Effectiveness, safety and discontinuation rates of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) in people with HIV using real-world data: a systematic review and meta-analysis.

BACKGROUND: The use of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) is based on the results of robust clinical trials. OBJECTIVES: To assess the effectiveness and safety of BIC/FTC/TAF in treatment-naïve (TN) and treatment-experienced (TE) people with HIV using available real-world cohort studies. METHODS: Systematic review and meta-analysis of publications and communications identified via Boolean search in Medline, PubMed and Embase, and conference abstracts reporting retrospective real-world use of BIC/FTC/TAF, published until 31 January 2024. The primary endpoint was the proportion of TN and TE people with HIV with viral load (VL) < 50 copies/mL at 48 weeks while on treatment. RESULTS: Of the 38 identified publications and conference abstracts, for the present analysis we included 12 publications (comprising 792 TN and 6732 TE individuals). For the three publications including 507 TN participants reporting the primary outcome, VL suppression was 97% [95% confidence intervals (CI): 89-100]. For the nine publications including 4946 TE participants reporting the primary outcome, VL suppression was 95% (95% CI: 94-96), with suppression >93% in all studies. Total discontinuations at 48 weeks in TE individuals were 3% (95% CI: 2-5), 1% (95% CI: 0-2) due to side effects. A total of four publications with 151 TE individuals with previous presence of M184V substitution were identified, reporting a suppression rate at 48 weeks of 95% (95% CI: 88-100). CONCLUSIONS: Real-world studies demonstrate low discontinuation rates and high rates of virologic suppression in individuals treated with BIC/FTC/TAF, both TN and TE with and without previous detection of M184V substitution.

Rapid initiation of bictegravir/emtricitabine/tenofovir alafenamide as first-line therapy in HIV infection. A prospective study.

INTRODUCTION: Rapid initiation of ART after HIV diagnosis is recommended for individual and public health benefits. However, certain clinical and ART-related considerations hinder immediate initiation of therapy. METHODS: An open-label, single-arm, single-centre 48-week prospective clinical trial involving ART-naïve HIV-diagnosed adults who started bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) within a week from the first hospital visit, before the availability of baseline laboratory and genotype results. The primary aim was to determine the proportion of people with at least one condition that would hinder immediate initiation of any recommended ART regimen other than BIC/FTC/TAF. Clinicaltrials.gov: NCT04416906. RESULTS: We included 100 participants: 79% men, 64% from Latin America, median age 32 years. According to European AIDS Clinical Society (EACS) and US Department of Health and Human Services 2023 guidelines, 11% (95%CI 6; 19) of participants had at least one condition that made any ART different from BIC/FTC/TAF less appropriate for a rapid ART strategy. Seventy-nine percent of the people started BIC/FTC/TAF within the first 48 hours of their first hospital visit. There were 16 early discontinuations (11 lost to follow-up). By week 48, 92% (95%CI 86; 98) of the participants of the ITT population with observed data achieved viral suppression. Eight grade 3-4 adverse events (AEs), five serious AEs and six ART-related AEs were identified. Adherence remained high. CONCLUSIONS: BIC/FTC/TAF is an optimal treatment for rapid initiation of ART. However, additional strategies to improve retention in care must be implemented.

[Epidemiology, treatment and prognosis of HIV infection in 2024: A practical review]. / Epidemiología, tratamiento y pronóstico de la infección VIH en 2024: revisión práctica.

In recent years, the epidemiology and prognosis of HIV infection have undergone significant changes thanks to the recommendation of antiretroviral therapy (ART) for all infected persons, the development of more effective and better tolerated drugs, and preventive measures such as pre-exposure prophylaxis (PrEP). The evolution of ART, now with simple oral and injectable options, has also contributed to improvements in comprehensive HIV treatment and care. With early diagnosis and early initiation of ART, the life expectancy of people with HIV has reached the same as the general population. However, many people with HIV remain undiagnosed or are diagnosed late, and some population groups experience greater vulnerability, affecting individual and collective health. In this review we review the current epidemiology, treatment and prognosis of HIV infection.

Evolving AIDS- and non-AIDS Mortality and Predictors in the PISCIS Cohort of People Living With HIV in Catalonia and the Balearic Islands (Spain), 1998-2020.

Background: Effective antiretroviral therapy (ART) has substantially reduced acquired immunodeficiency syndrome (AIDS)-related deaths, shifting the focus to non-AIDS conditions in people living with human immunodeficiency virus (HIV) (PLWH). We examined mortality trends and predictors of AIDS- and non-AIDS mortality in the Population HIV Cohort from Catalonia and Balearic Islands (PISCIS) cohort of PLWH from 1998 to 2020. Methods: We used a modified Coding Causes of Death in HIV protocol, which has been widely adopted by various HIV cohorts to classify mortality causes. We applied standardized mortality rates (SMR) to compare with the general population and used competing risks models to determine AIDS-related and non-AIDS-related mortality predictors. Results: Among 30 394 PLWH (81.5% male, median age at death 47.3), crude mortality was 14.2 per 1000 person-years. All-cause standardized mortality rates dropped from 9.6 (95% confidence interval [CI], 8.45-10.90) in 1998 through 2003 to 3.33 (95% CI, 3.14-3.53) in 2015 through 2020, P for trend = .0001. Major causes were AIDS, non-AIDS cancers, cardiovascular disease, AIDS-defining cancers, viral hepatitis, and nonhepatitis liver disease. Predictors for AIDS-related mortality included being aged ≥40 years, not being a man who have sex with men, history of AIDS-defining illnesses, CD4 < 200 cells/µL, ≥2 comorbidities, and nonreceipt of ART. Non-AIDS mortality increased with age, injection drug use, heterosexual men, socioeconomic deprivation, CD4 200 to 349 cells/µL, nonreceipt of ART, and comorbidities, but migrants had lower risk (adjusted hazard risk, 0.69 [95% CI, .57-.83]). Conclusions: Mortality rates among PLWH have significantly decreased over the past 2 decades, with a notable shift toward non-AIDS-related causes. Continuous monitoring and effective management of these non-AIDS conditions are essential to enhance overall health outcomes.

Toxic-Induced Encephalopathy Following Chemsex in a Young HIV-Positive Male: A Complex Case of Acute Cognitive Impairment with Anterograde Amnesia and Behavioral Alterations.

BACKGROUND: A broadened clinical spectrum of concomitant complications emerges among the escalating incidence of substance use, particularly within the 'chemsex' context. This case exemplifies the profound neurotoxic repercussions and neurological risk of chemsex in a young HIV-positive male and addresses the multifaceted challenges of such evolving paradigms in substance utilization. CLINICAL FINDING: After consuming cannabis, poppers, methamphetamine, and cocaine, a 28-year-old HIV-positive male exhibited significant neurological and cognitive impairment. The initial presentation included dysarthria and profound anterograde amnesia. Laboratory findings showed leukocytosis with a PCR of 3 mg/dl - elevated cerebrospinal fluid protein levels with no cells. Urine toxicology returned positive for cannabis and amphetamines. A brain CT scan revealed bilateral and symmetrical hippocampi and pale globes hypodensity, indicative of toxic-metabolic encephalopathy. MRI further identified lesions in the globus pallidus, cerebellum, and hippocampi. Following the detection of toxic encephalopathy, Initial neuropsychological was performed screening using the Montreal Cognitive Assessment (MoCA), which highlighted immediate memory deficits. An in-depth neuropsychological assessment conducted 3 weeks later included the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV), the Rey Auditory Verbal Learning Test (RAVLT), and tests for visuospatial skills, motor functions, and memory recall. The evaluations revealed pronounced anterograde amnesia, persistent long-term memory inconsistencies, and notable executive function challenges, detailed in Table 1. CONCLUSIONS: The detailed analysis of this case underpins the severe neurological consequences that can manifest from heavy substance use. Comprehensive diagnostic evaluations, including neuroimaging and neuropsychological assessments, are crucial in elucidating the full spectrum of substance-induced cognitive impairments. There is an urgent need for enhanced public awareness and preventative measures, especially in the context of chemsex, to bring forth multifaceted health, social, and government implications that modern society must adeptly navigate.

The potential of PGPR and Trichoderma-based bioproducts and resistant cultivars as tools to manage clubroot disease in cruciferous crops.

The objective of this research was to determine the potential use of eco-friendly technologies to reduce the clubroot disease caused by Plasmodiophora brassicae, the main constraint of cruciferous crops worldwide. Two commercial bioproducts were evaluated in susceptible broccoli, one based on the PGPR consortium (Bacillus amyloliquefaciens, Bacillus pumilus, and Agrobacterium radiobacter K84) and the other one based on Trichoderma koningiopsis Th003 (Tricotec® WG). Additionally, the resistant broccoli cv. Monclano® was tested under two concentrations of resting spores (RS) of P. brassicae, 1 × 103 and 1 × 105 RS g-1 of soil. The first phase of evaluations with broccoli was carried out under a greenhouse, while susceptible broccoli, cauliflower, and red cabbage were included in a subsequent field phase. Tebuconazole + Trifloxystrobin mixture and Fluazinam were included as positive controls. The effectiveness of the bioproducts depended on the nature of the biocontrol agent, the concentration of P. brassicae, and the dose of treatment. Tricotec® showed consistent plant growth promotion but no biocontrol effect against clubroot, and the rhizobacteria-based bioproduct significantly reduced the disease in both greenhouse and field experiments. Higher disease severity was observed with the higher dose of Tricotec®. Under field conditions, the rhizobacteria reduced the incidence progress by 26%, 39%, and 57% under high, medium, and low pressure of the pathogen, respectively. However, no reduction of clubroot severity under high pressure of the pathogen was observed. Complete inhibition of club formation in roots was achieved via the fungicide, but a phytotoxic effect was observed under greenhouse conditions. Fungicides reduced the incidence progress of clubroot, but not the severity under high inoculum pressure in the field. The fungicides, the bacterial treatment, and the combination of bioproducts tended to delay the progress of the disease compared with the negative control and Tricotec alone. The resistant broccoli showed a low level of disease under high concentrations of P. brassicae (less than 10% incidence and up to 2% severity). These results suggested the overall potential of commercial tools based on the PGPR consortium and plant resistance to control P. brassicae. The integration of control measures, the role of Trichoderma spp. in P. brassicae-cruciferous pathosystems, and the need to recover highly infested soils will be discussed.

El tercer espacio: propiedades de desplazamiento de la experiencia psicocultural / The Third Space: Displacement Properties of the Psycho-Cultural Experience

Resumen El propósito de este artículo consiste en presentar el tema El tercer espacio: propiedades de desplazamiento de la experiencia psicocultural. Se refiere al espacio potencial del desarrollo temprano humano,que hace contrapunto en su devenir histórico con el mundo sociocultural. Surge mayormente de la reflexión concienzuda obtenida de la clínica psicoanalítica con consultantes niños y adultos, así como de la investigación sobre la relación entre psicoanálisis y literatura. La psicoterapia con niños sucede en un espacio de juego, en un taller de trabajo psicológico donde se explicitan los síntomas perturbadores y se vehiculiza el conflicto, en una zona intermedia, así llamada por D.W. Winnicott, no tan lejana del tratamiento con consultantes adultos donde al transcurrir el proceso de análisis del inconsciente se produce un tiempo-espacio de ambigüedad y extrañamiento. Tales procesos de naturaleza clínica permiten observar que en el devenir y la producción cultural humana se hace notar un espacio que se abre hasta que se define el traslado experiencial. Ese es el tercer espacio. Otro modo de observar ese tercer espacio se encuentra en el lenguaje; ese componente ambiguo, incierto, se efectúa mediante el desplazamiento semántico en el texto literario. Así, ese tiempo-espacio de ambigüedad, propicio para el desplazamiento de procesos de lenguaje, convertido en hechos culturales como obra artística o fenómeno psicosocial, tiene como basamento procesos transicionales intrapsíquicos advertidos desde el desarrollo precoz. De manera amplia, el tercer espacio se propone como ámbito teórico e investigativo dado que constituye un aporte a la lectura y a la investigación textual psicoanalítica.

Abstract: The purpose of this article is to present the topic: The Third Space: Displacement Properties of the Psycho-Cultural Experience, referring to the potential space in early human development, which interacts with its historic occurrence in the socio-cultural world. It arises mostly from thoughtful consideration obtained from psychoanalytic consultation with children and adults, as well as investigation of the relationship between psychoanalysis and literatura Psychotherapy with children takes place in a play space, in a psychological workshop where the symptoms causing a disturbance are identified and the conflict is focused in an intermediate zone, thus named by D.W. Winnicott; it is not that far from the treatment of adult patients, wherein the analysis process of the subconscious takes place and creates a time and space of ambiguity and estrangement. Such processes of a clinical nature allow observing that throughout these and human cultural production there is a space which is opened until the transfer of the experience takes place, that is the: third space. Another way to observe this third space is through language; the ambiguous and uncertain component, which takes place in semantic displacement in the literary text. Therefore that temporal and spatial ambiguity, which encourages the displacement of language processes, into cultural expression and artistic productions or psychosocial phenomena, has as its foundation those intra-psychic transitional processes, noticed since early development. Taken amply, the third space is proposed as a theoretical and investigative field becauseit contributes to the reading and investigation of psychoanalytic texts

Evaluación de disfunción tiroidea según valores de TSH en una población del Centro de Atención Ambulatorio (CAA) Central Quito del Instituto Ecuatoriano de Seguridad Social, durante el año 2008 / Evaluation of thyroid dysfunction according to TSH values ​​in a population of the Center of Ambulatory Attention (CAA) Central Quito del Ecuadorian Social Security Institute, during 2008

Introducción: La cuantificación de la hormona estimulante de la tiroides (TSH) es una prueba confiable para detectar patologías tiroideas. En los pacientes que acuden por otras causas a nuestra unidad no existen datos epidemiológicos publicados. Objetivo: Determinar la frecuencia de disfunción tiroidea en la población que acude al Centro de Atención Ambulatorio (CAA) Central del Instituto Ecuatoriano de Seguridad Social (IESS). Métodos: Estudio retrospectivo que incluyó 270 mujeres y 96 hombres adultos, sin antecedentes de patología tiroidea ni consumo de hormona tiroidea, referidos por orden médica al laboratorio clínico del CAA Central Quito del IESS para la determinación por primera vez de niveles séricos de TSH por electroquimioluminiscencia. Resultados: La edad promedio de la población general fue de 55.97 (DE 14.80) años, sin diferencias significativa entre hombre y mujeres. El valor de TSH promedio para toda la muestra fue 3.08 mUI/L (DE 8.8; rango 0.01 a 32.77), sin diferencias significativas según sexo. Se encontró valores de TSH <0.27 mUI/L en 8 pacientes (2.18%), en rango normal (0.27-4.2 mUI/L) en 303 pacientes (82.78%), > 4.2 mUI/L pero < 10 mUI/L en 49 pacientes (13.38%) y niveles mayores de 10 mUI/L en 6 pacientes (1.63%). Se hallaron niveles elevados de TSH con mayor frecuencia a partir de la cuarta década de vida. Conclusión: Se justifica una búsqueda más activa de hipotiroidismo y su realización como prueba de tamizaje en mujeres mayores de 40 años. Los valores hallados de disfunción tiroidea solo aplican para esta población evaluada, en la cual se utilizó más una estrategia diagnóstica que de tamizaje y cuyas incidencias no pueden extrapolarse a la población general.

Introduction: The quantification of thyroid stimulating hormone (TSH) is a reliable test to detect thyroid pathologies. In the patients who come For other reasons, our unit does not have published epidemiological data. Objective: To determine the frequency of thyroid dysfunction in the population that attends to the Central Ambulatory Care Center (CAA) of the Ecuadorian Institute of Social Security (IESS). Methods: Retrospective study that included 270 women and 96 adult men, without history of thyroid pathology or thyroid hormone consumption, referred in order to the clinical laboratory of the CAA Central Quito of the IESS for the determination for the first time of serum TSH levels by electrochemiluminescence. Results: The average age of the general population was 55.97 (SD 14.80) years, without significant differences between men and women. The average TSH value for the entire sample it was 3.08 mUI / L (DE 8.8; range 0.01 to 32.77), without differences significant according to sex. TSH values ​​<0.27 mUI / L were found in 8 patients (2.18%), in normal range (0.27-4.2 mUI / L) in 303 patients (82.78%),> 4.2 mUI / L but <10 mUI / L in 49 patients (13.38%) and levels greater than 10 mUI / L in 6 patients (1.63%). Elevated levels of TSH were found more frequently at from the fourth decade of life. Conclusion: A more active search for hypothyroidism and its realization is justified as a screening test in women over 40 years old. The values ​​found of Thyroid dysfunction only applies to this population evaluated, in which more was used a diagnostic strategy that screening and whose incidents cannot be extrapolated to the general population.