This is the first case–control study in the developing world that has been able to describe risk factors and clinical features of SHLA. As d4T remains a widely used NRTI in first-line ART regimens throughout developing countries, efforts should be made to minimize the morbidity and mortality associated with this drug. According to these findings, obese women in such settings should preferably not be started on d4T-containing regimens. Any patient on d4T who gains more than 6 kg during their first 3 months of ART or any patient losing weight at any time during therapy should be assessed for SHLA,

especially if the duration on a d4T-containing ART regimen is between 6 and 18 months. Metformin Patients on ART who experience peripheral neuropathy, a loss of appetite, abdominal pain, vomiting or a combination of any symptoms during the same window of risk should be assessed for possible progression to SHLA. The potential association between moderate increases in ALT while on ART and SHLA requires further exploration. Thank you to both David Coetzee and Landon Myer for Natural Product Library cell line their epidemiological input and to Sumaya Mall for her support in data collection. Additional thanks to

Médicins Sans Frontières and the Desmond Tutu HIV Foundation for use of their database during sampling of controls. Graeme Meintjes is funded by the Wellcome Trust. Disclosures There was no financial support accepted for this study and the authors do not have an association that might pose Carbachol a conflict of interest. “
“Unprotected sexual intercourse between men who have sex with men (MSM) is the most common

route of HIV infection in Germany. Approximately 70% of newly infected people are MSM. Substance use is a determinant of sexual risk behaviour in the general population, but also in the MSM subpopulation. There are only a few studies, from the USA, on the correlation between substance use and sexual risk behaviour in HIV-infected MSM in specialized care. In a German sample of 445 HIV-infected MSM treated in specialized out-patient clinics, the influence of substance use on sexual risk behaviour was investigated. Information was obtained from subjects using self-report questionnaires and a structured interview. Recreational drug use was common. The prevalences of cannabis addiction (4.5%), harmful use of cannabis (4.3%) and harmful use of dissociative anaesthetics (0.4%) were higher than in the general German male population. A substantial proportion of patients reported unprotected insertive (32.9%) and receptive (34.6%) anal intercourse during the last 12 months. Use of cannabis, amyl nitrite, dissociative anaesthetics, cocaine, amphetamines and erectile dysfunction medication was significantly correlated with unprotected sexual contacts.