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Purpose of the study: Antiretroviral therapy reduces mortality and morbidity in HIV-infected individuals, most markedly when initiated early, before advanced immunodeficiency has developed. All international guidelines (IAS 2010, EACS 2011, DHHS 2012) tend to recommend starting ART in patients with high CD4 cell count. Some challenges need to be met before reaching this goal, particularly HIV-infected patients with late presentation-diagnosis. The objective of this study was to determine the frequency of and demographic features associated with delayed presentation to care in our centre. Methods: All patients, newly diagnosed with HIV between January 2007 and December 2011 and on follow-up in our AIDS Reference Centre, were included. 'Late presenter patient' was defined as patient with CD4 count 50 years, female sex, immigrant status and heterosexual contact were associated with late presentation for HIV diagnosis. In the multivariate analysis, patients aged >50 and migrant women were the only independent risk factors for late presentation. Except gender, other risk factors remain identical to those that were identified in our centre between 1997-2006 [1]. Conclusion: A considerable proportion of patients continue to be diagnosed with advanced HIV disease, despite the fact that risk factors for late presentation have been identified clearly. In order to be able to treat all patient at high CD4 cell counts as recommended in all guidelines, we need to develop policies focused directly to categories of people at high risk of late presentation. Conflict of interest: None. All co-authors have participated in, and agree with the content and conclusions. This work is original and does not infringe any copyright. Acknowledgement: A. Sasse, Institut de Sante Publique, Belgium (Published: 11 November 2012) Citation: Abstracts of the Eleventh International Congress on Drug Therapy in HIV Infection Vincent A et al. Journal of the International AIDS Society 2012, 15 (Suppl 4):18368 http://www.jiasociety.org/index.php/jias/article/view/18368 | http://dx.doi.org/10.7448/IAS.15.6.18368

Purpose of the study: Co-infection with HIV / hepatitis C virus (HCV) occurs commonly due to similar routes of transmission, mainly in MSM and IVDU patients. In 2009, EACS guidelines introduced the notion of systematic annual HCV screening among HIV-infected patients. This study evaluated staff knowledge, adherence to HCV screening recommendations and seroconversion rates for HCV in our HIV Reference Centre. Methods: Eight physicians (HIV specialists) were interviewed on recommendations and perceived adherence to EACS clinical guidelines on HCV screening [1]. We then reviewed medical records of our cohort of HIV-infected patients on regular follow-up in our centre each year, from 2008 to 2011. We considered a patient to be on regular follow-up when records showed at least two clinical reviews and one HIV viral load testing during the year. Demographic features and HCV serology tests were collected from the operating software of our institution (Medical Explorer v3r9, 2008). Diagnosis of HCV was retained when serology became positive and HCV RNA was detected. Summary of results: Though knowledge of current guidelines was excellent (100%), staff claimed a 87.5% adherence rate to these recommendations. Rate of screening rose gradually between 2008 and 2011, especially after introduction of EACS guidelines in 2009 (Table 1 and Fig 1). The maximal screening rate was in 2011, with 44% of patients tested among the general HIV population and 57% among MSM bisexual patients. This trend was statistically significant in both populations (p

Purpose of the study: Introduction of highly active antiretroviral therapy (HAART) has led to an improvement of life expectancy and quality of life in patients living with HIV. Concomitantly, concerns are arising about long-term side effects of chronic use of antiretroviral therapy. Avascular necrosis of the femoral head (ANFH) and other epiphyses is increasingly reported as one of these debilitating complications. The objective of this study is to analyse clinical characteristics and outcome of patients with avascular necrosis (AN) followed in our centre. Patients and methods: We analysed retrospectively the charts of 1020 HIV-1 infected patients followed in our centre and focused on symptomatic patients with radiologicaly proven AN. We analysed risk factors, demographic and clinical characteristics, treatment and outcome in these patients. Summary of results: Ten patients with AN were identified (prevalence of 0.98%). The average interval between HIV diagnosis and diagnosis of AN was 89.1 months (1-254). Four patients had no evidence of risk factors (40%) whereas 6 (60%) had at least one risk factor. One patient had three cumulated risk factors and for him the onset time for AN was shorter (36 months). All patients had been treated by antiretroviral therapy when AN was diagnosed, but one of the patients developed symptoms prior to start of antiretroviral treatment. All classes of antiretroviral drugs have been used: protease inhibitors (mean use duration of 34.7 months before the ONFH onset), non-nucleoside reverse transcriptase inhibitors (12 months), and nucleoside reverse transcriptase inhibitors (40.5 months). ANFH was unilateral in 4 patients and bilateral in 6 patients. In one of these 6 cases, multiple AN locations were present (table). In eight patients, total hip arthroplasty (THA) (88.8%) was the definitive treatment. Diagnosis of ANFH in the two patients who were not operated is very recent (5 and 13 months) but surgery is already indicated. The average interval between ANFH diagnosis and the first THA was 10.5 months. Conclusion: AN, and particularly ANFH, is a rare but debilitating complication in HIV-1 infected patients. The role of ARV in the pathogenesis of AN remains unclear. However, classical risk factors play an essential role and accumulation of several risk factors could shorten the time before onset of AN. In the presence of advanced disease (stage III-IV) the final treatment remains arthroplasty. (Published: 11 November 2012) Citation: Abstracts of the Eleventh International Congress on Drug Therapy in HIV Infection Wilmes D et al. Journal of the International AIDS Society 2012, 15 (Suppl 4):18325 http://www.jiasociety.org/index.php/jias/article/view/18325 | http://dx.doi.org/10.7448/IAS.15.6.18325