Time taken to undetectable viral load, following the initiation of HAART

The notes of all HIV patients in Sheffield, registered at the Department of Genitourinary Medicine at the Royal Hallamshire Hospital, who had initiated HAART in 2005 and 2006, were audited. The aim was to determine what percentage of these patients acquired an undetectable viral load within 24 weeks and whether this was greater than 75% in accordance with the BHIVA guidelines. Twenty-nine (78.4%) of the 37 patients who were initiating treatment for the first time had an undetectable viral load after 24 weeks.

Improvement in the clinical cure rate of outpatient management of pelvic inflammatory disease following a change in therapy

OBJECTIVE

In the United Kingdom many genitourinary medicine clinics use oral doxycycline and metronidazole to treat pelvic inflammatory disease (PID). A retrospective case note review of PID treatment at our department in 2000 showed that the clinical cure rate (CCR) was only 55% with oral doxycycline and metronidazole for 2 weeks. We therefore added ceftriaxone 250 mg intramuscularly to the doxycycline and metronidazole for treating PID. We have repeated the review and compared the results with those from 2000.

METHODS

All patients diagnosed as having PID between 1 July 2002 and 31 December 2002 were identified. These episodes were diagnosed on clinical presentations of pelvic pain, vaginal discharge or bleeding, and cervical motion tenderness on physical examination. The CCR was defined as patients who fully resolved their symptoms and signs during 2 week and 4 week follow up. The results were compared with those from 2000.

RESULTS

Women receiving ceftriaxone, doxycycline, and metronidazole had a CCR of 72%. In 2000 the CCR for women receiving only doxycycline and metronidazole was 55%. There were only 8% non-responders in 2002 compared with 18% in 2000. Comparing CCR and non-response rate, in 2002 there was a significant improvement in cure rate, OR 3.01 (95% CI 1.28 to 7.47) p = 0.009. Using an intent to treat analysis and including the defaulters as treatment failures there was still a significant improvement in cure rate, OR 2.03 (95% CI 1.18 to 3.50) p = 0.009.

CONCLUSIONS

The treatment of PID with ceftriaxone, doxycycline, and metronidazole gave a significantly higher CCR than doxycycline and metronidazole. Our experience would suggest that doxycycline and metronidazole alone is not a suitable regimen for treatment of PID in the United Kingdom.

Systemic lupus erythematosus or infection with HIV, or both?

The features of both HIV infection and connective tissue disease are often nonspecific and may mimic other disorders as well as each other. We treated a patient with presumed systemic lupus erythematosus (SLE) for 4 years, who finally admitted to longstanding infection with HIV. The coexistence of SLE and HIV is unusual and has, although reported in the rheumatological journals, not often been discussed in the dermatological literature.

An audit of baseline assessment of patients with HIV infection

A multicentre retrospective medical audit was conducted on the baseline investigations of new patients with HIV infection. A total of 20 investigations were audited for men and 21 for women. Data were received on 49 newly diagnosed patients infected with HIV from 8 centres in the Yorkshire region. The audit demonstrated that half of the patients were not screened for sexually transmitted infections. However, the majority of baseline assessment considered as standard of care, had been performed.