HIV Drug Therapy in the Americas 810 May 2014, Rio de Janeiro, Brazil

O111 Figure 1. Abstracts of the HIV Drug Therapy in the Americas Journal of the International AIDS Society 2014, 17 (Suppl 1) http://www.jiasociety.org/index.php/jias/article/view/19180


O112 HIV policy in Central America
Sosa Nestor Gorgas Memorial Institute, Panama City, Panama.
There have been significant improvements in the Central America region in HIV policy and care in three areas: (1) access to treatment, (2) reduction of stigma among health care providers and (3) the existence of national strategic plans. But, despite the existence of laws, norms, strategic plans and international agreements to respond to the HIV epidemic in the region, there are important gaps in the implementation, dissemination and monitoring of these policies. Stigma and discrimination against key populations disproportionately affected with HIV is considered a major hurdle in the implementation of HIV policies and still persists in the general population. The lack of political leadership to implement human rights laws for the protection and equality for key populations, and an appropriate response to genderbased violence are two other significant deficiencies that negatively impact the HIV policy environment. A fragmented civil society effort produces lack of cooperation and even competition between the different non-governmental organizations compromising the attainment of common goals. In many countries in the region, a lack of sufficiently strong national authority to solicit resources and coordinate the response has also been identified. In summary, despite advancement in certain areas of HIV policy and care in Central America, there are still many problems and obstacles that need to be addressed in order to improve this region's response to the HIV epidemic.
In 2012, the Pan American Health Organization estimated 280,000 new tuberculosis cases in the Americas, with an estimated incidence of 29/ 100,000 individuals, 16% associated with HIV. Brazil, Peru, Mexico, Haiti, Colombia and Bolivia account for 72% of the cases in the region. In large countries, tuberculosis is concentrated in certain populations, in particular among urban high-risk groups including HIV individuals, immigrants from TB high-incidence countries and underserved populations such as homeless and those with a history of drug and alcohol abuse. At the country level, elimination of TB requires the implementation of multiple measures focused on different layers of the population. The particular complexities of big cities, such as population density and social structure, create specific opportunities for transmission, but also enable targeted TB control interventions. The presentation will describe the current TB situation in the Americas, the most affected populations, and the general and specific social, educational, operational, legal and monitoring TB control interventions required for the control, as well as providing some recommendations with particular emphasis on HIV-related TB. In addition, a summary of new tools for prevention and control, including new technologies, vaccines and new drugs will be presented.

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The HIV treatment response prediction system: using the experience of treating tens of thousands of patients to guide optimal drug selection Introduction: Most low-to middle-income countries providing antiretroviral therapy for patients in need are located in Latin America. Scarce information about clinical and virological outcomes of this population is, however, available at a regional level. This data could have not only an individual therapeutic impact but also a public health impact. Our objective was to analyze patient characteristics and therapeutic outcomes of newly treated individuals with HIV infection in our region during combination antiretroviral era. Materials and methods: HIV' adult patients who initiated combination antiretroviral therapy between 2002 and 2006 were selected from the LATINA Retrospective Cohort database, comprising data from five regional reference HIV care centres located in four Latin American countries (Argentina, Brazil, Peru and Mexico). NNRTI and PI-based antiretroviral regimens were compared in terms of main composite outcome of all-cause mortality and AIDS defining clinical events by multivariate logistic regression. Secondary outcomes were non-AIDS clinical events, hazard of change of first-line treatment, time to the first severe event (AIDS defining, non-AIDS defining or death) and time to AIDS by Cox proportional regression models adjusted by site, gender, time since HIV diagnosis, baseline CD4' T-cell count and AIDS at baseline. Results: A total of 937 patients were included in the analysis. Nearly 25% of them were women. At treatment initiation, patients had a mean age of 37910 years and a CD4' T-cell count of 1469118 cells/mm 3 . Three hundred and twenty patients (34%) had AIDS and the median lapse from HIV diagnosis was 1.9 years. In 709 patients (75%), the first selection included an NNRTI -in 551 was efavirenzwhile 225 patients received a PI-based regimen and 158 of them included lopinavir. One hundred and forty four patients (15%) presented a reported adverse event during the first year of followup. No significant difference was detected in the odds for occurrence of the primary outcome, while CD4' cell count was the only covariate associated with it. The estimated hazard ratio for time to change (NNRTIs vs. PIs) was 0.58 (95% CI 0.45-0.75, pB0.01) Comments: Despite current treatment guidelines, patients with HIV infection start antiretroviral therapy with low CD4' T-cell count in our region, with a significant proportion of them having already had an AIDS diagnosis. NNRTI-based regimens are largely favoured over PI-based treatments as initial selection in Latin America and while the risk of significant clinical events appears to be similar between both strategies, the chance of a therapy switch at one year of followup is significantly higher with PI-based regimens. Twenty years ago, PACTG 076 demonstrated that administration of zidovudine during pregnancy, labour and to the newborn for six weeks reduced perinatal transmission by nearly 70%, providing the first demonstration of ''treatment as prevention.'' In the United States, a comprehensive national response resulted in rapid implementation of the PACTG 076 regimen, with decreases in perinatal transmission from 25% before 1994 to Â5% within two years. Currently, in wellresourced health systems like the United States, where 98% of women receive prenatal care primarily starting in the first trimester, with implementation of opt-out universal HIV testing of pregnant women, the provision of combination antiretroviral therapy (cART) regimens during pregnancy, with individualized, laboratory-guided management; elective caesarean delivery if HIV RNA is !1000 copies/ml near delivery; infant antiretroviral prophylaxis; and avoidance of breastfeeding, the risk of perinatal transmission has been reduced to about 1%, and elimination of new perinatal infections is now possible. Current United States guidelines for use of antiretroviral drugs for maternal health and reduction of perinatal transmission will be discussed, as well as potential challenges to the elimination of new perinatal infections. Such challenges include continuing new infections in women, late/no prenatal care, lack of identification of HIV status and late or no antiretroviral prophylaxis. Additionally, with the dramatic decline in perinatal infections, there are now thousands of HIVexposed infants who are now happily uninfected, but who have in utero exposure to multiple drugs with limited data on long-term safety. A major challenge Á but critical need and ethical obligation Á will be to evaluate potential long-term effects of antiretroviral exposures in uninfected children.

O212 Challenges in the prevention of perinatal HIV infection in Latin America
Bologna Rosa Hospital de Pediatria, Buenos Aires, Argentina.
In high-income countries, MTCT transmission has been virtually eliminated through universal HIV testing and counselling, access to effective antiretroviral prophylaxis and treatment, safer delivery practices, family planning and safe use of breast-milk substitute. Scientific and programmatic evidence shows that PMTCT interventions can reduce the risk to less than 5% even in breastfeeding populations. Latin America has a prevalence of 1.4 million HIV cases, with 6300 (3600Á9600) children newly infected per year. The estimated global rate of MTCT in 2011 for LA was 14.2% [5.8Á18.5] (9.2% without breastfeeding). Key targets for 2015 include reducing the MTCT rate to B2% and having less than 0.3 new infant HIV infections per 1000 live births and less than 0.5 congenital syphilis cases per 1000 live births. Increasing antenatal access to medical care, incorporating educational strategies to increase accurate perception of personal risk and including rapid assays to meet the demand, where HIV testing is the main barrier to PMTCT, are ways to improve counselling and testing. The main challenges are to strengthen health systems, and service delivery models that integrate prenatal care, HIV and sexual and reproductive health, and to promote early initiation of prenatal care and improving the quality of prenatal care. The regional coverage of HIV testing in pregnant women increased from 29% in 2008 to 66% in 2011. Calculated coverage of antiretroviral therapy for HIV-infected pregnant women was 70% in 2011. Many countries in the region are close to reaching the goals of elimination of MTCT of HIV. Early diagnosis and treatment saves children's lives. Expanding the availability of early infant diagnostic testing is a critical need. Primary prevention should be re-enforced. There is a need to identify populations that are still not reached and the reasons why they have no access or are not using available services, and to eliminate the gaps of inequity, especially in young women, aborigines and other women in vulnerable situations.
From the 127 HIV perinatally infected girls aged 14 years or older followed by Instituto de Infectologia Emílio Ribas, 30 became pregnant (23.6%), making a total of 39 pregnancies and 35 babies (four miscarriages). Two adolescents got pregnant three times and four got pregnant twice. The gestational age varied from 32 to 39 weeks (mean 36.8 weeks) with three cases of premature birth. Twenty-six adolescent mothers had a fixed sexual partner from which 24 were aware of the adolescent's HIV status. Two adolescents got pregnant through domestic artificial insemination. Three adolescents mentioned the use of illicit drugs while pregnant. Only 50% of the adolescents showed undetectable viral load results by the end of the pregnancy, while the remaining showed results varying from 260 to 67,127 copies/mm 3 (mean 20,555 copies/mm 3 ). Ritonavir boosted lopinavir was part of the antiretroviral treatment to prevent motherto-child transmission in 82.6% of the cases and all newborns received oral AZTsyrup prophylaxis. Caesarean section was the mode of delivery of choice in 32 pregnancies, while vaginal delivery was applied to three cases. Just one of the newborns was HIV infected. The weight at birth ranged from 1900 to 3280 g (mean 2546 g) and the height at birth varied from 42 to 49 cm (mean 45.5 cm). This group of HIV vertically infected adolescents, despite being educated since childhood concerning their HIV status, the risk of HIV transmission through sexual relationships, the care with their sexual partners and the risk of an undesirable pregnancy, showed a high rate of pregnancies.
http://dx.doi.org/10.7448/IAS.17. 2.19197 O214 Non-infectious diseases in perinatally HIV-infected children and adolescents from Latin America and the Caribbean and followed for the occurrence of 12 targeted categories of NI. Crosssectional and longitudinal analyses were performed to calculate prevalence of NI before enrolment and the incidence rates of NI after enrolment. Covariates included age, CDC clinical classification, viral load, WHO immunologic classification, ARV regimen and height/age at enrolment. Results: 537 (52%) of the 1032 vertically infected children had at least one NI prior to enrolment. The most prevalent disorders prior to enrolment were asthma/allergies (29%), malnutrition (24%) and neurologic disorders (18%). After enrolment, 728 new NI diagnoses were made among 464 (45%) children for an overall incidence of 18 per 100 person-years. The most common disorders per 100 person-years were asthma/allergies 9.4 (95% CI; 8.3Á10.5), malnutrition 2.9 (95% CI; 2.3Á3.5), neurologic 3.5 (95% CI; 2.8Á4.1) and behavioural 2.1 (95% CI; 1.6Á2.6). NIs related to cardiac, pancreatic, and renal conditions; encephalopathy; and neoplasms were relatively rare in this cohort, with all occurring at a rate B0.5/100 personyears. Those with NIs were significantly more immunosuppressed (p 00.01) and more likely to be Category C by CDC classification at enrolment (p 00.02). No difference regarding gender, age, viral load or ARV regimen at enrolment was found. Conclusions: The overall incidence of NI diagnoses in this cohort of perinatally HIV-infected children from Latin America and the Caribbean was 18 per 100 person-years. NIs were more common in those with advanced HIV disease, suggesting that these complications are more likely to be related to HIV than to ART. This study also confirms recent evidence in the literature that asthma/allergies are common among HIV-infected children. Introduction: Global HIV-1 prevalence estimate is currently 33.4 million and women comprise !50% of those infected. The majority of women may lack regular care and only 25% are virologically suppressed [1]. The ELLA study is a cross-sectional, non-interventional epidemiology study conducted across Latin America (LA), Europe, Canada and Asia that describes barriers to care for HIV-infected women and associations with disease stage, treatment effects and HRQoL. Methods: HIV-infected women eligible for ELLA ( ]18 years) completed the self-administered Barrier to Care Scale (BACS) comprising 12 items in four domains (index range 0Á12, overall range 1Á4, greater 0more barriers, overall score ]2 considered severe) and the ACTG Health Status Assessment questionnaire comprising 21 items assessing nine HRQoL domains (range 0-100, greater0better).
Healthcare providers documented medical history, HIV infection/comorbidities data and clinic attendance. This analysis presents correlations of BACS response, last reported VL and CD4 count with HRQoL outcomes. Spearman rank order was used to test correlations with statistical significance set at p B0.05. Results: Enrolment included 1931 women from 30 countries, including 519 in LA. Total population mean age was 40 years (16.9% !50 years), education B12 years was noted for 47.7% of subjects, 36% were unemployed and 82.9% resided in an urban area. HIV was acquired heterosexually in 83.0%. Current ART was reported for 88.2% of subjects; 57.5% had a VL B50 c/ml; mean CD4 was 540.5 c/ml. Mean [SD] BACS index and overall scores were 6.19 [3.47]  HIV epidemics in MSM are expanding in countries of all incomes and in many incidences of new infections is also rising. This talk will consider HIV epidemics in MSM and analyze the current and potential future roles of ART and condom use in limiting new infections. The analyses will be mainly based specifically on the UK epidemic as a typical example of an epidemic in MSM that has not been declining over time. The aim will be to discuss findings from modelling analyses in a manner that is readily understandable to non-modellers. The UK provides a good setting to use as an example due to the fact that there are multiple sources of data on various aspects of the epidemic, including on sexual HIV testing behaviour, as well as detailed data on HIV-infected populations. The link between the ''cascade of care'' and incidence of new infections will be made clear, which emphasizes the critical role of the HIV treatment and care system in controlling the epidemic. Adoption of effective policies to increase HIV testing rates and a change in ART initiation threshold to initiate ART at diagnosis (should this be supported by results from trials which are currently on-going) could potentially have a very high positive impact on HIV incidence. However, ART adherence and retention and condom-less sex are other key determinants of incidence and these need to be dealt with or the impact of higher testing and earlier ART will be lost.
In the Americas, the HIV epidemic is concentrated among men who have sex with men (MSM) and transgender women. In Latin America these groups continue to be hidden, stigmatized and discriminated against, even in health care facilities. The fight against the HIV epidemic in these populations requires tailored research on prevention strategies, structural changes, community participation and political willingness. After disappointing behavioural, vaccine and community level intervention trials, pre-exposure prophylaxis (PREP) has shown efficacy in preventing HIV acquisition in different populations including MSM (iPrEx study). Originally designed to be carried out in Latin America (LA), the iPrEx study was a multicenter clinical trial implemented in 11 sites from nine countries in four different continents. Finally, 74% of the 2499 participants came from either Brazil or the Andean Region. Despite such evidence, only Brazil has moved into the next steps to continue generating evidence to eventually make an informed decision about the potential role of PREP in LA. Implementation of PREP requires operational research to determine a variety of aspects such as priority target sub-populations, delivery systems, cost-effectiveness and public health impact based on ''real-world'' uptake and adherence data (including facilitators and barriers). Demonstration projects aimed to address these and other relevant factors are on-going in the US and Brazil. In spite of the proven efficacy of antiretrovirals in preventing HIV transmission, it is widely accepted that not a single strategy will be sufficient to curb the HIV epidemic in MSM. New promising interventions, such as rectal microbicides and HIV vaccines, are being evaluated; however, combined strategies will be needed to reach the goal of an AIDS-free generation. The next step in the HIV prevention research agenda for MSM would need to include the evaluation of acceptability, uptake of and adherence to behavioural, biological and structural components of a combined prevention package. This year's CROI meeting had important new data on cure, prevention and resistance. While a cure is not yet on the horizon, a number of advances provide clues about how HIV might be eradicated. At 2013 CROI, the case of a baby that started ART 30 hours after birth was presented. After 18 months, treatment was stopped persisting with undetectable viral load despite being off antiretrovirals. This year an update of the case reported that despite being off treatment for two years, this infant still has undetectable blood viral load and extensive testing has not found HIV in her PBMCs or other reservoirs, suggesting that very early therapy for infants may lead to a ''functional cure.'' In another cohort study, proviral reservoirs were significantly reduced in perinatally infected patients with virologic control on ART by one year of age vs. patients with later virologic control. Prevention efforts have more interesting options. In female macaques, GSK744 long-acting injections every four weeks provide prophylaxis against vaginal SHIV challenge. The most important presentation on prevention (PARTNER study) demonstrated zero HIV transmissions between serodiscordant couples with HIV-infected partner on suppressive ART, despite on-going condom-less sex, stressing the importance of early start on ART, while some other options as gene therapy with cells that do not express CCR5, that showed promising results are ready for human use. Transmitted resistance is still a problem despite higher virological control in treated individuals. Using enhanced sensitivity mutation-specific polymerase chain reaction assay a 70% higher prevalence of key reverse transcriptase mutations was detected, being higher among youths aged 13Á19 years vs. older age groups and lower among Hispanic individuals vs. black or white persons. However, the clinical significance of these mutants needs to be demonstrated. Looking for resistance-associated mutations to integrase strand transfer inhibitors, a retrospective study (2000Á2013)  In the last year, the HIV/AIDS research field remained active, and so, several good quality papers were produced and new data were presented at the IAS conference in Kuala Lumpur, the European Conference (EACS) in Brussels and the Retrovirus meeting (CROI) in Boston, among other meetings and conferences. New data provide stronger evidence supporting the initiation of antiretroviral therapy in HIV-1-infected individuals regardless of their CD4 count. Also, treatment as prevention has now more data supporting the evidence for the effectiveness of this strategy, as shown in MSM serodiscordant couples. Morbidity and mortality from non-AIDS-defining illness does not differ from that of the general population if CD4 counts above 500 cells/ml are achieved in HIV-infected people. The new WHO guidelines reflect this situation, by adopting the 500 CD4 threshold for treatment initiation, as well as recommending treatment in several situations, regardless of the CD4 cell count. The aim of achieving a functional cure has received further impulse, provided by reports suggesting that if ARV therapy is started very early during acute infection, functional cure may be achievable in some patients. New drugs, with better tolerability profile, ''user friendly'' in terms of dosing and with high antiretroviral potency have been approved by regulatory authorities in high-income and some middle-income countries. Last but not least, class-sparing strategies have been tested successfully, challenging the triple-drug paradigm. While the vaccine field has failed to move forward, ARV therapy is now simple, frequently based in fixed-dose combinations and easier to comply with. In this presentation, the state of the art on ARV therapy will be discussed. Approximately half of all patients living with HIV/AIDS (PLWHA) have underlying substance use disorders (SUDs), including problematic alcohol and drug use. In addition to the direct negative medical and psychiatric consequences associated with SUDs, they in turn are associated with a number of negative HIV treatment outcomes, including increased HIV risk behaviours, delayed HIV diagnosis, delayed linkage and retention in HIV care, decreased likelihood of being prescribed antiretroviral therapy (ART), decreased ART adherence and decreased likelihood of achieving viral suppression. As a result, PLWHA with underlying SUDs should be targeted using evidence-based interventions and provision of adequate support in order to achieve targets set forth for HIV treatment as prevention (TasP) to be optimized. In this presentation, a review of types of SUDs will be presented along with the negative medical and psychiatric consequences and their impact on HIV treatment outcomes. In addition, practical solutions for screening, brief interventions and referral to treatment (SBIRT) as well as evidence-based interventions that promote improved engagement in the HIV continuum of care will be covered to help guide HIV prevention and treatment strategies. Introduction: This study describes a faster and integral HIV/AIDS laboratory diagnosis for opportune attention and performs the epidemiological characterization of people who attended Voluntary Counselling and Testing (VCT) at Condesa Clinic (CC). On 2010, the HIV laboratory at VCT initiated a one-stop diagnosis approach. It was scaled-up in 2013 by the addition of rapid CD4 counting results available for post-test counselling by peer counsellors the same day. Methods: From November 2011 to September 2012, we studied 10,485 individuals who requested VCT at CC. We applied a rapid HIV test and established an algorithm to confirm all HIV rapid test positive results.
Additionally, each serum was assayed to identify antibodies against syphilis, hepatitis B and hepatitis C. CD4 cell counts and viral load were also obtained among HIV-positive individuals ( Figure 1). Late HIV infection diagnosis was defined if CD4 counts were lower than 200 cells. Prevalences of HIV and STIs were estimated and risks of HIV infection and late HIV diagnosis were calculated. Results: Women represented 32.3% of all individuals studied. Global seroprevalences of HIV, Syphilis, HBsAg and Anti-HCV markers were 20.1, 6.0, 1.0 and 1.0, respectively. Men had 5.7, 9.3, 14 and 1.6, times higher seroprevalence of HIV, Syphilis, HBsAg and Anti-HCV infections markers than women (Table 1).
Among women, HIV infection was related to age and syphilis but among men, age, hepatitis B, hepatitis C and syphilis markers were related to HIV infection. Prevalence of late HIV diagnosis was 31.8%. The risk of late HIV diagnosis was significantly higher among women and increases as age increases. There were eight cases of recent HIV infection in younger men who were negative to HIV Ab tests, positive to HIV Ag/Ab test and showed high viral load. Conclusions: A faster, patient-centred HIV diagnosis resulted in a great increase of HIV detections in CC while facilitating more opportune medical attention. This study also provides useful information resulting from the establishment of faster integral HIV infection diagnosis at CC in the context of a population with high HIV infection magnitude and large gender differences on HIV and STI prevalence as well as risk factors for HIV infection and late HIV diagnosis along the period of study. Conclusions: A decrease in the occurrence of late diagnoses in Mexico was observed, which reflects efforts in prevention, yet there is still a gap between early detection and the initiation of antiretroviral therapy. Reducing late diagnosis in women is a reflection of increased access to health services in our country, a result of the generation of inclusive and gender-sensitive public policy. There has been a clear increase in the availability and access to information on women's health, encouraging self-care. Currently, more women demand access to HIV testing and to health services in general. Hepatitis in the context of HIV infection is rapidly changing. The majority of individuals living with hepatitis B and HIV will be fully suppressed on a regimen including tenofovir and as yet there have been no confirmed reports of resistance developing to this drug in vivo. However, there will be some individuals who are not able to receive tenofovir principally due to renal dysfunction, and other strategies including dose reduction and the use of alternative agents may be required. The major revolution in the field of co-infection has been the development of direct acting antivirals to treat hepatitis C. Both in clinical trials and clinical practice the results in the co-infected mirror, or are even better, than that in the mono-infected population and HIV should not be a barrier to individuals receiving such agents. The first direct acting antivirals boceprevir and telaprevir have already been surpassed in efficacy results within clinical trials, by newer protease inhibitors including faldaprevir and somepravir. The results of the use of the polymerase show potentially even higher rates of treatment success in the HIV population when combined with Interferon and ribavarin. The recent results of the PHOTON study show HIV-infected individuals will also respond to Interferon sparring approaches, with similar success rates as in the monoinfected. Results of studies of combinations of oral DAAs in the monoinfected population have shown efficacy rates approaching 100%, with little drug associated toxicity.
The results of the SYNGERY study have suggested that individuals receiving such combinations may only need to receive these drugs for six weeks. However, there will remain barriers; these will include access to medications, the cost of the medications and the increasing reports of re-infection within the HIV population. Although treatment strategies are changing dramatically so will the need for the education of the co-infected population to prevent both initial and re-infection.

O332 HCV treatment access for HIV co-infected patients in Latin America
Sierra-Madero Juan National Institute of Medical Sciences and Nutrition, Mexico City, Mexico.
Advances in antiretroviral therapy and increased access have brought enormous benefits to affected populations; however, these benefits have been limited by the impact of other chronic conditions among which Hepatitis C occupies a significant place. Chronic liver disease due to Hepatitis C affects a large number of HIV-infected patients in Latin America and currently poses important challenges for the health systems in the region. Treatment for Hepatitis C infection in monoinfected and dually infected patients has improved dramatically in the past decade. New direct acting antiviral agents are substantially increasing the rate of sustained virological responses observed previously with Peg interferon plus ribavirin regimens specially in difficult to treat patients. Regimens free of Peg interferon more likely will replace the current standard of more toxic and less efficacious options, albeit at costs (if no major changes occur) that are unreachable to most governments. Even though anti-HCV treatment has a limited duration and its goal is viral eradication Á a concept not yet existent for HIV Á access to anti-Hepatitis C agents has not followed the same path as antiretroviral treatment in the region. In fact, the majority of countries in Latin America do not have specific programs for Hepatitis C treatment access as the ones created to treat HIV infection more than a decade ago. The current era of Hepatitis C treatment in some ways resembles the time in which HAART first became available. Communities, academia, governments and business from the region should learn from the experiences derived from that era in order to face the challenges that Hepatitis C treatment represent. Delaying or negating access now based on purely monetary reasons is not a wise option. Creative solutions to improve access should be sought and implemented in a joint fashion among the different actors. Transmitted drug resistance (TDR) has become an epidemiological and practical issue in any region where that there is widespread use of antiretrovirals. The World Health Organization (WHO) defines low TDR prevalence at a level below 5% and high-prevalence levels above 15%. There is a universal trend to maintain prevalence of NRTI resistance over time, increase NNRTI resistance and decrease PI resistance as a function of viral fitness and increasing use of boosted PIs. Emerging data confirm the relationship between TDR and virologic failure, thus emphasizing the importance of pre-treatment resistance determination. More sensitive methods to determine acquired drug resistance (ADR) using next-generation sequencing are promising and are helping to understand mechanisms of resistance, and also offering a window of opportunity to increase salvage therapy efficacy. Resistance mutants may be selected among lowlevel viraemic patients on antiretroviral treatment, especially for low genetic barrier drugs. Finally, in the test and treat era, treatment for longer periods of time may lead to long-term toxicity and to treatment interruptions. In this sense, the future points to personalized medicine where genetic tests targeting hosts may help to mitigate chronic side effects of antiretrovirals at an individual level. The search for drugs that are efficacious but have very few side effects, do not induce resistance and are simple in their administration is still a priority in HIV research. The integrase inhibitors have excellent tolerability and low rates of serious adverse events. Recently, the newest integrase inhibitor dolutegravir showed superiority over efavirenz and darunavir/r in randomized naïve studies mainly based on its excellent side effect profile. New drugs in the pipeline include an alternative to tenofovir, as tenofovir alafenamide fumarate (TAF), which may have less bone and renal toxicity. The pharmacokinetic booster cobicistat is used at the moment in Stribild to boost elvitegravir. It is also being co-formulated with darunavir and atazanavir as a single pill to simplify PI therapy. There are prospects of having a single pill ''boosted PI regimen.'' New drugs in later stages of development with recent data include the attachment inhibitor BMS-663068 from BMS and the long-acting integrase S/GSK744 from ViiV. The experimental entry inhibitor cenicriviroc, a. gne therapy is also being piloted. Nucleoside sparing strategies are still being pursued and a large trial of darunavir/r, and raltegravir in naïve patients (NEAT 001) was non-inferior to standard of care except in those patients with low CD4s and high viral loads. Another smaller study in naïve patients has shown that at least in the short-term, lopinavir plus 3TC was non-inferior to lopinavir plus 2 nucleosides. The use of Maroviroc with DRV/rI has not proven to be efficacious and the MODERN study had to be terminated early.

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How are generics shaping ARV use in Latin America?
This presentation will share the perspective of the Pan American Health Organization (PAHO) on the impact generic antiretrovirals (ARVs) have made in improving access to affordable, quality, safe and efficacious treatment to HIV in Latin America. Increased use of generic medicines, in particular ARVs has demonstrated to be a cost-effective approach and can result in significant reductions in expenditures on ARVs, which has allowed PAHO Member States to accelerate efforts to scale-up treatment towards sustained universal access to ARVs. Examples of how procurement of generic ARVs through the Regional Revolving Fund for Strategic Public Health Supplies (Strategic Fund) has resulted in significant cost savings in Latin America will be discussed. Additionally, the presentation will explore current barriers to accessing generic ARVs, focusing on current patents and licensing agreements between ARV manufacturers that limit the sale of generic ARVs Latin America. Research towards a HIV cure has emerged as a major goal of investigators throughout the world, with significant resources being mobilized by national funding agencies and foundations. This renewed sense of purpose is driven in part by the demonstration that cure (or ''sustained HIV remission'') may be possible, as illustrated by the Berlin patient and the Mississippi baby. A number of important steps forward in cure research have been reported. The report of a second baby positive at birth but in whom HIV cannot now be detected generated considerable interest at CROI 2014. Because this baby remains on antiretroviral therapy (ART), it is too soon to say whether ART-free remission has been achieved. Preliminary data from an on-going study of the histone deacetylase (HDAC) inhibitor panobinostat show that multiple cycles of the drug resulted in repeated stimulation of HIV expression, extending the results originally reported with vorinostat. In addition, studies in the macaque model of SHIV infection showed that broadly neutralizing monoclonal antibodies reduce the level of viraemia and decrease proviral DNA, suggesting that such antibodies may have a role in combination strategies for reducing the viral reservoir. Treatment interruption in two HIV-infected adults who had received allogeneic stem cell transplants for haematological malignancies and in whom no evidence of viral persistence could be detected in peripheral blood or rectal tissue resulted in virologic rebound after three and eight months. Although disappointing, these results nevertheless suggest an important role for graft-versus-host reaction in eliminating latently infected cells. Important questions that remain to be answered include identifying the site of viral persistence in these patients and determining whether additional interventions can prolong the time to viral relapse.  [1]. DENV prevalence has grown in the last years in tropical countries in Asia, the Pacific and the Americas [2]. The impact of the co-infection of DENV and HIV is not well described, but some data suggested that in DENV infections, a significant reduction of HIV viral load is observed [3]. Materials and methods: A cross-sectional study was conducted in patients with HIV-1 infection in follow-up, with signs and symptoms of DENV infection. DENV infection was confirmed by serological tests (IgG and IgM), at baseline, and after admission to the hospital. CD4' T cell count was assessed as well as HIV viral load before and three days after admission. Management of DENV infection was done according to the WHO guidelines for dengue management.
Results: Six patients with chronic HIV infection and without antiretroviral treatment reported signs and symptoms of DENV infection in a period of two years in an outpatient clinic in Santo Domingo. CD4' T cells count was assessed as well as HIV viral load at the onset of symptoms. After three days of admission, a plasma sample was obtained. A decrease in HIV viral load was observed in all the cases with a median of 21,532 copies/ml prior DENV infections, and a median of 7624 copies/ml of decrease at third day after admission (SD: 12487.7).
Conclusions: The decrease of HIV viral load in plasma reveals an interaction between the immune responses activated against DENV infection, which appears to also be involved in HIV replication. A recent study of in vitro study of DENV infection in intentionally infected cells with HIV revealed the role of NS5 replicative proteins [4]. Our study is consistent with these findings.

P4
Syphilis diagnosis at point of care provides faster confirmatory results and ensures treatment Introduction: Transgender women (TW) have been poorly studied in Mexico. Some qualitative studies suggest that they live in conditions of vulnerability and marginalization throughout their lifetime. These conditions usually result in greater risk of having seriously suicidal thoughts, make a suicidal plan or attempts. One of the main objectives of this study was to assess vulnerable conditions and relate them with TW with history of suicidality in a population-based sample in Mexico City.
Methods: This study was part of the first Health Survey with seroprevalence in Transgender Women in Mexico City. The survey was implemented in three sets: TW in prison, TW in meeting places and TW at the free care clinic in Mexico City (Clinica Especializada Condesa). After signing informed consent, they completed a questionnaire with socio-demographic questions, substance misuse, mental health status, complications from sex generic transformations and barriers related to healthcare access. Suicidality history was measured with WHO's international interview, CIDI 2. Stata/SE 12.0 was used for descriptive analysis, and t-test and x 2 for comparative analysis between the group with history of suicidality and the negative one.
Results: The total sample was 585 TW. Mean age was 32.3910.1 years old. Only 33% had completed high school or higher education, Abstract P4ÁFigure 1.

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Abstracts of the HIV Drug Therapy in the Americas Journal of the International AIDS Society 2014, 17 (Suppl 1) and 48% were sex workers. HIV prevalence was 33%. Throughout their lifetime, almost 35% had seriously suicidal thoughts, 15% a suicidal plan and 18% had at least one suicidal attempt. Mean of suicidal attempts was three (range01Á35), and mean age of the first one was 19.797.7 years old. Factors associated (p 50.01) with suicidality in this sample of TW were having lived on the street ever, have no family support for being TW, have suffered discrimination and have misuse of alcohol or any illegal drugs. Living with HIV was not related to suicidal behaviour (p 00.32). Conclusions: TW have, by far, a higher prevalence of suicidality than general Mexican population (2.8%). These findings suggest that poor social support, vulnerable conditions and misuse of substances that TW live throughout their lifetime are associated with suicidality. Mental healthcare systems should be adapted and available to this population to avoid suicidality and improve their quality of life. Introduction: Lack of HIV status awareness is common among highrisk populations in Peru and can lead to continued risk behaviours. We explored high-risk behaviours among participants of a study that included both HIV testing and reporting of previously known HIV infection. Materials and methods: Data are from a study implemented in Lima, Peru, from 2008 to 2009 assessing HIV prevalence among MSM/TW. The survey collected socio-demographic and risk behaviour data. HIV screening used enzyme immunoassay (EIA) with WB confirmation. HSV-2 testing used an EIA and syphilis testing used an RPR with TPPA confirmation. We conducted separate analyses comparing MSM/TW with known infection to HIV negatives, those with unknown infection to HIV negatives and known to unknown HIV infection. Statistical analyses used Chi-squared, t-tests and ANOVA. Results: Of the 714 participants, 131 (18.3%) were HIV positive; among these, 38 (29.0%) knew they were HIV positive, while the remaining 93 (71.0%) were unaware of their HIV infection. People with known HIV infection were significantly older, more likely to have unmet basic needs, more likely to report having only protected insertive anal sex, less likely to report unprotected receptive anal sex and less likely to report using alcohol prior to sex when compared to HIV negatives (all p-values B0.01). The only significant differences between participants with unknown HIV infection versus those who were HIV negative was an increase in their number of sexually active years (mean 16.7 vs. 14.9, p-value 0.05), HSV-2 (36.7% vs. 22.6%, p B0.01), history of syphilis (80.0% vs. 67.8%, p 00.04). The comparison of people with known HIV infection to those with unknown HIV infection followed the same patterns as the comparison between people with known HIV infection to those who were HIV negative. Introduction: Illicit drug use is an important public health issue around the world. Much of the estimated burden of disease attributable to the use of illicit drugs is probably due to blood-borne viral infections transmitted by sharing drug use equipment and unprotected sex. Hepatitis B, human immunodeficiency virus and hepatitis C are major health issues among illicit drug users (DUs) [1]. Epidemiological aspects of viral infections among illicit drug users in Northeast Brazil are poorly known. This study determined the prevalence of HIV infection, co-infections HIV-HBV and HIV-HCV and the factors associated with viral infections among DUs in the state of Piauí, Northeast Brazil. Materials and methods: This cross-sectional study of a nonprobabilistic convenience sample was based on information and biological samples provided by DUs attended at Central Laboratory and STD/AIDS Reference Unit, both within the Health Department of the State of Piauí. In all samples, the presence of HIV-1/2 was determined by enzyme immunoassay (EIA) and confirmed by Western blot and NASBA. Additionally, HBV, HCV and HDV infection has also been verified using EIA and real-time PCR [2,3]. Simple and multiple logistic regressions were calculated to assess the independent effects of variables. The fit of the final model was assessed using the HosmerÁLemeshow goodness-of-fit test. All statistical analyses were performed using SPSS 18.0. Results: In total, 243 DUs participated in this study. The majority of participants were male (72.4%). The mean age was 35 years (18Á51 years). Most participants (81.1%) reported having consumed more than one illicit drug during their lifetimes. Drug preference was grouped into four categories: cocaine paste (18.1%), cannabis ' cocaine paste (32.5%), cocaine powder (13.6%) and oxi cocaine (35.8%). Since, 16 DUs experienced at least once in a lifetime injecting drug. The prevalence of HIV infection among DUs was 44.4%. Being that the prevalence of HBV-HIV and HCV-HIV was 1.6% and 4.9%, respectively. A multivariate analysis identified four risk factors for HIV infection: injecting drug use, unprotected sex, sexual intercourse with another DUs and more than 10 sexual partners in the last year. Objective: 1) Determine the most frequent type of dermatosis in people with HIV/AIDS, 2) Propose as cutaneous markers the most frequent dermatosis observed during regular medical visits and thus recognize HIV infections for their opportune treatment and 3) Determine the most common sexually transmitted infections (STIs) in this population group. Methodology: Prospective observational and descriptive study that took place at Condesa Specialized Clinic in Mexico City between August 2005 and November 2013, in 1200 patients with HIV infection and evaluated during their first visit by a dermatologist, emphasizing on the diverse dermatosis and STIs during the consultation. The following variables from the clinical file were analyzed: age, gender, education, sexual activity initiation (SAI), condom use, number of partners; clinical/lab diagnosis (Serology: VDRL, anti-treponema antibodies, Hepatitis B and C; gonorrhoea, PCR for Chlamydia trachomatis, KOH and skin biopsy) and the relationship with CD4 count. All services were offered in a respectful and confidential manner, respecting their human rights. Results: A total of 1200 patients with HIV/AIDS were studied, all men who have sex with men (HSH); with HIV 422 (35.17%) (CDC: A1, B1 y C1 B2) and with AIDS 778 (64.83%) (CDC: A3, B3, C3). Average age 29 years (range 16Á74 years). Education: primary 14.9% and university (9.6%) (Degree), Average SAI: 16 years, avg. number of sexual partners: 34 in three years, avg. age of sexual abuse: seven years. Condom use 57.7% and for oral sex 7.4%, with an average of years from an HIV diagnosis. The initial dermatosis was registered on average two years after receiving an HIV diagnosis and one year if the diagnosis was AIDS. The five more frequent dermatosis in patients with HIV out of 15 observed were: seborrheic dermatitis 30.9% (371), HIV-related pruritic papular dermatitis (PPD) 29 Introduction: Latin America contains the third highest estimated number of people living with HIV-1 in the world [1]. Illicit drug users (DUs) are vulnerable to HIV and other blood-borne pathogens as a result of sharing contaminated syringes and other equipment [1]. Epidemiological aspects of HIV-1 infection in the Brazilian Amazon are poorly known, especially in risk groups. This study determined the prevalence and factors associated with infection by HIV-1 among DUs in the Marajó Archipelago, Brazilian Amazon. Materials and methods: This cross-sectional study of a nonprobabilistic convenience sample was based on information and biological samples provided by DUs in an area of intense illicit drug use located in the municipalities of Anajás, Bagre, Breves, Curralinho, Gurupá, Melgaço, Ponta de Pedras, São Sebastião da Boa Vista, Salvaterra and Soure, all from the Marajó Archipelago, Brazilian Amazon. DUs were sampled using the snowball technique (July 2012 to December 2013) [2]. In all samples, the presence of HIV-1 was determined by enzyme immunoassay (EIA) and confirmed by Western blot. Additionally, HCV infection has also been verified using ELISA and real-time PCR. Simple and multiple logistic regressions were calculated to assess the independent effects of variables. The fit of the final model was assessed using the HosmerÁLemeshow goodness-of-fit test. All statistical analyses were performed using SPSS 18.0. Results: In 466 DUs, most participants (73.2%) reported having consumed more than one illicit drug during their lifetimes. Drug preference was grouped into five categories: cannabis (23.8%), cocaine paste (7.9%), cannabis'cocaine paste (25.1%), cocaine powder (15.9%) and oxi cocaine (27.3%). Since, 92 DUs experienced at least once in a lifetime injecting drug. Table 1 shows the demographic and epidemiological characteristics of study participants. In 466 DUs, 165 (35.4%) were identified with HIV-1. The prevalence of co-infections with HIVÁHCV was 9.4%. A multivariate analysis identified seven risk factors for HIV-1 infection (Table 1). Conclusions: This study provided important information on HIV-1 infection among DUs that can be used for directing strategies and policies for prevention and control of this infection in this risk group and in the general population. Introduction: There has been an increasing number of immigrants to Chile in the last years, especially from South American countries. The phenomenon of immigration and its consequences has been studied by international literature, and different healthcare needs have been reported for this group as compared with local population. In Chile, this phenomenon is poorly studied and HIV prevention campaigns are focused on national population needs. The purpose of these study is to determine clinical and epidemiological characteristics of the HIV infection in Latin-American immigrants presenting to a referral HIV clinical care centre between the years 2003 and 2013 and bring up the need for development of different prevention strategies focusing in this groups special needs. Methods: A retrospective analysis was conducted. The baseline characteristics of Latin-American immigrants at admission to the infectious disease unit were compared to a peered group of Chileans in the same unit. Recollection of data included clinical variables: CDC stage, sexually transmitted diseases, AIDS defining disease(s), current status; socio-demographic variables: country of origin, gender, schooling, date of birth, use of drugs, tobacco and alcohol; variables related to HIV diagnose: date of confirmation, date of admission, mode of infection; laboratory tests: baseline CD4', serologies for toxoplasmosis, B and C hepatitis, Chagas and syphilis, PPD; others such as HAART adherence. Results: A total of 187 Latin-American immigrants where compared to 174 Chilean patients. There was an increase in the number of immigrants throughout the observation period. There were no differences in clinical presentation. Foreigners presented larger proportion of women (25% vs. 10%, p B0.0001) and heterosexual conduct as compared to nationals (36% vs. 22%, p B0.0099). The majority of immigrants came from Peru (51%) and Colombia (11%). In both groups, there was a high percentage of patients with reported sexually transmitted diseases (STDs) previous to HIV diagnose (45% for Chileans and 37% for immigrants). Conclusions: Clinical and epidemiological presentation in foreigner and native population was similar except for gender and sexual Introduction: Mexico has a concentrated HIV epidemic among the following groups: men who have sex with men, male sex workers, transgender women, injection drug users and female partners of men with HIV [1]. Mexico City has the oldest and largest epidemic in the country with a prevalence of 0.78% [2] vs. 0.38% [3]  epidemic in the city. Since its inception, CEC has had a symbiotic relationship with academia and civil society. Prior to HIV treatment universal access in Mexico, civil society and research institutes helped provide treatment to people with HIV. With HIV universal treatment access in the country, the HIV/Aids Program created linkages with key players from other sectors for the creation of programs to address the needs of specific population groups.

P8 HIV and the skin: frequent dermatosis as cutaneous markers in HIV detection
Results: The collaboration with civil society and academia has produced several effective programs linked to HIV detection, HIV retention, treatment adherence and prevention promotion. Specific programs such as the HIV Program in prison settings have helped reduce the mortality rate of HIV in prisons from 11% to less than 1%. The Women's program provides specific care to women with HIV, including prenatal care. The Program for Male Sex Workers is a collaboration with academia and started as a research project. This group has an HIV prevalence of 35% with high levels of drug use. Treatment desertion was reduced from 2012 to 2013 by more than 30% at CEC thanks to a collaboration with civil society. The change of access to services and the expediency of in-house lab services increased HIV' detection 45% in 2013 to 3171 new cases. The installation of the ''Test and Treat'' modality as part of a cascade process of care ( Figure 1) achieved a reduction of time of four and a half months to reach undetectable viral load in patients.
Conclusions: The control of the HIV pandemic can only be achieved with a multisectorial approach. Each sector has tools and competencies that can contribute towards the reduction of HIV incidence and improve the quality of life of people with HIV.
Methodology: HCV patients with stable HIV disease received SOF 400 mg QD and RBV 1000Á1200 mg/day; treatment-naïve GT 1 and treatment experienced GT 2/3 patients received 24 weeks and treatment naïve GT 2/3 patients received 12 weeks of treatment.
Multiple ART regimens were permitted as were patients with compensated cirrhosis. The primary efficacy endpoint was sustained virologic response 12 weeks after treatment, (SVR12); safety assessments included HIV RNA and CD4 cell levels.
Results: Baseline characteristics and virologic responses are shown in the table. Among treatment naïve GT 2 and 3 patients, SVR12 was achieved in 88% (23/26) and 67% (28/42) respectively. Among the 13 total virologic failures in these groups, only one had on-treatment virologic breakthrough due to study drug non-compliance. No S282T resistance mutations have been detected from virologic failures to date. Complete SVR24 results for all groups, including treatmentexperienced GT 2 and GT 3 patients, will be presented. In all groups, treatment discontinuations due to adverse events (AEs) have been uncommon (3%) and grade 3/4 AEs were reported in 25 (11%) patients. Two patients had HIV breakthrough: one in the setting of ART non-adherence, and one regained HIV control without ART change.
Conclusions: Treatment-naïve HCV GT 2 and 3 patients co-infected with HIV achieved high rates of SVR12 an interferon-free, all-oral regimen of SOF'RBV. These data suggest that SOF'RBV treatment was well-tolerated and safely co-administered with multiple ART regimens and may be equally safe and efficacious in patients with and without HIV co-infection. Introduction: HIV infection is associated with increased cardiovascular (CV) risk. Arterial elasticity assessment is a marker of early CV disease. We aim to compare arterial elasticity assessments in HIV-infected patients in virological suppression and non-infected subjects.
Methods: Large and small artery elasticity (LAE and SAE) were assessed by analysis of radial pulse waveform. A single set of measurements were performed in HIV-infected patients on stable ART with HIV RNA B50 cp/ml for at least one year and seronegative subjects. Patients with prior cardiovascular events, arritmias, pregnancy and systemic vasculitis were excluded. Univariate associations were analyzed using Spearman's correlation coefficients and multivariate linear regression to determine independent correlates of arterial elasticity.
Results: A total of 70 HIV-infected patients and 50 seronegative subjects were included. There were no differences between groups regarding to age (median 39 vs. 36 years), male sex (60 vs. 62%), BMI (24 vs. 25 kg/m2), smoking status (43% vs. 50% smokers), arterial hypertension (4% vs. 9%) and dyslipemia (29% vs. 12%) For HIV-infected patients, the median time from diagnosis was eight years with a median time of 60 months on ART (IQR 27Á108 months). As high as 76% of them were on NNRTIs and 24% on PI-based regimens with a median CD4' count of 539 cell/mm We found no differences neither in LAE (median 16.17 ml/mmHg)10 for HIV patients vs. 14.9 ml/mmHg )10 for seronegative subjects, p00.44) nor in SAE assessments (median 6.73 ml/mmHg )100 vs. 7.13 ml/mmHg) 100, p 00.59). LAE was inversely associated with older age (p 00.05), high levels of total cholesterol (p 00.009) and cumulative exposure to ART (p00.004), whereas SAE was only inversely associated with older age (p 00.03). Time since HIV diagnosis and CD4' count bore no association with arterial elasticity in HIV patients.
Conclusions: Well-controlled HIV infection was not associated with impaired arterial elasticity in this cohort. Our data is consistent with some previous studies assessing arterial stiffness. In addition to traditional risk factors, the time of exposure to antiretroviral therapy appears to be associated with detriment of arterial elasticity.
Introduction: Human papilloma virus (HPV) has been linked to anal, penile and cervical cancers [1]. HPV can be classified as highly oncogenic or low-oncogenic depending on strains related to cellular modifications induced by direct invasion of basal membrane in skin. When compared with HIV-uninfected women, women with HIV have higher rates of HPV infection and cervical dysplasia [2,3]. Materials and methods: Participants were selected depending on past clinical history of cervical cytological modifications. All patients were screened with cervical and anal samples with cytobrush and molecular analysis with HPV genotype assays. Results: Fifteen percent reported having anal sex with their sexual partners. Retro-prospective and prospective analysis of cervical Pap smear results revealed cervical intraepithelial neoplasia (CIN) ranging from I to III, CIN-I (n 052), CIN-II (n 032) and CIN-III (n016). Those findings were detected in a mean of one year. Cytological analysis of anal samples reported six cases of Anal Intraepithelial Neoplasia (AIN) grade I (n 06) and/or koilocytes (n 014); the correlation of AIN-I and Koilocytes was in a ratio of 6:14. Of these 14 cases, only one reported having anal intercourse. In the molecular analysis, we found that HPV16 was detected in 35 cases in either CIN-III/II/I, HPV18 in 21 cases of CIN, HPV45 was detected in six cases of CIN and four in AIN-I/Koilocytes, meanwhile HPV51, 52 and 68 were only detected among those with AIN-I/Koilocytes in anal epithelium.

Conclusions: Anal and cervical comparison in HIV-infected patients reveals a correlation of cellular modifications induced by HPV
infections. The finding that only one of 20 cases with HPV-related modifications (Koilocytes/AIN) reported having anal intercourse strongly suggests that not only anal intercourse must be considered as a mode of transmission of HPV, skin to skin contact within anal epithelium may confer a suitable mode of transmission in those with cervical or genital HPV infections. This is in addition to anal intercourse as a mode of transmission. Is also noted, a specific preference by some HR-HPV, specifically HPV45, HPV51 and HPV52.

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Value of the addition of a treponemal test (FTA-Abs) in the routine serologic screening for syphilis in an HIV-infected cohort Introduction: The diagnosis of syphilis can be complicated in HIV' patients because of false-negative and false-positive serological tests. A negative Rapid Plasma Reagin (RPR) test result may not rule out syphilis, particularly late latent syphilis. The purpose of this study was to evaluate the utility of both Fluorescent Treponemal Antibody Absorption (FTA-ABS) and RPR for the diagnosis of syphilis in HIV' patients, driven by an increasing number of syphilis cases during the last two years. Methods: Serum samples from 184 out of the 350 HIV' patients followed in our outpatient HIV Clinic were tested using both RPR and FTA-ABS to routinely screen for asymptomatic syphilis in sexually active patients on a periodic basis (every 6Á12 months).
Results: In 145/184 samples (78.80%), results were negative with both methods, excluding syphilis. In 26/184 (14.13%), FTA-ABS was positive, while 12/26 (46.15%) of these were RPR' and 14/26 (53.85%) RPR (; only five of these 14 patients had a history of treated syphilis. In additional 13/184 patients (7.07%), FTA-ABS was weakly positive, while in nine of them RPR was negative and in four positive (early symptomatic syphilis). There was no case of a falsepositive RPR test. Although the sensitivity of RPR in diagnosing syphilis is considered very high, case reports have rarely described RPR-seronegative syphilis in HIV' patients. A negative treponemal test may not rule out syphilis in patients with advanced immunosuppression. Reinfection may be difficult to rule out in some patients, and reactivation or relapse of a previously treated infection is also  Introduction: HIV drug resistance in Peru has been previously studied; however, data from general population of different regions of Peru is required. In this cohort, we have analyzed and described the resistance profile of HIV-infected Peruvian individuals sampled during period of 2008 and 2011. Materials and methods: For this proposal, we have selected 297 patients corresponding to the ten most prevalent regions of Peru.
To detect resistant mutation, we have used the Trugene commercial kit and an in-house Genotyping test. All patients included in this study were selected after of the approval of HIV Expert Committee of the Peruvian Ministry of Health. Results: From 297 genotyped patients, 245 (82%) were resistant to one or more antiretroviral (ART). M184V was the most frequent resistant mutation (30% for children and 26% for adults). Resistant profile revealed that children showed more resistance to 3TC/FTC (78%), while in adults it was EFV/NVP (50%). Regarding of pansensible patients, they showed similar virological and immunological failure than resistant patients (CD4/mL B200 and viral load up to 5 log). Of interest, we have identified six patients showing resistance to every known antiretroviral drug (Pan-resistant virus), including a seven-year old subject. Additional sequence analysis revealed two HIV samples with unusual mutations (hypermutation) and multiple stop codons. Despite this fact, blood samples showed high viral load and low CD4 cell count. Finally, we found that from 24 resistant patients genotyped twice or more, only 15 (63%) received a change of the treatment scheme. However, only five of them (21%) experimented a decreasing of their viral load.
Conclusions: We showed that HIV resistance profile in Peru is complex and follows different molecular evolution depending of infected age-group. Moreover, our data suggest that a re-planning of therapy strategies should be performed to diminish the resistance in Peruvian population according of new resistant mutations and their resistance profile. Introduction: The evaluation of health-related quality of life in children with chronic diseases has gained increasing interest as they face a host of psychological and social problems that need to be considered along with their physical treatments [1,2]. The aim of this research is to analyze the influence of physical well-being, family and  . Altogether, relations with parents and home life, physical well-being and social support and peers explained 40% of the children and adolescents' psychological well-being, 46% of their moods and emotions, but only 5% of their self-perception (see results of multivariate multiple regression in Figure 1). The relations with parents and home life did not show any significant influence. Inversely, the physical well-being had a strong influence on moods and emotions (b 00.59) and psychological well-being (b 00.46), but less in selfperception (b 00.22). Social support and peers showed a positive albeit moderate influence in psychological well-being (b 00.25) and moods and emotions (b 00.28), but not in self-perception. Conclusions: When considering the emotional and psychological health of young people with HIV, accounting for their physical well-being and supporting their socio-developmental tasks can serve as important protective factors, enhancing their quality of life and promoting more adaptive developmental pathways.
Introduction: The care giving experience has an impact on every facet of a caregiver's life, from physical to psychological and emotional health [1]. Caregivers of children with chronic diseases face circumstances that challenge their adaptation to the disease and influence their well-being. Introduction: Cardiovascular disease (CVD) is currently a leading cause of morbidity and mortality in HIV patients [1]. This is probably a result of combination of an increased prevalence of risk factors (RFs) exposure to ART and a direct effect of HIV. The Framingham Risk Score (FRS) is a calculated measure of CVD risk, recommended for routine HIV care. Identifying CVD risk scores in a given population is important to plan for interventions and future strategies [3]. Little information on CVD risk in HIV-infected patients has been reported from Latin America. The aim of this study was to determine the CVD risk profile in a large well-characterized Mexican cohort.

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Rilpivirine resistance mutations in patients failing first-line non-nucleoside reverse transcriptase inhibitor (NNRTI) treatments in Argentina we reported a previous study regarding resistance emergence to ETR, the first second-line agent of this class [1]. RPV is the newest agent approved by the FDA for HIV-1 treatment of naïve adult patients. Additionally, it may be used in switching therapy from EFV, in virologically suppressed patients [2]. Aim: To evaluate the prevalence of resistance-associated mutations (RAMs) and sensitivity to RPV in antiretroviral experienced patients failing to other NNRTIs. Materials and methods: A retrospective study was performed at the Public Health Central Laboratory in Có rdoba, Argentina, over 210 samples received from August 2013 to January 2014, for routine HIV resistance testing. A total of 103 cases that showed resistance to one or more NNRTIs were selected for the present analysis. Samples were genotyped using Trugene System [3]. HIV Stanford Database Program was used as an HIV variant sub-typing tool [4].
Conclusions: Whilst natural polymorphisms could influence the barrier to drug resistance, the overall prevalence of resistance to RPV did not differ significantly when comparing B vs. non-B subtypes. Almost all RAMs related to RPV were relatively frequent among NNRTIs experienced subjects, suggesting the local circulation of viral strains with reduced sensitivity to the novel agent. This study points out the need for resistance testing to determine whether the emergence of RAMs associated to RPV rules out the use of NNRTIs in clinical practice.
Introduction: The emergence of mutations associated with resistance to antiretroviral drugs (ARV) HIV-1 limits the effectiveness of treatment in HIV-infected patients, leading to virological and immunological failure. Secondary resistance occurs in individuals receiving treatment due to mutations of the virus and selection of resistant variants during exposure to ARVs. The aim of this study is to describe the most frequent mutations in the reverse transcriptase region and HIV protease associated with secondary resistance to ARVs. Materials and methods: A total of 823 plasma samples from HIVinfected with virologic failure receiving ARV treatment patients, who were referred to the National Institute of Hygiene ''Rafael Rangel'' in Caracas, Venezuela, during the period from June 2006 were studied to December 2012 by CONARESAR. Each sample was processed for plasma viral load determination and test of resistance by HIV genotyping Trugene Kit † .
Results: Of the samples tested, in 97 (12%) patients, no resistance mutations were detected, while 87% of the isolates showed secondary resistance mutations, of which 72% had mutations in both regions of reverse transcriptase and protease and 28% of patients had resistance mutations in either of the two regions studied. According to the group of ARV drugs, the most common resistance mutations associated with nucleoside reverse transcriptase inhibitors (NRTIs) were M184I/V (20%), T215C/F/S/V/Y (13%), D67N (11%), M41L (9%), K219Q/E (8%) and L74V (7%), and the most common resistance mutations associated with non-nucleoside inhibitors of reverse transcriptase inhibitors (NNRTIs) were K103H/N (40%), L100I (11%) K101E/P/Q (8%) and G190A/E/S (5%). Finally, mutations to the protease inhibitors (PI) were M36I/L/V (19%), A71V/T (18%), I54A/ L/M/S/T/V (16%), M46I/L (15%) and L90M (14%). Conclusions: In Venezuela, like other studies previously reported found a high level of secondary resistance to antiretrovirals, predominantly found in the NRTI mutations, followed by those associated with NNRTI and IP. These results also suggest studies of primary resistance in the country are necessary to assess the possible transmission of resistant strains due to the high frequency of resistance mutations found in our study.

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Resistance mutations and polymorphisms in patients infected with HIV-1, treated with raltegravir in Venezuela Introduction: There are few antiretrovirals that inhibit the action of HIV-1 integrase. Some treatments fail to produce mutations in this region; however, the majority of patients under antiretroviral therapy have shown good adhesion and is therefore very limited experience in patients with suspected virologic failure in this country. The aim of this study was to investigate the presence of resistance mutations and polymorphisms in the integrase coding region in the Venezuelan population infected with HIV-1 under antiretroviral therapy with integrase-inhibitors. Materials and methods: Plasma samples from six patients were studied under treatment with raltegravir, with suspected virologic failure, prior informed consent of the same, by a technique of chain reaction polymerase with specific primers that amplify the region 27 Abstracts of the HIV Drug Therapy in the Americas Journal of the International AIDS Society 2014, 17 (Suppl 1) between the codons 7Á288 of the pol gene. The PCR products were sequenced and analyzed by database Stanford University.
Results: The presence of resistance mutations G140S and Q148H was detected in 33% (2/6) of the patients, and only in 16% (1/6) of these, the Y143H mutation pattern was observed. Such patterns have been reported like primary resistance mutation and G140S as a compensatory resistance mutation. In the rest of the samples, some polymorphisms not associated with resistance to these inhibitors were observed.

Conclusions:
The results represent the first report of the presence of mutation associated with resistance to integrase inhibitors of HIV-1 in the Venezuela population. However, the number of samples tested was very low because there are few cases with suspected failure of adherence to treatment and those who are under this antiretroviral therapy have remained with undetectable viral loads to date.