Meeting the WHO 90% target : antiretroviral treatment efficacy in Poland is associated with baseline clinical patient characteristics

Introduction: Modern combined antiretroviral therapies (cART) allow to effectively suppress HIV-1 viral load, with the 90% virologic success rate, meeting the WHO target in most clinical settings. The aim of this study was to analyse antiretroviral treatment efficacy in Poland and to identify variables associated with virologic suppression. Methods: Cross-sectional data on 5152 (56.92% of the countrywide treated at the time-point of analysis) patients on cART for more than six months with at least one HIV-RNA measurement in 2016 were collected from 14 Polish centres. Patients’ characteristics and treatment type-based outcomes were analysed for the virologic suppression thresholds of <50 and <200 HIV-RNA copies/ml. CART was categorized into two nucleos(t)ide (2NRTI) plus non-nucleoside reverse transcriptase (NNRTI) inhibitors, 2NRTI plus protease (PI) inhibitor, 2NRTI plus integrase (InI) inhibitor, nucleos(t)ide sparing PI/r+InI and three drug class regimens. For statistics Chi-square and U-Mann Whitney tests and adjusted multivariate logistic regression models were used. Results: Virologic suppression rates of <50 copies/mL were observed in 4672 (90.68%) and <200 copies/mL in 4934 (95.77%) individuals. In univariate analyses, for the suppression threshold <50 copies/mL higher efficacy was noted for 2NRTI+NNRTI-based combinations (94.73%) compared to 2NRTI+PI (89.93%), 2NRTI+InI (90.61%), nucleos(t)ide sparing PI/r+InI (82.02%) and three drug class regimens (74.49%) (p < 0.0001), with less pronounced but significant differences for the threshold of 200 copies/mL [2NRTI+NNRTI-97.61%, 2NRTI+PI-95.27%, 2NRTI+InI-96.61%, PI/r+InI- 95.51% and 86.22% for three drug class cART) (p < 0.0001). However, in multivariate model, virologic efficacy for viral load <50 copies/mL was similar across treatment groups with significant influence by history of AIDS [OR:1.48 (95%CI:1.01–2.17) if AIDS diagnosed, p = 0.046], viral load < 5 log copies/mL at care entry [OR:1.47 (95%CI:1.08–2.01), p = 0.016], baseline lymphocyte CD4 count ≥200 cells/µL [OR:1.72 (95%CI:1.04–2.78), p = 0.034] and negative HCV serology [OR:1.97 (95%CI:1.29–2.94), p = 0.002]. For viral load threshold <200 copies/mL higher likelihood of virologic success was only associated with baseline lymphocyte CD4 count ≥200 cells/µL [OR:2.08 (95%CI:1.01–4.35), p = 0.049] and negative HCV status [OR:2.84 (95%CI:1.52–5.26), p = 0.001]. Conclusions: Proportion of virologically suppressed patients is in line with WHO treatment target confirming successful application of antiretroviral treatment strategy in Poland. Virological suppression rates depend on baseline patient characteristics, which should guide individualized antiretroviral tre0atment decisions

Very High Incidence of Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum among Low-Risk MSM in an Outpatient Clinic in Wroclaw, Poland in 2019&ndash;2020

Background: The rise in sexually transmitted infections and chemsex has led to syndemy with HIV, partly due to common routes of transmission and clustered transmissions. Despite this, barriers to STI care and PrEP still remain. We sought to determine whether MSM at low risk for HIV infection were also at low risk for other STIs. Methods: The study group was tested for HIV, HCV, and Treponema pallidum, as well as had urethral, rectal, and oropharyngeal smears performed for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) six months apart. The control group was tested once to define the background incidence. Results: Treponema pallidum, CT, and NG prevalence was very high at both time points and was similar to the control group. CT was especially common in the control group (20.58%) and the study group at the rectal site at the second time point (9.37%). NG dominated the oropharyngeal site (15.87%), with urethral site sparing. NG infection was associated with an increased number of partners, not condom use (OR, 1.082 [95% CI; 1.009&ndash;1.171]). Risk behavior did not change between the time points. Treponema pallidum, CT, and NG incidence was exceptionally high (12.5/100PY, 25.39/100PY, 34.92/100PY, respectively; pooled 87.5/100PY) and was comparable to other studies of high-risk MSM. Conclusions: Despite a lower risk for HIV acquisition, the study group was at a very high risk for other STIs, and this risk remained high throughout the study. Patients and medical professionals should be aware of syphilis, gonorrhea, and chlamydiosis transmission risks, and screening should be performed accordingly. Prophylactic programs need to be updated to specifically include lower-risk individuals

Diagnostyka wczesnego zakażenia HIV — czy możemy przewidzieć wszystkie trudności?

Human immunodeficiency virus (HIV) remains a major public health problem worldwide. Although the principles of diagnosing HIV infection have remained the same for many years, newer types of tests, as well as the possibility of dete cting the infection at an increasingly earlier stage, mean that the diagnostic process can be problematic, even zakażefor an experienced specialist. The present study presents the case of a 20-year-old male patient having sexual relations with men. The ver y early stage of HIV infection posed diagnostic difficulties, not only because of inconclusive test results, but also because of the ongoing COVID-19 pandemic. It proved crucial in this case to deepen the patient’s history, who only revealed new information about risky sexual contacts after a deeper interview at a later visit. Although the patient had symptoms presen ting in the course of acute retroviral disease, it was necessary to remain vigilant, as the early phase of HIV infection made interpretation of the results difficult due to seroconversion taking place at that time. The first test detected the p24 antigen, and subsequent tests already unequivocally indicated the presence of HIV antibodies. Virolog ical tests per formed confirmed the infection. We would like to draw physicians’ attention to the difficulties involved in diagnosing HIV infection and the similarity of the symptoms of retroviral disease to common seasonal infections. In addition, we emphasize how important it is to take a detailed medical history and how essential it is for people at risk of HIV infection to be aware of what exactly is meant by the term “risky sexual contact”.Ludzki wirus niedoboru odporności (HIV, human immunodeficiency virus) pozostaje poważnym problemem zdrowia publicznego. Choć zasady diagnostyki zakażenia HIV pozostają niezmienne od wielu lat, to wciąż proces diagnostyczny może stanowić problem nawet dla doświadczonego klinicysty. Obecnie coraz większa liczba pacjentów zgłasza się na bardzo wczesnym etapie zakażenia, gdy wyniki serologiczn e są jeszcze ujemne i istnieje potrzeba wykonania badań molekularnych lub powtórzenia badań serologicznych po 2–4 tygodniach. W niniejszej pracy przedstawiono przypadek 20-letniego mężczyzny mającego kontakty seksualne z mężczyznami. Bardzo wczesny etap zakażenia HIV sprawiał trudności diagnostyczne nie tylko ze względu na niejednoznaczne wyniki testów, ale także na trwającą w obecnym czasie pandemię COVID -19. Kluczowe w tym pr zypadku okazało się pogłębienie wywiadu z pacjentem, któr y nowe informacje o r yzykownych kontaktach seksualnych wskazał dopiero na jednej z późniejszych wizyt. Pierwsze badanie przesiewowe dało wynik reaktywny, jednak test potwierdzenia anty-HIV W estern blot był ujemny. Dopiero wykonane badanie molekularne potwierdziło zakażenie. Chcieliśmy zwrócić uwagę na trudności związane z diagnostyką wczesnego zakażenia HIV oraz na podobieństwo objawów choroby retrowirusowej do powszechnie występujących zakażeń wirusowych. Ponadto podkreślamy, jak istotne jest zebranie dokładnego wywiadu oraz jak ważne jest wyjaśnienie pacjentowi, co dokładnie oznacza pojęcie „ryzykownego kontaktu seksualnego”

Prevalence of Anti-SARS-CoV-2 Antibodies in HIV-Positive Patients in Wroclaw, Poland&mdash;Unexpected Difference between First and Second Wave

Background: The presence and level of anti-SARS-CoV-2 antibodies in PLWH from the Lower Silesia region in Poland. Material and Methods: A total of 216 serum samples of both sexes, aged 21&ndash;77, and treated with TDF or TAF together with FTC and INSTI at two points of time. Anyone who did not experience COVID-19 symptoms. Samples were checked for the presence and levels of anti-SARS-CoV-2 antibodies regarding CD4 + T and CD8 + T cells counts, the ratio of these cells, age, sex, VL, and type of tenofovir used. Results: The average level and prevalence of anti-SARS-CoV-2 antibodies during the first wave were 65.81 IU/mL and 4.17%, while during the second wave, they were 125.98 IU/mL and 14.29%, respectively. There was a significant correlation between the number and type of lymphocytes and the presence of anti-SARS-CoV-2 antibodies. We did not find the same correlation regarding anti-SARS-CoV-2 levels. The average level of antibodies was higher during the second wave. There was no difference between the type of tenofovir used and the humoral response, as well as no correlation of anti-SARS-CoV-2 levels with age, gender, or VL. Conclusion: PLWH can have asymptomatic SARS-CoV-2 infection, which can influence the presence, but not levels, of anti-SARS-CoV-2 Ab. No correlation with type of tenofovir was observed

Prevalence of transmitted drug-resistance mutations and polymorphisms in HIV-1 reverse transcriptase, protease, and gp41 sequences among recent seroconverters in Southern Poland

BACKGROUND: Monitoring of drug resistance-related mutations among patients with recent HIV-1 infection offers an opportunity to describe current patterns of transmitted drug resistance (TDR) mutations. MATERIAL/METHODS: Of 298 individuals newly diagnosed from March 2008 to February 2014 in southern Poland, 47 were deemed to have recent HIV-1 infection by the limiting antigen avidity immunoassay. Proviral DNA was amplified and sequenced in the reverse transcriptase, protease, and gp41 coding regions. Mutations were interpreted according to the Stanford Database algorithm and/or the International Antiviral Society USA guidelines. TDR mutations were defined according to the WHO surveillance list. RESULTS: Among 47 patients with recent HIV-1 infection only 1 (2%) had evidence of TDR mutation. No major resistance mutations were found, but the frequency of strains with ≥1 accessory resistance-associated mutations was high, at 98%. Accessory mutations were present in 11% of reverse transcriptase, 96% of protease, and 27% of gp41 sequences. Mean number of accessory resistance mutations in the reverse transcriptase and protease sequences was higher in viruses with no compensatory mutations in the gp41 HR2 domain than in strains with such mutations (p=0.031). CONCLUSIONS: Despite the low prevalence of strains with TDR mutations, the frequency of accessory mutations was considerable, which may reflect the history of drug pressure among transmitters or natural viral genetic diversity, and may be relevant for future clinical outcomes. The accumulation of the accessory resistance mutations within the pol gene may restrict the occurrence of compensatory mutations related to enfuvirtide resistance or vice versa

Transmission patterns of HIV-1 non-R5 strains in Poland

Abstract HIV-1 env sequencing enables predictions of viral coreceptor tropism and phylogenetic investigations of transmission events. The aim of the study was to estimate the contribution of non-R5 strains to the viral spread in Poland. Partial proviral env sequences were retrieved from baseline blood samples of patients with newly diagnosed HIV-1 infection between 2008–2014, including 46 patients with recent HIV-1 infection (RHI), and 246 individuals with long-term infection (LTHI). These sequences were subjected to the genotypic coreceptor tropism predictions and phylogenetic analyses to identify transmission clusters. Overall, 27 clusters with 57 sequences (19.5%) were detected, including 15 sequences (26.3%) from patients with RHI. The proportion of non-R5 strains among all study participants was 23.3% (68/292), and was comparable between patients with RHI and LTHI (11/46, 23.9% vs 57/246, 23.2%; p = 1.000). All 11 patients with non-R5 strains and RHI were men having sex with men (MSM). Among these patients, 4 had viral sequences grouped within phylogenetic cluster with another sequence of non-R5 strain obtained from patient with LTHI, indicating potential acquisition of non-R5 HIV-1 for at least 4/46 (8.7%) patients with RHI. We were unable to confirm the contribution of patients with RHI to the forward transmission of non-R5 strains, but a relatively high proportion of non-R5 strains among them deserves attention due to the limited susceptibility to CCR5 antagonists