BACKGROUND:Migration affects HIV outcomes; even with universal antiretroviral therapy (ART), migrant people living with HIV (PLWH) in Spain show worse immunovirological responses and retention in care. METHODS:A retrospective longitudinal study of 8398 PLWH followed from 2000 to 2023 was conducted at Hospital Clínic of Barcelona; 4566 (54%) were migrants. Mixed-effects and Cox models assessed immunovirological outcomes, retention, and loss to follow-up. RESULTS:Migrants were younger (median 34 vs 37) and more often male (92% vs 85%) and transgender (11% vs 1%). The baseline median cluster of differentiation 4 (CD4) was 413 cells/mm³. In 2009-2014, both treatment-naïve and treatment-experienced migrants had lower CD4 counts and immune recovery than non-migrants. In 2015-2023, treatment-naïve migrants showed reduced CD4 in the first 2 years of ART, and treatment-experienced migrants had lower CD4 and lower viral suppression (odds ratio: 0.33, 95% confidence interval [CI] 0.21-0.53). Retention at 2, 5, and 10 years was 78.2%, 67.3%, and 55.9% respectively, and was lower in migrants (51.4% vs 59.9% at 10 years). Migrant status was associated with LTFU (adjusted hazard ratio 1.31, 95% CI 1.20-1.43), and also low education, injecting drug use, transgender identity, and <1 year length residence. CONCLUSIONS:Migrants with HIV had poorer immune recovery and higher LTFU than non-migrants; thus, addressing social differences is critical to meet the 95-95-95 targets.

BACKGROUND:Long-acting cabotegravir/rilpivirine (LA-CAB/RPV) therapy for HIV, lacks activity against hepatitis B virus (HBV). We evaluate HBV serological profiles and risk of HBV reactivation (HBVr) or incident infection (HBVi) in people with HIV (PWH) switching to LA-CAB/RPV. METHODS:Prospective cohort study of PWH initiating LA-CAB/RPV at Hospital Clínic Barcelona between February/2023 and February/2025. HBV serology, vaccination status, and liver function tests (LFTs) were assessed at baseline. Follow-up LFTs were performed routinely (weeks 12, 28, and every 6 months), and HBV serology/DNA assessed if abnormal LFTs, acute hepatitis or clinical suspicion of reactivation. HBVr was defined as conversion from HBsAg negative to positive or detectable HBV DNA in anti-HBc-positive/HBsAg-negative individuals, or as HBV DNA ≥1 log increase or ≥100 IU/mL in chronic HBV (HBsAg-positive) participants. HBVi was defined as HBsAg seroconversion in HBV unexposed individuals. RESULTS:Among 741 participants-92% cis-gender male, median age 43 (IQR 35-52)-454 (61%) had vaccine-induced immunity and 25% had prior HBV exposure (anti-HBc-positive), with 3% showing isolated anti-HBc. Median follow-up was 54 weeks (IQR 28-77). No HBVr or HBVi were observed in people without chronic hepatitis at baseline. Four individuals (0.5%) with unnoticed chronic HBV infection (HBsAg-positive) started LA-CAB/RPV; two developed clinical HBVr and two remained stable after regimen switch, all four switched back to tenofovir-containing therapy. Transaminase elevations during follow-up occurred in 17% of the cohort, regardless of HBV serostatus. CONCLUSIONS:LA-CAB/RPV appears safe in individuals with prior HBV exposure, including isolated anti-HBc. Comprehensive HBV screening, vaccination, and liver monitoring are essential.

Determining the reasons for HIV test performance in women living with HIV (WLWH) is crucial for evaluating areas for improvement in early diagnosis. The primary objective of the study was to define the reasons for HIV testing in cisgender WLWH who had their first visit in Hospital Clínic, Barcelona, between January 2000 and December 2023. Reasons were classified into: pregnancy and preconception care, AIDS-defining events (ADE), diagnosis in a sexual partner, indicator condition (IC), patient-initiated testing, physician-initiated testing, and “other”. Secondary objectives included the proportion of late and advanced diagnosis, and analysing viral load (VL), CD4 count, and patient status at 48 weeks. Data were compared between two periods (January 2000 to December 2014 and January 2015 to December 2023). The study included 537 women. The main reasons for HIV testing were pregnancy and preconception care (24

BACKGROUND:The increasing heterogeneity in people with HIV makes it necessary to evaluate new follow-up strategies tailored to clinical/social complexity. METHODS:Prospective, single-center, randomized, non-inferiority clinical-trial comparing two follow-up strategies - semi-annual standard care (SoC) or annual visits for 24 months- in virologically suppressed people with HIVand low-complexity profile, according to the GeSIDA "HIV Patient Stratification System". The primary endpoint was non-inferiority (prespecified lower margin: -4%) in virological control (viral load <50 copies/mL; FDA snapshot). Secondary outcomes included adherence, quality of life, satisfaction, and healthcare costs. RESULTS:Of 394 eligible candidates, 71 declined participation (48% preferring to maintain SoC) and 321 were randomized (162 SoC, 159 Annual). Participants were predominantly male (89%), MSM (78%), Spanish (63%), median age of 45 years and 13 years of HIV follow-up, without baseline differences between groups. Overall, 283 (88%) completed the study; 25 switched to long-acting therapy and 10 were lost or transferred. Virological control was similar in SoC and Annual arms: 86.42% vs 86.79% (ITT) and 98.29% vs 97.87% (PP), although non-inferiority was not statistically demonstrated. During the study, the increment from baseline in the proportion of highly satisfied participants was significant in the Annual arm (p=0.001). Reductions in HIV-related direct costs (-25.3%; p<0.001) were greater in the Annual group. CONCLUSIONS:Among people with HIV and low complexity, annual follow-up achieved virological outcomes clinically comparable to semi-annual care, despite not meeting the formal non-inferiority threshold. Annual follow-up was associated with significant increment in patient satisfaction and lower HIV direct-related costs.

BACKGROUND:Long-acting intramuscular cabotegravir plus rilpivirine (LA-CAB + RPV) is an effective maintenance antiretroviral regimen for virologically suppressed people with HIV. However, its use in individuals receiving chronic anticoagulation is limited by concerns regarding intramuscular bleeding risk, and real-world data are scarce. METHODS:We conducted an observational, prospective, single-centre cohort study including all people with HIV (PVIH) who initiated LA-CAB + RPV at Hospital Clínic of Barcelona since February 2023 until April 2026. Patients receiving chronic anticoagulation during the follow-up were identified and assessed for safety and virological outcomes. RESULTS:Among 964 PVIH who started LA-CAB + RPV in our cohort, three were identified who received concomitantly chronic anticoagulation (direct oral anticoagulants or low-molecular-weight heparin). They received injections using standard deep intramuscular technique with post-injection compression. No clinically relevant injection-site hematomas or haemorrhagic complications were observed. Viral suppression was maintained in all cases. CONCLUSIONS:This real-world case series suggest that chronic anticoagulant therapy alone should not automatically preclude the use of LA-CAB + RPV. With careful patient selection and appropriate injection techniques, LA-CAB + RPV may represent a safe and effective treatment option for selected people with HIV receiving anticoagulation.

Long-acting intramuscular cabotegravir plus rilpivirine (LA-CAB/RPV) administered every 2 months (Q2M) has been available in Spain since January 2023 as a switch strategy for HIV treatment. We evaluated characteristics, effectiveness, tolerability, and acceptance, including patient-reported outcomes, stratified by sex in people with HIV switching to LA-CAB/RPV. Observational, prospective, cohort study in Hospital Clínic of Barcelona, Spain. Participant characteristics according to sex at birth and treatment effectiveness [HIV-RNA < 50 copies/mL by on treatment (OT), modified intention-to-treat (mITT), and intention to-treat (ITT) analyses] were evaluated. Self-administered electronic questionnaires were collected. From February 2023 to February 2025, 57/741 (8

The increasing adoption of tenofovir (TXF)-sparing antiretroviral therapy (ART) raises concerns regarding hepatitis B virus (HBV) susceptibility and reactivation risk among people with HIV (PWH). We characterized HBV serological profiles and vaccination status according to ART composition in a real-world cohort. A cross-sectional study of all PWH in active follow-up at Hospital Clínic, Barcelona, as of 30 June 2025. ART regimens were categorized as TXF-containing or TXF-sparing, with or without lamivudine (3TC). HBV serological patterns were classified as chronic infection, serologically resolved infection, isolated HBV core antibody (anti-HBc), no exposure/immunity, and vaccine-induced immunity. Demographic and clinical characteristics were compared using nonparametric and chi-squared/Fisher’s tests. Among the 6437 participants included (82

Background Reduced-frequency oral antiretroviral therapy may lessen treatment burden, but the exposure thresholds required to maintain virological suppression and the role of the HIV reservoir remain undefined. Methods BETAF-RED was a 48-week, single-centre, randomised, open-label, controlled phase 2 pilot trial conducted at Hospital Clínic, Barcelona, Spain. Eligible participants were adults aged 18 years or older with HIV-1 RNA <50 copies per mL for at least 6 months while receiving once-daily bictegravir, emtricitabine, and tenofovir alafenamide. Key eligibility criteria included stable clinical condition and CD4 count >350 cells per μL; key exclusions included previous virological failure or documented resistance to study drugs, active hepatitis B or C infection, and conditions judged to jeopardise adherence. Participants were assigned 1:1:1:1 to receive the oral fixed-dose single-tablet regimen bictegravir, emtricitabine, and tenofovir alafenamide 50/200/25 mg once daily, three times weekly, twice weekly, or once weekly for 48 weeks. The primary endpoint was maintenance of HIV-1 RNA <50 copies per mL (virological success) at weeks 12 and 48, assessed by Food and Drug Administration Snapshot in the intention-to-treat exposed population, defined as all randomised participants receiving study drug, and in the prespecified on-treatment analysis. Secondary outcomes were virological failure and no virological data. Safety analyses included all participants who received at least one dose of study drug. This was not a non-inferiority study, and no non-inferiority margin was specified. ClinicalTrials.gov, NCT05602506. Findings Between November 7, 2022, and July 3, 2023, 40 participants were enrolled; 39 received study medication. In the intention-to-treat exposed Food and Drug Administration Snapshot analysis, virological success was observed at week 12 in 9/9, 9/10, 10/10, and 8/10 participants in the once-daily, three-times-weekly, twice-weekly, and once-weekly arms, respectively. At week 48, virological success was observed in 8/9, 9/10, 9/10, and 7/10 participants in the once-daily, three-times-weekly, twice-weekly, and once-weekly arms, respectively. At week 12, virological failure and no virological data were observed in 0/9 and 0/9, respectively, in the once-daily arm; 1/10 and 0/10, respectively, in the three-times-weekly arm; 0/10 and 0/10, respectively, in the twice-weekly arm; and 2/10 and 0/10, respectively, in the once-weekly arm. At week 48, virological failure and no virological data were observed in 0/9 and 1/9, respectively, in the once-daily arm; 1/10 and 0/10, respectively, in the three-times-weekly arm; 0/10 and 1/10, respectively, in the twice-weekly arm; and 2/10 and 1/10, respectively, in the once-weekly arm. In the prespecified on-treatment analysis, virological success was observed in 36/37 participants at week 12 and in all 33 participants remaining on their assigned regimen at week 48; the only virological failure occurred at week 12 in the three-times-weekly arm, and no virological data were missing at either timepoint. All three participants with protocol-defined confirmed virological failure regained suppression after resuming once-daily therapy, without emergent resistance. Interpretation Most participants met the primary endpoint of maintained virological suppression at weeks 12 and 48 in the intention-to-treat exposed FDA Snapshot analysis. Early protocol-defined confirmed virological failures occurred in the once-weekly arm, and one confirmed low-level viraemia event occurred in the three-times-weekly arm. Because the trial was not powered for formal between-arm comparisons, these findings should be interpreted descriptively. Once-weekly dosing is not supported as a maintenance strategy; twice-weekly and three-times-weekly dosing require confirmation in larger, adequately powered studies with close virological monitoring before any clinical role can be considered. Funding Instituto de Salud Carlos III and Institut d’Investigacions Biomèdiques August Pi i Sunyer.

BACKGROUND:Following a successful pilot study of a three-day-per-week regimen of efavirenz, emtricitabine, and tenofovir disoproxil fumarate, we hypothesized that this strategy would sustain virological efficacy and reduce long-term toxicities. METHODS:After a 24-week randomized phase, participants in the A-TRI-WEEK trial (ClinicalTrials.gov NCT01778413) were offered the three-day-per-week regimen. The extension was approved by the Institutional Review Board, and participants provided informed consent; follow-up continued until further participation no longer offered additional clinical or research value. HIV-RNA, CD4 and CD8 cells, blood and urine chemistries, and bone mineral density (BMD) were assessed every 6 months. Treatment failure was defined a priori as virological failure (HIV RNA >1000 copies/mL once or ≥50 copies/mL confirmed), discontinuation, or loss to follow-up. Secondary outcomes included changes in lipids, estimated glomerular filtration rate (eGFR), urine protein/creatinine, and BMD. RESULTS:Of 61 participants completing the 24-week phase, 59 (97%) entered the extension. After 7 years, 37 (63%) remained free of treatment failure. Only one participant experienced virological failure, following an unintentional treatment interruption, with no resistance mutations detected. All other failures were due to discontinuations (CNS symptoms, n = 7; BMD decline, n = 7; drug interactions, n = 2; regimen preference, n = 2; cancer, n = 1; death unrelated, n = 1; loss to follow-up, n = 1). Laboratory parameters showed biphasic patterns, with initial stability followed by modest late declines in eGFR and BMD and increases in triglycerides and proteinuria. Most discontinuations occurred in the latter half of follow-up (years 4-7). CONCLUSIONS:A three-day-per-week regimen of efavirenz, emtricitabine, and tenofovir disoproxil fumarate maintained durable long-term viral suppression, while mitigating but not fully preventing toxicities associated with EFV/TDF/FTC. These findings support reduced-exposure antiretroviral therapy and warrant evaluation of similar strategies with modern integrase inhibitor-based regimens.

OBJECTIVES:The objective of this study is to evaluate the efficacy, resistance profile, pharmacokinetics (PK) and safety of switching from etravirine to doravirine in virologically suppressed, treatment-experienced individuals with prior non-nucleoside reverse transcriptase inhibitor (NNRTI)-associated resistance mutations (NNRTI-RAMs). METHODS:DorSwitch is a prospective pilot study including 13 adults with sustained virological suppression and documented historical NNRTI-RAMs. Etravirine was replaced by doravirine while maintaining the remaining antiretroviral backbone. Drug-specific resistance penalty scores were generated using the Stanford HIV Drug Resistance Database (HIVdb) algorithm. PK analyses were performed in participants receiving darunavir/cobicistat plus doravirine. Virological, immunological, metabolic and safety outcomes were assessed over 48 weeks. RESULTS:Twelve participants completed 48 weeks of follow-up; one discontinued at Week 4 for personal reasons while virologically suppressed. All participants evaluable at Weeks 24 and 48 maintained HIV-1 RNA < 50 copies/mL, and no virological failures occurred. The median number of NNRTI-RAMs per individual was 2 (IQR 1-3). Doravirine showed lower or equal Stanford HIVdb penalty score (HIVdb-PS) than etravirine in 11/13 participants. In two cases, higher doravirine PS were driven by Y318F and G190E mutations detected in peripheral blood mononuclear cell HIV-1 DNA; both individuals remained virologically suppressed through Week 48. In seven participants receiving darunavir/cobicistat plus doravirine, trough concentrations (Cmin) were consistent with expected exposure concentrations. Total cholesterol and LDL cholesterol decreased significantly over follow-up, while body weight showed a modest, non-significant reduction. No doravirine-related serious adverse events were observed. CONCLUSIONS:In this small, highly selected pilot cohort, switching from etravirine to doravirine as part of an otherwise suppressive regimen was associated with maintenance of virological suppression through Week 48 and a more favourable predicted NNRTI resistance profile in most participants. The favourable resistance profile, safety, metabolic effects and PK findings consistent with expected exposure-particularly in combination with darunavir/cobicistat- support further evaluation of doravirine as a switch option in carefully selected individuals with prior NNRTI failure.

Background: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are increasingly reported among gay, bisexual, and other men who have sex with men (GBMSM) engaging in chemsex, yet data remain limited. This ambispective cohort study conducted at Hospital Clínic of Barcelona (2018–2024) aimed to characterize CA-MRSA infections among GBMSM living with HIV. Methods: Epidemiological, behavioral, and clinical data were collected from medical records and standardized questionnaires. MRSA isolates from clinically indicated samples were identified by mass spectrometry and underwent antimicrobial susceptibility testing. Results: Among 446 participants, 62 (14%) were diagnosed with CA-MRSA, accounting for 109 infection episodes over a median follow-up of 3.21 years (IQR 1.39–5.05). All episodes involved skin and soft-tissue infections; 17% required hospitalization, 35% surgery, and 51% received non-active empirical antibiotics. Recurrent infections occurred in 32% of participants, and detectable HIV viral load was present in 28% of episodes. High levels of polydrug use were reported. Resistance to clindamycin (33%), cotrimoxazole (23%), and mupirocin (96%) was observed. Decolonization was attempted in 65% of participants. Conclusions: CA-MRSA infections were frequent, with substantial recurrence and antimicrobial resistance. These findings highlight challenges for infection control and antimicrobial stewardship and support further evaluation of preventive and decolonization strategies in this population.

Introduction: The incidence of pneumococcal disease (PD) in people living with HIV (PLWH) is higher than in the general population; therefore, this study aimed to analyze its incidence, clinical characteristics and vaccination coverage in PLWH. Methods: We conducted a retrospective, single-center study between 2015 and 2024 in Hospital Clínic, Barcelona, involving HIV patients who presented with PD during the study period (any patient with a microbiologically confirmed result). A descriptive analysis of cases was carried out and compared with patients who did not present PD during the study period. Results: A total of 177 episodes of PD were identified in 148 individuals, with a cumulative incidence of 1.7% (95% CI: 1.4–2.0). The median age at PD diagnosis was 45.9 (36–53) years; 64% of patients were Spanish-born; 50% of patients were men who have sex with men (MSM); the HIV transmission mode was intravenous drug use in 28% of cases; the median CD4 nadir was 181 (58–324) cells/mm3; the median CD4 prior to PD was 429 (240–663) cells/mm3; and the median peak HIV viral load (VL) was 176,839 (20,900–502,000) copies/mL. Intravenous drug use (OR 3.43; 95% CI 2.19–5.36; p < 0.001), peak HIV VL (OR 1.11; 95% CI 1.02–1.21; p = 0.011), and CD4 nadir (OR 0.92; 95% CI 0.87–0.98; p = 0.005) were independently associated with PD, and fifty-one percent of patients had not received any vaccination prior to their PD episode. Conclusion: PD incidence was high in our study and associated with poor immunological status. Research on new strategies to improve vaccination coverage and immunogenicity in PLWH is needed.

Chemsex, the intentional use of drugs to enhance sexual experiences among gay, bisexual, and other men who have sex with men (gbMSM), is linked to high-risk sexual behaviours and increased sexually transmitted infections (STIs). Data on its long-term evolution after implementing specific strategies in HIV settings are limited. We evaluated the incidence of drug use, sexual behaviour, STIs, and vulnerabilities over 3 years following a specific approach at the HIV Unit of Hospital Clinic in Barcelona, Spain. We included 209 gbMSM living with HIV who engaged in chemsex in a prospective cohort (2018–2022). Quarterly visits assessed sexual behaviours, drug use, and STIs screening. Data were collected via self-administered questionnaires, medical records, and microbiological tests. Statistical analyses included descriptive statistics and Poisson regression models. Chemsex incidence decreased significantly (IRR 0.88, 95

Protease inhibitors (PIs) remain an effective antiretroviral therapy (ART) option for people with human immunodeficiency virus (HIV) (PWH), particularly in complex clinical and virological scenarios. However, they are associated with greater metabolic toxicity and drug–drug interactions (DDI) compared with newer ART classes. This study aimed to characterize PWH currently receiving PI-based ART and to explore the reasons for maintaining these regimens. We conducted a cross-sectional, observational study of all PWH on PI-based ART as of 30 June 2024 at the HIV Unit of Hospital Clínic de Barcelona. Demographic, clinical, laboratory, ART history, and genotypic resistance data were extracted from the institutional database and compared with the rest of the cohort. Among 6261 PWH on ART, 724 (11.6

Implementation of universal antiretroviral treatment (ART) in pregnancy has improved maternal health and reduced vertical transmission. However, women living with HIV (WLHIV) still experience worse perinatal outcomes. This retrospective study compared demographic, virological factors, ART regimens and perinatal outcomes in pregnant WLHIV between 2000–2010 (n = 318) and 2011–2021 (n = 140) at a tertiary center in Barcelona. Significant demographic shifts included changes in ethnic distribution, substance use, educational attainment, and maternal BMI. Significant progress in infection control was observed, with increased ART coverage up to 97%, improved viral suppression (80% to 91.3%, p = 0.002), and enhanced immunological status. ART regimens shifted significantly, with an increase in integrase strand transfer inhibitors (INSTI)-based regimens (0.7% to 39.2%, p < 0.001). Obstetric management evolved, with a rise in vaginal deliveries (24.8% to 44.3%, p < 0.001) and a decline in intrapartum zidovudine (93.7% to 54.7%, p < 0.001). Notably, preterm birth rates sharply declined, yet small-for-gestational-age (SGA) infants (26.4% vs. 20%, p = 0.323) and preeclampsia rates remained unchanged and higher than in the general population. All statistical analyses were performed in IBM SPSS statistics 23. In conclusion, although maternal and perinatal outcomes in pregnant WLHIV have improved over the past two decades, a high rate of adverse perinatal outcomes related to placental dysfunction (SGA, preeclampsia) persist. Our findings highlight the need for optimized prenatal care and further research to develop targeted interventions for WLHIV.

BACKGROUND:Switching to dolutegravir plus lamivudine has been associated with weight gain. We aimed to assess factors associated with weight gain and changes in body composition in people with HIV switching to dolutegravir plus lamivudine in the DOLAM trial (EudraCT 201500027435). METHODS:People with HIV on suppressive triple therapy were randomized to switch to dolutegravir plus lamivudine or to continue triple therapy. Weight and height were measured, and dual X-ray absorptiometry (DXA) scans were performed at baseline and 48 weeks. Factors associated with 48 week weight change were estimated using linear regression models adjusted for weight at baseline. DXA-derived changes were assessed using age- and sex-adjusted linear or log-linear mixed-effects regression models. RESULTS:One hundred and eighty (68% of the DOLAM trial participants) (dolutegravir plus lamivudine, n = 88; triple therapy, n = 92) participants contributed with paired baseline and 48 week DXA scans. Mean (95% CI) weight changes were 1. 362 kg (0.437-2.287) in the dolutegravir plus lamivudine arm and 0.199 kg (-0.742 to 1.140) in the triple therapy arm. Treatment with dolutegravir plus lamivudine and age were independently associated with greater weight change at 48 weeks. DXA-derived changes in body fat mass (<0.5% in both arms), lean mass (<7% in both arms) and bone mineral density scans (<0.5% in both arms) did not differ between arms. CONCLUSIONS:Although weight at 48 weeks increased with dolutegravir plus lamivudine but not with triple therapy in the DOLAM study, we did not detect any significant DXA-derived changes in body fat, lean mass or bone mineral density between arms.

BACKGROUND:Decreasing medication burden with raltegravir plus lamivudine in virologically suppressed persons with HIV (PWH) maintained efficacy and was well tolerated at 24 weeks, but more comprehensive data over longer follow-up are required. METHODS:Prospective 48 week extension phase of the raltegravir plus lamivudine arm from a previous 24 week pilot randomized clinical trial in which virologically suppressed PWH were randomized 2:1 to switch to fixed-dose combination 150 mg lamivudine/300 mg raltegravir twice daily or to continue therapy. In this 48 week extension phase, raltegravir was dosed at 1200 mg/day and lamivudine 300 mg/day. Primary outcome was the proportion of PWH with treatment failure at Week 48. Secondary outcomes were changes in ultrasensitive plasma HIV RNA, HIV DNA in CD4 cells, serum IL-6, ultrasensitive C-reactive protein and sCD14, body composition, sleep quality, quality of life and adverse effects. RESULTS:Between May 2018 and June 2019, 33 PWH were enrolled. One participant experienced virological failure without resistance mutations and re-achieved sustained virological suppression without therapy discontinuation, and two others discontinued therapy due to adverse effects. Treatment failure was 9% (95% CI 2%-24%) and 3% (95% CI 0%-17%) in the ITT and on-treatment populations. There were significant changes between baseline and Week 48 in serum cytokines but not in other secondary outcomes. CONCLUSIONS:Switching to raltegravir and lamivudine in PWH with virological suppression maintains efficacy and is well tolerated. This maintenance regimen might be a cost-effective option for PWH at risk of drug-drug interactions or needing to avoid specific toxicities of certain antiretroviral drugs or their negative impact on comorbidities.

BackgroundLiver steatosis (LS) and liver fibrosis (LF) can increase the risk of cardiovascular disease in people with HIV, but their prevalence and associated factors are poorly understood. This study aimed to assess the prevalence of and factors associated with LS and LF in a large cohort of people with HIV.MethodsWe conducted a cross-sectional study of consecutive people with HIV attending the Clinic of Barcelona from September 2022 to September 2023, excluding those with chronic B or/and C hepatitis virus coinfection. LS was assessed using the Hepatic Steatosis Index (HSI) and Fatty Liver Index (FLI), and LF was assessed using the Non-Alcoholic Fatty Liver Disease Fibrosis Score (NFS), Fibrosis-4 score (FIB-4), and the European AIDS Clinical Society (EACS) algorithm in both the whole cohort (cohort 1) and in a specific cohort more susceptible to liver disease (cohort 2). We identified independent variables associated with LS and LF using logistic regression.ResultsCohort 1 included 4664 people with HIV; 76% and 37% of them had available HSI and FLI data, LS was present in 28% and 19%, respectively. LF risk was present in 1%, 2%, and 1% of people with HIV according to NFS, FIB-4, and EACS algorithm scores, respectively. Cohort 2 included 1345 people with HIV; 60% and 30% of them had available HSI and FLI data, LS affected 55% and 43% and LF 2%, 5%, or 3%, respectively. Factors associated with LS included current CD4 cell count, diabetes, and hypertension, whereas LF was associated with previous exposure to dideoxynucleoside drugs and current CD4 to LF. Current integrase strand transfer inhibitor (INSTI) therapy appeared protective for LF in cohort 1.ConclusionsIn this study, one in four people with HIV had LS, and the prevalence rose to one in two in those with cardiovascular risk factors. The prevalence of LF was low, but it should be considered in older people with HIV with low CD4 counts or high aspartate transaminase levels. A possible protective effect from INSTIs deserves further investigation.