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Introduction: HIV late presentation (LP) remains excessive in Europe. We aimed to analyze the factors associated with late presentation in the MSM population newly diagnosed with HIV in Portugal between 2014 and 2019., Methods: We included 391 newly HIV-1 diagnosed Men who have Sex with Men (MSM), from the BESTHOPE project, in 17 countrywide Portuguese hospitals. The data included clinical and socio-behavioral questionnaires and the viral genomic sequence obtained in the drug resistance test before starting antiretrovirals (ARVs). HIV-1 subtypes and epidemiological surveillance mutations were determined using different bioinformatics tools. Logistic regression was used to estimate the association between predictor variables and late presentation (LP)., Results: The median age was 31 years, 51% had a current income between 501-1,000 euros, 28% were migrants. 21% had never been tested for HIV before diagnosis, with 42.3% of MSM presenting LP. 60% were infected with subtype B strains. In the multivariate regression, increased age at diagnosis, higher income, lower frequency of screening, STI ever diagnosed and higher viral load were associated with LP., Conclusion: Our study suggests that specific subgroups of the MSM population, such older MSM, with higher income and lower HIV testing frequency, are not being targeted by community and clinical screening services. Overall, targeted public health measures should be strengthened toward these subgroups, through strengthened primary care testing, expanded access to PrEP, information and promotion of HIV self-testing and more inclusive and accessible health services., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Abrantes, Pimentel, Miranda, Silva, Diniz, Ascenção, Piñeiro, Koch, Rodrigues, Caldas, Morais, Faria, Gomes da Silva, Teófilo, Monteiro, Roxo, Maltez, Rodrigues, Gaião, Ramos, Costa, Germano, Simões, Oliveira, Ferreira, Poças, Saraiva da Cunha, Soares, Fernandes, Mansinho, Pedro, Aleixo, Gonçalves, Manata, Mouro, Serrado, Caixeiro, Marques, Costa, Pacheco, Proença, Rodrigues, Pinho, Tavares, Correia de Abreu, Côrte-Real, Serrão, Sarmento e Castro, Nunes, Faria, Baptista, Simões, Mendão, Martins, Gomes, Pingarilho, Abecasis and the BESTHOPE Study Group.)

Background: Integrase strand transfer inhibitor-based regimens are recommended for first-line therapy in human immunodeficiency virus type 2 (HIV-2). Nonetheless, dolutegravir (DTG) clinical trial data are lacking., Methods: We conducted a phase 2, single-arm, open-label trial to evaluate the safety and efficacy of a triple therapy regimen that included DTG in persons with HIV-2 (PWHIV-2) in Portugal. Treatment-naive adults receive DTG in combination with 2 nucleoside reverse transcriptase inhibitors (NRTIs). Treatment efficacy was evaluated by the proportion of patients who achieved a plasma viral load (pVL) <40 copies/mL and/or by the change from baseline in CD4+ T-cell count and in CD4/CD8 ratio at week 48., Results: A total of 30 patients were enrolled (22 women; median age, 55 years). At baseline, 17 (56.7%) individuals were viremic (median, pVL 190 copies/mL; interquartile range [IQR], 99-445). The median CD4 count was 438 cells/μL (IQR, 335-605), and the CD4/CD8 ratio was 0.8. Three patients discontinued the study. At week 48, all participants (27) had pVL <40 copies/mL. No virological failures were observed. Mean changes in CD4 count and CD4/CD8 ratio at week 48 were 95.59 cells/µL (95% confidence interval [CI], 28-163) and 0.32 (95% CI, .19 to .46). The most common drug-related adverse events were headache and nausea. One participant discontinued due to central nervous system symptoms. No serious adverse events were reported., Conclusions: DTG plus 2 NRTIs is safe and effective as first-line treatment for PWHIV-2 with a tolerability profile previously known. No virological failures were observed that suggest a high potency of DTG in HIV-2 as occurs in HIV-1., Clinical Trials Registration: M NCT03224338., Competing Interests: Potential conflicts of interest. A. R. S. reports consulting fees from and participation on a data and safety monitoring board (DSMB) or advisory board for MSD; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events; and support for attending meetings and/or travel from ViiV Healthcare, Gilead Sciences, and MSD. F. M. reports consulting fees from ViiV Healthcare, Gilead, Merck Sharp & Dohme, and Astra Zeneca; payment or honoraria for presentations from ViiV Healthcare, Gilead, and MercK Sharp & Dohme; and participation on an advisory board for ViiV Healthcare, Gilead, and MercK Sharp & Dohme. J. B. reports consulting fees from ViiV Healthcare and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Gilead and ViiV Healthcare. K. M. reports payment or honoraria as a conference speaker from Merck Sharp & Dome and ViiV Healthcare and payment for expert testimony for an advisory board from Gilead Sciences and ViiV Healthcare. N. M. reports payment or honoraria for speakers bureaus from Merck Sharpe & Dohme and Gilead Sciences. S. L. reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from ViiV Healthcare, MSD, Pfizer, and Gilead Sciences; support for attending meetings and/or travel from MSD; and participation on a DSMB or advisory board for ViiV Healthcare. D. T. reports payment or honoraria for presentations or educational events from ViiV Healthcare, Gilead, and MSD; support for attending an international meeting, scientific update from MSD; and participation on an advisory board from ViiV Healthcare, Gilead, and MSD. P. P. reports payment or honoraria for presentations from ViiV Healthcare, Gilead, MSD, and Janssen Cilag; support for attending meetings and/or travel from Janssen Cilag; and participation on an advisory board for Gilead Sciences, ViiV Healthcare, and MSD. P. G. reports grants or contracts from Gilead Sciences; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from ViiV Healthcare, Gilead Sciences, MSD, and Janssen; support for attending meetings and/or travel from ViiV Healthcare and MSD; and participation on a DSMB or advisory board from ViiV Healthcare and MSD. J. A. reports honoraria for an education event from ViiV Healthcare; support for attending meetings and/or travel from ViiV Healthcare; and participation on an advisory board from ViiV Healthcare. M. J. L. reports payment for a presentation from ViiV Healthcare. C. F. reports payment or honoraria as a specialist and speaker from ViiV Healthcare Unipessoal LDA and Gilead Sciences LDA and participation on an advisory board for ViiV Healthcare Unipessoal LDA and Gilead Sciences LDA. L. D. reports support for a virtual meeting registration from ViiV Healthcare; participation on an advisory board from Gilead Sciences; and a role as a member and paid collaborator from the GAT—Grupo de Ativistas em Tratamentos. D. P. reports consulting fees from ViiV Healthcare; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from ViiV Healthcare, AbbVie, and Roche; and support for attending meetings and/or travel from ViiV Healthcare and Merck Sharpe & Dohme. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: To investigate mutations selected in viruses from HIV-2-infected patients failing a highly active antiretroviral treatment (HAART) regimen including atazanavir/ritonavir., Methods: Twenty-eight HIV-2-infected patients previously exposed to atazanavir/ritonavir and failing therapy were studied. The protease (PR) gene was amplified and sequenced, and mutations emerging under atazanavir/ritonavir selective pressure were reported., Results: The I50L mutation emerged in 4 out of 28 HIV-2-infected patients failing a HAART regimen including atazanavir/ritonavir. Besides I50L, four PR mutations previously associated with protease inhibitor resistance (I54L, I64V, V71I and I82F) and six PR mutations of unknown impact (V10I, E37D, S43T, K45R, I75V and F85L) in HIV-2 were also identified in this small group of patients., Conclusions: Several mutations were associated with virological failure of a regimen including atazanavir/ritonavir in HIV-2-infected patients, including I50L for the first time. It should be included in HIV-2 algorithms for interpretation of genotypic resistance data, and taken into account when making therapeutic decisions for HIV-2-infected patients.