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Dolutegravir (DTG) is the third HIV integrase inhibitor (INI) available for prescription in Belfast since July 2014. It has shown high virological efficacy in both treatment-naïve and -experienced patients. We carried out a retrospective case chart analysis of HIV-1-positive adults commenced on DTG between July 2014 and September 2015. Patients were identified from records as either treatment-naïve or antiretroviral therapy (ART) experienced. Outcomes included: (1) virological response (HIV-1 RNA viral load at 0, 4, 8 and 12 weeks), (2) immunological response (CD4+ cell count at 0, 4, 8 and 12 weeks) and (3) tolerability (side effects and discontinuation). The main exclusion criteria were patients transferring care already established on DTG from other treatment centres or inadequate follow-up information (defined as attendance at Q25−196,413Q75); 73% were virally undetectable (HIV-1 RNA VL Q25−43,467Q75]), 10 were detectable after four weeks. For those with a recordable viraemia, the median HIV-1 VL reduced to 376 (220Q25−1181Q75). At week 12, four patients were detectable with a median VL of 12,390 (567Q25−52,285Q75). Overall, 56 (35%) reported side effects; 40 (25%) reported either difficulty with low mood, anxiety or sleep disturbance. Sixteen (10%) discontinued DTG, with 13 (8%) due to intolerable side effects. DTG is a useful drug in naïve or switch patients. It has the potential to effectively suppress the viral load within the first four weeks of treatment and thus reduces infectiousness. Within the cohort, DTG was generally well tolerated but side effects such as low mood, anxiety and sleep disturbance were high, with 8% of patients discontinuing treatment.

Summary Household contacts of hepatitis B (HBV) are at risk of infection, and guidelines advise vaccination of these contacts in addition to sexual partners (along with traditional high-risk groups). We present a case of intrafamilial transmission of acute hepatitis B virus (HBV) following failure to self-disclose status to family members. Complex confidentiality issues can arise following a diagnosis of HBV infection.

HIV-1 infection may persist in the central nervous system (CNS) despite antiretroviral therapy. We present a case of severe cognitive decline in a man with HIV-1 infection on a fully active regimen for five years. All infective causes were excluded. Despite fully suppressed virus in the blood, HIV RNA in the cerebrospinal fluid measured 3.52 log10 RNA copies/mL and genotyping of this sample showed an extensive pattern of resistance. This suggested that either the antiretroviral agents were not adequately penetrating the CNS or the CNS had resistant virus as a result of adherence problems. This case highlights the possibility that drug-resistant mutations may develop in the CNS compartment while plasma virus remains suppressed.

Premature ejaculation (PE) is the most common male sexual problem worldwide affecting 22–38% of men. It has a significant morbidity both on patients and their partners, causing distress, anxiety and relationship difficulties. The mainstay of treatment is a combined approach using behavioural therapies and non-licensed medication such as topical anaesthetic preparations, selective serotonin re-uptake inhibitors and phosphodiesterase-5 inhibitors. In recent years, there has been a greater emphasis placed on researching novel treatments and exploring the on-demand use of current preparations. This review provides an overview of current accepted treatments and emerging agents for the use in PE.

Co-infection with HIV-1 and -2 is rare, even in west Africa. We present the case of a 38-year-old pregnant Jehovah's Witness presenting late in pregnancy with triple infection with HIV-1, HIV-2 and hepatitis B virus. There was a successful outcome in averting vertical transmission despite objections to management based on religious and cultural beliefs.

The British HIV Association (BHIVA) has published guidelines for immunization of HIV-infected adults. A chart review of 200 HIV-infected patients diagnosed was conducted to determine shortcomings in previous practice and determine which vaccines should routinely be given in specialist HIV clinics and which might be able to be delegated to primary care clinics. Data were collected on administration of three categories of vaccinations: (1) vaccines used in all individuals with chronic disease (pneumococcal, influenza, swine flu H1N1); (2) targeted vaccinations used in non-immune individuals with HIV who are at risk of exposure (hepatitis A and hepatitis B); (3) routine vaccines traditionally delivered to the whole population (measles/mumps/rubella [MMR], diphtheria/tetanus/pertussis and meningitis C/ACWY). Pneumococcal vaccine was delivered to 54% of eligible patients, 52% of eligible individuals completed a full hepatitis B programme of vaccination and 21% (42/200) were naturally immune; hepatitis A vaccine was delivered to 36% of eligible individuals. With increasing demands on resources, it seems likely that HIV services will have to harness resources of primary care in vaccine programmes in relation to routine vaccines. By improving communication between primary and secondary care mistakes with live vaccination decisions could be avoided; HIV services should continue to perform targeted and chronic disease vaccines, i.e. for category 1 and category 2 vaccines.

An audit of 72 patients presenting for post-exposure prophylaxis following sexual exposure (PEPSE) to HIV (68 genitourinary medicine and 4 accident & emergency) was conducted from 2003 to 2009. The principal indications for PEPSE included 27 (38%) unprotected intercourse (15/27 vaginal and 12/27 anal) with a known HIV-positive partner, 20 (28%) unprotected receptive anal sex with male partner of unknown status, 17 (24%) following sexual assault and three (4%) unprotected sex with a partner from an endemic country. Of those who commenced PEPSE, 92% did so within the recommended 72 hours. Concurrent sexually transmitted infection (STI) was diagnosed in 8.3% patients (6.9% non-gonococcal urethritis and 1.4% rectal chlamydia). Fifty (69%) patients attended for follow-up and only 8% of these did not complete treatment. Twenty-five (35%) patients attended for repeat serology at three months and 18 (25%) at six months. All of the patients followed up remained HIV-negative.

HIV-positive men are commonly prescribed phosphodiesterase-5 (PDE5) inhibitors for erectile dysfunction (ED). When prescribing, consideration should be given to possible onward transmission of HIV, which is enhanced by the presence of other sexually transmitted infections (STIs).1–3 We were unable to find any reports of STI acquisition in men with HIV using PDE5 inhibitors. The aim was to audit the management of ED within our HIV cohort in Belfast according to British Society of Sexual Medicine guidelines.4 Documentation of STI diagnoses and safer sex discussion was also reviewed in …