HIV Infection Research Articles

High interest for long-acting injectable PrEP among men who have sex with men at most risk for HIV in San Francisco, 2021

Background Men who have sex with men (MSM) represent a disproportionate total of incident HIV cases. Oral pre-exposure prophylaxis (PrEP) has contributed to significant declines in total HIV incidence. Barriers to PrEP include individual and structural factors that can prevent PrEP adherence and persistence. Long-acting injectable PrEP (LA-IP) can be leveraged to address high incident rates of HIV. Methods This study was a secondary analysis of the National HIV Behavioral Surveillance (NHBS) survey. We measured interest in LA-IP and associated factors among MSM in San Francisco from June 2021 to December 2021. Results Of the 505 MSM who were recruited, 409 reported not living with HIV. Interest in LA-IP among MSM in San Francisco was high (78.0%). Interest was associated with the use of on-demand PrEP (adjusted prevalence ratio [aPR] 3.68, 95% confidence interval [CI] 1.24–10.9), having two or more sexual partners (aPR 3.65, 95% CI 1.89–7.03), and having condomless insertive anal intercourse (aPR 2.15, 95% CI 1.19–3.87). LA-IP was inversely associated with having a high school education or lower (aPR 0.23, 95% CI 0.08–0.70) and being aged 50 years or more (aPR 0.32, 95% CI 0.19–0.56). Strikingly, we found that five of the six participants who were found to have incident HIV infections in this study were interested in LA-IP. Further, they had used oral PrEP in the past 30 days with suboptimal adherence. Conclusions These findings suggest that a population with elevated risk for HIV and barriers to daily oral PrEP adherence may find LA-IP a preferable alternative to daily oral PrEP in meeting their HIV prevention needs.

Tuberculosis treatment outcomes and associated factors: A retrospective study in West Nusa Tenggara, Indonesia

Successfully treating tuberculosis (TB) could significantly help reduce its spread. The aim of this study was to identify factors associated with successful TB treatment. A retrospective study was conducted in West Nusa Tenggara, Indonesia, using data from the National TB Information System (SITB) covering patients from January 1 to December 31, 2022. Patients were classified into two groups: those with successful treatment outcomes (cured or completed treatment) and those with unsuccessful outcomes (including treatment failure, loss to follow-up, or death). Univariate and multivariate logistic regression analyses were performed to identify factors associated with treatment outcomes, providing odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals (CIs). A total of 2,225 TB patients (1,382 males and 843 females) were included in the study. Of these, 2,048 (92.1%) achieved successful treatment outcomes. Univariate analysis indicated that older age (OR: 0.47; 95%CI: 0.28–0.78) and a high number of AFB in sputum smears (OR: 0.23; 95%CI: 0.09–0.66) were associated with a higher likelihood of unsuccessful TB treatment. In contrast, having no HIV infection (OR: 13.44; 95%CI: 6.22–29.08), clinical TB cases (diagnosed clinically rather than bacteriologically) (OR: 1.50; 95%CI: 1.04–2.20) and longer duration of TB treatments were associated with successful treatment outcomes. Multivariate analysis suggested that the TB treatment durations of 4–6 months (aOR: 1256.95; 95%CI: 431.89–3658.19) and 7–12 months (aOR: 575.5; 95%CI: 99.1–3342.06) were associated with a significantly higher likelihood of success compared to durations of 0–3 months. In conclusion, this study highlights that a minimum treatment duration of three months was crucial for increasing the likelihood of successful TB treatment. These findings emphasize the importance of comprehensive support programs to ensure adherence to treatment guidelines and improve outcomes.

Accessibility of ART in the farming community of OR Tambo District Municipality in the Eastern Cape province

Background: South Africa accounts for 14% of all new HIV infections representing the highest annual rate of new HIV infections globally. In addition, South Africa is home to 21% of the worldwide HIV burden, with 7.97 million people living with HIV. HIV not only affects the health of those living with the virus but also impacts their economic well-being.Aim: The study aimed to develop an in-depth understanding of the accessibility of anti-retroviral treatment in the farming communities of the OR Tambo District Municipality in the Eastern Cape province.Setting: The study was conducted in two local municipalities of OR Tambo District Municipality in the Eastern Cape province.Methods: A qualitative approach was used to explore and describe the accessibility of anti-retroviral treatment (ART) in the farming communities.Results: The study revealed that travelling long distances, transport costs, lack of transportation and traditional beliefs were the major barriers for farming communities to access ART.Conclusion: The findings of the study propose that poor access to ART in farming communities is linked to socio-cultural status, weak social support and limiting socioeconomic status.Contribution: The Eastern Cape Provincial Department of Health’s management can use the study’s findings for recommendations to the National Department of Health management on how to improve HIV roll-out initiatives.

Tannic acid reactivates HIV-1 latency by mediating CBX4 degradation.

HIV-1 can integrate viral DNA into host cell chromosomes and establish a long-term stable latent viral reservoir, a major obstacle in curing HIV-1 infection. The reactivation of latent proviruses with latency-reversing agents (LRAs) is a prerequisite for the eradication of viral reservoirs. Previous reports have shown that tannic acid (TA) exerts several biological functions, including antioxidant and antitumor activities. Here, we identified a novel function of TA as a reactivator of HIV-1 latency. TA showed similar features to the HIV-1 transactivator of transcription (Tat) and was able to reactivate a larger number of proviruses from various integration sites. TA also showed a strong synergistic effect with other LRAs acting on different signaling pathways. Further studies revealed that the polycomb repressive complex 1 component, chromobox protein homolog 4 (CBX4), is specifically degraded by TA through ubiquitination. CBX4 is associated with the tri-methylation at lysine 27 of histone H3 (H3K27me3) which was enriched on HIV-1 long terminal repeat regions. The TA-induced CBX4 degradation decreased the H3K27me3 enrichment and subsequently enhanced the transcriptional activity of the integrated proviruses. These results suggest that TA is an efficient LRA aiming to a new target for HIV-1 latency, which could be developed to eradicate latent proviruses.IMPORTANCEHIV-1 remains a global health challenge, with its ability to integrate into the host genome and evade the effects of drugs. To overcome this obstacle, the "shock and kill" strategy was proposed, targeting the reactivation of latent HIV-1 for subsequent eradication through antiretroviral medication and immune system reinforcement. Here, we found a new reactivator for HIV-1 latency, tannic acid (TA), which can reactivate HIV-1 latency widely and deeply. Moreover, we demonstrated that TA could promote the interaction between the polycomb repressive complex 1 component CBX4 and the E3 ubiquitin ligase cullin 4A (CUL4A), resulting in CBX4 degradation through the ubiquitin-proteasome system. These events reduce H3K27me3 enrichment in the HIV-1 long terminal repeat region, thereby promoting HIV-1 transcription and ultimately reactivating HIV-1 latent infection. Our work may facilitate the identification of new latency-reversing agents and provide more theoretical evidence for the molecular mechanism of HIV-1 latency.

Polymorphonuclear myeloid-derived suppressor cells regulates immune recovery during HIV infection through PD-L1 and TGF-β pathways

BackgroundAlthough MDSCs are widely recognized for their immunoinhibitory effects in pathological conditions, their function during HIV infection particularly within the mechanisms underlying incomplete immune recovery remains elusive.MethodsWe conducted a cross-sectional study in which 30 healthy controls and 62 HIV-1-infected subjects [31 immunological non-responders (INRs) and 31 immunological responders (IRs)] were selected. The proportion of MDSCs was determined in each category of participants. Using flow cytometry and real-time PCR, immune regulatory molecules (including PD-L1, ARG1, iNOS, IL-10, TGF-β, and IDO) that are relevant for MDSCs activity were quantified. Furthermore, we investigated the impact of the blockade of PD-L1 and TGF-β pathways on MDSCs and their effects on CD4+ T-cells using in vitro functional experiments.ResultsPMN-MDSCs are more abundant and are negatively correlated to CD4 counts in HIV-infected individuals. In addition, PMN-MDSCs suppress CD4+ T-cell proliferation and IFN-γ production in INRs. Furthermore, correlations were found between PD-L1 expression on PMN-MDSCs and PD-1+ CD4+ T-cells. TGF-β expression on PMN-MDSCs was likewise enhanced in INRs. Importantly, inhibiting both PD-L1 and TGF-β pathways had a synergistic impact on restoring CD4+ T-cell activity in vitro.ConclusionsPMN-MDSCs expansion inhibits CD4+ T-cell responses. We suggest that targeting PD-L1 and TGF-β pathways together may significantly improve immune recovery in INRs.

Meningitis criptocócica en un paciente sin VIH. Reporte de caso clínico

Cryptococcal meningitis is a mycosis caused by Cryptococcus neoformans and Gattii, which is transmitted by air and affects the lungs and central nervous system. This disease is a common cause of meningitis in patients with HIV/AIDS; however, in recent years there has been an increase of cases in immunocompetent patients, for this reason, the following case report is made. The objective of this report is to present the case of a patient with cryptococcal meningitis in the absence of HIV infection by reviewing the clinical history. The following is the case of a 67-year-old male with a history of arterial hypertension, under treatment with losartan and amlodipine, who came to the emergency room with a clinical picture of asthenia, algic with severe headache 7/10 VAS scale, the clinical picture evolves with decreased strength in the lower limbs and severe headache 10/10. The need for further investigation of the immunopathological mechanisms of cryptococcal infection in seronegative individuals is emphasized, as understanding the immune responses could improve diagnosis and treatment. In cryptococcal meningitis, elevated intracranial pressure influences prognosis in 50% of cases. Limited diagnostic resources and time hinder accurate identification of the cause and effective treatment in seronegative patients.

Prevalence and trends of cigarette smoking among adults with HIV infection compared with the general population in Korea

Prevalence and trends of cigarette smoking among adults with HIV infection compared with the general population in Korea

Differential systemic immune-inflammation index levels in people with and without HIV infection.

HIV infection is linked to persistent inflammation despite effective antiretroviral therapy (ART). The Systemic Immune-Inflammation Index (SII) is a marker of inflammation in various conditions. We compared SII values between PWH and PWoH. Clinical blood laboratory data were used to calculate the SII for each participant using the formula [(Platelet count × Neutrophil count) / Lymphocyte count]. Differences in SII values between the groups were analyzed using the Wilcoxon test, and the impact potential confounders was assessed with multivariable regression models. The study included 343 PWH and 199 PWoH. Age and race did not significantly differ, but sex distribution did (83.1% male in PWH vs. 55.8% in PWoH, P < 0.0001). Among PWH, median [IQR] nadir and current CD4 counts were 199 cells/μL [50, 350] and 650 [461,858], respectively. Nearly all PWH were on ART, with 97.2% achieving viral suppression. PWH had lower SII values than PWoH (327 [224, 444] vs. 484 [335,657], P = 1.35e-14). PWH also had lower neutrophils and platelets (ps < 0.001) and higher lymphocyte counts (P = 0.001). These differences remained significant after adjusting for age, sex, and other potential confounders. Contrary to expectations, PWH had lower SII levels, likely due to altered hematologic parameters influenced by HIV and ART. These findings suggest that SII interpretation in PWH requires consideration of unique hematologic profiles and underscore the need for further research to understand the mechanisms and clinical implications of SII in HIV management.

Senescence of endothelial cells increases susceptibility to Kaposi's sarcoma-associated herpesvirus infection via CD109-mediated viral entry.

The aging process is characterized by cellular functional decline and increased susceptibility to infections. Understanding the association between virus infection and aging is crucial for developing effective strategies against viral infections in older individuals. However, the relationship between Kaposi's sarcoma-associated herpesvirus (KSHV) infection, a cause of Kaposi's sarcoma prevalent among the elderly without HIV infection, and cellular senescence remains enigmatic. This study uncovers a fascinating link between cellular senescence and enhanced KSHV infectivity in human endothelial cells. Through a comprehensive proteomic analysis, we identified caveolin-1 and CD109 as novel host factors significantly upregulated in senescent cells that promote KSHV infection. Remarkably, CRISPR-Cas9-mediated knockout of these factors reduced KSHV binding and entry, leading to decreased viral infectivity. Furthermore, surface plasmon resonance analysis and confocal microscopy revealed a direct interaction between KSHV virions and CD109 on the cell surface during entry, with recombinant CD109 protein exhibiting an intriguing ability to inhibit infection by blocking virion binding. These findings uncover a previously unrecognized role of cellular senescence in enhancing KSHV infection through upregulation of specific host factors and provide novel insights into the complex interplay between aging and viral pathogenesis.

Epidemic characteristics of HIV-infected people among Chinese and Burmese in Dehong Dai and Jingpo Autonomous Prefecture of Yunnan Province, 2000-2023

Objective: To analyze the epidemic characteristics and trends of newly reported HIV-infected people among Chinese and Burmese in Dehong Dai and Jingpo Autonomous Prefecture (Dehong Prefecture) of Yunnan Province, China, from 2000 to 2023, and provide evidence for formµlating AIDS prevention and control measures for the Burmese living in Dehong. Methods: The data were obtained from the Chinese Disease Control and Prevention Information System. The distribution of HIV-infected people with different population characteristics was analyzed, and the Joinpoint regression model was used to analyze the temporal trend of crude detection rate in different genders, ethnicities, and ages. Results: From 2000 to 2023, 24 989 newly HIV infections were reported in Dehong Prefecture, of which 14 594 (58.4%) were Chinese and 10 395 (41.6%) were Burmese. Compared with Chinese, Burmese women (32.9%, 3 416/10 395), those aged 20-29 (40.9%, 4 248/10 395), and Jingpo people (26.7%, 2 773/10 395) accounted for a higher proportion. The new diagnosis rate of Chinese nationals increased from 1.0/10 000 in 2000 to 15.4/10 000 in 2004, and then showed a downward trend, falling to 1.2/10 000 in 2023. Among them, compared with other age groups, Dai and other ethnic groups and women, the new diagnosis rate among 20-49 age group, Jingpo and men were relatively higher, at 1.7/10 000, 2.3/10 000 and 1.3/10 000 respectively. Regarding the method of detection, the Chinese HIV-infected people were mainly detected by key population testing (35.7%), while the Burmese HIV-infected people by key population testing (28.9%) and physical examination for entry-exit personnel (25.3%). The transmission routes of both nationalities were mainly heterosexual transmission, but compared with Chinese HIV-infected persons, the proportion of Burmese infected persons through non-marital non-commercial transmission was relatively higher (66.4% vs. 60.6%). The proportion of Chinese nationals with a first CD4+T lymphocyte (CD4) counts of <200 cells/µl (28.9%) was higher than that of Burmese nationals (19.8%). Conclusions: The rising trend of HIV infection among Chinese and Burmese people in Dehong Prefecture from 2000 to 2023 slowed down. The new diagnosis rate was higher in the 20-49 age group, Jingpo and men. Compared with Burmese HIV-infected people, the proportion of Chinese HIV-infected people with first CD4 counts <200 cells/µl was relatively higher. Comprehensive interventions should be further carried out for Myanmar nationals, and efforts should be made to expand testing for Chinese nationals.

Adolescent choices and caregiver roles: Understanding individual and interpersonal influences on sexual decision-making in South Africa.

South African adolescents are at-risk for HIV infection due to engaging in high-risk sexual behaviours. Understanding the factors influencing sexual decision-making is crucial for developing effective HIV prevention strategies. We conducted a qualitative study with adolescents and caregivers in Rustenburg, South Africa to explore individual and interpersonal factors that influence adolescent sexual decision-making. Focus Group Discussions (FGDs) were conducted in English and Setswana with 17 adolescents (13 females and 4 males) and 19 caregivers (17 females and 2 males) between April and July 2018. Thematic analysis revealed that while adolescents had access to sexual education from various sources, this knowledge did not translate into healthy sexual decision-making. Lack of effective communication and support between caregivers and adolescents in discussing sexual behaviours are a contributing barrier. Although adolescents expressed a strong need to be understood and supported by caregivers regarding sexual behaviours, there was perceived distrust, judgemental attitude from caregivers, poor role models of a father figure, and the traditional taboo nature of having these discussions with caregivers. While female adolescents and female caregivers discussed sexual matters, this type of communication was limited with adolescent males. Male adolescents were uncomfortable communicating with either caregiver, fearing caregiver judgemental attitudes and being misunderstood. Female caregivers perceived male caregiver roles to be absent and non-engaging. Caregivers desired to support their children, yet they seemed to doubt their skills. Communication tools and guidance on how adolescents and caregivers could communicate about sexual matters could create enabling environments for adolescents to make informed, healthy decisions regarding their sexual behaviours. Further, future interventions could consider gain-framed messaging to address adolescents translating knowledge of sexual behaviours to making healthy sexual choices. Improving equitable male caregiver role at home, is of particular importance in supporting adolescent sexual decision-making, and should be prioritized.

Extrapulmonary Tuberculosis at the Sylvanus Olympio University Hospital Center

Objective: describe the epidemiological, clinical, paraclinical and therapeutic aspect of extrapulmonary tuberculosis at Centre Hospitalier Universitaire Sylvanus Olympio in Lomé. Methodology: This was a retrospective and descriptive study over a period of 4 years, from November 2019 to October 2023, of extrapulmonary tuberculosis cases diagnosed at CHU SO in Lomé, and put on treatment. Results: We identified 132 cases of extrapulmonary tuberculosis during this period. The average of age of patients was 43.39 years old, with the extreme of 4 and 85 years. Low socioeconomic level was found on 65.2 % of patients. An history of tuberculosis contamination was found on 4.6 % of patients. On the 132 patients of our study, 31 performed BCG vaccination. An HIV infection was found on 21.2 %. In our study, loss of weight was found on 94 patients and 60 patients had vesperal fever. In our study the main localization was osteoarticular with 53.0 %. The diagnosis was presumptive in 78.8 % of cases. A confirmation diagnosis was most often histological (12.1 %). All our patients received a standard antituberculosis treatment, RHEZ during the initial phase. We noticed 3.0 % of death with a significative association with HIV infection. Conclusion: Extrapulmonary tuberculosis concerns all groups of age. Immunodepression favors its development. Its diagnosis is most often presumptive.

The quality of SIV-specific fCD8 T cells limits SIV RNA production in Tfh cells during antiretroviral therapy.

The attack and defense of infected cells and cytotoxic CD8 T cells occur in germinal centers in lymphoid tissue in chronic persistent HIV/SIV infection. Latently infected cells, the therapeutic target of HIV infection, accumulate in follicular helper T (Tfh) cells in lymphoid tissue; the impact of HIV-specific follicular CD8 (fCD8) T cells in lymphoid tissue on the latently infected cells remains unknown. We infected 15 cynomolgus macaques with SIVmac239 and examined the contribution of SIV-Gag-specific fCD8 T cells, defined by activation-induced markers (AIMs), to SIV-infected cells. Eight out of the 15 infected macaques served as progressors; a chronic phase combination antiretroviral therapy (cART) model was established for the eight macaques (progressors) with chronic persistent infection status, wherein cART was started in the chronic phase and discontinued after 27 weeks. Seven macaques that naturally controlled the viremia served as natural controllers. The frequency of SIV-Gag-specific fCD8 T cells was inversely correlated with the amount of cell-associated SIV-gag RNA in the Tfh only under cART or in the controllers but not in untreated progressors. scRNA-seq of SIV-Gag-specific fCD8 T cells in various conditions revealed that the gene expression pattern of SIV-Gag-specific fCD8 T cells in the controllers was closer to that of those under cART than the untreated progressors. Comparing the SIV-Gag-specific fCD8 T cells of those under cART to the controllers revealed their more exhausted and immunosenescent nature under cART. Improving the HIV/SIV-specific fCD8 T cells under cART by targeting those pathways might contribute to the development of potential curative strategies.IMPORTANCEWe infected cynomolgus macaques with SIVmac239 to establish an SIV-chronically infected cART model. We performed an in-depth characterization of Tfh and fCD8 T cells in three conditions-chronic stage of untreated, cART-treated, and natural controller cynomolgus macaques-by combining tissue section analysis and single-cell analyses of sorted cells. We revealed the inverse relationship between Tfh infection and SIV-Gag-specific fCD8 T cell frequencies as observed in HIV-infected individuals, thereby establishing the cynomolgus macaque as a relevant animal model to study the determinants of HIV/SIV persistence in lymphoid tissue. Additionally, scRNA-seq analysis of SIV-Gag-specific fCD8 T cells revealed an enrichment of exhausted or senescent transcriptomic signatures under cART. These data will provide the basic insights into virus-host CD8 T cell interactions, particularly within the follicular region, during latent HIV infection under ART.

The Impact of HIV on B Cell Compartment and Its Implications for COVID-19 Vaccinations in People with HIV

HIV causes intense polyclonal activation of B cells, resulting in increased numbers of spontaneously antibody-secreting cells in the circulation and hypergammaglobulinemia. It is accompanied by significant perturbations in various B cell subsets, such as increased frequencies of immature/transitional B cells, activated memory B cells, atypical memory B cells, short-lived plasmablasts and regulatory B cells, as well as by decreased frequencies of resting memory and resting naïve B cells. Furthermore, both memory and antigen-inexperienced naïve B cells show exhausted and immune-senescent phenotypes. HIV also drives the expansion and functional impairment of CD4+ T follicular helper cells, which provide help to B cells, crucial for the generation of germinal center reactions and production of long-lived plasma and memory B cells. By suppressing viral replication, anti-retroviral therapy reverses the virus-induced perturbations and functional defects, albeit inadequately. Due to HIV’s lingering impact on B cells, immune senescence and residual chronic inflammation, people with HIV (PWH), especially immune non-responders, are immunocompromised and mount suboptimal antibody responses to vaccination for SARS-CoV-2. Here, we review how functionally and phenotypically distinct B cell subsets are induced in response to a vaccine and an infection and how HIV infection and anti-retroviral therapy (ART) impact them. We also review the role played by HIV-induced defects and perturbations in B cells in the induction of humoral immune responses to currently used anti-SARS-CoV-2 vaccines in PWH on ART. We also outline different strategies that could potentially enhance the vaccine-induced antibody responses in PWH. The review will provide guidance and impetus for further research to improve the immunogenicity of these vaccines in this human population.

Contribution of malnutrition to infant and child deaths in Sub-Saharan Africa and South Asia

IntroductionMalnutrition contributes to 45% of all childhood deaths globally, but these modelled estimates lack direct measurements in countries with high malnutrition and under-5 mortality rates. We investigated malnutrition’s role in...

A duplex HiFi-LAMP assay for screening of two novel human circoviruses HCirV-1 and HCirV-2

Circoviruses belong to the family Circoviridae, which is classified into two genera, Circovirus and Cyclovirus. Some circoviruses have been identified in various organisms and/or their fecal samples and might be associated with diseases in their hosts. However, few circoviruses are reported in human. Recently, two novel circoviruses HCirV-1 and HCirV-2 were identified in humans through next-generation sequencing and were defined as the species of Circovirus human in the family Circoviridae. Both viruses are suspected to be associated with liver diseases, particularly among immunosuppressed people, showing potential health implication. Investigation on the prevalence of both viruses, and identification of vulnerable population are important and need a rapid, accurate, and specific assay for detecting and screening the two viruses. In this study, we developed a duplex HiFi-LAMP assay for simultaneous detection of HCirV-1 and HCirV-2. The assay exhibits high sensitivity with LOD of 64 and 49 copies per 25 µL reaction for HCirV-1 and HCirV-2, respectively. The duplex assay was demonstrated to have a rapid reaction time within 35 min. Clinical screening tests showed that neither HCirV-1 nor HCirV-2 were detected among 875 patients with infection of HBV, HIV-1 or other viruses. Large-scale screening of both viruses in diverse populations is encouraged to enhance our understanding of their relevance to various diseases.

Utilization of an Off-Site Patient Navigator to Facilitate HIV Pre-Exposure Prophylaxis Referrals in Patients with Sexually Transmitted Infections in the Emergency Department.

The emergency department (ED) is an important setting to identify people at increased risk of HIV infection who may benefit from HIV pre-exposure prophylaxis (PrEP). However, prescribing or referral for PrEP in the ED is not widespread. The purpose of this study is to evaluate the use of an off-site HIV PrEP patient navigator to facilitate PrEP access for patients who seek care for sexually transmitted infections (STIs) in the ED. Between January 1, 2023 and June 30, 2023, patients who tested positive for a bacterial STI in the ED were eligible for outreach by an off-site PrEP patient navigator. Interested patients were scheduled for telehealth appointments for PrEP. Demographic, clinical information and outcomes were obtained. During the study period, there were 160 patients eligible for PrEP outreach. Outreach was completed in 75 (47%) of patients, with 46/75 (61%) agreeable to scheduling a PrEP appointment. Of these 46 patients, median age was 30 years old [IQR 23, 35], 25 (54%) were male, 40 (87%) were Black/African American and 6 (13%) identified as men who have sex with men (MSM). Forty three of 46 interested patients (93%) scheduled an appointment and 35/46 (76%) completed an appointment. Thirteen of 35 (37%) patients who completed an appointment were prescribed PrEP, with 6/13 (46%) and 2/13 (15%) remaining on PrEP at 3 and 6 months, respectively. Use of an off-site patient navigator can facilitate referrals for HIV PrEP for patients who are diagnosed with bacterial STIs in the ED.

Rapid HIV pre-exposure prophylaxis (PrEP) initiation is safe and feasible: Experience from Wroclaw All Saints cohort in Poland 2017-2021.

HIV pre-exposure prophylaxis (PrEP) still faces many barriers around the world. Additional barriers such as retesting or rescheduling for result analysis and prescription might lead to abandoning PrEP initiation altogether. We wanted to explore whether there would be a significant number of alert issues among people starting PrEP that would warrant more in-depth clinical analysis before commencing PrEP safely. A retrospective medical data analysis of people who started PrEP at All Saints Clinic in Wroclaw, Poland between October 2017 and January 2021 was performed. Rapid (during the first visit) or delayed PrEP initiation was chosen at the discretion of the attending physician. A total of 308 people started PrEP in the analysed period and were included in the analysis. The median age was 33 years with 96.75% being men who have sex with men (MSM) and 68.5% opting for daily dosing at PrEP initiation. Most (n=233) started PrEP rapidly (i.e., during the first visit), whereas for 75 individuals the initiation was delayed by a median of 7 days. Logistic regression analysis showed that lack of test laboratory results, recent exposure or age over 50 years were reasons for delaying PrEP initiation. Median creatinine values increased from 0.93 mg/mL to 0.95 mg/mL 1 month after PrEP initiation. Despite being statistically significant (p = 0.0282, 95% CI 0.0015-0.027), the difference was not significant clinically. Rapid PrEP initiation was feasible and safe while contraindications were rare. HIV infection exclusion before PrEP initiation can be streamlined by utilizing remote consultations and patient self-interpretation of the results. Renal complications are either not clinically significant or occur rarely.

Healthcare resource utilization and related cost of non-HIV comorbidity management in people with HIV in a Spanish cohort from 2007-2016

Objective To estimate the cost and healthcare resource utilization (HRU) associated with the prevalence of comorbidities in people living with HIV (PLWH) in a Spanish cohort over ten years. Methods: Cohort study carried out at the HIV outpatient clinic of the University Hospital Virgen del Rocío based on data collected during 2007-2016. PLWH with at least one follow-up visit were included. Comorbidities were determined by examining diagnostic codes in the electronic medical records. Costs were estimated from hospitalizations, emergency and non-HIV visits, laboratory tests for conditions unrelated to HIV infection, HIV antiretroviral therapy, and other non-HIV diagnostic tests. A linear regression was performed with non-ART costs as the dependent variable and patient characteristics (sex, HIV transmission route, age, CD4, comorbidities, and infection duration) as independent variables. Results: The study included 2,798 PLWH; 83% were men with a mean age of 38.6 years. Overall, 52.5% of PLWH had at least one non-HIV comorbidity and 21.2% had ≥3 comorbidities. The most prevalent comorbidities were hepatitis C (25.3%) and hypertension (22.9%). The presence of comorbidities increased the total healthcare cost up to 80% in PLWH with ≥3 comorbidities compared with those without comorbidities (over a 10-year period (115,867.3€vs 64,290.7€, p < 0.001). The number of comorbidities was linked to higher healthcare costs in PLWH in the adjusted model. Conclusion: Comorbidities raised the total healthcare costs for PLWH, with a greater impact on those with multiple comorbidities compared to those with few or none. Both clinical and economic decision-makers must consider and assess the cost of comorbidities when evaluating HIV treatment guidelines or recommendations.

Accelerated initiation of antiretroviral therapy by virtual health in service members newly diagnosed with HIV infection.

Delays in HIV antiretroviral therapy (ART) have been associated with HIV disease progression and forward transmission. We evaluated the effectiveness of an accelerated ART virtual protocol (VP) for active duty (AD) members with incident HIV diagnosis. Under the traditional protocol (TP), service members stationed worldwide were evaluated in-person at Brooke Army Medical Center (BAMC) and received comprehensive HIV care. In February 2020, a VP was adopted to initiate HIV care at the local base. Chart reviews were conducted to obtain patient demographics and clinical data. Continuous variables were compared using 2-tailed t tests, categorical variables were evaluated with Fisher's exact or Chi squared tests. Time from HIV notification to ART initiation was significantly shorter with the VP compared to the TP (15days vs 25days; p = <0.05). The VP had a shorter time to viral suppression compared to the TP (96days [SD ± 86] compared to 269 days [SD ± 300], p = <0.05). The VP was associated with a shorter time to HIV specialty evaluation, ART initiation, and viral suppression. The use of virtual health protocols for other time sensitive medical interventions and/or for access to limited specialties should be considered as these may improve quality of care.