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With the aim of improving access and engagement to healthcare in people living with HIV (PLHIV), in 2022 Gregorio Marañón Hospital and the NGO COGAM developed a circuit for recruitment and referral to hospital. Program targeted PLHIV who were neither receiving antiretroviral treatment (ART) nor on medical follow-up (FU); but also, individuals at risk who underwent screening tests at the NGO and, if positive, were referred for confirmation. The result was an increase in annual new PLHIV seen in hospital by reaching a population who were, essentially, young men (94% male, median age 30 years), migrants (95%) with recent diagnosis of HIV (median 5 years) and who were recently arrived in Spain (median 5 months). Most of them hadn´t healthcare coverage (78%). In multivariate analysis, that included all PLHIV seen for the first time in the ID Unit between 2019 and 2022, lack of healthcare coverage was the only independent predictor of lost to FU that reached statistical significance (HR 5.19, CI 2.76–9.47). Furthermore, time from HIV diagnosis to ART initiating was shortened from 14 to 6 days without affecting linkage to care. Our conclusion is that collaboration with NGOs reinforce diagnosis, FU, and adherence to ART for PLHIV.

The incidence of stroke in human immunodeficiency virus (HIV)-infected individuals has been well analyzed in recent epidemiological studies. However, little is known about the specific contribution of hepatitis C virus (HCV) infection to stroke among HIV-infected individuals. The aims of this study were to analyze trends in the incidence rates of stroke in HIV-infected individuals during the combination antiretroviral (cART) era in Spain and to categorize them by the presence or absence of HCV coinfection. We analyzed hospital discharges with a diagnosis of stroke in Spain according to ICD-9-CM during 1997-2013. The study period was divided into four calendar periods (1997-1999, 2000-2003, 2004-2007, and 2008-2013). Patients were classified according to HCV serology. The number of HIV-infected patients was estimated based on data from the National Centre of Epidemiology. We calculated incidence rates (events per 10,000 patient-years) and in-hospital case fatality rates (CFR). The incidence of hemorrhagic stroke (HS) decreased in HIV-monoinfected patients (15.8 [1997-1999] to 6.5 [2008-2013]; P<0.001) and increased in HIV/HCV-coinfected patients (1.3 [1997-1999] to 5.5 [2008-2013]; P<0.001). The incidence of ischemic stroke (IS) decreased in HIV-monoinfected patients (27.4 [1997-1999] to 21.7 [2008-2013]; P = 0.005) and increased in HIV/HCV-coinfected patients (1.8 [1997-1999] to 11.9 [2008-2013]; P<0.001). The CFR was 3.3 times higher for HS than for IS for the whole study period. The CFR of HS in HIV-monoinfected patients decreased significantly (47.4% [1997-1999] to 30.6% [2008-2013]; P = 0.010) but did not change significantly among HIV/HCV-coinfected patients (41.4% [1997-1999] to 44.7% [2008-2013]; P = 0.784). The CFR of IS in the whole HIV-infected population decreased significantly (14.6% [1997-1999] to 10.9% [2008-2013]; P = 0.034), although no significant differences were found when each group was analyzed separately. In conclusion, after the introduction of cART, HS and IS rates decreased in HIV-monoinfected individuals, but increased steadily in HIV/HCV-coinfected individuals.

We report a patient diagnosed with Q fever who developed an acute hepatitis after tick exposure. Sequence analysis of PCR fragments from the patient´s blood and the tick from the patient ( ) showed homologous (100% identity) sequences, suggesting direct Q fever transmission by a tick.

In a patient on immunosuppressant treatment, SARS-CoV-2 RNA was documented in different extra-respiratory samples over several months in the absence of positive determinations in upper respiratory samples. Whole-genome sequencing of these samples showed the acquisition of different single-nucleotide polymorphisms over time, suggesting viral evolution and thus viral viability.

Background Mitochondrial DNA (mtDNA) haplogroups have been associated with advanced liver fibrosis and cirrhosis in patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). Our aim was to determine whether mtDNA haplogroups are associated with liver-related events (LREs) in HIV/HCV-coinfected patients. Methods We carried out a retrospective cohort study in HIV/HCV-coinfected patients who were potential candidates for therapy with interferon and ribavirin (IFN/Rib) between 2000 and 2009. The primary endpoint was the occurrence of LREs (decompensation or hepatocellular carcinoma). mtDNA genotyping was performed using the Sequenom MassARRAY platform. We used Fine and Gray proportional hazards model to test the association between mtDNA haplogroups and LREs, considering death as a competitive risk. Results The study population comprised 243 patients, of whom 40 had advanced fibrosis or cirrhosis. After a median follow-up of 7.7 years, 90 patients treated with IFN/Rib achieved sustained viral response (SVR), 18 patients had LREs, and 11 patients died. Patients with haplogroup H had lower cumulative incidence than patients with other haplogroups ( p  = 0.012). However, patients with haplogroup T had higher cumulative incidence than patients with other haplogroups ( p  = 0.074). In the multivariate analysis, haplogroup T was associated with an increased hazard of developing LREs [adjusted subhazard ratio (aSHR) = 3.56 (95% CI 1.13;11.30); p  = 0.030]; whereas haplogroup H was not associated with lower hazard of LREs [aSHR = 0.36 (95% CI 0.10;1.25); p  = 0.105]. When we excluded patients who achieved SVR during follow-up, we obtained similar SHR values. Conclusions European mitochondrial haplogroups may influence the natural history of chronic hepatitis C.

Background There is a paucity of knowledge on the long-term outcome in patients diagnosed with COVID-19. We describe a cohort of patients with a constellation of symptoms occurring four weeks after diagnosis causing different degrees of reduced functional capacity. Although different hypothesis have been proposed to explain this condition like persistent immune activation or immunological dysfunction, to date, no physiopathological mechanism has been identified. Consequently, there are no therapeutic options besides symptomatic treatment and rehabilitation. Methods We evaluated patients with symptoms that persisted for at least 4 weeks after COVID-19. Epidemiological and clinical data were collected. Blood tests, including inflammatory markers, were conducted, and imaging studies made if deemed necessary. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction (RT-PCR) in plasma, stool, and urine were performed. Patients were offered antiviral treatment (compassionate use). Results We evaluated 29 patients who reported fatigue, muscle pain, dyspnea, inappropriate tachycardia, and low-grade fever. Median number of days from COVID-19 to positive RT-PCR in extra-respiratory samples was 55 (39–67). Previous COVID-19 was mild in 55% of the cases. Thirteen patients (45%) had positive plasma RT-PCR results and 51% were positive in at least one RT-PCR sample (plasma, urine, or stool). Functional status was severely reduced in 48% of the subjects. Eighteen patients (62%) received antiviral treatment. Improvement was seen in most patients (p = 0.000) and patients in the treatment group achieved better outcomes with significant differences (p = 0.01). Conclusions In a cohort of COVID-19 patients with persistent symptoms, 45% of them have detectable plasma SARS-CoV-2 RNA. Our results indicate possible systemic viral persistence in these patients, who may benefit of antiviral treatment strategies.

Lipoprotein(a) [Lp(a)] has emerged as an important cardiovascular risk factor. However, the prevalence and determinants of elevated Lp(a) in people living with HIV (PLHIV) remain insufficiently characterised. Since PLHIV have an increased cardiovascular risk even under effective virological control, our aim was to explore the prevalence of elevated Lp(a) and its association with cardiovascular risk in this population. We conducted a single-centre observational study in adult PLHIV with sustained virological suppression and without active oncological or infectious comorbidities. According to most international consensus statements, elevated Lp(a) was defined as levels >50mg/dL. A total of 186 PLHIV were included. Of these, 21% had Lp(a) levels >50mg/dL. Individuals with elevated Lp(a) had significantly higher total cholesterol, Low-density lipoprotein cholesterol (LDL-C), and apolipoprotein B levels, as well as a higher odds of a cardiovascular event (OR 5.3, p = 0.018). Although the proportion of patients receiving lipid-lowering therapy was significantly higher among those with elevated Lp(a), the percentage achieving LDL-C targets according to cardiovascular risk was significantly lower compared with patients with Lp(a) <50mg/dL. No association was observed between elevated Lp(a) and antiretroviral therapy regimens, CD4 count, CD4/CD8 ratio, or duration of HIV infection. In our study, elevated Lp(a) was present among 21% of virologically suppressed PLHIV and was associated with an adverse lipid profile and cardiovascular events, whereas no association was observed with HIV-related factors. Lp(a) may represent a marker of residual cardiovascular risk in this population and could help refine cardiovascular risk stratification beyond traditional lipid parameters. •Elevated lipoprotein(a) (>50mg/dL) was present in 21% of virologically suppressed people living with HIV.•High Lp(a) levels were associated with an adverse lipid profile, including higher LDL cholesterol and apolipoprotein B.•Elevated Lp(a) was strongly associated with cardiovascular events, independently of HIV-related factors.•Patients with high Lp(a) less frequently achieved LDL cholesterol targets despite more frequent statin use.•Lp(a) may identify residual cardiovascular risk beyond traditional lipid parameters in people living with HIV.

ABSTRACTLymphogranuloma venereum (LGV) is a sexually transmitted infection caused by invasive serovars of Chlamydia trachomatis. There have been only a few case reports of oropharyngeal C. trachomatis infection complicated with cervical LGV. We report a case of a HIV-positive male patient with cervical LGV that presented a poor evolution despite appropriate treatment.

Since the COVID-19 outbreak, specific mRNA-based anti-SARS-CoV-2 vaccines have been developed and distributed worldwide. Because this is the first time that mRNA vaccines have been used, there are several questions regarding their capacity to confer immunity and the durability of the specific anti-SARS-CoV-2 response. Therefore, the objective of this study was to recruit a large cohort of healthcare workers from the Gregorio Marañón Hospital vaccinated with the mRNA-1273 or BNT126b2 vaccines and to follow-up on IgG anti-RBD levels at 8 months post-vaccination. We recruited 4,970 volunteers and measured IgG anti-RBD antibodies on days 30 and 240 post-vaccination. We observed that both vaccines induced high levels of antibodies on day 30, while a drastic wane was observed on day 240, where mRNA-1273 vaccinated induced higher levels than BNT162b2. Stratifying by vaccine type, age, gender, and comorbidities, we identified that older mRNA-1273-vaccinated volunteers had higher antibody levels than the younger volunteers, contrary to what was observed in the BNT162b2-vaccinated volunteers. In conclusion, we observed that mRNA-1273 has a higher capacity to induce a humoral response than BNT162b2 and that age is a factor in the specific response.

Leprosy remains infrequent in non-endemic areas. The objective of this study was to describe the cases of leprosy reviewed at a referral unit for imported diseases in Europe and to compare these findings with published data on imported leprosy. Cases of leprosy evaluated at a referral centre are described and salient features of autochthonous and imported cases are compared. A review of the literature on imported leprosy was performed. During the study period, 25 patients with leprosy were followed-up (10 were autochthonous cases and 15 were considered to be imported). Regarding imported cases, the majority were diagnosed in Latin American immigrants (10/15, 67%), mean age was 42 years, there were no differences in gender distribution, estimated average time from arrival in Spain to first visit at the unit was 3 years and from symptom onset to diagnosis was 2 years. Over 80% of imported cases had multibacillary disease and over one third of patients had been previously diagnosed with leprosy. One third had received alternate incorrect diagnoses initially, <50% of patients with imported leprosy completed standard therapy and were considered cured and over one third were lost to follow-up. Leprosy remains a complex disease for healthcare professionals unfamiliar with this infection. Manifestations are polymorphic so misdiagnoses and consequent delays in diagnosis are not infrequent and may lead to resulting disabilities. Early diagnosis and management are essential to prevent sequelae and possible transmission. Improving access to health care, especially for vulnerable groups, would be necessary to advance in the control of this disease.