BACKGROUND:Hepatitis C virus (HCV) has significantly impacted people with human immunodeficiency virus (HIV). Harm reduction programs, changing transmission patterns, and direct-acting antivirals (DAAs) have profoundly altered HIV/HCV coinfection trends. This study evaluates HCV prevalence among people with HIV in Spain over 2 decades. METHODS:We conducted 9 cross-sectional studies (2002-2023) in 39-43 centers. Sampled individuals were randomly sampled from people with HIV actively followed up at these centers, with proportional allocation. Main outcomes included the prevalence of anti-HCV antibody and active HCV infection (HCV RNA--positive result). RESULTS:The reference population ranged from 31 800 to 47 006, with sample sizes of 1260-1867. HIV transmission patterns shifted from 2002 to 2023, with injection drug use decreasing from 55% to 21% and the proportion of men who have sex with men increasing from 17% to 46%. HCV seroprevalence fell from 60.8% to 27.4%, and active infection from 46.3% to 0.9%. In the DAA era (2015-2023), active HCV infection dropped by 100% in heterosexuals, 94% in people who inject drugs, and 71% in men who have sex with men. Treatment uptake increased from 23% in 2002 to 99% by 2023 with all-oral DAAs. The prevalence of cirrhosis among active HCV cases peaked at 23.1% in 2015 but fell to 0% by 2021. Among those achieving sustained virologic response, cirrhosis prevalence was 20.4% in 2023. CONCLUSIONS:HIV/HCV coinfection has drastically declined in Spain, with active HCV infection prevalence <1% since 2021. DAAs were pivotal in this achievement. However, cirrhosis remains a concern among those with sustained virologic response. Ongoing surveillance and prevention efforts are essential to sustain these gains and address residual risks.

There is limited data on the efficacy of combined antiviral treatment for immunosuppressed COVID-19 patients. We describe the clinical and microbiological outcomes of a cohort of oncohaematological patients with persistent SARS-CoV-2 infection who received different dual and triple antiviral combination treatments. We selected the 15 patients (two of them with two episodes) who were prescribed combined anti-SARS-CoV-2 treatment in our institution (October 2021-December 2024). Combined antiviral therapy was administered as a compassionate use in the following indications: (i) persistence of SARS-CoV-2 positive quantitative RT-PCR (qRT-PCR) for > 14 days despite antiviral monotherapy and severe COVID-19 or (ii) need to achieve viral clearance before hematopoietic progenitor transplantation or administration of immuno-chemotherapy. Samples corresponding to positive qRT-PCR results with a Ct value < 32 were analysed by whole-genome sequencing. In 13 out of a total of 15 episodes, with control qRT-PCR after the combination therapy, with positivity periods ranging from 12 to 235 days, viral clearance was achieved 10-69 days after receiving the combination therapy. Whole genome sequencing revealed the emergence of resistance mutations in three cases prior to combination therapy. The therapy was able to overcome these mutations and lead to clearance. Genomic analysis identified one patient with three consecutive reinfections that had been mismanaged as persistent infection. In conclusion, combined antiviral treatment leads to satisfactory clinical and microbiological outcomes in a small cohort of immunocompromised patients with persistent SARS-CoV-2 infection. Early monotherapy treatment in these patients was associated with a high rate of clinical and microbiological failure, with sporadic documentation of resistance mutations that were overcome with combined antiviral therapy.

BACKGROUND:Lipoprotein(a) [Lp(a)] has emerged as an important cardiovascular risk factor. However, the prevalence and determinants of elevated Lp(a) in people living with HIV (PLHIV) remain insufficiently characterised. Since PLHIV have an increased cardiovascular risk even under effective virological control, our aim was to explore the prevalence of elevated Lp(a) and its association with cardiovascular risk in this population. METHODS:We conducted a single-centre observational study in adult PLHIV with sustained virological suppression and without active oncological or infectious comorbidities. According to most international consensus statements, elevated Lp(a) was defined as levels >50 mg/dL. RESULTS:A total of 186 PLHIV were included. Of these, 21% had Lp(a) levels >50 mg/dL. Individuals with elevated Lp(a) had significantly higher total cholesterol, Low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B levels, as well as a higher odds of a cardiovascular event [odds ratio (OR) 5.3, p = 0.018]. Although the proportion of patients receiving lipid-lowering therapy was significantly higher among those with elevated Lp(a), the percentage achieving LDL-C targets according to cardiovascular risk was significantly lower compared with patients with Lp(a) <50 mg/dL. No association was observed between elevated Lp(a) and antiretroviral therapy regimens, CD4 count, CD4/CD8 ratio or duration of HIV infection. CONCLUSIONS:In our study, elevated Lp(a) was present among 21% of virologically suppressed PLHIV and was associated with an adverse lipid profile and cardiovascular events, whereas no association was observed with HIV-related factors. Lp(a) may represent a marker of residual cardiovascular risk in this population and could help refine cardiovascular risk stratification beyond traditional lipid parameters.

OBJECTIVES:Lymphomas remain among the most frequent HIV-associated malignancies, with risk persisting despite effective virological control. This study describes the clinical, epidemiological and prognostic characteristics of lymphomas (both Hodgkin [HL] and non-Hodgkin [NHL]) in people living with HIV (PLWH), according to virological suppression at diagnosis and assesses lymphoma-related mortality at 1 year and overall survival at 5 years. METHODS:We conducted a multicentre retrospective study including PLWH from the Spanish CoRIS cohort, who were diagnosed with lymphoma between 2004 and 2022 and had HIV viral load data at diagnosis. Virological suppression was defined as HIV-1 RNA <100 copies/mL within the 6 months prior to and 1 month following lymphoma diagnosis. RESULTS:Among 18 573 PLWH included in CoRIS, 291 developed lymphoma, with virological data available for 245 individuals, of whom 49 (20%) had virological suppression. People with detectable HIV viral load had lower CD4 counts (median 180 cells/mm3 [IQR 80-330] vs. 371 cells/mm3 [IQR 202-583], p < 0.001) and more advanced Ann Arbor stage (stage III-IV: 82.0% vs. 64.1%, p = 0.027) compared with those with virological suppression. Despite this, they showed similar treatment response (complete remission: 67.1% vs. 76.2%) and relapse rates (16.3% vs. 18.4%, p = 0.779). Furthermore, virological suppression was not independently associated with 1-year lymphoma-specific or 5-year overall survival. CONCLUSIONS:In PLWH diagnosed with lymphoma, prognosis is independent of HIV virological status at diagnosis. These findings support that lymphoma management in PLWH should be guided by standard oncological criteria, alongside antiretroviral therapy, regardless of HIV viral suppression status.

With the aim of improving access and engagement to healthcare in people living with HIV (PLHIV), in 2022 Gregorio Marañón Hospital and the NGO COGAM developed a circuit for recruitment and referral to hospital. Program targeted PLHIV who were neither receiving antiretroviral treatment (ART) nor on medical follow-up (FU); but also, individuals at risk who underwent screening tests at the NGO and, if positive, were referred for confirmation. The result was an increase in annual new PLHIV seen in hospital by reaching a population who were, essentially, young men (94% male, median age 30 years), migrants (95%) with recent diagnosis of HIV (median 5 years) and who were recently arrived in Spain (median 5 months). Most of them hadn´t healthcare coverage (78%). In multivariate analysis, that included all PLHIV seen for the first time in the ID Unit between 2019 and 2022, lack of healthcare coverage was the only independent predictor of lost to FU that reached statistical significance (HR 5.19, CI 2.76–9.47). Furthermore, time from HIV diagnosis to ART initiating was shortened from 14 to 6 days without affecting linkage to care. Our conclusion is that collaboration with NGOs reinforce diagnosis, FU, and adherence to ART for PLHIV.

In a patient on immunosuppressant treatment, SARS-CoV-2 RNA was documented in different extra-respiratory samples over several months in the absence of positive determinations in upper respiratory samples. Whole-genome sequencing of these samples showed the acquisition of different single-nucleotide polymorphisms over time, suggesting viral evolution and thus viral viability.

BACKGROUND:The comparative effectiveness and tolerability of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) has not been sufficiently evaluated in people with AIDS who initiate therapy. METHODS:The aim of the current study was to compare the effectiveness and tolerability of BIC/FTC/TAF with other first-line antiretroviral therapy (ART) regimens in treatment-naive adults from the CoRIS cohort who initiated ART with AIDS. Logistic regression models were used to estimate odds ratios (ORs) of association between initial regimen and achievement of viral suppression (VS), defined as human immunodeficiency virus RNA <50 copies/mL, and immunological recovery (IR), defined as CD4 count >200 cells/μL. Time to VS and the proportion of treatment discontinuations were also evaluated and compared, with all analyses conducted at weeks 24 and 48 after initiation of ART. RESULTS:We analyzed 90 individuals initiating ART with BIC/FTC/TAF and 94 with other regimens, with similar baseline characteristics. At week 24, BIC/FTC/TAF was associated with a higher proportion of VS (75.6% vs 56.5%; adjusted odds ratio [aOR], 2.78 [95% confidence interval {CI}, 1.28-6.25]) and with a lower proportion of IR (47.7% vs 61.9%; aOR, 0.49 [95% CI, .25-.99]). These differences disappeared by week 48. The proportion of treatment discontinuations was significantly lower with BIC/FTC/TAF than with other regimens (week 24: 4.4% vs 20.2%; week 48: 10% vs 36.2%). At week 48, the main reasons for discontinuations were adverse events (3.3% vs 8.5%), toxicity prevention (1.1% vs 8.5%), ART simplification (0% vs 10.6%), and treatment failure (2.2% vs 4.3%). CONCLUSIONS:In light of our results, BIC/FTC/TAF is an effective and well-tolerated option for starting ART in people with AIDS.

We report a patient diagnosed with Q fever who developed an acute hepatitis after tick exposure. Sequence analysis of PCR fragments from the patient´s blood and the tick from the patient (Hyalomma lusitanicum) showed homologous (100% identity) Coxiella burnetii sequences, suggesting direct Q fever transmission by a H. lusitanicum tick.

BACKGROUND:Data on the immunogenicity of the recombinant zoster vaccine (RZV) in people living with HIV (PLWH) are limited, despite their high risk for herpes zoster. This study aimed to characterize the humoral (Varicella-zoster virus (VZV)-specific IgG) and cellular (VZV-specific IFN-γ/IL-2 T-cell) immune responses to RZV in PLWH on suppressive antiretroviral therapy (ART), stratified by sex and age. METHODS:This prospective study enrolled 207 PLWH on suppressive ART who received two doses of RZV. VZV-specific IgG antibody titers were quantified by in-house ELISA at baseline and post-vaccination and T-cell responses using FluoroSpot assays post-vaccination. We estimated geometric mean titers (GMTs), geometric mean fold rises (GMFRs), and adjusted arithmetic mean ratios (aAMRs) using generalized linear models. RESULTS:RZV vaccination induced a significant humoral response, with an overall GMFR of 16.7 and a 71 % positive response rate (≥4-fold rise in IgG titers). Females < 60 years old exhibited a markedly higher GMFR (43.8) than all other subgroups (p < 0.05). The vaccine also induced robust VZV-specific T-cell responses, with GMTs being comparable across all groups. Notably, a strong positive association was found between humoral and T-cell responses, particularly with IL-2-secreting cells (aAMR=1.6, p < 0.001). This association was most pronounced in participants < 60 years, especially females, and was attenuated in older individuals. CONCLUSIONS:RZV vaccination effectively induces both humoral and T-cell immunity in PLWH. However, host factors, such as sex and age, critically modulate immunogenicity. Females < 60 years showed a superior humoral response and the strongest association between immune compartments, highlighting important variability in vaccine responsiveness.

Background and Aims: We assessed long-term clinical outcomes and prognostic factors for liver disease progression after sustained viral response with direct-acting antivirals in patients coinfected with HIV/HCV with advanced fibrosis or cirrhosis. Approach and Results: A total of 1300 patients who achieved sustained viral response with direct-acting antivirals from 2014 to 2017 in Spain were included: 1145 with compensated advanced chronic liver disease (384 advanced fibrosis and 761 compensated cirrhosis) and 155 with decompensated cirrhosis. The median follow-up was 40.9 months. Overall, 85 deaths occurred, 61 due to non-liver non-AIDS-related causes that were the leading cause of death across all stages of liver disease. The incidence (95% CI) of decompensation per 100 person-years (py) was 0 in patients with advanced fibrosis, 1.01 (0.68-1.51) in patients with compensated cirrhosis, and 8.35 (6.05-11.53) in patients with decompensated cirrhosis. The incidence (95% CI) of HCC per 100 py was 0.34 (0.13-0.91) in patients with advanced fibrosis, 0.73 (0.45-1.18) in patients with compensated cirrhosis, and 1.92 (1.00-3.70) per 100 py in patients with decompensated cirrhosis. Prognostic factors for decompensation in patients with compensated advanced chronic liver disease included serum albumin, liver stiffness measurement (LSM), and fibrosis 4. In this population, LSM and LSM-based posttreatment risk stratification models showed their predictive ability for decompensation and HCC. Conclusions: Non-liver non-AIDS-related events were the leading causes of morbidity and mortality after direct-acting antiviral cure among coinfected patients with advanced fibrosis/cirrhosis. Among those with compensated advanced chronic liver disease, baseline LSM and posttreatment LSM-based models helped to assess decompensation and HCC risk.

The present outbreak of Human Monkeypox (HMPX) that has begun in May 2022 and has spread across all continents in less than two months has qualitative and quantitative characteristics that make it different from the pattern of human disease previously caused by this virus. It has spread with enormous ease, affects almost exclusively adults, behaves as a sexually transmitted disease and focuses on very specific groups and transmission conditions. The high incidence in the city of Madrid in males that have sex with males (MSM) has allowed us to observe and report the experience with the first 30 cases diagnosed in our institution. Patients presented with febrile symptoms, genital and paragenital skin lesions reminiscent of smallpox, but less extensive and severe. The disease may also cause proctitis, pharyngitis and perioral lesions. The PCR test for diagnostic confirmation has been shown to be very sensitive and effective, not only in skin lesions but also in blood and other fluids such as pharyngeal, rectal exudates and blood. A very high proportion of patients with HMPX also have other sexually transmitted diseases that must be actively detected in this context. The spontaneous evolution of our patients has been good and hospitalization has been practically unnecessary. Transmission to non-sexual cohabitants and health personnel has been nonexistent and the lesions have disappeared in less than 30 days without leaving sequelae and no need for specific antiviral treatment.

Journal Article Longitudinal Whole-Genome Sequence Characterization of a Persistent Severe Acute Respiratory Syndrome Coronavirus 2 Omicron BA.5 Infection in an Immunocompromised Patient Successfully Treated With Sotrovimab 1000 mg Get access Francisco Tejerina, Francisco Tejerina Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, SpainCIBERINFEC, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain Correspondence: F. T. Picado, Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, 46 C/Doctor Esquerdo, 28009, Madrid, Spain (pacotejerina@gmail.com). https://orcid.org/0000-0002-4136-3575 Search for other works by this author on: Oxford Academic PubMed Google Scholar Rosalía Palomino, Rosalía Palomino Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain Search for other works by this author on: Oxford Academic PubMed Google Scholar Pilar Catalan, Pilar Catalan Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain Search for other works by this author on: Oxford Academic PubMed Google Scholar Amadeo Sanz, Amadeo Sanz Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain Search for other works by this author on: Oxford Academic PubMed Google Scholar Mercedes Marin, Mercedes Marin Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain Search for other works by this author on: Oxford Academic PubMed Google Scholar Felipe Lopez-Andujar, Felipe Lopez-Andujar Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain Search for other works by this author on: Oxford Academic PubMed Google Scholar Leire Perez, Leire Perez Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, SpainCIBERINFEC, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain Search for other works by this author on: Oxford Academic PubMed Google Scholar Teresa Aldamiz, Teresa Aldamiz Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, SpainCIBERINFEC, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain Search for other works by this author on: Oxford Academic PubMed Google Scholar Patricia Muñoz, Patricia Muñoz Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, SpainDepartamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, SpainCIBERES, CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain https://orcid.org/0000-0001-5706-5583 Search for other works by this author on: Oxford Academic PubMed Google Scholar Carmen Rodriguez-Gonzalez, Carmen Rodriguez-Gonzalez Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain Search for other works by this author on: Oxford Academic PubMed Google Scholar ... Show more Cristina Diez, Cristina Diez Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, SpainCIBERINFEC, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain Search for other works by this author on: Oxford Academic PubMed Google Scholar Chiara Fanciulli, Chiara Fanciulli Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, SpainCIBERINFEC, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain Search for other works by this author on: Oxford Academic PubMed Google Scholar Laura Pérez Lago, Laura Pérez Lago Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain Search for other works by this author on: Oxford Academic PubMed Google Scholar Darío García de Viedma Darío García de Viedma Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón, Madrid, SpainCIBERES, CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain Search for other works by this author on: Oxford Academic PubMed Google Scholar Clinical Infectious Diseases, Volume 76, Issue 10, 15 May 2023, Pages 1872–1874, https://doi.org/10.1093/cid/ciad090 Published: 17 February 2023 Article history Published: 17 February 2023 Corrected and typeset: 07 March 2023

Since SAR-COV-2 infection emerged and spread worldwide, little is known about its impact on people living with human immunodeficiency virus (HIV). We performed a single-center retrospective study to describe the potential particularities and risk factors for respiratory failure (RF) in that population. This single-center retrospective study included patients infected with HIV, whose current follow-up is run in this center, above18 years of age, with diagnosis of SARS-CoV-2 infection between March 5, 2020 and April 15, 2021. We collected data regarding HIV immunological and virological status, main epidemiological characteristics, as well as those conditions considered to potentially influence in SARS-CoV-2 evolution; and clinical, microbiological, radiological, respiratory status, and survival concerning COVID-19. We compared all that, for patients with and without RF and performed a logistic regression for suspected risk factors for RF.One hundred seventy-seven HIV patients were diagnosed from COVID-19 (mean age 53.8 years, 81.3% male). At diagnosis, 95.5% were receiving ART and 91.3% had undetectable viral load, with median CD4 count of 569 cells/mu L. One hundred thirty-eight patients (78.4%) had symptoms, 44 (25%) developed RF and 53 (31%) developed bilateral pneumonia. The most commonly used treatments were: steroids (26.7%) and hydroxychloroquine (13.1%). When comparing patients with and without RF, we found statistically significant differences for 20 of the analyzed variables such as age (p < .001) and CD4 (p 0.002), and route of HIV transmission by intravenous drug users IVDU (p 0.002) were determined. In multivariate analysis, age [odds ratio (OR) 1.095] and CD4 count less than 350 cells/mu L (OR 3.36) emerged as risk factor for RF. People living with HIV whose CD4 count is <350 cells are at higher risk of developing RF when infected by SARS-CoV-2.

BackgroundThe Solidarity trial among COVID-19 inpatients has previously reported interim mortality analyses for four repurposed antiviral drugs. Lopinavir, hydroxychloroquine, and interferon (IFN)-β1a were discontinued for futility but randomisation to remdesivir continued. Here, we report the final results of Solidarity and meta-analyses of mortality in all relevant trials to date.MethodsSolidarity enrolled consenting adults (aged ≥18 years) recently hospitalised with, in the view of their doctor, definite COVID-19 and no contraindication to any of the study drugs, regardless of any other patient characteristics. Participants were randomly allocated, in equal proportions between the locally available options, to receive whichever of the four study drugs (lopinavir, hydroxychloroquine, IFN-β1a, or remdesivir) were locally available at that time or no study drug (controls). All patients also received the local standard of care. No placebos were given. The protocol-specified primary endpoint was in-hospital mortality, subdivided by disease severity. Secondary endpoints were progression to ventilation if not already ventilated, and time-to-discharge from hospital. Final log-rank and Kaplan-Meier analyses are presented for remdesivir, and are appended for all four study drugs. Meta-analyses give weighted averages of the mortality findings in this and all other randomised trials of these drugs among hospital inpatients. Solidarity is registered with ISRCTN, ISRCTN83971151, and ClinicalTrials.gov, NCT04315948.FindingsBetween March 22, 2020, and Jan 29, 2021, 14 304 potentially eligible patients were recruited from 454 hospitals in 35 countries in all six WHO regions. After the exclusion of 83 (0·6%) patients with a refuted COVID-19 diagnosis or encrypted consent not entered into the database, Solidarity enrolled 14 221 patients, including 8275 randomly allocated (1:1) either to remdesivir (ten daily infusions, unless discharged earlier) or to its control (allocated no study drug although remdesivir was locally available). Compliance was high in both groups. Overall, 602 (14·5%) of 4146 patients assigned to remdesivir died versus 643 (15·6%) of 4129 assigned to control (mortality rate ratio [RR] 0·91 [95% CI 0·82–1·02], p=0·12). Of those already ventilated, 151 (42·1%) of 359 assigned to remdesivir died versus 134 (38·6%) of 347 assigned to control (RR 1·13 [0·89–1·42], p=0·32). Of those not ventilated but on oxygen, 14·6% assigned to remdesivir died versus 16·3% assigned to control (RR 0·87 [0·76–0·99], p=0·03). Of 1730 not on oxygen initially, 2·9% assigned to remdesivir died versus 3·8% assigned to control (RR 0·76 [0·46–1·28], p=0·30). Combining all those not ventilated initially, 11·9% assigned to remdesivir died versus 13·5% assigned to control (RR 0·86 [0·76–0·98], p=0·02) and 14·1% versus 15·7% progressed to ventilation (RR 0·88 [0·77–1·00], p=0·04). The non-prespecified composite outcome of death or progression to ventilation occurred in 19·6% assigned to remdesivir versus 22·5% assigned to control (RR 0·84 [0·75–0·93], p=0·001). Allocation to daily remdesivir infusions (vs open-label control) delayed discharge by about 1 day during the 10-day treatment period. A meta-analysis of mortality in all randomised trials of remdesivir versus no remdesivir yielded similar findings.InterpretationRemdesivir has no significant effect on patients with COVID-19 who are already being ventilated. Among other hospitalised patients, it has a small effect against death or progression to ventilation (or both).FundingWHO.

OBJECTIVES:We assessed the prevalence of anti-hepatitis C virus (HCV) antibodies and active HCV infection (HCV-RNA-positive) in people living with HIV (PLWH) in Spain in 2019 and compared the results with those of four similar studies performed during 2015-2018.METHODS:The study was performed in 41 centres. Sample size was estimated for an accuracy of 1%. Patients were selected by random sampling with proportional allocation.RESULTS:The reference population comprised 41 973 PLWH, and the sample size was 1325. HCV serostatus was known in 1316 PLWH (99.3%), of whom 376 (28.6%) were HCV antibody (Ab)-positive (78.7% were prior injection drug users); 29 were HCV-RNA-positive (2.2%). Of the 29 HCV-RNA-positive PLWH, infection was chronic in 24, it was acute/recent in one, and it was of unknown duration in four. Cirrhosis was present in 71 (5.4%) PLWH overall, three (10.3%) HCV-RNA-positive patients and 68 (23.4%) of those who cleared HCV after anti-HCV therapy (p = 0.04). The prevalence of anti-HCV antibodies decreased steadily from 37.7% in 2015 to 28.6% in 2019 (p < 0.001); the prevalence of active HCV infection decreased from 22.1% in 2015 to 2.2% in 2019 (p < 0.001). Uptake of anti-HCV treatment increased from 53.9% in 2015 to 95.0% in 2019 (p < 0.001).CONCLUSIONS:In Spain, the prevalence of active HCV infection among PLWH at the end of 2019 was 2.2%, i.e. 90.0% lower than in 2015. Increased exposure to DAAs was probably the main reason for this sharp reduction. Despite the high coverage of treatment with direct-acting antiviral agents, HCV-related cirrhosis remains significant in this population.

Background There is a paucity of knowledge on the long-term outcome in patients diagnosed with COVID-19. We describe a cohort of patients with a constellation of symptoms occurring four weeks after diagnosis causing different degrees of reduced functional capacity. Although different hypothesis have been proposed to explain this condition like persistent immune activation or immunological dysfunction, to date, no physiopathological mechanism has been identified. Consequently, there are no therapeutic options besides symptomatic treatment and rehabilitation. Methods We evaluated patients with symptoms that persisted for at least 4 weeks after COVID-19. Epidemiological and clinical data were collected. Blood tests, including inflammatory markers, were conducted, and imaging studies made if deemed necessary. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction (RT-PCR) in plasma, stool, and urine were performed. Patients were offered antiviral treatment (compassionate use). Results We evaluated 29 patients who reported fatigue, muscle pain, dyspnea, inappropriate tachycardia, and low-grade fever. Median number of days from COVID-19 to positive RT-PCR in extra-respiratory samples was 55 (39–67). Previous COVID-19 was mild in 55% of the cases. Thirteen patients (45%) had positive plasma RT-PCR results and 51% were positive in at least one RT-PCR sample (plasma, urine, or stool). Functional status was severely reduced in 48% of the subjects. Eighteen patients (62%) received antiviral treatment. Improvement was seen in most patients (p = 0.000) and patients in the treatment group achieved better outcomes with significant differences (p = 0.01). Conclusions In a cohort of COVID-19 patients with persistent symptoms, 45% of them have detectable plasma SARS-CoV-2 RNA. Our results indicate possible systemic viral persistence in these patients, who may benefit of antiviral treatment strategies.