A re-audit of prescribing of post-exposure prophylaxis for HIV following sexual exposure in the Thames Valley demonstrated that an updated proforma has led to significant improvements in clinician-led outcomes, but had no impact on completion or follow-up rates.

Background The Johns Hopkins Hospital Emergency Department ((JHHED) has served as an observational window on the HIV-epidemic. We previously reported that HIV prevalence decreased among patients attending JHHED from 11.4% in 2003 to 5.6% in 2013 and incidence decreased from 0.99% in 2003 to 0.16%. This study sought to examine the potential contribution of changes in sexual and parenteral risk behaviour during this period by examining trends in HSV-2 and HCV infection in this population. Methods Identity unlinked-serosurveys were conducted in the adult JHHED in 2003, 2007, and 2013. Excess sera collected from 10,274 patients were tested for HSV-2 and HCV antibodies by the Focus HerpeSelect and Genedia HCV 3.0 ELISA.

Background HIV infection is the strongest single risk factor for the development of active tuberculosis (TB) in individuals with latent TB infection (LTBI). 1 NICE guidelines recommend screening HIV-positive patients for LTBI with an Interferon Gamma Release Assay (IGRA), plus a Tuberculin Skin Test (TST) in patients with a CD4 count <200 cells/mm 3 if IGRA negative. Method We began screening HIV-positive patients for LTBI in July 2011; this prospective study reports our 3 year data. Patients had an IGRA (T-SPOT. TB ®), and a TST was performed in those with a negative result and a CD4 count <200 cells/mm 3. Results 116 HIV-positive patients were screened (Table 1): CD4 Count ≥200 Group Of 88 patients, 4 (5%) had a history of previous TB infection and were excluded. 70/84 (83%) had a negative IGRA, 9/84 (11%) had a positive IGRA (3 had active TB and 6 LTBI) and 5/84 (6%) had inconclusive IGRA results. Of these, 4/5 had a repeat IGRA (2 positive, 1 negative, 1 awaited) and 1 was lost to follow up. CD4 Count <200 Group Of 28 patients, 1 (4%) had a history of previous TB infection and was excluded. 24/27 (89%) had a negative IGRA and were referred to TB clinic for a TST. Of these, 18/24 (75%) had a negative TST, 3/24 (12.5%) did not attend and 3/24 (12.5%) are awaiting appointments. 2/27 (7%) had a positive IGRA and were treated for LTBI. One (4%) had an inconclusive IGRA result but did not attend follow up. Conclusions Screening for TB in HIV is worthwhile, with a 12% detection rate in our cohort. Performing a TST did not detect any additional cases of TB infection in the CD4 <200 group. Performing this test is time-consuming, costly and inconvenient, and we suggest that screening should be with an IGRA alone. The detection rate of TB infection was lower in those with more advanced immunocompromise, which raises concern about the sensitivity of the screening tests.

The 2011 UK guidelines for the prescription of Post‐Exposure Prophylaxis for the Prevention of HIV infection following Sexual Exposure (PEPSE) take account of the reduction in the risk of HIV transmission from an HIV‐positive individual who has an undetectable serum HIV‐1 viral load as a result of combination antiretroviral therapy (cART) [1]. Prescription of PEPSE is no longer routinely recommended for individuals who have had sex with a partner who is HIV‐positive and is known to have an undetectable serum HIV‐1 viral load on cART, unless unprotected receptive anal sex is reported. In this study we assessed how the application of the new UK PEPSE guidelines would alter PEPSE prescription in our region. We performed a retrospective case note‐review of all PEPSE prescriptions occurring between the 1st of January 2011 and the 31st of December 2011 in 4 sexual health clinics in the Oxford deanery (Oxford, Banbury, Reading and Slough). 91/ 96 PEPSE prescriptions were available for review. The mean age of each PEPSE recipient was 30.3 years; 71/91 (78%) of recipients were male, of whom 54/71 (76%) were men who have sex with men (MSM). 63/91 (69%) of PEPSE recipients were of white UK ethnicity. In 32/91 (35%) of cases, the patient reported having sex with a partner was known to be HIV‐positive. Of these, 10/32 (31%) reported that their partner was taking antiretroviral therapy, and 4/10 (40%) of this group reported that their partner had an undetectable serum HIV‐1 viral load. Thus of 91 PEPSE prescriptions, 4 (4%) occurred in patients reporting sex with HIV‐positive partners who were taking antiretroviral therapy and had an undetectable HIV‐1 serum viral load: receptive anal sex was reported in 1 case, and vaginal sex in the remaining 3 cases. Despite a significant change in the UK PEPSE guidelines, in only 3/91 cases in which PEPSE was previously given would prescription no longer be recommended. 32/91 patients reported sex with an HIV‐positive partner, and the HIV‐1 viral load was either unknown or not documented in the majority of cases. It may not be possible to corroborate a patient's report of their partner's HIV‐1 viral load in all cases; thus PEPSE will still be required. However, the new PEPSE guidelines increase the incentive for all clinicians to actively seek and accurately document the HIV‐1 viral load of patients' HIV‐positive sexual partners.