Genital ulceration revealing a primary cutaneous anaplastic lymphoma.

general population in this high risk area, HIV test requests in the general practice sentinel network in Amsterdam have been recorded from 1989 to 1992, and from September 1994 to September 1996. The coverage of the network was reduced from 10% (198992) to 7% (1994-5) and 2% (1995-6) of the Amsterdam population, but it remained representative in terms of distribution of practices over the city and sex-age distribution. Through the years, homosexual men accounted for 15-20% of the HIV test requests and drug users for 3-6%. The average yearly incidence of test requests between 1989 and 1992 was 5-3 (4.7-5.5) per 1000 patients, after which it decreased to 3.9 (1994-5) and 2-6 (1995-6). The average percentage of positive test results between 1989 and 1996 was 7.0 (5.9-9 0), with peaks in 1991 (8.6%) and 1994-5 (9.0%). In the nationwide general practice sentinel network, which covers about 1% of the Dutch population, the yearly incidence of HIV test requests per 1000 patients rose steadily from 0-8 (1988) to 1-8 (1993). Of the tests performed, an average of 1% were positive.2 The higher incidence of test requests and positive test results in general practices in Amsterdam confirm the status of Amsterdam as a high risk area for HIV. The marked decline since 1992, in the incidence of test requests in general practices in Amsterdam is interesting, as it contradicts the trend seen elsewhere in the Netherlands. This may well reflect a certain saturation towards HIV testing among the general population in a high risk area. Towards the end of 1996, the new effective combination treatment for HIV became available.3 This is expected to stimulate HIV test requests from individuals who have been at risk for HIV but have not tested before. Given the trend described here, it remains to be seen if a rise in HIV test requests will occur in Amsterdam. L WIGERSMA Department of General Practice, Academic Medical Centre, Meibergdreef 15, 1105 AZ Amsterdam, Netherlands