Objective: Most laboratories in Japan are performing the HIV-1 genotypic drug-resistance testing with their in-house methods based on the one developed by National Institute of Infectious Diseases. However, the quality of their methods has never been assessed. In this study, we aimed to investigate the accuracy and reliability of the testing performed in 15 laboratories in Japan.
Materials and Methods: We assessed the accuracy and reliability of the in-house testing by sending two standard HIV-1 RNA samples to 15 voluntarily participating laboratories and by analyzing the reported results.
Results: The assessment revealed that the quality of HIV-1 genotypic drug-resistance testing was very high (97.3% accuracy). But there were sources of error, including human errors, poor electrophoregrams, and use of inadequate primers.
Conclusion: We proposed troubleshooting procedures to improve the quality of drugresistance testing in Japan.

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Objective: Many HIV-infected patients must undergo long-term highly active antiretroviral treatment (HAART), which can be associated with a variety of side effects that require careful management. We describe our successful treatment of a patient with hyperlipidemia resulting from HAART, using fenofibrate.
Case Presentation: A 28-year-old man diagnosed with appendicitis was admitted to our hospital. Preoperative examinations disclosed that he was HIV-antibody positive. Peripheral blood showed 8.64×10⁴ copies/ml of HIV RNA, CD4 cells numbered 160/μl, and the CD4/8 ratio was 0.14. Total cholesterol (TC), triglyceride (TG), LDL-cholesterol and HDLcholesterol were 201 mg/dl, 220 mg/dl, 120 mg/dl, and 55 mg/dl respectively. Medication with zidovudine in combination with lamivudine (Combivir), together with efavirentz (EFV), reduced HIV RNA below the limits of measurement, and CD4-positive lymphocytes increased. By 1 month later, however, TC and TG respectively had risen to 255 mg/dl and 406 mg/dl. EFV was changed to nevirapine (NVP) without improvement in hyperlipidemia, 18 months later TC and TG were 338 mg/dl and 2856 mg/dl. Pravastatin sodium was given, but TG did not decrease. After 24 months pravastatin sodium was replaced by fenofibrate, and TC and TG gradually were reduced. In addition to medication, exercise and dietary treatments were carried out. Current TC concentrations are between 200 and 230mg/dl, while TG values are 240 to 300mg/dl.
Conclusion: Hyperlipidemia, a risk factor for atherosclerosis which in turn can cause coronary artery disease, is known as a serious side effect of HAART. Changing from EFV to NVP did not improve our patient's hyperlipidemia, indicating that hyperlipidemia was caused by a component of Combivir. Fenofibrate contributed to considerable correction of hyperlipidemia. Hyperlipidemia also may occur even in HAART-treated patients not receiving protease inhibitors. Regular monitoring of lipids is necessary in all patients undergoing HAART.

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Objective: To characterize the state of management of HIV/AIDS patients at Kawasaki Medical School Hospital, which is a local core hospital for AIDS treatment in Okayama Prefecture.
Methods: The subjects of an HIV antibody survey and 21 HIV/AIDS patients treated at our hospital between January 2001 and December 2005 were investigated.
Results: The patients consisted of 20 men and one woman with a mean age of 32.7 years at initial presentation. There were 11 HIV-infected persons with a mean age of 30.9 years. Ten of these patients developed AIDS, and they had a slightly higher mean age of 34.7 years at initial presentation. The mean CD4-positive cell count of the 21 patients was 192/μl at diagnosis. The six patients who were diagnosed with AIDS in our hospital had a mean CD4-positive cell count of only 34/μl. All 21 patients were infected with HIV through routes other than blood products, including 13 patients infected through homosexual intercourse, three through heterosexual intercourse, and five via unknown routes. Eleven patients were referred from other prefectures, including five from Osaka and four from Tokyo. The number of the subjects of an HIV antibody survey increased in five years, but there were no positive patients.
Discussion: The main characteristic of HIV patients at this local core model hospital was that only a few of them were infected in Okayama Prefecture. Many of them were referred from larger cities outside the prefecture after they were transferred by their companies or returned home. However, it is expected that the number of patients infected within Okayama Prefecture will increase in the future. There is also an increasing trend for patients to develop AIDS before initial presentation. Therefore, it is important to increase the performance of HIV antibody testing.

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Purpose: To develop a program of HIV prevention, we reviewed the literature on programs about HIV and sexuality for parents of adolescents.
Methods: This paper reviewed English and Japanese literature on the relation between parenting and adolescent sexual behavior, and parent interventions with adolescents from year 1999 to 2006. In addition, we investigated the educational content, method, and evaluation of programs for parents.
Results/Conclusion: 1. An effective program should inform parents of the attitude of parents, including parent-adolescent communication and adolescent sexual behavior. 2. It needs to clarify the objectives of intervention for parents in accordance with the developmental stage of adolescents. 3. It is effective to educate parents, utilizing intervention such as videotapes at home and a newsletter. 4. It is necessary to evaluate adolescents' health when the program is evaluated. 5. We suggest that an educational program for parents should be developed according to the cultural characteristics of Japan.

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Objective: HIV medical care has advanced. Meanwhile, the number of persons with HIV who continue to stay in the hospital even they no longer need hospitalized medical care (long-term inpatients) is increasing gradually. Their immune systems are stabilized, however, it is difficult for them to live at home due to persisting disabilities such as physical disability, mental deficiency, dementia caused by PML, HIV encephalopathy, and cerebral infarction. The purpose of this study is to examine the necessity of medical care and a welfare environment through investigating actual conditions and background factors of long-term inpatients at AIDS core hospitals.
Methods: In 2004, questionnaires were distributed to AIDS core hospitals. Questions about experience, number, and outcome of long-term inpatient cases were included in the questionnaire. In 2005, another questionnaire survey was conducted targeting hospitals with consent. Period of hospitalization and number of days extended care were asked about. Semi-structured interviews about the background of cases were also conducted of staff members in 7 hospitals.
Results: It was found in the 2004 survey that 52 hospitals, out of 221 AIDS core hospitals responding to the questionnaire, experienced 131 cases. In the 2005 study, it was found that out of 82 cases of 32 hospitals, 68 cases extended the hospitalization, and average number of months was 9.1. Factors that cause long-term hospitalization were medical factors, medical institutional problems, patients and family, and systematic issues. Factors that prevent long-term hospitalization were a reliable medical care system, a substantial network, existence of a coordinator, leadership of the top position, etc.
Conclusion: The study showed the need for appropriate medical care security in accordance with HIV medical advancement, and development of a community care system to support the patient's life.

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