People aged 15 to 59 years seen at HIV services in the UK, expressed as a rate per 1,000 population.Data is presented by area of residence, and exclude people diagnosed with HIV in England who are resident in Wales, Scotland, Northern Ireland or abroad.RationaleThe geographical distribution of people seen for HIV care and treatment is not uniform across or within regions in England. Knowledge of local diagnosed HIV prevalence and identification of local risk groups can be used to help direct resources for HIV prevention and treatment.In 2008, http://www.bhiva.org/HIV-testing-guidelines.aspx recommended that Local Authority and NHS bodies consider implementing routine HIV testing for all general medical admissions as well as new registrants in primary care where the diagnosed HIV prevalence exceeds 2 in 1,000 population aged 15 to 59 years.In 2017, guidelines were updated by https://www.nice.org.uk/guidance/NG60 which is co-badged with Public Health England. This guidance continues to define high HIV prevalence local authorities as those with a diagnosed HIV prevalence of between 2 and 5 per 1,000 and extremely high prevalence local authorities as those with a diagnosed HIV prevalence of 5 or more per 1,000 people aged 15 to 59 years.When this is applied to national late HIV diagnosis data, it shows that two-thirds of late HIV diagnoses occur in high-prevalence and extremely-high-prevalence local authorities. This means that if this recommendation is successfully applied in high and extremely-high-prevalence areas, it could potentially affect two-thirds of late diagnoses nationally.Local authorities should find out their diagnosed prevalence published in UKHSA's http://fingertips.phe.org.uk/profile/sexualhealth , as well as that of surrounding areas and adapt their strategy for HIV testing using the national guidelines.Commissioners can use these data to plan and ensure access to comprehensive and specialist local HIV care and treatment for HIV diagnosed individuals according to the http://www.medfash.org.uk/uploads/files/p17abl6hvc4p71ovpkr81ugsh60v.pdf and http://www.bhiva.org/monitoring-guidelines.aspx .Definition of numeratorThe number of people (aged 15 to 59 years) living with a diagnosed HIV infection and accessing HIV care at an NHS service in the UK and who are resident in England.Definition of denominatorResident population aged 15 to 59.The denominators for 2011 to 2023 are taken from the respective 2011 to 2023 Office for National Statistics (ONS) revised population estimates from the 2021 Census.Further details on the ONS census are available from the https://www.ons.gov.uk/census .CaveatsData is presented by geographical area of residence. Where data on residence were unavailable, residence have been assigned to the local health area of care.Every effort is made to ensure accuracy and completeness of the data, including web-based reporting with integrated checks on data quality. The overall data quality is high as the dataset is used for commissioning purposes and for the national allocation of funding. However, responsibility for the accuracy and completeness of data lies with the reporting service.Data is as reported but rely on ‘record linkage’ to integrate data and ‘de-duplication’ to prevent double counting of the same individual. The data may not be representative in areas where residence information is not known for a significant proportion of people accessing HIV care.Data supplied for previous years are updated on an annual basis due to clinic or laboratory resubmissions and improvements to data cleaning. Data may therefore differ from previous publications.Values are benchmarked against set thresholds and categorised into the following groups: <2 (low), 2 to 5 (high) and≥5 (extremely high). These have been determined by developments in national testing guidelines.The data reported in 2020 and 2021 is impacted by the reconfiguration of sexual health services during the national response to COVID-19.

The heterosexual risk group has become the largest HIV infected group in the United Kingdom during the last 10 years, but little is known of the network structure and dynamics of viral transmission in this group. The overwhelming majority of UK heterosexual infections are of non-B HIV subtypes, indicating viruses originating among immigrants from sub-Saharan Africa. The high rate of HIV evolution, combined with the availability of a very high density sample of viral sequences from routine clinical care has allowed the phylodynamics of the epidemic to be investigated for the first time. Sequences of the viral protease and partial reverse transcriptase coding regions from 11,071 patients infected with HIV of non-B subtypes were studied. Of these, 2774 were closely linked to at least one other sequence by nucleotide distance. Including the closest sequences from the global HIV database identified 296 individuals that were in UK-based groups of 3 or more individuals. There were a total of 8 UK-based clusters of 10 or more, comprising 143/2774 (5%) individuals, much lower than the figure of 25% obtained earlier for men who have sex with men (MSM). Sample dates were incorporated into relaxed clock phylogenetic analyses to estimate the dates of internal nodes. From the resulting time-resolved phylogenies, the internode lengths, used as estimates of maximum transmission intervals, had a median of 27 months overall, over twice as long as obtained for MSM (14 months), with only 2% of transmissions occurring in the first 6 months after infection. This phylodynamic analysis of non-B subtype HIV sequences representing over 40% of the estimated UK HIV-infected heterosexual population has revealed heterosexual HIV transmission in the UK is clustered, but on average in smaller groups and is transmitted with slower dynamics than among MSM. More effective intervention to restrict the epidemic may therefore be feasible, given effective diagnosis programmes.

BackgroundIn the UK, approximately 4,200 men who have sex with men (MSM) are living with HIV but remain undiagnosed. Maximising the number of high-risk people testing for HIV is key to ensuring prompt treatment and preventing onward infection. This study assessed how different HIV test characteristics affect the choice of testing option, including remote testing (HIV self-testing or HIV self-sampling), in the UK, a country with universal access to healthcare.Methods and findingsBetween 3 April and 11 May 2017, a cross-sectional online-questionnaire-based discrete choice experiment (DCE) was conducted in which respondents who expressed an interest in online material used by MSM were asked to imagine that they were at risk of HIV infection and to choose between different hypothetical HIV testing options, including the option not to test. A variety of different testing options with different defining characteristics were described so that the independent preference for each characteristic could be valued. The characteristics included where each test is taken, the sampling method, how the test is obtained, whether infections other than HIV are tested for, test accuracy, the cost of the test, the infection window period, and how long it takes to receive the test result. Participants were recruited and completed the instrument online, in order to include those not currently engaged with healthcare services. The main analysis was conducted using a latent class model (LCM), with results displayed as odds ratios (ORs) and probabilities. The ORs indicate the strength of preference for one characteristic relative to another (base) characteristic. In total, 620 respondents answered the DCE questions. Most respondents reported that they were white (93%) and were either gay or bisexual (99%). The LCM showed that there were 2 classes within the respondent sample that appeared to have different preferences for the testing options. The first group, which was likely to contain 86% of respondents, had a strong preference for face-to-face tests by healthcare professionals (HCPs) compared to remote testing (OR 6.4; 95% CI 5.6, 7.4) and viewed not testing as less preferable than remote testing (OR 0.10; 95% CI 0.09, 0.11). In the second group, which was likely to include 14% of participants, not testing was viewed as less desirable than remote testing (OR 0.56; 95% CI 0.53, 0.59) as were tests by HCPs compared to remote testing (OR 0.23; 95% CI 0.15, 0.36). In both classes, free remote tests instead of each test costing £30 was the test characteristic with the largest impact on the choice of testing option. Participants in the second group were more likely to have never previously tested and to be non-white than participants in the first group. The main study limitations were that the sample was recruited solely via social media, the study advert was viewed only by people expressing an interest in online material used by MSM, and the choices in the experiment were hypothetical rather than observed in the real world.ConclusionsOur results suggest that preferences in the context we examined are broadly dichotomous. One group, containing the majority of MSM, appears comfortable testing for HIV but prefers face-to-face testing by HCPs rather than remote testing. The other group is much smaller, but contains MSM who are more likely to be at high infection risk. For these people, the availability of remote testing has the potential to significantly increase net testing rates, particularly if provided for free.

Abstract copyright UK Data Service and data collection copyright owner. This cross-national study investigates the experiences, needs and resilience of children and young people caring for parents or relatives with HIV/AIDS (‘young carers’) in Tanzania and the UK. This study explores similarities and differences in the experiences of this hidden group of young carers. The study aimed to understand children’s everyday experiences of unpaid care work in families affected by HIV/AIDS; the push and pull factors influencing whether and why they take on care-giving tasks; the outcomes for children and families; the factors that can reduce children’s vulnerability to negative outcomes and promote their ‘resilience’; caring relationships within families; and how young carers can best be supported in terms of policy and social welfare practice. The study's child-focused methodology acknowledged children’s active roles in constructing their caring roles and the social determinants which influence these. Ninety-three semi-structured interviews were conducted with children and young people with caring responsibilities, parents/relatives with HIV and service providers supporting the families in Tanzania and the UK. Participatory methods were also used with the children, including drawings, written diaries and photographs. Further information on the study is available from the ESRC's award page. Main Topics: Children's and young people's everyday experiences of caring for a parent/relative with HIV/AIDS in Tanzania and the UK; resilience of children and young people and impacts of young caregiving and HIV/AIDS on individual children, the family, school and wider community in Tanzania and the UK; children's and parents'/relatives' experiences of Non-Governmental Orginisation (NGO) services and professional support in Tanzania and the UK; service providers' experiences of effective practices in supporting children caring for parents/relatives with HIV/AIDS in Tanzania and the UK; needs and requirements for support of young carers and their families. Purposive selection/case studies Face-to-face interview Telephone interview Diaries Focus group Life story books and drawings with children and young people,

BackgroundStrong evidence suggests that HIV self-testing is highly acceptable to cisgender gay, bisexual and other men who have sex with men (GBMSM), trans and gender diverse people in England and Wales, and that this novel technology can make a meaningful difference to HIV testing behaviours. HIV self-testing is feasible to deliver at large scale, can increase testing uptake and frequency without negatively impacting on linkage to care or testing for sexually transmitted infections (STIs). Question remain as to how best to deliver HIV self-testing in a way that responds to entrenched health inequalities. This Implementation action framework and tool-kit has been produced to facilitate and promote HIV self-testing service delivery in England and Wales with the key goal of improving health equity.MethodsTo produce this guidance, we synthesised key studies from England and Wales using the consolidated framework for implementation research as a structure. Evidence supporting innovative HIV self-testing implementation includes a large randomised controlled trial conducted in England and Wales (SELPHI) and extensive social science research conducted through the NIHR funded PANTHEON programme grant, PANTHEON 2 programme development grant, and the wider academic literature. Community and sexual health sectoral engagement shaped and refined our recommendations.Implementation action framework and tool-kitThe implementation context in England and Wales is favourable for HIV self-testing. Those planning services, or seeking funding to do so, can harness this context by emphasising the need to continue to expand testing to meet the goal of HIV elimination by 2030. Concerns around linkage to care and surveillance can be addressed by highlighting the importance of respecting patient choice and autonomy.This guidance establishes a standard level of support that should be provided with HIV self-testing interventions. This includes an optional result reporting system, clear information on linkage to care, inclusion of a helpline as well as clinical follow-up for those who report reactive HIV self-testing results but have not linked to care. Potential intervention adaptations which can address health inequalities between groups of GBMSM, trans and gender diverse people include innovative approaches to HIV self-testing kit delivery, additional tests (e.g. for bacterial STIs) that can be provided in interventions, demand generation activities and the provision of additional support for those requiring it, including the most marginalised.Within organisations, HIV self-testing champions can highlight the importance of implementing this new technology and ensure buy-in of key organisational actors. When implementing, organisations should define the broad intervention and the components that will accompany it and engage with potential beneficiaries to optimise proposed approaches. Early, formative evaluation can help refined interventions, and summative evaluation can demonstrate outcomes to commissioners.Examples of best practice include trial infrastructure developed during the SELPHI RCT of HIV self-testing, intervention approaches from SH:24 and the Terrence Higgins Trust and advertising used during the English National HIV testing week campaign.ConclusionThis framework will be an invaluable resource for those seeking to plan and implement HIV self-testing among GBMSM, trans and gender diverse people in England and Wales. This guidance is not meant to be prescriptive, but rather provides an implementation roadmap detailing innovative approaches, and the evidence underpinning them, that can be used to improve health equity among the most marginalised.

Maraviroc (UK-427,857), a selective and reversible CCR5 coreceptor antagonist, has been shown to be active in vitro against a wide range of clinical isolates (including those resistant to existing classes). In HIV-1 infected patients, maraviroc (UK-427,857) given as monotherapy for 10 days reduced HIV-1 viral load by up to 1.6 log, consistent with currently available agents. Safety and toleration have been studied in over 400 subjects for up to 28 days at 300 mg twice daily. No significant effects were seen on the QTc interval. The purpose of this study is to evaluate the antiretroviral activity of maraviroc (UK-427,857) in HIV infected, treatment experienced patients who are failing their current antiretroviral regimen and infected with R5-tropic virus exclusively. This study will involve more than 100 centers in Europe and Australia to achieve a total randomized subject population of 500 subjects. Patients will be randomly (2:2:1) assigned to one of three groups: Optimized Background Therapy [OBT (3-6 drugs based on treatment history and resistance testing)] + maraviroc (UK-427,857) 150 mg taken once daily, OBT + maraviroc (UK-427,857) 150 mg taken twice daily, or OBT alone. The study will enroll over approximately a 9 month period with 48 weeks of treatment. This may be extended for an additional year depending on the results at 48 weeks. Physical examinations will be performed at study entry, weeks 4, 8, 12, 16, 20, 24, 32, 40 and 48. Blood samples will also be taken at study entry, weeks 2, 4, 8, 12, 16, 20, 24, 32, 40 and 48. Additionally, blood samples will be drawn twice, at least 30 minutes apart, at weeks 2 and 24 for maraviroc (UK-427,857) pharmacokinetic analysis. As part of this clinical study a blood sample will also be taken for non-anonymized pharmacogenetic analysis. Patients will undergo a 12-lead electrocardiogram at study entry, weeks 24 and 48.

All diagnoses of first episode genital herpes among people accessing sexual health services* in England who are also residents in England, expressed as a rate per 100,000 population. Data is presented by area of patient residence and include those residents in England and those with an unknown residence (data for those residents outside of England is not included).*Sexual health services providing STI related care (Levels 2 and 3). Further details on the levels of sexual healthcare provision are provided in the https://www.bashh.org/about-bashh/publications/standards-for-the-management-of-stis/ .RationaleGenital herpes is the most common ulcerative sexually transmitted infection seen in England. Infections are frequently due to herpes simplex virus (HSV) type 2, although HSV-1 infection is also seen. Recurrent infections are common with patients returning for treatment.Definition of numeratorThe number of diagnoses of genital herpes (first episode) among people accessing sexual health services in England who are also residents in England.Episode Activity codes (SNOMED or Sexual Health and HIV Activity Property Types (SHHAPT)) relating to diagnosis of genital herpes (first episode) were used. The clinical criteria used to diagnose the conditions are given at https://www.bashh.org/guidelines .Data was de-duplicated to ensure that a patient received a diagnostic code only once for each episode. Patients cannot be tracked between services and therefore de-duplication relies on patient consultations at a single service.Definition of denominatorThe denominators for 2012 to 2022 are sourced from Office for National Statistics (ONS) population estimates based on the 2021 Census.Population estimates for 2023 were not available at the time of publication – therefore rates for 2023 are calculated using estimates from 2022 as a proxy.Further details on the ONS census are available from the https://www.ons.gov.uk/census .CaveatsEvery effort is made to ensure accuracy and completeness of GUMCAD data, including web-based reporting with integrated checks on data quality. However, responsibility for the accuracy and completeness of data lies with the reporting service.Data is updated on an annual basis due to clinic or laboratory resubmissions and improvements to data cleaning. Data may differ from previous publications.Figures reported in 2020 and 2021 are notably lower than previous years due to the disruption to SHSs during the national response to the COVID-19 pandemic.

Abstract copyright UK Data Service and data collection copyright owner.NHS Health Scotland is the national agency for health education in Scotland, providing leadership for health promotion in Scotland. Its remit includes:educational action to strengthen individuals' knowledge, skills and capabilitiesbuilding the capacities of systems which shape the social, environmental and economic conditions which create and sustain healthNHS Health Scotland is also committed to measuring the effectiveness of its activities and commissions research to provide reliable evaluation evidence and to inform the development of programmes. As part of this research programme, BMRB Social Research were commissioned to conduct the first Health Education Population Survey (HEPS) every March and September from March 1996 until March 1999 (seven waves in total). The resulting data, covering all three years, are held at the UK Data Archive as a single study under SN 4949. The second and following HEPS surveys were then conducted every March and September until September 2005 (ten waves in total), with two waves comprising each yearly dataset (see SNs 4950-4952, 5202 and 5470). Fieldwork was then commissioned for a further four waves, with waves eleven and twelve (conducted January-April and August-December 2006) comprising the 2006 dataset, held under SN 5713. These were followed by waves thirteen and fourteen (conducted January-April and August-November 2007) and are held under SN 6023. The main objectives of HEPS are as follows:to monitor trends in health-related attitudes, knowledge, beliefs and behaviours, and to assess the impacts of specific activitiescontribute to planning and development of health promotion initiatives through the inclusion of more detailed modules on topical issuesIn the longer term, HEPS aims to develop a strategic view of how and where health promotion activity may be most effective. This can be achieved in the following ways:identifying levels of knowledge regarding the main causes of ill-healthidentifying salient attitudes with respect to health and means of improving healthidentifying levels of motivation with respect to behaviour change to improve healthdeveloping an understanding of how such indicators may be expected to vary between different population groupsdeveloping an understanding of individual patterns of health-related attitudes and behaviour and their relationship to the broader socio-cultural environmentdeveloping an understanding of specific areas of interest Further information and links to publications based on HEPS may be found by search on the healthscotland.com web site. Main Topics: This dataset contains the data collected during HEPS waves 5 and 6, comprising the 2003 HEPS. The following topics were covered in the questionnaire: general health (including GHQ12); diseases; nutrition; breastfeeding; physical activity; alcohol; smoking; oral health; accidents and safety; social capital; sexual health and relationships; HIV/AIDS; and drugs. One-stage cluster sample

Abstract copyright UK Data Service and data collection copyright owner. The aims and objectives of this survey were to: Describe the experience of and attitudes towards the care of people with AIDS or related conditions; describe the social context in which requirements of health care are negotiated; look at the continuity of care between hospital and community; describe balance of care between professional and lay carers; describe views and perceptions of care of patients and formal and informal carers; examine process of obtaining care; examine balance of care between hospital and community; look at social consequences of care received. Main Topics: Methodological issues in research; care of pwas; needs for health and social care of pwas; receiving a positive HIV antibody test; use of general practitioner services; care from the home support team; role of informal carers; role of the voluntary sector; symptoms of AIDS and their relief. No sampling (total universe) Face-to-face interview Identification of pwas through interviews with professionals based at two hospitals and two wards of the hospital and through home support team (HST). Questionnaire interviews with pwas, and follow-up 6-9 months later. Questionnaire interviews with all formal and informal carers, and follow-up for informal carers if pwa died (all specific patients). Additional general questionnaire for formal carers (informal carers nominated by pwas).

Q1.The makeup and qualifications of the panel members who sat on my appeal. Q2.Information if the panel members were in surgical practice in 1995 and whether they had specifical experience of Head trauma and Haematology. Q3. Were the panel members in practice dealing specifically with HIV and the cause and transmission of HIV. Q4. The number of approved applications after 2020 made to EIBSS for transmission of HIV infection via contaminated blood or blood products post 1985 Q5. What hours do the panel meeting meet e.g 9-3pm? and how much time do they have for lunch e.g. 30mins Q6.if the panel members, have at any time had any contact in either a personal or professional capacity with Mr Bracka or Dr Miller. Also, if they had any contact personal or professional with Dudley NHS Trust or Wordsley Hospital please describe when and in what capacity. Response I can confirm that the NHS Business Services Authority (NHSBSA) holds some of the information you have requested. Question 1 - The makeup and qualifications of the panel members who sat on my appeal. Under Section 21 of the FOIA we are not required to provide information in response to a request if it is already reasonably accessible to you. The information you requested is available at the following link: https://opendata.nhsbsa.net/dataset/foi-24399 Please see the following link to view the section 21 in full: https://www.legislation.gov.uk/ukpga/2000/36/section/21 Question 2 - Information if the panel members were in surgical practice in 1995 and whether they had specifical experience of Head trauma and Haematology I am writing to advise you that following a search of our paper and electronic records, I have established that the information you requested is not held by the NHSBSA. To answer this question, information would need to be provided by panel members from memory, rather than relying on recorded information. Question 3 - Were the panel members in practice dealing specifically with HIV and the cause and transmission of HIV I am writing to advise you that following a search of our paper and electronic records, I have established that the information you requested is not held by the NHSBSA. To answer this question, information would need to be provided by panel members from memory, rather than relying on recorded information. Question 4 - The number of approved applications after 2020 made to EIBSS for transmission of HIV infection via contaminated blood or blood products post 1985 I am writing to advise you that following a search of our paper and electronic records, I have established that the information you requested is not held by the NHSBSA. The England Infected Blood Support Scheme (EIBSS) does not retain the infection date of beneficiaries on the scheme, however we would highlight that the service specification notes: "all NHS blood in England was being screened for HIV from October 1985 onwards so it is very unlikely (although not impossible) that HIV was transmitted through infected NHS blood after October 1985.” So, while it is "very unlikely" for an infection post October 1985, it is not impossible, thus our medical assessors base their decision on the balance of probabilities that an infection could take place via NHS blood or blood products post 1985. This is determined by a combination of the application and all supporting evidence provided which the medical assessors will review. Question 5 - What hours do the panel meeting meet e.g 9-3pm? and how much time do they have for lunch e.g. 30mins I am writing to advise you that following a search of our paper and electronic records, I have established that the information you requested is not held by the NHSBSA regarding length of meetings or breaks Question 6 - if the panel members, have at any time had any contact in either a personal or professional capacity with Mr Bracka or Dr Miller. Also, if they had any contact personal or professional with Dudley NHS Trust or Wordsley Hospital please describe when and in what capacity. I am writing to advise you that following a search of our paper and electronic records, I have established that the information you requested is not held by the NHSBSA. To answer this question, information would need to be provided by panel members from memory, rather than relying on recorded information. Data Queries Please contact foirequests@nhsbsa.nhs.uk ensuring you quote the above reference if you have any specific questions regarding this response; or, if you feel you may be misunderstanding or misinterpreting the information; or, if you plan on publishing the data.

IntroductionPeople living with HIV (PLWH) now have near-normal life-expectancy, but still experience stigma, and HIV status is treated as sensitive health information. When UK healthcare patient data is curated into anonymised datasets for research, HIV diagnostic codes are stripped out. As PLWH age, we must research how HIV affects conditions of ageing, but cannot do so in current NHS research datasets. We aimed to elicit views on HIV status being shared in NHS datasets, and identify appropriate safeguards.MethodsWe conducted three focus groups with a convenience sample of PLWH recruited through HIV charities, presenting information on data governance, data-sharing, patient privacy, law, and research areas envisaged for HIV and ageing. Each focus group involved two presentations, a question session, and facilitated breakout discussion groups. Discussions were audio-recorded, transcribed and analysed thematically.Results37 PLWH (age range 23-58y) took part. The overarching theme was around trust, both the loss of trust experienced by participants due to previous negative or discriminatory experiences, and the need to slowly build trust in data-sharing initiatives. Further themes showed that participants were supportive of data being used for research and health care improvements, but needed a guarantee that their privacy would be protected. A loss of trust in systems and organisations using the data, suspicion of data users’ agendas, and worry about increased discrimination and stigmatisation made them cautious about data sharing. To rebuild trust participants wanted to see transparent security protocols, accountability for following these, and communication about data flows and uses, as well as awareness training about HIV, and clear involvement of PLWH as full stakeholders on project teams and decision-making panels.ConclusionsPLWH were cautiously in favour of their data being shared for research into HIV, where this could be undertaken with high levels of security, and the close involvement of PLWH to set research agendas and avoid increased stigma.

An estimated 32 million people live with HIV-1 globally. Combined antiretroviral therapy suppresses viral replication but therapy interruption results in viral rebound from a latent reservoir mainly found in memory CD4+ T cells. Treatment is therefore lifelong and not curative. Eradication of this viral reservoir requires hematopoietic stem cell transplantation from hemizygous or homozygous DCCR5 donors, which is not broadly applicable. Alternative cure strategies include the pharmacological reactivation of latently infected cells to promote their immune-mediated clearance, or the induction of deep latency. HIV-1 latency is multifactorial and linked to the activation status of the infected CD4+ T cell. Hence to perturb latency, multiple pathways need to be simultaneously targeted without affecting CD4+ T cell function. Hsp90 has been shown to regulate HIV-1 latency, although knowledge on the pathways is limited. Because Hsp90 promotes the proper folding of numerous cellular proteins required for HIV-1 gene expression, we hypothesized that Hsp90 might be a master regulator of latency. We tested this hypothesis using a polyclonal Jurkat cell model of latency and ex-vivo latently infected primary CD4+ T cells. We found that, in the Jurkat model, Hsp90 is required for HIV-1 reactivation mediated by the T-cell receptor, phorbol esters, TNF-a, inhibition of FOXO-1, and agonists of TLR-7 and TLR-8. In primary cells, Hsp90 regulated HIV-1 gene expression induced by stimulation the T-cell receptor or in the presence of IL-7/IL-15 or a FOXO-1 inhibitor. Chemical inhibition of Hsp90 abrogated activation of the NF-kB, NFAT and AP-1 signal transduction pathways. Within the CD4+ T cell population, CDRA45+ CCR7+ “naïve” and CD45RA- CCR7- “effector memory” cells were most sensitive to Hsp90 inhibition, which did not perturb their phenotype or activation state. Our results indicate that Hsp90 is a master regulator of HIV-1 latency that can potentially be targeted in cure strategies

All infectious syphilis (primary, secondary and early latent) diagnoses among people accessing sexual health services* in England who are also residents in England, expressed as a rate per 100,000 population. Data is presented by area of patient residence and includes those residents in England and those with an unknown residence (data for those residents outside of England is not included).*Sexual health services providing STI related care (Levels 2 and 3). Further details on the levels of sexual healthcare provision are provided in the https://www.bashh.org/about-bashh/publications/standards-for-the-management-of-stis/ .RationaleSyphilis is an important public health issue in men who have sex with men (MSM) among whom incidence has increased over the past decade.Definition of numeratorThe number of infectious syphilis (primary, secondary and early latent) diagnoses among people accessing sexual health services in England who are also residents in England.Episode Activity codes (SNOMED or Sexual Health and HIV Activity Property Types (SHHAPT)) relating to diagnosis of infectious syphilis (primary, secondary and early latent) were used. The clinical criteria used to diagnose the conditions are given at https://www.bashh.org/guidelines .Data was de-duplicated to ensure that a patient received a diagnostic code only once for each episode. Patients cannot be tracked between clinics and therefore de-duplication relies on patient consultations at a single service.Definition of denominatorThe denominators for 2012 to 2022 are sourced from Office for National Statistics (ONS) population estimates based on the 2021 Census.Population estimates for 2023 were not available at the time of publication – therefore rates for 2023 are calculated using estimates from 2022 as a proxy.Further details on the ONS census are available from the https://www.ons.gov.uk/census .CaveatsEvery effort is made to ensure accuracy and completeness of GUMCAD data, including web-based reporting with integrated checks on data quality. However, responsibility for the accuracy and completeness of data lies with the reporting service.Data is updated on an annual basis due to clinic or laboratory resubmissions and improvements to data cleaning. Data may differ from previous publications.Figures reported in 2020 and 2021 are notably lower than previous years due to the disruption to SHSs during the national response to the COVID-19 pandemic.

T cell receptor sequence data of 26 people living with HIV on long-term anti-retroviral therapy, and 12 HIV-negative healthy controls, produced using the UCL Chain lab protocol. All participants were Caucasian male adults recruited from London, UK. People living with HIV were on anti-retroviral therapy for a median of 8.5 years (interquartile range 3-16 years). They had undetectable plasma HIV viral load (<40 copies/ml) and median circulating CD4 counts of 703 cells/microliter (interquartile range 491-841 cells/microliter).Details of the study are provided in Turner et al, Front Immunol 2021 (10.3389/fimmu.2021.634489).The processed data files were generated using Demultiplexor, Decombinator and Collapsinator modules v3.1 (https://github.com/JamieHeather/Decombinator) and CDR3translator module v4 (https://github.com/innate2adaptive/Decombinator).The raw data files are available at the NCBI Sequence Read Archive, accession number PRJNA613091.

Broadly neutralising antibodies (bNAbs) targeting HIV show promise for both prevention of infection and treatment. Among these, 10-1074 has shown potential in neutralising a wide range of HIV strains. However, resistant viruses may limit the clinical efficacy of 10-1074. The prevalence of both de novo and emergent 10-1074 resistance will determine its use at a population level both to protect against HIV transmission and as an option for treatment. To help understand this further, we report the prevalence of pre-existing mutations associated with 10-1074 resistance in a bNAb-naive population of 157 individuals presenting to UK HIV centres with primary HIV infection, predominantly B clade, receiving antiretroviral treatment. Single genome analysis of HIV proviral envelope sequences showed that 29% of participants’ viruses tested had at least one sequence with 10-1074 resistance-associated mutations. Mutations interfering with the glycan binding site at HIV Env position 332 accounted for 95% of all observed mutations. Subsequent analysis of a larger historic dataset of 2425 B-clade envelope sequences sampled from 1983 to 2019 revealed an increase of these mutations within the population over time. Clinical studies have shown that the presence of pre-existing bNAb mutations may predict diminished therapeutic effectiveness of 10-1074. Therefore, we emphasise the importance of screening for these mutations before initiating 10-1074 therapy, and to consider the implications of pre-existing resistance when designing prevention strategies.

Adhering to HIV treatment everyday for the rest of your life is difficult. This may be particularly acute for an adolescent coming to terms with their HIV status and managing the challenges of growing up with HIV. This qualitative study focused on the lived experience of HIV treatment adherence for adolescents in Uganda (aged 10-24) taking part in an international clinical trial. Our research explored the acceptability of short cycle therapy (SCT), 5 days on HIV treatment and 2 days off, to the trial participants' themselves. This involved conducted qualitative longitudinal data with young people participating in the trial and their carers using in-depth interviews, audio diaries and focus group discussions. Maintaining adherence to HIV treatment is critical to determining long-term health outcomes, yet presents specific challenges for young people which have yet to be qualitatively studied over time. This is a qualitative study investigating factors mediating adolescents’ adherence to Highly Active Anti-retroviral Therapy (HAART) in Uganda. This study was embedded within a funded, clinical trial to assess the acceptability of Short Cycle Therapy as an intervention to promote optimum adherence amongst young people. The study aimed to explore social context, barriers and facilitators to adherence amongst HIV positive adolescents in Uganda, the acceptability of Short Cycle Therapy and their experience of participating in an international clinical trial. This was of the first qualitative, social science, studies in Uganda to examine young people’s adherence experiences over time. The study is embedded within a ground-breaking international clinical trial, BREATHER, conducted by the Paediatric European Network for the Treatment of AIDS (PENTA) and Medical Research Council (MRC) in 12 countries including the UK, which is testing the efficacy of the short cycle therapy (five days on ART, two days off) as an adherence intervention in 160 young people. The study ran in parallel to a linked qualitative study among YPLHIV in the UK, recently funded by the National Institute of Health Research, and developed by the applicants. The qualitative study added significant value to the trial by examining whether this intervention is acceptable to young people and their carers in facilitating optimum adherence, which will be crucial to assessing whether this intervention can be successfully rolled out in resource-stretched settings, including nationally and regionally. This study provides much needed learning on the specific challenges young people face in adhering to treatment over time during the transition of adolescence. We also explored the varying experiences of this international trial from the perspectives of the young participants and their carers. This was a qualitative study. We conducted three repeat in-depth interviews with 26 trial participants over the duration of the trial (2011-2014) from both the SCT and control (continuous therapy) arms. These interview were conducted towards the start of the trial, during the second half of the trial and during the process of being moved into the follow-up stage of the trial. There were two other sites connected to this study (UK and USA), funding for which came from different sources. 43 young people were involved in total in the interviews. We adopted a purposive sampling approach to reflect the diversity of the trial population in terms of sex, age and ethnicity. Participants were also invited to keep an audio diary, however we found this to be very challenging in this setting as although enthusiastic participants were not confident that they could keep their diaries safe once recorded and so generally chose not to use them. We also invited young people to keep a written diary should they have wanted to. No participants took up this opportunity. With the permission of the young people, we conducted 15 interviews with a subsample of their carers. We adopted a theoretically informed approach to our carer sample to include a wide range of carer/s, including non-biological carers, and circumstances. We also conducted 4 focus group discussions (2015) with 24 young people after they had been notified of the trial results to explore their reactions and attitudes towards SCT being rolled-out more broadly. Of this 24, 18 had been involved in the qualitative interviews through the trial and 6 trial participants were also included who had not previously been involved.

HIV-associated sensory peripheral neuropathy (HIV-SN) afflicts approximately 50% of patients on antiretroviral therapy, and is associated with significant neuropathic pain. Simple accurate diagnostic instruments are required for clinical research and daily practice in both high- and low-resource setting. A 4-item clinical tool (CHANT: Clinical HIV-associated Neuropathy Tool) assessing symptoms (pain and numbness) and signs (ankle reflexes and vibration sense) was developed by selecting and combining the most accurate measurands from a deep phenotyping study of HIV positive people (Pain In Neuropathy Study–HIV-PINS). CHANT was alpha-tested in silico against the HIV-PINS dataset and then clinically validated and field-tested in HIV-positive cohorts in London, UK and Johannesburg, South Africa. The Utah Early Neuropathy Score (UENS) was used as the reference standard in both settings. In a second step, neuropathic pain in the presence of HIV-SN was assessed using the Douleur Neuropathique en 4 Questions (DN4)-interview and a body map. CHANT achieved high accuracy on alpha-testing with sensitivity and specificity of 82% and 90%, respectively. In 30 patients in London, CHANT diagnosed 43.3% (13/30) HIV-SN (66.7% with neuropathic pain); sensitivity = 100%, specificity = 85%, and likelihood ratio = 6.7 versus UENS, internal consistency = 0.88 (Cronbach alpha), average item-total correlation = 0.73 (Spearman’s Rho), and inter-tester concordance > 0.93 (Spearman’s Rho). In 50 patients in Johannesburg, CHANT diagnosed 66% (33/50) HIV-SN (78.8% neuropathic pain); sensitivity = 74.4%, specificity = 85.7%, and likelihood ratio = 5.29 versus UENS. A positive CHANT score markedly increased of pre- to post-test clinical certainty of HIV-SN from 43% to 83% in London, and from 66% to 92% in Johannesburg. In conclusion, a combination of four easily and quickly assessed clinical items can be used to accurately diagnose HIV-SN. DN4-interview used in the context of bilateral feet pain can be used to identify those with neuropathic pain.

Abstract copyright UK Data Service and data collection copyright owner.NHS Health Scotland is the national agency for health education in Scotland, providing leadership for health promotion in Scotland. Its remit includes:educational action to strengthen individuals' knowledge, skills and capabilitiesbuilding the capacities of systems which shape the social, environmental and economic conditions which create and sustain healthNHS Health Scotland is also committed to measuring the effectiveness of its activities and commissions research to provide reliable evaluation evidence and to inform the development of programmes. As part of this research programme, BMRB Social Research were commissioned to conduct the first Health Education Population Survey (HEPS) every March and September from March 1996 until March 1999 (seven waves in total). The resulting data, covering all three years, are held at the UK Data Archive as a single study under SN 4949. The second and following HEPS surveys were then conducted every March and September until September 2005 (ten waves in total), with two waves comprising each yearly dataset (see SNs 4950-4952, 5202 and 5470). Fieldwork was then commissioned for a further four waves, with waves eleven and twelve (conducted January-April and August-December 2006) comprising the 2006 dataset, held under SN 5713. These were followed by waves thirteen and fourteen (conducted January-April and August-November 2007) and are held under SN 6023. The main objectives of HEPS are as follows:to monitor trends in health-related attitudes, knowledge, beliefs and behaviours, and to assess the impacts of specific activitiescontribute to planning and development of health promotion initiatives through the inclusion of more detailed modules on topical issuesIn the longer term, HEPS aims to develop a strategic view of how and where health promotion activity may be most effective. This can be achieved in the following ways:identifying levels of knowledge regarding the main causes of ill-healthidentifying salient attitudes with respect to health and means of improving healthidentifying levels of motivation with respect to behaviour change to improve healthdeveloping an understanding of how such indicators may be expected to vary between different population groupsdeveloping an understanding of individual patterns of health-related attitudes and behaviour and their relationship to the broader socio-cultural environmentdeveloping an understanding of specific areas of interest Further information and links to publications based on HEPS may be found by search on the healthscotland.com web site. Main Topics: This dataset contains the data collected during HEPS waves 7 and 8, comprising the 2004 HEPS. The following topics were covered in the questionnaire: general health (including GHQ12); diseases; nutrition; breastfeeding; physical activity; alcohol; smoking (including attitudes to smoking in public places); oral health; accidents and safety; social capital; sexual health and relationships; HIV/AIDS; and drugs (including legislation of cannabis). One-stage cluster sample Face-to-face interview