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Los pacientes infectados perinatalmente por el virus de la inmunodeficiencia humana (PVIH) tienen una larga historia de exposición al virus y al tratamiento antirretroviral (TAR) desde una edad muy temprana, incluso algunos de manera intrauterina. Los efectos del virus y su tratamiento sobre un sistema inmune inmaduro podrían producir alteraciones permanentes en la respuesta inmune. En adultos que viven con el VIH, a pesar del TAR y el control de la viremia, la infección crónica conduce a un estado proinflamatorio persistente que desdencadena un proceso de envejecimiento acelerado y aumento de comorbilidades. Estas alteraciones inmunológicas podrían ser más acusadas en el caso de los pacientes infectados por vía perinatal. Las primeras evidencias sugieren que los PVIH presentan una mayor prevalencia de comorbilidades, cuando se comparan con individuos no infectados de su misma edad. Entre las comorbilidades más comunes asociadas a la infección están las enfermedades cardiovasculares, los tumores, las alteraciones metabólicas, las alteraciones neurocognitivas, la enfermedad renal y la enfermedad hepática. Esta memoria se centra en la enfermedad hepática en el contexto de la infección por el VIH de transmisión perinatal, en relación con la coinfección por el virus de la hepatitis C (VHC), así como en el contexto de la enfermedad metábolica y los potenciales mecanismos subyacentes en relación con el sistema inmunológico..., Patients infected with perinatally transmitted human immunodeficiency virus (PHIV) have a long history of exposure to the virus and to the antiretroviral therapy (ART), often suboptimal, from a very early age, including sometimes intra-utero exposure. The effects of the virus and its treatment on an immature immune system could lead to permanent abnormalities in the immune response. In adults living with HIV, despite ART and viral suppression chronic infection leads to a persistent pro-inflammatory state that triggers an accelerated aging process and increased comorbidities. These immunological alterations could be more pronounced in the case of vertically infected patients. Early evidence suggests that PHIV have a higher prevalence of comorbidities when compared to uninfected individuals of the same age. Among the most common comorbidities associated with infection are cardiovascular disease, tumors, metabolic disorders, neurocognitive disorders, renal disease and liver disease. This report focuses on immunological and liver-related comorbidities in the context of perinatally transmitted HIV infection, in relation to hepatitis C virus (HCV) coinfection, as well as in the context of metabolic disease, and explores the potential underlying immune mechanisms...

Tras la revisión de la mejor información científica disponible, el CAV-AEP publica las nuevas recomendaciones para proteger con vacunas a las embarazadas, los niños y los adolescentes residentes en España. Se mantienen las mismas recomendaciones que el año anterior en cuanto a las vacunas hexavalentes y a la vacuna neumocócica conjugada de 13 serotipos, al refuerzo con tétanos, difteria, tosferina y poliomielitis inactivada (Tdpa-VPI) a los seis años y con tétanos, difteria y tosferina (Tdpa) a los 12-14 años y a las embarazadas a partir de la semana 27 (desde la semana 20 si hay alto riesgo de parto pretérmino). Lo mismo sucede con las vacunas del rotavirus, del meningococo B tetraantigénica (2 + 1), de la vacuna meningocócica tetravalente (MenACWY), de la triple vírica, de la varicela y de la vacuna del virus del papiloma humano (VPH), en ambos géneros. Como novedades este año el CAV-AEP recomienda: La vacunación antigripal de seis a 59 meses de edad siempre que sea factible y no perjudique al programa vacunal dirigido a las personas de mayor riesgo. En consonancia con las recomendaciones oficiales nacionales, el CAV-AEP recomienda el uso sistemático a partir de los 5 años de las vacunas para la COVID-19 de ARNm., After reviewing the best available scientific information, CAV-AEP publishes their new recommendations to protect pregnant women, children and adolescents living in Spain through vaccination. The same recommendations as the previous year regarding hexavalent vaccines, pneumococcal conjugate vaccine of 13 serotypes, booster with tetanus, diphtheria, pertussis and inactivated poliomyelitis (Tdpa-IPV) at 6 years and with tetanus, diphtheria and pertussis (Tdpa) at 12-14 years and pregnant women from week 27 (from week 20 if there is a high risk of preterm delivery). Also with rotavirus, tetraantigenic meningococcal B (2 + 1), meningococcal quadrivalent (MenACWY), MMR, varicella and human papillomavirus (HPV) vaccines, for both genders. As novelties this year the CAV-AEP recommends:. Influenza vaccination from 6 to 59 months of age whenever feasible and does not harm the vaccination program aimed at people at higher risk. According to official national recommendations, the CAV-AEP recommends the systematic use of COVID mRNA vaccines since 5 years old.

Los niños con enfermedad de células falciformes (ECF) tienen un riesgo aumentado de infección bacteriana grave (IBG), principalmente debido a la asplenia funcional que presentan. Sin embargo, en las últimas décadas, la incidencia de estas infecciones ha disminuido en estos pacientes, gracias a la instauración de medidas preventivas como la profilaxis antibiótica con penicilina y la vacunación. A pesar de ello, debido a su potencial riesgo, cuando estos pacientes presentan fiebre suelen recibir tratamiento antibiótico de amplio espectro, en muchas ocasiones con ingreso hospitalario. Se han descrito algunos parámetros, tanto clínicos como de laboratorio, como marcadores de IBG en estos pacientes, con distintos resultados. Sin embargo, hasta el momento, ninguno de ellos ha conseguido diferenciar de forma segura la etiología de la fiebre en estos niños. Las citoquinas proinflamatorias han sido estudiadas en pacientes con ECF en situación basal y con crisis vasooclusivas, pero no han sido estudiadas en casos de infección...

Los pacientes infectados perinatalmente por el virus de la inmunodeficiencia humana (PVIH) tienen una larga historia de exposición al virus y al tratamiento antirretroviral (TAR) desde una edad muy temprana, incluso algunos de manera intrauterina. Los efectos del virus y su tratamiento sobre un sistema inmune inmaduro podrían producir alteraciones permanentes en la respuesta inmune. En adultos que viven con el VIH, a pesar del TAR y el control de la viremia, la infección crónica conduce a un estado proinflamatorio persistente que desdencadena un proceso de envejecimiento acelerado y aumento de comorbilidades. Estas alteraciones inmunológicas podrían ser más acusadas en el caso de los pacientes infectados por vía perinatal. Las primeras evidencias sugieren que los PVIH presentan una mayor prevalencia de comorbilidades, cuando se comparan con individuos no infectados de su misma edad. Entre las comorbilidades más comunes asociadas a la infección están las enfermedades cardiovasculares, los tumores, las alteraciones metabólicas, las alteraciones neurocognitivas, la enfermedad renal y la enfermedad hepática. Esta memoria se centra en la enfermedad hepática en el contexto de la infección por el VIH de transmisión perinatal, en relación con la coinfección por el virus de la hepatitis C (VHC), así como en el contexto de la enfermedad metábolica y los potenciales mecanismos subyacentes en relación con el sistema inmunológico...

Los niños con enfermedad de células falciformes (ECF) tienen un riesgo aumentado de infección bacteriana grave (IBG), principalmente debido a la asplenia funcional que presentan. Sin embargo, en las últimas décadas, la incidencia de estas infecciones ha disminuido en estos pacientes, gracias a la instauración de medidas preventivas como la profilaxis antibiótica con penicilina y la vacunación. A pesar de ello, debido a su potencial riesgo, cuando estos pacientes presentan fiebre suelen recibir tratamiento antibiótico de amplio espectro, en muchas ocasiones con ingreso hospitalario. Se han descrito algunos parámetros, tanto clínicos como de laboratorio, como marcadores de IBG en estos pacientes, con distintos resultados. Sin embargo, hasta el momento, ninguno de ellos ha conseguido diferenciar de forma segura la etiología de la fiebre en estos niños. Las citoquinas proinflamatorias han sido estudiadas en pacientes con ECF en situación basal y con crisis vasooclusivas, pero no han sido estudiadas en casos de infección..., Children with sickle cell disease (SCD) are at risk of severe bacterial infection (SBI), mainly due to functional asplenia. However, in recent decades, the incidence of these infections has decreased in these patients, especially because of the introduction of preventive measures such as penicillin prophylaxis and vaccination. Despite this fact, due to their potential risk, they usually receive treatment with broad-spectrum antibiotics when they develop fever, with hospital admission in many cases. Some clinical and laboratory parameters have been described as markers of SBI in these patients, with different results. However, none among these parameters has proved to differentiate safely the etiology of fever in these children. Proinflammatory cytokines have been studied in patients with SCD at steady-state and with vaso-occlusive crises, but they have not been studied in cases of infection...

The CAV-AEP annually publishes the immunisation schedule considered optimal for all children and adolescent resident in Spain, taking into account the available evidence. The 2+1 schedule is recommended (2, 4, and 11 months) with hexavalent vaccines (DTPa-VPI-Hib-HB) and with 13-valent pneumococcal conjugate.A 6-year booster is recommended, preferably with DTPa (if available), with a dose of polio for those who received 2+1 schemes, as well as vaccination with Tdpa in adolescents and in each pregnancy, preferably between 27 and 32 weeks. Rotavirus vaccine should be systematic for all infants. Meningococcal B vaccine, with a 2+1 schedule, should be included in routine calendar. In addition to the inclusion of the conjugated tetravalent meningococcal vaccine (MenACWY) at 12 years of age with catch up to 18 years, inclusive, the CAV recommends this vaccine to be also included at 12 months of age, replacing MenC. Likewise, it is recommended in those over 6 weeks of age with risk factors or who travel to countries with a high incidence of these serogroups. Two-dose schedules for triple viral (12 months and 3-4 years) and varicella (15 months and 3-4 years) will be used. The second dose could be applied as a tetraviral vaccine. Universal systematic vaccination against HPV is recommended, regardless of gender, preferably at 12 years, and greater effort should be made to improve coverage. The 9 genotype extends coverage for both genders.

El CAV-AEP publica anualmente el calendario de vacunaciones que estima idóneo para los niños residentes en España, teniendo en cuenta la evidencia científica disponible. Se mantiene el esquema 2 + 1 (2, 4 y 11 meses) con vacunas hexavalentes (DTPa-VPI-Hib-HB) y con antineumocócica conjugada 13-valente. Se aconseja un refuerzo a los 6 años, preferentemente con DTPa (si está disponible), junto a una dosis de polio para aquellos que recibieron esquemas 2 + 1, así como vacunación con Tdpa en adolescentes y en cada embarazo, preferentemente entre las 27 y las 32 semanas. La vacuna del rotavirus debería ser sistemática para todos los lactantes. Se sigue proponiendo la incorporación en el calendario de la vacuna antimeningocócica B, con esquema 2 + 1 en lactantes. Además de la inclusión de la vacuna antimeningocócica conjugada tetravalente (MenACWY) a los 12 años con rescate hasta los 18 años, inclusive, el CAV recomienda que esta vacuna sea introducida también a los 12 meses de edad, sustituyendo a MenC. Igualmente, se recomienda en los mayores de 6 semanas de edad con factores de riesgo o que viajen a países de elevada incidencia de estos serogrupos. Se emplearán esquemas de 2 dosis para triple vírica (12 meses y 3-4 años) y varicela (15 meses y 3-4 años). La segunda dosis se podría aplicar como vacuna tetravírica. Se recomienda la vacunación sistemática universal frente al VPH, tanto a chicas como a chicos, preferentemente a los 12 años, debiendo realizar un mayor esfuerzo para mejorar las coberturas. La de 9 genotipos amplía la cobertura para ambos sexos., The CAV-AEP annually publishes the immunisation schedule considered optimal for all children resident in Spain, taking into account the available evidence. The 2 + 1 schedule is recommended (2, 4, and 11 months) with hexavalent vaccines (DTPa-VPI-Hib-HB) and with 13-valent pneumococcal conjugate. A 6-year booster is recommended, preferably with DTPa (if available), with a dose of polio for those who received 2 + 1 schemes, as well as vaccination with Tdpa in adolescents and in each pregnancy, preferably between 27 and 32 weeks. Rotavirus vaccine should be systematic for all infants. Meningococcal B vaccine, with a 2+1 schedule, should be included in routine calendar. In addition to the inclusion of the conjugated tetravalent meningococcal vaccine (MenACWY) at 12 years of age with catch up to 18 years, inclusive, the CAV recommends this vaccine tobe also included at 12 months of age, replacing MenC. Likewise, it is recommended in those over 6 weeks of age with risk factors or who travel to countries with a high incidence of these serogroups. Two-dose schedules for MMR (12 months and 3-4 years) and varicella (15 months and 3-4years) will be used. The second dose could be applied as a tetraviral vaccine. Universal systematic vaccination against HPV is recommended, both for girls and boys, preferably at 12 years, and greater effort should be made to improve coverage. The 9 genotype extends coverage for both genders

[Background] Tuberculosis (TB) is the leading opportunistic infection in children with human immunodeficiency virus (HIV), but is uncommon in low prevalence regions. We aim to describe the changing epidemiology and clinical presentation of TB-HIV co-infection in a cohort of HIV-infected children in Spain., [Methods] Children diagnosed with TB between 1995 and 2016 in the paediatric HIV cohort were identified. The incidence and clinical presentation were compared in three periods: 1995–1999 (P1, before initiation of combined antiretroviral therapy, cART), 2000–2009 (P2, increase in immigration), and 2010–2016 (P3, decrease in immigration)., [Results] We included 29 TB cases among 1183 children aged <18 years (2.4%, 243/100 000 person-years). The proportion was stable in P1 and P2 (1.3%), but decreased in P3 (0.8%). The median age at TB diagnosis was 6.4 years (IQR 4–10.6); most children in P3 were aged >10 years (20% vs. 23.1% vs. 83.3%, P = 0.01). TB was diagnosed at HIV presentation in 11/29 children (37.9%). Foreign-born children accounted for respectively 0%, 8% and 67% of the total number of children in each period (P ≤ 0.0001). One third had extrapulmonary TB; four children died (13.8%)., [Conclusion] In our cohort, the incidence of TB-HIV co-infection decreased with decline in immigration. In regions with adequate cART coverage and low TB transmission, paediatric TB-HIV coinfection is uncommon, but associated with significant morbidity. Strategies for TB surveillance, diagnosis and treatment in this vulnerable population should be reinforced.

HIV co‐infection has been suggested to play a deleterious role on the pathogenesis of liver fibrosis among vertically HCV‐infected children. The aim of this study was to describe the longitudinal evolution of vertically acquired HIV/HCV co‐infection in youths, in comparison with HCV infection alone. This was a retrospective, multicentre study including vertically HIV/HCV–co‐infected patients and age‐ and sex‐matched vertically HCV–mono‐infected patients. Progression to advanced liver fibrosis, defined as F3 or more by elastography or METAVIR biopsy staging, and response to treatment were compared by means of univariate and multivariate regression analyses and Cox regression models. Sixty‐seven co‐infected patients were compared with 67 matched HCV–mono‐infected patients. No progression to advanced liver disease was observed during the first decade. At a median age of 20.0 [19.0, 22.0] years, 26.7% co‐infected vs 20% mono‐infected had progressed to advanced fibrosis (P = .617). Peg‐IFN/RBV for HCV treatment was given to 37.9% vs 86.6% (P‐value < .001). At treatment initiation, co‐infected patients were older (16.9 ± 4.1 vs 11.7 ± 4.5 years, P < .001), and 47.1% vs 7.1% showed advanced fibrosis (P < .003), with no differences in hard‐to‐treat genotype distribution. Sustained viral response was comparable between groups (43.5% vs 44.0%, P = .122). In vertically HIV/HCV–co‐infected patients, the progression to liver fibrosis was rare during childhood. At the end of adolescence, over 25% of patients displayed advanced liver disease. Response to Peg‐IFN/RBV was poor and comparable in both groups, supporting the need for fast access to early treatment with direct‐acting antivirals against HCV for vertically co‐infected patients.

Data for a total of 57 patients vertically coinfected with human immunodeficiency virus (HIV)/hepatitis C virus (HCV) and 365 HIV-monoinfected patients were compared until their transition to adult care. No differences regarding the dynamics of CD4 and/or CD8 T-cell counts during childhood were found. The coexistence of HCV does not increase the risk of disease progression in vertically HIV-infected patients.

[Background] Combination antiretroviral therapy (cART) is associated with marked immune reconstitution. Although a long term viral suppression is achievable, not all children however, attain complete immunological recovery due to persistent immune activation. We use CD4/CD8 ratio like a marker of immune reconstitution., [Methods] Perinatal HIV-infected children who underwent a first-line cART, achieved viral suppression in the first year and maintained it for more than 5 years, with no viral rebound were included. Logistic models were applied to estimate the prognostic factors, clinical characteristics at cART start, of a lower CD4/CD8 ratio at the last visit., [Results] 146 HIV-infected children were included: 77% Caucasian, 45% male and 28% CDC C. Median age at cART initiation was 2.3 years (IQR: 0.5–6.2). 42 (30%) children received mono-dual therapy previously to cART. Time of undetectable viral load was 9.5 years (IQR: 7.8, 12.5). 33% of the children not achieved CD4/CD8 ratio >1. Univariate analysis showed an association between CD4/CD8 <1 with lower CD4 nadir and baseline CD4; older age at diagnosis and at cART initiation; and a previous exposure to mono-dual therapy. Multivariate analysis also revealed relationship between CD4/CD8 <1 and lower CD4 nadir (OR: 1.002, CI 95% 1.000–1.004) as well as previous exposure to mono-dual therapy (OR: 0.16, CI 95% 0.003–0.720)., [Conclusions] CD4/CD8 >1 was not achieved in 33% of the children. Lower CD4 nadir and previous exposure to suboptimal therapy, before initiating cART, are factors showing independently association with a worse immune recovery (CD4/CD8 < 1).

[Background] There are not enough nationwide studies on perinatal HIV transmission in connection with a combination of antiretroviral treatments in Spain. Our objectives were to study sociodemographic changes and trends in the rates of HIV diagnoses and perinatal transmission in Spain from 1997 to 2015., [Methods] A retrospective study using data from Spanish Paediatric HIV Network (CoRISpe) and Spanish Minimum Basic Data Set (MDBS) was performed. HIV- diagnosed children between 1997 and 2015 were selected. Sociodemographic, clinical and immunovirological data of HIV-infected children and their mothers were studied in four calendar periods (P1: 1997–2000; P2: 2001–2005; P3: 2006–2010; P4: 2011–2015). Rates of perinatal HIV diagnoses and transmission from 1997 to 2015 were calculated., [Results] A total of 532 HIV-infected children were included in this study. Of these children, 406 were Spanish (76.3%) and 126 immigrants (23.7%). A decrease in the number of HIV diagnoses, 203 (38.2%) children in the first (P1), 149 (28%) in the second (P2), 130 (24.4%) in the third (P3) and 50 (9.4%) in the fourth (P4) calendar periods was studied. The same decrease in the Spanish HIV-infected children (P1, 174 (46.6%), P2, 115 (30.8%), P3, 65 (17.4%) and P4, 19 (5.1%)) was monitored. However, an increase in the number of HIV diagnoses by sexual contact (P1: 0%; P2: 1.3%; P3: 4.6%; P4: 16%) was observed. The rates of new perinatal HIV diagnoses and perinatal transmission in Spanish children decreased from 0.167 to 0.005 per 100,000 inhabitants and 11.4% to 0.4% between 1997 and 2015, respectively., [Conclusions] A decline of perinatal HIV diagnoses and transmission was observed. However, an increase of teen-agers HIV diagnoses with sexual infection was studied. Public awareness campaigns directed to teen-agers are advisable to prevent HIV infection by sexual contact.

[Background] Kawasaki disease (KD) is an acute self-limited systemic vasculitis of unknown etiology affecting mainly children less than 5 years of age. Risk factors for cardiac involvement and resistance to treatment are insufficiently studied in non-Japanese children., [Objective] This study aimed to investigate the epidemiology, clinical features and risk factors for resistance to treatment and coronary artery lesions (CAL) in KD in Spain., [Methods] Retrospective study (May 2011-June 2016) of all patients less than 16 years of age diagnosed with KD included in KAWA-RACE network (84 Spanish hospitals)., [Results] A total of 625 cases were analyzed, 63% were males, 79% under 5 year-olds and 16.8% younger than 12 months. On echocardiographic examination CAL were the most frequent findings (23%) being ectasia the most common (12%). Coronary aneurysms were diagnosed in 9.6%, reaching 20% in infants under 12 months (p<0.001). A total of 97% of the patients received intravenous immunoglobulin (IVIG) with a median number of days from fever onset to IVIG administration of 7.2. A second dose was given to 15.7% and steroids to 14.5% patients. Only 1.4% patients received infliximab. No deaths were reported. A multivariate analysis identified anemia, hypoalbuminemia, hyponatremia, higher creatinine and procalcitonin as independent risk factors for treatment failure and length under 103 cm, hemoglobin < 10.2 mg/dL, platelets > 900,000 cells/mm3, maximum temperature < 39.5°C, total duration of fever > 10 days and fever before treatment ≥ 8 days as independent risk factors for developing coronary aneurysms., [Conclusions] In our population, children under 12 months develop coronary aneurysms more frequently and children with KD with anemia and leukocytosis have high risk of cardiac involvement. Adding steroids early should be considered in those patients, especially if the treatment is not started before 8 days of fever. A score applicable to non-Japanese children able to predict the risk of aneurysm development and IVIG resistance is necessary.

Introducción: la epidemia de la infección por el virus de la inmunodeficiencia humana (VIH) continúa siendo un grave problema de salud pública a nivel mundial, siendo el sida la principal causa de muerte entre los adolescentes (entre 10 y 19 años) en África y la segunda más común entre los adolescentes globalmente. La mayoría de los niños y niñas que viven con VIH en el mundo se infectaron por transmisión vertical (TV) durante el embarazo, el parto o la lactancia. Sin embargo, gracias a la generalización del uso de la Terapia Antirretroviral de Gran Actividad (TARGA), muchos de ellos han alcanzado la adolescencia y la juventud, por lo que se hace necesario establecer planes de transición desde las consultas o unidades de pediatría hacia las de adultos. Este proceso supone una etapa decisiva en el control de su enfermedad y un reto de abordaje complejo, cuyo objetivo fundamental es conseguir que el adolescente permanezca vinculado al sistema sanitario en lo referente al cuidado de su infección, de forma que pueda mantener un adecuado control de la misma y que, al tiempo, disminuyan las probabilidades de propagar la epidemia en la comunidad. En España, la Cohorte Nacional de Pacientes Pediátricos con VIH (CoRISpe) recoge de forma prospectiva desde 2008 y retrospectiva desde 1995 datos demográficos, sociológicos, clínicos y de laboratorio de pacientes infectados por VIH durante la edad pediátrica de hospitales de casi todo el territorio nacional. El 95,7% de los pacientes de CoRISpe se infectaron por TV..., Introduction: the epidemic of the Human Immunodeficiency Virus (HIV) remains a serious public health problem globally. AIDS remains the leading cause of death among adolescents (10 to 19) globally, and in Africa is the second most common cause of death among adolescents. Most children living with HIV worldwide were infected by vertical transmission (TV) during pregnancy, childbirth or breastfeeding. However, thanks to the widespread use of highly active antiretroviral therapy (HAART), many have reached adolescence and youth, so it is necessary to establish transition plans from pediatric units to the adult units. This process is a decisive step in the control of their disease and a challenge of complex approach whose main objective is to keep the adherence of the adolescents to the health system in relation to the care of their infection, in order to maintain proper control of their disease and, at the same time reducing the chances of spreading the epidemic in the community. In Spain, the national cohort of pediatric patients with HIV (CoRISpe) collected prospectively from 2008 and retrospectively since 1995 demographic, sociological, clinical and laboratory data from HIV-infected patients from pediatric hospitals in almost all the national territory. 95.7% of patients of CoRISpe were prenatally infected. Based on data from this cohort as part of national epidemiological program AIDS Research Network (RIS), in January 2013 the FARO project began to investigate the clinical, immunological and virological situation of adolescents and young adults perinatally infected that had been transferred to units of adult care, as well as to identify possible mistakes in the process of transition...

[Objective] To characterize children, adolescents and young adults infected with HIV/hepatitis C virus (HCV) vertically or before age of 18 years and living in Europe regarding mode of acquisition, HCV genotype, clinical status and treatment., [Design] Retrospective, cross-sectional study using pooled data from 11 European paediatric HIV cohorts., [Methods] Patients aged more than 18 months and less than 25 years, with HIV/HCV acquired vertically or in childhood, were included. Anonymized individual patient data were collected using a standard protocol and modified HIV Cohorts Data Exchange Protocol., [Results] Of 229 patients included, 142 (62%) had vertically acquired infection. Median age at last follow-up was 16.2 years. Most children had HCV genotype 1 (101/184, 55%) or 3 (57/184, 31%). One-fifth (46/214) had a previous AIDS diagnosis (data missing on prior AIDS diagnoses for 15). At their last clinic visit, 70% (145/208) had no/mild immunosuppression (Centers for Disease Control and Prevention stage 1), and 131 of 179 on antiretroviral therapy had undetectable HIV RNA (assay thresholds varied from <20 to <150 copies/ml). Overall, 42% (86/204) had hepatomegaly in the previous year, and 55% (116/213) had alanine aminotransferase more than 40 IU/l at their last test. Of 97 patients with transient elastography, 12 had results more than 9 kPa; this was associated with duration of HCV infection (P = 0.033), but not with CD4+ cell count, antiretroviral therapy use or sex in univariable analysis. Of 17 patients with liver biopsies, six had bridging fibrosis and one had cirrhosis. Twenty-five (11%) had been treated successfully for HCV., [Conclusion] The high proportion of patients with progressive liver disease underscores the need for close monitoring and earlier and more effective HCV treatment.