Accelerated implementation of remote reporting during the COVID-19 pandemic.

AIM: To assess, via a survey of UK radiological departments, if the COVID-19 pandemic led to a change in radiological reporting undertaken in a home environment with appropriate IT support. MATERIALS AND METHODS: All imaging departments in the UK were contacted and asked about the provision of home reporting and IT support before and after the first wave of the pandemic. RESULTS: One hundred and thirty-seven of the 217 departments contacted replied, producing a response rate of 61%. There was a 147% increase in the provision of remote access viewing and reporting platforms during the pandemic. Although 578 consultants had access to a viewing platform pre-pandemic, this had increased to 1,431 during the course of the first wave. CONCLUSION: This survey represents work undertaken by UK NHS Trusts in co-ordinating and providing increased home-reporting facilities to UK radiologists during the first wave of this global pandemic. The impact of these facilities has been shown to allow more than just the provision of reporting of both elective and emergency imaging and provides additional flexibility in how UK radiologists can help support and provide services. This is a good start, but there are potential problems that now need to be overcome.

Investigating Conceptual Models for the Relationship Between Depression and Condomless Sex Among Gay, Bisexual, and Other Men Who have Sex with Men: Using Structural Equation Modelling to Assess Mediation.

The aim of this study is to investigate five hypothesized mechanisms of causation between depression and condomless sex with ≥ 2 partners (CLS2+) among gay, bisexual, and other men who have sex with men (GBMSM), involving alternative roles of self-efficacy for sexual safety and recreational drug use. Data were from the AURAH cross-sectional study of 1340 GBMSM attending genitourinary medicine clinics in England (2013-2014). Structural equation modelling (SEM) was used to investigate which conceptual model was more consistent with the data. Twelve percent of men reported depression (PHQ-9 ≥ 10) and 32% reported CLS2+ in the past 3 months. AURAH data were more consistent with the model in which depression was considered to lead to CLS2+ indirectly via low self-efficacy for sexual safety (indirect Beta = 0.158; p < 0.001) as well as indirectly via higher levels of recreational drug use (indirect Beta = 0.158; p < 0.001). SEM assists in understanding the relationship between depression and CLS among GBMSM.

Age, time living with diagnosed HIV infection, and self-rated health.

OBJECTIVES: An increasing proportion of people living with HIV are older adults, who may require specialized care. Adverse physical and psychological effects of HIV infection may be greatest among older people or those who have lived longer with HIV. METHODS: The ASTRA study is a cross-sectional questionnaire study of 3258 HIV-diagnosed adults (2248 men who have sex with men, 373 heterosexual men and 637 women) recruited from UK clinics in 2011-2012. Associations of age group with physical symptom distress (significant distress for at least one of 26 symptoms), depression and anxiety symptoms (scores ≥ 10 on PHQ-9 and GAD-7, respectively), and health-related functional problems (problems on at least one of three domains of the Euroqol 5D-3L)) were assessed, adjusting for time with diagnosed HIV infection, gender/sexual orientation and ethnicity. RESULTS: The age distribution of participants was: < 30 years, 5%; 30-39 years, 23%; 40-49 years, 43%; 50-59 years, 22%; and ≥ 60 years, 7%. Overall prevalences were: physical symptom distress, 56%; depression symptoms, 27%; anxiety symptoms, 22%; functional problems, 38%. No trend was found in the prevalence of physical symptom distress with age [adjusted odds ratio (OR) for trend across age groups, 0.96; 95% confidence interval (CI) 0.89, 1.04; P = 0.36]. The prevalence of depression and anxiety symptoms decreased with age [adjusted OR 0.86 (95% CI 0.79, 0.94; P = 0.001) and adjusted OR 0.85 (95% CI 0.77, 0.94; P = 0.001), respectively], while that of functional problems increased (adjusted OR 1.28; 95% CI 1.17, 1.39; P < 0.001). In contrast, a longer time with diagnosed HIV infection was strongly and independently associated with a higher prevalence of symptom distress, depression symptoms, anxiety symptoms, and functional problems (P < 0.001 for trends, adjusted analysis). CONCLUSIONS: Among people living with HIV, although health-related functional problems were more common with older age, physical symptom distress was not, and mental health was more favourable. These results suggest that a longer time with diagnosed HIV infection, rather than age, is the dominating factor contributing to psychological morbidity and lower quality of life.

HIV testing in black Africans living in England.

We examined the uptake of HIV testing in black Africans living in England before the introduction of national testing guidelines. Analyses were conducted using data from an anonymous self-completed questionnaire linked to oral fluid samples to establish HIV status in black Africans attending community venues in England in 2004. Of 946 participants, 44% had ever been tested for HIV and 29% had been tested in the previous 24 months. Of those with undiagnosed HIV, 45% had previously had a negative HIV test. Almost a third of people tested in the UK had been at general practice. Uptake of HIV testing was not associated with perceived risk of HIV. These findings highlight the need for the implementation of national HIV testing guidelines in the UK, including the promotion of testing in general practice. Regular testing in black Africans living in the UK should be promoted regardless of their HIV test history.

Occupational transmission of hepatitis C in healthcare workers and factors associated with seroconversion: UK surveillance data.

The study aims were to describe a case series of occupationally acquired hepatitis C (HCV) infections in UK healthcare workers and examine factors associated with transmission using exposure data reported to the Health Protection Agency between July 1997 and December 2007. Fifteen reported cases of documented HCV seroconversion occurred after percutaneous exposure, the majority from hollow-bore needles used in the source patient's vein or artery and contaminated with blood or blood-stained fluid. The seroconversion rate was 2.2% (14/626). In multivariable analysis of healthcare workers with percutaneous exposure to blood or blood-stained fluid, we demonstrate that blood sampling procedures (odds ratio [OR], 5.75; 95% CI, 1.33-24.91; P = 0.01) and depth of injury (OR for deep vs superficial injury, 21.99; 95% CI, 2.02-239.61; P = 0.02) are independently associated with a greater risk of HCV seroconversion. This is the first UK study of occupationally acquired HCV in healthcare workers. It has reinforced our knowledge of risk factors for HCV transmission. Most of these exposures and transmissions were preventable. Healthcare employers should provide regular education on the risks of occupational exposure and prevention through standard infection control procedures. They should ensure the availability of effective prevention measures and facilitate prompt reporting and adequate follow-up of exposures.

Sexually transmitted infection risk exposure among black and minority ethnic youth in northwest London: findings from a study translating a sexually transmitted infection risk-reduction intervention to the UK setting.

OBJECTIVES: Young black women are disproportionately affected by sexually transmitted infections (STI) in the UK, but effective interventions to address this are lacking. The Young Brent Project explored the nature and context of sexual risk-taking in young people to inform the translation of an effective clinic-based STI reduction intervention (Project SAFE) from the USA to the UK. METHODS: One-to-one in-depth interviews (n = 37) and group discussions (n = 10) were conducted among men and women aged 15-27 years from different ethnic backgrounds recruited from youth and genitourinary medicine clinic settings in Brent, London. The interviews explored the context within which STI-related risks were assessed, experienced and avoided, the skills needed to recognise risk and the barriers to behaviour change. RESULTS: Concurrent sexual partnerships, mismatched perceptions and expectations, and barriers to condom use contributed to STI risk exposure and difficulties in implementing risk-reduction strategies. Women attempted to achieve monogamy, but experienced complex and fluid sexual relationships. Low risk awareness, flawed partner risk assessments, negative perceptions of condoms and lack of control hindered condom use. Whereas men made conscious decisions, women experienced persuasion, deceit and difficulty in requesting condom use, particularly with older partners. CONCLUSIONS: Knowledge of STI and condom use skills is not enough to equip young people with the means to reduce STI risk. Interventions with young women need to place greater emphasis on: entering and maintaining healthy relationships; awareness of risks attached to different forms of concurrency and how concurrency arises; skills to redress power imbalances and building self-esteem.

HIV and STI behavioural surveillance among men who have sex with men in Europe.

This paper describes behavioural surveillance for HIV and sexually transmitted infections (STI) among men who have sex with men (MSM) in Europe, focusing on the methods and indicators used. In August 2008, questionnaires were sent to European Union Member States and European Free Trade Association countries seeking information on behavioural surveillance activities among eight population groups including MSM. Thirty-one countries were invited to take part in the survey and 27 returned a questionnaire on MSM. Of these 27 countries, 14 reported that there was a system of behavioural surveillance among MSM in their country while another four countries had conducted behavioural surveys of some kind in this subpopulation. In the absence of a sampling frame, all European countries used convenience samples for behavioural surveillance among MSM. Most European countries used the Internet for recruiting and surveying MSM for behavioural surveillance reflecting increasing use of the Internet by MSM for meeting sexual partners. While there was a general consensus about the main behavioural indicators (unprotected anal intercourse, condom use, number of partners, HIV testing), there was considerable diversity between countries in the specific indicators used. We suggest that European countries reach an agreement on a core set of indicators. In addition we recommend that the process of harmonising HIV and STI behavioural surveillance among MSM in Europe continues.

Social and economic hardship among people living with HIV in London.

OBJECTIVES: To examine the social and economic circumstances of people living with HIV in London. METHODS: Between June 2004 and June 2005, 1687 people living with HIV (73% response) receiving treatment and care in north-east London National Health Service out-patient clinics completed a confidential, self-administered questionnaire. The questionnaire sought information on employment, income, education, residency status in the UK and housing. RESULTS: In total, 1604 respondents were included in the analysis: Black African heterosexual women (n=480) and men (224); White (646) and ethnic minority (i.e. non-White) homosexual men (112); White heterosexual men (64) and women (39); and Black Caribbean heterosexual women (26) and men (13). Black African heterosexual men and women consistently reported more difficulties than any other group in relation to employment, income, housing and residency status. Half the Black African heterosexual men (46.8%) and women (51.2%) reported insecure residency status in the UK, significantly more than any other group (P<0.001). Just under half the respondents (46.6%) were employed at the time of the survey; Black African heterosexual women (35.3%) and men (45.4%) were less likely to be employed than White (57.6%) or ethnic minority (53.7%) homosexual men (P<0.001). Forty per cent of Black African heterosexual men and women, 22.9% of ethnic minority homosexual men and 9.6% of White homosexual men did not have enough money to cover their basic needs (P<0.001). CONCLUSIONS: In this study of people living with HIV in London, a substantial number faced social and economic hardship, particularly Black African and other ethnic minority respondents. Our findings provide further evidence that in London HIV is associated with poverty, particularly among migrant and ethnic minority populations.

Over fifty and living with HIV in London.

OBJECTIVE: To examine age at diagnosis, sexual behaviour and some social characteristics of people living with HIV in London who are over the age of 50 years, with particular reference to gay men. METHODS: Patients with HIV infection attending National Health Service outpatient clinics in north-east London between June 2004 and June 2005 were asked to complete a confidential, self-administered questionnaire. RESULTS: 1687 people with diagnosed HIV were recruited (63% response rate) including 758 gay men, 480 black African heterosexual women and 224 black African heterosexual men. Just over 10% of the whole sample (184/1687, 10.9%) were aged 50 years or above; gay men 13.1%, black African heterosexual men 8.5%, black African heterosexual women 6.9% (p<0.01). A third of the HIV-positive gay men over 50 years were diagnosed with HIV in their 50s or 60s (33.3%, 32/96). Overall, one in five HIV-positive gay men (20.1%, 144/715) reported high-risk sexual behaviour in the previous 3 months. This did not vary significantly by age (p = 0.2). CONCLUSION: In this study of people living with HIV in London, one in seven gay men were over the age of 50 years. A third of the HIV-positive gay men over 50 years were diagnosed in their 50s or 60s, highlighting that this group is not just an ageing cohort of people who were diagnosed in their 30s or 40s. Positive prevention programmes should target HIV-positive gay men of all ages because older gay men with HIV were just as likely to report high-risk sexual behaviour as younger men.

Uptake of antiretroviral treatment among people living with HIV in London: ethnicity, gender and sexual orientation.

OBJECTIVE: To examine, by ethnicity, gender and sexual orientation, uptake of antiretroviral treatment among people living with HIV in London. METHODS: Between June 2004 and June 2005, 1687 people living with HIV (73% response) receiving treatment and care in North East London National Health Service outpatient clinics completed a confidential, self administered, questionnaire. Respondents were asked whether they were currently taking HIV treatments (antiretroviral or combination therapy) RESULTS: Overall, 73.7% (1057/1435) of respondents said they were currently taking HIV treatments: white men who have sex with men (MSM) 70.7%; ethnic minority MSM 70.9%; black African heterosexual women 75.0%; black African heterosexual men 80.8% (p<0.05). In all groups, taking HIV treatments was strongly associated with having a low CD4 cell count at diagnosis (p<0.001); 30.1% of white and ethnic minority MSM had a CD4 cell count less than 200 cells/mm(3) at diagnosis compared with 53.1% of the black African heterosexual women and 66.3% of the black African heterosexual men (p<0.001). After adjusting for CD4 cell count at diagnosis, no significant differences in uptake of HIV treatments remained between the groups: MSM AOR 1.00 (reference group); black African heterosexual women AOR 1.15, 95% CI 0.71 to 1.88, p = 0.6; black African heterosexual men AOR 0.88, 95% CI 0.43 to 1.80, p = 0.7. CONCLUSION: Our analysis suggests that in London, once HIV infection is diagnosed, people from the two main risk groups-MSM (mostly white men) and black African heterosexual men and women-receive HIV treatment according to clinical need regardless of their ethnicity, gender or sexual orientation.

Men who have sex with men who are born abroad and diagnosed with HIV in England and Wales: an epidemiological perspective.

Relatively little is known about the sexual health needs of men who have sex with men (MSM) born abroad who reside in the UK. We describe here the epidemiology of HIV among MSM born outside the UK and diagnosed with HIV in England and Wales. Reports of HIV diagnoses in England and Wales received at the Health Protection Agency Centre for Infections were analysed. Between 2000 and 2003, 6386 MSM were diagnosed with HIV in England and Wales. Country of birth was recorded for 3571 (56%). Of those with country of birth reported, 2598 (73%) were born in the UK and 973 (27%) abroad. Of those born abroad (973), 424 (44%) were born in Europe, 141 (15%) in Africa, 104 (11%) in South/Central America and the remainder in other regions. Where reported (949), 69% of MSM born abroad were White, 12% other/mixed, 9% Black Caribbean and 7% Black African. Probable country of infection was reported for 612 MSM born abroad: 52% were infected in the UK, 43% in their region of birth and 5% in another region. Men born abroad represent a significant proportion of HIV diagnoses among MSM in England and Wales. More than half probably acquired their HIV infection in the UK, strengthening the call for targeted HIV prevention and sexual health promotion among MSM who are not born in England and Wales.

Kaposi's sarcoma as a sexually transmissible infection: an analysis of Australian AIDS surveillance data. The National HIV Surveillance Committee.

OBJECTIVE: To further examine the hypothesis that Kaposi's sarcoma (KS) among people with AIDS is caused by a sexually transmissible infectious agent. DESIGN: Analysis of Australian AIDS surveillance data for the period 1982-1991 by sex, age, exposure category, country of birth, year and place of diagnosis. MAIN OUTCOME MEASURES: Percentage of people with AIDS who had KS. RESULTS: In Australia, by November 1991, 17.2% (527 out of 3067) of individuals with AIDS aged > or = 13 years had presented with KS as their AIDS-defining illness: men, 17.6% (524 out of 2977); women, 3.4% (three out of 87) (P < 0.001). KS was predominantly reported in people aged 20-49 years and there were no cases in children < 13 years of age. In general, KS was more common in those who had acquired HIV by sexual contact rather than parenterally. Among people aged > or = 13 years, the proportion with KS ranged from 0.0% (none out of 41) in men with haemophilia to 1 Iford 9.0% (483 out of 2542) in men reporting homosexual contact. Between 1984-1985 and 1990-1991, the percentage of men with AIDS reporting homosexual contact who presented with KS declined from 30% (37 out of 124) to 15% (145 out of 995) (chi 2 for a linear trend, P < 0.001). For men with AIDS reporting homosexual contact, the percentage with KS in New South Wales and Victoria (20.3%) was higher than in the other States and Territories (12.5%) (P < 0.001). New South Wales and Victoria have also reported the highest incidence of AIDS in Australia. CONCLUSION: The epidemiological characteristics of KS among people with AIDS in Australia are broadly consistent with those reported from the United States and Europe. This provides further evidence that KS may be caused by a sexually transmissible infectious agent. The nature of the infectious agent and its mode of transmission have yet to be determined.

Research into HIV and AIDS between 1981 and 1990: the epidemic curve.

The main features of research into HIV and AIDS between 1981 and 1990 were examined using a database of medical, nursing and dental journals [compact disc read-only memory (CD-ROM) version of the Medline database (Silver Platter Information Services, London, UK)]. More than 30,000 papers on HIV and AIDS were indexed by Medline between 1981 and 1990. Of these, only 3% were concerned with African populations although a quarter of AIDS cases worldwide were reported from African countries during the decade. The number of papers on HIV/AIDS increased from 24 in 1982 to an estimated 8300 in 1990. Between 1983 and 1988 the number of indexed papers on HIV/AIDS increased at around 50-60% per year; between 1988 and 1989, however, the rate of growth fell to 6%. The percentage of papers discussing the aetiology of AIDS fell from 25 to 3% between 1983 and 1990. During the same period, papers concerned with HIV increased from 2 to 37% of the HIV/AIDS total. Research into drug therapy also accounted for an increasing proportion of indexed papers during the decade. The percentage of papers dealing with prevention and control rose to 18% in 1988, but had declined to 12% by 1990. Priorities for the 1990s should include a renewed interest in aetiology and a sustained emphasis on prevention. Furthermore, countries that have so far been neglected should be granted priority in future research.

Seeking sex on the Internet and sexual risk behaviour among gay men using London gyms.

OBJECTIVE: To examine the association between seeking sex on the Internet and sexual risk behaviour among gay men in London. METHODS: In January-February 2000, gay men in London gyms were asked to complete self-administered questionnaires concerning use of the Internet, history of sexually transmitted diseases (STD) and recent unprotected anal intercourse (UAI). Internet sex seekers were compared with other men, also with Internet access, who did not seek sex in this way. RESULTS: Of 743 gay men included in the analysis (121 HIV-positive, 465 HIV-negative, 157 never-tested), 80.9% (601) had access to the Internet. Among those who had access, 34.4% (207) had used the Internet to find a sexual partner; this did not vary significantly by HIV status (P = 0.3). Internet sex seekers were more likely to have had an STD (HIV-negative men, 26.9 versus 17.5%, P = 0.04) or gonorrhoea (HIV-positive men, 22.2 versus 5.8%, P = 0.04) in the previous year than other men with Internet access. HIV-negative Internet sex seekers were also more likely to report non-concordant UAI in the previous 3 months [23.1 versus 11.8%; adjusted odds ratio (aOR), 1.9; 95% confidence interval (CI), 1.2--3.5; P = 0.01]. HIV-positive Internet sex seekers were more likely to report UAI with another positive man (37.8 versus 7.4%; aOR, 7.9; 95% CI, 1.8--34.6; P = 0.006). CONCLUSION: Seeking sex on the Internet was associated with recent STD and high-risk sexual behaviour among HIV-positive and -negative gay men in London. The contribution of seeking sex on the Internet to the recent increase in high-risk behaviour among London gay men merits further investigation.

Sexual risk behaviour among gay men in a relationship.

OBJECTIVE: To examine whether gay men in a relationship have adopted negotiated safety as an HIV risk reduction strategy. METHODS: A confidential, anonymous questionnaire was completed by 1004 gay men attending gyms in central London in September-October 1997. Information was sought on sociodemographic characteristics, HIV testing and sexual risk behaviour. Men reporting unprotected anal intercourse (UAI) in the previous 3 months were classified as 'status-unknown' if they did not know their own HIV status, that of their UAI partner(s) or both. Men who knew their own and their UAI partner's HIV status were classified as 'status-known'. RESULTS: Of the 1004 men surveyed, 986 provided complete information on relationship, personal HIV test history and HIV status of UAI partner. Over half (539) said they were currently in a relationship with another man, of whom 173 reported UAI in the previous 3 months; 140 (80.9%) with their main partner only, 18 (10.4%) with a casual partner only and 15 (8.7%) with both their main and casual partners. Of the 140 men reporting UAI only with their main partner, 62 (44.3%) did not know their own HIV status or that of their partner. Overall, a quarter (26.0%) of the men in a relationship reported UAI only with their main partner in the previous 3 months; 11.5% status-unknown UAI, 14.5% status-known UAI. In a multivariate logistic model, both age and being in a relationship were significantly associated with UAI (status-unknown and status-known). CONCLUSION: Gay men in a relationship, surveyed in central London gyms, have for the most part adopted the first principle of negotiated safety: only to have UAI with their main partner. However, not all have embraced the second principle: to establish HIV seroconcordance. Nearly half the men reporting UAI only with their main partner were unaware of their own HIV status, their partner's or both. As a consequence, more than one in 10 men in a relationship reported high-risk (i.e. status-unknown) UAI with their main partner. Because the study population, from central London gyms, was not randomly selected, these findings may not be generalizable to all gay men in London. Nonetheless, HIV prevention programmes should continue to encourage gay men in a relationship to seek an HIV test and establish seroconcordance if they wish to have UAI with each other.

Repeat HIV testers at a London same-day testing clinic.

OBJECTIVE: To compare the characteristics of repeat HIV testers with first-time testers in a National Health Service HIV testing clinic in London. SUBJECTS AND METHODS: A self-administered questionnaire was distributed to clinic attenders between September 1995 and January 1996. The sample was stratified by gender and sexual orientation. Repeat and first-time testers were compared with respect to recent sexual risk behaviour, reasons for taking the HIV test, condom use, knowledge of sex partner's HIV status, and sociodemographic and psychosocial variables. RESULTS: Of 965 clinic attenders surveyed, 404 (41.9%) reported at least one previous HIV test outside the window period and were classified as repeat testers: homosexual men, 62.5% (178 out of 285); heterosexual men, 35.1% (126 out of 359); heterosexual women, 31.2% (100 out of 321). Among homosexual men, repeat testers were more likely to report the following: two or more partners in the previous 6 months for both unprotected anal sex (25.8 versus 9.3%; P < 0.01) and unprotected oral sex (53.9 versus 37.4%; P < 0.01); ever having had a sexually transmitted disease (STD) other than HIV (49.4 versus 29.0%; P < 0.01); taking the present test "as part of a regular health check' (48.9 versus 28.0%; P < 0.01); and knowing others who had tested for or been infected with HIV. Repeat testing heterosexual men were more likely to report the following: two or more partners in the previous 6 months for unprotected vaginal sex (42.9 versus 30.9%; P < 0.05) and unprotected oral sex (41.3 versus 25.3%; P < 0.01); ever having had an STD other than HIV (31.7 versus 20.6%; P < 0.05); taking the present test "as part of a regular health check' (36.5 versus 26.2%; P < 0.05); and knowing others who had tested for or been infected with HIV. For heterosexual women, repeat testers were more likely to report ever having had an STD other than HIV (25.0 versus 14.5%; P < 0.05), and knowing others who had tested for or been infected with HIV. CONCLUSIONS: Repeat testing was associated with high-risk sexual behaviour, a previous STD, knowledge of others who have tested for or been infected with HIV, and seeking the test as part of a regular health check. Factors contributing to repeat testing are multi-faceted and vary between groups of different sexual orientation. Use of the impact of knowledge of others infected by HIV and the experience of contracting an STD other than HIV may guide the development of HIV counselling interventions aimed at reducing sexual risk behaviour.

HIV seroprevalence in a London same-day testing clinic.

OBJECTIVES: To determine the prevalence of HIV infection among people attending a confidential, non-genitourinary medicine based testing clinic that provides HIV antibody test results on the day of consultation. METHODS: Retrospective analysis of data collected on 2635 individuals attending the Same-Day HIV Testing Clinic at the Royal Free Hospital, London between March 1992 and February 1993. RESULTS: A total of 1612 men and 1023 women were tested for HIV antibody. The primary risk for HIV infection was heterosexual (71.7%; 1889 out of 2635) and homosexual contact (24.5%; 646 out of 2635). Fifty-four individuals were given positive HIV test results (46 men, median age 34 years; eight women, median age 27 years). Overall HIV seroprevalence was 2.0% (95% confidence interval, 1.5-2.5). HIV seroprevalence was highest among homosexual men (6.5%; 41 out of 635) and injecting drug users (5.7%; four out of 70). The rates for heterosexual men and women were 0.2% (two out of 915) and 0.7% (seven out of 974), respectively. Of the 54 individuals who were HIV-antibody-positive, 44 were Centers for Disease Control and Prevention stage II/III, eight stage IV and one was tested at the time of seroconversion (stage I; data were not available for one patient). Of the total numbers attending this clinic 27% (702 out of 2635) had previously been tested and received a negative result. Of a total of 54 HIV-antibody-positive individuals, 40% (21) had previously received a negative test result. CONCLUSIONS: The data suggest that seroprevalence amongst homosexual men attending a designated HIV testing clinic in London is lower than that reported by genitourinary clinic based testing sites. The large number of repeat testers who subsequently became infected with HIV suggests that there is a population requiring specific targetting for HIV risk reduction.

CD8 lymphocyte counts and serum immunoglobulin A levels early in HIV infection as predictors of CD4 lymphocyte depletion during 8 years of follow-up.

OBJECTIVE: To assess the ability of the CD8 lymphocyte count and immunoglobulin (Ig) A level, measured at the early stage of HIV infection when the CD4 lymphocyte count remains relatively high, to predict the future rate of CD4 lymphocyte loss and hence the risk of AIDS. DESIGN: Cohort of recently infected haemophiliacs with relatively high CD4 lymphocyte counts followed for up to 8.5 years from baseline measurement of CD8 lymphocyte counts and IgA levels. SETTING: A regional haemophilia centre based in a major teaching hospital. PATIENTS: Eighty-four of 111 patients with haemophilia who seroconverted to HIV between 1979 and 1985 in whom CD8 lymphocyte counts and IgA levels were measured soon after seroconversion (mean, 2.7 years; maximum, 5 years) while CD4 lymphocyte counts remained relatively high (median, 600 x 10(6)/l; minimum, 300 x 10(6)/l). OUTCOME MEASURES: Development of severe immunodeficiency defined by a CD4 lymphocyte count falling below 50 x 10(6)/l, and AIDS. RESULTS: Individuals with high CD8 counts (P < 0.008) and high IgA levels (P < 0.003) at baseline experienced a more rapid rate of CD4 lymphocyte loss than those with low baseline levels. A score was derived to combine the predictive ability of CD8 count and IgA level. Estimated proportions with CD4 counts below 50 x 10(6)/l after 8 years of follow-up were 100, 30 and 14% for those with high, intermediate and low baseline scores, respectively. The CD8/IgA score showed similar ability to predict the future occurrence of AIDS (P < 0.0001; log-rank test). CONCLUSION: Immune activation seen in HIV infection, as reflected by raised CD8 counts and IgA levels, appears to be linked to the process of CD4 lymphocyte depletion. Measurement of these markers in the years following infection, when CD4 lymphocyte counts remain high, provides a first indication of a patient's long-term prognosis.

Prediction of progression to AIDS by analysis of CD4 lymphocyte counts in a haemophilic cohort.

Serial CD4 lymphocyte counts were recorded in 112 anti-HIV-positive haemophiliacs who were followed for up to 8 years after seroconversion. The patients remained at low risk of developing AIDS until their CD4 lymphocyte count fell to 0.25 X 10(9)/l. From this point, the risk increased as their count approached zero. Using this result and on the assumption (which is evaluated) that the underlying trend over time in CD4 lymphocyte counts is linear, the predicted rate of progression to AIDS was calculated for the cohort. It was estimated that 73% (95% confidence limits 60-86%) of the cohort will develop AIDS within 15 years of HIV-seropositivity. During 8 years of follow-up, this cohort had shown similar rates of progression to AIDS to other cohorts--haemophilic and otherwise--suggesting that this estimate may well have general applicability. The method described could be used to plan the provision of health-care resources for groups of anti-HIV-positive patients as it allows the number of new cases of AIDS to be predicted year by year, even when the patients' dates of seroconversion are unknown.

Repeat HIV testing: high-risk behaviour or risk reduction strategy?

OBJECTIVE: To examine the characteristics of repeat and first-time HIV testers and consider their implications for HIV test counselling. METHODS: An anonymous questionnaire was completed by nearly 1500 people seeking an HIV test between September 1997 and July 1998 at a same-day HIV testing clinic in London, United Kingdom. Repeat testers were those people who had previously tested HIV negative and were returning for another test. Information was collected on self-reported unprotected penetrative sex (UPS) in the previous 3 months and reasons for seeking the present test. RESULTS: Overall, 50.6% (721/1446) of all clinic attenders were repeat testers: gay men 71.7% (337/470), heterosexual men 42.1% (208/494) and heterosexual women 38.6% (186/482). No significant differences were found between repeat and first time testers in the frequency of UPS (P > or = 0.06). However, gay men (but not heterosexual men and women) reporting three or more previous HIV tests were significantly more likely to report higher-risk UPS (i.e. with a partner whose HIV status was either positive or unknown) (42.2%) than those who had had one-two or no previous tests (25.3 and 25.4%, respectively; P = 0.002). Over half the heterosexual men and women, and one third of gay men said they were seeking the current HIV test in preparation for a new relationship; these proportions did not differ significantly between repeat and first-time testers (P > 0.1). CONCLUSION: In this London HIV testing clinic, no significant differences were found in the frequency of UPS between repeat and first-time testers with the exception of gay men with a history of three or more previous HIV tests, who reported elevated levels of high-risk sexual behaviour. For many people, repeat HIV testing has become part of a risk reduction strategy to establish seroconcordance with a regular partner. HIV test counselling provides the opportunity both to address high-risk behaviour and to reinforce personal risk-reduction strategies.