Sergio Moreno-Fornés

Coronavirus disease 2019 (COVID-19) disproportionately affects migrants and ethnic minorities, including those with human immunodeficiency virus (HIV). Comprehensive studies are needed to understand the impact and risk factors. Using data from the PISCIS cohort of people with HIV (PWH) in Catalonia, Spain, we investigated COVID-19 outcomes and vaccination coverage. Among 10 640 PWH we compared migrants and non-migrants assessing rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing, diagnosis, and associated clinical outcomes through propensity score matching and multivariable Cox regression. The cohort (mean age, 43 years; 83.5% male) included 57.4% (3053) Latin American migrants. Migrants with HIV (MWH) had fewer SARS-CoV-2 tests (67.8% vs 72.1%, P < .0001) but similar COVID-19 diagnoses (29.2% vs 29.4%, P = .847) compared to Spanish natives. Migrants had lower complete vaccination (78.9% vs 85.1%, P < .0001) and booster doses (63.0% vs 65.5%, P = .027). COVID-19 hospitalizations (8.1% vs 5.1%, P < .0001) and intensive care unit (ICU) admissions (2.9% vs 1.2%, P < .0001) were higher among migrants, with similar hospitalization duration (5.5 vs 4.0 days, P = .098) and mortality (3 [0.2%] vs 6 [0.4%], P = .510). Age ≥40 years, CD4 counts <200 cells/μL, ≥2 comorbidities, and incomplete/nonreception of the SARS-CoV-2 vaccine increased the risk of severe COVID-19 among migrants. MWH had lower rates of SARS-CoV-2 testing and vaccination coverage, although the rates of COVID-19 diagnosis were similar between migrants and non-migrants. Rates of COVID-19–associated hospitalizations and ICU admissions were higher among migrants in comparison with non-migrants, with similar hospitalization duration and mortality. These findings can inform policies to address disparities in future pandemic responses for MWH.

People with HIV (PWH) may be more susceptible to SARS-CoV-2 infection and worse clinical outcomes. We investigated the disparity in SARS-CoV-2 vaccination coverage between PWH and those without HIV (PWoH) in Catalonia, Spain, assessing primary and monovalent booster vaccination coverage from December 2021 to July 2022. The vaccines administered were BNT162, ChAdOx1-S, mRNA-127, and Ad26.COV2.S. Using a 1:10 ratio of PWH to PWoH based on sex, age, and socioeconomic deprivation, the analysis included 201,630 individuals (183,300 PWoH and 18,330 PWH). Despite a higher prevalence of comorbidities, PWH exhibited lower rates of complete primary vaccination (78.2% vs. 81.8%, p < 0.001) but surpassed PWoH in booster coverage (68.5% vs. 63.1%, p < 0.001). Notably, complete vaccination rates were lower among PWH with CD4 p < 0.001, all). However, PWH with CD4 < 200 cells/μL received more boosters (p < 0.001). In multivariable logistic regression analysis of the overall population, a prior SARS-CoV-2 diagnosis, HIV status, migrants, and mild-to-severe socioeconomic deprivation were associated with lower primary vaccination coverage, reflecting barriers to healthcare and vaccine access. However, booster vaccination was higher among PWH. Targeted interventions are needed to improve vaccine coverage and address hesitancy in vulnerable populations.

Introduction: People living with HIV who are lost to follow‐up have a greater risk of health deterioration, mortality, and community transmission.Objective: Our aim was to analyse both how rates of loss to follow‐up (LTFU) changed between 2006 and 2020 and how the COVID‐19 pandemic affected these rates in the PISCIS cohort study of Catalonia and the Balearic Islands.Methods: We analysed socio‐demographic and clinical characteristics of LTFU yearly and with adjusted odds ratios to assess the impact of these determinants on LTFU in 2020 (the year of COVID‐19). We used latent class analysis to categorize classes of LTFU based on their socio‐demographic and clinical characteristics at each year.Results: In total, 16.7% of the cohort were lost to follow‐up at any time in the 15 years (n = 19 417). Of people living with HIV who were receiving follow‐up, 81.5% were male and 19.5% were female; of those who were lost to follow‐up, 79.6% and 20.4% were male and female, respectively (p < 0.001). Although rates of LTFU increased during COVID‐19 (1.11% vs. 0.86%, p = 0.024), socio‐demographic and clinical factors were similar. Eight classes of people living with HIV who were lost to follow‐up were identified: six for men and two for women. Classes of men (n = 3) differed in terms of their country of birth, viral load (VL), and antiretroviral therapy (ART); classes of people who inject drugs (n = 2) differed in terms of VL, AIDS diagnosis, and ART. Changes in rates of LTFU included higher CD4 cell count and undetectable VL.Conclusions: The socio‐demographic and clinical characteristics of people living with HIV changed over time. Although the circumstances of the COVID‐19 pandemic increased the rates of LTFU, the characteristics of these people were similar. Epidemiological trends among people who were lost to follow‐up can be used to prevent new losses of care and to reduce barriers to achieve Joint United Nations Programme on HIV/AIDS 95‐95‐95 targets.

We aimed to assess the feasibility of TESTA’T COVID strategy among healthcare and education professionals.in Spain during the peak of the 6^th wave caused by Omicron variant. Kits were ordered online and sent by mail, participants answered an online acceptability/usability survey and uploaded the picture of results. 492 participants ordered a test, 304 uploaded the picture (61.8%). Eighteen positive cases were detected (5.9%). 92.2% were satisfied/very satisfied with the intervention; and 92.5% found performing the test easy/very easy. We demonstrated that implementing online COVID-19 self-testing in schools and healthcare settings in Spain is feasible.

People living with HIV (PLWH) are prioritised for SARS-CoV-2 vaccination due to their vulnerability to severe COVID-19. Therefore, the epidemiological surveillance of vaccination coverage and the timely identification of suboptimally vaccinated PLWH is vital. We assessed SARS-CoV-2 vaccination coverage and factors associated with under-vaccination among PLWH in Catalonia, Spain. As of 11.12.2021, 9945/14942 PLWH (66.6%) had received ≥1 dose of a SARS-CoV-2 vaccine. Non-Spanish origin (adjusted odds ratio (aOR) 0.64, 95% CI 0.59–0.70), CD4 count of 200–349 cells/μL (aOR 0.74, 95% CI 0.64–0.86) or 350–499 cells/μL (aOR 0.79, 95% CI 0.70–0.88), detectable plasma HIV-RNA (aOR 0.61 95% CI 0.53–0.70), and previous SARS-CoV-2 diagnosis (aOR 0.58 95% CI 0.51–0.65) were associated with under-vaccination. SARS-CoV-2 diagnosis (437 [9.5%] vs. 323 [3.5%], p < 0.001), associated hospitalisations (10 [2.3%] vs. 0 [0%], p < 0.001), intensive care unit admissions (6 [1.4%] vs. 0 [0%], p < 0.001), and deaths (10 [2.3%] vs. 0 [0%], p < 0.001) were higher among unvaccinated PLWH. Vaccination coverage was lower among PLWH with a CD4 count >200 cells/μL, detectable plasma HIV-RNA, previous SARS-CoV-2 diagnosis, and migrants. SARS-CoV-2 diagnosis, associated hospitalisations, and deaths among PLWH were lower among the vaccinated compared with the unvaccinated. SARS-CoV-2 vaccination prioritisation has not completely reached vulnerable PLWH with poorer prognosis. This information can be used to inform public health strategies.

Reports on the impact of some antiretrovirals against SARS-CoV-2 infection and disease severity are conflicting. We evaluated the effect of tenofovir as either tenofovir alafenamide/emtricitabine (TAF/FTC) or tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) against SARS-CoV-2 infection and associated clinical outcomes among people living with HIV (PLWH). We conducted a propensity score-matched analysis in the prospective PISCIS cohort of PLWH (n = 14 978) in Catalonia, Spain. We used adjusted Cox regression models to assess the association between tenofovir and SARS-CoV-2 outcomes. After propensity score-matching, SARS-CoV-2 diagnosis rates were similar in TAF/FTC versus ABC/3TC recipients (11.6% versus 12.5%, P = 0.256); lower among TDF/FTC versus ABC/3TC recipients (9.6% versus 12.8%, P = 0.021); and lower among TDF/FTC versus TAF/FTC recipients (9.6% versus 12.1%, P = 0.012). In well-adjusted logistic regression models, TAF/FTC was no longer associated with reduced SARS-CoV-2 diagnosis [adjusted odds ratio (aOR) 0.90; 95% confidence interval (CI), 0.78–1.04] or hospitalization (aOR 0.93; 95% CI, 0.60–1.43). When compared with ABC/3TC, TDF/FTC was not associated with reduced SARS-CoV-2 diagnosis (aOR 0.79; 95% CI, 0.60–1.04) or hospitalization (aOR 0.51; 95% CI, 0.15–1.70). TDF/FTC was not associated with reduced SARS-CoV-2 diagnosis (aOR 0.79; 95% CI, 0.60–1.04) or associated hospitalization (aOR 0.33; 95% CI, 0.10–1.07) compared with TAF/FTC. TAF/FTC or TDF/FTC were not associated with reduced SARS-CoV-2 diagnosis rates or associated hospitalizations among PLWH. TDF/FTC users had baseline characteristics intrinsically associated with more benign SARS-CoV-2 infection outcomes. Tenofovir exposure should not modify any preventive or therapeutic SARS-CoV-2 infection management.

Background: Late HIV diagnosis is associated with poorer outcomes. However, determinants of long-term mortality and factors influencing immune recovery within the first years after antiretroviral treatment (ART) initiation are poorly defined. Methods: Observational, prospective, multicentre cohort study using data from the PISCIS cohort of people living with HIV in Catalonia, Spain. We included all adults initiating ART between 2005 and 2019 and surviving the first two years. The primary outcome was all-cause mortality according to the two-year CD4 cell count. The secondary outcome was incomplete immune recovery (i.e., CD4 500 cells/µL, reference population). Overall, 113 patients (4∙2%) died. Mortality was higher among late presenters with two-year CD4 counts 200-500 cells/µL (adjusted mortality ratio 1∙95 [95%CI:1∙06-3∙61]) or 500 cells/µL, rergardless of being initially late presenters or non-late presenters (1∙05 [0∙50-2∙21]). Mortality rates within each group of two-year CD4 cell count were not affected by the initial CD4 cell count at ART initiation (test-interaction p=0∙48). The stronger factor influencing immune recovery was the CD4 cell count at ART initiation. First-line integrase-inhibitor-based regimens were associated with reduced mortality (0∙54 [0∙31-0∙93]) and reduced risk of incomplete immune recovery in late presenters (adjusted odds ratio 0∙70 [0∙52-0∙95]). Interpretation: In late presenters, immune recovery at two years is a better predictor of long-term mortality than initial CD4 cell count. Nearly half experienced a favorable immune recovery with a life expectancy similar to non-late presenters. Integrase inhibitor-based regimens were associated with higher rates of successful immune recovery and better survival. Funding Information: This work was supported by scholarships from the University of Southern Denmark, Danish AIDS-foundation and Public Regional Funds. The study was investigator-driven and thus independent of any pharmaceutical company. Declaration of Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. Ethics Approval Statement: The PISCIS cohort has been approved by the ethics committee of the coordinating centre, and patient data extraction is allowed by the 203/2015 Decree from the Catalan Health Department.

Epidemiological surveillance of HIV infection allows monitoring its incidence as well as possible epidemiological changes, allowing specific interventions to be planned and their impact monitored. The objective of this article is to describe the results of the monitoring and evaluation of the response to the HIV epidemic in Catalonia, based on data included in the Integrated System of Epidemiological Surveillance of AIDS/HIV and Sexually Transmitted Infections of Catalonia (SIVES). A descriptive analysis of the data from the different sources of information of the SIVES was performed. The time period was defined based on the availability of data from each of the sources of information included in the analysis. The information was structured according to the conceptual representation of the cascade of HIV care, as described in the World Health Organization consolidated strategic information guidelines for HIV. Of the total of 4,849 new diagnoses notified (2012-2018), 86% were men, of these; the most frequently reported transmission group was men having sex with men with 65%. The trend in the number of new diagnoses decreased in all transmission groups. It is estimated that in 2018 there were 32,429 people living with HIV in Catalonia, of which 89% were diagnosed, of these, 83% were under follow-up in a specialized unit and 78% of them were under treatment. 73% of people in treatment had suppressed the viral load. SIVES as an integrated system of different sources of strategic information allows monitoring the HIV epidemic in Catalonia and evaluating the response to it, identifying key populations and determinants to acquire HIV, as well as the barriers to which people living with HIV they face to achieve viral suppression.