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References Rizzardini G, Restelli U, Bonfanti P, Porazzi E, Ricci E, Casartelli L, et al. The cost of HIV disease in Northern Italy: the payer's perspective. J Acquir Immune Defic [...], Background: In Argentina, antiretroviral treatment (ART) is covered by the State for all the persons who do not have health insurances, who represent 70% of all HIV infected patients in the country. Since 1992, the Direction of Aids (Ministry of Health) buys and delivers ART, treatments for opportunistic infections and reagents to diagnose and follow?up HIV infection. Nevertheless, until now, an analysis of the evolution of the costs of the drugs acquired by the Direction of Aids has not been performed. The aim of this study was to analyze the direct costs of ART for the Direction of Aids in Argentina since 2006, and evaluate progression over time. Methods: The expenditure on ART and drugs for opportunistic infections was obtained. All values (in pesos) were converted to dollars. The cost of ART per patient per year was calculated. Changes in cost were determined for the total and per patient expenditures, and the reasons for the changes analyzed. Results: Total expenditure for ART (in uS dollars) went from 33.7 million in 2006 to 75 million in 2011 (123% increase). The number of patients on ART covered by the Aids Direction increased from 23228 in 2006 to 33279 (43%) by the end of 2011. The cost (u$s) of ART per person per year was: *06*: 1449; *07*: 1645; *08*: 1516; *09*: 1543; *10*: 1968; *11*: 2255. This represents a 56% increase from 2006 to 2011, though this change was uneven through the years. This was driven mainly by a decrease from 07 to 08, due to lack of acquisition of ART for political reasons; and a very steep increase in 09?10 due to incorporation of more expensive drugs such as tenofovir/emtricitabine, raltegravir and maraviroc. Conclusions: Annual cost of ART per person in Argentina has been increasing considerably in the last years. Even though this cost is much lower than those informed by some European countries (Italy: u$ 7500[1]; UK: u$ 9000[2], Germany: u$ 18000); it is one of the highest in Latin?America, where median cost is u$1200 (range: 200?3300). According to PAHO, the delivered ART in Argentina should cost u$ 1200 per person per year, or less. In view of the policy for treatment expansion (new Ministry of Health guidelines recommend ART with CD4?500/mm[sup.3] ), it is important to seek ways of lowering the cost of ART. Some of the strategies might be the incorporation of generics (Argentina has a young patents law, barriers to generic use seem not to be very strong but this might change in the future) and buying via strategic funds.

Background: Integrase strand-transfer inhibitors (INSTIs) and tenofovir alafenamide have been associated with weight gain in several clinical trials and observational cohorts. However, whether weight gain associated with INSTIs and tenofovir alafenamide confers a higher risk of weight-related clinical events is unclear. We aimed to assess whether changes in BMI differentially increase hypertension or dyslipidaemia risk in people with HIV receiving INSTIs, tenofovir alafenamide, or both versus other contemporary regimens., Methods: This multicentre, prospective observational study analysed prospective data from RESPOND, an international consortium of HIV cohorts for which recruitment began in 2017 and is still ongoing from HIV clinics and hospitals in 37 European countries and Australia. Participants were eligible if they were aged 18 years or older, receiving INSTI-containing antiretroviral therapy (ART) regimens or a contemporary non-INSTI, did not have hypertension or dyslipidaemia at baseline, and had baseline and at least two follow-up BMI, lipid, and blood pressure measurements. We excluded participants without baseline CD4 or HIV RNA results and those receiving non-ART medications associated with weight changes, including antipsychotics and mood stabilisers, corticosteroids, insulin, and insulin secretagogues. They were followed up from baseline until the earliest hypertension or dyslipidaemia event, their last visit, or Dec 31, 2021, whichever was earlier. The primary outcomes were incidence of hypertension and dyslipidaemia, for which we used multivariable Poisson regression adjusted for time-updated BMI to determine unadjusted and adjusted incidence rate ratios (IRRs) of hypertension and dyslipidaemia in people receiving INSTIs, tenofovir alafenamide, or both, and tested for interaction between time-updated ART regimen and BMI., Findings: Of the 35 941 RESPOND participants, 9704 (7327 [75·5 %] male and 2377 [24·5%] female) were included in the hypertension analysis and 5231 (3796 [72·6%] male and 1435 [27·4%] female) were included in the dyslipidaemia analysis. In the univariable model, hypertension was more common in individuals receiving an INSTI with tenofovir alafenamide (IRR 1·70, 95% CI 1·54-1·88) or an INSTI without tenofovir alafenamide (1·41, 1·30-1·53) compared with those receiving neither INSTIs nor tenofovir alafenamide. Adjustment for time-updated BMI and confounders attenuated risk in participants receiving an INSTI with (IRR 1·48, 1·31-1·68) or without (1·25, 1·13-1·39) tenofovir alafenamide. Similarly, dyslipidaemia was more common in participants using tenofovir alafenamide with an INSTI (IRR 1·24, 1·10-1·40) and tenofovir alafenamide alone (1·22, 1·03-1·44) than in participants using neither INSTI nor tenofovir alafenamide. Adjustment for BMI and confounders attenuated the risk in participants receiving tenofovir alafenamide with an INSTI (adjusted IRR 1·21, 1·07-1·37), whereas the risk in those receiving tenofovir alafenamide alone became non-significant (1·15, 0·96-1·38). The associations between increasing BMI and risk of hypertension and dyslipidaemia did not differ between participants receiving different ART regimens (p interaction =0·46 for hypertension; p interaction =0·31 for dyslipidaemia)., Interpretation: Although residual confounding cannot be entirely excluded, the use of INSTIs was associated with incident hypertension, and the use of tenofovir alafenamide was associated with dyslipidaemia, with the latter association partly mediated by weight gain. These results reiterate the need for hypertension and dyslipidaemia screening in people with HIV., Funding: The CHU St Pierre Brussels HIV Cohort, The Austrian HIV Cohort Study, The Australian HIV Observational Database, The AIDS Therapy Evaluation in the Netherlands national observational HIV cohort, The Brighton HIV Cohort, The National Croatian HIV Cohort, The EuroSIDA cohort, The Frankfurt HIV Cohort Study, The Georgian National AIDS Health Information System, The Nice HIV Cohort, The ICONA Foundation, The Modena HIV Cohort, The PISCIS Cohort Study, The Swiss HIV Cohort Study, The Swedish InfCare HIV Cohort, The Royal Free HIV Cohort Study, The San Raffaele Scientific Institute, The University Hospital Bonn HIV Cohort, The University of Cologne HIV Cohort, Merck Life Sciences, ViiV Healthcare, and Gilead Sciences., Competing Interests: Declaration of interests AM has received travel support and lecture and consultancy fees from Gilead Sciences, ViiV Healthcare, Eiland, and Bonnin, all outside the submitted work. VV is an employee of and has stocks in ViiV Healthcare. CC is an employee of and has stocks in Gilead Sciences. EB is an employee of and has stocks in MSD. ML has received sitting fees from Certa Therapeutics data safety monitoring board. KG-P has served on advisory boards and provided lectures for Gilead Sciences and ViiV Healthcare. AR has received support for attending meetings and travel from Gilead Sciences and Pfizer, received an investigator-initiated trial grant from Gilead Sciences, and participated on a data safety monitoring board or advisory board for MSD and Pfizer (all paid to the institution). All other authors declare no competing interests., (© 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Background: Rilpivirine-based regimens are now preferred or alternative first-line regimens according to many HIV treatment guidelines. Recently, a surveillance study conducted in Argentina determined that prevalence of pretreatment resistance to first-generation non-nucleoside reverse transcriptase inhibitors (NNRTIs) was 10%. The aim of this study was to analyse the prevalence of resistance mutations to newer generation NNRTIs in the population starting ART in Argentina., Methods: We analysed the prevalence of resistance mutations to rilpivirine and etravirine (according to the IAS list), obtained through a nationally representative pretreatment HIV-drug resistance (PDR) surveillance study performed in Argentina in 2014-2015. Briefly, 25 ART-dispensing sites throughout the country were randomly chosen to enrol 330 adults starting ART. Samples were processed with Trugene (Siemens) ® and analysed using the Stanford algorithm., Results: All 270 samples corresponding to participants with no prior exposure to antiretroviral drugs were included in this analysis. Median (IQR) age was 35 years (28-43); 66.7% were male; median (IQR) CD4 + T-cell count was 284 cells/mm 3 (112-489). The prevalence of resistance to any antiretroviral was 16% (±5%) and prevalence of NNRTI RAMs was 13% (±4%). The prevalence of resistance to rilpivirine was 8% (±3%). Prevalence of resistance to etravirine was 4% (±3%). The most frequent mutations conferring resistance to rilpivirine were: E138A (n=6) and G190A (n=4)., Conclusions: This PDR surveillance study showed concerning levels of HIV drug resistance (HIVDR) in Argentina, not only for first-generation NNRTIs but also to rilpivirine. In our setting, performing resistance testing would be necessary before prescription of ART even if a second-generation NNRTI-based regimen was used as first-line therapy.

Objective: Our objective was to estimate primary resistance in an urban setting in a developing country characterized by high antiretroviral (ARV) coverage over the diagnosed population and also by an important proportion of undiagnosed individuals, in order to determine whether any change in primary resistance occurred in the past five years., Design: We carried out a multi-site resistance surveillance study according to WHO HIV resistance guidelines, using a weighted sampling technique based on annual HIV case reports per site., Methods: Blood samples were collected from 197 drug-naive HIV-1-infected individuals diagnosed between March 2010 and August 2011 at 20 HIV voluntary counselling and testing centres in Buenos Aires. Clinical records of enrolled patients at the time of diagnosis were compiled. Viral load and CD4 counts were performed on all samples. The pol gene was sequenced and the resistance profile determined. Phylogenetic analysis was performed by neighbour-joining (NJ) trees and bootscanning analysis., Results: We found that 12 (7.9%) of the 152 successfully sequenced samples harboured primary resistance mutations, of which K103N and G190A were the most prevalent. Non-nucleoside reverse transcriptase inhibitors (NNRTI) resistance mutations were largely the most prevalent (5.9%), accounting for 75% of all primary resistance and exhibiting a significant increase (p=0.0072) in prevalence during the past 10 years as compared to our previous study performed in 1997-2000 and in 2003-2005. Nucleoside reverse transcriptase inhibitor (NRTI) and protease inhibitor primary resistance were low and similar to the one previously reported., Conclusions: Levels of primary NNRTI resistance in Buenos Aires appear to be increasing in the context of a sustained ARV coverage and a high proportion of undiagnosed HIV-positive individuals.

Unconjugated hyperbilirubinemia resulting from therapy with atazanavir is physiologically related to hyperbilirubinemia in Gilbert's syndrome (GS). In patients with GS, changes in diet have a significant impact on bilirubinemia. Our aim was to investigate whether changes in diet affect the level of serum bilirubin in patients receiving atazanavir. Thirty patients on stable therapy with ritonavir-boosted atazanavir without evidence of GS were enrolled. Hemolysis and chronic hepatitis were excluded. After a baseline period of normal intake of calories, the patients were randomized to follow a 24-h 400-calorie diet (fasting), then a 48-h period of normal calorie intake and, afterward, a 24-h period of a high-calorie diet, or the same interventions in inverse order. Serum bilirubin concentrations were measured before and after each intervention. A high adherence to the recommended diet was observed. The mean unconjugated bilirubin concentration before the high-calorie diet was 2.79±1.53 mg/dl and after such intervention it was 2.70±1.40 mg/dl. The mean difference between preintervention and postintervention was -0.08±0.69 mg/dl (p=NS). The mean unconjugated bilirubin concentration before the fasting diet was 2.31±1.23 mg/dl and it was 3.84±1.90 mg/dl after. The mean difference between prefasting and postfasting was 1.53±1.17 mg/dl (p=0.001). According to these results, short periods of fasting seem to increase the unconjugated bilirubin concentration in patients on atazanavir. A high-calorie diet did not have any impact in bilirubin probably because most patients follow similar diets in their everyday life.

Introduction: Human immunodeficiency virus (HIV)-infected patients are at higher risk for development of Non-Hodgkin's lymphoma (NHL). The estimated incidence of NHL in patients with acquired immunodeficiency syndrome (AIDS) is much higher when compared to the general population. Most AIDS-associated NHL are of intermediate- or high-grade B-cell type and involve extranodal sites more frequently. The most common sites are the central nervous system (CNS), gastrointestinal tract, liver, bone marrow and soft tissues., Methodology: We describe a 42-year-old male with risk factors for HIV infection who presented with left leg pain and an osteolytic lesion of the left medial tibia. He was subsequently diagnosed with HIV disease and an open biopsy of his left tibia established the diagnosis of NHL., Results: After starting antiretroviral therapy followed by chemotherapy he achieved remission., Conclusion: Bone lymphomas account for 3% of malignant bone tumors and 4-7% of all extranodal sites. NHL of bone has been infrequently described in patients with AIDS. To our knowledge, this is the first report of NHL of the bone in Argentina.

Objective: To evaluate neurocognitive performance in patients with preserved immunological status using the International HIV Dementia Scale (IHDS) and compare patients on and off highly active antiretroviral therapy (HAART)., Design: Cross-sectional study., Methods: Outpatients with more than 350 CD4 cells per cubic millimeter underwent evaluation by means of the IHDS, a cross-cultural scale designed to identify HIV-positive patients at risk for dementia., Results: A total of 260 patients were included, 158 on HAART and viral load <1000 copies per mL and 102 treatment naïve. Mean age was 38.2 (SD 8.03) years, 86% were male. Mean score was 10.9 (SD 1.77). Only age correlated with a significantly different score; younger patients performed better. When patients on and off HAART were compared, we found no significant differences in age, sex, time from diagnosis, educational level, risk factor for HIV acquisition, and current CD4 count. CD4 nadir was lower for patients on HAART: 246.0 (200.95) vs. 492.7 (233.33), P < 0.001. There was no difference between the scores obtained by patients on and off HAART (mean 11.0, SD 2.08; mean 10.8, SD 1.17; respectively, P = 0.70). There was no difference according to efavirenz use., Conclusions: Patients with preserved immunity performed well on IHDS. It didn't seem to be any difference between patients on and off HAART regarding neurocognitive status.