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Background & Aims: HBV coinfection is common among people living with HIV (PLWH) and is the most important cause of hepatocellular carcinoma (HCC). While risk prediction tools for HCC have been validated in patients with HBV monoinfection, they have not been evaluated in PLWH. Thus, we performed an external validation of PAGE-B in people with HIV/HBV coinfection.Methods: We included data on PLWH from four European cohorts who were positive for HBsAg and did not have HCC before starting tenofovir. We estimated the predictive performance of PAGE-B for HCC occurrence over 15 years in patients receiving tenofovir-containing antiretroviral therapy. Model discrimination was assessed after multiple imputation using Cox regression with the prognostic index as a covariate, and by calculating Harrell's c-index. Calibration was assessed by comparing our cumulative incidence with the PAGE-B derivation study using Kaplan-Meier curves.Results: In total, 2,963 individuals with HIV/HBV coinfection on tenofovir-containing antiretroviral therapy were included. PAGE-B was Conclusions: For individuals with HIV/HBV coinfection, PAGE-B is a valid tool to determine the need for HCC screening. Impact and implications: Chronic HBV infection is the most important cause of hepatocellular carcinoma (HCC) among people living with HIV. Valid risk prediction may enable better targeting of HCC screening efforts to high-risk individuals. We aimed to validate PAGE-B, a risk prediction tool that is based on age, sex, and platelets, in 2,963 individuals with HIV/HBV coinfection who received tenofovir-containing antiretroviral therapy. In the present study, PAGE-B showed good discrimination, adequate calibration, and a cut-off of

Many human activities in or near aquatic habitats generate alterations in their environmental conditions, which could affect the organisms that inhabit them. Maintenance dredging of navigation channels in order to allow large ships access to inland ports is one such source of disturbance. In this study, by taking multiple approaches (immediate-, short- and medium term), we analysed the effects of a maintenance dredging operation on physiochemical variables and the early life stages of fish and other macrofauna groups present in two zones of the Guadalquivir estuary with different salinity ranges (poly- and mesohaline). Most physiochemical variables were homogenized in the water column immediately after the water mass passed by the dredger, including sediment resuspension. However, this process seemed to be transient as no significant increments in the depth-averaged levels of turbidity were observed in the short- and medium-terms. Instead, metal concentrations of Cr, Fe and Zn increased in the polyhaline station. Even so, these perturbations did not appear to be severe enough to influence the macrofauna. Still, organisms can suffer direct mechanical impacts of the trailer suction. Hyperbenthic species, like Pomatoshcistus spp. or decapods, tended to decrease slightly, while pelagic species such as Engraulis encrasicolus or mysids did not, indicating that benthic organisms are usually more susceptible to high entrainment. Nonetheless, the possible effects of this disturbance were of the same order or less than those of natural ones; therefore, organisms of the macrofauna could be well adapted to cope with them. Plan Propio Universidad de Sevilla

Mechanisms that control the longitudinal transport of larvae and juveniles in nursery grounds such as estuaries are reported for some species. However, the behaviour and population consequences of these mechanisms are still uncertain. In this study, we tested selective tidal-stream transport from the along-channel (up- and downstream) and cross-channel (from one margin to the other) perspectives for two kinds of fish: estuarine-resident gobies (Pomatoschistus spp.) and marine estuarine-opportunistic anchovies (Engraulis encrasicolus). Three cruises were conducted in the lower Guadalquivir estuary, on the ebb and on the flood of spring tides in summer. Plankton samples were collected across a channel section, at three stations (one in the middle of the channel and two in adjacent shallower areas), near the surface and near the bottom simultaneously. In addition, multiple physico-chemical variables (temperature, turbidity, dissolved oxygen, pH, salinity, chlorophyll-a, along with wind and current direction and velocity) were measured to examine the different correlations used by the studied fish in their strategies. The benthic distribution of gobies indicated that they used flood currents near the bottom of lateral (shallow) areas to ingress into and remain in the estuary, temperature and/or dissolved oxygen being their main possible cues. On the contrary, the anchovies were more abundant near the surface, especially on the ebb tide, showing downstream advection, which was mainly influenced by salinity. However, the largest individual anchovies in the lateral/shallow zones suggested a behavioural ontogeny, which, together with wind induced transport, could contribute to their retention. This comparison also enhanced the knowledge of the habitat distribution of two species common and abundant in estuaries, anchovies and gobies. Universidad del Algarve UID/MAR/00350/2013

Hydrological, geomorphological, physicochemical and biological factors influence the nursery function of estuaries. Our study compared the environmental conditions and the assemblages of early life stages of fish in the main four estuaries of the Gulf of Cadiz (Cadiz Bay, Guadalquivir, Odiel-Tinto and Guadiana). Samples were taken within each estuary and on their adjacent coast, during the dry-warm seasons of 2016, 2017 and 2018. Results showed that rivers with smaller basins had a very low freshwater input and their estuaries, Odiel-Tinto and Cadiz Bay, were essentially sea extensions into the land, containing similar physicochemical conditions to nearshore zones, as well as similar assemblages and densities of early life stages of fish. Open water masses of these estuaries do not have important nursery functions. In contrast, inner zones of estuaries with bigger basins and higher freshwater discharges, Guadalquivir and Guadiana, have different environmental characteristics and a long transition zone with a well-defined salinity gradient. Their assemblages and densities of early life stages of fish were different between them and with other estuaries. The Guadalquivir estuary held the highest abundance of larval and early juvenile fish, as well as macrozooplankton biomass. The most abundant fish species in all zones of every estuary was the anchovy Engraulis encrasicolus; the Guadalquivir inner zone had the highest density. High concentration of suspended organic matter, provided by freshwater input and correlated with total suspended solid, suspended inorganic matter and turbidity, was the physicochemical characteristic more typical of the Guadalquivir. This characteristic, in addition to the salinity gradient, could explain the highest densities of macrozooplankton found in this estuary, and consequently, of early fish stages. Recurrent jellyfish blooms were observed in Cadiz Bay and the inner zone of Guadiana, affecting their nursery functions. Odiel-Tinto showed altered physicochemical and biological characteristics, which may need further specific research.

Understanding the effects of dredging in estuaries is a hard task due to the difficulty of implementing an adequate environmental diagnosis, as a consequence of the salinity gradient and anthropogenic disturbances. To assess the effects of maintenance dredging work on the Guadalquivir estuary (southwestern Spain), we used a Before-After-Control-Impact (BACI) approach to determine both direct and indirect effects in two salinity ranges. No effects were found on water and sediment physicochemical characteristics. The small impacts on dredged areas were followed by a rapid recovery of opportunistic species. The poor status of the benthos does not permit the detection of significant effects on macrofaunal community structure. The use of stable isotopes analysis to determine impacts on food web structure showed that changes over time seem to be explained by natural temporal variation rather than the dredging works. This paper emphasises the need to define proper management and conservation plans to improve the status of the benthic communities of the Guadalquivir estuary.

This study assesses the effects of dredged material disposal in a recurrent marine dump near the Guadalquivir Estuary (south-western Spain). We compared the changes observed with two reference areas combining a classical ecological approach with new stable isotope techniques to analyse trophic structure. We detected permanent changes in the macrofaunal community structure as well as in the diversity and biotic indices applied, which showed higher values in the disposal area. The community in the marine dump had lost the natural temporal variations observed in the reference areas. These effects could be due to the last disposal event carried out in the summer of 2015 or to the recurrent disposals since 2010. Despite the structural changes shown by the benthic community, these impacts were not reflected in the food web structure of the marine dump. Our results confirm the high variability of disposal disturbances. Hence, we recommend performing studies in every disposal event, merging different functional and structural approaches.

FOSIMI Investigators., This work was supported by the Ministerio de Sanidad y Consumo of Spain (Fondo de Investigaciones Sanitarias, Instituto de Salud Carlos III, Madrid, Spain, Grant #EC0800190). JMP received a “Rio Hortega” Research Grant (CM14/00135; 2015-16) from Instituto de Salud Carlos III and the Ministerio de Economia and Competitividad, Madrid (Spain) and the ESCMID/FEMS Research Fellowship 2016. JMM received a personal 80:20 research grant from the Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, during 2017–19.

In this study we assessed the effects of the recurrent disposal of dredged material from the Guadalquivir estuary (south-western Spain) in a marine disposal area. We analysed shifts in sediment characteristics as well as bioaccumulation and biomagnification of heavy metals through the benthic food web. Results showed that the significant increase in concentration of some heavy metals observed in the marine disposal area after the latest disposal event could be attributed to the deposition of river-dredged sediments. This increase could also explain the decreased amphipod survival in the ecotoxicology analysis. Heavy metal concentrations in organisms indicated some bioaccumulation in deposit feeders and predators but with no clear patterns nor biomagnification through the food web. Hence, combining studies that monitor shifts in sediment characteristics and their possible consequences for the food web seems to be an interesting approach that should be assessed further in this type of studies.

As a result of the increased urban and agricultural development in coastal environments, estuaries are among the most modified and threatened aquatic ecosystems. This study used stable isotopes to examine the effects of human impacts by contrasting the food web structures of two Iberian estuaries exposed to different degrees of human pressure. More complex feeding pathways were found in the more altered estuary (Guadalquivir). Greater spread among species along the carbon axis suggests that the primary consumers exploit organic matter with various origins, whereas different nitrogen signals of the secondary consumers suggest that they feed on different suites of prey. In contrast, the similar isotopic signals of secondary consumers in the relatively little influenced estuary (Guadiana) suggests similarity in diet composition and feeding on the same organic matter sources. Understanding trophic interactions in estuaries is vital for defining proper management and conservation, and the preliminary data provided here are one step in this direction.

The new biotic index BENFES (Benthic Families Ecological Status Index) for assessing the ecological status of soft-bottom communities based on presence/absence at the taxonomic family level, is described. BENFES was primarily developed for the communities from the Guadalquivir estuary (South-western Spain), but the aim of the present work was to evaluate the reliability and validity of this index for its application in the Water Framework Directive (WFD), especially as a preliminary and rapid assessment method for monitoring the ecological status of transitional and coastal waters. BENFES was compared with five widely used indices (BOPA, BO2A, BENTIX; AMBI and M-AMBI) in several studies from Southwestern Spain. In addition, we have also established comparisons between these indices and the most commonly used Shannon-Wiener diversity. M-AMBI and BENFES showed the best agreement in ecological status assignation and were the most useful and discriminant between the studied areas. BENTIX was a good discriminant in coastal areas but was severe with the environmental condition from estuaries; BOPA/BO2A did not show clear trends in most of the zones; and AMBI tended to provide overestimations of the ecological status. In conclusion, BENFES shows several advantages such as lower taxonomic resolution, greater reliability and only requiring presence/absence. All this implies a huge possibility to perform a simplified monitoring routine for the control of the ecological quality of water bodies.

Principios. Debe ir dirigido a suprimir al maximo la replicacion del VIH, con el fin de frenar el deterioro del sistema inmune y permitir su recuperacion espontanea. Clasificacion. Los principales farmacos antirretroviricos son los inhibidores de la transcriptasa inversa, analogos y no analogos de los nucleosidos y los inhibidores de la proteasa. Tratamiento inicial. Los puntos de corte para recomendar el inicio del tratamiento antirretrovirico en cuanto a niveles de CD4 y carga virica son menos de 350/mm3 y mas de 100.000 copias/ml respectivamente. Respuesta terapeutica. La monitorizacion mas eficaz del tratamiento se consigue con la determinacion de la carga virica, que a los 3-6 meses debe ser indetectable. Modificaciones terapeuticas. Existen diversas situaciones en las que se puede plantear la necesidad de cambiar la pauta o dosificacion del tratamiento antirretrovirico o suspensiones temporales del mismo.

Background: Several studies have reported on an association between hepatitis C virus (HCV) antibody status and the development of chronic kidney disease (CKD), but the role of HCV viremia and genotype are not well defined. Methods: Patients with at least three serum creatinine measurements after 1 January 2004 and known HCV antibody status were included. Baseline was defined as the first eligible estimated glomerular filtration rate (eGFR) (Cockcroft-Gault equation), and CKD was either a confirmed (>3 months apart) eGFR of 60 ml/min per 1.73m2 or less for patients with a baseline eGFR more than 60 ml/min per 1.73m2 or a confirmed 25% decline in eGFR for patients with a baseline eGFR of 60 ml/min per 1.73m2 or less. Incidence rates of CKD were compared between HCV groups (anti-HCV-negative, anti-HCV-positive with or without viremia) using Poisson regression. Results: Of 8235 patients with known anti-HCV status, 2052 (24.9%) were anti-HCVpositive of whom 983 (47.9%) were HCV-RNA-positive, 193 (9.4%) HCV-RNAnegative and 876 (42.7%) had unknown HCV-RNA. At baseline, the median eGFR was 97.6 (interquartile range 83.8-113.0) ml/min per 1.73m2. During 36123 personyears of follow-up (PYFU), 495 patients progressed to CKD (6.0%) with an incidence rate of 14.5 per 1000 PYFU (95% confidence interval 12.5-14.9). In a multivariate Poisson model, patients who were anti-HCV-positive with HCV viremia had a higher incidence rate of CKD, whereas patients with cleared HCV infection had a similar incidence rate of CKD compared with anti-HCV-negative patients. There was no association between CKD and HCV genotype. Conclusion: Compared with HIV-monoinfected patients, HIV-positive patients with chronic rather than cleared HCV infection were at increased risk of developing CKD, suggesting a contribution from active HCV infection toward the pathogenesis of CKD. © 2012 Wolters Kluwer Health.

VIH+ status: indication or contra-indication for liver transplantationBackground and aims:Since 1996 antiretroviral treatment drastically diminished morbidity and mortality of VIH infected patients. This fact allowed it to include patients with hepatic failure caused by Virus B or C in liver transplantation procedures. We intended to identify psychological factors interfering in the post-transplantation period with the further aim to define criteria for psychological assessment at the pre-transplantation period.Methods:From 2001 to 2006 we made a psychological investigation with 34 VIH+ patients during their usual pre-transplantation assessment. ICD-10 diagnoses were given after clinical non-structured interviews. Patients' psychosocial situations were also assessed in a non-structured way as well as drug and alcohol consumption was monitored. Patients were followed up during the whole time period.Results:We found an elevated prevalence of psychopathology among this group of VIH+ transplantation candidates, specially personality disorders, socio-familiar problems and substance abuse.Conclusions:It is important to include in-depth social and psychological assessment into the routine pre-transplantation procedure in order to preview and to minimize risk situations during the post-transplantation period.

This is a copy of an article published in the AIDS Research and Human Retroviruses © 2012 [copyright Mary Ann Liebert, Inc.]; AIDS Research and Human Retroviruses is available online at: http://online.liebertpub.com. Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't; End-stage renal diseases (ESRD) are becoming more frequent in HIV-infected patients. In Europe there is little information about HIV-infected patients on dialysis. A cross-sectional multicenter survey in 328 Spanish dialysis units was conducted in 2006. Information from 14,876 patients in dialysis was obtained (81.6% of the Spanish dialysis population). Eighty-one were HIV infected (0.54%; 95% CI, 0.43-0.67), 60 were on hemodialysis, and 21 were on peritoneal dialysis. The mean (range) age was 45 (28-73) years. Seventy-two percent were men and 33% were former drug users. The mean (range) time of HIV infection was 11 (1-27) years and time on dialysis was 4.6 (0.4-25) years. ESRD was due to glomerulonephritis (36%) and diabetes (15%). HIV-associated nephropathy was not reported. Eighty-five percent were on HAART, 76.5% had a CD4 T cell count above 200 cells, and 73% had undetectable viral load. Thirty-nine percent of patients met criteria for inclusion on the renal transplant (RT) waiting list but only 12% were included. Sixty-one percent had HCV coinfection. HCV-coinfected patients had a longer history of HIV, more previous AIDS events, parenteral transmission as the most common risk factor for acquiring HIV infection, and less access to the RT waiting list (p < 0.05). The prevalence of HIV infection in Spanish dialysis units in 2006 was 0.54% HCV coinfection was very frequent (61%) and the percentage of patients included on the Spanish RT waiting list was low (12%). Yes