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Objectives: The aim of this study was to evaluate the factors that can influence an incomplete viral response (IVR) after acute and early HIV infection (AEHI). Methods: This was a retrospective, observational study including patients with AEHI (Fiebig stages I–V) diagnosed between January 2008 and December 2014 at 20 Italian centres. IVR was defined by: (1) viral blip (51–1000 HIV‐1 RNA copies/mL after achievement of < 50 HIV‐1 RNA copies/mL); (2) virologic failure [> 1000 copies/mL after achievement of < 200 copies/mL, or ≥ 200 copies/mL after 24 weeks on an antiretroviral therapy (ART)]; (3) suboptimal viral response (> 50 copies/mL after 48 weeks on ART or two consecutive HIV‐1 RNA levels with ascending trend during ART). Cox regression analysis was used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for IVR. Results: In all, 263 patients were studied, 227 (86%) males, with a median [interquartile range (IQR)] age of 38 (30–46) years. During a median follow‐up of 13.0 (5.7–31.1) months, 38 (14.4%) had IVR. The presence of central nervous system (CNS) symptoms was linked to a higher risk of IVR (HR = 4.70, 95% CI: 1.56–14.17), while a higher CD4/CD8 cell count ratio (HR = 0.13, 95% CI: 0.03–0.51 for each point increase) and first‐line ART with three‐drug regimens recommended by current guidelines (HR = 0.40, 95% CI: 0.18–0.91 compared with other regimens including four or five drugs, older drugs or non‐standard backbones) were protective against IVR. Conclusions: Patients with lower CD4/CD8 ratio and CNS symptoms could be at a higher risk of IVR after AEHI. The use of recommended ART may be relevant for improving short‐term viral efficacy in this group of patients. [ABSTRACT FROM AUTHOR]

Objectives The aim of the study was to assess the rate, determinants, and outcomes of repeat pregnancies in women with HIV infection. Methods Data from a national study of pregnant women with HIV infection were used. Main outcomes were preterm delivery, low birth weight, CD4 cell count and HIV plasma viral load. Results The rate of repeat pregnancy among 3007 women was 16.2%. Women with a repeat pregnancy were on average younger than those with a single pregnancy (median age 30 vs. 33 years, respectively), more recently diagnosed with HIV infection (median time since diagnosis 25 vs. 51 months, respectively), and more frequently of foreign origin [odds ratio ( OR) 1.36; 95% confidence interval ( CI) 1.10-1.68], diagnosed with HIV infection in the current pregnancy ( OR: 1.69; 95% CI: 1.35-2.11), and at their first pregnancy ( OR: 1.33; 95% CI: 1.06-1.66). In women with sequential pregnancies, compared with the first pregnancy, several outcomes showed a significant improvement in the second pregnancy, with a higher rate of antiretroviral treatment at conception (39.0 vs. 65.4%, respectively), better median maternal weight at the start of pregnancy (60 vs. 61 kg, respectively), a higher rate of end-of-pregnancy undetectable HIV RNA (60.7 vs. 71.6%, respectively), a higher median birth weight (2815 vs. 2885 g, respectively), lower rates of preterm delivery (23.0 vs. 17.7%, respectively) and of low birth weight (23.4 vs. 15.4%, respectively), and a higher median CD4 cell count (+47 cells/μL), with almost no clinical progression to Centers for Disease Control and Prevention stage C ( CDC-C) HIV disease (0.3%). The second pregnancy was significantly more likely to end in voluntary termination than the first pregnancy (11.4 vs. 6.1%, respectively). Conclusions Younger and foreign women were more likely to have a repeat pregnancy; in women with sequential pregnancies, the second pregnancy was characterized by a significant improvement in several outcomes, suggesting that women with HIV infection who desire multiple children may proceed safely and confidently with subsequent pregnancies. [ABSTRACT FROM AUTHOR]

Objectives We evaluated the virological response in patients starting a regimen based on darunavir/ritonavir ( DRV/r), which is currently the most widely used ritonavir-boosted protease inhibitor. Methods Data from 206 drug-naïve and 327 PI-experienced patients starting DRV/r 600/100 mg twice daily ( DRV600) or 800/100 mg once daily ( DRV800) were examined. The probabilities of virological success ( VS) and virological rebound ( VR) were evaluated in survival analyses. Baseline DRV/r resistance and its evolution at failure were also examined. Results DRV600 was preferentially administered in patients with complex requirements (older age, higher viraemia, lower CD4 cell count and DRV/ PI resistance) compared with DRV800. By 12 months, the probability of achieving VS was 93.2% and 84.3% in drug-naïve and PI-experienced patients, respectively. The higher the baseline viraemia, the longer was the time required to achieve VS, both in drug-naïve patients [>500 000 HIV-1 RNA copies/ mL: median [interquartile range ( IQR)] 6.1 (5.1-10.3) months; 100 000-500 000 copies/ mL: median ( IQR) 4.9 (3.8-6.1) months; <100 000 copies/ mL: median ( IQR) 3.9 (3.5-4.8) months; P < 0.001] and in PI-experienced patients [≥100 000 copies/ mL: median ( IQR) 7.2 (5.7-11.6) months; <100 000 copies/ mL: median ( IQR) 2.8 (2.4-3.3) months; P < 0.001]. In PI-experienced patients, the probability of VR was higher for higher viraemia levels (22.3% for ≥100 000 copies/ml vs. 9.7% for <100 000 copies/mL; P = 0.007). Baseline resistance did not affect the virological response. At failure, a high percentage of patients maintained virus susceptible to all PIs (drug-naïve: 95%; PI-experienced: 80%). Despite being used more often in patients with more complex requirements, DRV600 performed as well as DRV800. Conclusions In clinical practice, use of DRV/r (with its flexible dosage) results in high rates of virological response. These data support the use of PI/r in patients whose characteristics require potent drugs with a high genetic barrier. [ABSTRACT FROM AUTHOR]