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Objectives: To compare the rate of hepatic fibrosis progression in hepatitis C virus (HCV) infected and human immunodeficiency virus (HIV)-HCV coinfected patients, and to identify factors that may influence fibrosis progression. Patients and methods: A total of 153 HCV infected and 55 HCV-HIV coinfected patients were identified from two London hospitals. Eligible patients had known dates of HCV acquisition, were HCV-RNA positive, and had undergone a liver biopsy, which was graded using the Ishak score. Univariate and multivariate logistic regression analyses were used to identify factors associated with fibrosis progression rate and the development of advanced fibrosis (stages 3 and 4). Results: The estimated median fibrosis progression rate was 0.17 units/year (interquartile range (IQR) 0.10-0.25) in HIV-HCV coinfected and 0.13 (IQR 0.07-0.17) in HCV monoinfected patients (p = 0.01), equating to an estimated time from HCV infection to cirrhosis of 23 and 32 years, respectively. Older age at infection (p < 0.001), HIV positivity (p = 0.019), higher alanine aminotransferase (ALT) level (p = 0.039), and higher inflammatory activity (p < 0.001) on first biopsy were all independently associated with more rapid fibrosis progression. ALT was correlated with histological index (r = 0.35, p < 0.001). A CD4 cell count ≤ 250×10[sup 6]/l was independently associated with advanced liver fibrosis (odds ratio 5.36 (95% confidence interval 1.26-22.79)) and was also correlated with a higher histological index (r = -0.42, p = 0.002). Conclusion: HIV infection modifies the natural history of HCV by accelerating the rate of fibrosis progression by 1.4 fold, and the development of advanced fibrosis threefold. A low CD4 cell count was independently associated with advanced disease and correlated with higher histological index, which suggests that early antiretroviral therapy may be of benefit in slowing HCV progression in coinfected patients. [ABSTRACT FROM AUTHOR]

Objectives: To retrospectively audit the management of post-exposure HIV prophylaxis following sexual exposure (PEPSE) against the British Association for Sexual Health and HIV 2004 draft guidance. Methods: A retrospective review of case notes from January 2000 to November 2004. The draft guidelines were not adopted into clinical practice during the study period. Results: 76 patients received PEPSE. 79% (95% Cl 68.08 to 87.46) of PEPSE prescriptions were given for exposures that were in accordance with the guidelines' recommended indications (target 90%). 87% (95% Cl 77.13 to 93.51) of PEPSE was prescribed within 72 hours of risk exposure (target 90%). 91% (95% Cl 81.94 to 96.22) of recipients received a recommended antiretroviral combination. 53% (95% Cl 40.84 to 64.21) of recipients completed the PEPSE course (target 75%). 45% of patients attended for the 3 month follow up HIV test but only 12% (95% CI 5.56 to 21.29) attended for both the 3 month and 6 month HIV test (target 75%). Conclusion: PEPSE is predominantly being prescribed for recommended indications and is dispensed within 72 hours of risk exposure. PEPSE completion rates and attendance for 3 months and 6 months post-exposure HIV testing need improving, perhaps by introducing a PEPSE clinic. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the amendment passed by the parliament in England which provides eligibility of overseas visitors for free secondary medical services in certain circumstances.