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Although antiretroviral therapy (ART) is effective in suppressing viral replication, HIV-1 persists in reservoirs and rebounds after ART has been stopped. However, a very few people (eg, elite and post-treatment controllers) are able to maintain viral loads below detection limits without ART, constituting a realistic model for long-term HIV remission. Here, we describe the HIV control mechanisms of an individual who showed exceptional post-treatment control for longer than 15 years.We report the case of a Hispanic woman aged 59 years with sexually acquired acute HIV infection, who was included in an immune-mediated primary HIV infection trial involving a short course of ciclosporine A, interleukin-2, granulocyte macrophage colony-stimulating factor, and pegylated interferon alfa, followed by analytical treatment interruption. We did the following viral assays: total and integrated HIV-1 DNA in CD4 T cells and rectal tissue, quantitative viral outgrowth assay, HIV-1 infectivity in peripheral blood mononuclear cells and CD4 T-cell cultures and viral inhibitory activity by natural killer (NK) and CD8 T cells. NK and T-cell phenotypes were determined by flow cytometry. HLA, killer cell immunoglobulin-like receptors, Δ32CCR5, and NKG2C alleles were genotyped.After ART and immunomodulatory treatment, the person maintained undetectable plasma viral load for 15 years. HIV-1 subtype was CFR_02AG, CCR5-tropic. We found progressive reductions in viral reservoir during the 15-year treatment interruption: total HIV DNA (from 4573·50 copies per 10We described long-term remission in a woman aged 59 years who was treated during primary HIV infection and has maintained undetectable viral load for 15 years without ART. Replication-competent HIV-1 was isolated. NKG2C-memory-like NK cells and γδ T cells were associated with the control viral replication. Strategies promoting these cells could bring about long-term HIV remission.Fondo Europeo para el Desarrollo Regional (FEDER), SPANISH AIDS Research Network (RIS), Fondo de Investigación Sanitaria (FIS), HIVACAT, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CERCA Programme/Generalitat de Catalunya, la Caixa Foundation, and Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC).For the Spanish translation of the abstract see Supplementary Materials section.

Puntos para una lectura rapida • La infeccion por el virus de la inmunodeficiencia humana (VIH) es una de las infecciones de transmision sexual (ITS) mas importantes. Suele ir asociada a otras ITS, a las que potencia. Se contrae con mayor facilidad cuando existe una puerta de entrada, como las lesiones ulcerosas de la sifilis, el chancroide o el linfogranuloma venereo, pero, en especial, el herpes genital por su caracter de erosion recidivante. • En la profilaxis de la infeccion por VIH es fundamental reducir las practicas de riesgo como la promiscuidad y utilizar regularmente el preservativo y la profilaxis preexposicion (PrEP). • La PrEP ha demostrado que disminuye la transmision del VIH en grupos de riesgo elevado. Ademas, ha demostrado ser coste-eficaz en poblaciones diana como los hombres que tienen sexo con hombres (HSH) y las parejas de afectados por el VIH. • Se recomienda la administracion de tratamiento antirretroviral (TAR) a todos los pacientes con infeccion por el VIH-1 para evitar la progresion de la enfermedad, disminuir la transmision del virus y limitar el efecto nocivo sobre posibles morbilidades coexistentes (grado de recomendacion A-I). • El TAR debe instaurarse lo mas precozmente posible una vez confirmado el diagnostico (grado de recomendacion A-III). • El inicio del TAR debe valorarse siempre individualmente. Ademas, se debe realizar una determinacion de linfocitos CD4+ y carga viral plasmatica previa al inicio del tratamiento (se puede comenzar en espera de los resultados si se utiliza una pauta cuya recomendacion no este condicionada a sus valores). • En el caso de transmision del VIH unicamente, la transmision se reduce drasticamente en el momento en el que se alcanza la indetectabilidad del virus en sangre o carga viral plasmatica indetectable debido a la toma correcta del tratamiento antirretroviral adecuado. • El diagnostico definitivo de la infeccion por VIH solo puede establecerse por pruebas de laboratorio mediante un analisis de sangre o de saliva. Las pruebas mas rapidas pueden obtener resultados en menos de 3 minutos. La prueba es voluntaria y confidencial. Debe ofrecerse a todos los pacientes al menos una vez en la vida o periodicamente dependiendo de las caracteristicas de cada persona.

Background: In people living with HIV, much is known about chronic kidney disease, defined as a glomerular filtration rate under 60 mL/min. However, there is scarce data about prevalence and risk factors for milder impairment (60–89 mL/min). Objective: The present study aims to assess the influence of sex, antiretroviral therapy, and classical risk factors on the occurrence of mild decreased renal function in a large Spanish cohort of HIV-infected patients. Methods: Cross-sectional, single center study, including all adult HIV-1-infected patients under antiretroviral treatment with at least two serum creatinine measures during 2014, describing the occurrence of and the risk factors for mildly decreased renal function (eGFR by CKD-EPI creatinine equation of 60–89 mL/min). Results: Among the 4337 patients included, the prevalence rate of mildly reduced renal function was 25%. Independent risk factors for this outcome were age older than 50 years (OR 3.03, 95% CI 2.58–3.55), female sex (OR 1.23, 95% CI 1.02–1.48), baseline hypertension (OR 1.57, 95% CI 1.25–1.97) or dyslipidemia (OR 1.48, 95% CI 1.17–1.87), virologic suppression (OR 1.88, 95% CI 1.39–2.53), and exposure to tenofovir disoproxil-fumarate (OR 1.67, 95% CI 1.33–2.08) or ritonavir-boosted protease-inhibitors (OR 1.19, 95% CI 1.03–1.39). Conclusions: Females and patients over 50 seem to be more vulnerable to renal impairment. Potentially modifiable risk factors and exposure to tenofovir disoproxil-fumarate or ritonavir-boosted protease-inhibitors are present even in earlier stages of chronic kidney dysfunction. It remains to be determined whether early interventions including antiretroviral therapy changes (tenofovir alafenamide, cobicistat) or improving comorbidities management will improve the course of chronic kidney disease. Keywords: HIV-infection, Antiretroviral drugs, Chronic kidney disease, Glomerular filtration rate estimates

Background The study aimed to investigate whether the clinical presentations and outcomes (length of stay, ICU admission, and 30-day mortality) of pneumococcal pneumonia in virologically suppressed patients who were HIV-infected on ART with a CD4+ T-cell count > 350 cells/mm3 are comparable to those seen in patients with HIV, using a case-control design. Methods A case-control study was carried out in Hospital Clinic, Barcelona, Spain (2001-2016). Control patients were matched by age (±10 years), sex, comorbidities, and pneumonia diagnosis in the same calendar period. Clinical presentation and outcomes of pneumococcal pneumonia in patients who were and were not infected with HIV were compared. Results Pneumococcal pneumonia was studied in 50 cases (HIV infection) and 100 control patients (non-HIV infection). Compared with the control patients, case patients had higher rates of influenza (14% vs 2%, P = .007) and pneumococcal vaccination (10% vs 1%, P = .016). The group of cases also presented a higher rate of coinfection with hepatitis B virus (6% vs 0%, P = .036). Both groups presented similar ICU admission (18% vs 27%, P = .22), need for mechanical ventilation (12% vs 8%; P = .43), length of stay (7 days vs 7 days, P = .76), and 0% of 30-day mortality. No evidence was found of a more severe presentation or a worse clinical outcome in cases than in control patients. Conclusions Pneumococcal pneumonia episodes requiring hospitalization in virologically suppressed patients with HIV with > 350 CD4+ T-cell count/mm3 were neither more severe nor had worse prognosis compared with uninfected patients. These results support the fact that such patients do not need treatment, admission, or care sites different to the general population. Trial Registry ClinicalTrials.gov; No. 2009/5451; URL: www.clinicaltrials.gov.

Background: Despite recent data suggest similar postoperative survival after cardiac surgery for HIV-infected patients and general cardiac surgical population, no studies have comprehensively addressed the impact of epidemiological changes observed during the last three decades affecting the profile of these patients. Methods: Retrospective analysis of the baseline characteristics, immune status and HIV treatment, surgical aspects and prognosis of consecutive HIV-infected patients undergoing cardiac surgery at our institution. Findings: Between 1985 and 2014, 72 patients underwent 87 operations. Median follow-up was 1650 days (IQR 357-3600). Most common indication for surgery was infective endocarditis (left-sided/mixed in 86%), with 40·2% of operations. Epidemiological changing pattern along the study periods was observed: from young (median age 27 years), intravenous drug users (100%) with infective endocarditis (88·2%), untreated and recent HIV diagnosis (

Since the introduction of combined antiretroviral therapy (cART), solid organ transplantation (SOT) has become a therapeutic option for the HIV-positive population. In contrast with liver and kidney transplantation, only three simultaneous pancreas-kidney transplants (SPKT) have been reported among HIV-infected patients. Herein we have reported the first SPKT in an HIV-infected patient in Spain. The pancreas graft failed at 2 weeks and the patient died at 9 months because of a Pseudomonas aeruginosa infection. The three recipients reported in the literature lived, despite the failure of both the pancreas and kidney grafts in one subject. Despite the poor outcome of our case, HIV-1 infection was controlled after transplantation (stable CD4(+) cells and no AIDS-related events), and the kidney graft functioned with no episodes of rejection. The cART regimen used in the pretransplant period was switched at the time of transplantation to raltegravir and two nucleoside reverse transcriptase inhibitors (NRTI). Raltegravir has no interactions with immunosuppressive drugs. Target plasma levels of tacrolimus were achieved at a dose similar to that used in HIV-negative transplant recipients. The most adequate antiretroviral regimen for HIV-infected SOT recipients has not yet been established; however, one may consider switching protease inhibitors or non-NRTI-based regimens for a raltegravir-based regimen at the time of transplantation.

Summary For geographical and historical reasons, Spain is receiving an increasing number of immigrants. The aim of this study was to evaluate some epidemiological aspects and the main public health issues of communicable diseases in Barcelona's immigrant population. From 2001 to 2004, a population of immigrants from tropical, subtropical regions and Eastern Europe was attended to in our centre. Each patient was offered a complete screening for tropical and common diseases. The prevalence and demographical characteristics of eight diseases with a potential risk of transmission in our setting were studied: latent and active tuberculosis, syphilis, human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV), Chagas disease, Giardia intestinalis and Entamoeba histolytica/Entamoeba dispar. In all, 2464 immigrants mainly from sub-Saharan Africa were seen. Among the patients who underwent the screening, 46.5% had a positive tuberculin skin test (⩾10 mm), incidence of active tuberculosis was 324.7/100,000 immigrants in the period of the study, 6.4% had a positive syphilis serology, 7.7% had a positive HBsAg, 3.1% had a positive serology for HCV and 2.8% were HIV positive, 41 patients from Latin America with risk factors for American Trypanosomiasis were screened for Chagas disease by immunofluorescence assay and 34% had a positive result; 5.4% of stools parasitological tests were positive for G. intestinalis ; 4.2% for E. histolytica/E. dispar. Communicable diseases in immigrant population could lead to emerging and re-emerging infections in the European Union with important issues for public health. European countries may have to establish guidelines for screening of infectious diseases in immigrants from low-income countries.

Lluis Castells, Antoni Rimola, Christian Manzardo, Andres Valdivieso, Jose Luis Montero, Rafael Barcena, Manuel Abradelo, Xavier Xiol, Victoria Aguilera, Magdalena Salcedo, Manuel Rodriguez, Carmen Bernal, Francisco Suarez, Antonio Antela, Sergio Olivares, Santos del Campo, Montserrat Laguno, Jose R. Fernandez, Gloria de la Rosa, Fernando Aguero, Inaki Perez3,y, Juan Gonzalez-Garcia, Juan I. Esteban-Mur, Jose M. Miro3,⇑, on behalf of the FIPSE LT-HIV investigators

to projected growth in prevalence based on empirical evidence of trends in risk factors such as obesity and diabetes, the primary drivers of NAFLD incidence. Results: The projected cumulative number of LTs averted for ESLD patients due to highly effective HCV treatment is estimated to be 10,490 over the period 2015–2035 (see Figure). Of this total, 7,320 livers would accrue to patients without HCV, accounting for 9% of livers used for all non-HCV liver transplants over this time period and approximately 123,700 life-years gained by non-HCV patients. Conclusions: More systematic use of highly effective treatments for HCV in the US may have substantial public health benefits for patients suffering from ESLD due to decreased liver transplantation in the HCV population. Most of these benefits accrue to patients without HCV.