COVID-19 in Madrid: Leading Pandemic Control after being the Spanish Epicenter.

The arrival of coronavirus disease (COVID-19) in Europe exploded initially in North Italy and soon thereafter at several other major European cities, including Madrid. Indeed, Madrid was the epicenter of SARSCoV-2 infection in Spain, with a dramatic surge of cases since mid-March 2020.

Coronavirus and other airborne agents with pandemic potential.

The recent emergence of a novel coronavirus (severe acute respiratory syndrome coronavirus 2) has caused a pandemic, which is the most severe infectious disease outbreak in many decades. Other infective agents such as influenza as well as other neglected viruses such as Lassa virus, Nipah virus or poxviruses are also a cause for concern owing to their attack rate and potential for global spread. Drug-resistant bacteria, such as , are already a significant public health issue in many countries, and it is expected that they will be expanding in the near future.

Treatment as Prevention: Should Hepatitis C Learn the Lessons from HIV?

Long-term experience in the treatment of HIV-infected individuals has shown indirect benefits of early initiation of antiretroviral therapy, particularly in preventing HIV transmission. With the advent of direct-acting antivirals for the treatment of hepatitis C, the strategy of treatment-as-prevention has become feasible. However, economic, clinical, ethical, and public health issues arise from the concept of using therapeutic interventions only as prevention strategies.

Dual antiretroviral therapy for HIV infection.

For two decades, triple combinations of antiretrovirals have been the standard treatment for HIV infection. The challenges of such lifelong therapy include long-term side effects, high costs and reduced drug adherence. The recent advent of more potent and safer antiretrovirals has renewed the interest for simpler HIV regimens.

Pharmacogenetics of antiretroviral therapy.

Introduction: Human genetic testing is rapidly entering into most medical disciplines, mainly as a way to predict hereditary conditions including predisposition to cancers or degenerative diseases. Another area of interest for human genomics is to ascertain the therapeutic effect and prevent potential toxicities and/or drug-drug interactions of medication.

Areas Covered: Several human genotypes have been associated with differences in the metabolism and transport of antiretroviral agents that ultimately affect drug exposure.

Dolutegravir, abacavir and lamivudine as HIV therapy.

Introduction: Antiretroviral therapy has evolved dramatically and more potent, safer and convenient drugs have replaced former compounds. Dolutegravir (DTG) is the most recently approved integrase inhibitor. It displays attractive properties such as one pill once daily (QD) dosing, high barrier to resistance and clean safety profile.

Spontaneous hepatitis C virus clearance in HIV patients with chronic hepatitis C bearing IL28B-CC alleles using antiretroviral therapy.

Background: A quarter of individuals acutely infected with hepatitis C virus (HCV) clear the virus spontaneously. Once chronic infection is established, HCV elimination generally can only be achieved using specific antiviral therapy, such as peg-interferon-ribavirin. Herein, we report a group of chronically HIV/HCV-coinfected patients that cleared HCV spontaneously while being treated only with antiretrovirals.

Hepatitis delta is a major determinant of liver decompensation events and death in HIV-infected patients.

Background: Coinfection with hepatitis viruses is common in individuals infected with human immunodeficiency virus (HIV) and has become a leading cause of complications and death in those receiving antiretroviral therapy (ART).

Methods: We retrospectively examined the effect of coinfection with hepatitis B, C, and/or D viruses (HBV, HCV, HDV, respectively) on liver decompensation events (ascites, variceal bleeding, encephalopathy, and/or hepatocellular carcinoma) and liver-related mortality in HIV-positive patients on regular follow-up since the year 2004 at a reference HIV clinic in Madrid, Spain.

Results: A total of 1147 HIV-infected patients (mean age, 42 years; 81% males; 46% intravenous drug users, 85.

Towards hepatitis C eradication from the HIV-infected population.

Around 10-15% of the 35 million people living with HIV worldwide have chronic hepatitis C virus (HCV) infection and are prone to develop liver-related complications. Exposure to HCV is almost universal among injecting drug users and is on the rise among homosexual men. Response to peginterferon-ribavirin therapy is generally lower in coinfection compared to HCV monoinfection.

Once-daily raltegravir moving ahead.

Raltegravir is a highly potent antiretroviral agent, with arguably one of the most favorable adverse event profiles in the HIV armamentarium. However, its standard twice-daily (BID) dosing schedule makes it less convenient than once-daily (QD) options. Although pharmacokinetic data suggest that QD raltegravir may provide adequate drug levels, the randomized phase III QDMRK trial (Eron, et al.

Emerging antiretroviral drugs.

Introduction: The potency, tolerability and convenience of antiretroviral agents have all significantly improved over the past years, making lifelong HIV therapy easier. However, several specific needs are still unmet, including low daily pill burden, friendly metabolic profile, lack of (or few) drug interactions and high resistance barrier.

Areas Covered: Updated summary of evidence-based information about the efficacy and safety of the most recently approved or forthcoming antiretroviral agents is provided.

Update on HIV/HCV coinfection.

Liver disease is currently one of the leading causes of hospitalization and death in HIV-positive individuals. Coinfection with the hepatitis C virus (HCV) is a major contributor to this trend. Besides hepatic damage, which is enhanced in the presence of HIV-associated immunosuppression, HCV may contribute to disease in coinfected individuals by potentiating immune activation and chronic inflammation, which ultimately account for an increased risk of cardiovascular events, kidney disease, and cancers in this population.

Low risk of liver toxicity using the most recently approved antiretroviral agents but still increased in HIV-hepatitis C virus coinfected patients.

Liver enzyme elevations (LEE) were investigated in 2717 episodes of initiation of antiretroviral therapy since January 2010 in 1982 HIV patients. Serum hepatitis C virus (HCV)-RNA was positive in 24%. Any grade of LEE was recognized in 9% of episodes, being 6% in HCV-negative and 17% in HCV-positive patients (P < 0.

Hepatitis C therapy with HCV NS5B polymerase inhibitors.

Introduction: Several HCV polymerase inhibitors are in advanced stages of clinical development. They are nucleos(t)ide and non-nucleoside analogs. Nucleos(t)ides inhibit viral replication acting as chain terminators whereas non-nucleosides block allosterically the HCV polymerase.

Liver stiffness predicts liver-related complications and mortality in HIV patients with chronic hepatitis C on antiretroviral therapy.

Background: Liver disease is currently one of the leading causes of death in HIV individuals. Hepatic fibrosis largely mediates this effect and infection with hepatitis C virus (HCV) is the most common cause. Few studies have examined so far the predictive value of liver fibrosis staging on mortality and liver decompensation in HIV/HCV-coinfected patients.

Management of hepatitis C in HIV and/or HBV co-infected patients.

Co-infection with either HIV or HBV in chronic hepatitis C patients is common, since all these viruses share transmission routes and geographical distribution. Interaction between these viruses generally amplifies liver damage, increasing the risk of developing end-stage liver disease and hepatocellular carcinoma. HIV-HCV co-infection is associated with poorer response to antiviral therapy.

Treatment of hepatitis C in patients infected with human immunodeficiency virus in the direct-acting antiviral era.

Chronic hepatitis C is a leading cause of clinical complications and mortality in individuals infected with human immunodeficiency virus (HIV). Approval for the first direct-acting antiviral (DAA) against the hepatitis C virus (HCV) has been eagerly awaited for treating patients coinfected with HIV/HCV. The use of first-generation HCV protease inhibitors is challenged by complicated dosing schedules, frequent serious toxicities, unwanted drug interactions, drug resistance, and high cost.

Rilpivirine: a next-generation non-nucleoside analogue for the treatment of HIV infection.

Introduction: HIV therapy has evolved rapidly since the 1990s; the arrival of more potent and safer antiretroviral drugs has transformed HIV infection into a chronic condition, which is rarely fatal. Non-nucleoside reverse transcriptase inhibitors (NNRTIs) are frequently used as a third agent - as part of a triple-combination therapy. Side effects and low barriers to resistance have been the major drawbacks of NNRTIs.

Antiretroviral drugs for pre-exposure prophylaxis of HIV infection.

Though a large number of antiretrovirals have been developed for the treatment of HIV infection, new HIV infections continue to occur, especially among certain high-risk groups, such as men who have sex with men. Overall, the current estimated incidence of HIV infection is 2.5-fold higher than the number of individuals that begin antiretroviral therapy every year worldwide.

Predicted effect of direct acting antivirals in the current HIV-HCV-coinfected population in Spain.

Background: Direct acting antivirals (DAAs) against HCV are eagerly awaited for HIV-HCV-coinfected individuals. However, the activity of first generation drugs is limited to HCV genotype 1 and is lower in cirrhotics, subtype 1a infections, prior interferon (IFN)-α exposure or unfavourable IL28B alleles. Herein, we report the current profile of HIV-HCV-coinfected patients at our institution in an attempt to predict the effect of DAAs.