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Introduction: Apart from some AZT mutations there are few data on long-term persistence of specific mutations after cessation of therapy. Long-term persistence implies a fitness advantage over wild-type or that the mutant was transmitted at primary or subsequent infection. The A098G mutation arises in vitro and in vivo after exposure to NNRTIs and is associated with resistance to nevirapine and delavirdine. We have examined our databases for persistence of this mutation. Methods: 282 of 10461 (2.7%) isolates had the A098G mutation and 77/282 (27%) had an associated K103N. Detailed clinic data on 18 patients with A098G was analysed. Eight patients were on NNRTI at the time the mutation was found and all eight had other associated NNRTI mutations. In one patient who subsequently stopped the NNRTI, the K103N mutation was no longer present 7 months later but the A098G persisted. Two patients with longterm exposure to nucleosides only also had this mutation. In eight other patients, the A098G mutation was present, median (range) 19 (1-48) months after cessation of NNRTIs. The exposure to NNRTIs was 14 (2-29) months. Two of three patients given MegaHAART, one given efavirenz and one a PI responded virologically. Two on nevirapine and one on nucleosides did not respond. Condusions: Patients who fail on NNRTIs may develop the A098G mutation and this may persist long-term and predict poor response to nevirapine subsequently. In the two patients never exposed to NNRTIs it is possible that this mutant may be transmitted. The A098G mutant appears to have a survival advantage over wildtype. The presence of this mutation at baseline might modify the choice of a HAART regimen. [ABSTRACT FROM AUTHOR]

Objective: To determine any differences in the demographics of 100 people diagnosed with HIV in 1994 (pre-HAART) compared to 1998 (post-HAART). Method: Data were collected from an established database and supplemented from medical and counselling notes. Results: Mean age was 31 in 1994 and 34 in 1998. Most were male (74%, 78%) and Caucasian (67%, 68%). In 1994 the main risk groups were 62% homosexual and 34% heterosexual compared with 69% and 28% in 1998, 3% in both years were IDU. In 1994 19% had AIDS at the time of diagnosis, in 1998 this was 12%. The mean CD4 in 1994 was 445 (CI 374-516) and in 1998313 (CI 258367). Mean viral load in 1998 was 5.07 log[sub 10]. Most people tested via the Same Day Testing Clinic (73%, 74%). In 1994 34% had been tested previously and in 1998, 33%. In 1994 18% of the 100 were using condoms regularly, in 1998 22%. In 1994 20% had a known HIV+ partner and 19% in 1998. Conelusion: Very few differences were seen in those diagnosed HIV+ in the pre- and post-HAART era. Many people still present with relatively advanced disease at a stage when antivirals would be considered. Mean CD4 at presentation was lower in 1998. New sites and increased availability for testing do not seem to be impacting yet on where and when people present. Most people newly diagnosed in our service were still homosexual men. [ABSTRACT FROM AUTHOR]

BACKGROUND: The USA bans entry to non-citizens unless they obtain a waiver visa. AIM: To establish how many people with HIV infection travelled to the USA, whether they were aware of the travel restriction, whether they travelled with a waiver visa and HIV inclusive medical insurance and how they managed with their antiretroviral medication (ARV). DESIGN: Collation of data from cross-sectional studies conducted independently at three different medical centres, Manchester, Brighton and London, using a structured self-completion questionnaire. RESULTS: The overall response rate was 66.6% (1113 respondents). 349 (31%) had travelled to the USA since testing HIV positive, of whom only 14.3% travelled with a waiver visa. 64% and 62% of the respondents at Manchester and Brighton were aware of the need of a waiver visa. 68.5% (212) were on ARV medication at the time of travel and, of these, 11.3% stopped their medication. Of those taking ARV medication, only 25% took a doctors' letter, 11.7% posted their medication in advance. Of those discontinuing treatment (n=27), 55.5% sought medical advice before stopping, 11 were on NNRTI-based regimen and one developed NNRTI-based mutation. Only 27% took up HIV inclusive medical insurance. Many patients reported negative practical and emotional experiences resulting from travel restrictions. CONCLUSION: The majority of HIV patients travel to the USA without the waiver visa, with nearly half doing so with insufficient planning and advice. A significant minority (11.3%) stop their medication in an unplanned manner, risking the development of drug resistance. [ABSTRACT FROM AUTHOR]

Objectives: To compare surrogate marker outcomes (SMO) between patients given HW/TB therapy concomitantly and those given HAART alone. Methods: Cases had culture-proven Mycobacterium tuberculosis. They presented between 10/96 and 3/99 and started HAART during the TB treatment course. Controls were consecutive patients without TB who started HAART between 1/97 and 3/99. Results: There were 57 cases and 127 controls. There was no significant difference in age, risk factors or ethnicity (black vs. non-black). At baseline cases had a significantly higher logro VL (5.23 vs. 4.75; P=0.001) and a lower CD4 count (68 vs. 121 cells/ mm[sup 3]; P=0.012). There was no difference in mean log[sub 10] VL decrease between the groups (6 months: 2.6 vs. 2.2; 12 months: 2.6 vs. 2.5). At 12 months 67% vs. 68% (P=0.944) had a VL<500. There was no significant difference in median CD4 rise from baseline at 3, 6 and 9 months; however, at 12 months the increase was 114 vs. 163 cells/mm[sup 3] in cases and controls, respectively (P=0.027). Similar proportions (60% cases vs. 72% controls) showed an increase of at least 100 cells at 12 months (P= 0.167). Conclusions: The two groups achieved similar SMOs despite having different baseline parameters, and receiving varying HAART/TB regimens for which PK data have yet to be evaluated. Further follow-up is required to assess the long-term impact of TB regimens on the effectiveness of HAART. [ABSTRACT FROM AUTHOR]

Objective: To compare a new point mutation assay with gene sequencing for the detection of the K103N and Y181C RT mutations. Methods: Plasma samples were obtained from patients failing HAART. These samples were sequenced (Visible Genetics) and were also tested using a novel 'in-house' assay for mutations at positions 103 and 181 of RT. The assay is an adaptation of 'Mutagenically Separated PCR' (MS-PCR, Rust et al.) and uses four primers in a three-round semi-nested reaction for each mutation. Results: Fifteen patient samples have been tested by both techniques. By sequencing, 4/15 samples were mutant (MT) for codon 103 and 10/15 were wild-type (WT). For codon 181, 6/15 patients were MT and 8/15 were WT. Twenty-four codons produced a result by both techniques, and of these 22/24 (91.7%) were identical. MS-PCR produced two MT codons which were not identified by sequencing. One patient sample failed to produce a result by sequencing and two failed by MS-PCR. Sensitivity of MSPCR for MT detection was 82%, with a specificity of 94.4%. Sequence data and gel electrophoresis images will be presented. Conclusions: MS-PCR is a new, cost-effective genotyping assay, which is simple and cheap to perform. There is no requirement for expensive hardware or software, lending the assay to high throughput screening. [ABSTRACT FROM AUTHOR]

Background: Individuals with HIV/AIDS generally experience decreased levels of health-related quality-of-life (HR-QoL). However, very few HR-QoL data exist for these individuais following the introduction of HAART. Methods: Individuals with HIV/AIDS were asked to complete the Medical Outcomes Study-HIV questionnaire, which measures HRQoL on 11 separate profiles from 0 to 100. Regression analysis was used to see whether CD4 count (cells/mm[sup 3] and logged vital load (copies/mL) predicted these scores once they had been factorized. Results: The 73 individuals who responded had a mean age of 37.4 (SD 8.1). The median CD4 count and logged vital load was 369 (range 0-1044) and 3.04 (range 1.69-5.82). The mean HR-QoL scores ranged between 49.4 and 70.3 but CD4 count did not predict HR-QoL (P=0.82). However, logged vital load independently predicted HR-QoL (P=0.02) after adjusting for differences in gender, mode of HIV transmission and age. Conclusion: Individuals with HIV/AIDS are still experiencing decreased levels of HR-QoL. Information on vital load may be more useful than CD4 counts in predicting HR-QoL in the era of HAAT. Background: Individuals with HIV/AIDS generally experience decreased levels of health-related quality-of-life (HR-QoL). However, very few HR-QoL data exist for these individuais following the introduction of HAART. Methods: Individuals with HIV/AIDS were asked to complete the Medical Outcomes Study-HIV questionnaire, which measures HRQoL on 11 separate profiles from 0 to 100. Regression analysis was used to see whether CD4 count (cells/mm[sup 3] and logged vital load (copies/mL) predicted these scores once they had been factorized. Results: The 73 individuals who responded had a mean age of 37.4 (SD 8.1). The median CD4 count and logged vital load was 369 (range 0-1044) and 3.04 (range 1.69-5.82). The mean HR-QoL scores ranged between 49.4 and 70.3 but CD4 count did not predict HR-QoL (P=0.82). However, logged vital load independently... [ABSTRACT FROM AUTHOR]