Objectives: To investigate changing nutritional demographics of treated HIV-1-infected patients and explore causes of obesity, particularly in women of African origin.Methods: We prospectively reviewed nutritional demographics of clinic attenders at an urban European HIV clinic during four one-month periods at three-yearly intervals (2001, 2004, 2007, and 2010) and in two consecutive whole-year reviews (2010–2011 and 2011–2012). Risk-factors for obesity were assessed by multiple linear regression. A sub-study of 50 HIV-positive African female patients investigated body-size/shape perception using numerical, verbal, and pictorial cues.Results: We found a dramatic rise in the prevalence of obesity (BMI > 30 kg/m2), from 8.5 (2001) to 28% (2011–2012) for all clinic attenders, of whom 86% were on antiretroviral treatment. Women of African origin were most affected, 49% being obese, with a further 32% overweight (BMI 25–30 kg/m2) in 2012. Clinical factors strongly associated with obesity included female gender, black African ethnicity, non-smoking, age, and CD4 count (all P < 0.001); greater duration of cART did not predict obesity. Individual weight-time trends mostly showed slow long-term progressive weight gain. Investigating body-weight perception, we found that weight and adiposity were underestimated by obese subjects, who showed a greater disparity between perceived and actual adiposity (P < 0.001). Obese subjects targeted more obese target “ideal” body shapes (P < 0.01), but were less satisfied with their body shape overall (P = 0.02).Conclusion: Seropositive African women on antiretroviral treatment are at heightened risk of obesity. Although multifactorial, body-weight perception represents a potential target for intervention.

Post-exposure prophylaxis after sexual exposure (PEPSE) awareness was audited in an HIV-positive cohort. A total of 403 out of 828 (48.7%) patients were PEPSE aware. Patients diagnosed post-2006 were more PEPSE aware; 57.2% vs. 44.2% (p = 0.0004). Men who have sex with men (MSM) were more PEPSE aware; 65.8% vs. 39.1% in heterosexuals (p < 0.0001).Younger patients, 68.1% aged 19-34 were PEPSE aware vs. 45.7% in those >35 years (p < 0.0001). In the 534 patients reporting sexual activity within the last year, awareness was 57.5%. In the 216 patients 'sometimes' or 'never' using condoms, awareness was 42.6%. In the 78 (9.4%) patients with detectable viral loads (>400 copies/mL), awareness was 64.1%. Overall, PEPSE awareness was unexpectedly low. MSM, younger patients, and those diagnosed after 2006 were significantly more likely to be PEPSE aware. More than one in three patients with detectable viraemia were PEPSE unaware.