Anaïs Corma-Gómez

To evaluate the proportion of gay, bisexual, and other men who have sex with men (GBMSM) with ongoing high-risk sexual practices not engaged in care, and to assess linkage to and retention in care following a community-based intervention. A two-phase study was conducted (January–June 2023) in a sex-on-premises venue in Spain. Community-based screening for HIV and hepatitis C virus (HCV) was offered, followed by a fast-track referral intervention. Individuals with reactive results were linked to specialized care. Individuals with negative results not engaged in care were referred to pre-exposure prophylaxis or sexually transmitted infections (STI) screening programs. Outcomes: (i) Primary: proportion of participants requiring care who were not engaged in routine sexual health services; (ii) Secondary: linkage to and retention in care at 6 months. Of 614 individuals invited, 405 (66%) participated. At baseline, 226 participants (56%) were not engaged in HIV or PrEP follow-up. One (0.3%) previously undiagnosed HIV infection was identified. One (0.2%) HCV infection was detected. Among 165 HIV-negative GBMSM residing in Andalusia who were not engaged in care, 148 (89.7%) were either not linked to sexual health services or not retained in PrEP care, including 63 (42.6%) who fulfilled PrEP criteria. In conclusion, a substantial proportion of GBMSM with ongoing high-risk sexual practices were not engaged in sexual health services. While few HIV and HCV infections were identified, linkage to and retention in PrEP and STI prevention services were limited, with losses before or shortly after first contact, underscoring persistent gaps in the prevention cascade among GBMSM.

Strongyloidiasis is traditionally regarded as a tropical disease; however, in the Valencian Community (Spain), it has historically been linked to localized endemic foci considered of declining relevance. This was a multicenter regional case series study across three hospitals including patients ≥16 years with strongyloidiasis defined by positive serology and/or parasitological confirmation diagnosed from 2015 to 2024. A total of 301 patients were included (median age 53 years (quartile 1–quartile 3, 40–72); 135 (44.9%) female). Most cases were autochthonous (176/299, 58.9%), while 123/299 (41.1%) occurred in migrants, predominantly from Latin America. Symptoms were present in 165/296 (55.7%), most frequently cutaneous (68/296, 23.0%) and gastrointestinal (62/296, 20.9%). Eosinophilia (>500 cells/µL) was observed in 144/298 (48.3%) and severe infection (hyperinfection syndrome) in 7/294 (2.4%). Annual diagnoses increased over time, with a significant temporal trend by case origin (p < 0.001), reflecting an increasing contribution of imported infections, whereas trends by sex (p = 0.068) and immune status (p = 0.926) were not significant. Stool-based methods demonstrated a low diagnostic yield (microscopy 7/157, 4.5%; culture 21/136, 15.4%; rtPCR 2/27, 7.4%). These findings document the sustained detection of cases classified as autochthonous beyond historically recognized foci and an increasing proportion of imported diagnoses in a temperate European setting.

Background: Liver stiffness (LS) predicts liver complication occurrence in patients with hepatitis C virus (HCV) infection after sustained virological response (SVR). The FibroScan-AST (FAST) score, which includes aspartate aminotransferase (AST) and controlled attenuation parameter (CAP; measured by FibroScan), may improve the prediction ability of isolated LS. Our aim was to compare the predictive capacity of LS vs FAST in this setting. Methods: Multicenter cohort study including individuals with HIV/HCV coinfection or HCV monoinfection from Spain if they had (1) LS ≥9.5 kPa pretreatment, (2) SVR with a direct-acting antiviral (DAA)–based regimen, and (3) LS and CAP measurement at SVR. Fatty liver disease (FLD) was defined as CAP ≥248 dB/m. The primary outcome was the occurrence of a liver complication (decompensation or hepatocellular carcinoma [HCC]) after SVR. Results: Three hundred patients were included; 213 (71%) had HIV. At SVR, 131 (44%) had FLD. The FAST score was 0.67 in 34 (12%) patients. After a median (Q1–Q3) follow-up of 73 (53–83) months, 36 (12%) liver complications (15 [5%] HCC) occurred. LS was independently associated with an increased risk of developing liver complications (sub–hazard ratio [sHR], 1.06; 95% CI, 1.04–1.08; P < .001). In a separate model, FAST ≥0.35 was also independently associated with greater risk of liver complications (sHR, 8.12; 95% CI, 3.11–21.17; P < .001). The area under the receiver operating characteristics curve of the model based on LS was 0.83 (95% CI, 0.76–0.91), and that of the model based on FAST was 0.80 (95% CI, 0.72–0.88; P = .158). Conclusions: The FAST score predicts the development of liver events after SVR but does not improve the predictive capacity of LS alone at this time point.

Background: Liver stiffness (LS) is not reduced in 10%–30% of patients who achieve sustained viral response (SVR) after hepatitis C virus (HCV) elimination with direct-acting antivirals (DAA). Our aim was to analyze whether the parameters associated with cellular aging measured at the DAA initiation date are related to LS reduction upon achieving SVR. Methods: In a prospective cohort study (GEHEP-011) we measured several parameters associated with cellular aging, such as telomere attrition, mitochondrial alterations, and soluble biomarkers associated with senescence-associated secretory phenotype at the DAA initiation date, and examined their associations with a significant (≥20%) LS decrease at the SVR time point. Results: In total, 175 individuals were included in this study. In 101 (57.7%) patients, the LS reduction was ≥20% at SVR. In the multivariate analysis adjusted for sex, age, CXCL10, hsPCR, and CCL11 levels, greater relative telomere length (RTL) emerged as the sole variable independently associated with a significant LS decrease in SVR (1.102; 95% confidence interval, 1.001–1.1214; P = .047). Furthermore, changes in LS, including significant decrease, decrease <20%, or increase, were congruently associated with RTL (P = .011). Conclusions: Greater RTL was independently associated with a significant LS reduction in SVR. Thus, increased cellular aging may be responsible for the absence of liver regeneration after HCV eradication. Further studies are required to assess the long-term effects of cellular aging after SVR. Clinical Trials Registration: NCT04460157.

Background: In patients with hepatitis C virus (HCV) chronic infection and advanced liver disease, the impact of human immunodeficiency virus (HIV) coinfection on the clinical outcome after sustained virological response (SVR) has not been sufficiently clarified. The aim of this study was to compare the mortality after SVR of patients bearing HCV chronic infection and advanced liver fibrosis, with and without HIV coinfection after a prolonged follow-up. Methods: This was a prospective multicenter cohort study including individuals with HIV/HCV coinfection and patients with HCV monoinfection from Spain, fulfilling (1) liver stiffness (LS) ≥9.5 kPa before treatment, (2) SVR with a direct-acting antiviral–based regimen, and (3) LS measurement available at SVR. The main outcome was overall survival. Mortality attributable to liver disease and nonhepatic causes was also assessed. Results: A total of 1118 patients were included, of whom 676 (60.5%) had HIV. The median (Q1–Q3) follow-up was 76 (57–83) months. After SVR, 46 (10%) HCV-monoinfected and 74 (11%) HIV/HCV-coinfected patients died. The overall mortality rate (95% CI) was 1.9 (1.6–2.2) per 100 person-years, 1.9 (1.4–2.5) per 100 person-years in patients with HCV monoinfection, and 1.8 (1.6–2.3) per 100 person-years in people with HIV. In the multivariable analysis, HIV coinfection was not associated with shorter survival (hazard ratio, .98; 95% CI, .61–1.58; P = .939). Conclusions: In patients with HCV chronic infection and advanced fibrosis, HIV coinfection does not reduce the overall survival after SVR. Clinical Trials Registration: Clinicaltrials.gov (NCT04460157).

To date, former research about the impact of HIV infection on mpox poor outcomes is still limited and controversial. Therefore, the aim of this study was to assess the impact of HIV on the clinical course of mpox, in a large population of patients from Spain. Nationwide case‐series study. Patients from 18 Spanish hospitals, with PCR‐confirmed mpox from April 27, 2022 to June 30, 2023 were included in this study. The main outcome was the development of long or complicated (LC) mpox, defined as: (i) duration of the clinical course ≥ 28 days, or; (ii) disseminated disease, or: (iii) emergence of severe complications. One thousand eight hundred twenty‐three individuals were included. Seven hundred eighty‐six (43%) were people living with HIV (PLWH), of whom 11 (1%) had a CD4 cell count < 200 cells/mm³ and 33 (3%) 3. HIV viral load ≥ 1000 cp/mL was found in 27 (3%) PLWH, none of them were on effective ART. Fifteen (60%) PLWH with HIV‐RNA ≥ 1000 cp/mL showed LC versus 182 (29%) PLWH with plasma HIV‐RNA load < 1000 copies/mL and 192 (24%) individuals without HIV infection (p < 0.001). In multivariate analysis, adjusted by age, sex, CD4 cell counts and HIV viral load at the time of mpox, only plasma HIV‐RNA ≥ 1000 cp/mL was associated with a greater risk of developing LC mpox [adjusted OR = 4.06 (95% confidence interval 1.57−10.51), p = 0.004]. PLWH with uncontrolled HIV infection, due to lack of ART, are at a greater risk of developing LC mpox. Efforts should be made to ensure HIV testing is carried out in patients with mpox and to start ART without delay in those tested positive.

Emerging studies have suggested several chromosomal regions as potential host genetic factors involved in the susceptibility to SARS-CoV-2 infection and disease outcome. We nested a COVID-19 genome-wide association study using the GR@ACE/DEGESCO study, searching for susceptibility factors associated with COVID-19 disease. To this end, we compared 221 COVID-19 confirmed cases with 17,035 individuals in whom the COVID-19 disease status was unknown. Then, we performed a meta-analysis with the publicly available data from the COVID-19 Host Genetics Initiative. Because the APOE locus has been suggested as a potential modifier of COVID-19 disease, we added sensitivity analyses stratifying by dementia status or by disease severity. We confirmed the existence of the 3p21.31 region (LZTFL1, SLC6A20) implicated in the susceptibility to SARS-CoV-2 infection and TYK2 gene might be involved in COVID-19 severity. Nevertheless, no statistically significant association was observed in the COVID-19 fatal outcome or in the stratified analyses (dementia-only and non-dementia strata) for the APOE locus not supporting its involvement in SARS-CoV-2 pathobiology or COVID-19 prognosis.

Liver stiffness (LS) at sustained virological response (SVR) after direct-acting antivirals (DAA)-based therapy is a predictor of liver events in hepatitis C virus (HCV)-infected patients. The study aim was to identify genetic factors associated with LS changes from the moment of starting anti-HCV therapy to SVR. This prospective study included HCV-infected patients from the GEHEP-011 cohort who achieved SVR with DAA-based therapy, with LS pre-treatment ≥ 9.5 kPa and LS measurement available at SVR. Plink and Magma software were used to carry out genome-wide single-nucleotide polymorphism (SNP)-based and gene-based association analyses, respectively. The ShinyGO application was used for exploring enrichment in Gene Ontology (GO) categories for biological processes. Overall, 242 patients were included. Median (quartile 1, quartile 3) LS values at pre-treatment and at SVR were 16.8 (12, 28) kPa and 12.0 (8.5, 19.3) kPa, respectively. Thirty-five SNPs and three genes reached suggestive association with LS changes from the moment of starting anti-HCV therapy to SVR. GO categories related to DNA packaging complex, DNA conformation change, chromosome organization and chromatin organization were significantly enriched. Our study reports possible genetic factors associated with LS changes during HCV-infection cure. In addition, our results suggest that processes related to DNA conformation are also involved in these changes.