Is immune recovery different depending on the use of integrase strand transfer inhibitor-, non-nucleoside reverse transcriptase- or boosted protease inhibitor-based regimens in antiretroviral-naive HIV-infected patients?

OBJECTIVES: To analyse whether integrase inhibitor (InSTI)-based regimens achieve better immunological recovery than NNRTI- or boosted PI (bPI)-based regimens as initial ART. METHODS: In a retrospective analysis, we selected patients who initiated ART with two NRTIs plus an InSTI, an NNRTI or a bPI and maintained both the same 'third drug' and an HIV-RNA <50 copies/mL in ≥95% of determinations once undetectable viral load had been achieved. We compared CD4+ count, %CD4+ and CD4+/CD8+ ratio recovery over 2 years. Data were analysed using mixed-effects regression models for repeated measures. RESULTS: Of the 836 patients included, 208, 481 and 147 initiated with InSTI, NNRTI and bPI, respectively. For CD4+, %CD4+ and CD4+/CD8+ two main slopes were identified: from month 0 to month 6, with the highest increments; and from month 6 to month 24, with smaller increases every semester. Although the patients on InSTI achieved undetectable viral load faster, for CD4+ and %CD4+ there were no differences in the slopes of change according to the third drug either for the first phase (P=0.137 and P=0.393, respectively) or from month 6 onwards (P=0.834 and P=0.159, respectively). The increase in CD4+/CD8+ was slightly higher for bPI compared with InSTI (difference of 0.0119, 95% CI 0.0020-0.0205; P=0.018), but clinically negligible. From month 6 onwards, no differences were found between treatment groups (P=0.176). CONCLUSIONS: Immune restoration measured as CD4+ count, %CD4+ and CD4+/CD8+ increases was independent of the third antiretroviral drug class used when given with two NRTIs.

The Dynamics of Lepus granatensis and Oryctolagus cuniculus in a Mediterranean Agrarian Area: Are Hares Segregating from Rabbit Habitats after Disease Impact?

The genera Oryctolagus and Lepus (order Lagomorpha) are essential elements in the trophic chain in the Iberian Peninsula, being the main prey of many predators, including some highly endangered predators such as the Iberian lynx (Lynx pardinus). Myxomatosis, a disease producing tumorations in conjunctive tissues, and produced by the Myxoma Virus, has caused mass mortalities in rabbits (Oryctolagus cuniculus) for decades. Recently, the virus has jumped interspecifically from rabbits to hares, and this has created a depletion in hare populations, generating great concern. We analyzed the population dynamics and distribution of both lagomorph species in a Mediterranean agricultural area of the south of Spain since the 1990s with a combination of systematic and non-systematic data. The appearance of the outbreak in the Iberian hare (Lepus granatenis) in 2018 enabled us to undertake an opportunistic analysis of its effects on the spatial structure and assemblages, as well as on the niches of both species using PCA analyses and ordination techniques. Analysis of the mortality effect on daily and seasonal cycles was also conducted, and relations with the temporal dimension was tested using generalized lineal models (GLMs). In our results, in addition to population and temporal patterns, we could observe a restructuring in hare distribution after the mortality event, highlighting that prior to the outbreak, rabbit and hare populations were spatially differentiated, although with some overlaps and niche similarities. However, since the outbreak, hare populations have been excluded from rabbit areas, suggesting that in the absence of rabbits, the virus has more difficulties to infect hares. We also provide an overview of the effect of this population depletion on the ecological and socio-economic dimension of this region, pointing out the importance of this situation for the area.