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14th Annual Conference of the British HIV Associations23-25 April 2008, Belfast |
Cite as: HIV Med. 2008 May; 9(Suppl 1):page number (abstract no. xx)
Example: HIV Med 2008 May; 9(Suppl 1):1 (abstract no. O1)
| ORAL ABSTRACTS Abstracts O1 to O30, pages 1 through 9 |
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| O1 | SHOULD WE TARGET COMMUNITY AND PRIMARY CARE HIV TESTING EFFORTS IN CERTAIN AREAS? ESTIMATES OF HIV PREVALENCE FOR KEY PREVENTION GROUPS BY REGION AND LOCAL AUTHORITY (LA) IN ENGLAND HIV Med. 2008 May; 9(Suppl 1):1 (abstract no. O1) T Chadborn, K Hutton, V Delpech and B Rice Discussions continue about how to enhance HIV testing but the epidemiology suggests a localized approach of targeting offers of HIV testing based on a simple risk assessment. This would also allow for local patient acceptability and setting appropriateness to be considered. Partner notification (including of the long-term diagnosed) is likely to be key to the earlier diagnosis of people in low prevalence areas. |
| O2 | FIRST PRESENTATION OF VERTICALLY ACQUIRED HIV INFECTION IN ADOLESCENCE HIV Med. 2008 May; 9(Suppl 1):1 (abstract no. O2) K Prime1, R Ferrand2, C Foster3, A Judd4, J Masters5, H Lyall3 and E Jungmann6 Young people with vertically acquired HIV infection are surviving childhood without ART and being diagnosed in adolescence. In this cohort a third were asymptomatic, highlighting the importance of testing all children born to HIV-infected women, regardless of age or symptoms. Increased awareness amongst clinicians is urgently required to prevent presentation with advanced disease and to reduce ongoing transmission as this population become sexually active. |
| O3 | DOES POINT-OF-CARE HIV TESTING IMPROVE TESTING AND DIAGNOSIS IN A HOSPITAL-BASED VOLUNTARY TESTING CLINIC? HIV Med. 2008 May; 9(Suppl 1):1 (abstract no. O3) G Nebbia1, A Evans2, Miss S Chaytor2, U Nandakumar2, T Fernandez2, G Clewley2, M Johnson1 and AM Geretti1 In a clinic-based voluntary HIV testing service, compared with same-day laboratory-based testing, HIV POCT reduces the number of those who do not wait for results. This comes at the cost of a high false positivity rate (1:11) and a significant delay in detecting early infection. |
| O4 | IDENTIFYING HIV INFECTION IN DIAGNOSTIC HISTOPATHOLOGY TISSUE SAMPLES HIV Med. 2008 May; 9(Suppl 1):1 (abstract no. O4) L Alarcon, U Mahadeva, M Moonim, J van der Walt and S Lucas Diagnostic histopathology can identify HIV infection directly in tissue samples when the viral load is sufficiently high. As well as confirming specific pathologies such as PGL and HIV encephalitis, p24 staining identifies patients not previously known to be HIV-infected. This technique should be applied more widely to diagnose HIV+ve patients earlier and bring them into treatment programmes. |
| O5 | DIAGNOSING THE UNDIAGNOSED: IDENTIFYING SYMPTOMATIC PRIMARY HIV INFECTION (PHI) PRESENTING TO PRIMARY AND EMERGENCY HEALTHCARE PHYSICIANS HIV Med. 2008 May; 9(Suppl 1):2 (abstract no. O5) K Nambiar1, D Pao1, J Whetham1, D Sudarshi1, G Homer1, G Murphy2, J Parry2 and M Fisher1 The PHI prevalence is substantially lower than expected. This may be due to patients not being venesected if an unspecified viral illness is suspected. It therefore remains essential that physicians are vigilant for symptoms of possible PHI and have a low threshold to test for HIV, particularly in high risk groups. The overall 1% undiagnosed HIV prevalence, however, suggests that more widespread testing in primary/ emergency care may be warranted. |
| O6 | UNDERSTANDING THE BARRIERS TO GP INVOLVEMENT IN THE CARE OF PATIENTS WITH HIV HIV Med. 2008 May; 9(Suppl 1):2 (abstract no. O6) M Kennedy1, Y Gilleece1, N Perry1, A Cressey1, J Wastie2, H Smith1 and M Fisher1 This study showed a much higher level of GP involvement compared to pre-HAART studies suggesting that a high level of primary care is achievable. Barriers still remain however for a significant minority of patients. These include a perceived lack of GP knowledge and experience of HIV and the issue of confidentiality. Secondary care providers need to work with patients and primary care to address these issues. |
| O7 | LOW PREVALENCE OF TRANSMITTED ANTIRETROVIRAL DRUG RESISTANCE IN A LARGE UK HIV-1 COHORT HIV Med. 2008 May; 9(Suppl 1):2 (abstract no. O7) B Payne1, E Nsutebu2, E Hunter3, O Olarinde4, P Collini4, J Dunbar5, M Basta2, J Elston6, M Schmid3, H Thaker6 and D Chadwick1 In a large unselected UK cohort, with high coverage of TDR testing, the prevalence of TDR was substantially lower than in most published literature. Differences in population mix did not appear to explain this low rate. TDR rates in the UK may now be falling compared with historical data. |
| O8 | THE IMPACT OF RESISTANCE TESTING IN ARV-NAÏVE PATIENTS: DOES IT GUIDE OPTIMAL THERAPY SELECTION AND IMPROVE LONG-TERM OUTCOMES? HIV Med. 2008 May; 9(Suppl 1):2 (abstract no. O8) L Bansi1, AM Geretti1, D Dunn2 and C Sabin1, UK CHIC Steering Committee1 Patients with low GSS tend to have poorer long-term outcomes and hence, as well as tolerability, selection of first-line HAART should take into account the presence of transmitted drug resistance, together with other recognised predictors of virological outcomes. |
| O9 | GAG-PROTEASE INTERRELATIONSHIPS IN DRUG RESISTANCE AND VIRAL FITNESS HIV Med. 2008 May; 9(Suppl 1):3 (abstract no. O9) CM Parry, A Kohli and D Pillay Many existing RC assays are limited in an ability to fully explore protease gag interrelationships -important in light of increasing evidence of gag effects on drug susceptibility and replication. We demonstrate a complete restoration of RC for a highly mutated protease by full-length gag, and are able to better identify the determinants of viral fitness. |
| O10 | EFFECT OF HIV-1 SUBTYPE ON VIROLOGICAL AND IMMUNOLOGICAL RESPONSES TO FIRST-LINE HAART HIV Med. 2008 May; 9(Suppl 1):3 (abstract no. O10) L Harrison1, AM Geretti2, H Green1, D Dunn1 and E Fearnhill1 Persons infected with prevalent non-B subtypes in the UK show excellent and durable responses to first-line HAART. Subtypes A and C respond more rapidly than B. Further studies are needed to explore the influence of ethnicity, risk group and adherence. |
| O11 | EMERGENCE OF DRUG RESISTANCE IN HIV-1 INFECTED PATIENTS AFTER FIRST-LINE HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART): A SYSTEMATIC REVIEW OF CLINICAL TRIALS HIV Med. 2008 May; 9(Suppl 1):3 (abstract no. O11) RK Gupta1, A Hill2, A Sawyer3 and D Pillay1 Initial therapy with boosted PI-based regimens results in less resistance within and across drug classes, preserving more treatment options at time of virological failure. |
| O12 | RESPONSES TO HAART AND CLINICAL EVENTS IN PATIENTS WITH A LOW CD4 COUNT: LATE PRESENTERS VERSUS LATE STARTERS HIV Med. 2008 May; 9(Suppl 1):3 (abstract no. O12) LJ Waters1, MJ Fisher2, J Anderson3, C Wood4 and C Sabin5, for the UK CHIC Study Group5 Late presenters achieve similar rates of viral suppression to subjects who present early but start HAART with CD4 <200 but CD4 rise is significantly less at 48 weeks. New AIDS events were significantly more common for late presenters versus late starters which may reflect factors, additional to CD4 count, associated with late presentation. |
| O13 | PREDICTORS OF VIROLOGICAL TREATMENT FAILURE IN THE HIV ROLL-OUT COHORTS OF THE WESTERN CAPE PROVINCE, SOUTH AFRICA HIV Med. 2008 May; 9(Suppl 1):4 (abstract no. O13) MI Datay1, A Boulle2, P Yudkin1 and D Mant1 The high prevalence of a very low baseline CD4 is concerning in light of its association with failure. Our study adds insight into the role of TI, choice of NNRTI and MTCT exposure. Further study of TI and travel is needed working towards intervention. |
| O14 | PREGNANCY LOSS IN HIV-POSITIVE WOMEN ATTENDING ANTENATAL CARE AT A LONDON CENTRE HIV Med. 2008 May; 9(Suppl 1):4 (abstract no. O14) J Anderson, R Evans-Jones, D Janga, L Sivyour, E Dorman and S Tariq Eight-percent of pregnancies resulted in late pregnancy loss; notably more than in a non-HIV setting. Post-mortems were performed in over 70%. The most common finding was chorioamnionitis, in keeping with the literature. A significant proportion of the women had complex psychosocial issues but all engaged with HIV follow-up after their loss. We advocate further large-scale research to elucidate the mechanisms underlying late pregnancy loss in HIV. |
| O15 | UNEXPECTEDLY HIGH RATES OF VITAMIN D DEFICIENCY IN AN INNER-CITY LONDON HIV CLINIC HIV Med. 2008 May; 9(Suppl 1):5 (abstract no. O15) MM Rosenvinge1, K Gedela1, A Wilkinson2, A Copas2, C Sheehy3, MR Pakianathan3, P Hay4 and ST Tariq4 There is an alarmingly high rate of vitamin D deficiency among our HIV cohort, associated with black ethnicity, younger age and higher random blood glucose. Importantly detection and treatment may improve clinical outcomes including insulin resistance, bone disease and susceptibility to TB. |
| O16 | PLASMA EXPOSURE OF 100 MG ONCE (OD) AND TWICE DAILY (BID) DECREASES HDL AND CD36 EXPRESSION BUT ONLY BID DOSING INCREASES TRIGLYCERIDES (TG): POTENTIAL IMPACT OF RTV ON CARDIOVASCULAR DISEASE (CVD) HIV Med. 2008 May; 9(Suppl 1):5 (abstract no. O16) C Fletcher1, M Boffito1, S Collot-Teixeira2, F De Lorenzo3, L Waters1, D Back4, S Mandalia1, A Pozniak1, JL McGregor2,5 and B Gazzard1 Hundred milligrams BID RTV but not 100mg OD RTV gave rise to an increase in TG over 2 weeks in healthy volunteers; the increase was related to higher RTV exposure. Reduced HDL and CD36 expression were observed for both RTV dosages. |
| O17 | HIGH INCIDENCE OF IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME (IRIS) DUE TO DERMATOLOGICAL CONDITIONS AND TUBERCULOSIS IN AN ART PROGRAMME IN SOUTH AFRICA HIV Med. 2008 May; 9(Suppl 1):5 (abstract no. O17) LJ Haddow1, MYS Moosa2, NG Khanyile2, NM Sithole2, Q Zulu2, A Mosam2, F Ibrahim1 and PJ Easterbrook1 IRIS occurred in 23% of patients and was more frequent in patients with advanced disease; most cases were dermatological. Despite low overall mortality, IRIS contributed to 25% of all deaths. |
| O18 | CHRONIC KIDNEY DISEASE IN HIV-INFECTED PATIENTS HIV Med. 2008 May; 9(Suppl 1):5 (abstract no. O18) FA Post1, Ms LJ Campbell1, F Ibrahim1, M Fisher2, SG Holt2 and BM Hendry2 Non-primary renal disease accounted for >90% of CKD in Caucasians. The risk of non-primary CKD in patients initiating IDV or TNF is modified by the presence of other risk factors for CKD, age and, for TNF, renal function and duration of prior antiretroviral treatment. |
| O19 | HIV AND AGEING HIV Med. 2008 May; 9(Suppl 1):6 (abstract no. O19) J Elford1, F Ibrahim1, C Bukutu1 and J Anderson2 In this study of people living with diagnosed HIV in London, just over ten percent were over the age of 50. Nearly half the over 50s were diagnosed in their 50s highlighting that this group does not solely comprise an ageing cohort of people diagnosed with HIV in their 30s and 40s. |
| O20 | WHAT ARE THE IMPLICATIONS OF INCREASING THE RECOMMENDED THRESHOLD FOR STARTING ANTI-HIV THERAPY (ART)? HIV Med. 2008 May; 9(Suppl 1):5 (abstract no. O20) T Chadborn and V Delpech There are likely to be both clinical and public health benefits of recommending all HIV-infected persons to start ART if CD4 <350 but some of the implications are: 1. the definition of late diagnosis should change; 2. treatment costs will increase (1000 additional adults would cost the NHS an additional ≤10 m per year); 3. transmission may be reduced through a reduction in viral load. |
| O21 | UTILITY OF CD4 COUNT MONITORING IN PATIENTS ON HAART WHO MAINTAIN VIRAL LOAD (VL) SUPPRESSION - EXPERIENCE FROM THE VS ARM (CONTINUOUS ART) OF THE SMART STUDY (STRATEGIES FOR MANAGEMENT OF ANTIRETROVIRAL THERAPY STUDY) HIV Med. 2008 May; 9(Suppl 1):6 (abstract no. O21) DN Chilton1, J Neuhaus2, A Palfreeman3, SG Edwards1 and IG Williams4 HIV related clinical events were rare in patients who maintained VL <50. Also in VL suppressed patients, the rate of CD4 decline to <350 is lower and total time with CD4 <350 less, than in those experiencing VL >400. These data suggest that reduced frequency of CD4 monitoring in patients who maintain VL<50 on HAART and have achieved good CD4 recovery (>350) may be clinically acceptable. |
| O22 | IS THERE AN UNRECOGNISED EPIDEMIC OF HEPATITIS C INFECTION IN MEN WHO HAVE SEX WITH MEN? HIV Med. 2008 May; 9(Suppl 1):6 (abstract no. O22) J Turner1, T Gikanga2, V Jones1, A Copas1, J Cooper1, J Stevens1, E Aarons2 and R Gilson1 In this study population there was no evidence of an epidemic of undiagnosed HCV infection in non-IDU MSM who were HIV negative or unaware of their HIV status. |
| O23 | VALIDATION OF ANAL CYTOLOGY IN THE UK HIV Med. 2008 May; 9(Suppl 1):6 (abstract no. O023) M Nathan1, N Garrett1, N Hickey1, T Prevost2, M Sheaff3 and N Singh3 High rates of anal squamous carcinoma have been identified in HIV+ MSM on HAART in London. No systematic screening for anal cancer precursors exist in the U.K. We looked at the validity of liquid-based cytology (smear) for screening amongst a high-risk population in London. |
| O24 | ANAL CYTOLOGY SCREENING IN HIV-POSITIVE HOMOSEXUAL MEN: EXPERIENCE IN A CITY CENTRE HIV CLINIC HIV Med. 2008 May; 9(Suppl 1):6 (abstract no. O24) L Goodall Anal smears are a valuable screening tool for detection of anal cytological abnormalities in HIV positive homosexual men. The high rate of cytological abnormalities seen argues for routine screening in this group at high risk of anal carcinoma. |
| O25 | PLASMA HHV8 DNA VIRAL LOAD AS A TUMOUR MARKER FOR MULTICENTRIC CASTLEMAN'S DISEASE (MCD) HIV Med. 2008 May; 9(Suppl 1):7 (abstract no. O25) V Campbell, J Krell, M Stancliffe, M Atkins, M Nelson, M Habibi, B Gazzard and M Bower MCD is a rare lymphoproliferative disorder occurring at increased incidence in people with HIV infection. Human herpesvirus-8 (HHV8) also known as Kaposi's sarcoma-associated herpes virus has a central role in pathogenesis of MCD. We evaluated the role of plasma HHV8 DNA quantification as a tumour marker in MCD. |
| O26 | THE INCIDENCE OF HIV-ASSOCIATED MULTICENTRIC CASTLEMAN'S DISEASE HIV Med. 2008 May; 9(Suppl 1):7 (abstract no. O26) J Krell1, A Bazeos2, V Campbell1, V Harding1, J Stebbing1, S Mandalia1, T Powles2 and M Bower1 Multicentric Castleman's disease (MCD) and Kaposi's sarcoma (KS) are causally related to infection with human herpesvirus8 (HHV-8). In HIV cohorts with access to highly active antiretroviral therapy (HAART) the incidence of KS is falling; however the incidence of MCD in this setting has not previously been described. |
| O27 | EFFECT OF PD1.3 SINGLE NUCLEOTIDE POLYMORPHISM ON CD4 AND CD3 T CELL COUNTS IN HAART-TREATED CHRONIC HIV-1+ PATIENTS HIV Med. 2008 May; 9(Suppl 1):7 (abstract no. O27) G Rosignoli1, N Liptrott2, N Imami1, M Bower1, F Gotch1 and A Owen2 The presence of the PD-1.3 allele is associated with higher CD3 and CD4 T cell counts in chronically infected HIV-1 patients suggesting that this polymorphism influences the PD-1/PD-L1 pathway and confers protection to CD4 and CD3 T cells. |
| O28 | INTENSIVE CARE ADMISSION AND OUTCOME IN RELATION TO CD4 COUNT IN PATIENTS INFECTED WITH THE HUMAN IMMUNODEFICIENCY VIRUS (HIV) IN THE ERA OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY: A SINGLE-CENTRE SURVEY HIV Med. 2008 May; 9(Suppl 1):7 (abstract no. O28) L Turtle1, R Vyakernam2, G Davies1, M Nelson2 and N Soni2 Since the advent of highly active antiretroviral therapy (HAART) prognosis of advanced HIV infection is now much improved. Data from the pre-HAART era showed that survival from critical illness was related to CD4 count in HIV+ patients. We hypothesized that since the advent of HAART CD4 count would be unrelated to outcome following intensive care unit (ICU) admission. |
| O29 | CHARACTERISTICS AND OUTCOMES OF HIV-INFECTED PATIENTS ADMITTED TO AN INNER LONDON INTENSIVE CARE UNIT HIV Med. 2008 May; 9(Suppl 1):8 (abstract no. O29) E Hamlyn, S Bhatt, P Gruber, L Campbell, V Metaxa, C Pahl and M Poulton Nearly half of HIV-infected patients admitted to ICU were newly diagnosed highlighting the problems associated with late presentation. A higher proportion of IVDU were admitted compared to the general HIV clinic population. Mortality was not significantly higher than in non HIV-infected patients. |
| O30 | ASSOCIATION BETWEEN ADVERSE EVENTS AND MORTALITY: A VALIDATION ANALYSIS HIV Med. 2008 May; 9(Suppl 1):8 (abstract no. O30) C Sabin1, L Bansi1, M Nelson2 and C Leen3, UK CHIC Steering Committee1 Recent published findings indicate that patients with laboratory abnormalities are at increased risk of mortality. However, these results were based on cross-sectional analyses and did not take account of the fact that toxicities may change in an individual over time. Using data from the UK CHIC Study, we wished to validate these analyses using time-updated laboratory scores. |
| POSTER ABSTRACTS Abstracts P1 to P150, pages 10 through 50 |
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| P1 | OPTIONE - EVALUATION OF INNOVATIVE HIV OUTPATIENT MODEL SHOWS STANDARD OF CARE MAINTAINED WITH FEWER CLINIC VISITS AND GREATER SATISFACTION HIV Med. 2008 May; 9(Suppl 1):10 (abstract no. P1) KM Coyne, A Kerley, S Mandalia and AG McOwan Clinics need to be accessible to an ever increasing number of adults living with HIV. We devised a model of care based on nurse-led review and phlebotomy. Results are reviewed by a doctor and patients notified by email. Information can be sent via web links or attachments, and patients can also make a doctor's appointment at any time. Patients are suitable for OptionE if they are stable on or off antiretroviral therapy with no unresolved medical issues. |
| P2 | UNDERSTANDING THE BARRIERS TO GP INVOLVEMENT IN THE CARE OF PATIENTS WITH HIV - THE GP PERSPECTIVE: A QUESTIONNAIRE-BASED STUDY HIV Med. 2008 May; 9(Suppl 1):10 (abstract no. P2) H Defty1, A Cressey2, H Smith1, Y Gilleece2, N Perry2 and M Fisher2 GPs still perceive significant barriers to their involvement in the management of patients with HIV. As patients with HIV age and experience co-morbidities, to increase GP involvement it may be best to involve specific interested GPs predominantly and to introduce effective interventions, such as specific training-updates. |
| P3 | CLINICAL MENTORING: A FAST WAY TO ADDRESS THE SHORTAGE OF TRAINED HEALTH WORKERS FOR SUCCESSFUL ART SCALE-UP IN RESOURCE-LIMITED SETTINGS HIV Med. 2008 May; 9(Suppl 1):10 (abstract no. P3) S Aggett1, M Nelson2, M Charles1, B Boyle3 and R Mair1 Clinical mentoring, in collaboration with national government HIV/AIDS programs, has a dramatic impact on improving the clinical skills and knowledge of local providers in developing counties. This creates sustainable patient care and enables clinics to manage increasing numbers of patients on treatment with existing healthcare staff. |
| P4 | IMPROVING ACCESS TO HIV TESTING BY A SCREENING PROGRAMME IN ABORTION CLINICS HIV Med. 2008 May; 9(Suppl 1):11 (abstract no. P4) KJ Adams1, E Morris2, A Newton3, R Meigh4, H Thaker1 and K Guthrie2 As far we are aware we are one of only very few units offering such a programme. Despite initial problems with introducing HIV screening into an area where it is not usually discussed we have shown that it is possible to run a successful programme. Our findings have implications for future screening programmes in clincal areas where HIV isn't usually broached. |
| P5 | IN EASTERN UGANDA TRAINING IN POST-EXPOSURE PROPHYLAXIS (PEP) AFTER OCCUPATIONAL EXPOSURE TO HIV PRODUCED SIGNIFICANT IMPROVEMENTS IN PRACTICE AND IMPROVED LINKS BETWEEN HIV UNITS TO ALLOW BETTER PRACTICE TO EXTEND THROUGHOUT THE REGION HIV Med. 2008 May; 9(Suppl 1):11 (abstract no. P5) JSO Obbo1, P Olupot-Olupot1, J Balyejjusa1 and J Meadway2 National Guidelines for PEP are not being followed in regions of Uganda. Training sessions for clinicians resulted in significant changes in practice at the main hospital and links which could extend improvements throughout the region. |
| P6 | MEDICO-LEGAL AND ETHICAL IMPLICATIONS OF AN ACCIDENTAL HIV TEST WITHOUT CONSENT HIV Med. 2008 May; 9(Suppl 1):11 (abstract no. P6) K Mohanty In a situation where an HIV test is done without consent the advice of the GMC, MDU and the Legal Department of the Trust should be sought before taking any further step and the details should be recorded in the patient's case notes. |
| P7 | SEXUALLY TRANSMITTED INFECTIONS (STIS) AND CERVICAL CYTOLOGY SCREENING IN WOMEN LIVING WITH HIV/AIDS (WLHA) ATTENDING A COMBINED HIV/GUM CLINIC IN A UK DISTRICT GENERAL HOSPITAL (DGH) HIV Med. 2008 May; 9(Suppl 1):11 (abstract no. P7) M Ghanem, L Riddell, J Kemp and N Cook Combined HIV/GUM clinic in a DGH setting achieved well against the BHIVA standards with low DNA rate and high level of communication with GPs. We now perform STIs screen for women under the care colposcopy clinic. |
| P8 | AN AUDIT OF THE SOCIAL SERVICES SUPPORT FOR PEOPLE LIVING WITH HIV IN NORTHERN IRELAND HIV Med. 2008 May; 9(Suppl 1):12 (abstract no. P8) S Quah, P Knowles and CLNY Wilson Almost all the patients who were referred to social work support avail of practical and emotional support for themselves, their partners and family members. There is evidence of an integrated community support service, liaison and co-working with statutory and voluntary agencies in the community. |
| P9 | 'I DON'T HAVE FEAR GO DIE, BUT I HAVE FEAR DON'T HAVE MONEY.' WHEN THE HEALTH NEEDS OF HIV PATIENTS ARE OVERSHADOWED BY THEIR SOCIAL NEEDS HIV Med. 2008 May; 9(Suppl 1):12 (abstract no. P9) N Friend-du Preez and J Anderson Results of this study shed light on practical ways to further help patients address their non- clinical needs. Despite cuts in HIV funding, HIV services continue to provide patients with the type of support they are unable to find elsewhere. Although staff may feel overwhelmed by the social needs of patients, helping patients to meet some of these needs provided them with increased job satisfaction. |
| P10 | COMPARING THE OUTCOME AND COST OF SECOND-LINE 2NRTIS + PI, 2NRTIS + 2PIS, 2NRTIS + PI-BOOSTED AND 3NRTIS FOR THOSE WHO FAILED ON 2NRTIS + NNRTI AS FIRST-LINE HAART IN THE UK, 1996-2002 HIV Med. 2008 May; 9(Suppl 1):12 (abstract no. P10) EJ Beck, S Mandalia, M Youle, B Gazzard, for the NPMS-HHC Steering Group 2NRTIs + PI and 2NRTIs + 2PI had longer time to treatment failure compared to 3NRTIs. Annual cost for 2NRTIs + PI less than 2NRTIs + 2PIs and similar to 3NRTIs. This suggests 2NRTIs + 1PI acceptable choice for 2nd line HAART. Relatively poor performance of 2NRTIs + PIboosted possibly related to shorter period of follow up compared with other regimens as only introduced in 2000. In addition, sample size was small. Await effect of longer periods of follow up and the introduction of newer antiretrovirals beyond the year 2002. |
| P11 | DEVELOPING A FRAMEWORK OF BEST PRACTICE FOR TACKLING BLOODBORNE VIRUSES IN UK PRISONS-EXPERIENCE AND RESULTS HIV Med. 2008 May; 9(Suppl 1):12 (abstract no. P11) S Johnston, N Douglas and Y Azad In 2004/2005 the National AIDS Trust (NAT) and Prison Reform Trust conducted a survey of healthcare managers in UK prisons in response to concerns about inconsistency of BBV prevention, treatment and care. The results indicated a wide variation in prisons' responses to BBVs, with some indicating no services in place. The survey report recommended the development of a best practice framework on tackling BBVs in prisons. |
| P12 | IMPROVING HIGH COST ANTIRETROVIRAL DRUG DISPENSING: THE IMPACT OF A DEDICATED HIV PHARMACY TECHNICIAN HIV Med. 2008 May; 9(Suppl 1):13 (abstract no. P12) I Stephenson, MJ Wiselka, D Pegg, A Aboo and TW Clarke Infectious Diseases supervises inpatient management and follow-up of all symptomatic HIV adults in Leicester. Repeat antiretroviral (ARV) scripts are written during consultation at outpatients, with a supply issued until the next appointment-typically 3/12. However, as pharmacy issues ARV drugs in calender pack months, and follow-up appts are variable (2-12 weeks), and often changed later due to cancellation, convenience or failure to attend, we note that patients may acquire 'excess' drug by attending outpatients earlier than anticipated, or from 'emergency' scripts issued if running out of drug before their next appointment. The cumulative effect of excess prescribing may be considerable. |
| P13 | INFLUENZA VACCINATION IN A LARGE TERTIARY HIV CENTRE IN THE UK HIV Med. 2008 May; 9(Suppl 1):13 (abstract no. P13) M Mirfenderesky, P Khan, T Fernandez, L Swaden, M Johnson and S Hopkins There were multiple missed IFV opportunities in this HIV population who attend. Low vaccine uptake, especially in those not on ARVs or with higher viral loads, may be due to either provider or patient reservations about vaccine safety or efficacy. We plan to implement a multimodal educational package to both staff and patients ahead of next years IFV programme to improve uptake in our centre. |
| P14 | THE NECESSITY FOR IMPROVED HEALTH SYSTEMS RESEARCH IN COUNTRIES WITH HIGH HIV PREVALENCE HIV Med. 2008 May; 9(Suppl 1):13 (abstract no. P14) CS Brown Further commitment is required from high prevalence countries to define policies and targets on health systems research to improve equitable access to HIV care and services. Assistance from health research organisations and institutional support that will help provide an enabling environment for such research to be conducted is required. |
| P15 | HIV CARE OF DETAINED ASYLUM SEEKERS IN SCOTLAND HIV Med. 2008 May; 9(Suppl 1):13 (abstract no. P15) C Duncan, WTA Todd, S Dundas and N Kennedy We identified several cases where deportation or transfer to another removal centre was likely to result in adverse impacts on the HIV management, physical or mental health of detainees. We identified some limitations in the basic information available to clinicians. |
| P16 | IDENTIFYING PATIENTS FOR CARDIOVASCULAR RISK REDUCTION IN A SPECIALIST METABOLIC CLINIC HIV Med. 2008 May; 9(Suppl 1):14 (abstract no. P16) C Stradling and M Roos This audit suggests that a specialist HIV metabolic clinic can be effective in reducing CV risk. The screening process facilitates appropriate referals, but the delay between identification of risk and referal to MC requires addressing. It may be due to interim lifestyle intervention appointments and attempting to sychronise patient clinic visits. Revisions are proposed to the pathway for CV screening and risk modification to enable future optimal management. |
| P17 | ONCE-DAILY AND TWICE-DAILY LOPINAVIR/RITONAVIR-BASED REGIMENS PROVIDE SIMILAR VIROLOGIC RESPONSE THROUGH 48 WEEKS: RESULTS OF A META-ANALYSIS HIV Med. 2008 May; 9(Suppl 1):14 (abstract no. P17) M King, L Fredrick, B da Silva, T Podsadecki and B Bernstein A meta-analysis of over 1500 ARV-naïve subjects indicated that virologic response through 48 weeks, as measured by 2 different endpoints, is similar between QD and BID LPV/r-based regimens and is independent of baseline viral load. |
| P18 | TREATMENT EXPERIENCE WITH ETRAVIRINE AND OPTIMISED BACKGROUND REGIMEN: 24-WEEK DATA FROM A SINGLE CENTRE COHORT HIV Med. 2008 May; 9(Suppl 1):14 (abstract no. P18) C Scott, R Jogiya, A Teague, M Bower, B Gazzard and M Nelson ETV is well tolerated and in combination with new novel anti-retroviral agents is a successful therapy in treatment experienced patients. |
| P19 | A SINGLE CENTRE COHORT EXPERIENCE WITH DARUNAVIR/ RITONAVIR (DRV/R) (600 MG/100 MG) AND OPTIMISED BACKGROUND REGIMEN IN CLINICAL PRACTIVE HIV Med. 2008 May; 9(Suppl 1):14 (abstract no. P19) C Scott, R Jogiya, A Teague, M Bower, B Gazzard and M Nelson DRV has shown impressive activity against protease resistant HIV in normal clinical practice and is well tolerated. |
| P20 | THE PREVALENCE OF VIRAL SUPPRESSION IN HIV PATIENTS ON ART AT A DISTRICT GENERAL HOSPITAL HIV Med. 2008 May; 9(Suppl 1):15 (abstract no. P20) M Sethupathi, W Simukonda, K Yoganathan and C Williams Our study demonstrated a high prevalence (94.1%) of viral suppression. The most common NRTI backbone was abacavir and lamivudine twice a day and combined mainly with NNRTI. The most common PI was atazanavir in our cohort. |
| P21 | A STANDARD VIRTUAL CLINIC HIV Med. 2008 May; 9(Suppl 1):15 (abstract no. P21) B Marett, L Garvey, L Rubinstein and N Mackie The clinical caseload at the VC is significant and demanding. The majority of patients were seen within 6 weeks of a resistance test or within 3 months of repeat VL >400 as recommended in the recent BHIVA standards document. The VC has now expanded to 3 sessions a month. |
| P22 | AN AUDIT ON EFAVIRENZ PRESCRIBING IN WOMEN OF CHILD-BEARING POTENTIAL ATTENDING AN HIV UNIT HIV Med. 2008 May; 9(Suppl 1):15 (abstract no. P22) MS Abu Bakar1, S Surah1, F Lyons2, L Hurley1 and A de Ruiter1 Documentation regarding the reproductive issues related to EFV was poor. Women of child bearing potential should be appropriately counselled with clear documentation regarding contraceptive and pregnancy related issues before EFV therapy. |
| P23 | USE OF RALTEGRAVIR FOR A GROUP OF PATIENTS WITH WIDE RANGE MUTATIONS AGAINST ANTI-RETROVIRAL AGENTS; REPORT ON THE FIRST NINE PATIENTS HIV Med. 2008 May; 9(Suppl 1):15 (abstract no. P23) K Manavi Raltegravir based regimes have proved to be highly successful in achieving full HIV viral suppression amongst patients with extensive resistance profile in short term. |
| P24 | SIMPLIFIED HAART (KALETRA IN MONO AND DUAL THERAPY) - A RETROSPECTIVE REVIEW (THE KIMODO STUDY) HIV Med. 2008 May; 9(Suppl 1):16 (abstract no. P24) L Waters1, M Youle2, J Boorman3, J van Wyk3 and M Norton4 In routine clinical practice, some patients receive treatment with <3 drug therapy including LPV/r. In KIMODO reasons for simplification were variable. Overall efficacy improved in patients who switched therapy, however cases of resistance and VF were observed. |
| P25 | EFFICACY AND SAFETY OF ONCE-DAILY ATAZANAVIR/RITONAVIR (ATV/R) COMPARED TO TWICE-DAILY LOPINAVIR/RITONAVIR (LPV/R), EACH IN COMBINATION WITH TENOFOVIR (TDF) AND EMTRICITABINE (FTC), IN ANTIRETROVIRAL (ARV) NAÏVE HIV-1 INFECTED SUBJECTS. THE CASTLE STUDY (AI424-138) 48 WEEK RESULTS HIV Med. 2008 May; 9(Suppl 1):16 (abstract no. P25) G Moyle, on behalf of the CASTLE study group In treatment-naïve patients, ATV/r demonstrated similar efficacy, a lower incidence of GI- related AEs, and a significantly better lipid profile (TC, TG, non-HDL) compared to LPV/r. In combination with TDF and FTC, both ATV/r and LPV/r were well tolerated with few discontinuations through 48 weeks. |
| P26 | IS RUNNING A DESIGNATED CLINIC FOR PATIENTS COMMENCING ANTIRETROVIRAL THERAPY WORTHWHILE? HIV Med. 2008 May; 9(Suppl 1):16 (abstract no. P26) LJ Garvey, R Weston, K Legg and A Winston Although not statistically significant, greater percentages of individuals have received adherence support and knowledge surrounding clinical trials since the introduction of this multidisciplinary clinic. |
| P27 | ONCE DAILY NEVIRAPINE WITH TRUVADA (TDF + FTC; TVD) OR KIVEXA (ABC + 3TC; KVX): 48 WEEK DATA - INDIVIDUALISING PATIENT CARE USING AN INTEGRATED MULTIDISCIPLINARY (MDT) CARE PATHWAY WITH THERAPEUTIC DRUG MONITORING (TDM) AND EARLY INTERVENTION IS ASSOCIATED WITH OPTIMAL OUTCOMES HIV Med. 2008 May; 9(Suppl 1):16 (abstract no. P27) C Robertson, A Berry, J Mahungu, C Stradling and S Taylor Patients taking OD NVP starting with an early intensive MDT protocol approach, including access to TDM and appropriate dose adjustment, have excellent therapeutic outcomes. This strengthens the case for individualised patient care. |
| P28 | TRANSMITTED HIV 1 ANTIRETROVIRAL DRUG RESISTANCE SURVEILLANCE IN IRELAND 2007 HIV Med. 2008 May; 9(Suppl 1):17 (abstract no. P28) CF De Gascun1, S Coughlan1, C Bergin2, C Fleming3, M Horgan4, S Mc Conkey5, WG Powderly6 and WW Hall1 Surveillance of transmitted drug resistance (TDR) may inform both HIV 1 related public health strategies and rational use of antiretroviral agents by clinicians. There is currently no drug resistance surveillance programme in Ireland. This study examines whether such a programme is required. |
| P29 | A SUSTAINED INCREASE IN CD4 COUNT AND HIGH PROPORTION OF PATIENTS REMAINING ON FIRST LINE THERAPY AT 36 MONTHS IN COHORT OF GHANAIAN PATIENTS ATTENDING A PUBLIC HIV TREATMENT CLINIC HIV Med. 2008 May; 9(Suppl 1):17 (abstract no. P29) U Schwab1, P Collini2, J Obeng-Baah3, FS Sarfo3, B Norman3, L Appiah3, D Chadwick4 and G Bedu-Addo3 Attrition in attendance is the biggest problem, but 2/3 continue to receive therapy, >90% showing a sustained immunological response. The majority of ART changes are single substitutions. The reasons for discrepancy in number between those with IF and those that switched are discussed. |
| P30 | CLINICAL EXPERIENCE WITH RALTEGRAVIR (MK-0518 OR ISENTRESS®), WITH AN OPTIMISED BACKGROUND REGIMEN IN HIGHLY TREATMENT-EXPERIENCED PATIENTS HIV Med. 2008 May; 9(Suppl 1):17 (abstract no. P30) A Teague, C Scott, T Youngstein, M Bower, B Gazzard and M Nelson Substitution of a PI/T20 with RGV is a successful strategy for those individuals no longer tolerant of these drugs. The use of RGV, a new class of drug, in combination with other active anti-retrovirals leads to an excellent virological response in highly experienced patients. The majority of patients reached an undetectable viral load, setting a new target for individuals in salvage therapy. |
| P31 | THE PHARMACOKINETIC PROFILE OF DARUNAVIR WITH LOW-DOSE RITONAVIR (DRV/R) IN VARIOUS MULTIPLE-DOSE REGIMENS OVER 120 HOURS HIV Med. 2008 May; 9(Suppl 1):18 (abstract no. P31) A Jackson1, M Boffito1, G Moyle1, A Hill2, V Sekar3, E Lefebvre4, M De Pauw5, R Hoetelmans5 and R DeMasi3 The 800/100mg qd regimen of DRV/r provides convenient once-daily dosing and can maintain adequate DRV plasma concentrations for prolonged periods of time. DRV's long half-life and suitable exposure are expected to provide benefits in patients, especially when considering the challenges of long-term adherence to antiretroviral therapy. |
| P32 | SEVERE HEPATOTOXICITY ASSOCIATED WITH DARUNAVIR HIV Med. 2008 May; 9(Suppl 1):18 (abstract no. P32) J Underwood, A Scourfield, C Bell, V Harding, M Bower and M Nelson This case illustrates a probable severe case of Darunavir hepatotoxicity in a Hepatitis C/HIV infected male. This was not thought to be a case of IRIS due to the rapidity of normalisation of his liver function on withholding Darunavir. |
| P33 | COMPARISON OF GASTROINTESTINAL ADVERSE EVENTS (GI AES) OF DARUNAVIR/RITONAVIR (DRV/R) AND LOPINAVIR/RITONAVIR (LPV/R) AT WEEK 48 IN ARTEMIS HIV Med. 2008 May; 9(Suppl 1):18 (abstract no. P33) B Clotet1, C Katlama2, G Hernandez-Martinez3, C Vanden Abeele4, R DeMasi5 and L Lavreys4 GI AEs frequently cause discontinuation in antiretroviral treatment. DRV/r was shown to be better tolerated in terms of diarrhoea than control PI. This analysis assessed GI tolerability of DRV/r versus LPV/r at week 48 in the phase III ARTEMIS trial. |
| P34 | CHANGES IN BLOOD PRESSURE AND LIPIDS UP TO WEEK 12 IN PATIENTS TREATED WITH ART DURING PRIMARY HIV INFECTION (PHI) AND UPON ART CESSATION: SPARTAC TRIAL HIV Med. 2008 May; 9(Suppl 1):18 (abstract no. P34) S Fidler1, M Fisher2, S Kinloch3, G Ramjee4, D Cooper5 and J Weber1 We found a temporary increase in triglyceride levels which fell to baseline levels following ART cessation, a temporary decrease in LDL:HDL ratio immediately following the cessation of ART, and no change in BP. This is the first report of the dynamics of lipid changes with short course ART in PHI. |
| P35 | PATIENTS' PERCEIVED DEGREE OF INTERFERENCE OF HAART THERAPY IN NORMAL LIFE AFTER TREATMENT SIMPLIFICATION TO AN ATAZANAVIR CONTAINING REGIMEN HIV Med. 2008 May; 9(Suppl 1):19 (abstract no. P35) R Horne1, J Walsh2, J Gatell3, G L'Italien4, V Wirtz4, L Odeshoo4 and I Villanueva5 Convenience may impact level of adherence and success of HAART therapy. In this study the perceived degree of interference in normal life and adherence to PI-containing HAART regimens in patients switched to Atazanavir (ATV) were assessed. |
| P36 | CONTRIBUTION OF CLINICAL AND NON-CLINICAL GROUPS TO SUPPORT ADHERENCE TO HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART) FOR PATIENTS ATTENDING A REGIONAL HIV CENTRE IN NORTHERN IRELAND HIV Med. 2008 May; 9(Suppl 1):19 (abstract no. P36) A McCourt and S Quay The life-long commitment to taking HAART requires a multidisciplinary approach between all stakeholders to provide personalised information and education as a part of a framework for self-management and supporting shared-care decision-making. Patients may find it difficult to seek that support from family and friends. Nurse specialists and pharmacists can have a role in coordinating adherence services. |
| P37 | DESCRIPTION AND ANALYSIS OF OUTCOMES FROM USE OF ATAZANAVIR (ATV) IN ROUTINE CLINICAL PRACTICE HIV Med. 2008 May; 9(Suppl 1):19 (abstract no. P37) RK Lodwick1, MS Youle2, FC Lampe1, CJ Smith1, AN Phillips1 and MA Johnson2 An increasing proportion of patients on PI-containing regimens are taking ATV. Most patients started ATV while virally suppressed and viral rebound was rare. |
| P38 | THE INTENSE STUDY: AN INTENSIFICATION STRATEGY OF ADDING ENFUVIRTIDE (ENF) TO AN ORAL HAART REGIMEN HIV Med. 2008 May; 9(Suppl 1):20 (abstract no. P38) A Capetti1, B Clotet2, LE Soto-Ramirez3, L Rowell4, M Salgo5 and JM Schapiro6 This study compared the efficacy and safety of induction with ENF + HAART versus HAART alone and maintenance with ENF + HAART versus dropping ENF or continuing HAART alone in participants in whom HAART alone (≥2 active agents) would be adequate. |
| P39 | USE OF NOVEL BOOSTED PROTEASE INHIBITORS IN THE HEAVILY TREATMENT-EXPERIENCED PATIENT: EXPERIENCE IN CLINICAL PRACTICE HIV Med. 2008 May; 9(Suppl 1):20 (abstract no. P39) LJ Garvey, R Weston, S Portsmouth and A Winston In this cohort TPV and DRV were well tolerated with high rates of virological suppression and low toxicity. Although nonsignificant more patients on DRV were suppressed to VL <50 copies/mL. Larger studies will demonstrate if our findings are representative and sustained longer-term. |
| P40 | EFFICACY AND TOLERABILITY IN THOSE SWITCHING FROM ZIDOVUDINE/LAMIVUDINE (COMBIVIR®) AND NEVIRAPINE TO ABACAVIR/LAMIVUDINE (KIVEXA®) AND NEVIRAPINE IN A UK CLINIC COHORT HIV Med. 2008 May; 9(Suppl 1):20 (abstract no. P40) V Akyeampong and I Reeves Our experience finds Kivexa®l/nevirapine to be a well tolerated regimen. There was no virological failure. There was a trend towards increased haemoglobin but lipid levels were unchanged. This study contributes to current evidence supporting proactive switching in stable patients. Long term outcomes in a larger cohort are required. |
| P41 | THE EFFICACY AND SAFETY OF DARUNAVIR/RITONAVIR (DRV/R) AND ETRAVARINE (ETV) IN A SERIES OF HIGHLY ACTIVE ANTI-RETROVIRAL THERAPY (HAART) TREATMENT EXPERIENCED PATIENTS WITH OR WITHOUT ENFUVIRTIDE (T-20) HIV Med. 2008 May; 9(Suppl 1):20 (abstract no. P41) R Varma, V Akyeampong, C Okoli and C Orkin DRV/r, a recently licensed protease inhibitor (PI), has shown potency in both experienced and naïve patients. Its use has been studied in combination with ETV, a novel non-nucleoside reverse transcriptase inhibitor (NNRTI), which has activity against certain NNRTI resistant viruses. We describe our series of patients receiving both drugs. |
| P42 | SWITCHING TO A ONCE-DAILY DOSING REGIMEN OF LOPINAVIR/RITONAVIR: OUTCOMES IN A CLINICAL SETTING HIV Med. 2008 May; 9(Suppl 1):21 (abstract no. P42) S Logan, A Aryee, P Khan, N Marshall, R Tsintas, M Tyrer and M Johnson A once-daily regimen of lopinavir/ritonavir is an effective strategy for many patients established on anti-retroviral therapy. A switch to this regimen offers advantages in terms of adherence, lack of need for refrigeration as well as suppression of viral replication with no significant change in tolerability or adverse effects on lipid profile. |
| P43 | THE EFFICACY AND SAFETY OF DARUNAVIR/RITONAVIR (DRV/R) WITH ETRAVARINE (ETV) AND RALTEGRAVIR (MK-0518), IN COMBINATION, IN A SERIES OF PATIENTS WITH TRIPLE CLASS RESISTANCE TO HIV-1 HIV Med. 2008 May; 9(Suppl 1):21 (abstract no. P43) R Varma, V Akyeampong, C Okoli and C Orkin In this series of highly experienced patients this combination appeared potent and well tolerated. Achieving an undetectable viral load is a realistic goal. |
| P44 | EFAVIRENZ DOSE REDUCTION BASED ON CYP2B6 GENOTYPE IS NOT SUPPORTED BY DATA FROM MEN IN SOUTH AFRICA HIV Med. 2008 May; 9(Suppl 1):21 (abstract no. P44) J Whetham1, S Charalambous2, J Lewis2, K Fielding3, H McIlleron4, A Walley5, GJ Churchyard1 and AD Grant3 CYP2B6 TT genotype is common in black South Africans and associated with higher, but usually therapeutic, plasma EFV levels. These data do not support EFV dose reduction based on CYP2B6 genotype in this population. |
| P45 | PATIENTS WITH HIV AND HEPATITIS C CO-INFECTION PERIENCE LESS ATAZANAVIR-INDUCED HYPERBILIRUBINAEMIA HIV Med. 2008 May; 9(Suppl 1):22 (abstract no. P45) A Cotter1, A Brown1, J Lambert2, G Sheehan1 and P Mallon2 Being HepC positive protects against ATV-induced byperbilirubinaemia. Further research is needed to determine the mechanism underlying this protective effect. |
| P46 | ANTIRETROVIRAL PRESCRIBING FOR HIV-POSITIVE INJECTION DRUG USERS AND EFFECTS ON PATIENT OUTCOME HIV Med. 2008 May; 9(Suppl 1):22 (abstract no. P46) C Maguire1, C Ni Cheallaigh1, C De Gascun2, A Jayaram1, M Moriarty1, WW Hall2, F Mulcahy1 and C Bergin1 We retrospectively compared HIV infected injection drug users (IDU) treated with NNRTI based ART with those treated with PI based ART. Outcome included failure of virologic suppression and acquisition of drug resistance. Non-drug users treated with the same regimens acted as controls. |
| P47 | THE SEROEPIDEMIOLOGY OF HUMAN T CELL LYMPHOTROPHIC VIRUS-I (HTLV-1) AMONGST GENITOURINARY MEDICINE ATTENDEES IN SOUTH EAST LONDON HIV Med. 2008 May; 9(Suppl 1):22 (abstract no. P47) C Turner1, C Cohen1, C Sabin2, J Tosswill3, J Best4, GP Taylor5, A de Ruiter6, D Barlow6 and Nicola Smith1 These results show a 100 fold higher seroprevalence of HTLV-I in GUM attendees compared with blood donors in the UK suggesting that HTLV-I screening should be considered in GUM clinics in order to identify infected patients. |
| P48 | SYPHILIS SEROCONVERSION DELAYED FOR YEARS IN A MONOGAMOUS HIV-POSITIVE COUPLE: CASE REPORT HIV Med. 2008 May; 9(Suppl 1):22 (abstract no. P48) CJ Brookings, S Hill, L Garvey, S Portsmouth and D Goldmeier Assuming no other sexual contact there are two possible modes of transmission. The first being that the husband had previously treated syphilis predating the HIV infection, and with immunosuppression, re-activated the syphilis, became contagious and infected his partner years later. The second is that the patient had a delayed antibody response to syphilis due to her HIV status. This case highlights the need for annual syphilis testing in HIV patients whatever the risk. |
| P49 | PREVALENCE OF SYPHILITIC HEPATITIS IN AN HIV COHORT HIV Med. 2008 May; 9(Suppl 1):23 (abstract no. P49) D Dhasmana, R Cramb and K Manavi With the current high prevalence of syphilis amongst HIV infected patients in the UK, it is important to recognize syphilitic hepatitis as relatively common complication of syphilis. Fulminant hepatic failure may be a consequence of syphilis but our patients had mild to moderate hepatitis which should be a reversible condition. |
| P50 | HIV PRONE OCCUPATIONAL EXPOSURES: EPIDEMIOLOGY AND FACTORS ASSOCIATED WITH INITIATION OF POST-EXPOSURE PROPHYLAXIS HIV Med. 2008 May; 9(Suppl 1):23 (abstract no. P50) D Zenner, S Tomkins, A Charlett, K Wellings and F Ncube PEP-uptake was associated with known transmission risk factors, suggesting awareness of current guidelines. The significant differences in PEP-uptake across occupation categories may be due to differential risk perceptions and other underlying factors. This is the first study to examine PEP-uptake following occupational exposures to HIV. Further research and exploration of these findings are warranted, to understand the role of PEP-uptake behaviour in preventing occupational HIV transmission. |
| P51 | BEHAVIOUR, PARTNER NOTIFICATION AND SURVEILLANCE HIV Med. 2008 May; 9(Suppl 1):23 (abstract no. P51) E Okpo1, J Bradlow2, L Rusere3, E Mayman3, A Shaw3 and M Kapembwa3 PN at NPH is by patient referral. A more effective PN strategy incorporating a combination of provider and patient referral is recommended in order to increase HIV testing of contacts. |
| P52 | MAPPING OF AN HIV NETWORK IN OUR REGION HIV Med. 2008 May; 9(Suppl 1):23 (abstract no. P52) CM Knapper1, J Roderick1, J Smith2, M Temple2 and HDL Birley1 In February 2007 a homosexual male was diagnosed HIV positive at this centre. He reported 62 sexual contacts in the previous 6 months. We characterise the HIV cluster elucidated and describe its geographical distribution and other features. |
| P53 | INITIAL HIV DIAGNOSIS AND PRESENTATION: DOES SITE INFLUENCE PARTNER NOTIFICATION? HIV Med. 2008 May; 9(Suppl 1):24 (abstract no. P53) U Nandy, J Democratis and J Dhar Our data indicates that initial presentation and diagnosis of HIV in a setting other than GU medicine may have a public health implication. Standards need to be set nationally. Measures taken locally to help a non GU department (ID) to achieve a high standard in partner notification will be discussed later on. |
| P54 | TALKING TURKEY HIV Med. 2008 May; 9(Suppl 1):24 (abstract no. P54) J Dhar1 and E Smit2 Recent changes in the UK removing the right of anonymity from sperm donors may prompt couples who want to use sperm/eggs from anonymous donors to go to unlicensed/backstreet clinics. This case highlights that women who identify as lesbian or women who have sex with women need to be informed about behaviours that may put them at risk. |
| P55 | CELLULAR IMMUNITY FOLLOWING CHEMOTHERAPY FOR SYSTEMIC AIDS-RELATED NON HODGKIN'S LYMPHOMA (NHL) HIV Med. 2008 May; 9(Suppl 1):24 (abstract no. P55) J Krell, M Tuthill, V Campbell, M Nelson, P Holmes, J Stebbing, T Powles and M Bower Chemotherapy and concomitant HAART for AIDS related NHL does not cause prolonged suppression of lymphocyte subsets. These data should provide reassurance regarding the long term immunological consequences of chemotherapy in people with HIV. |
| P56 | THE USE OF ANTIDEPRESSANTS AND RISK OF CANCER IN INDIVIDUALS INFECTED WITH THE HUMAN IMMUNODEFICIENCY VIRUS HIV Med. 2008 May; 9(Suppl 1):25 (abstract no. P56) V Campbell1, J Krell1, A Scourfield1, S Mandalia1, M Nelson1, T Powles2, J Stebbing3 and M Bower1 Pre-clinical and cohort studies suggest that certain antidepressants are associated with a predisposition to cancer whereas others decrease the risk. We aimed to assess whether different classes of antidepressants were associated with changes in cancer incidence in a population of HIV infected individuals, based on duration of exposure. |
| P57 | MINICHROMOSOME MAINTENANCE PROTEINS ARE PROMISING BIOMARKERS FOR CYTOLOGICAL DETECTION OF ANAL INTRAEPITHELIAL NEOPLASIA (AIN) AND ANAL CARCINOMA HIV Med. 2008 May; 9(Suppl 1):25 (abstract no. P57) C Scarpini1, M Nathan2, N Hickey2 and N Coleman1 We conclude that MCMs are promising biomarkers for improving detection of AIN and SCC in anal cytology samples. MCM testing is well suited to liquid based cytology specimens and is amenable to automation, which can increase throughput and reduce costs. |
| P58 | VOLUNTARY NAMED HIV TESTING AMONGST WOMEN UNDERGOING TERMINATION OF PREGNANCY (TOP) IS FEASIBLE AND ACCEPTABLE HIV Med. 2008 May; 9(Suppl 1):25 (abstract no. P58) G Crowe and F Chhibber The prevalence of HIV among women undergoing TOP has been shown to be increasing in seven inner London TOP services where unlinked anonymous testing of women has been carried out since 1995. The same survey has shown that the equivalent rate in women attending Antenatal clinics in London is around half that in TOP facilities. To date, however, it has not been shown that named voluntary HIV testing is feasible or acceptable to women undergoing TOP. Since 2003 we have offered HIV testing as an opt out test in our TOP service. Here we present the first 5 years of this data. |
| P59 | IMPROVING OUTCOMES FOR HIV-POSITIVE MOTHERS AND THEIR BABIES: INCREASE KALETRA DOSAGE IN THE THIRD TRIMESTER OF PREGNANCY DEPENDING ON HIV VIRAL LOAD RATHER THAN THERAPEUTIC DRUG LEVEL MONITORING RESULTS HIV Med. 2008 May; 9(Suppl 1):25 (abstract no. P59) CS Babu, S Bennett, O McQuillan, V Lee and M Kingston When the use of Highly Active Antiretroviral Therapy (HAART) results in an undetectable (<40 copies/mL) HIV viral load (VL) in the third trimester of pregnancy, not only do we minimize the risk of vertical transmission to the baby but we also enable the mother to consider elective vaginal delivery and the neonate requires mono rather than triple therapy. Kaletra is commonly prescribed in pregnancy and due to altered pharmacokinetics in the third trimester of pregnancy we routinely perform therapeutic drug level monitoring (TDM). We performed an audit of TDM results for Kaletra in pregnant women in the third trimester to evaluate how this altered management. |
| P60 | USE OF NEWER ANTIRETROVIRAL (ARV) DRUGS (DARUNAVIR, ETRAVIRINE AND ENFUVIRTIDE) IN HIV-POSITIVE PREGNANT WOMAN WITH PAN-CLASS RESISTANCE FAILURE HIV Med. 2008 May; 9(Suppl 1):26 (abstract no. P60) A Furco1, B Gosrani1, S Nicholas1, A Williams1, G Taylor2, D Asboe3, A Shaw1 and M Kapembwa1 PK studies for enfurvitide, etravirine and darunavir were within expected therapeutic ranges. At week 34, she was still undetectable and she delivered two healthy babies by caesarean section. Babies's optimised prophylactic ARV regimen comprised enfurvirtide, nevirapine and didanosine. Both babies remain uninfected. T20 was undetectable and darunavir/ritonavir and etravirine detectable in cord blood. Adverse events included injection site reactions, hypertriglyceridaemia, anaemia, transient hypereosinophilia and raised alanine transferase. |
| P61 | RENAL TUBULAR DYSFUNCTION ASSOCIATED WITH TENOFOVIR BASED HAART IN PERINATALLY ACQUIRED HIV: THE NEED FOR PAEDIATRIC FORMULATIONS AND PHARMACOKINETIC STUDIES HIV Med. 2008 May; 9(Suppl 1):26 (abstract no. P61) N Onyeador, D Patel, H Lyall, G Tudor-Williams, S Walters and C J Foster Although unlicensed, tenofovir is widely used in HAART experienced paediatric cohorts resulting in cases of renal tubular dysfunction. Paediatric formulations and pharmacokinetic studies are currently recruiting with results eagerly awaited. |
| P62 | PHARMACOKINETICS OF SAQUINAVIR IN PREGNANCY HIV Med. 2008 May; 9(Suppl 1):26 (abstract no. P62) M Hanlon, D Ward, S O'Dea, F Lyons, F Mulcahy and S Clarke In this cohort of pregnant women, the majority achieved adequate SQV levels and virological suppression at standard dosing. This supports the use of SQV/r at standard dosing in pregnancy with TDM. |
| P63 | BARRIERS TO INITIATING ANTIRETROVIRAL THERAPY (ART) IN HIV-INFECTED PATIENTS WITH TUBERCULOSIS (TB) CO-INFECTION HIV Med. 2008 May; 9(Suppl 1):26 (abstract no. P63) DN Chilton1, SG Edwards1, P Pellegrino1 and RF Miller2 Concurrent treatment of TB and HIV is complicated by overlapping toxicities, drug-drug interactions, and risk of immune reconstitution inflammatory syndrome (IRIS). We investigated factors affecting initiation of ART in patients taking anti-tuberculosis therapy (ATT) and compared our clinical practice against the BHIVA HIV/TB treatment guidelines. |
| P64 | CYP2B6 POLYMORPHISM -IMPLICATIONS ON MANAGEMENT OF HIV/TB CO-INFECTION HIV Med. 2008 May; 9(Suppl 1):27 (abstract no. P64) S Shanmuga Sundaram and R Mani CYP2B6 G516T polymorphism is more prevalent in Black Africans and is associated with high plasma levels of EFV (i.e. TT > GT > GG). This should be carefully considered before dose escalation of EFV with Rifampicin. In the absence of routine genotyping, clinicians should have a low threshold for early TDM to avoid drug toxicity in at risk patients. |
| P65 | COMPLIANCE WITH BHIVA HEPATITIS CO-INFECTION GUIDELINES HIV Med. 2008 May; 9(Suppl 1):27 (abstract no. P65) F Basheer and E Gkrania-Klotsas Compliance with BHIVA guidelines remains poor, 3 years after guideline publication. The incidence of liver-related mortality has increased substantially since HAART was introduced. A National Audit of compliance with BHIVA guidelines is necessary. |
| P66 | HIV, HEPATITIS B AND HEPATITIS C COINFECTION IN KENYA HIV Med. 2008 May; 9(Suppl 1):27 (abstract no. P66) R S Harania1, J Karuru1, M Nelson2 and J Stebbing2 Co-infection with HCV was less common than in European or American cohorts. Further work on the prevalence, incidence and treatment of hepatitis and HIV coinfection in larger cohorts in Africa are required. |
| P67 | SCREENING HIV PATIENTS FROM SUB-SAHARAN AFRICA FOR TROPICAL INFECTIONS: A RETROSPECTIVE REVIEW HIV Med. 2008 May; 9(Suppl 1):27 (abstract no. P67) P Lillie, R Bazaz and J Greig One in 10 patients from Africa had positive schistosomiasis serology. We would recommend screening for schistosomiasis in newly diagnosed African HIV patients. These results do not support the use of routine serological tests for filariasis and leishmaniasis and such tests should only be used as symptoms suggest. |
| P68 | THE USE OF TENOFOVIR/EMTRICITABINE FOR TREATMENT OF HEPATITIS B AMONGST PATIENTS WITH HIV/HBV CO-INFECTIONS WHEN COMPARED WITH LAMIVUDINE/ZIDOVUDINE HIV Med. 2008 May; 9(Suppl 1):29 (abstract no. P68) K Manavi1, P Nall1, S Barrett2, S Allan3, M Pegorie2 and P Bangerh2 Aiming for full suppression of HBV when treating HIV/HBV co-infected patients has been recommended by the guidelines. The combination of tenofovir and emtricitabine [truvada®] offer an easy to take combination for such patients. The aim of the present study was to compare anti-HBV effect of tenofovir/emtricitabine [truvada®] with lamivudine in a group of HIV/HBV co-infected patients. |
| P69 | HEPATITIS C (HC) VIRAEMIA FOLLOWING SUSTAINED VIROLOGICAL RESPONSE (SVR) TO PEGYLATED INTERFERON (PEG-IFN) AND RIBAVARIN (RBV) IN HIV POSITIVE MEN WHO HAVE SEX WITH MEN (MSM) - RE-INFECTION OR LATE RELAPSE? HIV Med. 2008 May; 9(Suppl 1):29 (abstract no. P69) R Jones1, E Lowe1, A Rodger2, D Brown2, S Bhagani2, M Nelson1 and D Asboe1 Six out of eight individuals were re-infected with a different strain. Re-infections were likely related to ongoing high-risk sexual activity. The clustering indicates that this is a relatively closed population, exchanging HCV within the cohort. In 2 cases, the strains were closely related indicating either late relapse or possible re-infection from a common source. Of note, since collecting this data, three further cases of potential re- infection have been identified. Their samples will be analysed and included. |
| P70 | HIV CO-INFECTION IN PATIENTS PRESENTING WITH PNEUMOCOCCAEMIA IN AN AREA BORDERING EAST LONDON HIV Med. 2008 May; 9(Suppl 1):29 (abstract no. P70) M Melzer1, T Tricot2 and B Black3 In patients presenting to KGH with pneumococcaemia, there is an opportunity to diagnose HIV at an early stage of infection. Due to limited testing, a larger study to determine the true prevalence of HIV in patients with pneumoococcaemia is required. |
| P71 | LONG-TERM EFFICACY AND SAFETY OF TENOFOVIR IN HIV/HBV CO-INFECTED PATIENTS IN A CLINICAL SETTING HIV Med. 2008 May; 9(Suppl 1):29 (abstract no. 71) A Rodger, AM Geretti, A Garcia, A Corr, M Haines, G Slapak, M Johnson and S Bhagani We report that tenofovir is safe and effective in coinfected patients with a median follow up of 4.3 years. Overall 83% of co-infected persons achieved long term suppression of HBV DNA with a significant improvement in liver function. None of those who achieved virological suppression subsequently rebounded. Renal function remained stable during follow up and no subjects had to stop tenofovir due to adverse events. |
| P72 | ASSESSMENT OF STAGING OF LIVER FIBROSIS BY TRANSIENT ELASTOGRAPHY IN HIV-POSITIVE PATIENTS WITH CHRONIC LIVER DISEASE USING LIVER BIOPSY AS THE GOLD STANDARD HIV Med. 2008 May; 9(Suppl 1):29 (abstract no. P72) A Rodger1, T Fernandez1, G Slapak1, G Dusheiko1, MA Johnson1, C Sabin2 and S Bhagani1 FibroScan is a reliable method for the diagnosis of significant fibrosis (>F2) and cirrhosis (F4) in HIV positive patients with chronic liver disease. This technique can effectively inform clinical decisions on the need to proceed to treatment for viral hepatitis coinfection or liver biopsy. The ability of fibroscan to monitor progression or regression of fibrosis over time in individual patients needs further assessment. |
| P73 | THE EXPERIENCE OF A BIRMINGHAM CITY CENTRE CLINIC IN THE MANAGEMENT OF MYCOBACTERIAL TUBERCULOSIS IN AN HIV-INFECTED POPULATION HIV Med. 2008 May; 9(Suppl 1):29 (abstract no. P73) N Lewis, R Whitmill and K Manavi Evaluation of visual acuity proved to be the least adhered to aspect of the management of TB/HIV coinfection in our centre. A proportion of patients may need extra-social support for completing anti-TB treatment course. |
| P74 | EVALUATION OF HIV-INFECTED PATIENTS FOR LATENT OR SUBCLINICAL TUBERCULOSIS WITH THE T-SPOT®.TB (ELISPOT) TEST HIV Med. 2008 May; 9(Suppl 1):29 (abstract no. P74) N Garrett, M Kall, T Ashcroft, I Reeves and J Anderson T-SPOT®. TB offers new options for the detection of LTBI in HIV+ patients, which may be important in preventing active disease. The prevalence of LTBI was expected in our clinic with a large number of migrants from countries with high TB incidence. Routine use of the test resulted in the detection of active TB in a patient with no prior clinical suspicion of disease. |
| P75 | USE OF ENTECAVIR (ETV) IN HIV AND HEPATITIS B VIRUS (HBV) CO-INFECTED INDIVIDUALS HIV Med. 2008 May; 9(Suppl 1):30 (abstract no. P75) VF Harding, C Bell, J Underwood, A Scourfield, F Ogilvie, E Lowe, R Jones and M Nelson All patients had previously failed on Lamivudine treatment, which reduces susceptibility to Entecavir. Of the individuals receiving Entecavir, three of the four with baseline undetectable levels remained undetectable. Of the three who failed Tenofovir and Lamivudine treatment and were not undetectable at baseline, one was able to fully suppress the virus on Entecavir. Our study suggests that Entecavir may be useful in the therapy of HBV/HIV co-infected individuals with HBV resistance. |
| P76 | RETROSPECTIVE DESCRIPTIVE COHORT STUDY OF HIV/ TB CO-INFECTION IN A HIGH INCOME COUNTRY AND ETHNICALLY DIVERSE URBAN HIV COHORT 2004-07: OUTCOMES, COMPLICATIONS, MORBIDITIES, RESISTANCE HIV Med. 2008 May; 9(Suppl 1):30 (abstract no. P76) R O'Connell1, R Varma1, L Hijazi2, S Limb3, J Anderson4, F Drobniewski5 and C Orkin1 In this cohort there is notable TB drug resistance. Significant morbidity persists in both newly diagnosed HIV patients and those known to have HIV, including those on ARVs. However, simultaneous HIV/TB diagnoses have higher morbidity and toxicity, suggesting case finding and earlier diagnosis would be advantageous. |
| P77 | OUTCOMES OF HCV TREATMENT IN HIV CO-INFECTED PATIENTS TREATED IN TWO UK CLINICS: THE EFFECT OF ABACAVIR CO-ADMINISTRATION HIV Med. 2008 May; 9(Suppl 1):30 (abstract no. P77) AC Bailey1, WC Loke2, K Nambiar3, DR Churchill3, R Kulasegaram2 and M Fisher3 Standard dose pegylated interferon and weight-based dose ribavarin for Hepatitis C (HCV) treatment in HIV co-infected patients is currently recommended for moderate to severe liver damage and considered for mild disease. Randomised controlled trials have shown sustained virological response (SVR) rates of 11-29% for genotype 1 and 43-73% in genotype non-1. Abacavir use has been associated with non- response to HCV treatment in a number of these studies. We present treatment outcome data for HCV in HIV co-infected patients from 2 UK clinics, including stratification by abacavir use. |
| P77A | FACTORS AFFECTING TOLERABILITY OF TB MEDICATIONS IN HIV-POSITIVE PATIENTS HIV Med. 2008 May; 9(Suppl 1):30 (abstract no. P77A) A Jackson, C Ni Cheallaigh, J Thornhill, JG Parker, A O'Reilly, S Clarke and C Bergin TB infects one third of the world's population. Therapy is complicated by side effects. The GUIDE clinic provides care for ∼2500 HIV patients (pts). The department manages all TB in the HIV cohort and all extra- pulmonary TB and some pulmonary infections in HIV-pts. The unit provides on-site dispensing of TB and HIV medications. |
| P78 | ACUTE SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) FOLLOWING PNEUMOCOCCAL VACCINE IN AN HIV-POSITIVE PATIENT HIV Med. 2008 May; 9(Suppl 1):31 (abstract no. P78) M Mina, S Bhaduri, A Rai and M Roberts We suggest that the pneumococcal vaccine triggered SLE in the context of immune reconstitution on HAART. SLE has only once been reported following pneumococcal vaccine and has not been described in this context with HIV. |
| P79 | META-ANALYSIS OF FIRST-LINE HAART WITH NRTIS PLUS BOOSTED PIS IN 2801 PATIENTS: EFFECTS ON RISES IN LIPID PARAMETERS HIV Med. 2008 May; 9(Suppl 1):31 (abstract no. P79) A Hill1, W Sawyer2 and B Gazzard3 1st-line HAART with LPV/r and fAPV/r were associated with greater rises in TCHOL, LDL and TRIGS, compared with either DRV/r, ATV/r or SQV/r. The NRTI backbones of ABC/3TC or d4T/3TC led to significantly greater rises in all four lipid parameters, relative to TDF/3TC. |
| P80 | CHANGES OF RENAL FUNCTION OF ANTIRETROVIRAL NAïVE PATIENTS STARTING ON TENOFOVIR/EMTRICITABINE COMPARED WITH ZIDOVUDINE/LAMIVUDINE IN COMBINATION WITH EFAVIRENZ HIV Med. 2008 May; 9(Suppl 1):31 (abstract no. P80) K Manavi1, S Barrett2, A McDonald1, N Wickramsinge2, H Fotiou2, B Kumari3 and S Das3 The use of tenofovir with emtricitabine and efavirenz in ART-naïve patients was not associated with clinically significant renal abnormality amonsgt our patients. Impact of tenofovir on renal function may be limited in the absence of other risk factors. |
| P81 | SARCOID-LIKE IMMUNE RESTORATION INFLAMMATORY SYNDROME (IRIS) PRESENTING WITH HYPERCALCAEMIA AND RENAL FAILURE IN HIV INFECTION HIV Med. 2008 May; 9(Suppl 1):31 (abstract no. P81) J Okosun, F Martin, M Murphy, C Orkin and J Moore-Gillon In this case, mycobacterial infection may have been the triggering agent in a patient who presented with clinical, biochemical and histological features consistent with sarcoidosis, and who responded to corticosteroid therapy. This case highlights the diagnostic difficulty and management complexity of patients with advanced HIV disease and IRIS. |
| P82 | SUB-CLINICAL NEPHROPATHY IN HIV-POSITIVE PATIENTS TREATED WITH TENOFOVIR OR NON-TENOFOVIR CONTAINING ANTI-RETROVIRAL THERAPY REGIMENS HIV Med. 2008 May; 9(Suppl 1):32 (abstract no. P82) AM Hall1, SG Edwards2, M Lapsley3, K Chetty2, S O'Farrell2, JO Connolly1, RJ Unwin1 and IG Williams1 Sub-clinical proteinuria is common in HIV patients, and may not always be detected by standard P/Cr tests, patients on TDF may have a higher risk than those not on TDF, the clinical significance of this is uncertain. |
| P83 | VITAMIN D DEFICIENCY PRESENTING WITH HYPOPHOSPHATEMIA, BONE PAIN AND A RAISED ALKALINE PHOSPHATASE IN A PATIENT ON TENOFOVIR HIV Med. 2008 May; 9(Suppl 1):32 (abstract no. P83) K Klassen and S Portsmouth Vitamin D deficiency should be considered and ruled out in pateints presenting with a low phosphate and raised alkaline phosphatase. |
| P84 | A PROSPECTIVE STUDY OF 48 WEEKS IN METABOLIC AND ANTHROPOMETRIC CHANGES IN HIV PATIENTS WHO HAD TENOFOVIR CONTAINING HAART IN A REGIONAL OUTPATIENT SETTING HIV Med. 2008 May; 9(Suppl 1):32 (abstract no. P84) JP Wembri, J Wotherspoon, ML Schmid, MH Snow and ELC Ong There were significant changes in BMI (P=0.002), body fat mass (P=0.008) and cholesterol/HDLc ratio (P=0.03) in patients starting or switching to tenofovir containing HAART over 48 weeks in this study thus supporting other randomised clinical tenofovir trials data. |
| P85 | WEIGHT AND BODY MASS INDEX (BMI) CHANGES IN A COHORT OF PATIENTS INFECTED WITH HIV ONLY AND COINFECTED WITH HEPATITIS C HIV Med. 2008 May; 9(Suppl 1):32 (abstract no. P85) T Russell, S Morris, C Leen, A Chiswick and A Wilson It was observed that a large number of our patients had gained weight since starting Highly Active Antiretroviral Therapy (HAART), the incidence of overweight-obesity in treated HIV patients is unknown. |
| P86 | A DELAYED HYPERSENSITIVITY REACTION TO ENFUVIRTIDE AFTER RECHALLENGE HIV Med. 2008 May; 9(Suppl 1):33 (abstract no. P86) CR Emerson1, JJ Post2 and C Workman3 In these cases the hypersensitivity reaction was described as occurring immediately post dose. Enfuvirtide is a useful drug in HIV-1 infected treatment experienced patients with reduced drug options. The possibility of delayed hypersensitivity has not been previously reported. We recommend if re-challenging with enfuvirtide do so in a hospital setting and monitor over 24 hours after administration. |
| P87 | LIPID-LOWERING EFFECT OF EZETIMIBE IN PATIENTS WITH HAART-ASSOCIATED DYSLIPIDAEMIAS HIV Med. 2008 May; 9(Suppl 1):33 (abstract no. P87) AK Asghar, M Bower, B Gazzard, P Holmes, HL Isenman and MR Nelson Ezetimibe is an effective alternative for the treatment of hyperlipidaemia for HAART-induced hyperlipidaemia. |
| P88 | THE IMPACT OF CONTINUED HAART VERSUS LOPINAVIR/RITONAVIR MONOTHERAPY (MLPV/R) ON BODY FAT AND BONE MINERAL DENSITY (BMD) AS MEASURED BY DEXA: 48 WEEK RESULTS OF A RANDOMISED STUDY HIV Med. 2008 May; 9(Suppl 1):33 (abstract no. P88) LJ Waters, A Jackson, S Mandalia, C Higgs, B Gazzard and MR Nelson Switch to mLPV/r in suppressed subjects is associated with maintained viral suppression and significantly greater increase in trunk fat compared with HAART. Limb fat and BMD were similar and stable to 48 weeks in both arms. |
| P89 | A COMPARISON OF MEASURED CREATININE CLEARANCE (CRCL) WITH TWO GLOMERULAR FILTRATION RATE (GFR) CALCULATIONS IN HIV-INFECTED PATIENTS RECEIVING TENOFOVIR (TDF) OR ABACAVIR (ABC) HIV Med. 2008 May; 9(Suppl 1):33 (abstract no. P89) LJ Waters, P Randell, J Taylor, S Mandalia, B Gazzard and G Moyle GFR is commonly estimated using Cockcroft-Gault (CG) or Modified Diet in Renal Disease (MDRD) calculations, but these remain unvalidated in HIV-infected subjects. Differences between NRTI choices may influence renal function. |
| P90 | HIGHLY ACTIVE ANTI-RETROVIRAL THERAPY (HAART) AND ISCHAEMIC STROKE-IS THIS AN IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME (IRIS) PHENOMENON? HIV Med. 2008 May; 9(Suppl 1):34 (abstract no. P90) M Desai, A Elgalib, T Rudd, P Holmes, M Gillies, JA White and R Kulasegaram Whilst chronic HIV infection and long-term HAART have been associated with cerebrovascular complications, little has been reported in terms of the association of stroke within 6 months of commencing treatment. Despite considering the risk factors in this young cohort, could stroke be due to an IRIS phenomenon? |
| P91 | DOCUMENTATION OF CONTRACEPTION IN HIV-1 INFECTED WOMEN OF CHILD BEARING POTENTIAL PRESCRIBED EFAVIRENZ HIV Med. 2008 May; 9(Suppl 1):34 (abstract no. P91) M Hanlon, S Clarke, F Mulcahy and F Lyons Efavirenz (EFV) was reclassified as an FDA Class D drug in December 2004. Therefore effective contraception is recommended in women of child bearing potential. We sought to determine the level of documentation of contraception in women of child bearing potential prescribed EFV at a busy inner city HIV clinic. |
| P92 | THREE CASES OF VENTRICULAR TACHYCARDIA (VT) IN HIV INFECTED INTRAVENOUS DRUG USERS RECEIVING METHADONE AND ATAZANAVIR/RITONAVIR HIV Med. 2008 May; 9(Suppl 1):34 (abstract no. P92) J Kieran1, D Gallagher1, G Sheehan1, JS Lambert1, N Mahon2 and P Mallon3 Co-administration of ATVr, methadone and long acting benzodiazepines appears to lengthen the QTc resulting in life threatening tachyarrythmias. Further studies are needed to see whether routine ECG monitoring of patients administered ATVr and methadone should be recommended. |
| P93 | HYPERPARATHYROIDISM SECONDARY TO VITAMIN D DEFICIENCY - A CAUSE OF ABNORMAL AKALINE PHOSPHATASE LEVELS IN PATIENTS ON HAART HIV Med. 2008 May; 9(Suppl 1):35 (abstract no. P93) MM Rosenvinge1, MR Pakianathan1, ST Sadiq2 and P Hay2 Efavirenz and protease inhibitors induce/inhibit liver enzymes involved in vitamin D metabolism. Treatment with enzyme- inducing antiepileptic agents are associated with low levels of 25(OH)D and elevated Alp. There is one case report of severe vitamin D deficiency diagnosed after introduction of HAART in an Ethiopian living in Sweden. Our experience indicates that the problem may be more prevalent. |
| P94 | TREATMENT OF METATARSAL FAT PAD LIPOATROPHY WITH VOLUMIZING INJECTIONS HIV Med. 2008 May; 9(Suppl 1):35 (abstract no. P94) A Kavouni1, E O’Donovan1, S Brown1, S Barton1, M Nelson1, S Levine2 and E Lautin2 PLLA injections led to improvements in pain distress and activity scores in individuals with lipoatrophy of the foot. There were no adverse effects and the tissue augmentation was significant at 8 weeks after the last injection. |
| P95 | HOW COMMON ARE ABNORMALITIES OF SERUM CALCIUM, PHOSPHATE AND VITAMIN D IN AN HIV-POSITIVE COHORT, AND WHAT IS THEIR CLINICAL SIGNIFICANCE? HIV Med. 2008 May; 9(Suppl 1):35 (abstract no. P95) S Hill1, R Parkes1 and B Holden2 Low calcium/phosphates were more common amongst all patients on ART. A notable proportion of patients had vitamin D deficiency, making further investigation of patients with hypocalcaemia and/or hypophosphataemia worthwhile. |
| P95A | RISK FACTORS FOR HYPOVITAMINOSIS D IN HIV-POSITIVE INDIVIDUALS HIV Med. 2008 May; 9(Suppl 1):35 (abstract no. P95A) K Klassen, A Winston and S Portsmouth We have described a high prevalence of hypovitaminosis D in an urban, diverse HIV-positive population. Unlike other reports, we have observed no relationship with season and levels of vitamin D. Furthermore Caucasian ethnicity was not the strongest predictor of higher vitamin D concentrations whereas current HAART use was. |
| P96 | GENOTYPIC ANTIRETROVIRAL DRUG RESISTANCE TESTING AT LOW PLASMA HIV-1 RNA LOADS IN THE UK HIV Med. 2008 May; 9(Suppl 1):36 (abstract no. P96) P Cane1, S Kaye2, E Smit3, P Tilston4, S Kirk5, J Shepherd6, M Hopkins7, H Zhang8 and AM Geretti9 This audit of current practice in the UK for undertaking genotypic resistance tests at viral loads <1000 copies/mL highlights the widespread use of such testing outside the BHIVA guidelines. The limitations of results obtained from such testing will be discussed. |
| P97 | HIV TESTING: CAN THIS BE INCREASED USING AN ONLINE PROTOCOL? HIV Med. 2008 May; 9(Suppl 1):36 (abstract no. P97) NR Armstrong, EF Monteiro, AD Hale and K Warburton It was encouraging that there had been an increase in the number of HIV tests performed since the publication of our protocol. However over 75% of non GUM tests from other hospital settings appeared to be from units which routinely screen for HIV (Renal Dialysis, Antenatal, Reproductive Medicine) suggesting that routine screening and/or opt out testing may be better options to significantly increase testing in specific settings. |
| P98 | HIV RESISTANCE TESTING FROM DRIED BLOOD SPOTS: A USEFUL SURVEILLANCE TECHNIQUE OR FLAWED SCIENCE? HIV Med. 2008 May; 9(Suppl 1):36 (abstract no. P98) AJ Buckton1, SL Bissett1, RE Myers1, S Beddows1, PA Cane1, S Edwards2 and D Pillay1 We have developed a highly effective tool for surveillance of drug resistance, even with low plasma viral loads. However, the predominant amplification of proviral DNA has identified a source of bias in our results, probably explained by an APOBEC effect leading to G to A hypermutation. Thus, amplification of integrated defective HIV-1 provirus may lead to spurious detection of resistance mutations. |
| P99 | SELF-REPORTED HUMAN IMMUNODEFICIENCY VIRUS TESTING PRACTICE AMONG PHYSICIANS TREATING TUBERCULOSIS IN AUSTRALIA AND NEW ZEALAND HIV Med. 2008 May; 9(Suppl 1):36 (abstract no. P99) CR Emerson1, U Vollmer-Conna2 and JJ Post3 Clinician factors influence the decision to offer HIV testing to people with TB. Some clinicians use risk factors to determine who should be offered testing, but some do not recognize cases at increased risk of HIV in clinical scenarios. We recommend policy and practice change to increase the widespread offer of HIV testing to patients with tuberculosis. |
| P100 | THE EVALUATION OF RAPID HIV SPOT TEST AGAINST ELISA ANTIBODY TESTS IN THE ACUTE CLINICAL SETTING HIV Med. 2008 May; 9(Suppl 1):36 (abstract no. P100) RS Harania, P Ojawng, M Nelson and D Grover Infection with HIV is a leading cause for morbidity and mortality in Kenya, with an overall prevalence of 6.7%. The availability of routine HIV testing is often limited due to the lack of laboratory facilities, equipment, and trained staff. Rapid HIV spot tests are often used to diagnose patients in the acute setting (but are also the sole tests in certain rural areas). We evaluated the performance of the Abbott determine spot test against the ELISA antibody test (used for routine testing) in patients presenting with an acute illness to a university hospital in Kenya. |
| P101 | THE IMPLICATIONS AND BENEFITS OF USING RAPID HIV TESTING IN A GUM CLINIC SETTING HIV Med. 2008 May; 9(Suppl 1):37 (abstract no. P101) J Harding, T Bagley, M Ndoro and JDC Ross Rapid HIV testing can be undertaken on selected patients in a GU clinic setting providing suitable support is available for those who test positive but such tests may not be suitable for screening large numbers of people. The test provides reliable negative results allowing for complete counselling/testing in one consultation although the pre/post counselling is more time consuming vs. a standard HIV test. Rapid tests have the potential to reduce the number of patients failing to collect their test results. |
| P102 | ARE PATIENTS DIAGNOSED WITH TB BEING OFFERED HIV TESTS? FINDINGS FROM OUR TB CLINIC HIV Med. 2008 May; 9(Suppl 1):37 (abstract no. P102) J Saunders, G Thomas, P Papineni, D Sharma, G Packe and S Limb British HIV Association (BHIVA) guidelines advise offering a Human Immunodeficiency Virus (HIV) test to all new diagnoses of Tuberculosis (TB) infection regardless of perceived HIV risk. We present findings from a case notes review in our TB clinic. |
| P103 | EVALUATION OF THE PREVALENCE OF LATENT TB IN AN HIV-SERO-POSITIVE POPULATION USING THE INTERFERON GAMMA RELEASE ASSAY T-SPOT.TB HIV Med. 2008 May; 9(Suppl 1):37 (abstract no. P103) ATT Ashcroft1, N Garrett1, M Kall1, A Boyd2, J Anderson1 and G Bothamley1 The immunospot test is feasible; within a routine HIV clinic. A patient with miliary TB was identified. The 13% indeterminate results is similar to that found in other reported studies. |
| P104 | LEVELS OF HIV TESTING IN THE IRISH POPULATION HIV Med. 2008 May; 9(Suppl 1):37 (abstract no. P104) C Donnelly1, R Layte2, H McGee3 and F Mulcahy4 Early diagnosis of HIV infection allows timely initiation of anti-retroviral therapy. In 2006, 10% of patients had AIDS when diagnosed with HIV in Ireland. EUROHIV figures showed Ireland had the lowest level of HIV testing in 2000. Methodology: A national sexual health study of the Irish population was undertaken in 2004-2005 to analyse different aspects of sexual health including HIV testing. Trained interviewers conducted anonymous telephone interviews using computer assisted techniques. Random computer generated phone numbers using dialling code stems were selected to ensure a representative sample. Respondents were asked if they had specifically ever sought a HIV test. |
| P105 | TRENDS IN TRANSMITTED ANTIRETROVIRAL RESISTANCE IN LONDON HIV Med. 2008 May; 9(Suppl 1):38 (abstract no. P105) G Nebbia1, C Booth2, A Garcia-Diaz2, C Smith1, S Chaitor2, M Johnson1 and AM Geretti1 Recent data suggest a declining prevalence of transmitted drug resistance (TDR) in the UK, but ascertainment bias may have confounded earlier estimates. Aims: to assess the prevalence and predictors of TDR among all newly diagnosed patients seen at a single London centre in 2004-2007, and determine changes over time. |
| P106 | THE BURDEN OF MUSCULOSKELETAL PAIN AMONG HIV-POSITIVE ADULTS: A CROSS-SECTIONAL SURVEY OF 858 PATIENTS HIV Med. 2008 May; 9(Suppl 1):38 (abstract no. P106) E Lawson1, N Perry1, Y Gilleece1, D Richardson1, G Dean1, DR Churchill1 , M Fisher1 and K Walker-Bone2 In this mostly male cohort of HIV positive patients, musculoskeletal pain is common, chronic and disabling. ARVs are associated with higher prevalence of pain at greater levels and worse disability. We postulate that this could be a direct adverse effect of HAART or the result of immune reconstitution. This association needs to be investigated by a prospective study. |
| P107 | DATA FOR LOCAL ACTION: USING HIV SURVEILLANCE TO INFORM TARGETED LOCAL PUBLIC HEALTH ACTION FOR MEN WHO HAVE SEX WITH MEN IN LONDON HIV Med. 2008 May; 9(Suppl 1):38 (abstract no. P107) M Ruf1, Katy Hutton1, U Osuagwu2, T Chadborn1, V Delpech1 and E Robinson3 The large MSM populations in LandS warrant inclusion of their health needs in routine PCT service planning and provision. This work supported the development of a new local community sexual health service explicitly targeting MSM, providing service continuity by linking clinical services with community based outreach. SOPHID can contribute significantly to local needs assessments for targeting HIV prevention, both at PCT and at Pan London level. |
| P108 | HOW DOES THE PRESENTATION OF AFRICAN PATIENTS DIFFER FROM NON-AFRICANS IN THE UK? HIV Med. 2008 May; 9(Suppl 1):39 (abstract no. P108) R Bazaz, P Lillie and J Greig African patients are more likely to be women, younger and to present with TB. Units with a large African cohort may find this data useful when planning services. |
| P109 | SUBTYPE DIVERSITY OF NEWLY DIAGNOSED HUMAN IMMUNODEFICIENCY VIRUS INFECTIONS IN IRELAND 2007 HIV Med. 2008 May; 9(Suppl 1):39 (abstract no. P109) CF De Gascun1, S Coughlan1, C Bergin2, C Fleming3, M Horgan4, S Mc Conkey5, WG Powderly6 and WW Hall1 Ireland's HIV 1 epidemic is becoming increasingly diverse. These findings have significant implications for the management of HIV in Ireland and should be used to inform national treatment strategies. |
| P110 | INCREASE IN PRE-THERAPY HIV DRUG RESISTANCE IN SOUTH AFRICA IS CONCENTRATED AMONGST PATIENTS WITH LOW CD4 CELL COUNTS HIV Med. 2008 May; 9(Suppl 1):39 (abstract no. P110) KHG Huang1, D Goedhals2, C van Vuuren2, A Katzourakis3, T De Oliveira4,P Klenerman5, R Phillips1 and J Frater1 In a pre-treatment cohort tested after the onset of ARV roll-out, we find an increase in baseline drug resistance and that resistance clusters amongst patients with low CD4 cell counts. These observations have implications for the South African ARV roll-out program, impacting on resistance prevention strategies, prioritisation of drug resistance testing, but particularly on the choice of ARV regimes in resource-limited settings where NNRTIs are frequently used first- line. |
| P111 | HIV DIAGNOSES IN A SOCIOECONOMICALLY DEPRIVED URBAN AREA: CHANGES IN DEMOGRAPHICS AND DISEASE PRESENTATION IN NEWLY DIAGNOSED CASES HIV Med. 2008 May; 9(Suppl 1):40 (abstract no. P111) C Hiley1, A Aitsi-Selmi2, PJ Tsemunhu3 and C Mazhude3 There is an increasing trend for late presentation, CD4 count <200 cell/µL at diagnosis, in our study in excess of national figures. This is due to delayed diagnosis in West African and Black Carribean males. Late presentation remains unacceptably high and this study highlights groups at which specific public health interventions may need to be targeted. |
| P112 | LOSS TO FOLLOW-UP, MORTALITY AND INTERMITTENT ATTENDANCE AMONG PERSONS ACCESSING HIV CARE IN THE UK HIV Med. 2008 May; 9(Suppl 1):40 (abstract no. P112) B Rice, T Chadborn and V Delpech Mortality rates are now low (although numbers of deaths have increased since 2000) and other work shows that some deaths are preventable. Intermittent attendance is low but LTFU is significant and may reflect emigration. Further research is needed to investigate the reasons for intermittent attendance and the possibility of unreported deaths. |
| P113 | CHANGES IN MORTALITY IN A DEDICATED PALLIATIVE CARE UNIT FOR PATIENTS WITH HIV INFECTION HIV Med. 2008 May; 9(Suppl 1):40 (abstract no. P113) K Forbes1, A Williams2 and S Rackstraw2 The death rate has fallen dramatically since the introduction of HAART in 1996. In recent years few deaths have occurred at the Mildmay which now functions as a unit specialising in patients with HIV related cognitive dysfunction. |
| P114 | EFFECTS OF IMMIGRATION ON THE PATTERN OF HIV INFECTION IN DUBLIN, IRELAND: A DUBLIN HIV COHORT STUDY HIV Med. 2008 May; 9(Suppl 1):40 (abstract no. P114) WL Chung1, AM Shaban1, P Coakley1, MB Codd2 and SJ McConkey1 These findings show a significant difference in various aspects of the HIV epidemic between Irish-born and migrant groups and allow for comparison with similar data in other health-care settings. These results could be used to inform public health approaches and to focus interventions that prevent spread of HIV infection and provide treatment services to those who need it. |
| P115 | LACK OF EVIDENCE FOR CD8 + T-CELL MEDIATED SELECTION PRESSURE ON PROVIRAL GAG P17 AND P24 IN CHRONICALLY INFECTED HIV-1 + INDIVIDUALS HIV Med. 2008 May; 9(Suppl 1):41 (abstract no. P115) SJ Westrop1, MR Nelson2, Dr M Jones1 and N Imami1 In chronic progressors, there is no difference in the number of aa changes in p17 and p24 epitopes presented to CTLs and epitopes that are not. IFN-γ production and lack of evidence for MHCI restricted selective pressure challenge the theory of viral escape. |
| P116 | FUNCTIONAL AND PHENOTYPIC PROFILING OF SUPPRESSIVE REGULATORY T CELLS IN A COHORT OF HIV-1-INFECTED INDIVIDUALS HIV Med. 2008 May; 9(Suppl 1):41 (abstract no. P116) C Burton1, I Eccles-James1, M Nelson2, M Bower2, F Gotch1 and N Imami1 We did not observe expression of CD73 on nTregs; consistent with our findings in healthy controls. We did however, observe CD39 on nTreg cells indicating a possible role of the adenosine pathway. CD39 has also been shown to be incorporated into HIV-1 particles, where it remains biologically active. CD27 and CD45RO were detected on high proportions of nTregs, CD127-/lo expression was inconsistent in the context of HIV-1 infection. The suppressive action of nTregs over CMV responses was maintained during HIV-1 infection. No recovery of the HIV-1-specific response was seen with the removal of nTregs indicating alternate mechanisms for this dysfunction. |
| P117 | DEFINITION, IDENTIFICATION AND RECRUITMENT OF HIV-EXPOSED UNINFECTED (EU) SUBJECTS FOR CHAVI 002 HIV Med. 2008 May; 9(Suppl 1):41 (abstract no. P117) SJ Fidler1, K Legg1, K Kuldanek1, S Okuma2, M Brady2, P Easterbrook2 and A McMichael3 The most efficient way to recruit EU couples has been by patient self-referral in response to targeted articles and advertisements. The elimination of intrusive genital examination and STI testing in asymptomatic participants has enhanced participant acceptance. |
| P118 | LIPOPOLYSACCHARIDE-INDUCED ACTIVATION OF NATURAL KILLER CELLS FROM HIV-1 INFECTED INDIVIDUALS HIV Med. 2008 May; 9(Suppl 1):41 (abstract no. P118) MR Goodier1, JNS Gregson1, D Constantinou1, AW Steel2, M Bower2, BG Gazzard2 and FM Gotch1 Bacterial endotoxin influences partial activation of NK cells from PWHA only in the presence of plasma viraemia and these cells are refractory to further stimulation by LPS. |
| P119 | QUALITY AS WELL AS QUANTITY OF CD4 CONTROLS HIV PROGRESSION: IMPLICATIONS FOR THE CLINIC HIV Med. 2008 May; 9(Suppl 1):42 (abstract no. P119) GS Thorborn, L Pomeroy, H Isohanni, A Vyakarnam and B Peters These data indicate for the first time that on a per cell basis S cells from HIV+ slow progressors are more potent than cells from healthy volunteers. These studies may provide novel insight to HIV pathogenesis. |
| P119A | FUNCTIONAL AND PHENOTYPIC T CELL ANALYSIS AFTER TETANUS TOXOID OR PNEUMOVAX VACCINATION IN HAART-TREATED HIV-1+ PATIENTS HIV Med. 2008 May; 9(Suppl 1):42 (abstract no. P119A) G Rosignoli1, C Burton1, G Moyle2, B Gazzard2, F Gotch1 and N Imami1 HIV-1 + patients can mount an immune response against TTox but this response in not sustained over time, this was confirmed by phenotypic analysis which showed no increase in activation and no changes in effector-memory T cell subsets. This might be a consequence of the immunological dysfunction caused by HIV-1 not completely corrected by HAART suggesting a different approach in therapy to such as starting therapy when CD4 counts are higher than 350 cells/µL blood. |
| P120 | TRIMETREXATE AND FOLINIC ACID: A VALUABLE SALVAGE OPTION FOR PNEUMOCYSTIS JIROVECII PNEUMONIA HIV Med. 2008 May; 9(Suppl 1):42 (abstract no. P120) CS Short, YC Gilleece, DR Churchill and M Fisher This is the first case series to characterize the use of trimetrexate in the context of adjunctive corticosteroids and HAART. 71% success rate in a patient group with several features associated with poor outcome, shows that trimetrexate is an extremely efficacious, safe agent that should remain a valuable option in PCP salvage therapy. |
| P121 | ADHERENCE TO ANTI-RETROVIRAL THERAPY IN PATIENTS IN BANGALORE, INDIA HIV Med. 2008 May; 9(Suppl 1):42 (abstract no. P121) M Cauldbeck1, C O'Connor2, JA Saunders3, A Rao4, A Mallesh4, A Praveen4, MB O'Connor5 and KS Satish4 Regular attendance for follow up was statistically significant for adherence. Positive trends were seen in those in larger families, older, those who had AIDS, simple regimes, and without side-effects. Education income, distance travelled and length of time diagnosed or treated had no effect. |
| P122 | CARDIOVASCULAR (CVD) DISEASE RISK MANAGEMENT IN HIV PATIENTS AT AN INFECTIOUS DISEASES UNIT IN UK HIV Med. 2008 May; 9(Suppl 1):43 (abstract no. P122) JE Mallewa, J Parish, A Prasad, G Alvares, EGL Wilkins and FJ Vilar 4.8%of the HIV patient population at our Infectious Diseases unit are at high risk of CVD and would merit closer attention in terms of treatment and life style advice, both were not done rigorously enough. Referrals to specialist clinics (hypertension, lipid, cardiology, dietician) or general practitioners could improve the management of these patients. |
| P123 | UPTAKE AND ATTITUDES TOWARDS OCCUPATIONAL HEALTH SERVICES BY HIV-POSITIVE HEALTH CARE WORKERS HIV Med. 2008 May; 9(Suppl 1):43 (abstract no. P123) L Hamzah1, M Pakianathan1, O McCarthy1, I King1 and F Burns2 Improving HCWs understanding of the role of OH in relation to HIV and its commitment to confidentiality may help improve uptake of OH services and alleviate anxieties around the impact of HIV on work. Provision of OH advice to agency workers or those unwilling to disclose presents practical, ethical and legal challenges in its implementation. |
| P124 | INTERACTIONS BETWEEN IMMUNOSUPPRESSANTS AND ANTIRETROVIRAL THERAPY (ARVT) IN SOLID ORGAN TRANSPLANT RECIPIENTS: A ROLE FOR NON-NUCLEOSIDE REVERSE TRANSCRIPTASE AND PROTEASE INHIBITOR-SPARING REGIMES HIV Med. 2008 May; 9(Suppl 1):43 (abstract no. P124) B Nathan1, M Tredger1, S Doshi1, R Kulasegaram2 and CB Taylor1 Interactions between immunosuppressants, NNRTIs and PIs are common and often unpredictable due to variable interactions with CYP3A4 and P-glycoprotein |
| P125 | THE SIGNIFICANCE OF LOW LEVEL PLASMA HIV VIRAL LOAD ON COBAS TAQMAN® HIV-1 ASSAYS FOR PATIENTS WITH UNDETECTABLE plasma viral load on COBAS Amplicor® monitor version 1.5 HIV Med. 2008 May; 9(Suppl 1):44 (abstract no. P125) K Manavi Short term detectable VL may be common with using TaqMan® assay. This phenomenon did not result in new mutations or failure of HAART in study patients in short term. |
| P126 | IS BEST PRACTICE TO DEVOLVE STATIN PRESCRIBING TO PRIMARY CARE IN PATIENTS ON HAART HIV Med. 2008 May; 9(Suppl 1):44 (abstract no. P126) PD Benn1, L Evans1, SG Edwards1, J Minton2 and R Miller3 This study identifies specific problems related to devolving statin prescribing to primary care. Communication with GPs must specifically state relevant contraindications and close follow-up is essential. Alternatively ongoing statin prescribing should remain the role of HIV practitioners. |
| P127 | ANALYSIS OF UK COSTS OF FULL VIROLOGICAL SUPPRESSION FOR TREATMENT EXPERIENCED, HIV-INFECTED PATIENTS IN THE DUET TRIALS HIV Med. 2008 May; 9(Suppl 1):44 (abstract no. P127) A Hill1 and S Martin2 In the DUET trials, treatment with TMC125 was associated with consistent reductions in the cost per patient with HIV RNA<50 copies/mL. This analysis does not account for differences in use of concomitant medications, drug toxicity, or progression to AIDS, which could also influence value assessments. |
| P128 | HOSPITAL ADMISSIONS OF HIV PATIENTS IN THE HIGHLY ACTIVE ANTIRETROVIRAL TREATMENT (HAART) ERA HIV Med. 2008 May; 9(Suppl 1):44 (abstract no. P128) S Soni, A Samarawickrama, M Lechelt, Y Gilleece and D Churchill This audit highlights two important points. Firstly, despite the advent of HAART and its associated reduction in morbidity from HIV, the number of admissions to hospital remains high. However the reasons for these are largely non-HIV related; a significant change from the pre- HAART era when most admissions were due to an AIDS defining illness. HIV is now a chronic disease and we are likely to see an increase in non- HIV related problems. The BHIVA Standards of Care document actively encourages specialist input in the care of complex patients as we do not have the expertise to manage all non-HIV medical problems and complications of HIV. |
| P129 | ARE LONDON HIV PATIENTS RECEIVING OPTIMAL CARE? (DEVELOPING AND MONITORING PILOT CLINICAL OUTCOMES) HIV Med. 2008 May; 9(Suppl 1):45 (abstract no. P129) T Chadborn and V Delpech London HIV patients receive a high level of care but there is a severe impact of late diagnoses, particularly with CD4<50. Further investigation should determine whether variation between clinics was due to casemix or patient management. Local clinical outcomes are feasible and helpful in monitoring clinical standards and can be used to share best practice. |
| P130 | OUTCOMES FROM A UNIQUE REHABILITATION PROGRAMME FOR PATIENTS WITH HIV-RELATED COGNITIVE IMPAIRMENT HIV Med. 2008 May; 9(Suppl 1):45 (abstract no. P130) S Rackstraw The Mildmay Hospital was founded to provide palliative care to patients suffering with advanced HIV disease. One ward was developed for patients with HIV related cognitive impairment. Highly active antiretroviral therapy and a structured rehabilitation programme enabled many patients to return to community living. An analysis of outcomes for the past 3 years was undertaken. |
| P131 | GROUP WORK WITH HIV+ TEENAGERS TO FACILITATE TRANSITION TO ADULT SERVICES AND AVOID LOSS TO FOLLOW-UP HIV Med. 2008 May; 9(Suppl 1):45 (abstract no. P131) T Campbell1, B Wilkins2 and H Beer1 A group work approach for HIV+ teenagers is useful to facilitate skills that enable them to take increased responsibility for their healthcare and engage appropriately with HIV services. |
| P132 | QUANTIFICATION OF PSYCHOLOGICAL MORBIDITY IN HIV-ASSOCIATED LIPODYSTROPHY HIV Med. 2008 May; 9(Suppl 1):45 (abstract no. P132) L Nelson1, KJ Stewart1 and A Winter2 Patients who develop HIV lipodystrophy have greater distress relating to body image and depression compared to HIV patients without lipodstrophy and healthy MSM controls. Treatment is associated with a significant improvement in these outcomes. |
| P133 | A STUDY OF NEEDLE STICK INJURIES AMONG NON-CONSULTANT HOSPITAL DOCTORS IN IRELAND HIV Med. 2008 May; 9(Suppl 1):46 (abstract no. P133) MB O'Connor1, MJ Hannon2, D Cagney3, R O'Connor4, U Harrington1, K Courtney3, F O'Brien4 and C O'Connor5 A NI history is greater among the surgical NCHDs than the medical NCHDs. The level of disposable glove usage is worryingly poor. Training in sharps handling and in dealing with a NI needs to be addressed. HIV is the blood borne infection most fear of being contracting as a consequence of a NI. |
| P134 | CODING AND THE CLINICIAN HIV Med. 2008 May; 9(Suppl 1):46 (abstract no. P134) P Holmes, M Nelson, M Bower, B Gazzard and S Barton In the NHS accurately coded clinical data is essential to ensure the appropriate funding of services and to plan for service development. Coding clinical data involves allocating a specific code to represent a diagnosis or item of care for a clinical record. In order to investigate the effect of accuracy of coding in individuals infected with the human immunodeficiency virus(HIV), we analysed the use of the S10 code, referring to HIV related in-patient admissions, since Payment By Results (PBR) was instituted in 2004/2005. |
| P135 | COGNITIVE FUNCTION IN HIV-1-POSITIVE GAY MEN IN THE POST-HAART (HIGHLY ACTIVE ANTIRETROVIRAL THERAPY) ERA - PRELIMINARY RESULTS HIV Med. 2008 May; 9(Suppl 1):46 (abstract no. P135) K Towgood1, R Kulasegaram2, M Pitkanen3, L Reed1, C Bradbeer4, A Fradera1, S Soni4 and M Kopelman1 Prior to the introduction of HAART, cognitive deficits in HIV-1 positive individuals had been estimated to fall between 30% and 50%. Current research has produced mixed findings regarding whether the introduction of HAART has changed the quantity and quality of these cognitive deficits. The objective of this study is to describe the occurrence and pattern of neuropsychological deficits in HIV-1 positive individuals in the post-HAART era. |
| P136 | THE INTERNATIONAL INDEX OF ERECTILE FUNCTION: VALIDATION OF AN ADAPTED TOOL FOR USE IN HIV-POSITIVE MEN WHO HAVE SEX WITH MEN HIV Med. 2008 May; 9(Suppl 1):46 (abstract no. P136) KM Coyne1, S Mandalia1, S McCollough1, J Catalan1, C Noestlinger2, B Colebunders2 and D Asboe1 Internal consistency was high overall. Frequency of attempts at sexual intercourse did not correlate with other aspects, although it was valid in the IIEF: perhaps in HIV positive MSM frequency is influenced by factors other than expected satisfaction. Satisfaction with a regular partner did not match overall satisfaction, perhaps because sex with casual partners is an important component. Questions about erections on awakening and with masturbation are not valid and were excluded. In the final analysis, this tool is suitable for HIV positive MSM and can be used in research, screening and monitoring treatment response. |
| P137 | TUBERCULOUS CHOROIDAL GRANULOMA AND IRIS: A CASE REPORT HIV Med. 2008 May; 9(Suppl 1):47 (abstract no. P137) JM Saunders1, K Papageorgiou2, P Papineni1, M Westcott2 and H Noble1 Follow up of the choroidal granuloma has not shown any reduction in size with therapy and it is not expected that he will recover any significant vision in that eye. We discuss the clinical management of this rare complication of systemic MTB infection. |
| P138 | FACTORS RELATED TO BAD OUTCOME IN HIV-INFECTED PATIENTS WITH CRYPTOCOCCAL MENINGITIS HIV Med. 2008 May; 9(Suppl 1):47 (abstract no. P138) G Alvarez-Uria, L Ratcliffe, L Jonson and FJ Vilar Patients with a bad outcome had higher CRAG in serum, lower lymphocytes and positive India ink in CSF and higher MIC for amphotericin B and flucytosine. The presence of hydrocephalus and the use of itraconazole in the consolidation phase were not associated with bad outcome. |
| P139 | AUDIT OF TREATMENT OUTCOMES IN HUMAN IMMUNODEFICIENCY VIRUS (HIV) ASSOCIATED CRYPTOCOCCAL MENINGITIS (CM) AT SINGLE OUTER LONDON CENTRE, 2000-2006 HIV Med. 2008 May; 9(Suppl 1):47 (abstract no. P139) S MacEoin1, J McSorley2, S Murphy2, A Shaw3 and M Kapembwa3 CM is the second most common cause of death in acquired immunodeficiency syndrome (AIDS) after tuberculosis. Several treatment guidelines have been proposed. This audit examines current CM treatment practice at one outer London centre against audit standard of 2 week induction IV amphotericin + oral flucytosine followed by consolidation/maintenance fluconazole, with view to making recommendations for effective therapy. |
| P140 | OUTCOME FROM AN INTENSIVE CARE UNIT (ICU) IN PATIENTS WITH NEWLY DIAGNOSED, LATE-STAGE HIV INFECTION HIV Med. 2008 May; 9(Suppl 1):47 (abstract no. P140) C Woodward1, SG Edwards1, PD Benn1 and R Miller2 This cohort of patients represent late presenters of AIDS defining opportunistic infection. 25/31 had potentially preventable infections if HIV had been diagnosed earlier. Our data concurs with a letter from the Chief Medical Officer in September 2007 highlighting the need to improve HIV detection rates and supports the role out of HIV testing. Outcome from ICU was good, despite immune supression. |
| P141 | A RETROSPECTIVE DESCRIPTIVE SURVEY OF PRESENTATION AND MANAGEMENT OF CYTOMEGALOVIRUS (CMV) VIRAEMIA AND END-ORGAN DISEASE HIV Med. 2008 May; 9(Suppl 1):48 (abstract no. P141) R O'Connell, S Lowe, P Bright, C Okoli, E Nikiphorou and J Deayton This cohort of patients represent late presenters of AIDS defining opportunistic infection. 25/31 had potentially preventable infections if HIV had been diagnosed earlier. Our data concurs with a letter from the Chief Medical Officer in September 2007 highlighting the need to improve HIV detection rates and supports the role out of HIV testing. Outcome from ICU was good, despite immune supression. |
| P142 | STEADY-STATE PHARMACOKINETIC (PK) COMPARISON OF GENERIC AND BRANDED FORMULATIONS OF LAMIVUDINE (3TC), STAVUDINE (D4T), AND NEVIRAPINE (NVP) IN HIV-INFECTED UGANDAN ADULTS HIV Med. 2008 May; 9(Suppl 1):48 (abstract no. P142) PBK Byakika-Kibwika1, ML Lamorde1, CM Merry2, AD D'Avolio3, SM Mauro3, GD Di Perri3, MB Boffito4 and SK Khoo5 To determine the steady-state PK, bioequivalence and tolerability of generic and branded formulations of 3TC, d4T, and NVP in HIV-infected Ugandans. |
| P143 | THERAPEUTIC DRUG MONITORING (TDM) FOR THE NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIS) NEVIRAPINE (NVP)AND EFAVIRENZ (EFV) - IS THERE A ROLE IN ROUTINE CLINICAL PRACTICE? HIV Med. 2008 May; 9(Suppl 1):48 (abstract no. P143) C Robertson, N Dufty, J Mahungu, A Berry and S Taylor On review of 83 pts on NVP, 20 were on non-standard doses. Only 2 of these had had TDM performed as per recommended indications within the BHIVA guidelines. In contrast only 6 of 54 pts on EFV were on non-standard doses. These findings suggest using TDM may be beneficial in individualising care in some patients. |
| P144 | THE IMPACT OF CYTOCHROME P450 2B6 SINGLE NUCLEOTIDE POLYMORPHISMS (SNPS) [516G>T AND 1459C>T ] ON THE EFFICACY AND TOXICITY OF EFAVIRENZ (EFV) BASED REGIMENS HIV Med. 2008 May; 9(Suppl 1):49 (abstract no. P144) TW Mahungu1, C Smith2, F Turner1, D Egan3, A Owen3, S Khoo3, DJ Back3, M Youle1 and MA Johnson1 In this study, despite a significant association between 516G>T and plasma EFV exposure and knowledge that EFV exposure predicts treatment failure, no association was found between this polymorphism and virological outcomes and toxicity. There is an ongoing discussion on the individualisation of EFV dosage in poor metabolisers. This should be explored in a prospective controlled clinical trial. |
| P145 | FACTORS INFLUENCING EFAVIRENZ (EFV) AND NEVIRAPINE (NVP) PLASMA CONCENTRATION HIV Med. 2008 May; 9(Suppl 1):49 (abstract no. P145) W Stöhr1, S Khoo2, D Dunn1, S Gibbons2, T Hill3, A Winston4, CA Sabin3 and D Back2 This is the first study to establish a clear association between ethnicity and NVP concentration, although this has previously been recognised for EFV. Our analyses confirm that concomitant rifampicin substantially decreases concentration of both NNRTIs. However, for EFV this effect was more than counter-balanced by the effect of ethnicity and increased dose. A further complication is the strong linear effect of weight, which should also be considered in dosing. Novel associations from our analysis (between TDF and NVP, and ZDV and EFV), require confirmation in formal PK studies. |
| P146 | ROLE OF MEASURING ANTIRETROVIRAL THERAPY DURING PLASMAPHERESIS; CONTRIBUTION TO THE MANAGEMENT OF SEVERE THROMBOTIC THROMBOCYTOPENIC PURPURA HIV Med. 2008 May; 9(Suppl 1):49 (abstract no. P146) EK Wedgeworth, S Soni, R Kulasegara and B Peters In this patient, plasma exchange affected the level of nevirapine, but not the level of lopinavir. Plasma exchange is increasingly used for HIV related conditions driven by autoantibodies. It is crucial this important treatment modality does not interfere with anti-retroviral treatment, as HIV is frequently the driving factor for the presenting condition. We would advise close monitoring of antiretrovirals during plasma exchange. |
| P147 | ARE THERE OPPORTUNITIES TO REDUCE THE NUMBER OF PATIENTS WITH A CD4 COUNT LESS THAN 200 ATTENDING FOR ROUTINE HIV CARE? HIV Med. 2008 May; 9(Suppl 1):49 (abstract no. P147) O Dosekun1, D Harte2, C Sethi1, T Chadborn3, R Patel4, RF Miller4, A de Ruiter1 and S Edwards2 In this study the majority of patients had been under follow up prior to CD4 drop. Strategies aimed at patient and doctor education around earlier therapy initiation and avoidance of treatment interruption, adherence support and recall of poor attendees may reduce prevalence of low CD4. |
| P148 | REDUCING CARDIOVASCULAR RISK: AN AUDIT OF DIETARY ADVICE AND LIPID-LOWERING MEDICATION PROVIDED TO HIV-POSITIVE PATIENTS REFERRED TO DIETICIAN FOR HYPERLIPIDEMIA HIV Med. 2008 May; 9(Suppl 1):50 (abstract no. P148) NA Billing and A Murungi Not all patients referred had cardiovascular risk calculated before referral and not all risk factors like smoking recorded during their first dietetic consultation. There was irregular follow up intervals and some patients were lost to follow up. The majority of patients seen by Dietician had a reduction in their cholesterol level, and the proportion on lipid reducing medication will also be presented. |
| P149 | FREQUENCY OF N348I IN DIVERSE HIV-1 SUBTYPES HIV Med. 2008 May; 9(Suppl 1):50 (abstract no. P149) KM Forbes1, DF Bibby1, D Clark1, J Anderson2, S Limb3, S Obeyesekera4, J Deayton1 and C Orkin1 We report the first case of N348I mutation in a treatment-naïve individual with HIV-1 subtype C. In addition we report N348I in a group of treatment-experienced patients with diverse HIV 1 subtypes. A highly significant association has been shown between N348I and NRTI and NNRTI mutations, suggesting the potential significance of the connection domain in GART analysis. |
| P150 | UTILITY OF GENOTYPIC RESISTANCE TESTING IN PATIENTS WITH HIV-1 VIRAL LOAD (VL) OF LESS THAN 1000 COPIES/ML: A RETROSPECTIVE ANALYSIS HIV Med. 2008 May; 9(Suppl 1):50 (abstract no. P150) A Elgalib1, M Aboud1, J Mullen2, I Chrystie2, R Kulasegaram1 and C Tong2 Samples from individuals with LLVF were successfully sequenced in up to 85% of cases, regardless of HIV-1 subtype. Detection of relevant RT and PR mutations were similar in high and low VL samples. |
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