MPXV suspected lesions were tested to other ulcerative pathogens in order to detect coinfections and establish an adequate diagnosis. Descriptive retrospective cross-sectional study taken at Centro Sanitario Sandoval, Madrid. Six hundred twenty ulcerative samples were tested by PCR for the main sexually transmitted pathogens including MPXV. A multivariate analysis was carried out to determine factors associated to MPXV. We detected 447 samples positive for MPXV, 38 of them were also positive for some of the other pathogens, mainly herpes simplex virus type 2 (HSV2). In the MPXV samples, 35.3% (61 of 173) of them were positive for ulcerative pathogens, mainly Treponema pallidum (TP). Men who have sex with men with genital or anorectal lesions were associated to MPXV infection. The clinical features may lead to diagnostic error, mainly with TP and HSV. MPXV should be considered as a sexually transmitted infection and should be included in the differential diagnosis of ulcerative STIs.

In August 2024, the World Health Organization declared mpox infection a Public Health Emergency of International Concern for second time since 2022 and recommended vaccinating all people at-risk, such as people with HIV-1 (PWH) and prophylaxis pre-exposition (PrEP) users. We recruited PWH and PrEP users who received one or two doses of subcutaneous Imvanex® or Jynneos® and compared specific T-cell immunity with participants who passed mpox natural infection or were Nonexposed to mpox. CD4 + T cells from people who had mpox showed the highest capacity to produce IL-2 (1.8-fold, p = 0.0328), as well as IFNγ (2.5-fold, p = 0.0247), and IL-4 (1.8-fold, p = 0.0373) from naïve CD4 + T cells, in response to MHC-II-restricted mpox-related peptides, compared to vaccinated participants. CD8 + T cells from individuals who had mpox also showed the highest capacity to produce IFN γ $\gamma $ (1.6-fold, p = 0.0321) and TNF α $\alpha $ (2.1-fold, p = 0.0084) against MHC-I-restricted peptides. Therefore, the most potent and robust T-cell responses were developed after mpox infection, while they were barely detectable after vaccination. These results support the need to explore booster doses or improved vaccines to enhance cellular immunity in at-risk populations. More studies are needed to evaluate the capacity of mpox vaccines to confer long-term protection.

BackgroundMpox is a viral disease caused by an orthopoxvirus called monkeypox virus. It experienced a significant increase in cases in 2022 worldwide, mostly with sexual transmission. The possibility of hidden circulation of this infection among asymptomatic individuals remains unclear.MethodsThis is a multi-centre, observational cross-sectional study conducted in a sexually transmitted infections (STIs) clinic in its referral hospital between July and October 2023 in Madrid, Spain. Pharyngeal and rectal swab samples were collected from each participant and processed to detect bacterial STIs and mpox. Socio-demographic, clinical and behavioural data were collected, and a descriptive analysis was performed.ResultsA total of 343 asymptomatic participants were included. The prevalence of asymptomatic mpox infection was 0.3% (n = 1) and the only positive case developed symptoms shortly after sampling, ruling out a fully asymptomatic infection. The percentage of vaccinated individuals was 36.1%. 13.2% had previously contracted mpox. Other STIs were detected in 21.6% of participants.ConclusionsAlthough routine screening for asymptomatic bacterial sexually transmitted infections is strongly recommended in at-risk individuals, testing for asymptomatic mpox should be evaluated based on the specific context and population. Additionally, the ongoing cases of mpox in Spain are likely not related to the presence of asymptomatic carriers.

OBJECTIVES:We evaluated the efficacy, safety and impact on viral reservoir of rapid bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) initiation during primary HIV infection (PHI). METHODS:Multicenter, single-arm clinical trial in participants with PHI of <3 months (seroconversion or incomplete serological pattern), starting BIC/FTC/TAF in 6 Spanish centers between January-2021 and September-2022. Primary endpoint was proportion of participants with viral load (VL)<50 copies/mL at 48-weeks on the Intention-to-treat-exposed population (ITTe). Cases were compared with randomly-matched retrospective PHI controls, starting other 3-drug Integrase-Strand-Transfer-inhibitor-based regimens. Reservoir was evaluated in PHI cases by Intact Proviral DNA Assay (IPDA). RESULTS:We included 64 participants, 94% cis-male, aged 32 (26;41) years.; 78% men-who-have-sex-with-men. At BIC/FTC/TAF initiation, Fiebig stages were II (14%), III (11%); IV (5%), V (54%) and VI (16%); VL was 496,520 (110,000;1,285,000) copies/mL; 62% were subtype B; median (IQR) CD4 T cell count was 406 (322;535) cells/µL; 6% had active hepatitis B virus co-infection. All participants started BIC/FTC/TAF at first specialist consultation. 81% (ITTe) and 93% (On-Treatment, OT) had VL<50 copies/mL at 48-weeks. 72% had adverse events, only 3% were grade 3/4; 91% were not-related, none led to BIC/FTC/TAF-discontinuation. 92% of controls (OT) had VL<50 copies/mL at 48-weeks (p=0.914), 11% (17%) modified initial antiretroviral regimen (p>0.001). Intact and defective proviral DNA levels significantly decreased at 48-weeks. CONCLUSIONS:BIC/FTC/TAF showed rapid viral decay, high suppression rates, good tolerability, and reservoir decline in PHI, making it an appealing regimen in this setting.

La reactivación de citomegalovirus (CMV) puede complicar la evolución de los pacientes con gastritis inducida por los inhibidores de puntos de control inmunitario.Se describe la experiencia en nuestro centro, y se realiza una revisión de la literatura.Se describe un caso de gastritis grave secundaria al tratamiento con un inhibidor del receptor de muerte celular programada-1 (anti-PD1), asociado a la reactivación de CMV. En la revisión sistemática, identificamos 5 casos de gastritis inmunomediada asociados a la reactivación de CMV. El tratamiento con ganciclovir contribuyó a la remisión clínica en la mayoría de los pacientes.La identificación precoz de una infección por CMV en los pacientes con gastritis inmunomediada grave o refractaria, permitirá el inicio del tratamiento dirigido, y podrá evitar aumentar la terapia inmunosupresora.Reactivation of cytomegalovirus can complicate the evolution of patients with gastritis induced by immune checkpoint inhibitors.The experience in our center is described and a review of the literature is performed.A case of severe gastritis induced by treatment with a programmed cell death receptor-1 (anti-PD1) inhibitor, associated with reactivation of cytomegalovirus (CMV) is described. In the systematic review, we identified 5 cases of immune-related gastritis associated with CMV reactivation. Ganciclovir treatment contributed to clinical improvement in most patients.The early identification of a CMV infection in patients with severe or refractory immune-related gastritis will allow the initiation of targeted treatment, and may avoid increasing immunosuppressive therapy.

ABSTRACT Invasive genotypes of Chlamydia trachomatis (L1–L3) are responsible for lymphogranuloma venereum (LGV), which, in industrialized countries, is prevalent among men who have sex with men. Our aim was to analyze the changing trends and diversification of LGV genovariants detected in Madrid, Spain. The study was launched at a public community healthcare center that has specialized in sexually transmitted infections (STIs) for 10 years (STI1). Screening rates have improved at this center, but LGV diagnoses have drastically increased, especially since 2016. We therefore extended the LGV diagnosis to another public community healthcare center that specializes in STIs (STI2), as well as to two general tertiary hospitals in Madrid from 2017 to 2019. Overall, between 2010 and 2019, 10,833 cases of C. trachomatis infection were detected among 121,955 screened samples with 1,253 LGV cases. The molecular characterization of L genotypes identified two main genovariants (ompA-L2 and ompA-L2b) in 2010–2014. However, three new successful genovariants (ompA-L2bV1, ompA-L2bV4, and ompA-L2bV7) emerged in 2016–2019. In recent years, 3.9% (31/803) of recombinant forms of ompA were detected between ompA-L2 and ompA-D. From the clinical and epidemiological standpoints, the patients infected by the ompA-L2 and ompA-L2bV1 genovariants were more frequently associated with asymptomatic infections and HIV (P = 0.001), while ompA-L2b and ompA-L2bV4 were more frequently associated with concomitant (P < 0.02) and previous (P = 0.003) STI infections, suggesting distinct sexual networks. These findings suggest a growing trend toward higher transmission rates in the population along with an increasingly complex epidemiological scenario due to the selection of LGV genovariants through mutation and recombination. IMPORTANCE Numerous international organizations, including the World Health Organization, have been drawing attention to the global increase in sexually transmitted infections. Twenty years ago, lymphogranuloma venereum (LGV) was mainly considered a tropical disease; in recent decades, however, LGV has been increasingly present in high-income countries. This increase has been linked to men who have sex with men who participate in highly interconnected sexual networks, leading to a rapid spread of LGV. This study focuses on the spread of LGV, presenting the largest time series of LGV prevalence in Spain, which includes more than a thousand diagnosed cases in one large city. The number of LGV cases diagnosed was analyzed over time, and a selection of strains was subjected to molecular genotyping. The results indicate that the LGV epidemic is gradually evolving toward an increasingly complex diversification due to the selection of successful genovariants that have emerged by mutation and recombination events, suggesting that we are moving toward an unpredictable scenario.

Background The transmission of monkeypox virus occurs through direct contact, but transmission through saliva or exhaled droplets and aerosols has not yet been investigated. We aimed to assess the presence of monkeypox virus DNA and infectious virus in saliva samples and droplets and aerosols exhaled from patients infected with monkeypox virus. Methods We did a cross-sectional study in patients with monkeypox confirmed by PCR who attended two health centres in Madrid, Spain. For each patient, we collected samples of saliva, exhaled droplets within a mask, and aerosols captured by air filtration through newly developed nanofiber filters. We evaluated the presence of monkeypox virus in the samples by viral DNA detection by quantitative PCR (qPCR) and isolation of infectious viruses in cell cultures. Findings Between May 18 and July 15, 2022, 44 patients with symptomatic monkeypox attended two health centres in Madrid and were included in the study. All were cisgender men, with a median age of 35 & BULL;0 years (IQR 11 & BULL;3). We identified high loads of monkeypox virus DNA by qPCR in 35 (85%) of 41 saliva samples. Infectious monkeypox virus was recovered from 22 (67%) of 33 saliva samples positive for monkeypox virus DNA. We also found a significant association between the number of affected cutaneous areas or general symptoms and the viral load present in saliva samples. Droplets exhaled from patients with monkeypox, detected inside a mask, contained monkeypox virus DNA in 32 (71%) of 45 samples, with two of the 32 positive samples showing the presence of the infectious virus. Monkeypox virus DNA in aerosols, collected from the medical consultation room, were detected in 27 (64%) of 42 samples, despite patients wearing an FFP2 mask during the visit. Infectious virus was not recovered from aerosol samples. High levels of monkeypox virus DNA were identified in aerosols collected from a hospital isolation room housing a patient with monkeypox. Interpretation The identification of high viable monkeypox virus loads in saliva in most patients with monkeypox and the finding of monkeypox virus DNA in droplets and aerosols warrants further epidemiological studies to evaluate the potential relevance of the respiratory route of infection in the 2022 monkeypox virus outbreak. Lancet Published November https://doi.org/10.1016/ S2666-5247(22)00291-9 *Contributed Centro Severo Superior Cientificas Autonoma Spain A Prof Sandoval Universitario Carlos, (A E O Ayerdi M J V Investigacion i (A Enfermedades Infecciosas, Madrid, N V Agroquimica

Different phenotypes exhibiting no evidences of disease progression have been described in ART-naïve HIV-1 positive individuals. Long-term non progressors (LTNP) and elite controllers (EC) are low frequent examples of immunological and virological control in HIV-1 positive subjects, respectively. The combination of both phenotypes is even less frequent and studied despite being considered as models of HIV-1 functional cure. A multicenter, prospective study in retrospect including clinical and epidemiological data collected from 313 LTNP of 21 Spanish hospitals was carried out. LTNPs maintaining CD4+ T cell counts over 500 cells/µl and viral loads (VL) under 10,000 copies/mL for at least 10 years in the absence of antiretroviral therapy were followed for a median of 20.8 years (IQR = 15.6–25.5). A 52.1% were considered EC (undetectable VL) and LTNP (EC-LTNP) and a total of 171 (54.8%) and 42 (13.5%) out of the 313 participants maintained LTNP status for at least 20 and 30 years, respectively. EC-LTNP showed lower CD4+ T cell count loss (9.9 vs 24.2 cells/µl/year), higher CD4/CD8 ratio (0.01 vs − 0.09 in ratio), and lesser VL increase (no increase vs 197.2 copies/mL/year) compared with LTNPs with detectable VL (vLTNP). Survival probabilities for all-cause mortality at 30 years from HIV + diagnosis were 0.90 for EC-LTNP and 0.70 for vLTNP ( p = 2.0 × 10 −3 ), and EC-LTNP phenotype was the only factor associated with better survival in multivariate analyses (HR = 0.28; 95% CI 0.10–0.79). The probability to preserve LTNP status at 30 years was 0.51 for EC-LTNP and 0.18 for vLTNP ( p < 2.2 × 10 −16 ). Risk factors associated to the loss of LTNP status was: higher age at diagnosis and the increase of VL, whereas the increase of CD4+ T cell counts and CD4/CD8 ratio, the initial EC-LTNP phenotype and HCV coinfection were protective factors. EC-LTNP phenotype was associated with improved survival and slower disease progression compared with other phenotypes of LTNP. EC-LTNP individuals represent one of the most favorable phenotypes of immune activation against HIV-1 found in nature and, therefore, are strong candidates to be considered a model of functional cure of HIV-1 infection.

INTRODUCTION:Serological test for primary syphilis could be negative the first 5-15 days. The aim of this study was to evaluate the benefit of including dark field microscopy (DFM) in the diagnosis algorythm for primary syphilis.MATERIALS/METHODS:Patients attended to a sexual transmission diseases clinic of Madrid, from 2015 to 2019, for a genital ulcer with clinical suspicion of primary syphilis. They were tested for DMF and serological test (EIA/TPPA/RPR).RESULTS:Over the total amount of samples (806), 53.2% (429) were positive for DFM. Thus, the 48% of the 429 patients had negative serological test (EIA/RPR) of which the 77.6% were positive at TPPA.CONCLUSIONS:DFM allows primary syphilis early diagnosis, even without serological test. If no direct detection methods are available, for patients without history of syphilis, TPPA could help to diagnose primary syphilis.

BACKGROUND:Monkeypox is the most prevalent Orthopoxvirus zoonosis infection since the eradication of smallpox. The current multi-country outbreak involves five WHO regions affecting mainly Europe. Accurate clinical and virological aspects of the disease outside endemic areas are needed. METHODS:We performed an observational study of cases diagnosed in Madrid (Spain) (May/June 2022). Confirmation from vesicular lesions swabs, Orthopoxvirus real-time PCR, sequencing, phylogenetic analysis, and direct detection by Electron microscopy was performed. In addition, a structured epidemiological questionnaire was completed systematically to gather sociodemographic, clinical, and behavioral data from all confirmed cases. FINDINGS:We extracted data from 48 patients, all cisgender men. The median age was 35 years (IQR 29 - 44), and 87.5% were MSM. The most prevalent symptoms were the presence of vesicular-umbilicated and pseudo-pustular skin lesions (93.8%), asthenia (66.6%), and fever (52.1%). In addition, the location of the lesions in the genital or perianal area was related to the role in sexual intercourse (p<0.001). Sequencing analysis indicated the virus circulating in Spain belongs to the western African clade. Like the other European cases in the outbreak, the Spanish isolates are a direct descendant of viruses previously detected in Nigeria, the UK, Singapore, and Israel in 2017-2018. CONCLUSIONS:Monkeypox is an emerging infectious disease in Europe where community transmission is reported, mainly in MSM. The first symptom was skin lesions instead of classical fever and rash. The disease follows a self-limited course, and there have been no cases with a serious presentation or severe complications.

Abstract Background Long-Term Non-Progressors (LTNPs) are untreated Human Immunodeficiency virus type 1 (HIV-1) infected individuals able to control disease progression for prolonged periods. However, the LTNPs status is temporary, as viral load increases followed by decreases in CD4 + T-cell counts. Control of HIV-1 infection in LTNPs viremic controllers, have been associated with effective immunodominant HIV-1 Gag-CD8 + T-cell responses restricted by protective HLA-B alleles. Individuals carrying HLA-B*14:02 control HIV-1 infection is related to an immunodominant Env-CD8 + T-cell response. Limited data are available on the contribution of HLA-B*14:02 CD8 + T -cells in LTNPs. Results In this study, we performed a virological and immunological detailed analysis of an HLA-B*14:02 LNTP individual that lost viral control (LVC) 27 years after HIV-1 diagnosis. We analysed viral evolution and immune escape in HLA-B*14:02 restricted CD8 + T -cell epitopes and identified viral evolution at the Env-EL9 epitope selecting the L592R mutation. By IFN-γ ELISpot and immune phenotype, we characterized HLA- B*14:02 HIV-1 CD8 + T cell responses targeting, Gag-DA9 and Env-EL9 epitopes before and after LVC. We observed an immunodominant response against the Env-EL9 epitope and a decreased of the CD8 T + cell response over time with LVC. Loss of Env-EL9 responses was concomitant with selecting K588R + L592R mutations at Env-EL9. Finally, we evaluated the impact of Env-EL9 escape mutations on HIV-1 infectivity and Env protein structure. The K588R + L592R escape variant was directly related to HIV-1 increase replicative capacity and stability of Env at the LVC. Conclusions These findings support the contribution of immunodominant Env-EL9 CD8 + T-cell responses and the imposition of immune escape variants with higher replicative capacity associated with LVC in this LNTP. These data highlight the importance of Env-EL9 specific-CD8 + T-cell responses restricted by the HLA-B*14:02 and brings new insights into understanding long-term HIV-1 control mediated by Env mediated CD8 + T-cell responses.

Background: The lack of the recovery of CD4+ T-cells (CD4+ recovery) among immunodeficiency virus (HIV)-infected patients on antiretroviral therapy (ART) is not well known. We aimed to analyze the association between single nucleotide polymorphisms (SNPs) underlying vitamin D metabolism and the CD4+ recovery in naïve HIV-infected patients who started ART with low baseline CD4+. Methods: We conducted a retrospective study in 411 naïve individuals with plasma HIV load >200 copies/mL and CD4+ <200 cells/mm3. During 24 months of follow-up, all patients had plasma HIV load <50 copies/mL. DNA genotyping was performed using the Sequenom MassARRAY platform. The outcome variable was the change in CD4+ during the study. Results: CD4+ recovery was higher in patients carrying DBP rs7041 AA genotype (AA versus CC/AC) and DHCR7 rs3829251 AA genotype (AA versus GG/AG) (p-value < 0.05). DBP rs7041 AA genotype was linked to increase in CD4+ (adjusted arithmetic mean ratio (aAMR) = 1.22; q-value = 0.011), increase in CD4+ ≥P75th [adjusted odds ratio (aOR) = 2.31; q-value = 0.005], slope of CD4+ recovery (aAMR = 1.25; q-value = 0.008), slope of CD4+ recovery ≥ P75th (aOR = 2.55; q-value = 0.005) and achievement of CD4+ ≥500 cells/mm3 (aOR = 1.89; q-value = 0.023). Besides, DHCR7 rs3829251 AA genotype was related to increase in CD4+ (aAMR = 1.43; q-value = 0.031), increase in CD4+ ≥P75th (aOR = 3.92; q-value = 0.030), slope of CD4+ recovery (aAMR = 1.40; q-value = 0.036), slope of CD4+ recovery ≥ P75th (aOR = 3.42; q-value = 0.031) and achievement of CD4+ ≥500 cells/mm3 (aOR = 5.68; q-value = 0.015). Conclusion: In summary, DHCR7 rs3829251 and DBP rs7041 polymorphisms were associated with CD4+ recovery in HIV-infected patients who started cART with low CD4+ T-cell counts.

Abstract Background We estimate the prevalence of drug injection, the variables associated with having ever injected and the proportion of ever injectors whose first drug injection was for having sex; we describe the first drug injection episode, analyze the drugs most frequently injected and estimate the prevalence of risky injecting behaviors. Methods The participants were 3387 MSM without a previous HIV diagnosis attending four HIV/STI diagnosis services in Madrid and Barcelona. Lifetime prevalence and prevalence ratios (PRs) by different factors were calculated using Poisson regression models with robust variance. We compared the characteristics of first drug injection episode, lifetime injection and risky injecting behaviors of those whose first injection was for sex (FIS) with those whose was not (non-FIS). Results Lifetime prevalence of injection was 2.1% (CI 1.7–2.7). In the multivariate analysis, it was strongly associated with having been penetrated by more than five men in the last 12 months (aPR = 10.4; CI 2.5–43.4) and having met most of their partners at private parties (aPR = 7.5; CI 4.5–12.3), and less strongly with other factors. Of those who had ever injected drugs, 81.9% injected for sex the first time they injected drugs (FIS). At first injection, FIS participants had a mean age of 31 years, 62.7% used mephedrone and 32.2% methamphetamine on that occasion. Of this FIS group 39.0% had ever shared drugs or equipment and 82.6% had always shared for sex. Some 30.8% of non-FIS reported having also injected drugs for sex later on. Conclusions Only two out of a hundred had ever injected, most to have sex and with frequent drug or injecting equipment sharing. Injecting for sex is the most common first episode of drug injection and is the most efficient risky behavior for the transmission of HIV, hepatitis B or C and other blood-borne infections. MSM participating in private parties should be considered a priority group for prevention policies.

Circulating recombinant forms (CRFs) are important components of the HIV-1 pandemic. Among 110 reported in the literature, 17 are BF1 intersubtype recombinant, most of which are of South American origin. Among these, all 5 identified in the Southern Cone and neighboring countries, except Brazil, derive from a common recombinant ancestor related to CRF12_BF, which circulates widely in Argentina, as deduced from coincident breakpoints and clustering in phylogenetic trees. In a HIV-1 molecular epidemiological study in Spain, we identified a phylogenetic cluster of 20 samples from 3 separate regions which were of F1 subsubtype, related to the Brazilian strain, in protease-reverse transcriptase (Pr-RT) and of subtype B in integrase. Remarkably, 14 individuals from this cluster (designated BF9) were Paraguayans and only 4 were native Spaniards. HIV-1 transmission was predominantly heterosexual, except for a subcluster of 6 individuals, 5 of which were men who have sex with men. Ten additional database sequences, from Argentina (n = 4), Spain (n = 3), Paraguay (n = 1), Brazil (n = 1), and Italy (n = 1), branched within the BF9 cluster. To determine whether it represents a new CRF, near full-length genome (NFLG) sequences were obtained for 6 viruses from 3 Spanish regions. Bootscan analyses showed a coincident BF1 recombinant structure, with 5 breakpoints, located in p17(gag), integrase, gp120, gp41-rev overlap, and nef, which was identical to that of two BF1 recombinant viruses from Paraguay previously sequenced in NFLGs. Interestingly, none of the breakpoints coincided with those of CRF12_BF. In a maximum likelihood phylogenetic tree, all 8 NFLG sequences grouped in a strongly supported clade segregating from previously identified CRFs and from the CRF12_BF "family" clade. These results allow us to identify a new HIV-1 CRF, designated CRF66_BF. Through a Bayesian coalescent analysis, the most recent common ancestor of CRF66_BF was estimated around 1984 in South America, either in Paraguay or Argentina. Among Pr-RT sequences obtained by us from HIV-1-infected Paraguayans living in Spain, 14 (20.9%) of 67 were of CRF66_BF, suggesting that CRF66_BF may be one of the major HIV-1 genetic forms circulating in Paraguay. CRF66_BF is the first reported non-Brazilian South American HIV-1 CRF_BF unrelated to CRF12_BF.

Objectives: We aimed to assess the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and factors associated with seropositivity and asymptomatic coronavirus disease 2019 (COVID-19) among people with HIV (PWH). Methods: This was a cross-sectional study carried out within the cohort of the Spanish HIV Research Network. Participants were consecutive PWH with plasma collected from 1st April to 30th September 2020. We determined SARS-CoV-2 antibodies (Abs) in plasma. Illness severity (NIH criteria) was assessed by a review of medical records and, if needed, participant interviews. Multivariable logistic regression analysis was used to identify predictors of seropositivity among the following variables: sex, age, country of birth, education level, comorbidities (hypertension, chronic heart disease, diabetes mellitus, non-AIDS-related cancer, chronic kidney disease, cirrhosis), route of HIV acquisition, prior AIDS, CD4+ cell count, HIV viral load, nucleoside/nucleotide reverse transcriptase inhibitor (N [t]RTI) backbone, type of third antiretroviral drug, and month of sample collection. Results: Of 1076 PWH (88.0% males, median age 43 years, 97.7% on antiretroviral therapy, median CD4+ 688 cells/mm(3), 91.4% undetectable HIV viral load), SARS-CoV-2 Abs were detected in 91 PWH, a seroprevalence of 8.5% (95%CI 6.9-10.3%). Forty-five infections (45.0%) were asymptomatic. Variables independently associated with SARS-CoV-2 seropositivity were birth in Latin American countries versus Spain (adjusted odds ratio (aOR) 2.30, 95%CI 1.41-3.76, p 0.001), and therapy with tenofovir disoproxil fumarate plus emtricitabine (TDF/FTC) versus tenofovir alafenamide (TAF)/FTC as the N(t)RTI backbone (aOR 0.49, 95%CI 0.26-0.94, p 0.031). Conclusions: Many SARS-CoV-2 infections among PWH were asymptomatic, and birth in Latin American countries increased the risk of SARS-CoV-2 seropositivity. Our analysis, adjusted by comorbidities and other variables, suggests that TDF/FTC may prevent SARS-CoV-2 infection among PWH. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.

We compared the characteristics and clinical outcomes of hospitalized individuals with COVID‐19 with [people with HIV (PWH)] and without (non‐PWH) HIV co‐infection in Spain during the first wave of the pandemic.

Circulating recombinant forms (CRFs) contribute substantially to the HIV-1 pandemic. Among 105 CRFs described in the literature, 16 are BF intersubtype recombinants, most of South American origin, of which CRF12_BF is the most widely spread. A BF recombinant cluster identified in Bolivia was suggested to represent a new CRF_BF. Here we find that it belongs to a larger cluster incorporating 39 viruses collected in 7 countries from 3 continents, 22 of them in Spain, most from Bolivian or Peruvian individuals, and 12 in South America (Bolivia, Argentina, and Peru). This BF cluster comprises three major subclusters, two associated with Bolivian and one with Peruvian individuals. Near full-length genome sequence analyses of nine viruses, collected in Spain, Bolivia, and Peru, revealed coincident BF mosaic structures, with 13 breakpoints, 6 and 7 of which coincided with CRF12_BF and CRF17_BF, respectively. In a phylogenetic tree, they grouped in a clade closely related to these CRFs, and more distantly to CRF38_BF and CRF44_BF, all circulating in South America. These results allowed to identify a new HIV-1 CRF, designated CRF89_BF. Through phylodynamic analyses, CRF89_BF emergence was estimated in Bolivia around 1986. CRF89_BF is the fifth CRF member of the HIV-1 recombinant family related to CRF12_BF.

This study compares the prevalence of drug use and the typologies of polydrug use (PDU) in men who have sex with men (MSM) and general population men (GPM). Participants were men aged 16–64, living in the provinces of Madrid and Barcelona: 1720 were recruited in a GPM survey, and 2658 were HIV-negative MSM from HIV/STIs diagnosis services. Lifetime and last-year prevalence of drug use and prevalence ratios (PRs) of MSM to GPM for the different drugs were calculated using Poisson regression. Latent class analysis (LCA) was performed to identify typologies of PDU. Lifetime use of the drugs considered was higher in MSM, and even higher for drug use in the last-year: PRs for cannabis, hallucinogens and cocaine ranged from 2–5; for amphetamine, ecstasy and methamphetamine 12–16; and above 60 for ketamine, GHB/GBL, inhalants and mephedrone. In the LCA for lifetime PDU four classes arose from the GPM (No-PDU (79.6%); Conventional PDU (13.8%); Intensive conventional PDU (4.9%); Heavy PDU (1.8%)) and four among MSM (No-PDU (57.7%); Conventional PDU plus poppers (18.8%); PDU preferring chemsex drugs (6.4%); Heavy PDU (17.2%)). For PDU during the last-year, three classes arose in the GPM: No-PDU (94.7%); Conventional PDU (4.3%); Heavy PDU (0.9%). For MSM, we identified four classes: No-PDU (64.7%); Conventional PDU plus poppers (15.6%); PDU preferring chemsex drugs (6.2%); Heavy PDU (13.5%). MSM should be considered a priority group for the prevention of the use of all drugs but the heterogeneity of PDU typologies regarding users’ preference towards conventional and/or sexualised drugs needs to be taken into account.