Objective: To compare the incidence of hypertension in people living with HIV receiving integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) versus non-nucleoside reverse transcriptase inhibitors (NNRTIs) or boosted protease inhibitors (PIs) in the RESPOND consortium of HIV cohorts. Methods: Eligible people with HIV were aged ≥18 years who initiated a new three-drug ART regimen for the first time (baseline), did not have hypertension, and had at least two follow-up blood pressure (BP) measurements. Hypertension was defined as two consecutive systolic BP measurements ≥140 mmHg and/or diastolic BP ≥90 mmHg or initiation of antihypertensives. Multivariable Poisson regression was used to determine adjusted incidence rate ratios (aIRRs) of hypertension, overall and in those who were ART naïve or experienced at baseline. Results: Overall, 4606 people living with HIV were eligible (INSTIs 3164, NNRTIs 807, PIs 635). The median baseline systolic BP, diastolic BP, and age were 120 (interquartile range [IQR] 113-130) mmHg, 78 (70-82) mmHg, and 43 (34-50) years, respectively. Over 8380.4 person-years (median follow-up 1.5 [IQR 1.0-2.7] years), 1058 (23.0%) participants developed hypertension (incidence rate 126.2/1000 person-years, 95% confidence interval [CI] 118.9-134.1). Participants receiving INSTIs had a higher incidence of hypertension than those receivingNNRTIs (aIRR 1.76; 95% CI 1.47-2.11), whereas the incidence was no different in those receiving PIs (aIRR 1.07; 95% CI 0.89-1.29). The results were similar when the analysis was stratified by ART status at baseline. Conclusion:Although unmeasured confounding and channelling bias cannot be excluded, INSTIs were associated with a higher incidence of hypertension than were NNRTIs, but rates were similar to those of PIs overall, in ART-naïve and ART-experienced participants within RESPOND.

Achieving optimal adherence to ARV’s in a rural paediatric population is challenging. Monitoring adherence by frequent viral load assay is not always feasible or sustainable in rural communities. A relatively cheaper, reliable, valid and sustainable measure of adherence for children is required for routine management. This study retrospectively assessed adherence outcomes using monthly pill count and viral load data, including reasons reported for non-adherence, in a paediatric cohort in rural KwaZulu-Natal, South Africa. Between 2008 and 2013, 78 children, mean age of 7.1 years, were enrolled in the CAPRISA 052 AIDS Treatment Programme. Monthly treatment adherence by pill count was categorized as either high (≥95%) or low (<95%). Overall median monthly adherence to treatment by pill count was 87.8% at month six, 88.9% at month 12 and 90.8% at month 24. However, the proportion of children with an undetectable viral load (< 400 copies/ml) was 84.0% (63/74), 86.6% (58/67), and 84.5% (49/58) at the three time points respectively. Agreement between pill count and viral load showed that only 33.9%, 36. 3% and 30.6% of children were truly adherent by pill count at months six, 12 and 24 respectively. In conclusion, this treatment programme demonstrated that adherence of >95% by pill count is not an ideal indicator of virological suppression in children aged six months – 13 years. Viral load assessment remains the gold standard for assessing treatment success in this age group.

Many public surveys on the issue of HIV and AIDS have concentrated on the relationship between attitudes and knowledge. Often this relationship has been found wanting or at most tenuous. A recent survey of 1,002 people in Wales has supported these earlier findings, but found additionally that discriminatory and complacent attitudes on AIDS or towards people with the 'AIDS virus' are held by a significant proportion of the population. The survey also discovered that people correctly perceive the risk of HIV infection as being minimal. Depending on the question 17%-65% of the sample expressed discriminatory attitudes towards people that have the 'AIDS virus'. There was also no marked change over previous surveys in the degree of complacency surrounding AIDS. Younger people (aged (15-34) considered themselves to be more at risk of infection with the 'AIDS virus' but overall the perceived risk of infection was low. A sustained low key education programme in a variety of settings and independent of perceived risk is necessary to combat prejudice and complacency.

This paper presents information on changes in public knowledge and attitudes to HIV/AIDS in Wales between 1987 and 1992. The results indicate that throughout this period the majority of adults in Wales were aware of the high risk of infection from sexual intercourse and sharing needles with, and coming into contact with the blood of, someone with HIV. Nevertheless, the proportion who said that sexual intercourse with someone with HIV carries a high risk declined, and in 1992 confusion still remained about the nature of HIV infection amongst a substantial minority of respondents. More than one in ten of the adults in the most recent survey were of the opinion that kissing or being near someone with HIV who is coughing or sneezing carries a high risk of infection. The data also indicate that attitudes to those with HIV remained uneven in 1992. Whilst a greater proportion in 1992 than in 1987 held the view that people with HIV should be able to live normally in the community, attitudes appear to have hardened towards those perceived to be practising high risk behaviours, such as injecting drug users and homosexuals. The data also suggest that attitudes appear to be closely related to levels of knowledge. Given the apparent confusion and prejudice highlighted by the surveys, it is suggested that there is a continuing need for general campaigns to maintain public awareness of HIV-related issues, although this must also be complemented by more in-depth targeted education programmes.