Search

ObjectivesHIV outcomes centre primarily around clinical markers with limited focus on patient-reported outcomes. With a global trend towards capturing the outcomes that matter most to patients, there is agreement that standardizing the definition of value in HIV care is key to their incorporation. This study aims to address the lack of routine, standardized data in HIV care.MethodsAn international working group (WG) of 37 experts and patients, and a steering group (SG) of 18 experts were convened from 14 countries. The project team (PT) identified outcomes by conducting a literature review, screening 1979 articles and reviewing the full texts of 547 of these articles. Semi-structured interviews and advisory groups were performed with the WG, SG and people living with HIV to add to the list of potentially relevant outcomes. The WG voted via a modified Delphi process - informed by six Zoom calls - to establish a core set of outcomes for use in clinical practice.ResultsFrom 156 identified outcomes, consensus was reached to include three patient-reported outcomes, four clinician-reported measures and one administratively reported outcome; standardized measures were included. The WG also reached agreement to measure 22 risk-adjustment variables. This outcome set can be applied to any person living with HIV aged > 18 years.ConclusionsAdoption of the HIV360 outcome set will enable healthcare providers to record, compare and integrate standardized metrics across treatment sites to drive quality improvement in HIV care.

BackgroundLittle is known about the influence of ongoing barriers to care in the persistence of hepatitis C virus (HCV) viremia after treatment with direct-acting antivirals (DAAs) among people living with human immunodeficiency virus (PLWH).MethodsWe conducted a retrospective cohort analysis of PLWH treated through the standard of care in 3 Western countries, to investigate the predictors of HCV treatment failure (clinical or virologic), defined as having a detectable serum HCV ribonucleic acid within 12 weeks after DAA discontinuation. In addition to HCV and liver-related predictors, we collected data on ongoing illicit drug use, alcohol abuse, mental illness, and unstable housing. Logistic regression analyses were used to identify predictors of HCV treatment failure.ResultsBetween January 2014 and December 2017, 784 PLWH were treated with DAA, 7% (n = 55) of whom failed HCV therapy: 50.9% (n = 28) had a clinical failure (discontinued DAA therapy prematurely, died, or were lost to follow-up), 47.3% (n = 26) had an HCV virologic failure, and 1 (1.8%) was reinfected with HCV. Ongoing drug use (odds ratio [OR] = 2.60) and mental illness (OR = 2.85) were independent predictors of any HCV treatment failure. Having both present explained 20% of the risk of any HCV treatment failure due to their interaction (OR = 7.47; P < .0001). Predictors of HCV virologic failure were ongoing illicit drug use (OR = 2.75) and advanced liver fibrosis (OR = 2.29).ConclusionsPeople living with human immunodeficiency virus with ongoing illicit drug use, mental illness, and advanced liver fibrosis might benefit from enhanced DAA treatment strategies to reduce the risk of HCV treatment failure.

On May 23-24, 2024, the 1st Spanish Conference on Genomic Medicine convened in Madrid, Spain. An international and multidisciplinary group of experts gathered to discuss the current state and prospects of genomic medicine in the Spanish-speaking world. There were 278 attendees from Latin America, US, UK, Germany, and Spain, and the topics covered included rare diseases, genome medicine in national health systems (NHS), artificial intelligence, and commercial development ventures. One particular area of attention was our still sketchy understanding of genome variants. This is evidenced by the fact that many diagnoses in rare diseases continue to yield odysseys that take years, with up to 50% of cases that may go undiagnosed. Since a lot of the genome remains to poorly understood, as new technologies such as long read sequencing become more ubiquitous and cheaper, it is expected that current gaps in genome references will improve. However, disparities within the NHS suggest that advancements do not necessarily rely on resources but the appropriate regulation and pathways for education of professionals being properly implemented. This is where Genomics England can be a clinical genomic implementation example for routine health care. Ethical challenges, including privacy, informed consent, equity, representation, and genetic discrimination, also require the need for robust legal frameworks and culturally sensitive practices. The future of genomics in Spanish-speaking countries depends on addressing all of these issues. By navigating these challenges responsibly, Spanish-speaking countries can harness the power of genomics to improve health outcomes and advance scientific knowledge, ensuring that the benefits of personalized medicine are realized in an inclusive and equitable manner. [ABSTRACT FROM AUTHOR]

BackgroundOne of the more clinically relevant co-morbidities in HIV-infected patients is the development of progressive liver disease due to hepatitis B virus (HBV) or hepatitis C virus (HCV). In addition, hepatotoxicity has been observed with prolonged use of antiretroviral agents.ObjectiveTo evaluate the hepatic safety of maraviroc in combination with other antiretroviral agents in HIV-1-infected subjects co-infected with HCV and/or HBV.MethodsIn this 148-week randomized, double-blind, placebo-controlled, multicentre study (NCT01327547), subjects received maraviroc twice daily (n = 70) or placebo (n = 67) in combination with other antiretroviral agents.Primary endpointthe percentage at week 48 of subjects with Grade 3 and Grade 4 ALT abnormalities, defined as >5 ×  upper limit of normal (ULN) if baseline ALT ≤ ULN or >3.5 ×  baseline if baseline ALT>ULN in the maraviroc versus the placebo arm.ResultsAt week 48, one subject in each group had met the primary endpoint definition. No subjects met protocol-defined liver stopping criteria and there were no cases of Hy's law or treatment-related hepatobiliary serious adverse events. No significant difference in change from baseline in enhanced liver fibrosis or hepatic elastography was observed between groups. Treatment-related hepatobiliary adverse events were reported in one and two subjects receiving maraviroc and placebo, respectively; discontinuations due to treatment-related AEs occurred in four and two subjects receiving maraviroc and placebo, respectively; two deaths were reported in the placebo group.ConclusionsThe use of maraviroc does not increase hepatotoxicity in HIV-1-infected subjects co-infected with HCV and/or HBV through 48 weeks of treatment.

The creation of the universe out of nothing (ex nihilo) is attributable to the eternal God. Would a direct divine intervention be needed for other singular events, such as the origin of life? Taking apart the human being, created to image and resemblance of God, we argue that current scientific knowledge allows us to rationally admit a continuity between the origins of the universe and the emergence of life on Earth. Although the irruption of living beings from inert matter is a leap or discontinuity in creation, a direct intervention of God would not be indispensable. The initial impulse of creation, with matter and energy in a space-time imbalance, could have triggered reactions between the different elements and a self-organization of metabolites, in accordance with natural physical-chemistry laws. This paradoxical increase of complexity ended with a transition from chemistry to biology. It happened when independence, metabolism, heritability, and life cycle took place in a protocellular unit. In this way, the emergence of life on earth could be part of an evolutionary dynamic of the timeless God's creative act. [ABSTRACT FROM AUTHOR]