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Objective To assess whether differences in safety profiles between nevirapine (NVP) and efavirenz (EFV), as observed in the 2NN study, translated into differences in ‘health related quality of life’ (HRQoL).Design A sub-study of the 2NN study, with antiretro-viral-naive patients randomly allocated to NVP (once or twice daily), EFV or NVP+EFV, in addition to stavudine and lamivudine.Methods Comparing differences in changes of HRQoL over 48 weeks as measured with the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire, using analysis of variance.Results The 2NN study enrolled 1216 patients. No validated questionnaires were available for 244 patients, and 55 patients had no HRQoL data at all, leaving 917 patients eligible for this sub-study. A total of 471 (51%) had HRQoL measurements both at baseline and week 48. The majority (69%) of patients without HRQoL measurements did, however, complete the study. The change in the physical health score (PHS) was 3.9 for NVP, 3.4 for EFV and 2.4 for NVP+EFV (P=0.712). For the mental health score (MHS) these values were 6.1, 7.0 and 3.9, respectively (P=0.098). A baseline plasma HIV-1 RNA concentration (pVL) =100 000 copies/ml and a decline in pVL (per log10) were independently associated with an increase of PHS. An increase of MHS was only associated with pVL decline. Patients experiencing an adverse event during follow-up had a comparable change in PHS but a significantly smaller change in MHS, compared with those without an adverse event.Conclusions First-line ART containing NVP and/or EFV leads to an improvement in HRQoL. The gain in HRQoL was similar for NVP and EFV, but slightly lower for the combination of these drugs.

IntroductionCervical self-collection is a safe and efficient method for detecting sexually transmitted infections (STIs). The study aims to verify the acceptance of cervical self-collection and the prevalence of HPV, HHV-2 and HIV-1 infection in women living in the TapajÓÔáéáós region, AmazÓÔáéáóônia, Brazil.MethodsCross-sectional study with women attending in SantarÓÔáéáóôém-ParÓÔáéáóôéá. The collection was performed between August 2015 and January 2017. Participants collected cervical scrapings and peripheral blood. Those who accepted, also performed cervical self-collection. Detection of HPV DNA was performed by nestedPCR with MY09/11 and GP5/6+primers and typing was done by sequencing. Detection of HHV-2 DNA was performed by real-time PCR with Taqman. Identification of anti-HIV-1/2 antibodies was made by Alere Determine Kit.ResultsA total of 206 specimens were obtained from 112 women. The acceptance of cervical self-collection was 84% (94/112) and HPV DNA was identified in 39.4% (37/94) of the samples. While the prevalence of HPV infection in cervical scraping was 32.1% (36/112). All the women presented Papanicolaou negative for malignancy. The most prevalent types were HPV-16 and HPV-18. The overall prevalence of HHV-2 infection was 8.9%. The concordance rate in the molecular diagnosis between cervical scraping and cervical self-collection was 65% (26/40) for HPV and 50% (4/8) for HHV-2. No woman had HIV-1 reactive serology.ConclusionA high prevalence of HPV infection was found in women without dysplastic lesion. Cervical self-collection had high acceptance, moderate concordance rate in the detection of HPV DNA compared to cervical scraping, and alone it was more efficient in the detection of HPV. This is the first study in women living in TapajÓÔáéáóôéáós region and the findings strongly suggest that cervical self-collection may be a useful tool for increasing access to diagnosis of STIs and screening for cervical cancer in women living in the Amazon.