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OBJECTIVES Our objective was to determine whether antiretroviral drugs (ARVs) were used according to the European AIDS Clinical Society (EACS) guidelines for people with HIV/hepatitis C virus (HCV) coinfection treated with direct-acting antivirals (DAAs) between 30 November 2014 and 31 December 2019 in the pan-European EuroSIDA study. METHODS At each publication date of the EACS guidelines, plus 3 and 6 months, we calculated the number of people receiving DAAs with potential and actual ARV contraindications ('red shading' in the EACS guidelines). We used logistic regression to investigate factors associated with using contraindicated ARVs. RESULTS Among 1406 people starting DAAs, the median age was 51 years, 75% were male, 57% reported injected drug use as an HIV risk, and 76% were from western Europe. Of 1624 treatment episodes, 609 (37.5%) occurred while the patient was receiving ARVs with potential contraindications; among them, 38 (6.2%; 95% confidence interval [CI] 4.3-8.2) involved a contraindicated ARV (18 non-nucleoside reverse transcriptase inhibitors), 16 involved protease inhibitors, and four involved integrase strand transfer inhibitors. The adjusted odds of receiving a contraindicated ARV were higher (3.25; 95% CI 1.40-7.57) among participants from east/central east Europe (vs. south) and lower (0.22; 95% CI 0.08-0.65) for 2015-2018 guidelines (vs. 2014). In total, 29 of the 32 (90.6%) patients receiving a contraindicated ARV and 441 of the 461 (95.7%) with potential ARV contraindications experienced a sustained virological response ≥12 weeks after stopping treatment (SVR12; p = 0.55). CONCLUSION In this large heterogenous European cohort, more than one-third of people with HIV/HCV coinfection received DAAs with potential ARV contraindications, but few received a contraindicated ARV. Use of contraindicated ARVs declined over time, corresponding to the increased availability of ARV therapy regimens without interactions with DAA across Europe. Participants who received a contraindicated DAA and ARV combination still had a high rate of SVR12.

Chronic hepatitis B (CHB) is a potentially life-threatening and prevalent disease worldwide. Far from attaining the ultimate treatment goal, hepatitis B virus (HBV) infection eradication, the two current therapeutic options aim to prevent progression to end-stage liver disease, maintaining long-term suppression of HBV replication. Pegylated interferon-α (PEG-INFα) is often poorly tolerated and disregarded considering the orally administered nucleos(t)ide analogues. However, PEG-INFα may achieve similar treatment endpoints with a finite course of treatment. We report a case of PEG-INFα-treated CHB that attained sustained off-treatment virological response with only 16 weeks of treatment, with loss of both HBeAg and HBsAg (this latter the optimal treatment endpoint).

The infectious risk associated with biological therapy is well studied today and screening and prophylaxis strategies have been stablished. However, this may not be true for systemic steroids or DMARDs (disease-modifying anti-rheumatic drugs) such as methotrexate and cyclosporine, even after long term use. The dose and duration of therapy with systemic steroids are related to the occurrence of opportunistic infection. Doses above 5 mg/day are associated with bacterial infection, above 10 mg/day with herpes zoster virus (HZV) reactivation, and above 15 mg/day or for more than 2 to 4 weeks with tuberculosis reactivation, which implies proper screening and chemoprophylaxis. Systemic steroids also appear as one of the main risk factors for the development of pneumocystosis in non-HIV patients and prolonged doses, for more than 4 weeks, can lead to hepatitis B virus (HBV) infection reactivation, and justify the beginning of prophylaxis with tenofovir disoproxil fumarate or entecavir. Cases of strongyloidiasis with hyperinfection syndrome have also been reported in patients on steroids. The degree of immunosuppression conferred may contraindicate live attenuated vaccines. Methotrexate and cyclosporine have a low infectious risk when used as monotherapy. Symptom surveillance is the main preventive strategy. However, both are immunomodulators, contraindicate live attenuated vaccines administration and are associated with infectious risk. Cyclosporine can lead to bacterial infection and HZV reactivation, and methotrexate is associated with HZV and HBV reactivation, especially if administered at a dose >0.4 mg/kg/week. Both are linked with active tuberculosis when in therapeutic combination with other immunosuppressants. Understanding and studying the risk of infection when using immunosuppressive therapy allows its use in a more informed and safe manner.

HIV-2 infection is endemic in some countries in West Africa. Due to the lower prevalence in industrialized countries, there is limited experience and knowledge on management of HIV-2 infected individuals in Europe. Compared to HIV-1, there are differential characteristics of HIV-2 regarding diagnostic procedures, clinical course and, most importantly, antiretroviral therapy. We integrated the published literature on HIV-2 (studies and reports on epidemiology, diagnostics, clinical course, treatment) as well as expert experience in diagnosing and clinical care of HIV-2 infected to provide recommendations for a present standard of medical care of HIV- infected in Western European countries, including an overview of strategies for diagnosis, monitoring and treatment, with suggestions for effective drug combinations for first- and second line treatment, post-exposure prophylaxis and prevention of mother-to-child transmission as well as listings of mutations related to HIV-2 drug resistance- and CCR5/CRCX4 co-receptor tropism.

A COVID-19 é uma séria ameaça à capacidade de resposta dos serviços de saúde. Neste contexto espera-se que os trabalhadores de saúde (TdS) laborem longas horas, sob grande pressão profissional, familiar e emocional, com recursos muitas vezes inadequados, enquanto aceitam os perigos inerentes à atividade, à proximidade com pessoas infeciosas, aos perigos inseparáveis dos ambientes de trabalho. O impacto na pandemia reflete-se nos TdS enquanto indivíduos, mas também afeta as suas famílias, quer relativamente ao menor tempo disponível quer ao nível da saúde mental. Fatores como a quantidade, o custo, a disponibilidade bem como a falta de hábito no uso de equipamentos de proteção individual (EPI) condicionam a sua utilização pelos TdS. A utilização de EPI não é proteção suficiente se não for acompanhada da adoção de outras medidas de controlo de infeção, como a higienização das mãos e distanciamento físico entre funcionários em todas as situações. Deve também ser dada prioridade à testagem de TdS. A pandemia desafia os sistemas de saúde a uma adaptação dinâmica na gestão dos recursos existentes, com um especial enfoque nos sistemas de informação. Os serviços digitalizados ou de telemedicina podem potencialmente reduzir o contato com o paciente e, portanto, os riscos de infeção por SARS-CoV-2. Na perspetiva de uma vacina contra o SARS-CoV-2 para breve, os TdS deverão estar entre os grupos prioritários para a receber. Os TdS são dos recursos mais importantes de um país, pelo que há que cuidar destes profissionais em todos os aspetos nas organizações de saúde, para que os TdS estejam em melhores condições de responder às exigências desta pandemia e outras que eventualmente irão ocorrer no futuro. A pandemia não reconhece fronteiras. Devendo ser abordada de forma a fortalecer uma colaboração internacional que possibilite a solidariedade e a partilha equitativa de recursos. COVID-19 is a serious threat to the responsiveness of health services. In this context, health workers (HW) are expected to work long hours, under great professional, family and emotional pressure, with resources often inadequate, while accepting the dangers inherent in the activity, the proximity to infectious people, inseparable dangers of work environments.The impact of the pandemic is reflected in HW as individuals, but it also affects their families, both in terms of less time available and in terms of mental health. Factors such as quantity, cost, availability as well as the lack of habit of use of personal protective equipment (PPE) affects its use by HW. The use of PPE is not sufficient protection if not accompanied by the adoption of other infection control measures, such as hand hygiene and physical distance. Priority should also be given to testing H W. The pandemic challenges health systems to a dynamic adaptation in the management of existing resources, with a special focus on information systems. Telemedicine services can potentially reduce direct contact with the patients and, therefore, the risk of SARS-CoV-2 infection. In the perspective of a SARS-CoV-2 vaccine soon, HW should be among the priority groups to receive it .HW are one of the most important resources in a country, so it is necessary to take care of these professionals in all aspects in health organizations, so that HW are able to respond to the demands of this pandemic and others that will eventually occur in the future. The pandemic does not recognize borders. It must be addressed in a way that strengthens international collaboration that enables solidarity and equitable resource sharing. publishersversion published

A COVID-19 é uma séria ameaça à capacidade de resposta dos serviços de saúde. Neste contexto espera-se que os trabalhadores de saúde (TdS) laborem longas horas, sob grande pressão profissional, familiar e emocional, com recursos muitas vezes inadequados, enquanto aceitam os perigos inerentes à atividade, à proximidade com pessoas infeciosas, aos perigos inseparáveis dos ambientes de trabalho. O impacto na pandemia reflete-se nos TdS enquanto indivíduos, mas também afeta as suas famílias, quer relativamente ao menor tempo disponível quer ao nível da saúde mental. Fatores como a quantidade, o custo, a disponibilidade bem como a falta de hábito no uso de equipamentos de proteção individual (EPI) condicionam a sua utilização pelos TdS. A utilização de EPI não é proteção suficiente se não for acompanhada da adoção de outras medidas de controlo de infeção, como a higienização das mãos e distanciamento físico entre funcionários em todas as situações. Deve também ser dada prioridade à testagem de TdS. A pandemia desafia os sistemas de saúde a uma adaptação dinâmica na gestão dos recursos existentes, com um especial enfoque nos sistemas de informação. Os serviços digitalizados ou de telemedicina podem potencialmente reduzir o contato com o paciente e, portanto, os riscos de infeção por SARS- CoV-2. Na perspetiva de uma vacina contra o SARS-CoV-2 para breve, os TdS deverão estar entre os grupos prioritários para a receber. Os TdS são dos recursos mais importantes de um país, pelo que há que cuidar destes profissionais em todos os aspetos nas organizações de saúde, para que os TdS estejam em melhores condições de responder às exigências desta pandemia e outras que eventualmente irão ocorrer no futuro. A pandemia não reconhece fronteiras. Devendo ser abordada de forma a fortalecer uma colaboração internacional que possibilite a solidariedade e a partilha equitativa de recursos., Anais do Instituto de Higiene e Medicina Tropical, Vol 19 (2020)

Introdução: A avaliação da presença de mutações que confiram resistência aos fármacos usados no tratamento da infeção por VIH-1, faz parte da avaliação laboratorial efetuada no quadro de um diagnóstico de novo, e a monitorização da sua prevalência é preconizada internacionalmente. Objetivos: Avaliar a frequência de mutações de resistência (MR) entre doentes com diagnóstico estabelecido em 2018 e identificar determinantes para a sua ocorrência. N/A