The aim of this study was to determine whether drug-resistant virus persists in peripheral blood mononuclear cells (PBMCs) after long-term suppression of virus replication. Proviral DNA was extracted from the PBMCs of 11 patients on long-term highly active antiretroviral therapy (HAART). Genotyping of the reverse transcriptase (RT) and protease gene of several proviral variants was performed using limiting dilution polymerase chain reaction and single-copy sequencing. All patients were on successful HAART for a mean period of 59 months but had a history of suboptimal therapy and genotypic drug resistance before. Comparison of the amino acid sequence of the RT and protease gene in the different proviral variants, with that of the plasma virus isolated before HAART treatment, revealed that the different drug-resistant viral variants that evolved during the process of gradually building up resistance were still detectable in the PBMCs in 10 of the 11 patients tested. The proportion of resistant variants was found to correlate with the time that the resistant variants had been able to replicate. These data clearly show that virus variants that are able to replicate for a certain period enter the latent reservoir and remain archived in the PBMCs for a very long period.

Tuberculous brain abscesses (TBA) are an unusual clinical presentation of central nervous system tuberculosis occurring extremely infrequently in developed countries, and almost always in immunocompromised patients. Before the introduction of highly active antiretroviral therapy (HAART), TBA were associated with a high mortality rate in AIDS patients. We describe an HIV-infected patient presenting with multiple TBA who recovered completely with a combination of HAART and anti-tuberculous treatment.

Background: Due to overlap ways of transmission, HIV and hepatitis C (HCV) co-infection is highly prevalent. The aim of this study was to characterize the HCV cascade of care among HIV/HCV infected individuals in a major HIV center in Buenos Aires, Argentina.Methods & Materials: Data was drawn from Electronic Medical Records of HIV/HCV co-infected individuals. We assessed the number and proportion of patients achieving each step of the HCV cascade: RNA confirmation, fibrosis staging, treatment initiation, treatment completion, and sustained virological response (SVR).Results: Of the estimated 1650 HIV/HCV co-infected individuals, only 803 (49%) were actually tested for HCV antibody. Only 355/1650 (21%) were tested for HCV-RNA, of whom 320 were positive, confirming chronic infection (90%). Meanwhile, 46/1650 (3%) had only fibrosis staging. Among the 320 patients with positive RNA, 243 (76%) underwent fibrosis staging, and in 119 (37%) treatment was prescribed. Of them, 42 (35%) had received interferon-based therapy (the only drugs available before 2016), 34 (29%) received direct-acting antivirals (DAA), and 43 (36%) are going to initiate treatment with DAA this year. Among the 76 patients that completed treatment, 57 (75%) achieved SVR. Of the 34 individuals who received DAA, 100% achieved SVR. Conclusion:In accordance to what has been reported worldwide, we observed gaps in our HCV care cascade. In particular, large gaps were documented at the diagnostic stages, with less than a quarter actually receiving RNA confirmation. These results highlight the need to identify and address barriers that are preventing our HCV/HIV co-infected populations from benefitting from highly efficacious newer DAA-based treatments. It is crucial to generate awareness about the importance of active search of HCV coinfection in HIV patients, and the steps required to complete HCV evaluation and treatment. This goal can mainly be achieved by a continuous medical and patient education.

Since the use of Highly Active Antiretroviral Therapy (HAART) for HIV infection, there have been increasing reports of systemic manifestations of immune restoration. This new clinical syndrome among HIV-infected patients is associated with underlying co-infections with mycobacteria, cytomegalovirus, hepatitis B and C infections, etc.... We report on an HIV/tuberculosis (TB) co-infected patient who developed an immune restoration inflammatory syndrome after initiation of HAART and anti-TB treatment. She developed fever, large abscesses and pleural and peritoneal effusions. Systemic symptoms decreased during corticosteroid treatment, but abscesses only disappeared 8 months after the start of the anti-TB treatment.

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