Assessment of the implementation and knowledge of the UK National Guidelines for HIV Testing (2008) in key conditions at a UK district general hospital.

The objective of this study is to audit the implementation and knowledge of the British HIV Association (BHIVA) UK National guidelines for HIV testing (2008) in key conditions at Basildon & Thurrock University Hospital. Basildon Hospital is a district general hospital, serving over 400,000 patients in south-west Essex. A total of 348 patients were assessed through electronic to pathology data and patients' notes to investigate if they had been tested for HIV when diagnosed with the following conditions: tuberculosis (TB), hepatitis B and C, cervical intraepithelial neoplasia grade II/III, lymphoma, anal cancer, seminoma or Castleman's disease. The physicians involved were questioned as to their knowledge of the HIV testing guidelines. Of the 348 patients who were identified as having the above mentioned conditions, only 13.8% of those with any of the key conditions had received an HIV test. Only one non-HIV physician was aware of the guidelines. Knowledge of the 2008 BHIVA HIV testing guidelines is scanty among non-HIV-trained physicians. Health-care professionals in the field, irrespective of their role, should work harder to disseminate information and reduce prejudice that decreases testing of at-risk individuals.

Tipranavir/T20-based salvage regimens highly effective and durable against HIV-1 with evidence for genotypic predictability of response in clinical practice.

Escalating drug resistance in treatment-experienced HIV-1-infected patients has made management increasingly difficult. In clinical trials, tipranavir (TPV) has produced potent and durable responses in such patients, although experience in clinical cohorts is limited. A retrospective clinical case review was undertaken of triple-class experienced HIV-1-infected patients receiving optimized boosted TPV-containing regimens and T20 with up to 108 weeks follow-up. Antiretroviral therapy (ART) resistance profiles were characterized using International Aids Society (IAS)-USA scoring and 'TPV resistance score' (TPV-RS) at baseline and failure. Five of 12 patients had undetectable virus (<50 copies/mL) after median 84 weeks (range 60-108), and 1/12 < had 700 copies/mL after 40 weeks. Six of 12 patients failed after 36 (range 12-48) weeks and were more likely to have > or = 3 TPV-RS mutations than non-failures (P = 0.06). Presence of a major IAS-USA mutation at baseline was strongly associated with absence of a 1 log viral load drop at 24 weeks (P = 0.02). TPV-containing regimens showed impressive efficacy and tolerability in this heavily experienced cohort.