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Objectives Tuberculosis (TB) is the most common opportunistic infection and cause of mortality among people living with HIV, and it is possible that it may also influence the evolution of the HIV infection. We assessed the differences between HIV-positive and -negative people infected with TB. Methods The present study is a cross-sectional retrospective study by electronic record revision. We included patients admitted to a tertiary hospital with a diagnosis of TB between 2011 and 2016, comparing those with HIV coinfection with non-HIV patients, according to demographic and clinical characteristics. Results This study included 591 patients, of whom 32% were HIV-coinfected. HIV-TB patients were younger, with a predominance of male gender. Considering TB risk factors, there was a higher prevalence of homelessness and intravenous drug use in the HIV group. In the non-HIV group, direct contact with other patients with TB and immunosuppression were more prevalent. Relative to TB characteristics, the HIV-coinfected group presents with a higher prevalence of disseminated disease and a higher occurrence of previous TB infection. Cancer was the most frequent cause of immunosuppression in the HIV group and the number testing positive for TB via microbiological culture was lower. Assessment of microbiological resistance and in-hospital mortality showed similar numbers in both groups. Conclusions There are few papers comparing clinical course of TB between HIV-infected and non-infected patients. Our study differs from others in the literature as we focused on a country with middling incidence of TB and further characterized the differences between HIV-infected and non-infected patients which can contribute to the management of these patients.

Background/purpose Despite effectiveness and favourable safety profile, antimalarials have the potential to cause irreversible macular retinopathy. Screening methods have evolved over the last decade and the optimal dose of hydroxychloroquine (HCQ) is now set at under 5 mg/kg real body weight. HCQ in Portugal comes only as a 400 mg pill and in 10 pills per package, which is neither friendly for optimising safe dosing nor for promoting compliance. This study aims to test the frequency of retinal hydroxychloroquine toxicity in a single-centre cohort. Methods Cross-sectional study conducted between January-2016 and May-2017, of a convenience sample of chronically compliant and well characterised patients. The screening strategy consisted of automated threshold visual fields and objective test: spectral-domain optical coherence tomography, fundus autofluorescence and multifocal electroretinogram. Toxicity was diagnosed on the basis of compatible visual fields defects together with at least one positive objective test. Univariate statistical analysis was performed using the Wilcoxon Mann-Whitney (WMW) and Chi-Square (CS) tests for non-parametric distributed data. Results Of the 62 patients screened, 32 (51%) had no prior ophthalmological examination. Median age was 46 years (y), IQR 37–60; range 27–83; 59 (95%) were female; the majority, 28 (45%) took HCQ due to SLE, 4 (6%) for Sjogren syndrome, 12 (19%) for UCTD, 11 (18%) for incomplete/cutaneous forms of lupus and 7 (11%) for other CTD. No patient had concomitant renal or liver disease. Median duration and cumulative dose were respectively 8 y (IQR 3–12; range 0.4–31) and 1168 g (IQR 584–2044; range 36–8760). Retinal toxicity was confirmed in 6 SLE and 1 non-SLE patient; in all HCQ was stopped (2/7 screen-naive; 1/7 on tamoxifen; 1/7 with visual loss). Toxicity correlated to disease (p=0,003) and HCQ therapy (p=0,002) duration, cumulative HCQ dose (p=0,001) and SLE (p=0,04). Table 1 dose adjustments were performed in 13 patients. Conclusion Using a standardised referral protocol for HCQ retinopathy screening led to cessation of therapy due to toxicity (11%) and adjustment of daily dosing (21%). This study highlights that regular adjustment of dose and retinal toxicity screening is mandatory in patients on prolonged HCQ therapy and reinforces lobbying for more flexible dosages. In addition, HCQ toxicity raises the need for alternative therapies in patients with CTD.

Background Portugal has one of the highest prevalence and incidence of tuberculosis (TB) and latent TB (LTB) in Western Europe 1 . Screening and treatment is performed in Centers for Diagnosis of Chest Pathology (CDP), specifically designated by the Health Authority. Biological Therapy (BT) for Systemic Autoimmune Diseases (SAID) has been associated with an increased reactivation of TB 2 and national 3 and international 4 guidelines recommend LTB screening before therapy onset, a practice that has been followed in our Unit since 2001, when the first patient started BT. The most recent American College of Rheumatology guidelines recommend that patients with negative baseline screening should be re-screened annually 4 . Methods The aim of our study was to capture and treat LTB infections in all patients undergoing current biological treatment for SAID in our Unit. We conducted a prospective study by sending the patients a letter of referral to the CDP, requesting TB re-screening, to be followed by therapy if required. The letter explained to the patient the need for referral and contained clinical information for the CDP. Six months later, medical records were reviewed and patients were contacted telephonically when clinical information was absent or insufficient. Screening intent involved the following: 52 patients with Rheumatoid Arthritis (RA), 26 with Ankylosing Spondylitis (AS), 16 with Psoriatic Arthritis (PA), 4 with Inflammatory Bowel Disease (IBD) and 2 Seronegative Spondyloarthropathies (SS). Demographic characteristics were as follows: RA: F:M=42:10, x age 59 y, x disease duration 12 y; x BT for 4.9 y. AS:F:M=10:16, x age 47 y, x disease duration 11 y, x BT for 5.5 y; PA: F:M=8;8, x age 55 y, x disease duration 14 y, x BT for 6.9 y; IBD: F:M=3:1, x age 47 y, x disease duration 7.5 y and x BT for 3.75 y. The SS group consisted of 2 females; x age 51 y, x disease duration 8.5 y, x BT for 4 y. BT mostly consisted of infliximab, etanercept, adalimumab or tocilizumab; 12 RA patients were on Rituximab on demand. Before BT onset, 14/52 patients with RA, 4/26 with AS and 1/16 with PA had a history of treated tuberculosis. Results Only 36 out of 100 patients were screened at the CDP as a result of our study: 23 received the letter but did not read it, 19 did not receive the letter for several reasons, 3 refused to schedule but 9 promised to schedule the appointment after the telephone contact, 8 already had their follow-up appointment at the CDP within the past year, 1 had a future appointment scheduled and 1 had to suspend the biological agent shortly after receiving the letter. Screening was performed in 9 patients with RA, 18 with AS, 6 with PA, 2 with IBD, 1 in the SS group. Overall, 16 of 36 screened patients required LTB therapy, interrupting BT/the next cycle in the first month of LTB treatment (3 with AR, 10 with AS, 2 with PA and 1 with IBD). Conclusions LTB is an important problem in our patient population under BT. Our study emphasizes the need for systematic re-screening of these patients and the development of more accessible screening mechanisms. References European Centre for Disease Prevention and Control/WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2013. Arthritis Rheum. 2003;48:2122-7. Acta Reumatol Port. 2008;33:77-85. Arthritis Care Res 2012;64:625–39. Disclosure of Interest None declared

according to gender, age, seropositive RA, DAS28, mean disease duration, use of BMR, type and onset of primary malignancy. Results: Of the n= 155 pts with RA, n = 57 were receiving a biological agent. Of these n= 38 pts were female, with an average age of 55.37 years, a mean disease duration of 9.35 years andmean duration of BMR use of 3.6 years. The mean DAS28 was 5.9 and after BMR use 3.1. The n= 6 pts with neoplasia had an average age of 67.33 years (only n= 1 pt b65 years), a mean disease duration of 11.83 years; a mean duration of BMR use of 5.2 years (etanercept n= 3 pts, rituximab n= 2 pts and adalimumab n= 1 pt). The mean DAS28 was 5.3 and after BMR use 3.0. Neoplasia onset was previous to the use of a BMR in n= 2 pts (12 and 15 years), of which ovary n= 1 pt, breast and cervix n= 1 pt, there were no recurrences; in n= 4 pts the neoplasia occurred after the use of BMR (3, 4, 5 and 7 years), of which skin n= 2, breast n = 1 and prostate n= 1. None of the pts died, but n= 1 suspended BMR. Of the n= 108 pts under traditional DMARDs, n= 13 had the diagnosis of malignant diseasewith themean age of 61.54 years and n= 6 of themhad it before the diagnosis of RA. The remaining n= 7had the diagnosis of neoplasia a mean of 11.43 years after the diagnosis of RA. The types of primary neoplasia were gynecological n = 4, gastrointestinal tract n= 3, breast n = 2, leukemia n= 1, lung n= 1, kidney n= 1 and prostate n= 1. Conclusions: In our sample, the pts with malignancy were older, with a longer mean duration of a BMR use and similar DAS28 to all of the pts with RA. However, pts with RA without BMR have a lower age of onset and the distribution between the types of primary neoplasia is slightly different, which might be explained by the therapy's antiinflammatory effects in some malignancies vs. immunosuppression in others.