Human Immunodeficiency Virus/Hepatits C Virus Coinfection in Spain: Elimination Is Feasible, but the Burden of Residual Cirrhosis Will Be Significant.

BACKGROUND: We assessed the prevalence of antibodies against hepatitis C virus (HCV-Abs) and active HCV infection in patients infected with human immunodeficiency virus (HIV) in Spain in 2016 and compared the results with those of similar studies performed in 2002, 2009, and 2015. METHODS: The study was performed in 43 centers during October-November 2016. The sample was estimated for an accuracy of 2% and selected by proportional allocation and simple random sampling. During 2016, criteria for therapy based on direct-acting antiviral agents (DAA) were at least significant liver fibrosis, severe extrahepatic manifestations of HCV, and high risk of HCV transmissibility. RESULTS: The reference population and the sample size were 38904 and 1588 patients, respectively. The prevalence of HCV-Abs in 2002, 2009, 2015, and 2016 was 60.8%, 50.2%, 37.7%, and 34.6%, respectively (P trend <.001, from 2002 to 2015). The prevalence of active HCV in 2002, 2009, 2015, and 2016 was 54.0%, 34.0%, 22.1%, and 11.7%, respectively (P trend <.001). The anti-HCV treatment uptake in 2002, 2009, 2015, and 2016 was 23.0%, 48.0%, 59.3%, and 74.7%, respectively (P trend <.001). In 2016, HCV-related cirrhosis was present in 7.6% of all HIV-infected individuals, 15.0% of patients with active HCV, and 31.5% of patients who cleared HCV after anti-HCV therapy. CONCLUSIONS: Our findings suggest that with universal access to DAA-based therapy and continued efforts in prevention and screening, it will be possible to eliminate active HCV among HIV-infected individuals in Spain in the short term. However, the burden of HCV-related cirrhosis will continue to be significant among HIV-infected individuals.

Effectiveness and safety of simplification therapy with once-daily tenofovir, lamivudine, and efavirenz in HIV-1-infected patients with undetectable plasma viral load on HAART.

OBJECTIVE: To evaluate the effectiveness and tolerability of a simplification regimen with tenofovir DF (TDF), lamivudine (3TC), and efavirenz (EFV) in HAART-experienced HIV-1-infected subjects with sustained viral suppression. METHOD: Patients with HIV-1 RNA <200 copies/mL during the previous 6 months and who switched their current twice-daily or three-times-daily HAART to a simplified once-daily regimen of TDF (300 mg), 3TC (300 mg), and EFV (600 mg) were included. RESULTS: 154 patients (70% males, mean age 42 years) were included. Previous HAART included a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen in 55% of the patients and a thymidine analog in 87%. The percentage of patients with viral load <200 copies/mL in the intent-to-treat (ITT) data set was 83% at 6 months and 75% at 12 months (98% and 96%, respectively, in the on-treatment [OT] analysis). Five patients (3%) were identified as virologic failures according to the study protocol. The mean CD4 T-cell count increased significantly 12 months after simplification (from 570 to 632 cells/mm3; p < .01). At 12 months, mean triglyceride levels decreased from 233 to 170 mg/dL (p < .01) and mean cholesterol levels decreased from 205 to 189 mg/dL (p < .01). Thirty-three patients (21%) discontinued the study treatment prior to completing the 12-month follow-up. CONCLUSION: Simplification to a once-daily regimen containing TDF, 3TC, and EFV is virologically and immunologically effective, well-tolerated, and safe with benefits in the lipid profile in the majority of patients.

[Changes in knowledge, attitudes, and habits of the general population with regard to HIV infection]. / Evolución de los conocimientos, actitudes y hábitos de la población general sobre la infección por el VIH.

INTRODUCTION: Knowledge of the social changes related to HIV infection can be helpful in the attempts to design more effecting preventive strategies for this disease. The aim of this study was assess the progress that has occurred in the knowledge, attitudes and habits of the general population in relation to HIV infection between 1997 and 2005. METHODS: With this objective, a multidisciplinary team designed a questionnaire survey containing 64 items, which was validated through a pilot study performed with 100 subjects. The target population included all residents of the city of Zamora aged 18 to 70 years old. The population was stratified by district (five), sex, and age (younger or older than 40 years old) into 20 groups. The sample size was calculated and a randomly selected list of participants was obtained for each group. The questionnaire was filled out at the homes of the selected population with the help of trained personal in 1997, and was repeated in 2005. Results from the two time points were compared. RESULTS: In 2005, a larger number of people were interested in gaining more information about the disease and showed concern about the risk of infection. However, there were no significant changes in the related knowledge or habits, and frequent errors persisted regarding prevention of sexual transmission. Nonetheless, the attitude toward infected patients had improved. CONCLUSIONS: Over the 8 years of the study, knowledge about HIV infection has not changed, and errors regarding sexual prevention remain, although there is a more positive attitude toward patients with this disease. Modifying this deficit in the understanding of HIV may contribute to preventing this disease.

[Seroprevalence of hepatitis C virus in the general population]. / Seroprevalencia del virus de la hepatitis C en la población general.

AIM: To determine the prevalence of hepatitis C virus (HCV) infection and to study associated risk factors in the general population of the province of Zamora. PATIENTS AND METHODS: For this transversal, observational, descriptive, population study, we randomly selected 1973 individuals over 14 years old and grouped them according to age and sex. The study included completion of a questionnaire containing socio-demographic information and data on risk factors. Serum samples were collected for analysis of antibodies to HCV by means of a third-generation ELISA, and were confirmed by an immunoblot technique. Viral load and genotype analyses were carried out in positive cases by polymerase chain reaction technique. RESULTS: Among the total, 600 complete studies (questionnaires and serum samples) 657 questionnaires and 675 samples were obtained. Eleven serum samples tested positive for HCV and among these, 5 were confirmed by immunoblot. The positive samples corresponded to 3 men and 2 women; 4 lived in urban settings and all 5 had one or more known risk factors for acquiring the infection. CONCLUSIONS: The prevalence of HCV infection in our geographical area was 0.74% (95% CI, 0.27-1.82). The seropositive individuals detected in this population screening study had a history of parenteral risk activities and most lived in urban areas.