OBJECTIVES:People living with HIV face several challenges as they age, including the potential for polypharmacy and increased susceptibility to drug-related adverse effects. Thus, effective and well-tolerated regimens with minimal or no drug interactions would be useful in this population. We present real-world effectiveness and safety data for individuals aged >50 years who achieved virological suppression (HIV-1 RNA <50 copies/mL) and switched to dolutegravir/lamivudine (DTG/3TC). METHODS:This retrospective, observational, single-centre study conducted in Portugal included individuals aged >50 years who switched to DTG/3TC while virologically suppressed and had ≥12 months of follow-up. Proportions of individuals maintaining virological suppression were described at 12 months; CD4+ cell counts were described at baseline and 12 months. Descriptive subgroup analyses were performed based on age, sex assigned at birth, and availability of historical genotypic resistance results. RESULTS:Overall, 538 individuals aged >50 years were included (74% male; mean age, 62 years; mean time on previous therapy, 160 months). High proportions (intention-to-treat population, 97%; on-treatment population, 98%) of individuals who switched to DTG/3TC maintained virological suppression through 12 months of follow-up. CD4+ cell counts remained stable (mean baseline: 727 cells/mm3 [range 94-2371]; mean month 12: 742 cells/mm3 [range 99-2659]). No individuals experienced virological failure. Nine (2%) individuals discontinued DTG/3TC for non-treatment-related reasons. Proportions with virological suppression at month 12 were similar between on-treatment subgroups by age, sex assigned at birth, and historical genotypic resistance results availability. CONCLUSIONS:DTG/3TC demonstrated robust effectiveness and a good safety profile in individuals aged >50 years with virological suppression in Portugal.

Abstract Background Antiretroviral therapy (ART) has the most effective treatment for people with HIV, but its effectiveness depends on the individual medication adherence. Morisky Medication Adherence Scale (MMAS-8) is one of the most widely used scales to assess patient adherence. Thus, we aimed to validate a Portuguese version of MMAS-8 and determine its psychometric properties in HIV positive patients. Methods A cross-sectional survey was conducted in Centro Hospitalar Universitário São João (Porto, northern Portugal) at the infectious diseases department. After authorization to use the scale - granted by the author - and, a standard forward-backwards procedure to translate MMAS-8 to Portuguese, the questionnaire was applied to 233 patients with HIV doing ART. Reliability was assessed using Cronbach's alpha and test-retest reliability. Three levels of adherence were considered: 0 to < 6 (low), 6 to < 8 (medium), 8 (high). Results In the studied sample, the mean age was 45.03 years (SD = 11.63), 80.3% men, 19.3% women and 1 transgender, and 53.8% had ≤9 years of education. The mean number of prescribed ART per patient was 1.76. The mean score for the medication adherence scale was 7.29 (SD = 6.74). For the reliability analysis, 12 patients were excluded due to missing data (n = 221). Regarding the level of adherence, 22.5% were low adhering, 71.6% medium and 5.9% high. Corrected item-total correlations showed that 1 item does not correlate very well with the overall scale and was dropped. Scale reliability analysis for the remaining 7 items revealed an overall Cronbach's alpha of 0.661. Women had a protective effect on adherence (OR = 0.31;95%CI:0.15-0.66). Number of years doing ART, age of participants, and type of residence didn't show to be correlated with adherence. Conclusions MMAS-8 is a reliable and valid measure to detect patients at risk of non-adherence. A satisfactory Cronbach's alfa (0.661) was obtained. In general, adherence to medication was medium or high. Key messages This scale can be applied nationwide in other different hospitals, as it could serve as a tool for measuring adherence to ART that can allow for better health care to the ones that are low adhering. A Portuguese version of the MMAS-8 was created for measuring adherence to ART that maintained a similar structure to the original MMAS-8 and good psychometric properties.

Background: In the current COVID-19 pandemic, some risk factors for severe disease and death have been identified, including age, male gender, diabetes mellitus, cardiovascular and lung diseases, chronic kidney disease and cancer Although still scarce, current data does not support an increased risk for severe COVID-19 on PLWH [1,2] Our aim was to describe clinical characteristics and outcomes of PLWH with COVID-19 followed in our hospital, a reference centre for emerging infectious diseases in Portugal Materials and methods: Retrospective analysis on cases of PLWH with a confirmed COVID-19 diagnosis between 2 March and 14 July 2020 The data showcased in Table 1 was collected from patient records Proven COVID-19 required a positive SARS-CoV-2 nucleic acid amplification test on respiratory samples Results: We followed 2092 patients with COVID-19, eight of whom were PLWH (six males, mean age 48 ± 15 years) on ART at the time of diagnosis, which included protease inhibitors (PI) in two and tenofovir alafenamide in two Median CD4 + T cell count was 626 (range 14 to 1337) cells/mm3 Seven were virally suppressed and had a CD4 + T cell count =350 cells/mm3, and six had at least one comorbidity other than HIV Two patients received treatment with hydroxychloroquine, both of whom were hospitalised: one with concomitant ankylosing spondylitis on methotrexate and the other diagnosed with SARS-CoV-2 pneumonia while hospitalised for candidaemia The latter was a 67-year-old HIV-2 infected patient on a failing ART regimen without immune recovery and with detectable HIV viraemia, and the only casualty in our cohort He had multiple comorbid conditions and required treatment with supplemental oxygen therapy Seven patients were classified as having mild disease, six of whom currently considered fully recovered with a median 40 5 days (range 21 to 74 days) until two consecutive negative SARS-CoV-2 PCR tests Conclusions: PLWH accounted for \u003c 0 4% of patients with COVID-19 in our centre PLWH may still get infected during PI-and/or tenofovir-based ART A severe clinical picture among those with viral suppression on ART was not seen thereby adding to the growing body of evidence supporting the notion that adequately controlled HIV does not by itself place one at increased risk for severe disease or excess mortality

Dual human immunodeficiency virus (HIV) 1 and HIV-2 super-infections are rare but challenging. A HIV-1-infected patient receiving effective antiretroviral therapy was investigated for a severe CD4+ cell count decline. HIV-2 superinfection was diagnosed and genotypic test revealed mutations conferring resistance to most drug class, limiting options for treatment.

ObjectiveEvaluate the effectiveness and safety of simplification of tenofovir/emtricitabine/efavirenz (TDF/FTC/EFV) in selected treatment‐experienced HIV‐1‐infected patients who have been virologically suppressed for>3 months on their current regimen.MethodsWe selected patients who started the simplified regimen between December 1st 2008 and March 31st 2012. Exclusion criteria: prior therapeutic failure, presence of resistance mutations to any component of TDF/FTC/EFV and patients previously observed in other centers. Efficacy and safety assessments were performed at baseline, 4 weeks after switch and then every 12–24 weeks. Statistical analysis was performed with SPSS version 20.0.Results384 patients were evaluated; 302 (79%) male; mean age 47 (SD=10) years; median CD4 cells count was 504 cells/mm3 (367–710). Baseline median glomerular filtration rate (eGFR; Cockcroft‐Gault equation) was 100 mL/min (86–116) and median ALT was 33 U/L (21–47). Median total cholesterol (TC) was 205 mg/dL (176‐236), high‐density lipoproteins (HDL) 45 mg/dL (38–54); low‐density lipoproteins (LDL) 130 mg/dL (108–151); triglycerides (TG) 125 mg/dL (84–176). Prior NNRTI‐based regimen in 327 (85%) patients (TDF/FTC and EFV in 76%); protease inhibitor in 52 (14%) and integrase inhibitor in 5 (1%). Discontinuation of treatment occurred in 49 patients (13%) after a mean time of 1.1 years (SD=1.1) of follow‐up: nervous system symptoms (n=11), decreased eGFR (n=5), virological failure (n=5), pregnancy (n=5), gastrointestinal symptoms (n=3), rash (n=1), other reasons (n=2); 12 patients dropped out the treatment and 5 died. Occurrence of blips (transient increase in VL ≤200 copies/mL) was documented in 98 (26%) patients; in 70, VL decreased to <20 copies/mL after the blips and in 28 VL is not yet available. 317 patients (83%) achieved≥48 weeks of follow‐up after simplification. Compared with baseline, significantly higher levels of CD4 cells count, HDL and eGFR were found and lower levels of TC, LDL and TG. CD4 AST ALT TC HDL LDL TG eGFR Baseline Median 501 27 32 203 46 130 123 100 Percentiles 25 358 22 22 174 39 108 84 85 Percentiles 75 712 36 45 236 54 151 179 113 Follow‐up Median 541 28 32 196 49 123 115 111 Percentiles 25 397 22 22 174 41 101 80 96 Percentiles 75 734 36 46 223 57 141 155 133 p‐value <0.001 0.395 0.513 <0.001 <0.001 <0.001 <0.001 <0.001 ConclusionSimplification to TDF/FTC/EFV was shown to be an efficient and safe option in virologically suppressed patients and without a previous virological failure.

IntroductionCurrent guidelines recommend the start of antiretroviral therapy before advanced immunosuppression, which is not always possible. The purpose of this study is to evaluate factors associated with the degree of immunosuppression at the diagnosis of HIV infection.MethodsWe evaluated demographic and epidemiological data of HIV‐infected patients observed at the Department of Infectious Diseases diagnosed between 2006–2011, and analyzed the relationship between these data and the immune status at diagnosis. Statistical analysis was performed using SPSS version 20.0 for Windows.ResultsData from 600 new patients were analyzed. 584 (97.3%) infected by HIV‐1. 426 (71%) male. Mean age=42 years (SD=14). Risk factor for HIV infection: sexual in 548 patients (91.3%) (22.8% homo/bisexual). 153 (25.5%) patients had AIDS ‐defining illness. Origin of patients: general practitioner ‐ 153 (25.5%), hospitalization in the Department of Infectious Diseases ‐ 110 (18.3%), diagnostic screening after partner's diagnosis ‐ 69 (11.5%), hospital consultation ‐ 68 (11 3%), emergency room ‐ 61 (10.2%), anonymous diagnostic testing center ‐ 46 (7.7%), other hospital inpatient services ‐ 31 (5.2%), hospitalization in another hospital ‐ 30 (5%), attempted blood donation ‐ 15 (2.5%), drug addiction treatment center ‐ 8 (1.3%), pregnancy screening ‐ 3 (0.5%) and patient's own initiative ‐ 6 (1%). The mean CD4+ cell count was 319 cells/cmm (SD=274; range: 2–1416). Women were diagnosed at significantly higher CD4+ cell count levels (p=0.005), as well as younger patients (p<0.001). Homo/bisexual patients had CD4+ cell counts significantly higher than the other groups (p<0.001). There were differences in CD4+ cell count depending on the origin of the patients (p<0.001): patients diagnosed at anonymous diagnostic center, drug addiction treatment center, blood donors, pregnant women and coming on their own initiative, had higher CD4+ cell count levels (p<0.001). Patients admitted in the Department of Infectious Diseases were those with the lower CD4+ cell counts. No relationship was found between CD4+ cell count level and year of diagnosis.ConclusionThese results indicate the importance of early HIV screening even in individuals without a perceived risk of acquisition of this infection, so they can benefit from antiretroviral treatment before having advanced immunosuppression.

BackgroundWith the availability of the 2nd‐generation non‐nucleoside reverse transcriptase inhibitor (NNRTI) etravirine (ETR), it is possible to obtain undetectable plasma viral load in HIV‐1‐infected treatment experienced patients with resistance mutations to NNRTIs. The purpose of this study is to determine the proportion of patients with prior exposure to NNRTIs who may benefit from a therapeutic regimen including ETR.Patients and methodsAnalysis of the genotypic resistance tests of patients having failed efavirenz (EFV) or nevirapine (NVP) antiretroviral‐based regimens, in a 5‐year period (2007–2011). Susceptibility to ETR was assessed using four different algorithms: HIVdb Stanford University HIV Drug Resistance Database, ANRS score, REGA score and Tibotec weighted genotypic score.ResultsOf 170 patients with a history of failure or abandonment of regimens containing EFV or NVP, 68 (40%) had mutations conferring resistance to these NNRTIs (RAMs). Resistance tests were carried out from seven months before to 3 years after (X=48±207 days) the NNRTIs discontinuation. Of the HIV‐1 subtypes identified (n=67), most were were subtype B (53.7%) and G (34.3%) RAMs found in the 68 samples successfuly genotyped: V90I (n=2), A98G (n=1), L100I (n=7), K101E (n=5), K103N (n=38), K103S (n=2), V106A (n=1), V106M (n=1), V108I (n=4), V179D (n=4), Y181C (n=18), Y188C (n=1), Y188H (n=1), G190A (n=11), G190E (n=1), G190S (n=1), H221Y (n=6), P225H (n=1), F227L (n=3) and K238T (n=2). In 27 (39.7%) patients only one RAM was detected, 30 (44.1%) had 2, 6 had three mutations and 5 other patients had more than three RAMs to NNRTIs. Susceptibility to ETR varied depending on the used algorithm: Susceptible Intermediate resistance Resistant ANRS 60 (88.2%) 3 (4.4%) 5 (7.4%) HIVdb 49 (72.0%) 17 (25.0%) 2 (3.0%) REGA 40 (58.8%) 27 (39.7%) 1 (1.5%) Tibotec 44 (64.7%) 23 (33.8%) 1 (1.5%) ConclusionIn this population with resistant virus to EFV and NVP, we found a low frequency of mutations conditioning severely impacting on susceptibility to ETR. Based on these results, ETR could be a useful component of effective treatment regimens for the majority of these patients with prior exposure to 1st‐generation NNRTIs.

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

Lymphadenopathy is very common in HIV-infected patients (pts). In Portugal tuberculosis (TB) remains the main AIDS defining opportunistic infection and the etiologic diagnosis of enlarged lymph nodes is a challenging problem. The aim of the study was to assess the usefulness of FNAB in the evaluation of these pts. The results of all FNAB exams performed in a 10 year period were analysed. Pts clinical status and demographic, immunologic and virologic data at the time of the procedure were collected. Ziehl-Neelsen stain and culture (Lowenstein and/or Mycobactec), and after the year 1999, PCR for M. tuberculosis (Mt) were performed routinely. Other stainings as well as immunophenotypic and microbiological studies were performed wherever necessary. A total of 524 procedures were performed in 412 pts: in 36% the risk factor for HIV infection was sexual exposure and 61% were IVDUs; 24% pts had AIDS. Pts mean age was 33.5 yrs; 4 pts were children < 13 years old. Adult pts mean CD4 cell count was 330 cells/mm3; 98% of the pts were HIV-1 infected with a mean VL 148490 cps/ml, 18% had undetectable VL and 12% had a VL > 750000 cps/mL. 2% of the pts were HIV-2 infected. Most common FNAB diagnosis was reactive lymphoid hyperplasia n = 287 (55%). TB was diagnosed in 120 (23%) samples based on: acid-fast bacilli in the cytologic smears (n = 51), granulomatous/necrotising caseous patterns (n = 94), Mt positive PCR (n = 44), culture (n = 75). Lymphoma (n = 11). Disseminated MAC disease (n = 5). Other diagnosis (n = 3). In 18% of the samples the material obtained by FNAB was scanty or acellular or non-conclusive - in none of these cases was a malignant tumour later found. FNAB was found to be a simple and reliable evaluating procedure for lymphadenopathies in the HIV-infected patient, enabling the correct diagnosis of a major opportunistic infection.