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The use of two potent, well-tolerated, drugs could permit the maintenance of virologic suppression even in heavily pretreated people living with HIV. In this retrospective, multicenter, simplification study (NCT03348449), we included those patients with virologic suppression who switched to raltegravir (RAL) plus boosted darunavir (b/DRV). Overall, 345 patients (75 females, 25%) were included. Patients were largely pretreated (mean, 9.4 regimens), suppressed for a median of 41.1 months. Fifty patients had ≥1 mutation against DRV. At 96 weeks, the efficacy by intention-to-treat analysis (snapshot) was 73% (95%CI, 68.4–77.8%), but 97.1% (95%CI, 95.4–98.9) excluding changes due to non-virologic reasons, and virologic failure was rare (0.9%; 95%CI, 0.1–1.2%). Median CD4/CD8 ratio increased from 0.59 to 0.62 (p < 0.01), CD4+ cell count by +90 cells/µl (p < 0.01), and mean estimated glomerular filtration rate (eGFR) increased from 85.2 to 88.5 ml/min at 96 weeks, greater for patients receiving tenofovir disoproxil fumarate (eGFR, +3.6 ml/min, p = 0.04; serum phosphate +0.33 mg/dl; p < 0.01). There was a continued and significant improvement in the total cholesterol/high-density lipoprotein-cholesterol ratio. In conclusion, the simplification to a dual regimen with the combination of RAL and b/DRV is associated with maintenance of virologic suppression, even in largely pretreated patients, with improvements in CD4+ cell count, CD4/CD8 ratio, and in renal and lipid parameters.

[Background] Few women have been included in darunavir/cobicistat clinical development studies, and hardly any of them were antiretroviral experienced or treated with anything other than triple-based therapies., [Objectives] Our aim was to increase our knowledge about women living with HIV undergoing darunavir/cobicistat-based regimens., [Methods] A multicentre (21 hospitals), retrospective study including a centrally selected random sample of HIV-1 patients starting a darunavir/cobicistat-based regimen from June 2014 to March 2017 was planned. Baseline characteristics, 24 and 48 week viral load response (<50 copies/mL), CD4+ lymphocyte count increase, time to change darunavir/cobicistat and adverse event occurrence were all compared by sex. The study was approved by each of the 21 ethics committees, and patients signed informed consent., [Results] Out of 761 participants, 193 were women. Similar characteristics were found for both sexes, except that the women had a longer duration of HIV infection (P = 0.001), and were less frequently pre-treated with darunavir/cobicistat in their previous regimen (P = 0.02). The main reason for using a darunavir/cobicistat-based regimen was simplification, without differences by sex, while monotherapy seems to be more frequently prescribed in women than in men (P = 0.067). The main outcomes, HIV viral load response, CD4+ lymphocyte count increase at 24 or 48 weeks, occurrence of adverse events, main reasons for changing and time to the modify darunavir/cobicistat regimen, did not show differences between the sexes., [Conclusions] No sex disparities were found in the main study outcomes. These results support the use of a darunavir/cobicistat-based regimen in long-term pre-treated women. Clinical Trial.gov No. NCT03042390.

[Background]: The objective was to analyze the effectiveness and safety of dual therapy with rilpivirine plus boosteddarunavir (RPV + bDRV) in real-life patients., [Methods]: Observational, retrospective, multi-center study in HIV+ patients who had received RPV + bDRV for 24 weeks to optimize/simplify their previous antiretroviral treatment. We determined the percentage of patients without virologic failure (2 consecutive viral loads > 50 copies/mL) at 24 weeks of treatment., [Results]: The study included 161 patients from 15 hospitals with median age of 49 years; 29.3% had previous AIDS stage and median CD4+ lymphocyte nadir of 170 cells/uL. They had been diagnosed with HIV for a median of 17 years and had received 14 years of ART, with five previous treatment combinations, and 36.6% had a history of virological failure. The reasons for the switch were simplification/optimization (49.7%), toxicity/intolerance (17.4%), or inadequate effectiveness of previous ART (10.6%). Baseline VL of 50–1000 copies/mL was recorded in 25.5% of the patients. In the“intention-to-treat” analysis at 24 weeks, 87.6% of 161 patients continued the study treatment without virologic failure criteria. In the “on treatment” analysis (excluding patients who discontinued treatment with dual therapy for any reason other than virologic failure) the efficacy was 94.6% (141/149 patients)., [Conclusions]: Dual therapy with RPV + DRVb proved to be effective and safe in patients with advanced HIV infection, long exposure to ART, low CD4 nadir, previous virologic failure, and/or history of ineffective ART.

[Objective]: To assess the performance of ultrasound surveillance for the diagnosis of hepatocellular carcinoma (HCC) in HIV-infected patients., [Methods]: The GEHEP-002 cohort recruits HCC cases diagnosed in HIV-infected patients from 32 centers across Spain. The proportion of ‘ultrasound lack of detection’, defined as HCC diagnosed within the first 3 months after a normal surveillance ultrasound, and the proportion of ‘surveillance failure’, defined as cases in which surveillance failed to detect HCC at early stage, were assessed. To assess the impact of HIV, a control population of 104 HCC cases diagnosed in hepatitis C virus-monoinfected patients during the study period was used., [Results]: A total of 186 (54%) out of 346 HCC cases in HIV-infected patients were diagnosed within an ultrasound surveillance program. Ultrasound lack of detection occurred in 16 (8.6%) of them. Ultrasound surveillance failure occurred in 107 (57%) out of 186 cases diagnosed by screening, whereas this occurred in 18 (29%) out of 62 diagnosed in the control group (P < 0.0001). HCC cases after ultrasound surveillance failure showed a lower frequency of undetectable HIV viral load at diagnosis. The probability of 1-year and 2-year survival after HCC diagnosis among those diagnosed by screening was 56 and 45% in HIV-infected patients, whereas it was 79 and 64% in HIV-negative patients (P = 0.038)., [Conclusion]: The performance of ultrasound surveillance of HCC in HIV-infected patients is very poor and worse than that shown outside HIV infection. A HCC surveillance policy based on ultrasound examinations every 6 months might be insufficient in HIV-infected patients with cirrhosis.

[Background] Late HIV diagnosis remains one of the challenges in combating the epidemic. Primary care providers play an important role in screening for HIV infection. Our study aims to evaluate the relationship between knowledge and barriers to HIV testing and screening outcomes. The impact of an education program for primary care providers, towards improving HIV testing and late diagnosis rates, is also assessed., [Methods] A self-administered questionnaire that was developed within the framework of the European project OptTEST was used to examine HIV knowledge and barriers to HIV testing scores before and after being involved in an HIV education program. A quasi-experimental design with pre- and post-intervention measures was performed to investigate its impact. We performed multivariable logistic regression analysis to assess the relationship between variables for the HIV testing offer., [Results] A total of 20 primary care centers and 454 primary care staff were included. Baseline OptTEST results showed that more knowledgeable staff offered an HIV test more frequently (OR 1.07; CI 95% 1.01–1.13; p = 0.027) and had lower barrier scores (OR 0.89; CI 95% 0.77–0.95; p = 0.005). Nurses had lower scores in knowledge-related items (OR 0.28; CI 95% 0.17–0.46; p<0.001), but higher scores in barrier-related items than physicians (OR 3.28; CI 95% 2.01–5.46; p<0.001). Specific centers with more knowledgeable staff members had a significant association with a greater level of new HIV diagnosis rates (OR 1.61; CI 95% 1.04–2.49; p = 0.032). After the intervention, we found that 12 out of 14 individual questions showed improved scores. In the 6 months after the training program, we similarly found a higher HIV testing rate (OR 1.19; CI 1.02–1.42; p = 0.036)., [Conclusions] This study highlights the association between knowledge and barriers to HIV testing, including HIV testing rates. It shows that it is possible to modify knowledge and reduce perceived barriers through educational programs, subsequently improving HIV screening outcomes.

[Resumen] La lenta circulación del agua en los sistemas fisurales de macizos rocosos silíceos permite una notable actividad microbiológica que, junto con el agua, actúan sobre la roca produciendo la disolución del silicio y su posterior precipitación en forma de ópalo amorfo, que constituirá una variada gama de espeleotemas silíceos. Se han estudiado los productos de la meteorización y la microbiota asociada por técnicas de difracción de rayos X y mediante microscopía óptica y electrónica de barrido, estableciéndose las relaciones geobiológicas, roca y biota, que presentan una gran homogeneidad tanto en los tipos de espeleotemas como en los microorganismos implicados, lo que permite deducir que siempre que coincidan los agentes principales: agua, biota y medio físico confinado rico en silicio, se repetirá el mismo resultado. Esta investigación ha sido elaborada desde una perspectiva geológica, aunque con una amplia base biológica, siendo este nuevo enfoque geobiológico su principal novedad. Además, se ha conseguido ampliar los horizontes previamente establecidos para los espeleotemas silíceos: de cuevas, a pequeños abrigos naturales; de granitos, a cualquier roca con sílice disponible; de lo puramente inorgánico, a un sistema geobiológico, e incluso, todavía a modo de hipótesis, del medio terrestre, a otros posibles ambientes fuera de nuestro planeta., [Resumo] A lenta circulación da auga nos sistemas fisurales de macizos rochosos silíceos permite unha notable actividade microbiolóxica que, xunto coa auga, actúan sobre a rocha producindo a disolución do silicio e a súa posterior precipitación en forma de ópalo amorfo, que constituirá unha variada gama de espeleotemas silíceos. Estudáronse os produtos da meteorización e a microbiota asociada por técnicas de difracción de raios X e mediante microscopía óptica e electrónica de varrido, establecéndose as relacións xeobiolóxicas, rocha e biota, que presentan unha grande homoxeneidade tanto nos tipos de espeleotemas coma nos microorganismos implicados, o que permite deducir que sempre que coincidan os axentes principais: auga, biota e medio físico confinado rico en silicio, repetirase o mesmo resultado. Esta investigación foi elaborada dende unha perspectiva xeolóxica, aínda que cunha ampla base biolóxica, sendo este novo enfoque xeobiolóxico a súa principal novidade. Ademais, conseguiuse ampliar os horizontes previamente establecidos para os espeleotemas silíceos: de covas, a pequenos abrigos naturais; de granitos, a calquera rocha con sílice dispoñible; do puramente inorgánico, a un sistema xeobiolóxico, e, mesmo aínda a xeito de hipótese, do medio terrestre, a outros posibles ambientes fóra do noso planeta., [Abstract] The slow water circulation in the fissure systems of siliceous rocky massifs allows a remarkable microbiological activity that, together with the water, act on the rock producing the dissolution of the silica and its later precipitation as amorphous opal, which will form a varied range of siliceous speleothems. The results of the weathering and the associated microbiota have been studied by means of X-ray diffraction techniques, and optical and electronic scanning microscopy, establishing the geobiological relationships, rock and biota, which present a great homogeneity both in the types of speleothems and the implied microorganisms. This allows inferring that the same result will always be repeated whenever the main agents coincide: water, biota and physical environment. This research has been carried out from a geological perspective though with a broad biological basis, this new perspective being its main novelty. Moreover, the goals previously established for the siliceous speleothems have been enlarged: from caves to small natural shelters; from granites to any rock with available silica; from purely inorganic to a geobiological system, and even, as hypothesis, from the terrestrial environment to other possible environments outside our planet.