SummaryWe examined how HLA types A1-B8-DR3 and B27 were related to progression of clinical disease and rate of loss of CD4 lymphocytes in the Edinburgh City Hospital cohort of HIV-positive patients, mainly injection drug users. Patients (n = 692) were prospectively followed from 1985 through March 1994. Accurately estimated seroconversion times were determined retrospectively for a subgroup of 313 (45%). Of 262 patients (39%) who were fully or partially HLA typed, 155 (50%) had known seroconversions. Of 34 patients typed positive for A1-B8-DR3, 29 progressed to CDC stage IV, 22 to AIDS and 20 died. Twelve patients were typed positive for B27; six of these progressed to CDC stage IV, one to AIDS and none died. In a proportional hazards analysis of the 313 patients with known seroconversions, A1-B8-DR3 was significantly associated with covariate-adjusted relative risks of 3.7 (95% Cl 1.9-7.2), 3.1 (1.6-6.0) and 1.9 (1.1-3.2) for progression from seroconversion to death, AIDS and CDC stage IV, respectively. Events for B27 were too rare to include B27 in analyses to death and AIDS, but B27 was significantly associated with slower progression to CDC stage IV (0.3, Cl 0.1 -0.9). Random effects growth curve models were used to estimate individual rates of loss of square root CD4 count and loss of CD4 percentage, for 603 and 617 patients, respectively. A1-B8-DR3 was associated with rapid loss of both markers ( p = 0 . 0 2 and p = 0.01, respectively); B27 was associated with slow loss of both markers ( p = 0 . 0 4 and p< 0.005).

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During 1985 many drug abusers who lived in Edinburgh were found to be infected with the human immunodeficiency virus (HIV). As a result an alternative counselling and screening clinic for testing for antibodies to HIV was established for use by drug abusers. Four hundred and forty one patients were counselled in the first year, and over 60% were either drug abusers or their sexual contacts. One hundred and fourteen (26%) patients were positive for HIV antibody, and 100 (88%) ofthese were current or former drug abusers. The HIV seropositivity rate in drug abusers was 52% but was only 7% in their sexual contacts. Services were provided for these people as well as counselling before and after the test. The cost of this counselling service for the first year was £27 000 or £61.22 per patient.The unexpected mobility of 23% of the Edinburgh drug abusers, particularly to other areas of Britain, suggests that similar services need to be set up elsewhere.City Hospital, Edinburgh EH10 5SB R P BRETTLE, FRCP, consultant physician, infectious disease unit K BISSET, MB, CHB, medical officer, city screening clinic S BURNS, MB, CHB, senior registrar and counsellor, regional virus laboratory and city screening clinic J DAVIDSON, MB, CHB, medical officer, city screening clinic S J DAVIDSON, SRN, SCM, counsellor, city screening clinic J M N GRAY, RGN, SCM, counsellor, city screening clinic J M INGLIS, MRCPATH, top grade virologist, regional virus laboratory J S LEES, MB, CHB, medical officer, city screening clinic J MOK, MD, MRCP, consultant, community child health Correspondence to: Dr Brettle.