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[Objectives] The aim of this study was to assess the immunogenicity of SARS-CoV-2 available vaccines among people living with HIV (PLWH) after a complete vaccination scheme, and determine predictors of seroconversion., [Methods] This multicentre prospective cohort study included 420 PLWH who had received a standard immunization, either with mRNA or adenoviral-vectored COVID-19 vaccines. Antibody response was evaluated within 1 to 2 months after the last dose of the vaccine with a quantitative determination of antitrimeric spike protein-specific IgG antibodies and IgG neutralizing antibodies., [Results] Overall, 384 of 420 PLWH (91%) showed antibody response to vaccination. Seroconversion was observed in 308 of 326 individuals with cluster of differentiation 4 (CD4) counts ≥350 cells/mm3 (95%), 55 of 61 PLWH with 200 to 349 cells/mm3 (90%), and 21 of 33 PLWH with CD4 counts, [Discussion] HIV-related immunosuppression impairs the antibody response to SARS-CoV-2 vaccines. Specific vaccination schemes should be urgently tailored in this setting, particularly in patients with CD4 cell counts, This work was supported, in part, by the Spanish Network for AIDS Investigation (www.red.es/redes/inicio; RD16/0025/0040) as part of the Nacional I + D + I, ISCIII Subdirección General de Evaluación and the European Fund for Development of Regions. Juan Antonio Pineda received a research extension grant from the Programa de Intensificación de la Actividad de Investigación del Servicio Nacional de Salud Carlos III. Anaïs Corma-Gómez received a Río...

Background Obesity among persons living with HIV (PLWH) has increased and weight gain after antiretroviral therapy (ART) can lead to metabolic disorders and impact survival. Our objective was to analyze weight and metabolic changes in HIV näive patients after 48 weeks of ART. Methods Observational, retrospective, multicentered cohort study comprising naïve-patients who started tenofovir alafenamide/emtricitabine/elvitegravir/cobicistat (TAF/FTC/EVG/c) or abacavir/lamivudine/dolutegravir (ABC/3TC/DTG), with no change in treatment for 48 weeks. Clinical and metabolic parameters were collected at baseline and week-48. Statistical program used was SPSS 21.0.0. Results The study included 329 participants from 6 hospitals. Participants were 89% male and 10% had AIDS diagnosis. Median age was 35 (IQR 27–43) years. Median baseline CD4 count was 417 (IQR 250–569) cell/mm3 and HIV viral load 4.65 (IQR 4.21–5.18) log10 copies/ml. Baseline median weight was 70 (IQR 62–79) kg, body mass index 23.4 (IQR 21.2–26.0) kg/m2; 22.7% overweight and 6.4% obese. ART regimens: ABC/3TC/DTG (196), TAF/FTC/EVG/c (133). Baseline characteristics were similar in both ART groups. Average weight gain at week-48 was 2.9 (SD 5.5) kg ( p < 0.0001) with no differences between both groups. There was an increase in obesity (6.4%–8%; p < 0.003) and overweight (22.7%–28.9%; p < 0.0001). Weight increase was associated with AIDS: OR 3.05 (95%; CI 1.009–9.22), p = 0.048; and lower baseline weight: OR 1.032 (95% CI 1.009–1.05), p = 0.006. Conclusions After ART initiation patients gain weight regardless of the regimen they take. Weight gain is associated with AIDS and the use of TAF/FTC/EVG/c.

[Objectives] Real world data on glecaprevir/pibrentasvir (G/P) among active drug users are scarce. We evaluated the sustained virological response (SVR) rates of G/P among individuals with and without active drug use in routine clinical practice., [Methods] Two ongoing prospective multicenter cohorts of individuals starting G/P were analyzed. Overall SVR intention-to-treat (ITT), discontinuations due to adverse effects and dropouts were evaluated. Results in patients with active, past and without active drug use were compared., [Results] Overall, 644 individuals started G/P and have reached the date of SVR evaluation. Of them, 613 (95.2%) individuals achieved SVR. There were two (0.3%) relapses, one (0.2%) discontinuation due to side effects and 35 (5.4%) dropouts. SVR rates for patients with active drug use, past drug use and those who never used drugs were 85.4%(n/N = 70/82), 96.1%(n/N = 320/333) and 97.4%(n/N = 223/229) respectively (p < 0.001). After adjustment by sex, age, HCV genotype and opioid agonist therapy, active drug use was the only factor independently associated with SVR (ITT) [adjusted OR (95%confidence interval): 0.29(0.09–0.99),p = 0.048]., [Conclusions] Active drug use was independently associated with lower SVR rates to G/P, mainly due to voluntary dropout. G/P could be particularly beneficial in this scenario but specific strategies designed to increase the retention in care are needed., This study has been funded by Instituto de Salud Carlos III through the project “PI018/00606″ (Co-funded by European Regional Development Fund/European Social Fund "A way to make Europe"/"Investing in your future"). This work was supported by the Ministry of Science, Innovation and Universities of Spain for A.G.-S and A.R.-J who are recipients of a Miguel Servet Research Contract (CP18/00146 and CP18/00111), co-financed by the FSE ‘El Fondo Social Europeo invierte en tu futuro’. A.C.-G. has received a Rıo Hortega grant from the Instituto de Salud Carlos III (CM19/00251) and a research extension grant Acción B, Acción para el Refuerzo de la Actividad Investigadora en las Unidades Clínicas del Servicio Andaluz de Salud 2021, Clínicos Investigadores (grant number B-0061-2021). J.A.P. has received a research extension grant from the Programa de Intensificacion de la Actividad de Investigacion del Servicio Nacional de Salud Carlos III (3SNS). J.M. has received a research extension grant Acción A, Acción para el Refuerzo anual de la Actividad Investigadora en las Unidades Clínicas del Servicio Andaluz de Salud 2021(grant number A1-0060-2021).

Este artículo discute la forma en que la política pública entiende el concepto de inclusión de los estudiantes con necesidades educativas especiales o discapacidad, lo traduce en normativa y lleva tales regulaciones a la práctica. A partir de una observación etnográfica, exploramos las variadas formas en que se implementan prácticas inclusivas en el marco de la política edu- cacional chilena. Nuestro hallazgo principal es que no existe un concepto de inclusión único y fijo en la actualización de la política pública, sino que se materializa en la práctica de formas dinámicas y múltiples, poniendo en contacto diversos actores, humanos y no-humanos, los cuales despliegan sus agencias. Esta situación hace difícil la puesta en marcha de una política nacional unívoca, pero a la vez abre paso a la posibilidad de territorializar situadamente ciertas prácticas y saberes.

OBJECTIVE There is scarce available evidence on the distribution over time of liver complications emergence in hepatitis C virus (HCV)-infected patients who achieve sustained virological response (SVR) with direct-acting antiviral (DAA)-based therapy. Therefore, we aimed at describing the kinetics of liver-related events appearance in this setting. DESIGN A multicentric prospective cohort study. METHODS HCV-monoinfected and HIV/HCV-coinfected patients from GEHEP-011 cohort, whose inclusion criteria were had achieved SVR with DAA-based therapy; liver stiffness prior to starting treatment at least 9.5 kPa; and available liver stiffness measurement at SVR. SVR was considered as the baseline time-point. RESULTS One thousand and thirty-five patients were included, 664 (64%) coinfected with HIV. Before DAA-based therapy, 63 (6.1%) individuals showed decompensated cirrhosis. After SVR, 51 (4.9%) patients developed liver complications. Median (Q1-Q3) time to the emergence of hepatic events was hepatic encephalopathy 11 (7-24) months, ascites 14 (6-29) months, hepatocellular carcinoma (HCC) 17 (11-42) months and portal hypertension gastrointestinal bleeding (PHGB) 28 (22-38) months (P = 0.152). We define two profiles of liver complications: those emerging earlier (encephalopathy and ascites) and, those occurring continuously during the follow-up (HCC, PHGB) [median (Q1-Q3) time to emergence 12.7 (6.6-28.2) months vs. 25.4 (12.5-41.53) months, respectively (P = 0.026)]. CONCLUSION The vast majority of HCV-infected patients who develop liver complications after reaching SVR with DAA do it within 3 years after SVR time-point. Specifically, hepatic encephalopathy and ascites do not usually emerge after this period. Conversely, HCC and PHGB may occur in longer term. It is critical to identify patients at risk of developing hepatic events to continue performing surveillance for them.

BackgroundCobicistat, dolutegravir and rilpivirine are all modest inhibitors of proximal tubular creatinine secretion (IPTCrS) and hence a moderate and early non-progressive creatinine estimated glomerular filtration rate (Cr-eGFR) reduction has been observed in clinical trials. Data regarding the impact of combination of those drugs on Cr-eGFR, in the clinical practice, are scarcely known.MethodsChanges in Cr-eGFR after starting darunavir/cobicistat alone or in combination with dolutegravir and/or rilpivirine were studied in a nationwide retrospective cohort study of consecutive HIV-infected patients initiating darunavir/cobicistat. The relationship between Cr-eGFR changes over time and the use of darunavir/cobicistat alone or darunavir/cobicistat plus dolutegravir and/or rilpivirine adjusted by different HIV patient’s characteristics, socio-demographics, HIV severity and use of tenofovir concomitant medication other than antiretrovirals was explored through univariate and multivariate analyses.ResultsThe analysis included 725 patients. At 48 weeks, the combination of two or more IPTCrS (darunavir/cobicistat with rilpivirine and/or dolutegravir) was associated with higher decreases in Cr-eGFR [adjusted median difference (±SD) –3.5 ± 1.6 (95% CI –6.6 to –0.3), P = 0.047], and a decrease up to or higher than 15 mL/min/1.73 m2 was more frequent [adjusted OR 3.233 (95% CI 1.343–7.782), P = 0.009], with respect to darunavir/cobicistat alone. The Cr-eGFR changes between darunavir/cobicistat and darunavir/cobicistat with rilpivirine and/or dolutegravir showed more significant decreases in patients taking two or more IPTCrS at 12, 24 and 48 weeks. (ClinicalTrials.gov: NCT03042390).ConclusionsConcomitant use of darunavir/cobicistat plus IPTCrS dolutegravir, rilpivirine, or both produced an additive effect in the expected Cr-eGFR decrease.

Objectives Spain is close to HCV microelimination, so rates of recently acquired HCV infection (RAHC) should decrease. Nowadays, men who have sex with men (MSM) carry the highest risk of HCV acquisition. Our aim was to estimate the incidence of and the factors associated with RAHC, together with reinfection rates, among patients sexually infected by HIV. Methods Primary RAHC infection was diagnosed when anti-HCV antibody seroconversion was documented. In anti-HCV positive patients, initially without HCV viraemia, a diagnosis of reinfection was established if plasma HCV RNA was detected. Results All 350 patients tested negative for anti-HCV at baseline and had at least one follow-up visit. Among them, there were 16 RAHC cases from 2016 to 2019. RAHC incidence rates [IR (95% confidence interval, CI)] per 100 person-years were 3.77 (0.5-12.9) in 2016, 1.85 (0.6-4.3) in 2017, 1.49 (0.4-3.8) in 2018 and 1.98 (0.6-4.5) in 2019. Only previous sexually transmitted infections [incidence rate ratio (IRR) = 18.23, 95% CI: 1.93-172.1; P = 0.011], male sex (IRR = 8.33, 95% CI: 1.38-54.15; P = 0.026) and sharing chem-sex drugs (IRR: 4.93, 95% CI: 1.17-20.76; P = 0.030), were independently associated with RAHC. Four out of 42 (9.5%) patients became reinfected. Conclusions The incidence of RAHC among HIV-infected patients showed a decrease after 2016, although a lower but steady incidence of residual cases still remains. HCV reinfections showed a similar pattern. New infections were associated with sharing chem-sex drugs among MSM.

Background In the setting of hepatitis C virus (HCV) active infection, liver stiffness (LS)–based strategies identify patients with low risk of developing esophageal variceal bleeding (VB) episodes, in whom unnecessary upper esophagogastroduodenoscopy (UGE) screening can be safely avoided. However, after sustained virological response (SVR), data on the accuracy of the criteria predicting this outcome in HCV-infected patients with cirrhosis, with or without human immunodeficiency virus (HIV) coinfection, are very limited. Methods This was a multicenter prospective cohort study, where HCV-monoinfected patients and HIV/HCV-coinfected individuals were included if they had (1) SVR with direct-acting antiviral–based therapy; (2) LS ≥9.5 kPa previous to treatment; and (3) LS measurement at the SVR time-point ≥14 kPa. Diagnostic accuracy of HEPAVIR, expanded Baveno VI, and HIV cirrhosis criteria, at the time of SVR, was evaluated. Missed VB episodes, negative predictive values (NPVs), and number of spared UGEs were specifically assessed. Results Four hundred thirty-five patients were included, 284 (65%) coinfected with HIV. Seven (1.6%) patients developed a first episode of VB after SVR. In patients without a previous VB episode, HEPAVIR, expanded Baveno VI and HIV cirrhosis criteria achieved NPV for first VB episode after SVR of 99.5% (95% confidence interval [CI], 97.1%–100%), 100% (95% CI 97.8%–100%), and 100% (95% CI 98%–100%) while sparing 45%, 39%, and 44% of UGEs, respectively. When considering HIV coinfection, the performance of the 3 criteria was similar, both in HCV-monoinfected and HIV/HCV-coinfected individuals. Conclusions After SVR, predictive LS-based strategies accurately identify HCV-infected patients, HIV coinfected or not, with low risk of developing VB during follow-up. In these specific patients, using HIV cirrhosis criteria maximize the number of spared UGEs while missing no VB episode.

Resumen Antecedentes La mayor supervivencia de los pacientes con infeccion por VIH gracias al tratamiento antirretroviral (TAR) se acompana de una mayor frecuencia de enfermedad cardiovascular (ECV). Analizamos la prevalencia de los factores de riesgo cardiovascular (FRCV) y la estimacion del riesgo de ECV en una cohorte de personas con infeccion por VIH en Espana. Metodos Estudio transversal, observacional de los FRCV en la cohorte espanola VACH de pacientes con infeccion por VIH que recibian TAR. Resultados Se evaluaron 15.559 pacientes con infeccion por VIH (76% varones; edad media: 46 anos). Un 3,7% habia experimentado al menos un evento de ECV. La prevalencia de FRCV era elevada: hiperlipidemia, 64%; tabaquismo, 47%; HTA, 22%; y diabetes, 16%. Segun la escala Framingham, un 10,9% presentaba alto riesgo de ECV y un 28,8% riesgo moderado. De los pacientes con elevado riesgo de ECV, el 49% recibia inhibidores de proteasa y el 43% abacavir. Se usaron farmacos hipotensores en el 53% de los pacientes con diagnostico de HTA, y farmacos antidiabeticos en el 2,6% de los pacientes con diabetes. Conclusiones Los FRCV tradicionales son frecuentes en los pacientes con infeccion por VIH con TAR en Espana, y una elevada proporcion de ellos tiene riesgo moderado-alto de ECV. Por tanto, el control de los FRCV modificables en los pacientes con infeccion por VIH deberia mejorarse y valorar el uso de farmacos con mejor perfil de riesgo cardiovascular.

Lima Metropolitana experimenta una constante congestión vehicular, invirtiendo desmesurado tiempo en el desplazamiento de la población hacia su destino, sumándole a ello la falla mecánica de ciertos vehículos, ocasionando caos, estrés y frustración en los ciudadanos. Los conductores se ven en la necesidad de comprar autopartes y repuestos, implicando un esfuerzo adicional en obtenerlos, ya que en ocasiones es difícil hallar el repuesto útil para su vehículo, existiendo una gran diversidad de precios que impiden saber si se está comprando el repuesto adecuado o si la tienda cuenta con stock del producto. Estas tiendas venden convencionalmente, sin un espacio alterno al físico limitando su competitividad. Por ello, se realiza la propuesta del Marketplace Mister Fix para venta de repuestos y accesorios vehiculares, como un punto de encuentro entre ofertantes y demandantes de repuestos (comercio B2C) logrando conseguir los repuestos basado en 3 pilares: Marca, precio y ubicación según su necesidad. Posee herramientas que ofrecen mejorar el control de su stock, publicar de forma automatizada y manejar un “sistema de venta proactivo”, conocer el tiempo de vida del producto vendido logrando contactarlo antes que el repuesto esté en el final de su vida útil. Además, los clientes podrán buscar los productos que necesitan orientados por variables que ayudarán con la búsqueda del catálogo de la plataforma, cuenta con un sistema de pago electrónico y delivery según la ubicación especificada. Se busca minimizar los costos de implementación en una plataforma de venta de repuestos y autopartes, y según los pronósticos de ventas se espera un crecimiento dinámico de acuerdo a la demanda a partir del segundo año, siendo un gran atractivo para los futuros inversionistas. Finalmente, como resultados se obtuvo que los clientes potenciales pertenecen al distrito de Miraflores (32%) y La Victoria (25%), de 30 a 40 años (58%) Metropolitan Lima experiences constant vehicular congestion, investing inordinate time in moving the population to their destination, adding to this the mechanical failure of certain vehicles, causing chaos, stress and frustration in citizens. Drivers find it necessary to buy auto parts and spare parts, implying an additional effort to obtain them, since sometimes it is difficult to find the useful spare part for their vehicle, and there is a great diversity of prices that prevent knowing if they are buying the right spare part. or if the store has stock of the product. These stores sell conventionally, without an alternative space to the physical one, limiting their competitiveness. For this reason, the proposal of the Marketplace Mister Fix is made for the sale of vehicle parts and accessories, as a meeting point between suppliers and demanders of parts (B2C trade) managing to obtain the parts based on 3 pillars: Brand, price and location according to your need. It has tools that offer to improve the control of its stock, publish in an automated way and manage a "proactive sales system", knowing the life time of the product sold, managing to contact it before the spare part is at the end of its useful life. In addition, customers will be able to search for the products they need guided by variables that will help with the search of the platform's catalog, it has an electronic payment system and delivery according to the specified location. The aim is to minimize implementation costs in a platform for the sale of spare parts and auto parts, and according to sales forecasts, dynamic growth is expected according to demand as of the second year, being a great attraction for future investors. Finally, as results, it was obtained that the potential clients belong to the district of Miraflores (32%) and La Victoria (25%), from 30 to 40 years old (58%)

RESUMEN Presentamos una revisión del estado de la legislación sobre educación especial en Chile y un análisis cualitativo de su aplicación en escuelas regulares con Programas de Integración Escolar. Exponemos que la normativa para la integración de niñas/os con Necesidades Educativas Especiales se enmarca en un contexto enfocado en la rendición de cuentas sin criterios comunes que faciliten su interpretación. Como consecuencia, los actores involucrados ponen en práctica las normas de diversas formas, lo que incluye el abordar la normativa respecto a asuntos administrativos y financieros para intentar que no obstaculice la inclusión de manera universal. ABSTRACT We present a review of the state of legislation on special education in Chile and a qualitative analysis of the concrete application of this regulation in regular schools with School Integration Programs. We expose that the regulations governing the integration of children with Special Educational Needs into regular classes are part of a broader legal context characterized by dispersion and little systematization, focus on accountability and lack of common criteria to facilitate their interpretation. As a result, the actors involved program the standards in a variety of ways, including addressing regulations regarding administrative and financial matters to try not to hinder inclusion in a universal way.

This article explores the professional identities of SEN teachers as related to new Chilean policies for educational inclusion. It focuses on the way in which professional identities are transforme...

Background: The use of combination antiretroviral therapy has led to dramatic improvements in the life expectancy of HIV-infected persons. As result, the HIV population is aging and increasingly facing illnesses typically seen in the elderly, such as chronic kidney disease (CKD). Methods: A retrospective longitudinal study was conducted using data from years 2010 and 2014 in all HIV-infected persons enrolled at the Spanish VACH cohort. We analyzed the prevalence and the predictive factors for developing CKD (estimated glomerular filtration rate, eGFR

Background & Aims People who inject drugs (PWID) and are on opioid agonist therapy (OAT) might have lower adherence to direct-acting antivirals (DAAs) against hepatitis C virus (HCV) and, therefore, lower rates of sustained virologic response (SVR). Because of this, we compared the SVR rates to interferon-free DAA combinations in individuals receiving OAT and those not receiving OAT in a real-world setting. Methods The HEPAVIR-DAA cohort, recruiting HIV/HCV-coinfected patients (NCT02057003), and the GEHEP-MONO cohort (NCT02333292), including HCV-monoinfected individuals, are ongoing prospective multicenter cohorts of patients receiving DAAs in clinical practice. We compared SVR 12 weeks after treatment (SVR12) in non-drug users and PWID, including those receiving or not receiving OAT. Intention-to-treat and per protocol analyses were performed. Results Overall, 1,752 patients started interferon-free DAA treatment. By intention-to-treat analysis, 778 (95%, 95% CI 93%–96%) never injectors, 673 (92%, 95% CI 89%–93%) PWID not on OAT and 177 (89%, 95% CI 83%–92%) PWID on OAT achieved SVR12 (p = 0.002). SVR12 rates for ongoing drug users (with or without OAT) were 68 (79%) compared with 1,548 (95%) for non-drug users (p Conclusions HCV-infected PWID achieve high SVR12 rates with DAAs whether they are on OAT or not, but their response rates are lower than those of patients who never used drugs. This is mainly attributable to more frequent loss to follow-up. Accounting for active drug use during DAA therapy nearly closed the gap in SVR rates between the study groups. Lay summary Patients with hepatitis C virus infection who are on opioid agonist therapy can achieve high cure rates with current treatments. The use of illicit drugs during treatment can drive drop-outs and reduce cure rates. However, hepatitis C can be cured in most of those using drugs who complete treatment and follow-up. Clinical trial number: HEPAVIR-DAA cohort, NCT02057003; GEHEP-MONO cohort, NCT02333292.

Background: The life expectancy of HIV-infected individuals has dramatically improved with potent antiretroviral therapies. However, organ-specific toxicities of some antiretrovirals and persistent inflammation and immune activation due to residual virus replication account for a high burden of age-associated comorbidities in the HIV population. Methods: The prevalence of overt cardiovascular, renal and bone diseases as well as their major risk factors were cross-sectionally examined during the year 2014 in the VACH cohort, a large nationwide population of HIV-infected individuals in Spain. Results: A total of 10,897 HIV-infected patients were examined. Seventy-one point four percent were male and the mean age was 48 years. Mean time since HIV diagnosis was 15.8 years and mean time on antiretroviral therapy was 13.1 years. The proportion of patients with undetectable viral load was 87.1%, whereas 65.7% had CD4 counts >500 cells/mm(3). Overall, cardiovascular, renal and bone disease were recorded in 4.7%, 5.9% and 2.8%, respectively. The prevalence of major risk factors was as follows: smoking 51.3%, alcohol abuse 7.8%, overweight/obesity 42.2%, diabetes 19.9%, dyslipidaemia 72.6%, hypertension 25.6%, and osteoporosis 11.1%. In the subset of patients older than 55 years-old (18%), all figures for overt disease and their major risk factors were significantly greater. Conclusion: Major age-related medical conditions and most of their risk factors are highly prevalent in HIV-infected individuals on long-term antiretroviral therapy in Spain. Preventive actions, including careful selection of antiretroviral agents, should be prioritized in the ageing HIV population. (C) 2018 Elsevier Espana, S.L.U. and Sociedad Espanola de Enfermedades Infecciosas y Microbiologia Clinica. All rights reserved.

Early diagnosis and treatment of incident cases of hepatitis C virus (HCV) infection is fundamental to eliminate HCV in HIV-positive patients. From January 2016 to December 2019, we attended 40 episodes of acute HCV infection (AHC) in 35 subjects (9 reinfections) who were coinfected with HIV. The patients were treated with direct-acting antiviral agents (DAAs) in seven hospitals in Andalusia, Spain. All were men who have sex with men (MSM), mean age was 42.9 (±8.3) years and median time of HIV infection was 46.6 months (IQR: 20.4–67.2). All received antiretroviral therapy and had undetectable HIV viral load (except 2 with 65 and 68 copies/mL); median CD4 count was 632 cells/mm3 (IQR: 553–896). Over half (74.3%) also had another concomitant sexually transmitted infection, syphilis (48.6%) being the most common. AHC was asymptomatic in 32 cases (80%). Genotypic distribution was G1a 65%, G4 32.5% and G1b 3%. Median time to DAA was 6 weeks (IQR: 4.3–18.3) and median baseline HCV RNA was 6.1 Log (IQR: 5.6–6.5). DAA regimens were SOF/LDV (19 episodes), SOF/VEL (14), ELB/GZV (5) and GLP/PIB (2). All presented sustained viral response and none discontinued due to adverse effects. In conclusion, early treatment with DAA in AHC patients proved effective and safe. It could be an excellent strategy to eliminate HCV infection in HIV-coinfected MSM.

By the middle of 2021, we are still immersed in the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The concurrence of this new pandemic in regions where human immunodeficiency virus (HIV) and tuberculosis (TB) infections possess the same epidemiological consideration, has arisen concerns about the prognosis, clinical management, symptomatology, and treatment of patients with triple infection. At the same time, healthcare services previously devoted to diagnosis and treatment of TB and HIV are being jeopardized by the urgent need of resources and attention for COVID-19 patients. The aim of this review was to collect any article considering the three conditions (HIV, TB, and SARS-CoV-2), included in PubMed/Medline and published in the English language since the beginning of the COVID-19 pandemic. We focused on detailed descriptions of the unusual cases describing the three co-infections. Eighty-four out of 184 publications retrieved met our inclusion criteria, but only three of them reported cases (five in total) with the three concomitant infections. The clinical evolution, management, and therapy of all of them were not different from mild/severe cases with exclusive COVID-19; the outcome was not worse either, with recovery for the five patients. Cases of patients with COVID-19 besides HIV and TB infections are scarce in literature, but studies deliberately embracing the triple infection as a priori inclusion criterion should be carried out in order to provide a complete understanding of joint influence.

Resumen: La implementación de políticas educativas inclusivas en Chile ha sido un proceso que no ha estado exento de dificultades. Este artículo explora diferentes prácticas sociales e institucionales desarrolladas durante la escolarización de estudiantes sordos/as. Se analizan interacciones entre estudiantes, docentes e intérpretes en clases con estudiantes sordos/as, interacciones sociales entre estudiantes, disposiciones escolares respecto a la inclusión y, por último, aspectos administrativos y financieros relacionados al modelo de política pública imperante. A través de una aproximación a dos escuelas públicas en Santiago de Chile, profundizamos en los modos en que el estudiantado sordo se desenvuelve entre la integración y la inclusión. Basándonos en observaciones de clases y entrevistas con profesores, intérpretes, estudiantes y directivos de comunidades escolares, describimos hallazgos respecto de la significación de la lengua de señas, los roles de intérpretes y educadores, el aprendizaje comunitario de la lengua de señas y el rol del aula de recursos. Se discuten los resultados en torno a las condiciones necesarias para la inclusión de estudiantes sordos, describiendo las prácticas docentes como un elemento clave para la generación de una verdadera inclusión dentro del aula, y las prácticas culturales de la comunidad escolar como posibles favorecedoras de la inclusión fuera de ella.

This article explores the role played by affects and emotions in the way students labeled as having special educational needs (SEN) or students with disabilities learn. I present classroom lessons as situated practices in which affects and emotions shape the arrangement of learning possibilities. My aim is to show the centrality of the “work of emotions” in the way in which these groups of students and teachers build their relationships in the classroom, recess, and other school space-time. Drawing on an ethnographic approach, field notes describe diverse moments and spaces at the observed schools. They make clear how affects are at the core of education, and how teaching and learning are embodied practices that cannot be understood without their affective dimension.

[Background] Scale-up of hepatitis C virus (HCV) treatment for HIV/HCV coinfected individuals is occurring in Spain, the vast majority (> 85%) with a reported history of injecting drug use and a smaller population of co-infected men who have sex with men (MSM). We assess impact of recent treatment scale-up to people living with HIV (PLWH) and implications for achieving the WHO HCV incidence elimination target (80% reduction 2015–2030) among PLWH and overall in Andalusia, Spain, using dynamic modeling., [Methods] A dynamic transmission model of HCV/HIV coinfection was developed. The model was stratified by people who inject drugs (PWID) and MSM. The PWID component included dynamic HCV transmission from the HCV-monoinfected population. The model was calibrated to Andalusia based on published data and the HERACLES cohort (prospective cohort of HIV/HCV coinfected individuals representing > 99% coinfected individuals in care in Andalusia). From HERACLES, we incorporated HCV treatment among diagnosed PLWH of 10.5%/year from 2004 to 2014, and DAAs at 33%/year from 2015 with 94.8% SVR. We project the impact of current and scaled-up HCV treatment for PLWH on HCV prevalence and incidence among PLWH and overall., [Results] Current treatment rates among PLWH (scaled-up since 2015) could substantially reduce the number of diagnosed coinfected individuals (mean 76% relative reduction from 2015 to 2030), but have little impact on new diagnosed coinfections (12% relative reduction). However, DAA scale-up to PWLH in 2015 would have minimal future impact on new diagnosed coinfections (mean 9% relative decrease from 2015 to 2030). Similarly, new cases of HCV would only reduce by a mean relative 29% among all PWID and MSM due to ongoing infection/reinfection. Diagnosing/treating all PLWH annually from 2020 would increase the number of new HCV infections among PWLH by 28% and reduce the number of new HCV infections by 39% among the broader population by 2030., [Conclusion] Targeted scale-up of HCV treatment to PLWH can dramatically reduce prevalence among this group but will likely have little impact on the annual number of newly diagnosed HIV/HCV coinfections. HCV microelimination efforts among PWLH in Andalusia and settings where a large proportion of PLWH have a history of injecting drug use will require scaled-up HCV diagnosis and treatment among PLWH and the broader population at risk., This study was funded by Gilead Sciences. The funder had no role in the analysis or presentation of the results. NM and AB were additionally supported by the National Institute for Drug Abuse [grant number R01 DA037773]. NM and BS had partial support from the University of California San Diego Center for AIDS Research (CFAR), a National Institute of Health (NIH) funded program [grant number P30 AI036214] which is supported by the following NIH Institutes and Centers: NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NIA NIGMS, and NIDDK. NM was supported by the National Institute of Allergy and Infectious Diseases and National Institue for Drug Abuse [grant number R01 AI147490], and BS was supported by the National Institute for Drug Abuse [grant number K01DA049665]. This work was also supported by the Ministerio de Sanidad (RD12/0017/0012) integrated in the Plan Nacional de I + D + I, and cofinanced by the ISCIII-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER), the Fundación para la Investigación en Salud (FIS) del Instituto Carlos III (PI15/01017), and the Red de Investigación en SIDA de España ISCIII-RETIC (grant number: RD16/0025/0034).

Background The aim of this study was to assess the impact of human immunodeficiency virus (HIV) infection on the risk of developing hepatocellular carcinoma (HCC) in patients infected with hepatitis C virus (HCV) who achieve sustained virological response (SVR) with direct-acting antiviral (DAA). Methods Multisite prospective cohort study, where HCV-monoinfected patients and HIV/HCV-coinfected individuals were included if they met: (1) SVR with DAA-based combination; (2) liver stiffness (LS) ≥9.5 kPa previous to treatment; (3) LS measurement at the SVR time-point. The main endpoint was the occurrence of HCC. Propensity score (PS) was calculated to address potential confounders due to unbalanced distribution of baseline characteristics of HIV/HCV-coinfected and HCV-monoinfected patients. Results In total, 1035 HCV-infected patients were included, 667 (64%) coinfected with HIV. After a median (Q1–Q3) follow-up time of 43 (31–49) months, 19 (1.8%) patients developed HCC (11 [3.0%]; HCV-monoinfected, 8[1.2%]; HIV/HCV-coinfected individuals; P = .013). In the multivariable analysis, HIV coinfection was associated with a lower adjusted risk of developing HCC (subhazard ratio [sHR] = 0.27, 95% confidence interval [CI]: .08–.90; P = .034). Predictors of HCC emergence were: HCV genotype 3 (sHR = 7.9, 95% CI: 2.5–24.9; P < .001), MELD score at SVR >10 (sHR = 1.37, 95% CI: 1.01–1.86; P = .043) and LS value at SVR (sHR = 1.03, 95% CI: 1.01–1.06, for 1 kPa increase; P = .011). Using inverse probability weighting method on the PS, HIV-infected patients had a lower risk of HCC (powered HR = 0.33, 95% CI: .11–.85). Conclusions Among HCV-infected patients with advanced fibrosis, who achieve SVR with DAA, HIV coinfection seems to be associated with a lower risk of HCC occurrence. The underlying causes for this finding need to be investigated.

The presence of transmission clusters (TCs) and their epidemiological characteristics in a treatment-naive cohort of HIV-1 patients in southern Spain over a decade (2004-2015) were evaluated. Protease and reverse transcriptase sequences provided by each genotype test were used in the phylogenetic study, performed first by the neighbor-joining method and then confirmed by Bayesian analysis. We collected clinical, immunovirological, and demographic data for all patients included. Our cohort comprised 757 patients, 428 (56.5%) belonging to a TC. Overall, we found 123 TCs, 21 of them comprising five or more individuals and three with ≥10 sequences. Forty-three TCs (35.0%) remained active. The clustered patients were mainly men (92.8%) who had sex with men (MSM) (81.5%), Spanish (80.6%), and young adults (median age at diagnosis of 32.6 years). They had lower percentages of late diagnosis and AIDS cases (42.1% and 13.6%, respectively), whereas the presence of recent seroconverters (31.1%), HIV-1 B subtypes (79.4%), and transmission drug resistance (20.3%) increased within TCs, with regard to not-clustered individuals. Among the TCs of non-B variants, circulating recombinant forms (CRF) were predominant (87.5%), with the highest frequencies for CRF19_cpx (17.0% of non-B subtype sequences in TCs); CRF02_AG (15.9%); and CRF01_AE (9.1%). In conclusion, over half of our cohort was included within a TC. More than a third of TCs found could be considered active transmission events. Belonging to a TC was related to MSM, Spanish origin, recent seroconversion, high prevalence of resistance mutations, and B HIV subtype. Among the non-B genetic forms in TCs, we found a high prevalence of CRF19_cpx, CRF02_AG, and CRF01_AE variants.

Background APOBEC3H (A3H) gene presents variation at 2 positions (rs139297 and rs79323350) leading to a non-functional protein. So far, there is no information on the role played by A3H in spontaneous control of HIV. The aim of this study was to evaluate the A3H polymorphisms distribution in a well-characterized group of Elite Controller (EC) subjects. Methods We analyzed the genotype distribution of two different SNPs (rs139297 and rs79323350) of A3H in 30 EC patients and compared with 11 non-controller (NC) HIV patients. Genotyping was performed by PCR, cloning and Sanger sequencing. Both polymorphisms were analyzed jointly in order to adequately attribute the active or inactive status of A3H protein. Results EC subjects included in this study were able to maintain a long-term sustained spontaneous HIV-viral control and optimal CD4-T-cell counts; however, haplotypes leading to an active protein were very poorly represented in these patients. We found that the majority of EC subjects (23/30; 77%) presented allelic combinations leading to an inactive A3H protein, a frequency slightly lower than that observed for NC studied patients (10/11; 91%). Conclusions The high prevalence of non-functional protein coding-genotypes in EC subjects seems to indicate that other innate restriction factors different from APOBEC3H could be implicated in the replication control exhibited by these subjects.

This article examines how flexible work economy has been affecting a group of beauty salons’ workers in Santiago, Chile. They do not have a work contract and receive their payment as if they were giving an independent service, but depend on the rules their bosses impose them. The kind of work described in the article appears to be a new arrangement within the context of urban informality, which has present and future implications regarding social security and uncertainty. Drawing on ethnographic observation in four beauty salons, I describe how the embodied belief of being an independent worker helps to enact many skills required by the flexible work economy.

BIRDi study group., The use of two potent, well-tolerated, drugs could permit the maintenance of virologic suppression even in heavily pretreated people living with HIV. In this retrospective, multicenter, simplification study (NCT03348449), we included those patients with virologic suppression who switched to raltegravir (RAL) plus boosted darunavir (b/DRV). Overall, 345 patients (75 females, 25%) were included. Patients were largely pretreated (mean, 9.4 regimens), suppressed for a median of 41.1 months. Fifty patients had ≥1 mutation against DRV. At 96 weeks, the efficacy by intention-to-treat analysis (snapshot) was 73% (95%CI, 68.4–77.8%), but 97.1% (95%CI, 95.4–98.9) excluding changes due to non-virologic reasons, and virologic failure was rare (0.9%; 95%CI, 0.1–1.2%). Median CD4/CD8 ratio increased from 0.59 to 0.62 (p

Background Some people living with hepatitis C virus (HCV) with sustained virological response (SVR) develop hepatic complications. Liver stiffness (LS) predicts clinical outcome in people living with human immunodeficiency virus (HIV) with active HCV coinfection, but information after SVR is lacking. We aimed to analyze the predictive ability of LS at SVR for liver complications in people living with HIV/HCV with advanced fibrosis treated with direct-acting antivirals (DAA). Methods In sum, 640 people living with HIV/HCV fulfilling the following criteria were included: (i) Achieved SVR with DAA-including regimen; (ii) LS ≥ 9.5 kPa before therapy; and (iii) LS measurement available at SVR. The primary endpoint was the occurrence of a liver complication—hepatic decompensation or hepatocellular carcinoma (HCC)—or requiring liver transplant after SVR. Results During a median (Q1–Q3) follow-up of 31.6 (22.7–36.6) months, 19 (3%) patients reached the primary endpoint. In the multivariate analysis, variables (subhazard ratio [SHR] [95% confidence interval]) associated with developing clinical outcomes were: prior hepatic decompensations (3.42 [1.28–9.12]), pretreatment CPT class B or C (62.5 [3.08–1246.42]) and MELD scores (1.37 [1.03–1.82]), CPT class B or C at SVR (10.71 [1.32–87.01]), CD4 cell counts Conclusions LS at the time of SVR after DAA therapy predicts the clinical outcome of people living with HIV/HCV with advanced fibrosis. These results suggest that LS measurement may be helpful to select candidates to be withdrawn from surveillance programs.

Integration of molecular, clinical, and demographic data represents a powerful tool to understand the dynamics of local HIV-1 transmission chains (TCs). The aim of our study was the phylogenetic analysis of the TCs within a HIV-1 cohort and the description of the relevant patient data within a TC. We performed a phylogenetic analysis of 757 sequences from newly HIV-1 diagnosed patients in Málaga (Southern Spain) during the period 2004–15. We used partial pol gene sequences in a preliminary phylogenetic reconstruction using the Neighbour Joining method (MEGA v6.06 program). After eliminating branches with bootstrap values

This article reflects on the relations between transport infrastructure, affect and daily mobility. While transport systems has been always designed along the lines of discrete choice model paradigms, we want to show choice as a situated practice in which affects and emotions shape the way in which the infrastructure experience is configured. We show that decisions (regarding which mode of transport to use, which changes or connections to make, and which routes to prefer) are intertwined with affects and emotions that define relationships with the infrastructure and the situations encountered. Drawing on the travel experiences of the users of Santiago de Chile transport system ( Transantiago ) we analyse choice from the perspective of affects and emotions and examine the way in which certain decisions by users are temporally and empirically stabilized and constructed. Additionally, through this reflection we explore an aspect that is relatively undocumented in Science and Technology Studies (STS) about infrastructures, concerning the role played by affects and emotions in the way certain urban structures and technologies are used and appropriated.

This article examines how the practices of street vendors in contemporary Santiago relate to changes in their identities, which have been reconfigured along with city’s form and organization under the capitalist economic system. It explores the way street sellers adapt their working practices to a new understanding of their work as maximizing economic returns over all else. As part of this process, they display diverse spatial techniques (to circumvent increased policing, for example), use infrastructure and traffic flow changes for their own purposes, and adapt their public images and organization to the modernization of the transport system. On the basis of ethnographical observation, this article argues that the practices of street selling in Santiago have acquired particular traits from the interrelations between specific elements: The sellers develop skills and attitudes pertaining to the flexible labor economy, such as the ability to adapt to new enterprises and individual ambition, and that these new dispositions reconfigure their identities.