HIV Drug Therapy in the Americas 16–18 April 2015, Mexico City, Mexico

Antiretroviral therapies have proved life‐saving in HIV infection, dramatically reducing morbidity and mortality. With longer survival, morbidities and mortalities in HIV infection are increasingly similar to the morbidities and mortalities associated with ageing. In treated HIV infection, the risk of these morbidities and mortalities is linked to immune activation, inflammation and coagulation indices. And in persons with treated HIV infection, failure to restore circulating CD4 T cell numbers is associated with a greater risk of morbidities and mortalities as well as to heightened levels of inflammation and coagulation. The drivers of immune activation, inflammation and coagulation in treated HIV infection are incompletely defined and could be related to sustained low levels of viral replication in tissues, to translocation of microbial products across a damaged gut mucosa, to replication of co‐pathogens such as cytomegalovirus, to increased levels of inflammatory lipids, or to homeostatic responses to lymphocytopenia that may drive expansion of CD8 T cell numbers. We present here models that link inflammation and coagulation to morbid outcomes as well as to the pathogenesis of CD4 T cell restoration failure and CD8 T cell expansion.


IMMUNE ACTIVATION
geographic regions: Western Europe and Canada, LA, Central/Eastern Europe and Asia. Eligible women completed self-administered Barriers to Access to Care Scale (BACS) and other health status questionnaires. Patients rated each of the 12 BACS items using a four-point Likert scale (10''No problem at all'' to 40''Major problem''). Questionnaires with ]6 items completed were included in the analysis, mean score !2.0 was considered a significant barrier to access to care.
Results: A total of 519 women participated in ELLA from the LA region (total N01922). For these women, mean age was 42.2 years and 96.7% acquired HIV through sexual contact. A total of 54.4% had been diagnosed with HIV !5 years and 87.3% were currently on ART. Recent CD4 count was !500/mm 3 in 48%, and most recent viral load was B50 c/ml in 52.2%. More than 8 years formal education was reported by 69.3%, 45.9% lived with a partner/husband, and 55.3% were employed. Mean overall BACS score was 2.2 across all 12 individual items. Highest barriers to access to care were related to community stigma (mean score 3.1), lack of personal resources (mean score 2.5). Women had an average of 1.9 children (range 0Á12) with 17% indicating a desire to have more children (32% in women B35 years). Birth control strategies were mainly based on female surgery ( Despite the advance that highly active antiretroviral therapy (HAART) represents for the prognosis of HIV infection, opportunistic infections (OIs) continue to be a significant cause of morbidity and mortality in HIV-positive patients. Lack of access, late diagnosis, leaks in the HIV cascade of care, lack of treatment adherence and failure put patients at risk of developing OIs and dying from AIDS. Nevertheless, HAART introduced changes in the prevalence of some IOs. Currently, the frequency of severe cytomegalovirus (CMV) retinal disease, Mycobacterium avium-intracellulare (MAI) and latent membrane protein (LMP) is lower than in the early years of the epidemic. Pneumocystis jiroveci, tuberculosis and toxoplasmic encephalitis are the most common opportunistic infections. Disseminated mycoses are very frequent in the region, for example, in countries such as Brazil or Colombia, cryptococcal meningitis is even more frequent than toxoplasmic encephalitis. Some diseases are limited to our continent. This is the case of Histoplasmosis, whose diagnosis might be difficult in areas where urinary antigen is not available. The diagnosis and management of Chagas disease, a parasitic disease endemic only in Latin America, might be also challenging. Viral infections are more frequent in HIV-positive patients (HAV, HBV, HCV, HPV, CMV and herpes). Some can be easily prevented through vaccines (HAV, HBV, HPV), and some are associated with the development of cancer (HBV, HPV, HHV8, EBV). Finally, an increased trend in sexually transmitted diseases is being observed among HIV-positive individuals. A summary of the current status of the most frequent infections and guidance on the diagnostic, specific treatment and antiretroviral treatment will be presented. The global epidemics of tuberculosis and HIV are closely linked. Among persons with latent Mycobacterium tuberculosis infection, HIV is the strongest risk factor for progressing to active, infectious tuberculosis. Although antiretroviral therapy substantially decreases the risk of developing tuberculosis, it may also unmask previously unrecognized tuberculosis in the setting of immune reconstitution. Concomitant treatment of tuberculosis and HIV can be complicated by drug-drug interactions and immune reconstitution inflammatory syndrome (IRIS). The timing of antiretroviral therapy initiation in relation to initiation of anti-tuberculosis therapy is also important. Treatment of latent M. tuberculosis infection in HIV-infected persons decreases tuberculosis risk in addition to the benefit provided by antiretroviral therapy, though the optimal duration of preventive therapy may vary according to local tuberculosis incidence. Introduction: Since 2009, earlier initiation of highly active antiretroviral therapy (HAART) after an opportunistic infection (OI) has been recommended based on lower risks of death and AIDS-related progression found in clinical trials. Delay in HAART initiation after OIs may be an important barrier to successful outcomes in patients with advanced disease. Timing of HAART initiation after an OI in ''real life'' settings in Latin America has not been evaluated. Methods: All CCASAnet patients !18 years of age at enrolment, from 2001 to 2013, who had an OI before HAART initiation were included. Patients were divided in an Early HAART group (those initiating within four weeks of an OI) and a Delayed HAART group those initiating more than four weeks after an OI. Patients with cancer or cryptococcal infection were excluded. Patients with more than one OI were included using the first OI reported only. Calendar trends in the proportion of patients in the Early HAART group (before and after 2009) were estimated by site and for the whole cohort. Factors associated with Early HAART initiation were estimated with logistic regression.
Results: A total of 20,148 patients were included; 1558 patients had an OI before HAART initiation and were included in the analysis: 207 from Argentina, 746 from Brazil, 322 from Chile, 112 from Honduras and 171 from Mexico. The proportion of patients who started treatment within four weeks of the OI was statistically different between sites (pB0.001).
Median time since all OIs and non-TB OIs to HAART initiation decreased from 41 (IQR: 20Á85) days before 2009 to 30 (IQR: 14Á50) after 2009 ( Figure 1). Factors associated with Early HAART group were CD4' at HAART initiation B200 cell/mm 3 (pB0.001), non-tuberculosis OI (pB0.001), site and year of initiation (before 2009; pB0.001). Discussion: The time from diagnosis of an OI to HAART initiation has decreased in this Latin American Cohort coinciding with the publication of evidence of its benefit. We found important heterogeneity between sites which may reflect differences in clinical practices, local guidelines and access to HAART. The impact of the timing of HAART initiation after OI on patient survival on this ''real life'' context needs further evaluation.

O212
Long term outcomes (10 years) of a cohort of AIDS patients on ART in Haiti of their last visit. Median age for the entire cohort was 38 years old (IQT 32Á45); 54% were females; the median entry CD4 counts was 130/mm 3 (51Á217); and 40% had AIDS by WHO criteria. The overall probability of survival at one year, five years and ten years was respectively 82, 72 and 50%. Mortality was 23% during the period. It was highest during the first three months and lowest from 5 to 10 years. The lost to follow-up rate during the 10-year period was 15% and was more evenly distributed. Factors associated with mortality and lost to follow-up will be presented. HIV infection is rapidly becoming an affliction of older individuals. It is estimated that sometime in 2015, over 50% of HIV-positive individuals in the United States will be over 50 years of age, and this phenomenon is occurring all over the world. It is a function of both patients living longer and older individuals becoming infected more frequently than in the past. Multiple factors are associated with the widely held misconception by the general public and healthcare workers that HIV continues to be a disease of younger people. Thus, more aggressive efforts need to be directed at testing, diagnosing and bringing into care older patients. However, we also need to develop more effective educational messages for those uninfected but at-risk individuals who mistakenly assume that they are protected from HIV infection because they are ''old.'' With this ageing of the population, it is becoming clear that specific challenges have arisen. While older patients frequently exhibit better adherence to antiretroviral therapy and respond quite well to it, their immune recovery is slower, they are at higher risk of progressing to AIDS and their mortality is higher. In addition to this, the normal ageing process seems to be accelerated by HIV infection itself, and it has become clear that the morbidities associated with advancing age are both more frequent and advance faster than in non-infected, age-matched individuals. Thus, more effective screening, prevention and management programs are needed for cardiovascular, metabolic, neurocognitive, renal, hepatic, hematologic and oncologic diseases of an ageing HIV-positive population. Overall, using intent-to-treat (ITT), all regimens were of similar efficacy but if switching for tolerability or toxicity was taken into account, then raltegravir was better than the boosted proteases. Nucleoside-free or -limiting approaches were also prominent with the 96-week data from NEAT 001 study of darunavir and ritonavir plus either raltegravir or nukes. The combination did not perform well when the CD4 was B200 cells/mm. The 48-week GARDEL study of the two drug regimen of lopinavir and ritonavir plus lamivudine showed similar efficacy as triple therapy. This same nukelimiting strategy was used in maintenance treatment with the SALT study, atazanavir and ritonavir plus lamivudine and the open label extension (OLE) study of lopinavir and ritonavir plus lamivudine. A nearly twofold increased risk for suicidality in efavirenz-treated patients was found by a post hoc analysis of several ACTG studies which has not been seen in the cohort studies. More controversy has been fuelled by the recent North American-AIDS Cohort Collaboration on Research and Design (NA-ACCORD) data linking abacavir and myocardial infarct although the most restricted analysis was statistically nonsignificant. Interferon-free therapy for hepatitis C is becoming a reality with different combinations of oral drugs such as sofosbuvir plus simeprevir or with ledipasvir or the Abbvie triple combination. The issues still remain regarding cost as well as how to treat the most difficult patients. The big opportunistic infection (OI) trial was the COAT study confirming that early HIV treatment was associated with a worse outcome in cryptococcal meningitis. Finally cure Á only one patient has been cured of HIV the others who were thought to have been, the Boston two stem cell transplant patients and the Mississippi baby Á all relapsed. A TLR7 agonist is going into human trials so the field is moving slowly forward. Introduction: Countries in the Americas committed to eliminating mother to child transmission (MTCT) of HIV and syphilis by 2015. Ambitious goals were set for virtual elimination of both conditions by 2015 through a robust public health approach. The Pan American Health Organization (PAHO) monitors country and regional progress towards elimination. The analysis presented may assist policy-makers and healthcare workers in their efforts to achieve elimination of MTCT of HIV and syphilis in the Americas. Methods: The presentation will summarize progress towards elimination goals from 2010, using data reported by countries to PAHO on sexual and reproductive health, policies and provision of services, and outcomes regarding paediatric HIV and congenital syphilis cases in the Americas.
Results: The coverage of HIV testing among pregnant women in Latin America and the Caribbean has increased from 62% in 2010 to 74% in 2013, and the estimated coverage of ARV coverage among HIV-positive pregnant women has increased from 59% in 2010 to 93% in 2013. The calculated regional vertical HIV transmission rate has decreased from 18% (14Á25%) in 2010 to 5% (2Á23%) in 2013. Progress in the area of syphilis has been less pronounced, with the coverage of syphilis testing among pregnant women remaining stable in 20 reporting countries at around 80%. Syphilis treatment coverage for pregnant women remains largely unreported. Based on 2013 data, at least seven countries and territories may have achieved the dual EMTCT targets, with at least another eight approaching the targets. Around 21 countries had insufficient information to ascertain progress, of which several may also have achieved dual elimination.
Conclusions: The progress in the region of the Americas illustrates how political and programmatic efforts can result in rapid progress and major public health gains. Cirrhosis, n (%) 22 (10) 2 (4) 6 (20) 6 (14) 3 (5) 29 (44) 8 (26) Log 10 HCV RNA (IU/mL), mean (SD) 6.5 (0.8) 6.6 (0.6) 6.5 (0.8) 6.6 (0.6) 6.3 (0.7) 6.3 (0.7) 5.9 (0.9) CD4 T-cell count (cells/mL), mean (SD) 632 (  The number of patients receiving care at Clínica Especializada Condesa increased from 3870 to 10,064 in 2008Á2014. The time from access to care to ART initiation decreased from four months to two weeks. The median time to achieve undetectable HIV-VL after ART initiation decreased from 8.2 to 3.3 months in 2008 to 2012. The programme now provides services for inmates, male and female sex street-workers, people living in the street, drug users and juvenile detainees and also provides specialized clinical care for trans-gender women, acutely HIV-positive patients, STDs, and reproductive and sexual health services for teenagers and sexual violence victims. Conclusions: Mexico City HIV/AIDS Programme has implemented a multi-disciplinary approach for the prevention and control of the HIV-epidemic in an urban context in a middle-income country. The continuum between preventive, clinical care and supportive services and the cooperation of federal and local government instances with civil society organizations have been paramount for the programme's success. Introduction: Optimal adherence is critical to achieve the benefits of the antiretroviral (ARV) treatment and minimizes the risk of ARV resistance. Multiple aspects are involved in adherence in children and adolescents. Although, published evidence about strategies to improve it is scarce in our setting [1Á3]. The aim of this study is to evaluate the effects on adherence to ARV treatment using mobile devices as a communication strategy to improve it. Materials and methods: A prospective study was conducted in a cohort of HIV infected patients less than 25 years old. Patients taking ARV were evaluated to establish suboptimal adherence (SOA). Inclusion criteria were: HIV infection, taking ARV, viral load (VL) !1000 copies/ml, SOA reported by the primary physician, use of a mobile device. The intervention was based on mobile generic contact twice a month through any of the applications the patient chose (WhatsApp, Facebook, text message, etc.) during an eight month period. If the patient or parent required additional information, a feedback phone contact was generated. VL was performed before and after the intervention as an outcome measure of adherence.
Results: Twenty-five of forty-seven patients identified as SOA were able to be contacted. One refused to participate and two have no mobile. Twenty-two patients were enrolled. Median age was 17.2 years old (range: 6Á25); 15 (68%) were female; median baseline VL was 25,100 copies/ml (range: 500,000Á1020 copies/ml), median log was 4.3 log (range: 3Á5.7 log). Seven of twenty-two were contacted through their parents. Ten (45%) preferred to be contacted by WhatsApp, 8 (36%) by text message, 4 (18%) by Facebook and others. Each participant received a total of 16 contacts, 84% (296) were answered by the patient. Sixty-five percent (189)  Introduction: Chikungunya virus (CHIKV) is an alpha virus causing acute febrile illness characterized by crippling arthralgia [1], and a disseminated rash [2]. First recognized in 1953 in East Africa, CHIKV has been spread over the world due to the expansion of Aedes mosquitoes within warm countries [3]. CHIKV is an emerging disease in The Americas after the first cases were recognized in the lesser islands of the Caribbean [4] known as the Lesser Antilles. Immune modulatory response to CHIKV infection appears to be T lymphocyte and macrophage-mediated [5], which is the same for long-lasting chronic arthralgia in immunosuppressed and immune deprived individuals [4]. People living with HIV are included among the highrisk populations for atypical clinical manifestations of CHIKV infection [1]. Introduction: By April 2013, the first autochthonous transmission of chikungunya virus (CHIKV) in the Dominican Republic was confirmed [1]. A total of 537,628 suspected cases were recorded by EW51 in 2014, and 84 confirmed cases [2]. According to the PAHO/WHO a confirmed case is a suspected case with any specific CHIK test (viral isolation, RT-PCR, IgM or four-fold increase of CHIKV specific antibodies titters) [3]. The objective of this study was to measure the presence of IgM-specific neutralizing antibodies among HIV-positive individuals after clinical onset of symptoms during the last outbreak in the Dominican Republic. Materials and methods: During the peak of incidence of cases, patients attending an outpatient clinic for HIV-positive individuals in Santo Domingo with signs and symptoms suggestive of CHIKV infection (fever !388C, severe arthralgia or arthritis) were asked to participate in this study. After informed consent was collected a blood sample was obtained for CHIKV-IgM detection and analyzed using reagents provided by Aria CHIKV IgM detection (CTK Biotech, CA).
Results: A total of 100 cases were tested. Women represented 73% (n 037), while men represented 27% (n 014). The immunological status in HIV positive was measured with the level of CD4' T cells at the moment of onset of symptoms; 76.4% (n 039) having greater than 350 cells/ml, followed by 19.6% (n 010) with 101Á350 cells/ml. HIV viral load was undetected in 74.5% (n038) of the sample, and 11.7% (n 06) with a VL !50,000 copies/ml. CHIKV-IgM detection in HIV(') was positive in 21.57% (n 011), and 30.61% in HIV(Á). First positive IgM detection in HIV(Á) was observed after one month of onset of symptoms; while in HIV(') was 2w 1d ( Figure 1 and Table 1 (Figure 1). Twenty-one percent (60) initiated HAART in the previous six months, 5.2% (10) initiated their HAART protocol, in virology failure 2.1% (4), 1% (2) with persistent low grade viraemia (VL B1000) and 2.1% (4)  Introduction: We test conditional economic incentives (CEI) to motivate self-protection and health-care-seeking behaviours among male sex workers (MSW) in Mexico City. We present baseline and follow-up results for MSW, aged 18Á30, recruited in Mexico City (n 0227). Materials and methods: Participants were randomized into four groups. In Treatment 1 (n 057) participants received a medium CEI ( Â$50 USD/each time) only if they were free of new, curable STIs at months 6 and 12. Treatment 2 (n 053) received a high CEI ( Â$75 USD/each time) only if they were free of new, curable STIs at months 6 and 12. Controls (n 061) did not receive any incentives even if they were free of STIs at months 6 and 12. Participants in the unconditional economic incentive (UEI) arm (n056) received a medium incentive ( Â$50 USD at months 6 and 12) regardless of STI status. In addition, everyone received inconvenience fees ( Â$10 USD/each time at baseline, month 6 and month 12). We recruited from various sites in Mexico City. All eligible men took part in a standard one-hour HIV education/information session after completing baseline measures, and before random assignment. All received HIV/STI testing; those infected were offered treatment (for curable STI). Chronic STIs were not used for the conditional incentives. Any participant that was HIV' was allowed to continue in the trial and was referred to treatment as indicated by Mexico guidelines. Unadjusted and adjusted models were estimated with random effects and robust standard errors; and interactions that can modify the effect of the incentives. Results: Higher incentives were associated with higher participation rates. Introduction: Early diagnosis of HIV infection is crucial for early treatment, which can lead to better individual prognosis and some benefits in public health, such as reduction of the HIV transmission.
One of the proposed strategies to improve the opportunity of early diagnosis is to widespread the HIV screening to different settings, including health care units. It has been shown that routine HIV screening could be justified in cost-effectiveness terms in settings where the prevalence of undiagnosed HIV is 0.1% or greater. The aim of the present study was to determine the prevalence of undiagnosed HIV infection at the emergency room in a city considered to have a low prevalence of HIV in its population [1Á5]. Materials and methods: A cross-sectional study was performed at the Hospital General Regional de Leon (HGRL). Leon is the biggest city in Guanajuato, which is located at the centre in Mexico and is considered one of the states with lowest prevalence of HIV in the country. During a 10-month period, HIV rapid testing was offered to all patients attended in the emergency room area, counselling was given to all patients and those who accepted to participate signed an informed consent. Patients were excluded from HIV testing if they (1) were unable to provide consent for HIV testing as determined by the clinical staff (e.g. altered mental status or critical illness); (2) were detainees or prisoners; or (3)  Introduction: Violence and HIV are two problems of public health that affects millions of women worldwide [1]. At least one in three women worldwide has suffered physical, economic, sexual or psychological violence in their lifetime [2,3]. Belonging to the female gender increases the risk of receiving violence [4]. A history of violence has been associated with an increased risk for transmission/acquisition of HIV and poor medication adherence [5].

Materials and methods: Of the information collected between 2013 and 2014 amongst 1773 patients recently diagnosed with HIV Condesa
Specialized Clinic, 199 were women and transgender women. We asked for socio-demographic data, history of violence, the stage in life which the presented violence and perpetrators. STATAv13 was used. Frequencies and percentages of groups of women and transwomen were performed. Comparisons between the men, women and transgender were performed taking the history of violence, Chi 2 used for the OR.
Results: The 80.4% (n 0160) were women and 19.5% (n 039) were transgender women. In the group of women 46% (n 073) were single, average age 34 years (SD99.9), mean education 8.5 years (SD99.9), 47.5% (n 076) have a paid employment of these only 0.62% (n 01) is engaged in sex work. In the group of transgender women 92.3% (n 036) were single, average age 34 years (SD99.1), mean education 9.2 years (SD93.9), 92.3% (n 036) have gainful employment of these 30.7% (n012) were engaged in sex work. It was reported that 57.8% (n 0115) have a history of violence throughout the life of the patients, 46.8% (n 093) were female and 11% (n022) were transwomen (X 2 023.14, p 50.001). The 42% (n 039) of women with a history of violence reported that the main perpetrator of the violence was the couple and 19.3% (n 018) a family being the second most common. The 27.2% (n06) of women-trans reported that a relative had been the perpetrator and 18.1% (n 04) were family members. Women with a history of violence Introduction: Antiretroviral therapy (ART) has reduced morbidity and mortality related to human immunodeficiency virus (HIV) infection, but in spite of this advance, HIV mutations decrease antiretroviral susceptibility, thus contributing to treatment failure in patients [1]. Illicit drug users (DUs) are vulnerable to HIV and other blood-borne pathogens as a result of sharing contaminated syringes and other equipment [2]. In Piauí, there is a high prevalence of HIV-1 infection among DUs [3]. There is a paucity of information on the circulation of HIV-1 subtypes and the resistance to the primary drugs in this vulnerable group. We found a serologic evidence of Hepatitis C co-infection in 33%, the majority was genotype 1a and none received HCV treatment, moreover, the 8% of patients had serologic markers for hepatitis B. Regarding opportunistic infections; pulmonary tuberculosis was the most frequent (36%), followed by disseminated histoplasmosis (10%). The principal comorbidity was dyslipidaemia in 42 and 16% had metabolic syndrome. The 89% used to smoke daily, 76% used any kind of drug (principally, marijuana and cocaine) and 85% were alcohol consumers.
Conclusions: Efficiency of highly active antiretroviral therapy (HAART) among our prisons is higher compared to other cohorts [1]; however, the high frequency of comorbidities, smokers and drugs users, could increase the mortality and complicate HIV-infection by itself [2,3]; moreover, the high prevalence of HCV and HBV could be indicative of potentially risky blood-borne exposures or unprotected sexual contacts. So, new care strategies are needed for integral treatment of these patients.  (Table 1); no patients experienced virologic relapse between post-treatment week 12 and 24. Two patients in the 24-week treatment group had evidence of HCV re-infection by nucleotide sequence and phylogenetic analyses. The majority of adverse events (AEs) were mild or moderate, and no serious AE or discontinuations due to an AE were reported. The most common AEs were fatigue (48%), insomnia (19%) and nausea (18%). Elevation in total bilirubin was the most common laboratory abnormality, occurring predominantly in patients receiving atazanavir. No patient had a confirmed HIV-1 breakthrough ]200 copies/ml during treatment.

P010 HIV/STI prevalence and sociodemographic data in incarcerated female adolescents in Mexico City
Conclusions: In treatment-naïve and -experienced GT1 HCV/HIV-1 coinfected patients with or without cirrhosis, the high rates of virologic response and low rate of treatment discontinuation were consistent with those in HCV GT1-monoinfected populations receiving 3D'RBV. Introduction: The infection of the human papilloma virus (HPV) of high risk (HR) is a necessary factor for cervical lesions and invasive cervical cancer (ICC) [1]. In women with human immunodeficiency virus (HIV), HPV infections are more frequent with a higher risk of ICC [2,3]. Materials and methods: Learn the HPV (HR) and cervical lesions prevalence, describing the distribution of different genotypes, and the epidemiologic clinical characteristics of women co-infected with HIV and HPV (HR   Introduction: Tuberculosis (TB) continues to be a major cause of morbidity and mortality in HIV patients globally, and this is particularly true in Peru. Our objectives are to describe the frequency, clinical characteristics and outcomes of tuberculosis in HIV/TB co-infected patients at a tertiary care hospital in Lima, and compare these findings among patients receiving highly active antiretroviral therapy (HAART) chronically (Group 1), recently started (Group 2) and not receiving HAART (Group 3). Materials and methods: Retrospective review of medical records of HIV patients who developed TB during 2014 at Guillermo Almenara Hospital in Lima, Peru. Group 1 included patients receiving HAART for !180 days. Short-term mortality was defined as death during hospitalization or within 30 days post-discharge.
Results: There were 23 cases of TB during the period of study. Affected patients were 87% male with a mean age of 37.9 years and a mean CD4 count of 62. Thirteen cases were pulmonary (56.5%). Extra-pulmonary presentations (10/23, 43.5%) included one CNS involvement (4%), one gastro-intestinal disease (4%) and three multi-organ involvements (13.04%). Twenty-one diagnoses were confirmed microbiologically, 34.7% was MDR and one case was XDR. There were seven (30.4%) patients in Group 1,four (17.4%) in Group 2 Á one associated to immune reconstitution Á and 11 (47.8%) in Group 3 Á associated with recent HIV/AIDS diagnoses. Short-term mortality was significant only in Group 3 (27.3%). Time to TB diagnosis averaged 18.8 days, and diagnoses delays were related to complicated or atypical presentation or lack of access to microbiological confirmation. Conclusions: TB significantly affected HIV-positive patients. Shortterm mortality was high in patients not receiving HAART. Although a relatively low proportion of cases had microbiologically confirmed diagnoses, drug resistance was documented for a high number of cases and higher than other Latin-American countries. Introduction: Early diagnosis in HIV represents a public health issue. In spite of disease-awareness strategies and follow up in HIV patients, there is a large proportion of individuals that seek medical care in an advanced stage [1Á3]. The aim of the study was to determine the temporal trends observed of early diagnosis and the correlation with the number of HIV tests in the city of Leó n, Guanajuato, Mexico. Materials and methods: All newly diagnosed from 2005 to 2014, ARV naïve, non-insured HIV patients in Leó n, Mexico were included. Baseline CD4' counts were categorized into four groups: B200 CD4/ml, 201Á350 CD4/ml, 351Á500 CD4/ml and !500 CD4/ml (early diagnosis). To evaluate the proportion of patients in each category for the evaluated period and the number of HIV tests done for the period of 2008 to 2014 the X 2 test for trends was performed. The Pearson test was used to make a correlation between early diagnosis and the number of HIV tests. Results: Of 699 patients, 593 (85%) male were diagnosed during the study period. From 2005 to 2014, the proportion of late diagnosis decreased from a 64 to 31% (X 2 019.85, pB0.0001), the proportion of early diagnosis increased from 5 to a 44% (X 2 021.9, p B0.0001) in the same time period. There was an increase in the number of rapid HIV testing performed per year with a significant trend line (R 2 00.7685).
In the linear regression analysis there was a correlation within the number of the rapid HIV tests effectuated and the percentage of early diagnosis with a correlation coefficient of R 2 00.8258.
Conclusions: A significant increase in the proportion of early diagnosed HIV patients was observed during the study period in the city of Leó n. A strong correlation was found with the increment of the HIV testing during the same years suggesting widespread testing may have an effect on the clinical stage at presentation.
of Molecular Biology Dinamica IPS Colombia (June 2011 to October 2014). For genotype sequences RT-PR of HIV-1, the TRUGENE HIV-1 Genotyping Assay (Siemens) using the DNA GeneObjects Sequencing System 4.1 software was used [2]. For analysis of HIV-1 subtypes and their CRFs the software of the National Center for Biotechnology Information (NCBI) was employed, using the database Genotyping Reference Dataset (Human Immunodeficiency Virus (HIV-1)) ''pure'' & CRFs 2005 [3]. The subtypes and recombinant forms were confirmed using the REGA HIV-1 Subtyping Tool software [4,5]. Results: We genotyped and analyzed a total of 301 samples from HIV-1 positive Colombian patients, with failure to antiretroviral therapy. Geographical distribution of the samples: 23 ( Introduction: Histoplasmosis is the second most frequently diagnosed systemic fungal infection in Argentina. Among people living with HIV (PLWH) and low CD4 counts (i.e. B100 cells/mm 3 ), it presents as a disseminated disease. Microscopic examination and culture remain today as the reference methods for diagnosis. However, their sensitivity is limited and culture might take some weeks. In this context the detection of urinary antigen (UAg) for Histoplasma capsulatum might represent an important advance for the diagnosis.The goal of our study was to explore the aggregated value of the routine detection of UAg among HIV patients with advanced infection, without ARTor failing the current regimen. Materials and methods: Between April and December 2014, PLWH with 5100 CD4/ml on follow-up in a major public HIV centre in Buenos Aires, Argentina, underwent routine screening of UAg through of an antigen capture enzyme-linked immunosorbent assay (ELISA, IMMY). A cut-off of 0.5 units was considered positive for histoplasmosis. In addition, lysis-centrifugation fungal blood culture and antibodies detection using immunodiffusion were performed. For patients with skin lesions direct examination and culture were also performed.
Results: In total, 114 patients were included: 63.1% were male, the majority was currently off ART (78.9%) and the median CD4 count was 44 cells/ml (IQR 18Á81). With the standard algorithm, seven patients were diagnosed as having histoplasmosis (three had positive blood culture plus histopathological diagnosis, two had only histopathological diagnosis while the other two had only blood culture diagnosis). Only one sample had positive serology. Four additional patients were identified with UAg positive. Two of them were symptomatic and improved with itraconazole, the remaining two were lost to follow up. When we included UAg positive samples as cases the prevalence of histoplasmosis increased from 6.1 to 9.6%. Sensitivity, specificity, VPP and VPN were 71, 96, 63 and 98%, respectively. Conclusions: UAg increased the diagnosis rate of histoplasmosis and has higher sensitivity than other serological tests based on antibodies. These preliminary findings suggest that screening for histoplasmosis infection among PLWH and advanced disease in our setting might be an effective strategy to improve clinical care of PLWH.
http://dx.doi.org/10.7448/IAS.18. 3.20147 NEW TREATMENTS AND STRATEGIES P017 Low virologic failure on TDF/FTC/RPV in HIV-infected naïve and virologically suppressed patients with strict clinical selection and/or DNA genotyping Methods: OCEAN II is a prospective, two-centre observational study. From September 2012 to December 2013, all antiretroviral naïve patients with HIV RNA B100,000 copies/ml or wish to switch for simplification were considered for treatment with TDF/FTC/RPV. A systematic review of potential obstacles to TDF/FTC/RPV administration was undertaken, including food requirement, PPI coadministration, physician's issues regarding adherence, and in case of undetectable plasma HIV RNA, DNA genotyping to detect archived RPV and/or NRTI-associated resistance mutations. Results: TDF/FTC/RPV was discussed in 498 patients: TDF/FTC/RPV was not offered to 194 patients (39%), mainly for NNRTI or NRTI resistance on genotypic testing (historical RNA or current proviral DNA) and/or history of virologic failure on dual NRTI therapy or NNRTI-containing regimen (n 055), issues on adherence (n 035), patient refusal to change their current regimen (n 031), difficulties to take treatment with meals (n 018) or concomitant PPI therapy Introduction: The introduction of highly active antiretroviral therapy (HAART) has significantly improved life expectancy on HIV-infected subjects and the population is becoming older. The CDC considers elderly HIV-patients at the age ]50 years due to the impact of HIV-infection per se and the use of antiretrovirals [1]. Information regarding the elderly-infected population is still limited. The aim of this study was to describe the profile in a cohort of patients ]50 years followed-up in a HIV-care at Guadalajara, Mexico. Materials and methods: Patients were retrospectively analyzed at the HIV-unit in Hospital Civil de Guadalajara. Patients ]50 years currently being followed-up at the site were included. Data were obtained from an electronic database. Significance level was established 55%.
Results: A total of 393 patients were included which represent the 17% of the total of patients currently followed-up at the site. Eightytwo percent were male, and age ranged from 50 to 90. Women have a higher Body Mass Index (BMI) than men and are mostly classified as pre-obesity. The 37% of patients were diagnosed at an age ]50 years, and age at diagnosis was higher in women (mean 47 vs 49, p 00.025), but, men were more likely to present with advancedstage (70% C stage); moreover, the 70% had a CD4-count nadir B200 cells/ml without gender differences. Overall, 88% of patients have virologic control, and although no statistically significant the percentage was higher in men, however, 8% of them remained with a CD4-count 5200 cells/ml (mean of 8.9 years on-HAART) compared to 5% of women (mean of 7.9 years on-HAART); we found two elitecontroller women (p 00.032).
Smoking index was higher in men (median 6 vs 1.4, p 00.004), and there was a higher prevalence of arterial hypertension and depression (31% vs 17% and 32% vs 13%, respectively), with a significant higher VACS index among women (median 28 vs 18, p00.003).
Conclusions: Contrary to the reports on young women, it seems that old women reached a good virologic response and immune reconstitution percentages as well as old men. The higher BMI and the association of the VACS Index to markers of chronic inflammation and hypercoagulability [2] may pose special risks for cardiovascular diseases on women and tobacco use and more advanced stages for men. Our population is young, but we need to do early intervention in modifiable cardiovascular risk factor. Conclusions: There was a significant fall in the mortality rate of the first and the last years of HIV infection as a result of more effective therapeutic use. The introduction of HAART has led to a change in the cause of death, with relative increase in mortality related with chronic hepatic disease, not opportunistic infections and tumours. Introduction: Mental disorders are more prevalent in people with HIV [1]. Having a mental disorder interferes with highly active antiretroviral therapy (HAART) adherence. Impulsivity and depressive symptoms have been reported in association with risky sexual behaviour and poor adherence to HAART in people with HIV [2,3]. The main objective of this study was to compare the level of impulsivity and depressive symptoms in a sample of HIV patients diagnosed with a common mental disorder. . After signing informed consent, participants completed the SIS and demographic data. The analysis of SIS psychometric properties was made using standard procedures: reliability with Cronbach's coefficient and the inter-item correlations to define the rotation method for the factor analysis. The item's lowest limit load to be included was 0.40. The factorial congruence between the two factorial loads (original version and this study) was tested with Wrigley and Nauhaus coefficient. The statistical analysis was performed in SPSS v. 20, considering pB0.01 significant [5].
Results: Internal consistency analysis obtained a mean Cronbach's alpha of 0.92. Using factor analysis with oblique rotation (mean inter-item correlations r 00.71, KMO00.93), we found two factors: attentional-automatism and gratification (17 of 20 items). These factors explained 42.1 and 6.9% of the variance, respectively. The subsequent analysis of internal consistency indicated a total coefficient of 0.84 to 0.91 for each factor. The factorial congruence coefficients between the two versions of SIS (original and adapted) ranged from 0.598 to 0.971 (Table 1). Introduction: Lipid abnormalities in patients on HAART have been associated with use of boosted protease inhibitor (bPI), but some of them, such as atazanavir, are considered more lipid-friendly. Our aim was to investigate the effects of boosted atazanavir (ATV/r) and lopinavir (LPV/r) on lipids, and the proportion of patients who need lipid-lowering agents (LLA), in Mexican HIV-positive patients.

Materials and methods:
We conducted a retrospective cohort study in patients followed at the HIV clinic of the INCMNSZ in Mexico City. Patients receiving LPV/r or ATV/r for at least one year, and having a complete lipid profile, were included. History of antiretroviral therapy (ART), use of LLA and triglycerides (TG), total cholesterol (TC), HDL and LDL were collected at baseline and after one year of the start of PI/r. The primary endpoint was changed in TC, LDL and HDL and TG, and proportion of patients who needed to use LLA. We considered severe dyslipidemia (SD) TC values ]240 and/or TG ]500 mg/dl. Results: A total of 101 (14.8% female, median age 44 [21Á75]) patients were evaluated: 48 (47.52%) received ATV/r and 53 (52.47%) LPV/r. Sixteen and fourteen patients received ATV/r and LPV/r, respectively, as first line treatment, whereas 32 and 39 had ATV/r and LPV/r as salvage. At baseline, in patients with ATV/r, 16 (33%) were using LLA and 14/48 (29%) had SD, while in those on LPV/r, 14 (26%) were using LLA and 4/53 (7.5%) had SD. Thirty (29%) patients started LLA during treatment, with a median duration of 6.76 mo., most of them fibrates (83%); 16 (53%) belonged to ATV/r, and 14 (46%) to LPV/r (p 00.23). At the end of the study, TC levels increased by 16.88% from baseline with LPV/r regardless of the use of LLA, while a slight decrease by 10.75% was seen for ATV/r. However, these values did not surpass normal limits. LDL increased slightly with ATV/ r and LPV/r, without reaching abnormal values. No statistical difference was found between the groups for TC and LDL. TG and HDL increased significantly for both drugs between baseline and one year (p50.001). However, no difference was seen in mean changes in TG (p 00.10) and HDL (p 00.18) between the two drugs. Regarding SD, the number of cases in the ATV/r group decreased significantly in patients without LLA (p 00.05); however, the decrease was not significant (p 00.48) in patients receiving LLA. In the group with LPV/r, no significant differences were seen. No significant difference was found between groups.
Conclusions: The main lipid alteration seen in our study was hyper TG, related to the use of ritonavir and not different between the two bPI studied. No significant differences in lipid profiles, use of LLA nor in presence of SD were found between both ATV/r and LPV/r, especially in cases with dyslipidemia before treatment. For cases with lipid abnormalities before treatment, other lipid-friendly drugs should be preferred. Introduction: In children with HIV vertical transmission infection, successful response to antiretroviral therapy (ART) depends on the previous susceptibility to antiretroviral drugs. In consequence, the virological failure (VF) may emerge due to the presence of drugresistant viruses and clinical outcome could be deleterious. In lowresource countries, the causes of VF are not routinely assessed by genotyping assays, resulting in a continuous failure to different ART combinations. The aim of the study was to describe the emergence of resistance mutations (RMs) during the follow-up of HIV-1-infected children with VF, compared to patients with successful treatment. Material and methods: Longitudinal study including plasma samples from 37 vertically infected HIV children collected between 1998 and 2011. Eighteen basal samples were obtained before starting treatment from patients that responded to ART, and 57 samples were obtained from 19 patients with VF in different time points during the follow-up. The samples were stored at (708C, until the genotypic analysis was performed. A nested RT-PCR was utilized to amplify a fragment of 1084 bp, including protease and reverse transcriptase (RT) sequence. The resistance genotype was determined using a Stanford Genotypic resistance interpretation algorithm. Results: In basal samples, none of the successfully treated patients had protease inhibitor (PI) drug resistance mutations (DRM) compared to patients with VF (26% had PI DRM). With respect to RT inhibitors (NRTI/NNRTI), 44% of the responders had RT DRM (NRTI (28%), and NNRTI (16%)), and for the VF group, 47% (NRTI (32%) NNRTI (16%)). During the follow-up of the patients with VF, 63% acquired new PI DRM (I54V (58%), V82A (53%), M46I (23%), I84V (21.1%)). Only 16% did not have acquired RT DRM, but 84% developed Abstract P026ÁFigure 1. E/C/F/TAF in adolescents: virologic success and CD4 recovery.
Introduction: The SAILING study compared the efficacy and tolerability of a dolutegravir (DTG) versus a raltegravir (RAL) containing regimen in antiretroviral-experienced, integrase-inhibitor-naïve adults with HIV-1. This subgroup analysis explores key efficacy and safety data for subjects enrolled in SAILING from Latin American (LA) countries. Methods: SAILING was a 48-week, Phase III, randomized, doubleblind, active controlled, multinational, non-inferiority study, which compared DTG 50 mg once daily with RAL 400 mg twice daily, both in combination with investigator-selected background therapy (no more than two agents) in subjects with at least two class resistance. The primary endpoint was the proportion of subjects with HIV-1 RNA B50 copies/ml at Week 48 (FDA snapshot, modified intent-to-treat exposed population) [1]. This post hoc analysis includes subjects enrolled at centres from Argentina, Brazil, Chile and Mexico. Results: LA subjects accounted for 238/715 (33%) of the study population. Baseline characteristics and virologic response rates are shown in the table (Table 1). For the overall study, superiority of DTG compared to RAL was demonstrated at Week 48. For the LA sub group analysis, a higher proportion of subjects who received DTG compared to RAL achieved HIV-1 RNA B50 copies/ml in both the snapshot and treatment-related discontinuation equals failure analyses. There were fewer virologic non-responders in the DTG group (DTG, 20%; RAL 25%), and fewer subjects with protocol-defined virologic failure (DTG: n 08, 7%, RAL: n 017, 15%). There were few safety events leading to discontinuation from LA countries (DTG: 1 subject (B1%); RAL: 4 (3%)). The most common drug-related adverse events were diarrhoea (7% vs 5%) and nausea (2% vs 6%) for DTG vs RAL subjects, respectively. Conclusions: Consistent with the overall study results, DTG 50 mg once daily was effective and well tolerated in the subgroup of subjects enrolled in the SAILING study from Latin America. Low rates of virologic failure and discontinuations due to adverse events were observed in the DTG arm. DTG represents an important new therapeutic option for patients across Latin America and globally.