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López Seguí F, Oyón Lerga U, Laguna Marmol L, Coll P, Andreu A, Meulbroek M, López Casasnovas G, Estrada Cuxart O, Ara Rey J, Quiñones C, Pérez F, Fernandez J, Rivero À, Ricou Ríos L, Clotet B. Cost-effectiveness analysis of the daily HIV pre-exposure prophylaxis in men who have sex with men in Barcelona. PLoS One 2023; 18:e0277571. [PMID: 36649273 PMCID: PMC9844874 DOI: 10.1371/journal.pone.0277571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/28/2022] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Pre-Exposure Prophylaxis (PrEP) for HIV prevention has been implemented in several countries. Previous literature has shown that its cost-effectiveness (and, under some specifications, cost-saving character) is dependent on the reduction in price due to generics, the time-horizon and its effectiveness. The intervention has never been studied in Catalonia after the approval of the PrEP, a territory with extensive implementation. METHODS Economic evaluation of the implementation of HIV pre-exposition prophylaxis using administrative data from Men who have Sex with Men (MSM) who receive the treatment (at the generic price) compared with non-implementation. A deterministic compartmental model and a social perspective with a micro-costing approach over the time horizon 2022-2062 are used. A baseline 86% effectiveness of PrEP is assumed. RESULTS Daily oral PrEP is found to be cost-saving: discounted savings in costs are attained after 16 years, and after 40 years they reach 81 million euros. In terms of health indicators, 10,322 additional discounted QALYs are generated by the intervention. Results are sensitive to sexual behavioral patterns among MSM, the price of PrEP (reduced if offered on-demand), its effectiveness and the discount rate. CONCLUSIONS The use and promotion of PrEP in Catalonia is predicted to result in substantial health and monetary benefits because of reductions in HIV infections. Short-term investments in the promotion of PrEP will result in important cost-savings in the long term.
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Affiliation(s)
- Francesc López Seguí
- Hospital Germans Trias i Pujol, Barcelona, Spain
- Centre de Recerca en Economia de la Salut, Barcelona, Spain
- Fundació Lluita Contra les Infeccions, Barcelona, Spain
- Research Group on Innovation, Health Economics and Digital Transformation (IGTP), Barcelona, Spain
- * E-mail:
| | | | | | - Pep Coll
- Fundació Lluita Contra les Infeccions, Barcelona, Spain
- AIDS Research Institute-IrsiCaixa, Barcelona, Spain
| | | | | | | | | | | | | | - Fèlix Pérez
- Projecte dels NOMS-Hispanosida, Barcelona, Spain
| | | | - Àngel Rivero
- Projecte dels NOMS-Hispanosida, Barcelona, Spain
| | - Laura Ricou Ríos
- Hospital Germans Trias i Pujol, Barcelona, Spain
- Centre de Recerca en Economia de la Salut, Barcelona, Spain
- Research Group on Innovation, Health Economics and Digital Transformation (IGTP), Barcelona, Spain
| | - Bonaventura Clotet
- Fundació Lluita Contra les Infeccions, Barcelona, Spain
- AIDS Research Institute-IrsiCaixa, Barcelona, Spain
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2
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Bailón L, Llano A, Cedeño S, Escribà T, Rosás-Umbert M, Parera M, Casadellà M, Lopez M, Pérez F, Oriol-Tordera B, Ruiz-Riol M, Coll J, Perez F, Rivero À, Leselbaum AR, McGowan I, Sengupta D, Wee EG, Hanke T, Paredes R, Alarcón-Soto Y, Clotet B, Noguera-Julian M, Brander C, Molto J, Mothe B, Benet S, Cobarsi P, Geleziunas R, Leselbaum AR, Loste C, Meulbroek M, Miranda C, Muñoz J, Naval J, Nieto A, Pujol F, Puig J. Safety, immunogenicity and effect on viral rebound of HTI vaccines in early treated HIV-1 infection: a randomized, placebo-controlled phase 1 trial. Nat Med 2022; 28:2611-2621. [PMID: 36302893 DOI: 10.1038/s41591-022-02060-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 09/28/2022] [Indexed: 01/15/2023]
Abstract
HIVACAT T-cell immunogen (HTI) is a novel human immunodeficiency virus (HIV) vaccine immunogen designed to elicit cellular immune responses to HIV targets associated with viral control in humans. The AELIX-002 trial was a randomized, placebo-controlled trial to evaluate as a primary objective the safety of a combination of DNA.HTI (D), MVA.HTI (M) and ChAdOx1.HTI (C) vaccines in 45 early-antiretroviral (ART)-treated individuals (44 men, 1 woman; NCT03204617). Secondary objectives included T-cell immunogenicity, the effect on viral rebound and the safety of an antiretroviral treatment interruption (ATI). Adverse events were mostly mild and transient. No related serious adverse events were observed. We show here that HTI vaccines were able to induce strong, polyfunctional and broad CD4 and CD8 T-cell responses. All participants experienced detectable viral rebound during ATI, and resumed ART when plasma HIV-1 viral load reached either >100,000 copies ml-1, >10,000 copies ml-1 for eight consecutive weeks, or after 24 weeks of ATI. In post-hoc analyses, HTI vaccines were associated with a prolonged time off ART in vaccinees without beneficial HLA (human leukocyte antigen) class I alleles. Plasma viral load at the end of ATI and time off ART positively correlated with vaccine-induced HTI-specific T-cell responses at ART cessation. Despite limited efficacy of the vaccines in preventing viral rebound, their ability to elicit robust T-cell responses towards HTI may be beneficial in combination cure strategies, which are currently being tested in clinical trials.
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Affiliation(s)
- Lucia Bailón
- Fundació Lluita Contra les Infeccions, Infectious Diseases Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Catalonia, Spain
| | - Anuska Llano
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Samandhy Cedeño
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Tuixent Escribà
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Miriam Rosás-Umbert
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain.,Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mariona Parera
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Maria Casadellà
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Miriam Lopez
- Fundació Lluita Contra les Infeccions, Infectious Diseases Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Francisco Pérez
- Fundació Lluita Contra les Infeccions, Infectious Diseases Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Bruna Oriol-Tordera
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Marta Ruiz-Riol
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain.,CIBERINFEC, ISCIII, Madrid, Spain
| | - Josep Coll
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain.,CIBERINFEC, ISCIII, Madrid, Spain.,Projecte Dels Noms-Hispanosida, Bcn Checkpoint, Barcelona, Spain
| | - Felix Perez
- Projecte Dels Noms-Hispanosida, Bcn Checkpoint, Barcelona, Spain
| | - Àngel Rivero
- Projecte Dels Noms-Hispanosida, Bcn Checkpoint, Barcelona, Spain
| | - Anne R Leselbaum
- Projecte Dels Noms-Hispanosida, Bcn Checkpoint, Barcelona, Spain
| | - Ian McGowan
- AELIX Therapeutics S.L, Barcelona, Spain.,University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Edmund G Wee
- The Jenner Institute, The Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Tomáš Hanke
- The Jenner Institute, The Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Roger Paredes
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain.,CIBERINFEC, ISCIII, Madrid, Spain.,Centre for Health and Social Care Research (CESS), Faculty of Medicine. University of Vic - Central University of Catalonia (UVic - UCC), Vic, Barcelona, Spain.,Germans Trias I Pujol Research Institte, Badalona, Spain
| | - Yovaninna Alarcón-Soto
- Fundació Lluita Contra les Infeccions, Infectious Diseases Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain.,Departament d'Estadística I Investigació Operativa, Universitat Politècnica de Catalunya/BARCELONATECH, Barcelona, Spain
| | - Bonaventura Clotet
- Fundació Lluita Contra les Infeccions, Infectious Diseases Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain.,IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain.,CIBERINFEC, ISCIII, Madrid, Spain.,Centre for Health and Social Care Research (CESS), Faculty of Medicine. University of Vic - Central University of Catalonia (UVic - UCC), Vic, Barcelona, Spain
| | - Marc Noguera-Julian
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain.,CIBERINFEC, ISCIII, Madrid, Spain.,Centre for Health and Social Care Research (CESS), Faculty of Medicine. University of Vic - Central University of Catalonia (UVic - UCC), Vic, Barcelona, Spain
| | - Christian Brander
- IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain.,CIBERINFEC, ISCIII, Madrid, Spain.,AELIX Therapeutics S.L, Barcelona, Spain.,Centre for Health and Social Care Research (CESS), Faculty of Medicine. University of Vic - Central University of Catalonia (UVic - UCC), Vic, Barcelona, Spain.,ICREA, Barcelona, Spain
| | - Jose Molto
- Fundació Lluita Contra les Infeccions, Infectious Diseases Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain. .,CIBERINFEC, ISCIII, Madrid, Spain. .,Germans Trias I Pujol Research Institte, Badalona, Spain.
| | - Beatriz Mothe
- Fundació Lluita Contra les Infeccions, Infectious Diseases Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain.,IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain.,CIBERINFEC, ISCIII, Madrid, Spain.,Centre for Health and Social Care Research (CESS), Faculty of Medicine. University of Vic - Central University of Catalonia (UVic - UCC), Vic, Barcelona, Spain.,Germans Trias I Pujol Research Institte, Badalona, Spain
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3
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Di Ciaccio M, Delabre RM, Vilotitch A, Corbelli GM, Villes V, Ros Sánchez A, Zantkuijl P, Sweers H, Sanchez F, Meulbroek M, Cairns G, Bernier A, Ghosn J, Carvalho Rocha LM, Cosmaro ML, Duken SB, Dan M, Schlegel V, Stranz R, Jonas KJ, Spire B, Rojas Castro D. PrEP in the Context of Other HIV Risk Reduction Strategies Among Men Who Have Sex with Men: Results from the Flash! PrEP in Europe Survey. Arch Sex Behav 2022; 51:2451-2464. [PMID: 35725849 PMCID: PMC9208709 DOI: 10.1007/s10508-022-02322-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/14/2022] [Accepted: 03/05/2022] [Indexed: 06/15/2023]
Abstract
Combination HIV prevention covers a range of biomedical, behavioral, and socio-structural interventions. Despite the growing availability of pre-exposure prophylaxis (PrEP), it is not always accessible in European Centre for Disease Prevention and Control reporting countries and may not meet the needs of all at-risk populations. Based on the Flash! PrEP in Europe data, multiple correspondence analysis and hierarchical clustering were used to identify patterns in HIV prevention strategies among 9980 men who have sex with men (MSM). PrEP interest was evaluated among four identified clusters: (A) "high condom use, sometimes Treatment as Prevention (TasP)"; (B) "mix of methods, infrequent condom use"; (C) "high condom use, tendency to choose partners based on serological status" and (D) "moderate use of condoms mixed with other prevention strategies". Clusters B and D had higher PrEP interest. These results suggest that MSM use a range of behavioral and biomedical risk reduction strategies that are often combined. On-demand PrEP may meet the needs of MSM who infrequently use condoms and other prevention methods.
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Affiliation(s)
- Marion Di Ciaccio
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France.
- Groupe de Recherche en Psychologie Sociale (GRePS), Université Lyon 2, 69500, Bron, France.
| | | | - Antoine Vilotitch
- INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de l'Information Médicale, ISSPAM, Aix Marseille Univ, Marseille, France
- ORS PACA, Observatoire Régional de La Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | - Virginie Villes
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
| | | | | | | | - Flor Sanchez
- Department of Social Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | - Adeline Bernier
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
| | - Jade Ghosn
- Hôpitaux Universitaires Paris Nord, Service des Maladies Infectieuses, Site Bichat-Claude Bernard, Paris, France
| | | | | | - Sascha Béla Duken
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Monica Dan
- Department of Research, Monitoring and Evaluation, ARAS, Bucarest, Romania
| | | | - Richard Stranz
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
- Community-based Laboratory, AIDES, Pantin, France
| | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Bruno Spire
- INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de l'Information Médicale, ISSPAM, Aix Marseille Univ, Marseille, France
| | - Daniela Rojas Castro
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
- INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de l'Information Médicale, ISSPAM, Aix Marseille Univ, Marseille, France
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4
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Oriol-Tordera B, Esteve-Codina A, Berdasco M, Rosás-Umbert M, Gonçalves E, Duran-Castells C, Català-Moll F, Llano A, Cedeño S, Puertas MC, Tolstrup M, Søgaard OS, Clotet B, Martínez-Picado J, Hanke T, Combadiere B, Paredes R, Hartigan-O'Connor D, Esteller M, Meulbroek M, Calle ML, Sanchez-Pla A, Moltó J, Mothe B, Brander C, Ruiz-Riol M. Epigenetic landscape in the kick-and-kill therapeutic vaccine BCN02 clinical trial is associated with antiretroviral treatment interruption (ATI) outcome. EBioMedicine 2022; 78:103956. [PMID: 35325780 PMCID: PMC8938861 DOI: 10.1016/j.ebiom.2022.103956] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The BCN02-trial combined therapeutic vaccination with a viral latency reversing agent (romidepsin, RMD) in HIV-1-infected individuals and included a monitored antiretroviral pause (MAP) as an efficacy read-out identifying individuals with an early or late (< or > 4weeks) viral-rebound. Integrated -omics analyses were applied prior treatment interruption to identify markers of virus control during MAP. METHODS PBMC, whole-genome DNA methylation and transcriptomics were assessed in 14 BCN02 participants, including 8 Early and 4 Late viral-rebound individuals. Chromatin state, histone marks and integration analysis (histone-3 acetylation (H3Ac), viral load, proviral levels and HIV-specific T cells responses) were included. REDUC-trial samples (n = 5) were included as a control group for RMD administration alone. FINDINGS DNA methylation imprints after receiving the complete intervention discriminated Early versus Late viral-rebound individuals before MAP. Also, differential chromatin accessibility and histone marks at DNA methylation level were detected. Importantly, the differential DNA methylation positions (DMPs) between Early and Late rebounders before MAP were strongly associated with viral load, proviral levels as well as the HIV-specific T-cell responses. Most of these DMPs were already present prior to the intervention and accentuated after RMD infusion. INTERPRETATION This study identifies host DNA methylation profiles and epigenetic cascades that are predictive of subsequent virus control in a kick-and-kill HIV cure strategy. FUNDING European Union Horizon 2020 Framework Programme for Research and Innovation under Grant Agreement N°681137-EAVI2020 and N°847943-MISTRAL, the Ministerio de Ciencia e Innovación (SAF2017_89726_R), and the National Institutes of Health-National Institute of Allergy and Infectious Diseases Program Grant P01-AI131568.
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Affiliation(s)
- Bruna Oriol-Tordera
- IrsiCaixa, AIDS Research Institute, Institute for Health Science Research Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, 2nd floor, Ctra del canyet s/n, Badalona, Barcelona 08916, Spain; Departament de Biologia Cel·lular, de Fisiologia i d'Immunologia, Universitat Autònoma de Barcelona, Av. de Can Domènech 737, Cerdanyola del Vallès, Barcelona 08193, Spain
| | - Anna Esteve-Codina
- Centro Nacional de Análisis Genómico (CNAG), Barcelona Science Park - Tower I, Carrer de Baldiri Reixac 4, Barcelona 08028, Spain; Universitat Pompeu Fabra (UPF), Plaça de la Mercè 10-12, Barcelona 08002, Spain
| | - María Berdasco
- Cancer Epigenetics and Biology Program (PEBC), Bellvitge Biomedical Research Institute, Vinguda de la Granvia de l'Hospitalet 199, L'Hospitalet de Llobregat, Barcelona 08907, Spain; Epigenetic Therapies Group, Experimental and Clinical Hematology Program (PHEC), Josep Carreras Leukaemia Research Institute, Ctra de Can Ruti - Camí de les Escoles, s/n, Badalona, Barcelona 08916, Spain
| | - Míriam Rosás-Umbert
- IrsiCaixa, AIDS Research Institute, Institute for Health Science Research Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, 2nd floor, Ctra del canyet s/n, Badalona, Barcelona 08916, Spain; Department of Clinical Medicine - Department of Infectious Disease, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, East Jutland, Aarhus 8200, Denmark
| | - Elena Gonçalves
- Centre d'Immunologie et des Maladies Infectieuses - Paris (Cimi-Paris), INSERM U1135, Sorbonne Université, Bd de l'Hôpital 91, Paris, Île de France 75013, France
| | - Clara Duran-Castells
- IrsiCaixa, AIDS Research Institute, Institute for Health Science Research Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, 2nd floor, Ctra del canyet s/n, Badalona, Barcelona 08916, Spain; Departament de Biologia Cel·lular, de Fisiologia i d'Immunologia, Universitat Autònoma de Barcelona, Av. de Can Domènech 737, Cerdanyola del Vallès, Barcelona 08193, Spain
| | - Francesc Català-Moll
- IrsiCaixa, AIDS Research Institute, Institute for Health Science Research Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, 2nd floor, Ctra del canyet s/n, Badalona, Barcelona 08916, Spain
| | - Anuska Llano
- IrsiCaixa, AIDS Research Institute, Institute for Health Science Research Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, 2nd floor, Ctra del canyet s/n, Badalona, Barcelona 08916, Spain
| | - Samandhy Cedeño
- IrsiCaixa, AIDS Research Institute, Institute for Health Science Research Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, 2nd floor, Ctra del canyet s/n, Badalona, Barcelona 08916, Spain
| | - Maria C Puertas
- IrsiCaixa, AIDS Research Institute, Institute for Health Science Research Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, 2nd floor, Ctra del canyet s/n, Badalona, Barcelona 08916, Spain; CIBERINFEC, Madrid, Spain
| | - Martin Tolstrup
- Department of Clinical Medicine - Department of Infectious Disease, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, East Jutland, Aarhus 8200, Denmark
| | - Ole S Søgaard
- Department of Clinical Medicine - Department of Infectious Disease, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, East Jutland, Aarhus 8200, Denmark
| | - Bonaventura Clotet
- IrsiCaixa, AIDS Research Institute, Institute for Health Science Research Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, 2nd floor, Ctra del canyet s/n, Badalona, Barcelona 08916, Spain; CIBERINFEC, Madrid, Spain; Fundació Lluita contra la Sida, Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Ctra del Canyet s/n, Badalona, Barcelona 08916, Spain; Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic - Central University of Catalonia (UVic - UCC), Carrer Miquel Martí i Pol, 1, Vic, Barcelona 08500, Spain
| | - Javier Martínez-Picado
- IrsiCaixa, AIDS Research Institute, Institute for Health Science Research Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, 2nd floor, Ctra del canyet s/n, Badalona, Barcelona 08916, Spain; CIBERINFEC, Madrid, Spain; Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic - Central University of Catalonia (UVic - UCC), Carrer Miquel Martí i Pol, 1, Vic, Barcelona 08500, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Passeig de Lluís Companys, 23, Barcelona 08010, Spain
| | - Tomáš Hanke
- The Jenner Institute, University of Oxford, Old Road Campus Research Build, Roosevelt Dr, Headington, Oxford, Oxfordshire OX3 7DQ, UK; Joint Research Center for Human Retrovirus Infection, Kumamoto University, Honjo 2-2-1, Kumamoto City, Chuo-ku 860-0811, Japan
| | - Behazine Combadiere
- Centre d'Immunologie et des Maladies Infectieuses - Paris (Cimi-Paris), INSERM U1135, Sorbonne Université, Bd de l'Hôpital 91, Paris, Île de France 75013, France
| | - Roger Paredes
- IrsiCaixa, AIDS Research Institute, Institute for Health Science Research Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, 2nd floor, Ctra del canyet s/n, Badalona, Barcelona 08916, Spain; CIBERINFEC, Madrid, Spain; Fundació Lluita contra la Sida, Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Ctra del Canyet s/n, Badalona, Barcelona 08916, Spain; Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic - Central University of Catalonia (UVic - UCC), Carrer Miquel Martí i Pol, 1, Vic, Barcelona 08500, Spain
| | - Dennis Hartigan-O'Connor
- Department of Medical Microbiology and Immunology, University of California, Veterinary Medicine 3A, Davis, CA 95616, USA; Division of Experimental Medicine, UC Davis School of Medicine, 4610 X Street, Sacramento, CA 95817, USA
| | - Manel Esteller
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Passeig de Lluís Companys, 23, Barcelona 08010, Spain; Cancer and Leukemia Epigenetics and Biology Program (PEBCL), Josep Carreras Leukaemia Research Institute, Ctra de Can Ruti - Camí de les Escoles, s/n, Badalona, Barcelona 08916, Spain; Centro de Investigacion Biomedica en Red Cancer (CIBERONC), Av. Monforte de Lemos 3-5. Pabellón 11. Planta 0, Madrid 28029, Spain; Department of Physiological Sciences II, School of Medicine, University of Barcelona, Feixa Llarga, s/n, L'Hospitalet de Llobregat, Barcelona 08907, Spain
| | - Michael Meulbroek
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Carrer del Comte Borrell, 164-166, Barcelona 08015, Spain
| | - María Luz Calle
- Biosciences Department, Faculty of Sciences and Technology, University of Vic-Central University of Catalonia, Carrer de la Laura 13 - Torre dels Frares, Vic, Barcelona 08500, Spain
| | - Alex Sanchez-Pla
- Statistics Department, Biology Faculty, University of Barcelona, Diagonal 643, Barcelona 08028, Spain; Statistics and Bioinformatics Unit Vall d'Hebron Institut de Recerca (VHIR), Passeig de la Vall d'Hebron, 129, Barcelona 08035, Spain
| | - José Moltó
- CIBERINFEC, Madrid, Spain; Fundació Lluita contra la Sida, Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Ctra del Canyet s/n, Badalona, Barcelona 08916, Spain
| | - Beatriz Mothe
- IrsiCaixa, AIDS Research Institute, Institute for Health Science Research Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, 2nd floor, Ctra del canyet s/n, Badalona, Barcelona 08916, Spain; CIBERINFEC, Madrid, Spain; Fundació Lluita contra la Sida, Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Ctra del Canyet s/n, Badalona, Barcelona 08916, Spain; Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic - Central University of Catalonia (UVic - UCC), Carrer Miquel Martí i Pol, 1, Vic, Barcelona 08500, Spain
| | - Christian Brander
- IrsiCaixa, AIDS Research Institute, Institute for Health Science Research Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, 2nd floor, Ctra del canyet s/n, Badalona, Barcelona 08916, Spain; Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic - Central University of Catalonia (UVic - UCC), Carrer Miquel Martí i Pol, 1, Vic, Barcelona 08500, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Passeig de Lluís Companys, 23, Barcelona 08010, Spain
| | - Marta Ruiz-Riol
- IrsiCaixa, AIDS Research Institute, Institute for Health Science Research Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, 2nd floor, Ctra del canyet s/n, Badalona, Barcelona 08916, Spain; CIBERINFEC, Madrid, Spain.
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5
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Muñoz-Moreno JA, Carrillo-Molina S, Martínez-Zalacaín I, Miranda C, Manzardo C, Coll P, Meulbroek M, Hanke T, Garolera M, Miró JM, Brander C, Clotet B, Soriano-Mas C, Moltó J, Mothe B. Preserved central nervous system functioning after use of romidepsin as a latency-reversing agent in an HIV cure strategy. AIDS 2022; 36:363-372. [PMID: 34750296 DOI: 10.1097/qad.0000000000003121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the central nervous system (CNS) impact of a kick&kill HIV cure strategy using therapeutic vaccine MVA.HIVconsv and the histone deacetylase inhibitor (HDACi) romidepsin (RMD) as latency-reversing agent. DESIGN Neurological observational substudy of the BCN02 trial (NCT02616874), a proof-of-concept, open-label, single-arm, phase I clinical trial testing the safety and immunogenicity of the MVA.HIVconsv vaccine and RMD in early-treated HIV-1-infected individuals. A monitored antiretroviral pause (MAP) was performed, with cART resumption after 2 pVL more than 2000 copies/ml. Reinitiated participants were followed for 24 weeks. METHODS Substudy participation was offered to all BCN02 participants (N = 15). Evaluations covered cognitive, functional, and brain imaging outcomes, performed before RMD administration (pre-RMD), after three RMD infusions (post-RMD), and at the end of the study (EoS). A group of early-treated HIV-1-infected individuals with matched clinical characteristics was additionally recruited (n = 10). Primary endpoint was change in a global cognitive score (NPZ-6). RESULTS Eleven participants from BCN02 trial were enrolled. No significant changes were observed in cognitive, functional, or brain imaging outcomes from pre-RMD to post-RMD. No relevant alterations were detected from pre-RMD to EoS either. Scores at EoS were similar in participants off cART for 32 weeks (n = 3) and those who resumed therapy for 24 weeks (n = 7). Controls showed comparable punctuations in NPZ-6 across all timepoints. CONCLUSION No detrimental effects on cognitive status, functional outcomes, or brain imaging parameters were observed after using the HDACi RMD as latency-reversing agent with the MVA.HIVconsv vaccine in early-treated HIV-1-infected individuals. CNS safety was also confirmed after completion of the MAP.
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Affiliation(s)
- Jose A Muñoz-Moreno
- Fundació Lluita contra la SIDA (FLS), Hospital Universitari Germans Trias i Pujol, Badalona
- Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya (UOC), Barcelona
| | - Sara Carrillo-Molina
- Fundació Lluita contra la SIDA (FLS), Hospital Universitari Germans Trias i Pujol, Badalona
| | - Ignacio Martínez-Zalacaín
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat
- Department of Clinical Sciences, Universitat de Barcelona (UB)
| | - Cristina Miranda
- Fundació Lluita contra la SIDA (FLS), Hospital Universitari Germans Trias i Pujol, Badalona
| | - Christian Manzardo
- Infectious Diseases Department, Hospital Clínic-IDIBAPS
- University of Barcelona (UB)
| | - Pep Coll
- Fundació Lluita contra la SIDA (FLS), Hospital Universitari Germans Trias i Pujol, Badalona
- Projecte dels NOMS - Hispanosida, BCN Checkpoint, Barcelona
- IrsiCaixa AIDS Research Institute - HIVACAT, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
| | | | - Tomáš Hanke
- The Jenner Institute, University of Oxford, Oxford, UK
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Maite Garolera
- Neuropsychology Unit, Consorci Sanitari Hospital de Terrassa (CSHT), Terrassa
- Grup de Recerca Consolidat en Neuropsicologia, Universitat de Barcelona (UB), Barcelona
| | - Josep M Miró
- Infectious Diseases Department, Hospital Clínic-IDIBAPS
- University of Barcelona (UB)
| | - Christian Brander
- IrsiCaixa AIDS Research Institute - HIVACAT, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
- Faculty of Medicine, Universitat de Vic - Universitat Central de Catalunya (UVic-UCC), Vic
- ICREA, Barcelona
| | - Bonaventura Clotet
- Fundació Lluita contra la SIDA (FLS), Hospital Universitari Germans Trias i Pujol, Badalona
- IrsiCaixa AIDS Research Institute - HIVACAT, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
- Faculty of Medicine, Universitat de Vic - Universitat Central de Catalunya (UVic-UCC), Vic
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona
| | - Carles Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat
- CIBER Salud Mental (CIBERSAM), Carlos III Health Institute, Barcelona
- Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Catalonia, Spain
| | - José Moltó
- Fundació Lluita contra la SIDA (FLS), Hospital Universitari Germans Trias i Pujol, Badalona
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona
| | - Beatriz Mothe
- Fundació Lluita contra la SIDA (FLS), Hospital Universitari Germans Trias i Pujol, Badalona
- IrsiCaixa AIDS Research Institute - HIVACAT, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
- Faculty of Medicine, Universitat de Vic - Universitat Central de Catalunya (UVic-UCC), Vic
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona
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6
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Saz J, Dalmau-Bueno A, Meulbroek M, Pujol F, Coll J, Herraiz-Tomey Á, Pérez F, Marazzi G, Taboada H, Culqui DR, Caylà JA. Use of fourth-generation rapid combined antigen and antibody diagnostic tests for the detection of acute HIV infection in a community centre for men who have sex with men, between 2016 and 2019. PLoS One 2021; 16:e0255065. [PMID: 34314468 PMCID: PMC8315512 DOI: 10.1371/journal.pone.0255065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/08/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To assess the use of fourth-generation rapid diagnostic tests in identifying acute infection of Human Immunodeficiency Virus (HIV). Methods BCN Checkpoint promotes sexual health among men who have sex with men (MSM), with a focus on diagnosing HIV early, initiating combined antiretroviral treatment (cART) promptly, and recommending regular repeat testing for those who have tested negative. This cross-sectional study included all test results obtained at the centre between 25 March 2016 and 24 March 2019. The Alere™ HIV Combo (now rebranded to Determine™ HIV Ultra, from Abbott) was used to detect p24 antigen (p24 Ag) and/or immunoglobulin M (IgM) and G (IgG) antibodies to HIV-1/HIV-2 (HIV Ab). Rapid polymerase chain reaction (PCR) confirmatory testing and Western blot (WB) were performed for clients with a positive rapid test result. Confirmed HIV cases were promptly referred to the HIV unit for care and cART prescription. Results A total of 12,961 clients attended BCN Checkpoint during the study and 27,298 rapid tests were performed. 450 tests were found to be reactive, of which 430 confirmed as HIV-positive, representing a prevalence of 3.32%. Four confirmed cases (0.93%) were detected as “p24 Ag only”, nine (2.09%) as “both p24 and HIV Ab” and 417 (96.98%) as “HIV Ab only”. The “p24 Ag only” group had a 1-log higher viral load than the other groups and initiated treatment on the following working day. Overall, there were 20 false-positive results (0.07% and 4.44% of total and reactive tests, respectively), of which 10 positive for “p24 Ag only” and 10 for “HIV Ab only”. Conclusions Four Acute HIV Infections (AHI), with very high viral loads, have been detected with the “p24 Ag only” while the HIV Ab were still absent. Referral to the HIV unit and initiation of cART on the following working day contributed to improving persons’ health and to reduce HIV transmission chain.
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Affiliation(s)
- Jorge Saz
- Projecte dels NOMS-Hispanosida, Barcelona, Spain
- * E-mail:
| | | | | | - Ferran Pujol
- Projecte dels NOMS-Hispanosida, Barcelona, Spain
| | - Josep Coll
- IrsiCaixa AIDS Research Institute, Fight AIDS and Infectious Diseases Foundation, Badalona, Spain
| | | | - Félix Pérez
- Projecte dels NOMS-Hispanosida, Barcelona, Spain
| | | | | | - Dante R. Culqui
- Grupo Pulso (a company of Evidenze Group), Sant Cugat del Vallés, Spain
- Isabel Roig-Blauclinic Socio-Sanitary Centre, Barcelona, Spain
| | - Joan A. Caylà
- Tuberculosis Research Unit of Barcelona (UITB) Foundation, Barcelona, Spain
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7
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Meulbroek M, Dalmau-Bueno A, Saz J, Marazzi G, Pérez F, Coll J, Taboada H, Pujol F. Falling HIV incidence in a community clinic cohort of men who have sex with men and transgender women in Barcelona, Spain. Int J STD AIDS 2020; 31:841-848. [PMID: 32623981 DOI: 10.1177/0956462420932424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Barcelona, Spain prior to 2006, HIV testing was mostly limited to formal healthcare facilities with no incidence data reported. A community-based organization (BCN Checkpoint) was established to increase HIV testing in a peer-led community location to generate incidence data in men who have sex with men and transgender women. Three community engagement interventions were conducted between 2009 and 2017 as follows: 2009-2011 (peer-led point-of-care testing for HIV), 2012-2014 (12-monthly HIV testing with an emphasis on testing in partnerships), 2015-2017 (three-monthly HIV testing with rapid referral for antiretroviral initiation). Between 2009 and 2017 a predominantly cisgender male (99.4%) and Spanish national (62.4%) population with mean age of 34.8 years had 49,630 visits. Mean visit number increased from 1.69 in the first to 2.07 in the last three-year period. HIV incidence fell from 4.17 (95% confidence interval [CI]: 3.53-4.93) per 100 person-years in 2009-2011 to 1.57 (95% CI: 1.30-1.89) per 100 person-years in 2015-2017. This represents a 62% reduction (incidence rate ratio: 0.38, 95% CI: 0.29-0.48) between the first and third study period (p < 0.001). These early interventions may have contributed to the reduction seen in HIV incidence in this cohort.
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Affiliation(s)
| | | | - Jorge Saz
- Projecte dels NOMS-Hispanosida, Barcelona, Spain
| | | | | | - Josep Coll
- BCN Checkpoint, Barcelona, Spain.,IrsiCaixa, Badalona, Spain
| | | | - Ferran Pujol
- Projecte dels NOMS-Hispanosida, Barcelona, Spain
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8
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Mothe B, Rosás-Umbert M, Coll P, Manzardo C, Puertas MC, Morón-López S, Llano A, Miranda C, Cedeño S, López M, Alarcón-Soto Y, Melis GG, Langohr K, Barriocanal AM, Toro J, Ruiz I, Rovira C, Carrillo A, Meulbroek M, Crook A, Wee EG, Miró JM, Clotet B, Valle M, Martinez-Picado J, Hanke T, Brander C, Moltó J. HIVconsv Vaccines and Romidepsin in Early-Treated HIV-1-Infected Individuals: Safety, Immunogenicity and Effect on the Viral Reservoir (Study BCN02). Front Immunol 2020; 11:823. [PMID: 32435247 PMCID: PMC7218169 DOI: 10.3389/fimmu.2020.00823] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/09/2020] [Indexed: 12/30/2022] Open
Abstract
Kick&kill strategies combining drugs aiming to reactivate the viral reservoir with therapeutic vaccines to induce effective cytotoxic immune responses hold potential to achieve a functional cure for HIV-1 infection. Here, we report on an open-label, single-arm, phase I clinical trial, enrolling 15 early-treated HIV-1-infected individuals, testing the combination of the histone deacetylase inhibitor romidepsin as a latency-reversing agent and the MVA.HIVconsv vaccine. Romidepsin treatment resulted in increased histone acetylation, cell-associated HIV-1 RNA, and T-cell activation, which were associated with a marginally significant reduction of the viral reservoir. Vaccinations boosted robust and broad HIVconsv-specific T cells, which were strongly refocused toward conserved regions of the HIV-1 proteome. During a monitored ART interruption phase using plasma viral load over 2,000 copies/ml as a criterium for ART resumption, 23% of individuals showed sustained suppression of viremia up to 32 weeks without evidence for reseeding the viral reservoir. Results from this pilot study show that the combined kick&kill intervention was safe and suggest a role for this strategy in achieving an immune-driven durable viremic control.
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Affiliation(s)
- Beatriz Mothe
- IrsiCaixa AIDS Research Institute-HIVACAT, Badalona, Spain.,Fundació Lluita contra la Sida, Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Faculty of Medicine, Universitat de Vic-Central de Catalunya (UVic-UCC), Vic, Spain
| | - Miriam Rosás-Umbert
- IrsiCaixa AIDS Research Institute-HIVACAT, Badalona, Spain.,Department of Cellular Biology, Physiology and Immunology, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Pep Coll
- IrsiCaixa AIDS Research Institute-HIVACAT, Badalona, Spain
| | | | | | | | - Anuska Llano
- IrsiCaixa AIDS Research Institute-HIVACAT, Badalona, Spain
| | - Cristina Miranda
- Fundació Lluita contra la Sida, Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Miriam López
- Fundació Lluita contra la Sida, Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Yovaninna Alarcón-Soto
- Departament d'Estadística i Investigació Operativa, Universitat Politècnica de Catalunya/BARCELONATECH, Barcelona, Spain
| | - Guadalupe Gómez Melis
- Departament d'Estadística i Investigació Operativa, Universitat Politècnica de Catalunya/BARCELONATECH, Barcelona, Spain
| | - Klaus Langohr
- Departament d'Estadística i Investigació Operativa, Universitat Politècnica de Catalunya/BARCELONATECH, Barcelona, Spain
| | - Ana M Barriocanal
- Department of Cellular Biology, Physiology and Immunology, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain.,Department of Infectious Diseases, Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Jessica Toro
- Fundació Lluita contra la Sida, Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Irene Ruiz
- Hospital Clinic- IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Cristina Rovira
- Hospital Clinic- IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Antonio Carrillo
- Department of Infectious Diseases, Germans Trias i Pujol Research Institute, Badalona, Spain
| | | | - Alison Crook
- The Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Edmund G Wee
- The Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Jose M Miró
- Hospital Clinic- IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Bonaventura Clotet
- IrsiCaixa AIDS Research Institute-HIVACAT, Badalona, Spain.,Fundació Lluita contra la Sida, Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Faculty of Medicine, Universitat de Vic-Central de Catalunya (UVic-UCC), Vic, Spain.,Department of Cellular Biology, Physiology and Immunology, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain
| | - Marta Valle
- Department of Cellular Biology, Physiology and Immunology, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain.,Pharmacokinetic/Pharmacodynamic Modeling and Simultation, Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau-IIB Sant Pau, Barcelona, Spain
| | - Javier Martinez-Picado
- IrsiCaixa AIDS Research Institute-HIVACAT, Badalona, Spain.,Faculty of Medicine, Universitat de Vic-Central de Catalunya (UVic-UCC), Vic, Spain.,ICREA, Barcelona, Spain
| | - Tomáš Hanke
- The Jenner Institute, University of Oxford, Oxford, United Kingdom.,Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Christian Brander
- IrsiCaixa AIDS Research Institute-HIVACAT, Badalona, Spain.,Faculty of Medicine, Universitat de Vic-Central de Catalunya (UVic-UCC), Vic, Spain.,ICREA, Barcelona, Spain
| | - José Moltó
- Fundació Lluita contra la Sida, Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Infectious Diseases, Germans Trias i Pujol Research Institute, Badalona, Spain
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9
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Mothe B, Manzardo C, Sanchez-Bernabeu A, Coll P, Morón-López S, Puertas MC, Rosas-Umbert M, Cobarsi P, Escrig R, Perez-Alvarez N, Ruiz I, Rovira C, Meulbroek M, Crook A, Borthwick N, Wee EG, Yang H, Miró JM, Dorrell L, Clotet B, Martinez-Picado J, Brander C, Hanke T. Corrigendum to 'Therapeutic vaccination refocuses T-cell responses towards conserved regions of HIV-1 in early treated individuals (BCN 01 study)' EClinicalMedicine 11 (2019) 65-80. EClinicalMedicine 2020; 18:100250. [PMID: 31956858 PMCID: PMC6956742 DOI: 10.1016/j.eclinm.2019.100250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
[This corrects the article DOI: 10.1016/j.eclinm.2019.05.009.].
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Affiliation(s)
- Beatriz Mothe
- IrsiCaixa AIDS Research Institute-HIVACAT, Hospital Universitari Germans Trias i Pujol, Crta Canyet s/n, 08916 Badalona, Spain
- Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Universitat de Vic, Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
- Corresponding author at: IrsiCaixa AIDS Research Institute-HIVACAT, Hospital Universitari Germans Trias i Pujol, Crta Canyet s/n, 08916 Badalona, Spain.
| | | | - Alvaro Sanchez-Bernabeu
- IrsiCaixa AIDS Research Institute-HIVACAT, Hospital Universitari Germans Trias i Pujol, Crta Canyet s/n, 08916 Badalona, Spain
| | - Pep Coll
- IrsiCaixa AIDS Research Institute-HIVACAT, Hospital Universitari Germans Trias i Pujol, Crta Canyet s/n, 08916 Badalona, Spain
- Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Sara Morón-López
- IrsiCaixa AIDS Research Institute-HIVACAT, Hospital Universitari Germans Trias i Pujol, Crta Canyet s/n, 08916 Badalona, Spain
| | - Maria C. Puertas
- IrsiCaixa AIDS Research Institute-HIVACAT, Hospital Universitari Germans Trias i Pujol, Crta Canyet s/n, 08916 Badalona, Spain
| | - Miriam Rosas-Umbert
- IrsiCaixa AIDS Research Institute-HIVACAT, Hospital Universitari Germans Trias i Pujol, Crta Canyet s/n, 08916 Badalona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Patricia Cobarsi
- Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Roser Escrig
- Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Núria Perez-Alvarez
- Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Technical University of Catalonia, Barcelona, Spain
| | - Irene Ruiz
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Cristina Rovira
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Alison Crook
- The Jenner Institute, University of Oxford, Oxford, UK
| | | | - Edmund G. Wee
- The Jenner Institute, University of Oxford, Oxford, UK
| | - Hongbing Yang
- Nuffield Department of Medicine and Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Jose M. Miró
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Lucy Dorrell
- Nuffield Department of Medicine and Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Bonaventura Clotet
- IrsiCaixa AIDS Research Institute-HIVACAT, Hospital Universitari Germans Trias i Pujol, Crta Canyet s/n, 08916 Badalona, Spain
- Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Universitat de Vic, Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Javier Martinez-Picado
- IrsiCaixa AIDS Research Institute-HIVACAT, Hospital Universitari Germans Trias i Pujol, Crta Canyet s/n, 08916 Badalona, Spain
- Universitat de Vic, Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
- ICREA, Pg. Luis Companys 23, Barcelona, Spain
| | - Christian Brander
- IrsiCaixa AIDS Research Institute-HIVACAT, Hospital Universitari Germans Trias i Pujol, Crta Canyet s/n, 08916 Badalona, Spain
- Universitat de Vic, Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
- ICREA, Pg. Luis Companys 23, Barcelona, Spain
| | - Tomáš Hanke
- The Jenner Institute, University of Oxford, Oxford, UK
- International Research Center for Medical Sciences, Kumamoto University, Kumamoto, Japan
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Meulbroek M, Pujol F, Pérez F, Dalmau-Bueno A, Taboada H, Marazzi G, Carrillo A, Cabas A, Gata A, Aldabó E, Roldán B, Coll P, Añez F, Pantaleón J, Mochales M, Gómez V, Marín O, Mir JF, Decoca J, Saz J. BCN Checkpoint: same-day confirmation of reactive HIV rapid test with Point Of Care HIV-RNA accelerates linkage to care and reduces anxiety. HIV Med 2019; 19 Suppl 1:63-65. [PMID: 29488706 DOI: 10.1111/hiv.12595] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND The introduction in 2006 of the rapid HIV test by BCN Checkpoint in a non-clinical setting has been a successful step forwards in the uptake of testing. Nevertheless, HIV serostatus should be reported as HIV positive only when a reactive result has been tested again using a different assay (WHO guidelines 2015). The standard confirmation test has been the Western Blot (WB) test. However confirmation results take around 7 days to come back. AIMS This study explores the possibility of Point of Care PCR testing for a same-day confirmation. MATERIALS AND METHODS Between March 2015 and September 2016 a POC PCR test (Xpert® HIV-1 Qual) was performed in parallel to the Western Blot test after a reactive HIV rapid test (Alere Determine™ HIV-1/2 Ag/Ab Combo and Alere™ HIV Combo). HIV confirmed positive cases received emotional support by peers, were informed and prepared for treatment initiation and rapidly linked to HIV clinic. RESULTS During the study period 11 455 tests were performed to 7163 clients. A total of 249 reactive rapid HIV tests were found. For analysis a total of 33 cases were excluded due to the lack of PCR and/or WB test. Results of comparison of the 216 cases showed 194 concordant positive confirmations and 14 concordant negative results. In three cases PCR was positive and WB negative. In five cases PCR was negative and WB positive. CONCLUSION The POC PCR assay is easy to use and feasible in a community-based center. Reducing time for confirmation to 90 min has been possible in 91.2% (197/216) of cases with positive PCR result. In cases of a negative PCR result an additional test (WB, Elisa or PCR quantitative) was needed to distinguish false positive results (6.5%) from viral load results below level of detection (2.3%). Clients expressed satisfaction with same-day confirmation and less anxiety.
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Affiliation(s)
- M Meulbroek
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - F Pujol
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - F Pérez
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - A Dalmau-Bueno
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - H Taboada
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - G Marazzi
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - A Carrillo
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - A Cabas
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - A Gata
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - E Aldabó
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - B Roldán
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - P Coll
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - F Añez
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - J Pantaleón
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - M Mochales
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - V Gómez
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - O Marín
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - J F Mir
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - J Decoca
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - J Saz
- Projecte dels NOMS-Hispanosida, BCN Checkpoint, Barcelona, Spain
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Mothe B, Manzardo C, Sanchez-Bernabeu A, Coll P, Morón-López S, Puertas MC, Rosas-Umbert M, Cobarsi P, Escrig R, Perez-Alvarez N, Ruiz I, Rovira C, Meulbroek M, Crook A, Borthwick N, Wee EG, Yang H, Miró JM, Dorrell L, Clotet B, Martinez-Picado J, Brander C, Hanke T. Therapeutic Vaccination Refocuses T-cell Responses Towards Conserved Regions of HIV-1 in Early Treated Individuals (BCN 01 study). EClinicalMedicine 2019; 11:65-80. [PMID: 31312806 PMCID: PMC6610778 DOI: 10.1016/j.eclinm.2019.05.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Strong and broad antiviral T-cell responses targeting vulnerable sites of HIV-1 will likely be a critical component for any effective cure strategy. METHODS BCN01 trial was a phase I, open-label, non-randomized, multicenter study in HIV-1-positive individuals diagnosed and treated during early HIV-1 infection to evaluate two vaccination regimen arms, which differed in the time (8 versus 24 week) between the ChAdV63.HIVconsv prime and MVA.HIVconsv boost vaccinations. The primary outcome was safety. Secondary endpoints included frequencies of vaccine-induced IFN-γ+ CD8+ T cells, in vitro virus-inhibitory capacity, plasma HIV-1 RNA and total CD4+ T-cells associated HIV-1 DNA. (NCT01712425). FINDINGS No differences in safety, peak magnitude or durability of vaccine-induced responses were observed between long and short interval vaccination arms. Grade 1/2 local and systemic post-vaccination events occurred in 22/24 individuals and resolved within 3 days. Weak responses to conserved HIV-1 regions were detected in 50% of the individuals before cART initiation, representing median of less than 10% of their total HIV-1-specific T cells. All participants significantly elevated these subdominant T-cell responses, which after MVA.HIVconsv peaked at median (range) of 938 (73-6,805) IFN-γ SFU/106 PBMC, representing on average 58% of their total anti-HIV-1 T cells. The decay in the size of the HIV-1 reservoir was consistent with the first year of early cART initiation in both arms. INTERPRETATION Heterologous prime-boost vaccination with ChAdV63-MVA/HIVconsv was well-tolerated and refocused pre-cART T-cell responses towards more protective epitopes, in which immune escape is frequently associated with reduced HIV-1 replicative fitness and which are common to most global HIV-1 variants. FUNDING HIVACAT Catalan research program for an HIV vaccine and Fundació Gloria Soler. Vaccine manufacture was jointly funded by the Medical Research Council (MRC) UK and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreements (G0701669. RESEARCH IN CONTEXT Evidence Before this Study: T cells play an important role in the control of HIV infection and may be particularly useful for HIV-1 cure by killing cells with reactivated HIV-1. Evidence is emerging that not all T-cell responses are protective and mainly only those targeting conserved regions of HIV-1 proteins are effective, but typically immunologically subdominant, while those recognizing hypervariable, easy-to-escape immunodominant 'decoys' do not control viremia and do not protect from a loss of CD4 T cells. We pioneered a vaccine strategy focusing T-cell responses on the most conserved regions of the HIV-1 proteome using an immunogen designated HIVconsv. T cells elicited by the HIVconsv vaccines in HIV-uninfected UK and Kenyan adults inhibited in vitro replication of HIV-1 isolates from 4 major global clades A, B, C and D.Added Value of this Study: The present study demonstrated the concept that epitopes subdominant in natural infection, when taken out of the context of the whole HIV-1 proteome and presented to the immune system by a potent simian adenovirus prime-poxvirus MVA boost regimen, can induce strong responses in patients on antiretroviral treatment and efficiently refocus HIV-1-specific T-cells to the protective epitopes delivered by the vaccine.Implications of all the Available Evidence: Nearly all HIV-1 vaccine strategies currently emphasize induction of broadly neutralizing Abs. The HIVconsv vaccine is one of a very few approaches focussing exclusively on elicitation of T cells and, therefore, can complement antibody induction for better prevention and cure. Given the cross-clade reach on the HIVconsv immunogen design, if efficient, the HIVconsv vaccines could be deployed globally. Effective vaccines will likely be a necessary component in combination with other available preventive measures for halting the HIV-1/AIDS epidemic.
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Affiliation(s)
- Beatriz Mothe
- IrsiCaixa AIDS Research Institute-HIVACAT, Badalona, Spain
- Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Universitat de Vic - Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
- Corresponding author at: IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Crta Canyet s/n, 08916, Badalona, Barcelona, Spain.
| | | | | | - Pep Coll
- IrsiCaixa AIDS Research Institute-HIVACAT, Badalona, Spain
- Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Miriam Rosas-Umbert
- IrsiCaixa AIDS Research Institute-HIVACAT, Badalona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Patricia Cobarsi
- Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Roser Escrig
- Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Núria Perez-Alvarez
- Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Technical University of Catalonia, Barcelona, Spain
| | - Irene Ruiz
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Cristina Rovira
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Alison Crook
- The Jenner Institute, University of Oxford, Oxford, UK
| | | | - Edmund G. Wee
- The Jenner Institute, University of Oxford, Oxford, UK
| | - Hongbing Yang
- Nuffield Department of Medicine and Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Jose M. Miró
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Lucy Dorrell
- Nuffield Department of Medicine and Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Bonaventura Clotet
- IrsiCaixa AIDS Research Institute-HIVACAT, Badalona, Spain
- Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Universitat de Vic - Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Javier Martinez-Picado
- IrsiCaixa AIDS Research Institute-HIVACAT, Badalona, Spain
- Universitat de Vic - Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
- ICREA, Pg. Luis Companys 23, Barcelona, Spain
| | - Christian Brander
- IrsiCaixa AIDS Research Institute-HIVACAT, Badalona, Spain
- Universitat de Vic - Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
- ICREA, Pg. Luis Companys 23, Barcelona, Spain
| | - Tomáš Hanke
- The Jenner Institute, University of Oxford, Oxford, UK
- International Research Center for Medical Sciences, Kumamoto University, Kumamoto, Japan
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Iniesta C, Álvarez-Del Arco D, García-Sousa LM, Alejos B, Díaz A, Sanz N, Garrido J, Meulbroek M, Pujol F, Moreno S, Fuster-RuizdeApodaca MJ, Coll P, Antela A, Del Romero J, Ayerdi O, Riera M, Hernández J, Del Amo J. Correction: Awareness, knowledge, use, willingness to use and need of Pre-Exposure Prophylaxis (PrEP) during World Gay Pride 2017. PLoS One 2019; 14:e0216376. [PMID: 31034518 PMCID: PMC6488067 DOI: 10.1371/journal.pone.0216376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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13
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Iniesta C, Álvarez-del Arco D, García-Sousa LM, Alejos B, Díaz A, Sanz N, Garrido J, Meulbroek M, Pujol F, Moreno S, Fuster-Ruiz de Apocada MJ, Coll P, Antela A, del Romero J, Ayerdi O, Riera M, Hernández J, del Amo J. Awareness, knowledge, use, willingness to use and need of Pre-Exposure Prophylaxis (PrEP) during World Gay Pride 2017. PLoS One 2018; 13:e0204738. [PMID: 30339690 PMCID: PMC6195256 DOI: 10.1371/journal.pone.0204738] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/13/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the awareness, knowledge, use, and willingness to use and need of PrEP among men who have sex with men (MSM) and transgender women (TW) who attended World Gay Pride (WGP) 2017 in Madrid. DESIGN AND METHODS Online survey. Participants were recruited through gay-oriented dating apps and HIV Non-Governmental Organizations´ social media. Inclusion criteria included being MSM or TW, age 18 years old or above, and having attended WGP in Madrid. Information regarding the participant's awareness and knowledge, use or willingness to use, and need for PrEP was collected, as well as sociodemographic characteristics. Participants were considered to be in need of PrEP if they met one of the following indication criteria: having practiced unprotected anal intercourse with more than 2 partners, having practiced chemsex, or having engaged in commercial sex-all in the preceding 6 months. Descriptive and multivariable analyses with logistic regression were conducted. RESULTS 472 participants met the inclusion criteria and completed the questionnaire. The mean age was 38, 97.7% were MSM, 77% had a university education, and 85% were living in Spain, mostly in big cities. Overall, 64% of participants were aware of PrEP, but only 33% knew correctly what PrEP was. 67% of HIV-negative participants were willing to take PrEP, although only 5% were taking it during WGP, mostly due to lack of access. 43% of HIV-negative respondents met at least one PrEP indication criteria. For HIV-negative men living in Spain, university education and living in big cities was associated with PrEP awareness. Lower education level and meeting PrEP criteria was associated with willingness to use PrEP. CONCLUSIONS Our study shows that among MSM attending WGP 2017 in Madrid, there was limited PrEP awareness, low accuracy of PrEP knowledge, and a high need and willingness to use PrEP. Health authorities should strengthen existing preventive strategies and implement PrEP.
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Affiliation(s)
- Carlos Iniesta
- National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - Débora Álvarez-del Arco
- Universidad Complutense de Madrid, Madrid, Spain
- La Doctora Álvarez Communication Agency, Madrid, Spain
| | | | - Belén Alejos
- National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - Asunción Díaz
- National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | | | | | | | - Ferran Pujol
- Projecte dels NOMS, Hispanosida, Barcelona, Spain
| | - Santiago Moreno
- Hospital Universitario Ramón y Cajal, Madrid, Spain
- Universidad Alcalá de Henares, Madrid, Spain
| | | | - Pep Coll
- AIDS Research Institute-IrsiCaixa, Barcelona, Spain
| | - Antonio Antela
- Hospital Clinico Universitario de Santiago de Compostela, Infectious Diseases Department, Santiago de Compostela, Spain
| | | | - Oskar Ayerdi
- Centro Sanitario Sandoval IdISSC, Unidad ITS/VIH, Madrid, Spain
| | | | - Juanse Hernández
- Grupo de Trabajo sobre Tratamientos del VIH -gTt-VIH, Barcelona, Spain
| | - Julia del Amo
- National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain
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14
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García LM, Iniesta C, Garrido J, Fuster MJ, Pujol F, Meulbroek M, Poveda T, Riera M, Antela A, Moreno S, Dalmau D, Rivero A, García D, Espacio R, Del Amo J. HIV pre-exposure prophylaxis (PrEP) in Spain: political and administrative situation. Enferm Infecc Microbiol Clin 2018; 37:656-660. [PMID: 29910148 DOI: 10.1016/j.eimc.2018.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 11/27/2022]
Abstract
This study focuses on actions at the political and administrative level in Spain in relation to the implementation of pre-exposure prophylaxis (PrEP). We analysed a whole range of different formal initiatives taken by the political and administrative actors involved. The information was obtained from official public data sources. As of February 2018, PrEP had not been implemented. The decision is dependent on both state and regional governments. The Ministry of Health and some Autonomous Regions are working on different interventions, but without providing an implementation timetable. The political parties have kept a very low profile in terms of initiatives related to the implementation of PrEP. From a legal point of view, proceedings are passing back and forth with the extension of the patent. The role of intergovernmental and interdepartmental institutions is very important for the implementation of PrEP in Spain.
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Affiliation(s)
- Luis Miguel García
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España; Spanish Network of Excellence on HIV Research, RIS, España.
| | - Carlos Iniesta
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España; Spanish Network of Excellence on HIV Research, RIS, España
| | | | - María José Fuster
- Spanish Network of Excellence on HIV Research, RIS, España; SEISIDA, Madrid, España
| | | | | | | | - Melchor Riera
- Spanish Network of Excellence on HIV Research, RIS, España; Servicio de Medicina Interna-Infecciosas, Hospital Son Espases, Palma de Mallorca, España
| | - Antonio Antela
- Spanish Network of Excellence on HIV Research, RIS, España; Unidad de Enfermedades Infecciosas, Hospital Clínico Universitario, Santiago de Compostela, España
| | - Santiago Moreno
- Spanish Network of Excellence on HIV Research, RIS, España; Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, España; GeSIDA, Madrid, España
| | - David Dalmau
- Spanish Network of Excellence on HIV Research, RIS, España; SEISIDA, Madrid, España; Grupo de Investigación VIH+/SIDA, Hospital Universitario Mútua Terrassa, Terrassa, España
| | - Antonio Rivero
- Spanish Network of Excellence on HIV Research, RIS, España; Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, España; GeSIDA, Madrid, España
| | | | | | - Julia Del Amo
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España; Spanish Network of Excellence on HIV Research, RIS, España; SEISIDA, Madrid, España
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15
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Moreno S, Antela A, García F, Del Amo J, Boix V, Coll P, Fortuny C, Sirvent JLG, Gutiérrez F, Iribarren JA, Llibre JM, Quirós JCLBD, Losa JE, Lozano A, Meulbroek M, Olalla J, Pujol F, Pulido F, Crespo Casal M, García JG, Aldeguer JL, Molina JAP, Podzamczer Palter D, Román AR. Executive summary: Pre-exposure prophylaxis for prevention of HIV infection in adults in Spain: July 2016. Enferm Infecc Microbiol Clin 2017; 35:377-383. [PMID: 28236498 DOI: 10.1016/j.eimc.2016.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 11/09/2016] [Accepted: 11/25/2016] [Indexed: 11/30/2022]
Abstract
Administration of antiretroviral drugs to individuals exposed to, but not infected by, HIV has been shown to reduce the risk of transmission. The efficacy of pre-exposure prophylaxis (PrEP) makes it obligatory to include it in an integral program of prevention of HIV transmission, together with other measures, such as use of the condom, training, counseling, and appropriate treatment of infected individuals. In this document, the AIDS Study Group (GeSIDA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica [SEIMC]) provides its views on this important subject. The available evidence on the usefulness of PrEP in the prevention of transmission of HIV is presented, and the components that should make up a PrEP program and whose development and implementation are feasible in Spain are set out.
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Affiliation(s)
| | - Antonio Antela
- Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Felipe García
- Hospital Clínic, Hospital Universitario Ramón y Cajal, IRYCIS , Barcelona, Spain
| | | | | | - Pep Coll
- IrsiCaixa, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | | | | | | | - Josep M Llibre
- Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | | | - Ana Lozano
- Hospital de Poniente, El Ejido, Almería, Spain
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16
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Borges ÁH, Neuhaus J, Babiker AG, Henry K, Jain MK, Palfreeman A, Mugyenyi P, Domingo P, Hoffmann C, Read TRH, Pujari S, Meulbroek M, Johnson M, Wilkin T, Mitsuyasu R. Immediate Antiretroviral Therapy Reduces Risk of Infection-Related Cancer During Early HIV Infection. Clin Infect Dis 2016; 63:1668-1676. [PMID: 27609756 DOI: 10.1093/cid/ciw621] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/01/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND In the Strategic Timing of Antiretroviral Treatment (START) study, immediate combination antiretroviral therapy (cART) initiation reduced cancer risk by 64%. We hypothesized that risk reduction was higher for infection-related cancer and determined by differences in CD4 cell counts and human immunodeficiency virus (HIV) RNA between the study arms. METHODS Incident malignancies in START were categorized into infection-related and infection-unrelated cancer. We used Cox models to assess factors associated with both cancer categories. We used sequential adjustment for baseline covariates, cancer risk factors, and HIV-specific variables to investigate potential mediators of cancer risk reduction with immediate cART. RESULTS There were 14 cancers among persons randomized to immediate cART (6 infection-related and 8 infection-unrelated) and 39 cancers in the deferred arm (23 infection-related and 16 infection-unrelated); hazard ratios of immediate vs deferred cART initiation were 0.26 (95% confidence interval [CI], .11-.64) for infection-related and 0.49 (95% CI, .21-1.15) for infection-unrelated cancer. Independent predictors of infection-related cancer were older age, higher body mass index, low- to middle-income region, HIV RNA, and baseline CD8 cell count. Older age and baseline CD8 cell count were independent predictors of infection-unrelated cancer. Adjustment for latest HIV RNA level had little impact on the protective effect of immediate cART on infection-related cancer. Adjustment for latest HIV RNA level, but not for CD4 cell count or cancer risk factors, attenuated the effect of immediate cART on infection-unrelated cancer. CONCLUSIONS Immediate cART initiation significantly reduces risk of cancer. Although limited by small sample size, this benefit does not appear to be solely attributable to HIV RNA suppression and may be also mediated by other mechanisms.
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Affiliation(s)
- Álvaro H Borges
- Centre for Health and Infectious Diseases Research, Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Denmark
| | - Jacqueline Neuhaus
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis
| | - Abdel G Babiker
- Medical Research Council Clinical Trials Unit, University College London, United Kingdom
| | - Keith Henry
- Hennepin County Medical Center, Minneapolis, Minnesota
| | - Mamta K Jain
- Division of Infectious Disease, UT Southwestern Medical Center, Dallas, Texas
| | - Adrian Palfreeman
- Department of Infectious Diseases, University Hospitals Leicester NHS Trust, Leicester, United Kingdom
| | | | - Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona and Red de Investigación en SIDA, Barcelona, Spain
| | - Christian Hoffmann
- Infektionsmedizinisches Centrum Hamburg Study Center, Hamburg.,Department of Medicine II, University of Schleswig-Holstein, Kiel, Germany
| | - Tim R H Read
- Melbourne Sexual Health Centre, Alfred Hospital and Central Clinical School, Monash University, Australia
| | - Sanjay Pujari
- Institute of Infectious Diseases, Pune, Maharashtra, India
| | | | - Margaret Johnson
- Ian Charleson Day Centre, Royal Free Hospital, London, United Kingdom
| | - Timothy Wilkin
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York
| | - Ronald Mitsuyasu
- Center for Clinical AIDS Research and Education, David Geffen School of Medicine, University of California, Los Angeles
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Ferrer L, Loureiro E, Meulbroek M, Folch C, Perez F, Esteve A, Saz J, Taboada H, Pujol F, Casabona J. High HIV incidence among men who have sex with men attending a community-based voluntary counselling and testing service in Barcelona, Spain: results from the ITACA cohort. Sex Transm Infect 2015; 92:70-5. [PMID: 26136507 DOI: 10.1136/sextrans-2015-052042] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 06/13/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To identify the HIV incidence and its associated factors (AFs) of the ITACA, a community-based cohort of HIV-negative men who have sex with men (MSM) established in Barcelona, Spain from 2008 to 2011. METHODS Participants were men aged 18 years or older, having a negative HIV test result at baseline and agreeing to participate. Bio-behavioural data were collected by peers in each visit. HIV incidence rates using person-time measures and 95% CIs were calculated. Cox logistic regression models were used to identify AFs to seroconversion. RESULTS Over the period, 3544 participants with at least one follow-up visit or those who had a first visit no longer than a year prior to the date of data censoring were included in the analysis contributing 3567.09 person-year (p-y) and 85 MSM seroconverted for an overall HIV incidence of 2.4 per 100 p-y (95% CI 1.9 to 2.9) ranging from 1.21/100 (2009) to 3.1/100 p-y (2011). Independent AF included: foreign origin, having more than five HIV tests at baseline, reporting in the preceding 6 months the following: condomless anal sex with the last steady partner of unknown serostatus, more than 10 casual partners, condomless anal sex with casual partner, self-reported gonorrhoea and entered in the cohort in 2010 or 2011. CONCLUSIONS The ITACA cohort revealed a high and increasing HIV incidence among MSM, especially important among foreign-born men. The findings underscore the need to implement multilevel interventions for MSM taking into account different types of partners, cultural origins and the exposure to other sexually transmitted infections.
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Affiliation(s)
- Laia Ferrer
- Center for Epidemiological Studies on STI and AIDS of Catalonia (CEEISCAT), Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain Institut d'Investigacio Germans Trias i Pujol (IGTP), Badalona, Spain CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | - Eva Loureiro
- Center for Epidemiological Studies on STI and AIDS of Catalonia (CEEISCAT), Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain Institut d'Investigacio Germans Trias i Pujol (IGTP), Badalona, Spain CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | | | - Cinta Folch
- Center for Epidemiological Studies on STI and AIDS of Catalonia (CEEISCAT), Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain Institut d'Investigacio Germans Trias i Pujol (IGTP), Badalona, Spain CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine, Universitat Autònoma de Barcelona (UAB), Bellaterra (Cerdanyola), Spain
| | - Felix Perez
- Projecte dels Noms-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - Anna Esteve
- Center for Epidemiological Studies on STI and AIDS of Catalonia (CEEISCAT), Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain Institut d'Investigacio Germans Trias i Pujol (IGTP), Badalona, Spain CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine, Universitat Autònoma de Barcelona (UAB), Bellaterra (Cerdanyola), Spain
| | - Jorge Saz
- Projecte dels Noms-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - Hector Taboada
- Projecte dels Noms-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - Ferran Pujol
- Projecte dels Noms-Hispanosida, BCN Checkpoint, Barcelona, Spain
| | - Jordi Casabona
- Center for Epidemiological Studies on STI and AIDS of Catalonia (CEEISCAT), Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain Institut d'Investigacio Germans Trias i Pujol (IGTP), Badalona, Spain CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine, Universitat Autònoma de Barcelona (UAB), Bellaterra (Cerdanyola), Spain
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Geffen N, Aagaard P, Corbelli GM, Meulbroek M, Peavy D, Rappoport C, Schwarze S, Collins S. Community perspective on the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial. HIV Med 2015; 16 Suppl 1:10-3. [PMID: 25711318 PMCID: PMC4341942 DOI: 10.1111/hiv.12228] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2014] [Indexed: 01/08/2023]
Abstract
Determining when to start antiretroviral treatment (ART) is vitally important for people living with HIV. Yet the optimal point at which to start to maximize clinical benefit remains unknown. In the absence of randomized studies, current guidelines rely on conflicting observational data and expert opinion, and consequently diverge on this point. In the USA, ART is recommended irrespective of CD4 cell count. The World Health Organization now recommends starting ART at a CD4 cell count of 500 cells/μL, while the threshold for the UK and South Africa remains at 350 cells/μL. The Strategic Timing of AntiRetroviral Treatment (START) study, one of the largest clinical trials on the treatment of HIV infection, will answer this question. START compares two treatment strategies: immediate treatment at a CD4 cell count of 500 cells/μL or higher versus deferring treatment until the CD4 cell count decreases to 350 cells/μL or until AIDS develops. START includes seven substudies, five of which will clarify the relative contributions of HIV and ART in common comorbidities. START is fully enrolled and expected to be completed in 2016. HIV advocates support the study's design and have been involved from inception to enrolment. The trial will produce rigorous data on the benefits and risks of earlier treatment. It will inform policy and treatment advocacy globally, benefitting the health of HIV-positive people.
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Affiliation(s)
- N Geffen
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
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Ruiz-Riol M, Llano A, Ibarrondo J, Zamarreño J, Yusim K, Bach V, Mothe B, Perez-Alvarez S, Fernandez MA, Requena G, Meulbroek M, Pujol F, Leon A, Cobarsi P, Korber BT, Clotet B, Ganoza C, Sanchez J, Coll J, Brander C. Alternative effector-function profiling identifies broad HIV-specific T-cell responses in highly HIV-exposed individuals who remain uninfected. J Infect Dis 2014; 211:936-46. [PMID: 25249264 DOI: 10.1093/infdis/jiu534] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The characterization of host immune responses to human immunodeficiency virus (HIV) in HIV controllers and individuals with high exposure but seronegativity to HIV (HESN) is needed to guide the development of effective preventive and therapeutic vaccine candidates. However, several technical hurdles severely limit the definition of an effective virus-specific T-cell response. By using a toggle-peptide approach, which takes HIV sequence diversity into account, and a novel, boosted cytokine staining/flow cytometry strategy, we here describe new patterns of T-cell responses to HIV that would be missed by standard assays. Importantly, this approach also allows detection of broad and strong virus-specific T-cell responses in HESN individuals that are characterized by a T-helper type 1 cytokine-like effector profile and produce cytokines that have been associated with potential control of HIV infection, including interleukin 10, interleukin 13, and interleukin 22. These results establish a novel approach to improve the current understanding of HIV-specific T-cell immunity and identify cellular immune responses and individual cytokines as potential markers of relative HIV resistance. As such, the findings also help develop similar strategies for more-comprehensive assessments of host immune responses to other human infections and immune-mediated disorders.
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Affiliation(s)
- Marta Ruiz-Riol
- HIVACAT, Irsicaixa AIDS Research Institute, Autonomous University of Barcelona
| | - Anuska Llano
- HIVACAT, Irsicaixa AIDS Research Institute, Autonomous University of Barcelona
| | - Javier Ibarrondo
- Center for HIV Prevention Research, University of California-Los Angeles
| | - Jennifer Zamarreño
- HIVACAT, Irsicaixa AIDS Research Institute, Autonomous University of Barcelona
| | | | - Vanessa Bach
- HIVACAT, Irsicaixa AIDS Research Institute, Autonomous University of Barcelona
| | - Beatriz Mothe
- HIVACAT, Irsicaixa AIDS Research Institute, Autonomous University of Barcelona Fundació Lluita Contra La Sida, Hospital Universitari Germans Trias i Pujol University of Vic, Spain
| | | | - Marco A Fernandez
- Flow Cytometry Facility, Health Sciences Research Institute Germans Trias i Pujol, Badalona
| | - Gerard Requena
- Flow Cytometry Facility, Health Sciences Research Institute Germans Trias i Pujol, Badalona
| | | | | | | | - Patricia Cobarsi
- Fundació Lluita Contra La Sida, Hospital Universitari Germans Trias i Pujol
| | | | - Bonaventura Clotet
- HIVACAT, Irsicaixa AIDS Research Institute, Autonomous University of Barcelona Fundació Lluita Contra La Sida, Hospital Universitari Germans Trias i Pujol University of Vic, Spain
| | | | - Jorge Sanchez
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | - Josep Coll
- HIVACAT, Irsicaixa AIDS Research Institute, Autonomous University of Barcelona Fundació Lluita Contra La Sida, Hospital Universitari Germans Trias i Pujol
| | - Christian Brander
- HIVACAT, Irsicaixa AIDS Research Institute, Autonomous University of Barcelona Institució Catalana de Recerca i Estudis Avancats (ICREA), Barcelona University of Vic, Spain
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Meulbroek M, Ditzel E, Saz J, Taboada H, Pérez F, Pérez A, Carrillo A, Font G, Marazzi G, Uya J, Cabrero J, Ingrami M, Marín R, Coll J, Pujol F. BCN Checkpoint, a community-based centre for men who have sex with men in Barcelona, Catalonia, Spain, shows high efficiency in HIV detection and linkage to care. HIV Med 2013; 14 Suppl 3:25-8. [DOI: 10.1111/hiv.12054] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2013] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - J Saz
- Projecte dels NOMS-Hispanosida
| | | | - F Pérez
- Projecte dels NOMS-Hispanosida
| | - A Pérez
- Projecte dels NOMS-Hispanosida
| | | | - G Font
- BCN Checkpoint; Barcelona; Spain
| | | | - J Uya
- BCN Checkpoint; Barcelona; Spain
| | | | | | - R Marín
- BCN Checkpoint; Barcelona; Spain
| | - J Coll
- BCN Checkpoint; Barcelona; Spain
| | - F Pujol
- Projecte dels NOMS-Hispanosida
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Smit PJ, Brady M, Carter M, Fernandes R, Lamore L, Meulbroek M, Ohayon M, Platteau T, Rehberg P, Rockstroh JK, Thompson M. HIV-related stigma within communities of gay men: a literature review. AIDS Care 2011; 24:405-12. [PMID: 22117138 PMCID: PMC3379736 DOI: 10.1080/09540121.2011.613910] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 08/09/2011] [Indexed: 11/16/2022]
Abstract
While stigma associated with HIV infection is well recognised, there is limited information on the impact of HIV-related stigma between men who have sex with men and within communities of gay men. The consequences of HIV-related stigma can be personal and community-wide, including impacts on mood and emotional well-being, prevention, testing behaviour, and mental and general health. This review of the literature reports a growing division between HIV-positive and HIV-negative gay men, and a fragmentation of gay communities based along lines of perceived or actual HIV status. The literature includes multiple references to HIV stigma and discrimination between gay men, men who have sex with men, and among and between many gay communities. This HIV stigma takes diverse forms and can incorporate aspects of social exclusion, ageism, discrimination based on physical appearance and health status, rejection and violence. By compiling the available information on this understudied form of HIV-related discrimination, we hope to better understand and target research and countermeasures aimed at reducing its impact at multiple levels.
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Affiliation(s)
- Peter J Smit
- Dutch HIV Association, 'Hivnieuws' Editorial Board, Amsterdam, The Netherlands.
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