Low prevalence of transmitted antiretroviral drug resistance in a large UK HIV-1 cohort.

OBJECTIVES: To describe current practice in testing for transmitted antiretroviral drug resistance (TDR) and the prevalence of TDR in a large UK HIV-1 cohort. METHODS: The study includes a retrospective analysis of newly diagnosed HIV-1-infected patients presenting to eight HIV clinics in the north of England between March 2005 and March 2007. Resistance mutations were defined by IAS-USA. Predicted phenotypes were calculated by the Stanford University database. RESULTS: Five hundred and fifty-eight patients were studied, of whom 394 (70.6%) had heterosexually acquired HIV and 377 (67.6%) were infected outside the UK. TDR testing was performed in 406 patients (72.8%). Thirteen of 392 viral resistance profiles (3.3%) showed genotypic TDR. There was no significant association between TDR and any demographic or risk factor or baseline CD4 count. In particular, rates of TDR were similar in white British (6/147, 4.1%) and black African (7/224, 3.1%) patients. The numbers of patients with TDR to individual drug classes were: nucleoside reverse transcriptase inhibitors, 2 (0.5%); non-nucleoside reverse transcriptase inhibitors, 7 (1.8%); and protease inhibitors, 4 (1.0%). No patients had multi-class resistance detected. Eleven patients (2.8%) were predicted to have significant phenotypic resistance to at least one drug. CONCLUSIONS: In a large unselected UK cohort, with high coverage of TDR testing, the prevalence of TDR was low and is in accordance with recent data, showing a decrease in the prevalence of TDR in the UK. Differences in population mix did not appear to explain this low rate.

Be wary, this is not a case of vulval warts!

We present a 40-year-old woman who presented to the genitourinary medicine department with a two-year history of recurrent non-painful vulval lumps. She was in a stable relation with one male sexual partner over the preceding 20 years and her sexual health screen was negative. Clinical examination of these lumps was suggestive of anogenital warts for which she has been treated on numerous occasions over the last two-year-period with liquid nitrogen cryotherapy and podophyllotoxin 0.15% cream. As the lumps were not responding to conventional wart treatment, a biopsy from these lesions was performed. The histological appearance showed focal fibrin thrombus formation within dilated vascular channels consistent of a subepidermal cavernous haemangioma. This case demonstrates that the clinical diagnosis of anogenital warts is not always straightforward. It highlights the importance of obtaining a tissue diagnosis from the resistant or atypically looking warty lesions to avoid making the wrong diagnosis.

An educative genitourinary medicine clinic website: value to users and impact on service demand.

In 2004, the Newcastle genitourinary medicine clinic launched a new website. To assess its value to users and impact on service demand, we surveyed those attending the clinic with a new episode between September and December 2005 by a questionnaire. One hundred and fifteen of 601 respondents (19%) visited the website. Fifty-nine percent of users were men with those aged between 35 and 44 ranking the highest percentage (31.7%) among those who visited the website. Fourteen (12.5%) would not have attended if they had not visited the website. One hundred and two (88.7%) found it easy to use and 81 (70.4%) looked for specific information of whom 73 (89%) were successful. Web users were more likely to present with an episode not requiring treatment possibly indicating increased demand promoted by our prevention information but less likely to have bacterial vaginosis, anaerobic balanitis and anogenital candidosis (not statistically significant).

Unilateral syphilitic perioptic neuritis in a patient coinfected with human immunodeficiency virus type 1.

Perioptic neuritis caused by secondary syphilis is a rare ophthalmic manifestation in the HIV-infected host. Early diagnosis and treatment of this condition is required to prevent further visual damage. We report a case of unilateral syphilitic perioptic neuritis in a patient coinfected with HIV-1.