The prevalence of HIV/ESRF increased during the HAART era to reach nearly 1% in black patients, in whom favourable survival rates were observed. Earlier HIV diagnosis will be an important strategy to stem the rising trend of HIV/ESRF.

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The HIV-infected population is ageing. Issues including polypharmacy and co-morbidities led us to develop a dedicated clinic for HIV-infected individuals over 50. We describe our service evaluation after two years. The over 50 clinic commenced in January 2009. The team comprises a registrar, consultant, nurse practitioner and is supported by a pharmacist and mental health services. Patients undergo a full medication and drug interactions review, neurocognitive assessment, adherence self-assessment and investigations including therapeutic drug monitoring (TDM), coronary artery calcium scores (CACS) and bone mineral density. Over two years of activity, 150 patients attended the service. Median (range) age was 58 (50-88), all were on combined antiretroviral therapy and 38% (57/150) were on ≥3 non-HIV drugs. CACS was high (>90th centile) in 14%. Thirty-eight percent had osteopaenia and 18% had osteoporosis requiring treatment. Thirteen out of 125 men had an increased prostate specific antigen, four were diagnosed with prostate cancer. Drug interaction, TDM and neurocognitive assessments were useful for several patients. Asymptomatic patients over 50 in long-term follow-up had new pathologies detected through targeted screening. The clinic has improved general practitioner (GP) liaison and facilitated closer working relationships with other specialties. Patients have reacted positively to the clinic, particularly as many do not routinely access their GP.

The aim of the study was to examine the service use and characteristics of young people diagnosed with HIV infection aged under 25 years in order to design appropriate services. MethodsA retrospective review of medical records of all individuals diagnosed as HIV positive aged under 25 years at Chelsea and Westminster Hospital, London, UK was carried out. The Health Protection Agency traced all individuals who had been lost to follow-up. We collected demographic, clinical, social and behavioural data. ResultsOf the 100 individuals diagnosed as HIV positive aged <25 years, 91% acquired HIV sexually; the median age at diagnosis was 21 years. Fifty-nine per cent were born outside the UK. Of 91 individuals diagnosed in the UK, 20% were diagnosed outside genitourinary medicine. Almost half had tested HIV negative a median of 13 months previously. At HIV diagnosis, 26% had a concurrent sexually transmitted infection; thereafter 34% had a documented risk of HIV transmission. The prevalence of psychiatric comorbidity was high (23%). Cervical screening rates were low; of nine women screened, five required treatment for cervical or vulval neoplasia. One fifth of the cohort were lost to follow-up a median 6 months from diagnosis. ConclusionsYoung people with sexually acquired HIV infection have complex medical and psychosocial needs and many disengage from health services. Current services are not meeting the needs of these young people. Specialist young people's clinics may improve standards of care for this vulnerable group.

Research and development of HIV entry inhibitors is ongoing and provides new classes of drug that can be used in the treatment of HIV. Clinical trials will soon commence to assess the benefit of CCR5 antagonists in immune reconstitution and other therapeutic uses.