IMPACT of TENOFOVIR on SARS-CoV-2 INFECTION among PEOPLE LIVING with HIV

Background: The impact of some antiretrovirals against SARS-CoV-2 infection and disease severity is conflicting. We evaluated the effect of tenofovir alafenamide/emtricitabine (TAF/FTC) and tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) against SARS-CoV-2 infection and associated clinical outcomes among people living with (PLWH). Methods: We conducted a propensity score-matched analysis leveraging data from the PISCIS cohort of PLWH in Catalonia (Spain). We matched for TAF/FTC versus ABC/3TC in a ratio of 1:1, and 1:3 for TDF/FTC versus ABC/3TC, and TDF/FTC versus TAF/FTC. We used logistic regression to assess the association between tenofovir-based ART and SARS-CoV-2 diagnosis and associated hospitalisation. Results: In our entire cohort [median age: 46.1 years, 82.3% males], 7550 PLWH were being treated with TAF/FTC, 1020 receiving TDF/FTC, and 4135 receiving ABC/3TC. After propensity score-matching, SARS-CoV-2 diagnosis rates were the same in TAF/FTC versus ABC/3TC recipients (12.2% vs 12.2%, P=1.00);lower among TDF/FTC versus ABC/3TC recipients (9.7% vs 12.4%, P=0.05) with borderline significance;and lower among TDF/FTC versus TAF/FTC recipients (9.7% vs 12.6%, P=0.03). In well-adjusted logistic regression models, TAF/FTC was not associated with reduced SARS-CoV-2 diagnosis (adjusted odds ratio [aOR] 0.97;95% confidence interval [CI], 0.83-1.12) or associated hospitalisation (aOR 0.95;95% CI, 0.62-1.45). TDF/FTC compared to ABC/3TC, was not associated with reduced SARS-CoV-2 diagnosis (aOR 0.81;95% CI, 0.61-1.07) or hospitalisation (aOR 0.49;95% CI, 0.14-1.27). TDF/FTC was not associated with reduced SARS-CoV-2 diagnosis (aOR 0.81;95% CI, 0.61-1.07) or associated hospitalisation (aOR 0.47;95% CI, 0.14-1.22) compared to TAF/FTC. Conclusion: TAF/FTC or TDF/FTC were not associated with reduced SARS-CoV-2 diagnosis rates or associated hospitalisations among PLWH. TDF/FTC users had baseline characteristics intrinsically associated with more benign SARS-CoV-2 infection outcomes. Tenofovir exposure or not should not modify the preventive or therapeutic SARS-CoV-2 infection management.

HIV and SARS-CoV-2 Co-infection: Epidemiological, Clinical Features, and Future Implications for Clinical Care and Public Health for People Living with HIV (PLWH) and HIV Most-at-Risk Groups.

PURPOSE OF REVIEW: The purpose of this review is to use the currently available clinical and epidemiological data, to identify key aspects to improve both the clinical management and public health response to SARS-CoV-2/HIV co-infection among HIV vulnerable populations and people living with HIV (PLWH). RECENT FINDINGS: While at the beginning of the COVID-19 pandemic, the lack of robust information on SARS-CoV-2/HIV co-infection, prevented a clear picture of the synergies between them, currently available data strongly support the importance of common structural factors on both the acquisition and clinical impact of these infections and the relevance of age, comorbidities, and detectable HIV viral load as associated worse prognostic factors among PLWH. Although more information is needed to better understand the biological, clinical, and epidemiological relationship between both infections, a syndemic approach to prevent SARS-CoV-2 among HIV high-risk groups and PLWH, targeting these populations for SARS-CoV-2 vaccines and protocolizing early identification of PLWH with worse COVID-19 prognosis factors, is crucial strategies to decrease the overall impact of SARS-CoV-2 /HIV co-infection.

Impact of the lockdown in an externalized HCV linkage-to-care model focusing on PWID patients with ongoing high risk practices

Background: The lockdown during the COVID-19 pandemic had an strong impact on the management of patients with liver diseases in Spain We analyzed the impact of the lockdown period on PWID with ongoing high-risk practices attending an externalized hepatology outpatient clinic at the biggest harm reduction center (HRC) in Barcelona Methods: On site HCV point-of-care screening for HCV-IgG antibody and HCV-RNA (GenXpert®), liver stiffness measurement (LSM), antiviral therapy delivery and sustained virological response (SVR12) assessment were performed at the HRC Dried blood spot (DBS) was collected at baseline, SVR12 and every 6 months in order to differentiate relapse vs reinfection Adherence was assessed by daily or weekly visits The program included educative and harm-reduction interventions Results: Before the lockdown 845 individuals had been prospectively enrolled in the program Of these, 386 (46%) accepted HCV screening, of whom 212 (55%) were HCV-RNA positive Of the 149 (70%) individuals who already started treatment, median (P25-P75) age was 42 years (35-47), 86% were male, 45% foreigners, 33% homeless, 73% unemployed and 62% had been imprisoned before At enrolment, 72% injected daily (55% more than once a day) In regard to high risk practices, 30% reported either needle or paraphernalia sharing and 38% unprotected sexual relationships Baseline LSM values were 6 (4 9-7 6) kPa with 12% patients having advanced fibrosis (>9.5 kPa). All patients received pan-genotypic antiviral therapy either 8 or 12 weeks During Spain's lockdown period the center's attendance was reduced from 300 users/day to 70 users/day and the program recruitment rate from 6 6 to 1 3 individuals/day No patient initiated antiviral therapy during this period Overall 34 (28%) missed their follow-up visits during this period, including 4/10 patients under ongoing antiviral therapy The overall reinfection rate was 16/100 patients/year, 4(23%) happened after lockdown Although there was an increase in the use of drugs on the street/at home, 50% reduced the injection frequency during the lockdown period Conclusion: This patient-centered circuit demonstrates that HCV treatment can be successfully delivered to active PWID with high-risk practices However, the lockdown had a negative impact on loses to follow-up and also altered drug consumption habits, supporting the role of specific interventions.