Real-life experience with bictegravir/emtricitabine/tenofovir alafenamide in a large reference clinical centre.

BACKGROUND: The use of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) is mainly based on robust, pivotal clinical trials. OBJECTIVES: To provide data on clinical use of BIC/FTC/TAF in real life. PATIENTS AND METHODS: This was an observational, retrospective and single-centre study. We included all adult, treatment-naive (TN) and treatment-experienced (TE) people living with HIV (PLWH) starting BIC/FTC/TAF from 8 June 2018. We evaluated effectiveness [on treatment (OT), modified intention-to-treat (mITT) and intention-to-treat (ITT)], tolerability and safety in those patients who reached 6 months of follow-up (M6). RESULTS: We included 1584 PLWH [213 TN (13%) and 1371 TE (87%)]. The median (IQR) follow-up was 16 (7-21) months, with 81% and 53% of PLWH reaching M6 and M12, respectively. By OT, mITT and ITT, HIV-RNA <50 copies/mL was 77%, 70% and 62% at M6 and 92%, 77% and 63% at M12 for TN PLWH and 94%, 89% and 83% at M6 and 93%, 85% and 78% at M12 for TE PLWH, respectively. In PLWH carrying an M184V/I substitution, OT RNA <50 copies/mL was 89.5% at M6. The median CD4 cell count increased from 329 to 511/µL in TN PLWH and from 630 to 683/µL in TE PLWH at M6. Of the total, 1148 (88%) PLWH continued on BIC/FTC/TAF at M6. The most frequent known reason for discontinuation was toxicity [42 (69%) cases]; only 7 cases were considered virological failures (0.6% of the total OT cohort at M6), with no emerging resistance substitutions. CONCLUSIONS: In real life, BIC/FTC/TAF showed high rates of virological suppression and also in PLWH carrying lamivudine/emtricitabine resistance substitutions. The tolerability and safety of BIC/FTC/TAF were good, with high persistence observed for patients on this regimen at M6.

Prevalence of late diagnosis of HIV infection. / Prevalencia de diagnóstico tardío en infección por VIH.

BACKGROUND: Prevalence of late diagnosis (LD) and identifying missed opportunities. METHODS: Retrospective observational study of new HIV diagnoses between 2013 and 2018 in our referral area. Sociodemographic and clinical-analytical variables were analysed at the time of diagnosis. The patient's clinical history in the last 5 years before the HIV diagnoses was reviewed to identify missed opportunities for early diagnosis. RESULTS: Seventy-four patients were included. The prevalence of LD was 44.6%, and 23% as an advanced disease. A tendency for LD was observed in patients older than 40 years, especially among Spaniards. Being tested 11for HIV protected against LD. All patients who had previous contact with the health system had clinical indicators or risk factors associated with HIV, but only 50% had ever been tested in their lifetime of HIV. CONCLUSIONS: In spite of multiple contacts with our health system, almost half of the new cases of HIV infection are diagnosticated late. Different strategies should be implemented to improve the identification of the risk factors and clinical indicators of possible HIV infection.

Prevalencia de diagnóstico tardío en infección por VIH / Prevalence of late diagnosis of HIV infection

OBJETIVO: Prevalencia de diagnóstico tardío (DT) e identificar oportunidades perdidas. MÉTODOS: Estudio observacional retrospectivo de nuevos diagnósticos de VIH entre el 2013 y el 2018 en nuestra área de referencia. Se analizan variables sociodemográficas y clínico-analíticas en el momento del diagnóstico. Se revisa la atención sanitaria prestada en los 5 años previos para identificar oportunidades perdidas de diagnóstico precoz. RESULTADOS: Setenta y cuatro pacientes. Edad media 35,3 años, 83,8% hombres. Prevalencia de DT del 44,6% y de enfermedad avanzada del 23,0%. Tendencia aumentada de DT en los pacientes mayores de 40 años, en especial entre los españoles. Ser testado de VIH protege de presentar un DT. Todos los pacientes con contacto previo con el sistema sanitario presentaban indicadores o factores de riesgo asociados al VIH, pero tan solo el 50% había sido testado del VIH. CONCLUSIONES: A pesar del contacto repetido de nuestros pacientes con el sistema sanitario, casi la mitad de nuevos diagnósticos se realizan de forma tardía. Es importante implementar estrategias que permitan identificar mejor a aquellos pacientes con factores de riesgo o indicadores clínicos para una detección más precoz del VIH

BACKGROUND: Prevalence of late diagnosis (LD) and identifying missed opportunities. METHODS: Retrospective observational study of new HIV diagnoses between 2013 and 2018 in our referral area. Sociodemographic and clinical-analytical variables were analysed at the time of diagnosis. The patient's clinical history in the last 5 years before the HIV diagnoses was reviewed to identify missed opportunities for early diagnosis. RESULTS: Seventy-four patients were included. The prevalence of LD was 44.6%, and 23% as an advanced disease. A tendency for LD was observed in patients older than 40 years, especially among Spaniards. Being tested 11for HIV protected against LD. All patients who had previous contact with the health system had clinical indicators or risk factors associated with HIV, but only 50% had ever been tested in their lifetime of HIV. CONCLUSIONS: In spite of multiple contacts with our health system, almost half of the new cases of HIV infection are diagnosticated late. Different strategies should be implemented to improve the identification of the risk factors and clinical indicators of possible HIV infection