laboratory provision, in a community setting is acceptable to clients. More than 96% of clients seen were managed within the service. Evidence of infection was found in 444 (62.1%); achieved rates of HIV tests offered and contacts traced fell within national targets (DH 2002, SSHA 2004). R Buckley, F Mulcahy GUIDE Clinic, St James’s Hospital, Dublin, Ireland Background: The number of students travelling abroad is increasing yearly. This study raises the issues of the sexual ‘risk behaviour’ among college students when they travel abroad. Method: A quantitative study was conducted among undergraduate students. 385 students were invited to participate, yielding a 78% response rate. Results: 30% had casual sex while abroad. Exploring this group showed 35% had unprotected sex, more males than females. 62% who had casual sex abroad travelled with the intention of having sex, 86% were male. Casual sex was more common among single people however; unprotected casual sex was more common with those who were already in an existing relationship at home. The time during sexual intercourse in which a condom was put on varied from before genital contact to after some penetration, increasing risk for sexually transmitted infections. 98% of the college students were under the influence of alcohol and 79% felt they drank excessively. Perception of risks is lower than behaviour suggests. Conclusion: Many perceive their risk as lower than their behaviour suggests. Addressing this behaviour requires a health promotion campaign challenging how holidays are promoted and addressing the influence of alcohol and drugs on sexual health and correct use of condoms. P118 ■ Sex work practices and condom use in female sex workers in Sydney J Fox1, RL Tideman1, S Gilmore1, C Marks1, I van Beek2, A Mindel1 1Department of Medicine, Imperial College, London, 2Sexually Transmitted Infections Research Centre, The University of Sydney, Westmead Hospital, Westmead, Australia Objective: To determine sex work practices, sexual behaviour and predictors of condom use among sex workers (SWs) in Sydney. Methods: Female SWs were recruited from two sexual health centres in Sydney. Participants completed a self-administered questionnaire covering demographic, sexual and reproductive characteristics and sex work practices. The association of each variable with condom use was assessed. Results: 148 International (born in Asia) and 141 Local SWs (born in Australia, New Zealand or the UK) were recruited. 54% of International SWs and 21% Local SWs had worked outside Australia (p=0.001). Local SWs saw more clients per shift (p=0.002), but International SWs worked more shifts per week (p=0.001). Local SWs had more non-paying partners in their lifetime than International SWs (p=0.001). International SWs used condoms less consistently at work but more consistently with non-paying partners (=0.01) than Local SWs (0.001). On multivariate analysis, inconsistent condom use was associated with speaking Thai (p<0.001) or Chinese (p<0.001) and previous sex work in Thailand (p=0.02). Conclusions: International SWs used condoms less consistently than Local SWs. Speaking Thai or Chinese and previous sex work in Thailand were the only independent variables showing an association with inconsistent condom use. Condom use with non-paying partners was poor. 45 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P119 ■ Heterosexual men and women are less likely to use the internet to look for sex than gay men ■ Is advice on condom use from HIV clinic staff associated with sexual risk behaviour among HIV-positive gay men? J Elford1, G Bolding1, M Davis1, L Sherr2, G Hart3 1City University London, 2Royal Free and University College Medical School London, 3MRC Social and Public Health Sciences Unit, Glasgow, UK Aim: To examine the extent to which heterosexual men, women and gay men use the Internet to look for sexual partners. Methods: Heterosexual men, women and gay men attending a London HIV testing clinic in 2002–2003 were asked to complete a questionnaire concerning their use of the Internet for seeking sexual partners. Results: 331 heterosexual men (median age 30 years), 330 heterosexual women (28 years) and 319 gay men (32 years) were included in the analysis (response rate 75%). The majority of respondents were white, employed, had a higher education and had access to the Internet at home or at work. Nearly half the gay men (43%) had used the Internet to look for sex in the previous 12 months compared with 10% of heterosexual men and 5% of heterosexual women (p<0.001). Rates of high risk sexual behaviour were elevated among those who used the Internet to look for sex (gay men, 25% v 12%, p<0.001; heterosexual men, 39% v 25%, p=0.2; heterosexual women, 38% v 17%, p=0.1). Conclusion: While heterosexual men and women are less likely to use the Internet to look for sexual partners than gay men, those who do so may be at elevated risk for STI. G Bolding1, M Davis1, LL Sherr2, G Hart3, J Elford1 1City University London, 2Royal Free and University College Medical School London, 3MRC Social and Public Health Sciences Unit, Glasgow, UK Aim: To examine whether advice on condom use from HIV clinic staff (in relation to HIV cross infection or undetectable viral load) is associated with sexual behaviour among HIV positive gay men. Methods: HIV positive gay men attending a London HIV outpatient clinic in 2002–2003 were asked to complete a self administered questionnaire (n=483, response 72%). Results: Two-thirds of respondents (n=319) said they had discussed HIV cross-infection with clinic staff and had been advised to always use condoms for anal sex with another HIV positive man. The remainder had not discussed it. There was no association between discussing this with clinic staff and reporting unprotected anal intercourse (UAI) with another HIV positive man (13% v 13%, p=1.0). Two-thirds (n=304) said they had discussed HIV transmission risk when their viral load was undetectable and had been advised to always use condoms to avoid passing on HIV. There was no association between discussing this with clinic staff and UAI with a partner of unknown or discordant HIV status (26% v 23%, p=0.5). Conclusions: Two-thirds of respondents had been advised by HIV clinic staff to use condoms in specific situations but there was no association between receiving this advice and their sexual behaviour. P120 P122 ■ Sexual behaviour of HIV-positive men who have sex with men with gonorrhoea C Newey, E Jungmann Mortimer Market Centre, Camden PCT, London, UK Backgound: Bacterial sexually transmitted infections (STIs) are important risk factors for the transmission and acquisition of HIV, together with increasing reports of unprotected anal intercourse (UAI) with casual partners of unknown or discordant HIV status. This may explain the sustained high incidence of HIV in men who have sex with men (MSM). Aim: To determine the sexual behaviour of HIV positive MSM with gonorrhoea and estimate the risk of onward transmission of HIV. Methods: Retrospective case note review of HIV positive patients with gonorrhoea at a large HIV outpatient centre in London (01/04–09/04). Results: 139 patients with gonorrhoea were identified. Preliminary results of 61 patients showed the total number of partners recorded for the preceding 4 weeks was 127 (1–4). Of these, 35% were known to be HIV positive, 50% were of unknown or discordant HIV status 15% missing. 70 (55%) were casual partners. 54% of episodes were UAI. Median viral load was 165756 (200–1680700 copies/ml). Full results will be presented at the conference. Conclusion: This study shows the potentially high risk of onward transmission of HIV in MSM with gonorrhoea and the need to offer repeat screening for HIV to HIV negative MSM with gonorrhoea. 46 P121 ■ Surveillance data on HIV and other sexually transmitted infections (STIs) in the UK in 2003: can we reach targets set in the National Strategy for Sexual Health and HIV? V Delpech, K Sinka, C Lowndes, J Parry, B Evans, N Gill on behalf of the HIV/STI Department CDSC, Centre for Infection, Health Protection Agency, London, UK Aim: Current national surveillance data on the intersecting epidemics of HIV and other STIs in the UK will be presented within the context of targets of Sexual Health Strategy to reduce the undiagnosed prevalence and transmission of STIs and HIV. Results: Of the estimated 53 000 people living HIV in 2003, 27% were undiagnosed. New diagnoses continued to rise among heterosexual men and women born in sub-Saharan Africa, most acquiring their infection abroad. Sustained high level of new diagnoses in MSM may be partly explained by improved testing (uptake of 47% among MSM attending GUM clinics in 1998 cf 64% in 2003). However, increases in HIV incidence (3.7% of MSM attending GUM clinics in 2003) are of concern. Antenatal HIV screening uptake is now high: >90% of HIV infected women are diagnosed prior to delivery. Prevalence among pregnant women born in the UK remains stable (0.03%). STI trends are difficult to interpret but indicate limited progress in curtailing the epidemic. Compared to 2002, chlamydial diagnoses increased by 8%; genital warts 2%; syphilis 28% in men and 32% in women (cf a 4% decline in gonorrhoea). STIs remain particularly high among young people, MSM and ethnic minority groups. 11th P123 Poster Abstracts ■ Is there a heterosexual epidemic of HIV in the UK? PJ White, GP Garnett Imperial College, London, UK Aim: The annual number of new HIV diagnoses in heterosexuals in the UK has increased rapidly in recent years, accompanied by increases in reported risk behaviour and in the incidence of other sexually-transmitted infections. However most of these newly-diagnosed HIV infections were acquired outside the UK. We examine whether there is a self-sustaining HIV epidemic – with continued onward transmission leading to a potential explosion of cases – occurring in heterosexuals in the UK. Methods: We compare annual numbers of new UK-acquired heterosexual HIV cases with the UK prevalence of HIV in heterosexuals, to calculate the average annual number of new infections per prevalent infection. This number must exceed a threshold value for there to be sustained transmission. Since diagnoses reflect past incidence of infection, sensitivity to the delay between infection and diagnosis is examined. Results: The average annual number of new infections per prevalent infection is currently too low for there to be a self-sustaining UK epidemic. However, of concern is the increase in this rate over time, consistent with reported increasing risk behaviour. Discussion: The evidence does not indicate a heterosexual HIV epidemic currently occurring in the UK. However, transmission rates are increasing and there is no room for complacency. P124 ■ The use of geographical information software (GIS) in sexually transmitted infections mapping R Arms, A Wright, MR Pakianathan Courtyard Clinic, St Georges Hospital, London, UK Objectives: To explore the use of GIS to assess access to genitourinary medicine (GUM) clinics according to ward of residence and to identify areas of high sexually transmitted infection (STI) incidence. Methods: Data from patients aged 15–29, living within a predefined area, attending a GUM clinic from July 2003-2004 were analysed. Attendance rates were calculated using census data. Ethno demographic characteristics were compared between patients testing positive for a non-viral STI (chlamydia, gonorrhoea, or syphilis) and those attending for other reasons. Mapping was performed using ARC GIS ©software. Results: Of the 7442 patients identified, 749 (10.1%) were diagnosed with a non-viral STI. Those with non-viral STIs were more likely to be of black ethnicity (39.5% c.f 26.4%) [p≤0.001], particularly those with gonorrhoea (63.4% vs. 26.4%) [p≤0.001] or be male (47.9% c.f 37.9%)[p≤0.001]. GIS software demonstrated that the highest rates of attendance were from wards in close proximity to the clinic. High disease incidence areas were also clearly demonstrated. Conclusions: GIS is a useful in mapping access patterns of populations to GUM services. It may also have a role in identifying ‘hotspots’ of disease, thus assisting in targeted disease control initiatives. GIS maps will be presented at the meeting. P125 ■ STISS: developing a national web-based STI coding system in Scotland AJ Winter1, C Thompson2 on behalf of the STISS steering group 1Sandyford Initiative, Glasgow, 2Department of GU Medicine, Edinburgh Royal Infirmary, Edinburgh, UK Problem: By 2002 Scottish GUM clinic ISD(D)5 (KC60 equivalent) data collection was 3 years behind due to combination of failing stand-alone IT systems, delays in processing paper-based returns and lack of prioritisation by NHS trusts. Intervention: A Scottish Executive-funded STI epidemiology working group recommended adoption of centralized web-based data collection. The STISS (STI Surveillance Scotland) system was developed by Information Services of National Services Scotland. All clinics were given NHS-net-enabled computers; diagnostic codes were revised to introduce service codes, yielding denominator data. Key advantages include: real-time secure data collection; real-time validation, enhancing data completeness and accuracy; context-sensitive help; flexible revisions to codes; scaleability to any number of locations with minimum site visits. Outcome: Web-based coding went live on 22/04/04. By 31/12/04, 11812 records had been submitted from 16 sites, with 60% of clinics in Scotland participating. New mandatory service records were complete for every record. Chlamydia positivity rate was 11.9% in women, 13.3% in men. HIV test uptake rate 51.9% overall, 47.3% in those with acute STI. Conclusion: The new STISS system has greatly improved data collection and quality and allows timeous reporting of STI trends and positivity rates. P126 ■ Follow-up to establish the probable route of infection for individuals diagnosed with HIV between 1997 and 2003 in England, Wales and N Ireland VL Gilbart, KJ Sinka, RD Smith, S Dougan, BG Evans The Health Protection Agency’s Centre for Infections, Colindale, London, UK Introduction: Understanding the epidemiology of HIV infection in the UK requires establishing the transmission route for as many as possible of those diagnosed. The national surveillance process includes standardised follow-up of all cases where the likely transmission route cannot be determined from the case report. Methods: The route of infection categorisations of cases with diagnosed HIV infection were compared before and after follow-up for reports received between January 1997 and December 2003 by examining the up-dated data as it stood at the end of 2004. The contribution of this to the overall understanding of HIV infection in the UK was evaluated. Results: 10,911 reports required following up between 1997 and 2003. At the end of 2004 full allocation to one of the established transmission route categories was achieved for 9,205, 181 had been closed unresolved and for 1,487 follow-up was continuing. Of those allocated to a category, most were infected heterosexually and the follow-up ascertained that the majority of these infections occurred abroad. Thirty-eight cases which did not fall into one of the four main transmission routes were identified. Conclusion: Detailed follow-up provides a more complete understanding of the changing epidemic in the UK, information fundamental to the appropriate targeting of prevention efforts. 47 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P127 ■ Late presentation of HIV infection - more evidence of health inequalities? S Kegg, S Mitchell, J Russell Queen Elizabeth Hospital, London, UK Aim: To investigate determinants of late presentation of HIV (CD4<200). Methods: Notes review of all new diagnoses of HIV infection in 2004. Results: 84 adults were newly diagnosed HIV antibody positive in our centre in 2004. Late presentation was defined by baseline CD4<200. No significant differences in baseline CD4 count were observed between males and females, although black African men were significantly more likely than black African women to present with advanced disease (p=0.024). Moreover, no significant differences were seen in baseline CD4 count between black African women testing as part of the antenatal screening programme compared to those testing in the GUM clinic setting. Predictably, individuals testing positive as inpatients had significantly worse CD4 counts than those electively testing in the GUM clinic (p=0.007). A higher proportion of antenatal diagnoses had well-preserved CD4 counts compared to those testing in GUM clinic (p=0.037). Duration of stay in the UK at time of diagnosis had no impact on baseline CD4 count. Conclusion: Black African men remain a difficult to reach group for early elective HIV testing. The impression that seeking HIV care drives migration from high prevalence/resource-poor countries would appear to be a largely false one. P129 ● Patient preferences for partner notification A Apoola1, KW Radcliffe2, S Das3, V Robshaw1, G Gilleran2, M Kumari3, M Boothby2, R Rajakumar1 1Derbyshire Royal Infirmary, Derby, 2Whittall Street Clinic, Birmingham, 3Coventry and Warwickshire Hospital, Coventry, UK Aim: To identify patient preferences for notification of sexual contacts. Methods: A questionnaire survey of 2500 patients attending the Genito-Urinary clinics at the participating sites. Results: An interim analysis of the first 1239 respondents is presented. The median age was 24 years (range 13–69). The index patient's ratings of the methods of contacting a sexual partner if they are found to have a sexually transmitted infection are as follows: Conclusions: Provider referral is less acceptable to patients than patient referral for partner notification*. Notifying contacts through a letter seems to be more acceptable than phoning, text messaging or email**. P128 P130 Withdrawn as requested Who fails to attend following contact tracing? ● R Finch1, G Bell2, KE Rogstad2 1Sheffield University School of Medicine, 2Department of Genitourinary Medicine, Sheffield, UK Aim: To identify the characteristics of contacts of chlamydia who fail to attend following provider referral. Methods: 217 (151 M; 66 F) heterosexual contacts of chlamydia notified by a health adviser in 2003 from a provincial city GUM were classified according to attendance, age, gender, ethnicity and deprivation score. Postcodes were 'deprived' if below the 20th centile on the Index of Multiple Deprivation Super Output Area Levels. C2 analysis was carried out using Epi Info. Results: 70.9 % of males attended, v 80.3 % females (p=0.20); 74/107 (69.2%) ‘deprived’ attended v 86/110 (78.2%) less deprived (p=0.18); 65/97 (67.0%) under 20 attended v 95/120(79.2%) over 20s (p=0.06). For ethnicity, differences in attendance patterns were highly significant: 135/157 (86%) of whites compared with only 19/33 (56%) of non-whites (p=0.0004). Conclusions: Poorer outcomes for provider referral are strongly associated with non-white ethnicity, and young age is almost statistically significant; there is a trend for association with male gender and poverty. This gives a useful insight into which populations find access to sexual health services most difficult, and where other control strategies (e.g. screening programmes) may be targeted most effectively. 48 11th P131 Poster Abstracts ● P133 ● Stakeholder perspectives on delivering sex and relationships education (SRE) in Tower Hamlets Psychological and psychosexual impact of HIV infection in an older population T Fernandez, J Chapman, C Estcourt St Bartholomews and The London, QMW, London, UK Introduction: Sexpression, a Medical Student International Network initiative is a voluntary, student led society at Bart's and The London medical school. Set up in Tower Hamlets, Sexpression identified a need for targeted, culturally specific Sex and Relationships Education (SRE) in this ethnically diverse community. Working with the PCT and sexual health services, Sexpression recruits and trains medical students to deliver SRE to young people. Trained medical students will provide informal interactive teaching to young people, thus supporting local agencies and schools in the community. Sexpression highlights the need for developing culturally sensitive and relevant SRE in line with the needs of the local community. Aim: Determine stakeholder perceptions of SRE delivery in Tower Hamlets. Determine stakeholders views on the role of Sexpression within context of SRE delivery as a community initiative. Methods: Semi-structured interviews with a cross section of stakeholders including teachers, nurses, youth workers, community leaders, sexual health services managers, parents centre manager, department of education. Results: Qualitative inductive thematic analysis will be presented using data from the semistructured interviews. The results include themes about consumer involvement, cultural sensitivity, and educational content. Conclusion: Data highlights that consumer involvement is crucial for organisational and personnel development of delivery plans for SRE. S Delamere , F Mulcahy, S Clarke Genito-Urinary and Infectious Diseases Clinic (GUIDE), St James’s Hospital, Dublin, Ireland Background: As people become older their sexual habits change. This study is looking at how this affects sexual habits of HIV positive patients. A total of 27 patients aged 60 years and over (Males =23, Females =4) attend the HIV Clinic. Aim: The aim of this study is to identify the psychological and psychosexual impact of a HIV diagnosis in an older patient cohort. Methodology: A mini-mental assessment and a detailed structured questionnaire was performed on the first sequential twelve patients aged 60 years and over. This recorded demographic information, previous medical history, psychological aspects of their diagnosis and the psychosexual impact of a HIV diagnosis. Results: Twelve patients were interviewed (male 9, female 3) mean age 69 years (Range 62–81 years) Risk factor for HIV acquisition was Heterosexual (5) Bisexual (6) Blood transfusion (1). Mini-mental assessment scores ranged from 22–30. (Normal range 25–30). Following their diagnosis, 50% of patients described a new onset of insomnia, 33% of patients described significant anxiety symptoms. Prior to diagnosis nine patients enjoyed sexual intercourse, one enjoyed sex post diagnosis, eight patients no longer had sex because of HIV, four patients described new onset of erectile dysfunction post diagnosis. Conclusion: This study demonstrates a significant morbidity associated with the aging HIV population. P132 P134 ● One-stop shop versus collaborative integration: what is the way forward? RS French1, C Fenton1, M Gerressu1, A Graham2, D Gray2, C Salisbury2, J Coast2, S Hollinghurst2, A Robinson1, K Miles1, CH Mercer1, K Rogstad3, J Stephenson1 1Centre for Sexual Health and HIV Research, The Mortimer Market Centre, University College London, London, 2Department of Community-Based Medicine, University of Bristol, Bristol, 3Dept of GUM, Royal Hallamshire Hospital, Sheffield and Chesterfield and North Derbyshire Royal Hospital, UK Aim: To examine models of integrated and/or one-stop shop (OSS) sexual health services (including general practice, mainstream specialist services and designated young people's services), exploring their relative strengths and weaknesses. Methods: Literature review, interviews with key-informants involved in developing the UK's National Strategy for Sexual Health and HIV (n=11), and site observations at services taking part in the national OSS evaluation. Results: Contraceptive and genito-urinary medicine issues are closely related. However, there is no agreement about what it means to have integrated services, about which services should be integrated or where integration should happen. There are concerns OSSs will result in over-centralisation, precluding the continuation of stand-alone and satellite services. OSS models are potentially more user-focused, but the stigma that surrounds sexual health services may create an access barrier. From staff perspectives, the highlights are greater career opportunities and increased responsibility, while the downsides are concerns OSSs will result in loss of expertise and professional status. Parallel services are expensive and limited resources often mean there are reduced opening hours, however data on cost-effectiveness is contradictory. Conclusion: Despite a policy commitment to developing OSS services, the evidence gap around the impact and appropriateness of this approach is substantial. ● Did the ‘Brazilian’ kill the pubic louse? NR Armstrong, JD Wilson Department of Genitourinary Medicine, The General Infirmary at Leeds, Leeds, UK Background: Anecdotes suggest a recent reduction in cases of pubic lice despite increasing patient numbers and increasing prevalence rates of other sexually transmitted infections (STIs). The aim was to determine the prevalence rates of pubic lice between 1997 and 2003, and compare these with rates of gonorrhoea and chlamydia over the same period. Methods: Annual cases of pubic lice, gonorrhoea and chlamydia were obtained for 1997 to 2003. Prevalence rates were calculated by dividing these figures by new patient numbers. Results: The prevalence rates were: Year GC CT Public lice 1997 1.7% 9.4% 0.41% 1998 1.3% 11.1% 0.43% 1999 1.6% 12.3% 0.39% 2000 2.8% 12.8% 0.25% 2001 2.6% 12.2% 0.27% 2002 3.8% 13.2% 0.30% 2003 3.5% 12.0% 0.17% Comparing 2003 with 1997 there was a significant drop in prevalence of pubic lice (OR 0.41; 95%CI 0.23–0.70) whereas there was a significant increase in gonorrhoea (OR 2.18; 1.86-3.48) and chlamydia (OR 1.31; 1.21–1.43). Conclusion: Sexual behaviour changes cannot account for this discordant pattern of STIs so there must be another explanation. The drop in pubic lice in women was around 2000 and coincided with the introduction of new trends in pubic hair removal. Full breakdown of the figures will be presented and correlated with pubic hair removal practices. 49 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P135 ■ ■ Characteristics of patients declining an HIV test in a genitourinary medicine clinic KNOW4SURE – a community-based rapid HIV point of care test (POCT) clinic J Zhou1, R Webb2, S Ghosh1 ST Sadiq2, MR Pakianathan1 Medical School, London, UK Aim: To determine the characteristics of patients who decline HIV testing in a GUM clinic since the introduction of a routine testing policy. Methods: Retrospective case notes analysis of patients declining HIV testing compared to those accepting over a three-month period in 2004. Demographic characteristics, risk behaviour and KC60 diagnostic codes were compared. Results: Of a total of 1996 patients who were offered HIV testing, 797 (39.9%) declined the test. A random sample of 220 (103 accepting, 117 declining) was analysed further. Factors associated with an increased likelihood of accepting an HIV test included same sex relationships for men (odds ratio [OR] 5.01, confidence interval [CI] 1.72 to 14.60) and a discernible HIV risk factor ( OR 9, CI 2.40 to 5.07). Declining testing was not association with gender, a concurrent STI diagnosis or having tested previously. However, 20% of patients declining the test had identified risk factors for HIV infection. Conclusions: A routine testing policy for HIV within GUM clinics does not guarantee universal uptake. While patients perceived to be at risk are more likely to test, a significant proportion of patients with risk factors continue to decline testing. Further detailed analysis will be presented at the meeting. R Mugezi1, A Barrat1, A Wilkinson3 A Waters1, A McOwan2, AK Sullivan1 1John Hunter Clinic, London, 1,2Chelsea and Westminster Hospital, London, 3Terence Higgins Trust, Lighthouse West London, London, UK Aim: To evaluate an outreach, rapid HIV POCT clinic. Method: We reviewed the case records of all attendees to a community-based, weekday evening clinic offering a maximum of 10 tests per session. Results: 626 individuals attended over 21 months, 73% men, 30% MSM, 0.5% IVDU. The mean age was 31.7 years, and 23% were from BME communities. 96% of responders indicated a preference for evening/Saturday clinics, 87% preferred a walk-in service. 55% had tested before, mean 2.1. 9% were expecting a positive test result, and 26% admitted to high level worry regarding HIV. The availability of a rapid test influenced the decision to test for 96%. Identified risks included unprotected intercourse; 52% vaginal, 16% anal and 16% oral. 60% had a partner of unknown HIV status and 6% a known HIV+ partner. 597 tests were performed, 22 (3.7%) were positive. Recent increase in number of tests and staff has resulted in 30% increased attendance. Conclusion: A large proportion of individuals testing were at low risk for HIV, reflected in the relatively low diagnosis rate. Current interventions are underway to increase the attendance of individuals at higher risk. Rapid testing and 'out of hours' services are preferred. P136 P138 1Courtyard Clinic, St George’s Hospital, London, 2St George’s Hospital ■ Do differences in access to GUM clinics or HIV testing behaviour of African men and women account for the high proportion of women testing HIV-positive in the UK? K Bond, I Begum, EF Fox Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, UK Background: In 2003, 59% of new UK HIV diagnoses were acquired through heterosexual sex, and 65% of these were women, predominantly from Africa. We aimed to determine if this could be due to higher uptake of HIV tests in African women than men, through increased access to our GUM clinic, or being offered or accepting a test more often than men. Methods: All African-born new patients of Black African ethnicity attending between January and June 2004 were reviewed to determine if an HIV test was offered and accepted. Data collected on sex, age, sexuality, presenting complaint and STI diagnosis, was analysed using Chi squared. Results: 234 men and 190 women attended. 95.5% men and 94.6% women were offered an HIV test (p=0.813) and 73.8% men and 72.8% women accepted (p=0.906). 12 men and 12 women tested positive (p=0.517). Asymptomatic patients were significantly more likely to accept an HIV test than symptomatic patients (p=0.009). Discussion: Women and men were equally likely to be offered and accept an HIV test in our clinic. More men than women attended. This study did not demonstrate that greater testing of women than men in GUM accounts for the high proportion of new infections in women. 50 P137 ■ Acceptability of voluntary HIV testing among NHS staff: results from a questionnaire-based survey M Hamill1,2, S Murphy2 1Patrick Clements Clinic, Central Middlesex Hospital, London, 2Jefferiss Wing, St Mary’s Hospital, London, UK Background: Numbers of healthcare workers from high endemnicity areas employed by the NHS are increasing. The DoH has guidelines for the responsibilities of HIV infected staff but none for universal voluntary testing of healthcare workers. Aims: To assess the acceptability of voluntary HIV testing for NHS staff. Methods: Anonymous questionnaire to staff at a London DGH. Results: Of the first 69 respondents: 75.4% were female, 23.3% male, 1.4% no data available (NDA). Ethnicity: 11.6% black British, 30.4% white British, 8.7% Asian British, 5.8% Caribbean, 11.6% African, 11.6% Asian, 2.9% black other, 13% white other and 4.3% NDA. 38% were nurses, 19% doctors, 16% clerical/administrative, 7% healthcare assistants, 20% other. 92.4% understood the terms HIV/AIDS, NDA 5.8%. 39% had a previous HIV test. None were known HIV positive. 42% worked in areas offering routine HIV testing, 55% did not, NDA 3%. 62% would consider having an HIV test, 38% would not. Of the 62%, reasons given were: Of the 38%, reasons given were: 11th P139 Poster Abstracts ■ Effects of restrictions to HIV-positive people travelling to the USA P141 ■ Non disclosure of HIV-positive status M Mahto, E Wilkins North Manchester General Hospital, Manchester, UK Background: The USA bans entry to non-citizens with HIV unless they obtain a waiver visa. Aim: To establish how many people with HIV infection travelled to the USA, whether they were aware of the travel restriction, whether they travelled with a waiver visa and medical insurance, how they managed with their HAART and their feelings towards the ban. Design: Cross sectional study, using a structured self-completion questionnaire. Results: 408 questionnaires were returned (73%). 99 (24%) had travelled to the USA since testing positive of whom 83% took out medical insurance, 64% were aware of the waiver visa, and 76% were on HAART. Of those taking HAART, 10% posted their medicines before travel, 47% took their drugs on time, 32% took a doctors letter, and 16% were searched. Only 5% of patients obtained a waiver visa before travel with 9% discontinuing their medication before entering the USA. Many patients reported negative practical and emotional experiences resulting from the travel restrictions. Conclusion: The majority of HIV patients travel without the waiver visa, many with insufficient planning and advice; in nearly 10% of patients, this led to discontinuation of therapy without medical advice. N NÌ Rathaille, S Flynn, J Herbst, O Halvey, E O'Donoghue, F Mulcahy St James Hospital, Dublin, Ireland Objectives: To examine the social and demographic status of patients who have reported sexual contacts without disclosure. Methods: From Jun 04–Nov 04 patients were interviewed in depth by medical social workers (MSW) to establish patterns of non-disclosure and thereby facilitate contact tracing. Results: 22 HIV+ heterosexuals, (9 male, 13 female) of whom 5 (23%) identified their source of infection as IVDU, were interviewed. 18 had received post-test counselling. 16 (73%) reported being in a relationship >6 months, (4 married, 7 co-habiting.) 17 denied any casual sexual contacts. 12 report to be sexually active, 10 of these reporting regular condom use. 14 partner contact details were withheld. In 11 cases, disclosure occurred within the first 6 months of strategic disclosure intervention. The majority of disclosures were undertaken by patients (n = 9). 1 by a third party and 1 through anonymous contact tracing. 11 have yet to disclose and work is ongoing. Factors impeding disclosure include fear of relationship breakdown (n = 14) and domestic violence (n= 5). Conclusion: This research revealed a complex and broad range of difficulties around the issue of disclosure. This may necessitate a considered, individualised approach when working on disclosure issues and the need for further research. P140 P142 ■ What impact can an HIV conference have on the lives of people living with HIV? B Evans On behalf of the four Changing Tomorrow conference partners: National AIDS Trust; National Long-Term Survivors Group, Positively Women, UK Coalition of People Living with HIV and AIDS, UK Aim: To investigate whether Changing Tomorrow had an impact on the lives of participants. Methods: 208 pre-conference questionnaires completed, an independently assessed evaluation of the conference and post-conference questionnaires. Pre-conference findings: Only 5% of participants said they were in poor health. 70% were taking HIV treatment, however 85% worry about long-term effects. A further 9% are put off as a result. 70% were satisfied with both their treatment and experiences of health care. Only 6% were unhappy with their specialist HIV care. White people rated their understanding of the NHS higher and had more confidence to get involved. A disproportionate number of heterosexual men were not satisfied with many aspects of their life. Most participants had told somebody about their HIV status, only 13% receiving a negative reaction. Conference evaluation findings: 65% felt more confident about disclosure. 97% stated intentions to take further action (involvement in the NHS, being proactive about health, increasing levels of optimism). Post-conference findings: analysis of post-conference questionnaires identified actions taken by participants and changes in attitudes and behaviour; 44% were less worried about the long-term effects of HIV medication; moderate levels of involvement had increased by over 40%; 51% were more satisfied with the overall quality of their life; 46% were eating more healthily. Conclusion: Changing Tomorrow had a significant impact on the lives of participants living with HIV. ● HIV opt-out increases the offer and uptake of HIV tests in patients at low risk for HIV (LRP) in a genitourinary medicine (GUM) clinic H Price, I Thompson, J Birchall, C Newey, E Musgrave, F Smith, AM Waters, AK Sullivan Department of Genitourinary Medicine, Chelsea and Westminster Hospital, London, UK Aim: To evaluate the effect of introducing HIV opt-out testing for patients assessed as LRP on test offer and uptake rates in the John Hunter Clinic (JHC). Methods: The case notes of 100 consecutive new attendees at 3 clinics (JHC,C2,C3) were reviewed before (T1) and after (T2) the introduction of HIV opt-out testing in JHC. Results: The notes of 600 patients were reviewed, 319 were male, 23% MSM, mean age was 29.4 years. The offer of HIV tests rose in JHC vs C2+3 (88 to 94% vs 85 to 83%, p<0.001). The number of LRP offered a test increased in JHC T1 vs T2: 64 vs 80%, p=0.012. The number of tests performed increased in JHC vs 2+3, for all patients 70 vs 56%, p=0.045, for LRP 72 vs 52% p=0.003. Of LRP in JHC offered a test, uptake did not change, 77%. Conclusion: The introduction of HIV opt-out for low HIV risk patients increased the number of HIV tests offered and performed. The increase in LRP uptake appears to be due to increased offer rather than increased proportion accepting the offer, suggesting this was not influenced by a change in staff input beyond the opt out process. 51 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P143 ● HIV testing and the sexual health strategy: are we ‘targeting’ the right people? 52 ● Successful implementation of a new HIV testing service in an inner-city primary care practice I Reeves, M Poulton, M Tenant-Flowers King’s College Hospital, London, UK Aim: To investigate whether national targets for HIV testing are being achieved and whether those at high risk test. Method: A retrospective audit of patients attending for an STI screen during one week with collection of risk data. Results: The notes of 333 patients were reviewed. New patients: 95% offered HIV testing with 57% uptake. Of 125 re-attending patients 45% tested for HIV: 44% not offered and 50% declining a test had never tested. All 11 gay men and one female commercial sex worker accepted a test. Black patients were significantly less likely to test than White patients when attending for a first screen (p = 0.016). This relationship remained significant only for Black Caribbean patients amongst all Black ethnic groups. The testing uptake for those reporting >1 or 1 or 0 sexual partners in the previous three months was not significantly different. Overall 33% of those diagnosed with an STI also had an HIV test. Conclusions: National strategy targets for HIV testing can be achieved but do not necessarily result in uptake of testing amongst those at high risk. Further work is needed to identify ways to increase uptake in certain groups. Sensitive, non-invasive testing may offer a solution. P144 P145 ● R Bickersteth1, A Benhene Poku2, SGG Sekweyama2, B Bailey1, EF Fox1 1Guy's and St Thomas’ NHS Foundation Trust, 2Trafalgar General Practice, Southwark, London, UK Background: The national strategy for sexual health and HIV supports outreach services to target risk groups with high rates of undiagnosed HIV. We started a weekly community HIV testing service in Southwark, incorporated into the new patient health check, targeted at the African population. It is run by practice nurses following training by the STI Management in Primary Care Project, supported by the community health adviser. Methods: All new patients registering with the practice are offered HIV testing. Data was collected on age, ethnicity, country of birth, acceptance of HIV test, HIV result and attendance for results from the first 3 months of the service, 2004. One year data will be presented. Results: 6 women and 11 men attended. 8/17(47%) were Africans and 2/17(12%) Jamaican. 16/17(94%) had not tested for HIV previously. All attendees accepted an HIV test following pre-test discussion. 2/17(12%) patients tested HIV +ve. 12/17(71%) DNA’d their result appointment. Discussion: It is possible to set up an HIV testing service in collaboration with primary care colleagues, which successfully targets at-risk individuals who have not previously tested for HIV. Given the high DNA rate for results, alternative methods of informing patients of their results should be considered. P146 ● Bridging the gap – reducing undiagnosed HIV infection through targeted training in non-specialist settings Uptake of HIV test is enhanced by a special post-carnival 'KNOW4SURE' clinic offering rapid HIV point of care testing (POCT) J Roberts, M Ottewill, G Dean, DR Churchill, M Fisher Claude Nicol Centre, Royal Sussex County Hospital, Brighton, UK Background: Late diagnosis of HIV is associated with poorer outcome to treatment. Many ‘late presenters’ have previously received care by specialities without HIV being recognised. To attempt to reduce such late diagnosis we constructed an interactive training package on HIV testing with individualised case studies for each speciality. Methods: Questionnaires were completed to determine attitudes and barriers to HIV testing. HIV testing patterns were measured for 3 monthly periods both prior to and after the training package and any positive diagnoses were noted. Results: 6 specialities undertook the course, totalling 57 participants. 54% had previously performed an HIV test. Commonest barriers were uncertainty regarding testing procedure, concern about raising patient anxiety and giving a positive result. Confidence in testing increased from 17.5% to 47.3% after the course. HIV tests performed during 3 month periods before and after the course was essentially unchanged (20 vs 19). However 3 new HIV diagnoses were made, in the postcourse period. A further 18 patients were referred to GUM for testing, of which 3 tested positive. Conclusions: A focused course improves confidence in HIV testing and targeted referral to GUM. It has minimal effect on testing frequency but may assist in identifying a small number of infections. R Mugezi1, A Wilkinson3, U Kalidini2, R Betourney1, A Waters1, J Anderson2, AK Sullivan1 1John Hunter Clinic, Chelsea and Westminster Hospital, 2Homerton University Hospital NHS Foundation Trust, 3Terence Higgins Trust, Lighthouse West, London, UK Aims: To evaluate the effect of providing specific event-related HIV testing clinics following targeted promotion at a community event, and the effect of offering rapid HIV testing at one of the clinics. Method: Two one-off HIV testing clinics were held following promotion to Black and Minority Ethnic (BME) communities at the Notting Hill Carnival. A Saturday clinic offering rapid HIV POCT was held at the Lighthouse West London (KNOW4SURE) and a Thursday evening clinic offering standard HIV testing was held at the Homerton Hospital (HH). Results: 17 people attended KNOW4SURE, none attended HH. Eight were male, 14 heterosexual and the mean age was 32.1 years. 73% identified themselves as being BME, compared to 24% of those attending the regular weekly ‘KNOW4SURE’ Monday evening clinics held at the same location (p<0.001). 10/10 (100%) attendees preferred evening or weekend clinics. 12/13 (92%) were influenced by the availability of one hour testing and 7/13 (54%) would not have tested had it not been available. Conclusion: Promotion of an event specific clinic increased the proportion of individuals from a target population attending. The availability of rapid HIV POCT appears to influence testing behaviour. 11th P147 Poster Abstracts ● P149 ● Unusual mode of transmission of HIV The complexity of travelling with HAART C Emerson, C Cunningham, SP Quah Royal Victoria Hospital, Belfast, UK We report an unusual case of HIV transmission that would be missed by traditional assessment of risk. A 39 year old Caucasian man developed flu like illness with symptoms of lethargy and weakness, August 2002. Persistent lymphadenopathy lead to HIV being considered January 2003. A subsequent HIV test was positive. He has one lifetime female Caucasian partner. He had no past history of blood transfusions or IVDU. Of note his 37 year old brother had contracted HIV in Botswana via heterosexual contact two years previous. He was on HAART (combivir and nevaripine) and had a CD4 350 (16%) with viral load 4800 (log 3.68). A bloody fight had occurred between them July 2002. Post exposure prophylaxis was not considered. To determine if this was the mode of transmission phylogenetic analysis was undertaken. Analysis of the pol gene region indicated that samples from both brothers belonged to the subtype C clade of HIV-1, and that the sequences were closely related to one another. We present this subject to highlight the importance of careful history taking. Exposure risk data is extremely useful in helping counsel patients prior to HIV testing but as this case illustrates must not be used in a rigid way. MA Schuhwerk1, J Richens2, H Wyss1, L Kirkpatrick1, C Ashton1, RH Behrens3 1Mortimer Market Centre, Camden Primary Care Trust, 2Centre for Sexual Health, University College Hospital, 3Hospital for Tropical Diseases, University College Hospital, London, UK Aim: To investigate the issues of antiretroviral therapy in the context of foreign travel Methods: Retrospective questionnaire based survey of HIV positive individuals attending the Bloomsbury HIV outpatient clinic. Results: 72% (n=216) of study participants were on HAART, 4% had started therapy less than 4 weeks prior to travelling and 8% less than 3 months. 5% were on a triple nucleoside, 26% on a PI, 64% on an NNRTI and 5% on a PI/NNRTI regimen. 12% stopped HAART for the duration of their holiday. 26% reported side-effects to HAART prior to travelling, 8% had worsening and 2% new side-effects during their trip. 81% reported no change in adherence, 11% worse and 8% better adherence to medication whilst travelling. 14% reported storage problems and 15% were searched and questioned at border entry point. Nobody had been refused entry. 38% of patients travelling were unaware of potential drug interactions. Transport to destination: 81% carried medication in their hand-luggage, 32% in their suitcase, 6% mailed HAART to their destination. Individuals used a variety of ways to adapt to time zone changes. Conclusion: Travelling on HAART has many complex issues and needs appropriate discussion with the HIV positive individual. P148 P150 ● Non-disclosure of previously known HIV seropositivity in patients newly diagnosed with HIV infection M Natha1, A Newell1, M Pakianathan1,2 South West London HIV and GUM Clinical Services Network, 1Heath Clinic, Mayday University Hospital, Croydon, 2Courtyard Clinic, St George’s Hospital, London, UK We present a case series of five individuals who had previously been diagnosed with HIV, who then re-presented for HIV antibody testing and subsequent treatment without disclosing their HIV positive status. All patients were of African origin. Reasons for non-disclosure included fear of discrimination, immigration worries and concerns as to how they may be treated. Non-disclosure can lead to failure to recognise pre-existing antiretroviral drug resistance and toxicities, failure to address relevant social problems and inappropriate antenatal treatment increasing the risk of mother-to-child-transmission. Antiretroviral resistance already documented in several sub-saharan African countries is likely to increase with expanded access to treatment. Clinical clues such as a raised mean cell volume and lipodystrophic morphology raised suspicion in our cases. Deranged lipid profiles or pigmentation are other indicators. The supposition that patients with low viral loads may have a non-B clade viral subtype may not always be accurate. Therapeutic drug monitoring and genotypic resistance testing can also be useful. Three out of our five cases had extensive multi-class resistance. In all cases, disclosure occurred after multiple clinic attendances. Clinicians should consider the possibility of HIV status non-disclosure and previous exposure to antiretrovirals when seeing newly diagnosed patients with HIV. ● How accurately do patients with HIV know their viral load and CD4 cell count? G Bolding1, M Davis1, L Sherr2, G Hart3, J Elford1 1City University London, 2Royal Free and University College Medical School London, 3MRC Social and Public Health Sciences Unit, Glasgow, UK Aim: To examine how accurately HIV positive gay men recall their most recent CD4 cell count and viral load test result. Methods: 523 HIV positive gay men (72% response rate) attending a London HIV outpatient clinic in 2002–2003 completed a self administered questionnaire in which they reported their last CD4 cell count and viral load test result. Self-reported data were compared with corresponding data abstracted from patient records. Results: Four out of five men said they knew the result of their last CD4 cell count (404/519, 78%) or viral load test (428/518, 83%). Half the men (51%) who said they knew their last CD4 cell count correctly reported it to within 50 cells/mm 3. The remainder under- or over-estimated their CD4 cell count by more than 50 cells/mm3 (27%, 21% respectively). Most men who knew their viral load test result correctly reported it as being detectable or undetectable; 95% of the 269 men with a laboratory-confirmed undetectable viral load, and 91% of the 126 men with a laboratory-confirmed detectable viral load correctly reported this. Conclusion: Most HIV positive gay men correctly reported whether their viral load was detectable or not and half knew their CD4 cell count to within 50 cells/mm3. 53 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P151 ● Diagnostic value of bone marrow (BM) sampling in HIV-infected patients in the era of HAART MJ Llewelyn, M Noursadeghi, A Dogan, SG Edwards, RF Miller University College London, London, UK Aim: To assess the diagnostic value of BM sampling in investigation of HIV infected patients since availability of HAART. Results: 114 consecutive patients underwent BM sampling between 1999 and 2004. BM aspirates were normal or non-diagnostic, apart from lymphoma in one and mycobacterial infection in two patients; culture identified mycobacterial infection in nine. BM trephine had a diagnostic yield of 26.1 % in patients with fever and cytopaenia [mycobacteriosis in 13.9 %, lymphoma in 6.2 %, Castleman disease in 3 %, 'drug effect' in 3 %], a yield of 20 % in patients with fever, but no cytopaenia [mycobacteriosis in each case] and a yield of 19.1 % in patients with cytopaenia in the absence of fever [lymphoma in 4.8 % and ‘drug effect’ in 14.3 %]. For investigation/staging of lymphoma diagnostic yield was 36%. Diagnostic yield from BM sampling was 30.2% in patients receiving HAART and 22.5% in those not receiving HAART. BM sampling was of most diagnostic value in patients where fever and cytopaenia coexisted in the absence of localizing signs of infection, and in the staging/investigation of lymphoma. Conclusions: BM sampling continues to have a diagnostic utility in HIV infected patients in the era of HAART. P152 ● Vitamin D deficiency in HIV-seropositive individuals AJ Tunbridge, E Ronan, S Naylor, DH Dockrell, SC Metcalf Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield, UK Background: Vitamin D levels are associated with immune system differentiation and function. Nutritional deficiencies are common in HIV sero-positive individuals. Little information is however available on the incidence of Vitamin D deficiency in HIV sero-positive individuals or its impact on immune function. Methods: Vitamin D levels (assayed by immunoassay), basic demographic data, CD4 T-lymphocyte counts and HIV viral loads obtained at the same visit were recorded for 43 sero-positive individuals. Results: 63% were male and the median age was 39 (range 23–63). The median CD4 T-lymphocyte count was 363 (range19–1127) with 8 (19%) of individuals having a CD4 count < 200 cells. 27 (63%) of individuals were receiving HAART with a low or undetectable viral load. The median Vitamin D level was 38.3 (range 11.9–124.8 nmol/L). According to local guidelines one individual (2.3%) had severe vitamin D deficiency (<15nmol/L) and 11 (25.3%) had mild deficiency (15–30 nmol/L). The median CD4 counts in the deficient group was 311(19–663) vs. 416 (131–1127) in the non-deficient group. This represented a weakly positive (r=0.17) but not significant correlation. Conclusions: Mild vitamin D deficiency is common in HIV positive individuals and shows a weakly positive correlation with CD4 T-lymphocyte numbers. 54 P153 ● HIV infection and sexually transmitted infections among persons with insecure immigration or seeking asylum in the UK V Lee1, E Foley1, R Patel1, JM Tobin2 1Department of GU Medicine, Southampton University Hospitals NHS Trust, 2Department of GU Medicine, St Mary’s Hospital, Portsmouth, UK Background: Recently over 30% of new HIV infections diagnosed in the UK are in those born outside this country. An increasing work load in GU Medicine clinics arises from individuals with insecure immigration or seeking asylum. Aim: To determine the prevalence of HIV infection and other STI’s in an immigration removal centre in the UK. Method: From April 2004 a sexual health screening clinic was established in a male immigration removal centre. Results: To date 99 individuals have attended, representing 15% of the total inmates. The majority (74%) were from African countries and the mean age was 29 years. 16% had previously had a negative HIV antibody test. 40% admitted to sexual intercourse with a UK national. During the study 4 new HIV, 3 latent syphilis, 2 gonorrhoea and 1 chlamydia infections have been diagnosed. Conclusion: A small proportion of the group were diagnosed HIV antibody positive, yet its prevalence (4%) is higher than that of the general population in the UK. A smaller number of STI’s were diagnosed yet in all cases these were asymptomatic. In view of this higher level of serious infection targeted screening services should be made available at an early stage to this group. P154 ■ Five years of non-occupational post-exposure prophylaxis (NONOPEP) in a south London teaching hospital S Day, A Mears, K Bond, R Kulasegaram Harrison Wing, St Thomas' Hospital, London, UK Aim: An observational study of non-occupational post-exposure prophylaxis (NONOPEP) prescription. Methods: Data was collected from NONOPEP recipients managed in a South London Genitourinary clinic between 1st Jan 2000 and 1st Dec 2004. Results: 101 patients received NONOPEP. These were predominantly white (81%), homosexual (57%) and male (82%), of median age 33yrs (range 20 to 65yrs). 44% initially attended Casualty. 33% prescriptions were given during the last six months alone. Exposure type was usually sexual intercourse (75%) [anal(56/76), vaginal(18/76)]. 74% sexual exposures received NONOPEP in accordance with BASHH guidelines. 91% sexual acts were consensual of whom 68% knew their source. Antiretroviral therapy and HIV viral load of ‘known’ sources was reported in 43% and 29% respectively. 88% received combivir/nelfinavir. 45% completed the course. Side effects were experienced by 56% and were the predominant reason for therapy discontinuation. Median ‘exposure to NONOPEP’ time was 19.5hrs. No patients seroconverted although, only 46% attended for 3m/6m HIV testing. 75% received baseline HIV testing. Baseline screening identified one patient infected with Hepatitis C. Conclusion: NONOPEP prescription has increased in the last six months possibly due to enhanced public awareness. NONOPEP is prescribed following predominantly ‘high-risk’ exposures with recommended combinations. Follow up attendance rates are poor. 11th P155 Poster Abstracts ■ Impact of BASHH guidelines upon PEP provision following sexual exposure to HIV ■ STI self-treatment, STI prophylaxis and auto-PEP A Beattie, S Roedling, SG Edwards, P Benn Department of Genitourinary Medicine, Mortimer Market Centre, Camden PCT, London, UK Background: BASHH guidelines for post exposure prophylaxis (PEP) following sexual exposure to HIV outlines when PEP is recommended (R), should be considered (C) or not recommended (NR). Aim: To establish whether introduction of the guidelines has influenced prescribing practice. Methods: Retrospective case note review of individuals requesting PEP pre- (21/3/03-20/3/04) and post-introduction of the BASHH guidelines (17/7/04–31/12/04). Demographics, exposure characteristics and clinical data were collected. Prescribing practice was classified: 1/R, 2/C or 3/NR according to the guidelines. Results: Pre-guidelines 97 individuals requested PEP, of which 51/97 (52.5%) followed sexual exposure. 48/51 (94.1%) started PEP: 40/48 (83.3%) were classified as R, 5/48 (10.4%) as C and 3/48 (6.25%) as NR. Following introduction of guidelines 100 individuals requested PEP of which 80 followed sexual exposure. Data were available for 69. 62/69 (89.8%) started PEP: 52/62 (83.8%) were classified as R, 8/62 (12.9%) as C and 2/62 (3.2%) as NR. Overall only 5/110 (4.5%) who received PEP were classified as NR. Conclusions: The majority of PEP is issued within guidelines and since their introduction prescribing practice appears unchanged at MMC. Practice may be most influenced by these guidelines outside GUM settings or where prior demand has been low. P156 P157 ■ Impact of raising awareness of post exposure prophylaxis for HIV infection following sexual exposure S Roedling1, I Reeves2, A Beattie1, S Edwards1, A Copas1, M Fisher2, P Benn1 1Department of Genitourinary Medicine, Mortimer Market Centre, Camden PCT, London, 2Claude Nicol Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK Background: Terrence Higgins Trust launched a campaign promoting awareness of post exposure prophylaxis (PEP) following sexual exposure to HIV in July 2004. Aims: Determine the campaign's impact upon demand for PEP in two GUM clinics. Methods: Retrospective case notes review of individuals requesting PEP in 2004. Comparisons between demographics, clinical data, exposure characteristics and campaign awareness pre- and post campaign were made. Results: 216 individuals requested PEP (165 MMC, 51 Brighton). Data were available for 196/216 (90.7%). The proportion following sexual exposure significantly increased after the campaign (pre- 49/89 (55.1%), post- 90/127 (70.9%) (p=0.025)). 126/139 (90.6%) commenced PEP following sexual exposure. There was a trend towards more men reporting unprotected anal intercourse (UPAI) with a partner of unknown HIV status (11/24 (45.8%) pre- and 41/72 (56.9%) post-campaign (p=0.48). The campaign was cited by 30.7%. Mean time to initiation of PEP was unchanged (30.4 vs 31.5 hours) and completion rates poor (47.8% vs 48.8%) pre- and post-campaign respectively. Attendances for PEP following sexual exposure at MMC have increased significantly since 1997 (8 in 1997 to 121 in 2004 p<0.001). Conclusion: Post-campaign demand for PEP following sexual exposure has significantly increased. Time to initiation and completion rates remain unchanged. A Menon-Johansson Chelsea and Westminster Hospital, London, UK Aim: To determine the extent of self-initiated treatment and prophylaxis for STI and partner initiated HIV post-exposure prophylaxis (PEP) Methods: Anonymous questionnaires were given to 150 consecutive patients in two inner London clinics. Results: A 70% response rate (n = 105) was obtained in the GU clinic. Of these individuals 55% were male, 24% described themselves as homosexual/bisexual, 5% were HIV positive and 49% had a previous STI. Ten percent reported treatment outside the healthcare setting and another 5% self-initiated antibiotics as STI prophylaxis. GP treatment was reported in 11%. In the HIV clinic, a response rate of 64% (n = 96) was obtained. Of these individuals 93% were male, 84% described themselves as homosexual/bisexual and 84% had a previous STI. Three percent reported STI treatment outside the healthcare setting and another 6% self-initiated STI prophylaxis. STI treatment outside the GUM setting (by GP or HIV physician) occurred in 26%. Three respondents reported giving anti-retroviral treatment to a partner as HIV prophylaxis ('auto-PEP') without medical supervision. Conclusions: STI self-treatment and prophylaxis is reported by a significant proportion of clinic attendees. Further research, especially in the community, is required to determine the full extent and implications of this practice. P158 ■ Experience in providing technical assistance to the ARV Roll-Out Program in Kwa-Zulu Natal (KZN), South Africa: The Kings College-Nelson Mandela University Partnership S Barrett1, L Campbell2, C Ball1, R Pawinski3, K Moshal4, P Easterbrook1 1Kings College Hospital, London, 2Post Shepstone Hospital, Kwa-Zulu Natal, South Africa, 3Nelson Mandela Medical School, Durban, South Africa, 4Great Ormond Street Hospital, London, UK Background: In 2004, one of the largest Anti-retroviral (ARV) roll-out programmes worldwide was initiated in Kwa-Zulu Natal (KZN). A key challenge is the shortage of health care workers (HCW) trained in ARV use. We have established an institutional partnership to provide ARV training to participating sites. We report our initial experience and evaluation of ARV roll-out at one of the 12 nodal roll-out sites – Port Shepstone Hospital (PSH). Methods: The initial Kings College programme has been led by a consultant team and an SPR on a ten week attachment to PSH, liaison with LC at PSH and RP in Durban. Results: Between 08/04 and 12/04 160 patients started ARVs at PSH. Key achievements included the introduction of structured and standardized approaches for initial visits and monitoring; strategies for improving clinic access for infected HCWs; an audit of reasons for drop-out of the ARV training programme; and optimising Ol treatment protocols. 7 HCWs at PSH have been trained in ARV use through tutorials, lectures and direct clinical supervision. Conclusions: The partnership has contributed to improvements in both clinical care and streamlining of clinic operational procedures at PSH. We plan to extend to additional sites in 2005. 55 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV P159 ■ ■ Why do HIV-positive patients drop out of ARC access programmes? Experience from a newly established ARV clinic in Kwa-Zulu Natal (KZN), South Africa Reaching the parts free ARVs do not reach: a sustainable UK sponsorship programme for staff with HIV in a Tanzanian hospital S Barrett1, L Campbell2, R Pawinski3, T Welz1 P Easterbrook1 J Meadway, K Collins Medicines for Muheza, Essex, UK, Hospitali Teule, Muheza, Tanga Region, Tanzania Aim: To establish a programme at a district hospital in Tanzania to provide HIV positive staff with antiretroviral (ARV) treatment whilst government programmes are not supplying free ARVs. Background and Method: Muheza Hospital serves a rural population of 280,000 in north east Tanzania. The UK charity Medicines for Muheza (MforM) provides up to 9% of the annual hospital income. In 2001 there was a death every month from HIV amongst the 316 staff and in 2002 a programme for ARVs began with new regular donors sponsoring individual staff through MforM. Treatment follows WHO guidelines using generic ARVs. Results: 25 patients entered the programme, of whom two died of advanced HIV after a short time, and two more are not on ARVs. Twenty-one staff are on ARVs, 15 on stavudine, lamivudine and nevirapine (Triomune) and 6 on zidovudine and lamivudine (Duovir) with efavirenz. Three are temporarily off work because of tuberculosis and 18 are well and working. Staff morale has improved, and HIV stigma has decreased. Free ARVs remain unavailable, but the success of the scheme encourages recruitment of new donors in the UK to keep pace with entrants to the programme. Conclusion: A sustainable ARV programme has provided great benefit to hospital staff. Expertise in HIV management, monitoring, dispensing, and adherence support have been developed in readiness for an extensive programme when free ARVs become available. 1Kings College Hospital, London, UK, 2Post Shepstone Hospital, Kwa-Zulu Natal, South Africa, 3Nelson Mandela Medical School, Durban, South Africa Background and Aims: Eligibility criteria for Antiretroviral therapy (ARV) in the newly established KZN government ARV programme include: CD4 count <200 copies/ml, disclosure of HIV status, and completion of 3 HIV/ARV educational sessions. We aimed to identify factors associated with drop-out during pre-treatment education at a district hospital. Methods: We retrospectively analysed the log of patients referred for ARVs and completing 3 training modules between 09/04 and 11/04. Results: 173 patients were referred. 118 (69%) were female. Mean CD4 count and age at first visit were 196 (SD 133) and 31.8yrs (SD 9.2). 64 (37%) had CD4 count >200. 173 patients completed module 1, 147 (85%) module 2, and 129 (75%) module 3. Univariate analysis showed no association between drop-out and gender or CD4 count. However, patients aged 20-30yrs were less likely to drop out (7%) than those younger (30%) or older (27%) (p=0.018). 3 patients died during training. Conclusions: One-quarter of patients referred for treatment did not complete the prerequisite training and were therefore ineligible for ARVs. Young adults were least likely to drop out. Qualitative interviews are in progress to further explore reasons for drop-out. Preliminary data suggest travel distance and transport money as obstacles to attendance. P160 ■ Why are HIV-infected care workers reluctant to attend an ARV clinic? Experience from the Port Shepstone Hospital Rollout Programme in Kwa-Zulu Natal, South Africa S Barrett1, L Campbell2, R Pawinski3, P Easterbrook1 1Kings College Hospital, London, UK, 2Post Shepstone Hospital, Kwa-Zulu Natal, South Africa, 3Nelson Mandela Medical School, Durban, South Africa Background and Aims: HIV seroprevalence in Kwa-Zulu Natal (KZN) is 36% and 16% among health care workers (HCW). A dedicated ARV clinic was established at Port Shepstone Hospital (PSH) in 08/04, where an estimated 200 HIV-infected HCWs work. By 11/04 only 2 staff had presented for ARVs. We investigated the reasons for reluctance of staff to attend the ARV clinic, and identified strategies to improve attendance. Methods: A confidential, anonymous 20-item questionnaire available in English and Zulu, was randomly distributed to 200 HCWs at PSH. Results: The response rate was 79%. The main reasons given for non-attendance were: concerns about confidentiality and stigmatisation (75%); lack of awareness of their HIV status (56%); unaware of the existence of the clinic (44%); and poor knowledge about the benefits of ARVs (54%). Motivating factors for staff to attend were the ability to see ARV physicians privately (73%), the provision of an off site (58%) and out of hours clinic (34%). Conclusions: Concerns about confidentiality remain a key barrier to improving HCW access to ARV therapy. Strategies in progress at PSH include a staff education programme on the benefits of ARVs and knowing your HIV status, and the establishment of an off-site clinic. 56 P161 11th Printed Abstracts PA1 PA3 Clinical nurse specialist led GUM service for HIV-positive men Review of cases referred to genitourinary medicine by community paediatrics/forensic medical examiner Y Dass, C Bell, C Marfo, J Walsh The Jefferiss Wing, St Mary’s Hospital, London, UK Introduction: Evidence suggests high rates of STIs in HIV positive men. A nurse practitioner led clinic was established in June 2004 to improve GUM screening access, opportunities to discuss safer sex, PEP and ensure adequate hepatitis A & B vaccinations. Method: 125 HIV positive men attended this clinic between June–August 2004. Retrospective data was collected from 66 notes using a specially designed audit tool. Results: The clinic was utilised mainly by 125 HIV positive men, who were mainly white (n = 40) and homosexual (n = 61). Mean CD4 541; 34 men were on antiretroviral therapy. 14 men had received STI screening in the last year. The average number of sexual partners in the preceding 3 months was 13 range 1–450. 30 men had an STI diagnosed requiring treatment including gonorrhoea (12), early syphilis (2) and epidemiological treatment for syphilis (2). None of the men audited used condoms for anal sex. Safer sex was discussed with all men. Previous studies indicate HIV positive men prefer a GUM service within their HIV centre. This new service was introduced to reflect this finding. During this review the service was well utilised, the high rates of infection reflect a continuing need for this service. C Thompson NHS Lothian, University Hospitals Division, Lothian, UK Introduction: This department has a dedicated clinic (SA) for adult victims of sexual assault for STI screening but STI screening in children has traditionally been undertaken on an ad-hoc basis. Links with local Forensic Medical Examiners (FME) and Community Paediatricians (CP) have been strengthened to facilitate referral of younger patients for appropriate screening. Pre-pubertal children, usually with chronic rather than acute sexual abuse, were seen at the SCAN (suspected child abuse and neglect) clinic run by CP, in a co-ordinated ‘one-stop shop’ approach, with FME, video-colposcopy and STI screening. Post-pubertal youngsters, particularly those disclosing an acute assault, were seen in the SA clinic, having already had a two doctor forensic medical examination. The case load for CP/FME referrals from 1/4/03–31/3/04 was reviewed by retrospective case record examination. Results: Nineteen (5 boys, 14 girls) were referred. Eight (4 boys) aged 1–13 were seen at SCAN. Eleven (one boy) aged 12–14 were seen at SA. Two girls (1 and 3) had vulval erythema and genital warts respectively with no suggestion of abuse. Fifteen (4 boys) alleged non-consensual sexual intercourse (SI) in whom no STI were detected. Conclusion: Awareness of STI risk in SCAN patients allows co-ordinated and comprehensive examination and appropriate screening. PA2 PA4 The epidemiology, clinical features, and diagnosis of women with trichomoniasis in a south London sexual health clinic: 2003–2004 Audit of child protection issues in under 15 year olds attending a department of genitourinary medicine M Natha1, J Watson1, C Fernandez2 1Department of Genitourinary Medicine, 2Department of Clinical Audit, Mayday University Hospital, Croydon, UK Aims: To determine the clinical presentation and management of female genitourinary medicine clinic attendees with Trichomonas vaginalis infection. Methods: A retrospective case notes review was undertaken of all cases of T. vaginalis infection diagnosed in females in a 12 month period between January 2003 and December 2003 (n=155). Descriptive features of these patients were collated. Results: The incidence of T. vaginalis infection was 3.0% in 2003. The mean age of patients was 28.8 years. Black Caribbean and Black African women were over-represented. Overall, patients were more likely to be symptomatic at presentation (78.1%) and have vaginal discharge as their presenting symptom (87%). 19% had co-existing chlamydia infection and 7% had co-existing gonorrhoea infection. There were 2 new HIV diagnoses. Culture improved diagnosis, identifying an additional 10% of cases. Contact tracing was initiated in 81.3% of cases. There was one ‘true’ treatment failure. Conclusions: The mean age of 28.8 years is lower than that quoted in other studies. Most patients were symptomatic at presentation. The rate of co-infection with chlamydia was high, we should consider giving empirical treatment for chlamydia in patients diagnosed with T. vaginalis infection. Routine test of cure could be stopped. C Thompson NHS Lothian, University Hospitals Division, Lothian, UK Introduction: More young people under the age of 16 years are sexually active, with consequent child protection issues. This department's policy is for all attendees under 16 to be seen by a Health Adviser (HA) to highlight any child protection concerns. This was audited by retrospective case-note review for those aged <15 years, attending 1/4/03–31/3/04. Results: Thirty-six people aged <15 were seen; 6/36 were excluded (not sexually active). Eleven, (one boy, 10 girls) aged 12–14, were seen at the dedicated sexual assault clinic; all were referred by the police with child protection team (CPT) involvement. Nineteen (2 boys, 17 girls) were seen at routine clinics; one girl aged 13, 18/19 aged 14. Two girls reported non-consensual sexual intercourse (SI) when drunk. Of 17 (15 girls) admitting consensual SI, partners were aged <16 in 12, 16–17 in 3, 22 in one and unknown in one. HA saw 16/19 attending routine clinics; 3/19 were already known to CPT. A responsible adult (carer/parent) was identified in 11/19; of the seven admitting consensual SI without an identified responsible adult, all had partners <16; all were deemed Fraser competent. Conclusion: No cases of un-addressed child protection concerns were identified in patients aged <15 years. 57 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV PA5 PA7 Kaposi’s sarcoma progressing during pregnancy – lack of suppression by hCG Reception triage in the HIV emergency clinic B Gazzard, C Thirlwell, L Waters, T Powles, M Nelson, M Bower Chelsea and Westminster Hospital, London, UK Background: HIV associated KS is rarer in women. The pregnancy associated hormone human chorionic gonadotropin (hCG) induces apoptosis of HIV associated KS cells in vitro and in mouse xenograft models. Methods: Since 1986 1137 HIV+ patients have been diagnosed with KS including 18 women (1 gender reassignment). Two presented during pregnancy. The clinicopathological features and clinical course of these patients were examined. Results: The clinical features are shown and in both cases there was a disease progression during the third trimester. Following delivery one woman had spontaneous regression of disease whilst another required radiotherapy. Conclusions: We report two cases of KS presenting and progressing during pregnancy when hCG levels are extremely high. This contradicts two previously reported cases where spontaneous remissions of KS during pregnancy where observed. Moreover this observation contradicts the laboratory findings of KS response to hCG. PA6 PA8 Switching to once daily antiretroviral therapy Hypertrophic herpes simplex genitalis in HIV-1 infection L McDonald, R Arjoonsingh, M Chikohora, MG Brook Central Middlesex Hospital, London, UK Aim: To assess the uptake of the offer of once daily HAART on patients already established on HAART. Methods: A retrospective analysis of 78 consecutive individuals who had been assessed for once daily therapy. Results: 33 individuals were not offered the switch: 22 because of the inability to construct an o.d. regimen, 4 due to pregnancy and 11 due to other clinical reasons. 45 individuals were offered a switch to once daily HAART of whom 35 (78%) accepted. Of the 10 who declined 4 (40%) were afraid of the consequences and the other 6 (60%) were happy with their current regimen. 10/35 (29%) switched for clinical reasons on the advice of the clinician. The reasons given by the other patients for accepting a switch were: increased convenience (9, 26%) and reduced pill burden (17, 49%). The patients who switched for non-clinical reasons had previously received 1–11 (median 3) regimens. The commonest nucleoside backbones were abacavir/3TC (8, 23%) and tenofovir/3TC (6, 17%). Nevirapine (15, 43%), boosted Atazanavir (10, 29%) and efavirenz (8, 23%) were the commonest third agents. Conclusion: A high proportion of patients who are suitable for o.d. therapy will decide to change if offered the choice. 58 M Raychaudhuri, M Poulton, M Solmon King’s College Hospital, Caldecot Centre, London, UK Background: HIV patients were attending the HIV Emergency Clinic with issues that could be appropriately dealt by someone other than the doctor. Alteration in this service could potentially improve care if patients were seen by appropriate staff. Aim: To assess the appropriate use of walk in clinics. Method: We audited attendances over 1 week prospectively. Data collected included reason for attendance, if considered appropriate and who else could have dealt with the problem. Data was re-audited after 5 months. Results: Only 45% attendances were deemed appropriate and 41% patients could have been dealt by other members of staff. A questionnaire was developed for use at reception to help redirect individuals walking in to appropriate members of staff or outside agencies. In addition posters and leaflets were produced to advise patients of the appropriate use of the emergency clinic. On re-auditing, 54% attendances to the clinic were deemed appropriate and only 18% of patients could have been dealt with by someone other than the doctor. Conclusion: Reception triage has been helpful in improving the appropriate use of the HIV emergency service. Further work is planned to develop nurse triage and encourage increased use of GP services. A Holmes, M McMenamin, C Bergin, F Mulcahy St. James’s Hospital, Dublin, Ireland Aim: Description of 3 cases of Hypertrophic Herpes Simplex Genitalis [HSV] in HIV 1 infected patients. Cases: One 30yo Congolese man. 3-year history of HIV, on antiretroviral therapy [ART], viral load [VL] <50cpm, CD4 >400 × 106/l. Recurrent genital ulceration despite Valacyclovir prophylaxis. He developed multiple disfiguring hypertrophic lesions of the penis and perineum. No response to Foscarnet or Cidofovir. TK mutation negative. Excellent response to Thalidomide/ Valacyclovir combination. 2: 48 year old Rwandan woman. 7-year diagnosis of HIV, VL<50cpm on ART. CD4 count <200 × 106/l. Dapsone as PCP prophylaxis. Recurrent HSV 2 initially responded to episodic Valacyclovir, but progressed to hypertrophic lesions. No response to Cidofovir; relapse within weeks of Foscarnet. Trials of Valgancyclovir and Thalidomide unsuccessful. Histology at vulvectomy: VIN 3 3: 34-year-old Ugandan woman. 2-year diagnosis of HIV, on ART with a CD4 > 500 × 106/l.Genital ulceration treated episodically with Valacyclovir; culture negative. Developed hypertrophic labial and perineal lesions. Histology: Marked lymphocytic, plasmacytic and eosinophilic infiltrates and immunohistochemistry positive for HSV. Discussion: Hypertrophic HSV is unusual, even in the setting of HIV [3/1200 in our cohort, all African], difficult to treat, and may predispose to dysplastic changes. 11th Printed Abstracts PA9 PA11 Acceptability of the role of Advanced Nurse Practitioner (Sexual Health): A comparison study with the Senior House Officer (SHO) on patients attending for sexual health screening in the Genito-Urinary and Infectious Diseases Clinic (GUIDE), St James Hospital, Dublin Recurrent cryptococcal meningitis in a HIV positive man despite HAART and induction/maintenance therapy. Can CD4 counts mislead? S Delamere, G Courtney, V Wong GUIDE Clinic, St James Hospital, Dublin Background: The role of the Advanced Nurse Practitioner (Sexual Health) was initially proposed and developed in 1997 following the increasing incidence of sexually transmitted infections (STI’s) both locally and nationally. Aim: The aim of this study is to demonstrate that patients are receiving equally satisfactory care from the ANP (Sexual Health) as they are from the SHO. Methodology: A quantitative approach was employed, by administering an anonymous questionnaire, designed to measure the satisfaction with the service. Results: Overall 90% response rate, 97% from patients seen by the ANP and 83% from patients seen by the SHO. Results were favourable from both groups. Higher scores measuring information given to patients on ‘what to do should difficulties with treatment arise’, ANP (76%) and SHO (60%), and on what to do 'should a recurrence of problem occur' ANP (81%) and SHO (57%), were seen in the ANP group. A higher number of patients were referred to the Health Advisor and Counsellor by the SHO, demonstrating the breadth of the professional remit of the ANP. Conclusion: In this sexual health clinic, the investigation has shown that patients are equally satisfied with the care provided by the ANP as they are with that offered by the SHO. C Cunningham, C Emerson, RD Maw Royal Victoria Hospital, Belfast, UK A 55 year old HIV positive Caucasian man was admitted in July 2002 with increasing headache, nausea and vomiting. CD4 count 280 cells/mm3, on HAART (Trizivir) and viral load undetectable. He had cranial nerve palsies and a small midbrain lesion on CT scanning. Blood cultures identified Cryptococcus neoformans var. neoformans. Therapy: 2 weeks of I.V. Ambisome and Flucytosine. He had worsening visual acuity. CT Brain showed ventricular dilatation and opening pressure on lumbar puncture was 46cms/H2O, therefore a ventriculoperitoneal shunt was inserted. CSF culture was negative for fungal growth. He was discharged on Fluconazole 400mg. In October 2002 he was readmitted with recurrent symptoms despite treatment adherence. CD4 count 100 cells/mm3, CSF was positive for Cryptococcal Ag and culture. He received induction and maintenance therapy as before, CSF samples at 2 and 4 weeks were clear. In July 2004 he presented with arm weakness, confusion and seizures. CD4 count 200 cells/mm3, Serum and CSF cryptococcal Ag positive, MRI Brain showed focal lesions. Therapy: I.V. Ambisome for 3 weeks (with marked clinical improvement). On discharge CSF Ag titre 1:2, culture negative and continued maintenance therapy of Fluconazole 400mg. He remains well with quarterly CSF surveillance. Interestingly viral loads were undetectable throughout. PA10 PA12 A review of service delivery in a community-based HIV service: 1989-2004 HIV-associated pulmonary arterial hypertension (PAH) S Dawson, N Desmond, C Woods, C Cornish, B Brett, F Hawkins The Garden Clinic, Upton Hospital, Berkshire, UK The HIV service started in a community based Genitourinary Medicine (GUM) setting in 1988 becoming part of an holistic Sexual Health Service in 1993. There have been major changes in the epidemiology of the cohort (586) over 15 years. Responsive to patients' needs, audits of practice were carried out leading to specific service developments. HIV sexual health clinics were established focussing on pre-conceptual counselling, contraception, cytology and STI screening. Increased recruitment of women required the development of a Family clinic, an antenatal clinic and a postnatal clinic, facilitated by the availability of clinicians working within the integrated service. The full range of antiretroviral therapies, resistance testing and therapeutic drug monitoring was available. Treatment outcome audits showed equivalence to figures from clinics within teaching hospital or DGH settings. Close collaboration from the local DGH, three miles distant, led to the development of paediatric and obstetric protocols. Antenatal testing (96%) and the prevention of vertical transmission (0/40) have been very successful. There has been less success in providing robust in-patient medical management. Conclusion: This review shows that the vast majority of HIV care can be provided from such a community base should clinicians with the interest and skills wish to develop it. C Cunningham, C Emerson, RD Maw Royal Victoria Hospital, Belfast, UK A 44-year-old Caucasian woman with no prior history of cardiorespiratory disease presented in March ’04 with increasing dyspnoea, dry cough and lethargy. Her oxygen saturation was normal but she was tachypnoeic and had a loud P2 and pan-systolic murmur. A V/Q scan, high-resolution CT scan, CT pulmonary arteriogram and Echo showed elevated right ventricular systolic pressure (RVSP=85mmHg) and a dilated right ventricle (end-diastolic diameter RVEDD=47mm). Cardiac catheterisation confirmed PAH. Epoprostenol (prostacyclin analogue) infusion during the procedure produced no significant fall in pulmonary arterial pressure. On six-minute walk testing she covered 93m with no desaturation. Her husband originated from Zimbabwe, therefore both were tested and found to be HIV-positive. Her baseline CD4 180 cells/mm3 with viral load 7,900 copies/ml. She commenced HAART (Combivir and Efavirenz) and Bosentan (endothelin receptor antagonist) at 62.5mg bd for 4 weeks, 125mg bd thereafter with monthly LFT checks and TDM for Efavirenz. On repeat six-min walk testing at 2 months she covered 186m with no desaturation. Most recent Echo revealed a RVSP 61mmHg, RVEDD 43 mm. This case illustrates that combination treatment with HAART and Bosentan may significantly improve functional and haemodynamic parameters in a disease previously considered to have a uniformly poor prognosis. 59 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV PA13 PA15 Diagnosing hepatitis C (HCV): an opportunity lost? Audit of sexually transmitted infections (STI), Hepatitis B (HBV) and Hepatitis C (HCV) monitoring in HIV positive patients H Wankowska Department of Sexual Health, Ipswich Hospital NHS Trust, Suffolk, UK Aim: To see if unsuspected cases of HCV are missed in a G-U Medicine clinic in a District General Hospital. Method: HCV tests were offered to all New Episode (New=N and Rebook=R) patients, opting for an HIV test. (01/01/2004–31/03/2004). Previously, HCV tests were offered only to patients with a ‘risk’ history, (injecting drug use, HIV positive etc.). Initial test, ELISA antibody (a/b) (ortho eci on vitros). Confirmation, ELISA a/b (biorad). RNA, PCR (artus). Results: Total New Episodes=1622. (N=845+R=777). Total HIV tests, (S2+P1A)=833; HIV offered, (P1B)=489. Total HCV tests=700. Initial test: 14 non-negative=7 reactive+7 intermediate. (None HIV positive). Confirmation: 7 reactive=5 positives+1 intermediate+1 negative; 7 intermediates=7 negatives. RNA: Of 5 a/b positives; RNA=3 positives+2 negatives; (a/b intermediate & a/b negative=RNA negative). HIV positives:=3 (All negative HCV). 5 patients = Hepatitis C positive. All 5 had given ‘risk’ history. 1= ‘possible HCV’ (No ‘risk’ history). (All 6 referred Gastroenterology.) 8 = ‘HCV Negative’ (No ‘risk’ history); advised. Conclusions: In this clinic, no definite cases of HCV, would have been missed if tests were offered only to patients with ‘risk’ history. A patien’'s history is an excellent guide to risk of HCV. References: Hepatitis C Strategy for England, Department of Health, August 2002. Wankowska, H. A Year in Prison, Poster Presentation, BASHH, Bath, 2004. PA14 Audit of virological and immunological outcome of a patient group on treatment with Tenofovir (TDF) and didanosine (ddI) plus Efavirenz (EFV) or Nevirapine (NVP) K Forbes, M Murphy, C Skinner, G Baily, Y Gilleece, C Orkin Bart’s and London NHS Trust, The Royal London Hospital, Whitechapel, London Aim: To audit efficacy of ddI+ TDF + EFV/NVP-containing regimes in clinic population following reports of suboptimal CD4 and Viral load (VL) responses in HIV infected individuals. Methods: Clinical audit of individuals identified on the above regimes. Results: 12 individuals identified: 8 male, 4 female. Median age: 41.5 years (32–70). 10 received EFV, 2 NVP. 3 groups: 3 were naïve, 9 had received prior HAART: 5/9 had been switched for lipodystrophy (S), 4/9 started on this regime after a treatment interruption (TI). Median time on therapy: 9.5 months (2–33). Median baseline VL: 2425 copies/ml (<50–136,000). Median baseline CD4 count: 257 cells/mm3 (38–529). At 3 months 10 were suppressed on treatment. 2 experienced virological failure: 1 naïve and 1 TI. The naïve patient had mutations: 211K 98S 135T 179D 190C 190S. At 6 months (n=8) all remained suppressed. At 9 months (n=6) 5 remained suppressed. At 12 months (n=3) all remained suppressed. At 15 months another (S) had virological failure. Median CD4 count increase (? CD4) at 3 months was 40 (–786–419) and at 6 months was 32.5 (-281-388). Conclusion: 3 individuals on ddI+ TDF + EFV/NVP-containing regimes experienced virological failure and the ? CD4 was small. 60 M Pammi, IH Ahmed, K Mian, A Ahmed Nottingham City Hospital, Nottingham, UK Aim: To monitor STI & HBV/HCV status in all the HIV positive patients attending GUM clinic in Nottingham between September2003 and October2004. Audit standard: All HIV positive patients should be offered sexual health screen yearly and HBV/HCV status identified and vaccinated as appropriate. Methods: Retrospective case note audit was performed. Demographic, epidemiological and clinical data were collected. Results: 100 case notes analysed.49% patients had STI screen in the last one year and among them 49% had at least one STD diagnosed. Syphilis testing was done in 54%. The reasons for no STI screen: 37% not offered; 29% not sexually active; 22% not indicated. HBV status assessed in 91%, 44% were susceptible but only 15% were vaccinated. 75% were screened for HCV, 9% had HCV coinfection. Conclusion: We are not achieving the standard for STI screening in sexually active HIV+ patients. In patients who were screened a significant proportion of STI were identified. Although majority were screened for HBV/HCV, a significant proportion of them were not appropriately vaccinated. STI screen must be offered at least once a year and HBV vaccination should be offered in those who are susceptible. Author Index Abbara A Aboud M Adebiyi A Aderogba K Adjei M Ahmed A Ahmed IH Ahmed-Jushuf I Al Alabri S Aldam D Alexander S Allen L Allison K Almond L Amenyah R Amin S Anderson H Anderson J Anderson P Annan NT Annan T Antoine D Apoola A Arellano J Arjoonsingh R Arms R Armstrong NR Asboe D Ashton C Atkins M Atzori C Azadian B P41 P7 O35 O17, P80 O9 PA15 PA15 P2a, P9a P90 P20 O37 O46 O2 P33 O9 P70 O39 P58, P146 P21 O23, P85 P88 P110 P129 O8 PA6 P124 P134 O26 P22, P149 O26 P112 P85, P88 Back D Bailey A Bailey B Bailey J Bailey MC Baily G Ball C Ballinger J Bansi L Barber TJ Barker R Barrat A Barrett L Barrett S Barter J Barton S Barton SE Bates C Beadles WI Beattie A Beckles M Bedu-Addo G Beeching B Beeching NJ Begum I Behrens RH Bell C Bell G Bendall R Benfield T Benhene Poku A Benn P Bennett S Benzie AA Bergin C O24, P29, P33 P17 P145 P112c P39 P30, PA14 P158 P27, P111 P24 P35 P17 P137 O10 P158, P159, P160 P3 P2a, P79, P91 O6, P49 P116 P48 P155, P156 P95 O9 P116 P90 P136 O32, P149 P43, PA1 P130 P67 P112 P145 O16, O38, P155, P156 P115 P25 O11, P36, P100, P101, P112a, PA8 P69 P146 P2a, P9, P82 O25, O27, P27, P50, P102, P103 P41 P145 O6 P77 P72 P142 P81, P86 O16 O23 Berkt F Betourney R Bhaduri S Bhagani S Bhuya A Bickersteth R Bickford J Bignell CJ Bilek N Birchall J Birley H Blackham JE Boer M Boffito M Bolding G Bond K Bonington A Boothby M Bower M Bowman C Bradley M Brady M Brays DH Breen R Brett B Brex PA Brook G Brook MG Brookings C Brown D Brown M Brown S Browne R Bryne M Buckley R Bunting P Burns F Butler K Butler P Butler S Bybee A Byrne J Cafferkey M Cameron S Campbell L Cane P Carder C Carlin E Carne C Carrick-Anderson K Cartledge JD Cassell J Castelino S Chadborn TR Chadwick D Challenor R Chandramani S Chapman C Chapman J Chawla A Checkley A Chew N Chew S Chibber F Chiganze A Chikohora M Chirlwell C Churchill D Clancy J Clarke A Clarke J Clarke S Clerici M Clutterbuck DJ Coast J Cohen CE Cohen H Collini P Collins E Collins K Collins L Collins SA Cooper V Copas A Cornforth D Cornish C Coughlan S Courtney G Cox S Coyne K O24 O14, P119, P121, P150 P136, P154 P53 P46, P129 O26, O28, O44, O45, O48, P34, P40, P41, P52, P54, P55, P56, P94, P105, P106, P107, P108, P109, PA5 P2a, P77 P90 P1 O20 O30, P95, P111 PA10 P64 P113 O12a, P97, P113a, PA6 P42 O25, P103 P62 P49 O26, P42, P45 P60 P89, P117 P78 P18 O10 O34 P9a O30 P16 O10 O4 P158, P159, P160 O17 O38 P2a P78 O2 O33 O12a, P113, P113a P26 O19, O43 O9 O3 O3, P75 P57 P113, P131 O42 P112e P37 P36, P101 P70 P81 PA6 P107 O33, P144 P93 O34 P13 P53, P134 O20 O2, P5 P132 P12, P115 P63 O9 P2 P161 P7 P72 O31 O13, O22, O46, P28, P156 P20 PA10 O11 P99, PA9 P109 P96 Crabtree N Crates D Crean M Cropley I Crowe G Culkin A Cullen BR Cunningham C Cunningham R P46 P1 P99 P95 P61, P70 P59 O29 P76, P147, PA11, PA12 O5 Daniels D Danta M Das R Das S Dass Y Davies A Davies M Davies E Davies J Davies L Davis M Dawkins DA Dawson S Day S De Esteban N De Silva S De Souza BC De Souza C Dean G Delamere S Delpech V O3, P78 O25, P102, P103 P86 P129 PA1 P81 P86 P40 P116 P41 O14, P119, P121, P150 P42 P2a, PA10 P154 O32 P62 P35 O35 O17, P2, P17, P144 P133, PA9 O16, O19, O43, P110, P122 P43 PA10 P116 P60 P8, P57 P109 P95 O48, P94, P105, P106, P107, P108 P68 P95 P152 O12 P151 P5 O42 P126 P53 O30 P23 P85 O12 O27, P102, P103 DeRuiter A Desmond N Devine M Devitt E Dhar J Dharmana H Dheda K Dhillon T Dickson CF Dilworth JP Dockrell DH Doerholt K Dogan A Donald J Donnelly C Dougan S Dunbar E Dunleavy A Dunn D Dunning J Duong T Dusheiko G Easterbrook P Evans H Ezeokoli A P24, P47, P158, P159, P160 P90 P104 O46, P4, P20, P28, P63, P151, P155, P156 P64 P68 O14, P119, P121, P150 P90, P98 P76, P147, PA11, PA12 O13 P58 P113, P131 O1 O16, O19, O43, P110, P122, P126, P140 P44 P92 Fakoya A Farrell G Fenton C Fenton KA Ferguson W Fernandez C O33 P100, P101 P132 O13, O37, P18 O10 PA2 Edrisinghe D Edwards A Edwards S El Gadia S Elawad B Elford J Ellks RK Emerson C Erens B Erskine KJ Estcourt C Evans AL Evans B 61 11th Annual Conference of the British HIV Association with the British Association for Sexual Health and HIV Fernandez T Fernie I Fidler S Finch R Fisher M Flynn S Foley E Forbes K Forde J Forsyth S Fox E Fox J Fox R French P French RS Garcia-Garcia JA Gardiner C Garnett GP Gazzard BG 62 P131 P80 O15, O18 P130 O17, O25, O31, O35, O47, P17, P144, P156 P141 P114, P153 PA14 P110 O46, P28 P74, 136, P145 O15, O18, P118 P21 O38 O7, P132 Gellaitry G Geretti AM Gerressu M Ghosh S Gibb DM Gibbons N Gibbons S Gilbart VL Gill N Gilleece Y Gilleran G Gilmore S Gilson RJC Glasier A Goh B Goncalves R Goode M Goold P Gorsuch T Graham A Gray D Gray S Green H Greenhouse P Griffiths C Griffiths V Grover D Guiver M Gumley HR Gupta M P50 P32 P123 O21, O23, O24, O26, O28, O44, O45, O48, P34, P40, P41, P42, P45, P51, P52, P54, P55, P56, P94, P105, P106, P107, P108, P109, PA5 O31 O42 P132 P135 O12 P112a O24, P29, P33 P126 P122 O26, P30, PA14 P46, P129 P118 O22, O27, P102 O4 O39, P83 P47 O10 P77 P111 P132 P132 P15, P76 O46 P2a P20 P2a, P9a O46 O40 P6 P90 Hackett R Haddon L Halvey O Hamill M Handy P Harkin PJP Harrison N Harrisson U Harry TC Hart G Harte E Hawkins DA Hawkins F Hawkins M Hawkins PN Hay P Helweg-Larsen J Herbst J Hewart R Hill T Hodgson C Hollinghurst S Holmes A Holmes P Holmes S P11 P67 P141 O38, P138 P10 P13 P5 P44 P2a O14, P119, P121, P150 P53 P45 PA10 P74 O30 O33, O35, P112e P112 P141 P14 O47 P47 P132 O36, P32, PA8 P34 P106 Hopkins S Horne R Hussain S Hutchinson J O27, O30 O31 P7 P64 Ison C O37, O38, P72, P85, P86 Jaleel H Janoosy G Johnson AM Johnson M P46 P95 O12a, O13, P113a, P18 O27, O33, O34, O42, P6, P19, P27, P41a, P44, P50, P95, P102, P111 O4 O27, P102 P116 O32, P116 P99 O44, O45 P51, P52, P55, P56, P108 P75 O12a, O38, P113a, P4, P120 Johnstone A Johnstone R Jones C Jones K Jones L Jones R Jones R Joseph A Jungmann E Kalidindi I Kalidini U Kamutasa C Kane R Keane FEA Keane J Keating S Kegg S Kell P Khan W Khoo S Kieran J Killingley B King G Kinghorn GR Kinghorn H Kingori P Kingston A Kingston M Kinloch S Kirkpatrick L Klein J Klenerman P Kontodimas S Kozakis L Kudesia G Kulasegaram R Kumari M P30 P146 P112c O7 P15, P67 P112a P99 P127 O8 P42, P45 P29, P33, P61 P36, P101 P41a P97 P71, P113a O12a O7 P88 P2a P44 P149 P74 P103 O8 P65 P71 P7, P26, P154 P129 Lacey CJN Lachowycz K Lambourne J Larbalastier N Lascar RM Lechelt M Lee V Leen C Lessells R Lewis D Lewthwaite P Lipman M Llewelyn MJ Lomax N Loveday C Low L Lowndes C Lyall EGH Lynch A Lyons F Lyons M Lysakova L O1 O7 P100, P101, P112a P7 O27, P102 P30 P114, P153 O33, P48 P48 P74 O40 O30, P110, P95, P111 P151 O39 P30 P88 O37, P122 P44 P76 O11 P86 P49 MacDonald N Machin SJ Mackie NE O37, O38, P85 P63 P25 Madge S Mahto M Mahungu T Maitland D Malu MK Mandalia S Mann M Marchetti D Marfo C Marks C Marshall J Martin D Martin IMC Maserati R Maw RD Mazzotta F McAndrew S McClean H McClure M McCormick K McCormick S McDermott H McDonald L McGarvey MJ McKay L McLean K McMenamin M McOwan A McQuillan O Meadway J Mears A Menon A Menon-Johansson A Menson EH Mercer CH Mercey D Metcalf SC Mian K Miflin G Miles K Miller RF Mindel A Minton C Mirfenderesky M Mitchell H Mitchell S Monteiro EF Montgomery H Moore MD Morgan E Morrall I Morris AK Morris EJ Moshal K Moussa R Moyle G Mugezi R Mulcahy F Mullan DM Mullens Y Munday P Murcie N Murphy C Murphy M Murphy S Musgrave E Myles H Natha M Nathan M Naylor S Nazroo J Needham A Nelson M P19, P44 P139 O27 O24 O5, P87 O6, O21, O23, O24, O26, O28, O44, O45, O48, P12, P51, P52, P54, P55, P56, P94, P115 P9, P82 O20 PA1 P118 P115 P3 O37, P72 O20 P76, PA11, PA12 O20 P112c P78 O15, O18, O29 P40 P26 O11, P100 PA6 O29 O2 P85, P115 PA8 P96, P137 P14 P161 P154 O10 P96, P157 O12 O7, O12a, O13, P113a, P132 O1, P4 P152 PA15 P1 P20, P132 P63, P78, P111, P112, P151 P118 P9, P20, P82 O42 P22 P127 O1, P112b P44 O29 P2a, P14 P75 O41 P112b P158 P84 O24, O33, P49 P137, P146 O11, O36, P32, P36, P89, P100, P101, P117, P133, P141, PA8 P28 P40 P65 P21 P90 O33, P30, PA14 P138 P142 P16 P38, P148, PA2 P92, P112d P152 P18 P8 O21, O23, O24, O25, O26, O28, O44, O45, Author Index Ni Rathaille N Nicholson M Noble H Nolan B Noone M Northfield J Northwood J Noursadeghi M O48, P34, P41, P51, P52, P54, P55, P56, P85, P94, P105, P107, P108, P109, PA5 P40, P106 P148 P4, P120, P142 O48, P94, P105, P106, P107, P108 P141 P79, P91 P43 P101 O8 P103 O5 P151 O’Connor C O’Connor G O’Connor M O’Connor S O’Dea S O’Donoghue E O’Dwyer A O’Grady P O’Mahony C O’Shea S Ong J Orkin C Osmond M Ottewill M Oxenius A P16, P69, P93 P32 P16 P16 O11, O36 P141 O36 P89 P2a P16 O34 P30, PA14 P4 P2, P144 O18 Pabris P Pakianathan M Pallan M Palmer HM Pammi M Pang F Pao D Parisaei M Parry J Patel R Pattman RS Pawinski R Pearce AI Penn Z Perry N Peters B Phillips R Pillay D Pinsent S Pittrof R Ponnusamy K Popat R Porter K Poulton M Powderly WG Powles T Pren S Prestage M Pribram V Price H Pybus O Pym AS P103 P38, P124, P135, P148 P75 O41 PA15 O35 O17 P58 P122 P153 P11 P158, P159, P160 P90 P44 P31 P7 O18 O17, O46 O3 P3 P77 P41 O18, P23 P143, PA7 P60 O48, P94, P105, P106, P107, PA5 P51 O32 P47 P52, P55, P56, P142 O25 P64 Quaglia A Quah SP P50 P147 Rackstraw S Radcliffe KW Rajakumar R Rajkumar A Randell A Ransom D Ratcliffe P Raychaudhuri M Raza M Rea A Recabarron X P83 P87, P129 P129 P96 P96 P6 P42 PA7 O42 P72 P48 Nelson P Newell S Newey C Newsom-Davis T Rees N Reeves I Reilly G Rice BD Richards J Richens J Rider A Riley A Rizzardini G Roberts J Roberts P Robertson-Bell D Robinson A Robshaw V Roedling S Rogstad K Ronan E Ross J Roy A Rubinstein L Rudd E Ruddy C Russell J Russell RA Ryan C P6 O47, P73, P143, P156 O33 O19 P10 O32, P149 O22 O8 O20 P144 P116 P19 P132 P129 P63, P155, P156 P130, P132 P152 O12a, P2a, P113a P109 P97 P86 P40 P127 O29 P71 Sabin C Sutcliffe L Sutherland M Swaden L O22, O25, O33, O47, P6, P23, P24, P25 P135 P38 P132 P80 P68 P15, P67 P39 O32, P28, P149 P111 O2, O4 P51 O18 O33, O35 P63 P145 P103 P44 P46 O12 O5 P60 O14, P50, P119, P121 O19, O43, P122, P126 P30, PA14 P50 P26, P43, P74 O17 P19, P111 P142 P85, P115 P126 P51 P39 PA7 P72 P63 O28, O48 P51 P22 O7, O12a, P113a, P132 P55 P23 P59 P98 O21, P12, P88, P51, P137, P142, P146 O12a, P 113, P113a P5 P27, P111 Taylor C Taylor G Taylor Y Tenant-Flowers M Theobald N P47 P43 P13 P73, P143 O3, P69 Sadiq ST Sadiq T Salisbury S Samuel I Sankar KN Saulsbury N Schmid ML Schuhwerk MA Schwenka A Scott GR Scourfield A Scriba T Scullard G Scully M Sekweyama SGG Semmo N Shah S Shahmanesh M Sharland M Shaw S Sheehan G Sherr L Sinka K Skinner C Slapak G Slater C Smit E Smith CJ Smith F Smith NA Smith RD Smythe J Snow MH Solmon M Spratt BG Starke R Stebbing J Stefanovic M Stephens E Stephenson J Stevanovic M Stöhr W Stradling C Sugunendran H Sullivan AK Theofan G Thirlwell C Thomas D Thompson C Thompson C Thompson I Thomson C Tideman RL Tilbury J Tilston P Tobin JM Tong C Torpey K Toward D Trabattoni D Tunbridge AJ Tung M Turner A Turner J Tyrer M O20 O48, P94, P105, P106, P108, PA5 P86 P125 PA3, PA4 P142 P5 P118 P15 P53 0P153 P26 O9 O35 O20 P152 O21, P34, P88 O40 O27, P102 P27, P44, P50 Van Beek I Varma R Vilar J Viswalingam ND Vuddamalay J P118 P112d P53 P83 P65 Walker AS Walker RWH Wallace E Walsh A Walsh J Walsh K Wankowska H Ward H Waters A Waters L O12 P64 P60 O10 P25, P62, PA1 P114 PA13 O15, O37 P12, P137, P142, P146 O28, O44, P54, P79, P91, PA5 PA2 P8 P135 O15, O18 P2a O7, O13 O12 P24, P159 P25 O39 P101 P123 O1 O33, P53, P139 P137, P146 O7 O5 P2 O27, P20, P28, P102 P112c P104 P134 P21, P125 O34 PA9 PA10 P100 P124 P89 P149 Watson J Watt J Webb R Weber J Weir M Wellings K Wells C Welz T Weston RJ Wheeler H White B White PJ Wilcox MH Wilkins E Wilkinson A Wilkinson P Willcox JR Williams D Williams I Williams OE Williams PM Wilson JD Winter A Withey S Wong V Woods C Woods S Wright A Wyer A Wyss H Youle M Young AM Young H Young Y P6, P27 O28, O48, P94, P105, P106, P107, P108, P109 O41 O4 Zhou J P135 63
