RETENTION IN CARE AMONG PERUVIAN MSM AND TGW IN A REAL-WORLD HIV PrEP PROGRAM

Background: Tenofovir-based daily oral HIV pre-exposure prophylaxis (HIV PrEP) is a highly efficacious HIV prevention modality, but sustained use over time is needed for continued protection among individuals at high risk for HIV exposure. Suboptimal adherence and retention in care threaten to diminish the impact of HIV PrEP on reducing HIV burden. PrEP PERU is an ongoing, multi-site, prospective cohort study evaluating HIV PrEP implementation among adult men who have sex with men (MSM) and transgender women (TGW) accessing care at non-government health centers in Peru. We sought to evaluate HIV PrEP adherence and retention in care among PrEP PERU participants prior to the onset of COVID-19 service disruptions. Method(s): We analyzed baseline and follow-up data from the PrEP PERU study through 3/15/2020, the first day of Peru's COVID-19 lockdown. MSM and TGW >=18 years of age with at least one HIV risk factor were eligible for enrollment. After the first follow-up visit at 4 weeks, TDF/FTC refills and clinic visits occur quarterly, at the discretion of the prescribing clinician. The medication is provided free of charge, but participants pay for laboratory testing plus a small service fee for clinic visits. Data is collected at baseline and quarterly follow-up visits on sexual risk behaviors and HIV PrEP use. We used bivariate analysis to evaluate the association between baseline factors and 6-month HIV PrEP retention in care. As a proxy for adherence, pharmacy dispensation records were used to calculate the proportion of days covered (PDC) by TDF/FTC. Result(s): Overall, 351 participants started TDF/FTC at four study sites in Lima from 1/23/2017 to 3/15/2020. Of this analysis population, 94% were cisgender men, 10% identified as bisexual, and median age was 31 (interquartile range [IQR], 27 - 38). Among those with at least 6 months of observation time (n=302), 91% attended >=1 follow-up visit and 77% attended >=2 follow-up visits during the 6 months after enrollment. The proportion with favorable adherence (PDC >=0.8) was 85%. There were 6 confirmed HIV seroconversions in the analysis period (1.2 per 100 person-years). Conclusion(s): In this analysis of HIV PrEP outcomes among MSM and TGW prior to COVID-19 pandemic disruptions in Peru, over 3/4 of the population remained in care and had favorable measures of adherence during the first 6 months after.

Dysregulation of cardiac endothelial lncRNA H19 in COVID19 patients induces endothelial dysfunction, which impairs cardiomyocyte function

Background: COVID19 is accompanied by cardiac complications. Long non-coding RNAs (lncRNAs) have been implicated in the pathogenesis of cardiovascular diseases. However, their contribution to the cardiac manifestation of COVID19 is unknown. Methods and results: We discovered that endothelial-enriched lncRNA H19 is downregulated in the heart of patients with COVID19 (∼2 fold, p<0.01). H19 was highly expressed in cardiac microvascular endothelial cells (CMEC) as compared to the other endothelial cell types (∼10 fold, p<0.05), suggesting its cardiac enrichment. H19 silencing in CMEC induced endothelial stress phenotype and a reduction in endothelial markers VE-cadherin and eNOS (∼1.5 fold, p<0.01), indicating its importance in endothelial physiology. Using the endothelial-cardiomyocyte co-culture system we previously developed, we showed that H19 silencing in CMEC reduced cardiomyocyte (CM) relaxation and contraction (∼1.5 fold, p<0.01). Interestingly, exposure to plasma from COVID19 patients decreased endothelial H19 level and impaired endothelial enhancement of CM function. Mechanistically, reduced level of H19 increased endothelial IL6 expression (∼1.5 fold, p<0.01). Further, exposure of CMs to IL6 also impaired CM relaxation and contraction, suggesting that endothelial cells devoid of H19 release IL6 which represses CM function. Interestingly, we found increased IL6 levels in the heart of COVID19 patients (∼2 fold, p<0.05). Indeed, the impairment of endothelial enhancement of CM function upon H19 silencing in CMEC was restored in the presence of tocilizumab, an IL6 receptor antagonist (∼1.5 fold, p<0.01). Furthermore, the impairment of the endothelial control on CM function upon exposure to COVID19 plasma was mitigated when the patients were treated with tocilizumab (∼1.5 fold, p<0.01). Conclusion: COVID19 reduces cardiac endothelial H19 level and induces impairment of endothelial enhancement of CM function via increased release of endothelial-derived IL6, the effect that can be rescued in the presence of IL6 receptor blocker tocilizumab. Funding Acknowledgement: Type of funding sources: Public grant(s) – EU funding. Main funding source(s): ERCFigure 1Figure 2

A forgotten technique of RRT for correction of severe hyponatremia in CKD: Case report

Introduction: Patients with chronic kidney disease (CKD) present electrolytes disorders. This represents a challenge when hyponatremia is below 125mmol/L associated with any criteria for urgent renal replacement therapy (RRT) with conventional hemodialysis because of higher risk of over correction above the security threshold of 10mmol/L/day and osmotic demyelination syndrome. Case Description: A 49-year-old Guatemalan female with history of 15 days of edema and slurred speech. Only history of T2DM. Was brought to the ER with BP 100/80mmHg and anasarca. Initial laboratories: negative COVID-19Ag, Cr 5.12mg/dl, (previous 2mg/dl) BUN 105mg/dl, glucose 156mg/dl, Na 108mmol/L, K 5.2meq/L, Cl 70meq/L. SOsm 224mOsm/kg, UOsm 875mOsm/kg, UNa 28meq/L. Because of neurologic symptoms, received a 150ml bolus of 3% saline twice with a rise to 112mmol/L. After the bolus, we initiated a 24-hour infusion with 3% hypertonic solution reaching a rise of Na up to 119mmol/L in 48 hours, but because of persistence of neurologic symptoms plus fluid overload >10% of body weight and hyperkalemia, we initiated RRT. In the absence of CRRT or CVVH we planned a conventional HD with blood flow of 100ml/min, dialysate flow 600ml/min, dialysate Na 130meq/L (the lowest Na possible) and 3 hours duration. After the first session had neurological and edema improvement. After two sessions with interdialytic period of 48 hours, Na control of 122mmol/L and 132mmol/L respectively with resolution of uremic syndrome. Later was diagnosed with hospitalacquired pneumonia receiving antibiotic treatment for 14 days and was discharged home with ambulatory HD. Discussion: In undeveloped countries where the access to CRRT or CVVH is unavailable, conventional modalities can be used with low blood flows and modification of the dialysate Na to a minimum (130mmol/L) offering a safe option to Na correction for patients with severe hyponatremia and any other HD criteria.

Online Codesign Activities to Co-create a 'Loneliness' Exhibition

Loneliness is a complicated emotion, experienced in different situations, irrespective of gender, age, occupation or nationality. It isn't necessarily about being alone, but a complex state of mind that people experience individually. This paper presents a study using online codesign activities to co-create the conceptual design for a digital interactive art exhibition around "Loneliness". Conducted during the early stages of self-isolation of the COVID-19 pandemic in Australia, we trialed codesign activities, usually conducted in face-to-face mode, through online methods. We held a mixture of online activities and interviews with 47 participants to unpack people's experiences of loneliness, especially in these unusual times, and explore their strategies to overcome it. We identified the "last lonely hour before bedtime"as an interesting concept to inspire our exhibition. Online codesign gave us flexibility in time and place, access to more participants in the time available, and the benefit of asynchronous data collection. © 2020 Owner/Author.