The precise effects of HIV-1 on the gut microbiome are unclear. Initial cross-sectional studies provided contradictory associations between microbial richness and HIV serostatus and suggested shifts from Bacteroides to Prevotella predominance following HIV-1 infection, which have not been found in animal models or in studies matched for HIV-1 transmission groups. In two independent cohorts of HIV-1-infected subjects and HIV-1-negative controls in Barcelona (n = 156) and Stockholm (n = 84), men who have sex with men (MSM) predominantly belonged to the Prevotella-rich enterotype whereas most non-MSM subjects were enriched in Bacteroides, independently of HIV-1 status, and with only a limited contribution of diet effects. Moreover, MSM had a significantly richer and more diverse fecal microbiota than non-MSM individuals. After stratifying for sexual orientation, there was no solid evidence of an HIV-specific dysbiosis. However, HIV-1 infection remained consistently associated with reduced bacterial richness, the lowest bacterial richness being observed in subjects with a virological-immune discordant response to antiretroviral therapy. Our findings indicate that HIV gut microbiome studies must control for HIV risk factors and suggest interventions on gut bacterial richness as possible novel avenues to improve HIV-1-associated immune dysfunction.

Human immunodeficiency virus (HIV)-1 infection causes severe gut and systemic immune damage, but its effects on the gut microbiome remain unclear. Previous shotgun metagenomic studies in HIV-negative subjects linked low-microbial gene counts (LGC) to gut dysbiosis in diseases featuring intestinal inflammation. Using a similar approach in 156 subjects with different HIV-1 phenotypes, we found a strong, independent, dose-effect association between nadir CD4+ T-cell counts and LGC. As in other diseases involving intestinal inflammation, the gut microbiomes of subjects with LGC were enriched in gram-negative Bacteroides, acetogenic bacteria and Proteobacteria, which are able to metabolize reactive oxygen and nitrogen species; and were depleted in oxygen-sensitive methanogenic archaea and sulfate-reducing bacteria. Interestingly, subjects with LGC also showed increased butyrate levels in direct fecal measurements, consistent with enrichment in Roseburia intestinalis despite reductions in other butyrate producers. The microbiomes of subjects with LGC were also enriched in bacterial virulence factors, as well as in genes associated with beta-lactam, lincosamide, tetracycline, and macrolide resistance. Thus, low nadir CD4+ T-cell counts, rather than HIV-1 serostatus per se, predict the presence of gut dysbiosis in HIV-1 infected subjects. Such dysbiosis does not display obvious HIV-specific features; instead, it shares many similarities with other diseases featuring gut inflammation.

ObjectivesWe assessed the efficiency of BCN Checkpoint in detecting new cases of HIV infection and efficiently linking newly diagnosed individuals to care. MethodsThis study analysed during 2007-2012 the number of tests performed and the number of persons tested in BCN Checkpoint, the HIV prevalence, global and in first visits, the capacity of HIV detection compared to the reported cases in MSM in Catalonia, and the linkage to care rate. ResultsDuring the six years a total of 17.319 tests were performed and 618 HIV-positive cases were detected. Median prevalence of clients who visited the centre for the first time was 5.4% (4.1-5.8). BCN Checkpoint detected 36. 3% (35.0-40.4) of all reported cases in MSM during [2009][2010][2011]. Linkage to care was achieved directly in 90.5% of the cases and only 2.4% of cases were lost to follow-up. ConclusionsA community-based centre, addressed to a key population at risk, can be less effort consuming (time and funding) and show high efficiency in HIV detection and linkage to care. . These factors discourage persons from sexual minorities from seeking and receiving essential HIV prevention, testing, care and treatment services, condemning them to remain at disproportionately high risk of HIV acquisition [6]. Greater access to testing and availability of prevention and care services for persons infected with HIV can reduce new infections and lead to reductions in HIV-associated morbidity and mortality [7]. To overcome some of these barriers to the early diagnosis and linkage to care of infected persons, the patient-based organization Projecte dels NOMS-Hispanosida created in 2006 BCN Checkpoint, a community-based centre (CBC) for MSM in the gay area of Barcelona. This centre offers HIV testing free of prejudice, peer counselling and support, and linkage to medical care for people diagnosed with HIV infection. The centre is staffed by a part-time physician, a nurse, 12 counsellors, a receptionist and two administrative assistants. All members of the team are gay, some are HIV positive and six counsellors are part-time volunteers. Peer support is fundamental in helping HIV-infected persons to deal with the emotional impact of receiving such a diagnosis, as well as in helping them to seek medical care and adhere to treatment. This CBC is dedicated to MSM because Barcelona has a significant MSM community with a high prevalence of HIV infection (17%) [8]. Awareness of serostatus also results in a reduction in the risk of transmission of HIV to sex partners, as a substantial proportion of PLWHIV reduce sexual behaviours likely to transmit HIV after discovering that they have HIV infection [9]. Thus, HIV testing represents secondary prevention for people who know their HIV status (reduction of prevalence and severity of the disease) and primary prevention for the community (reduction of HIV incidence). KeywordsProjecte dels NOMS-Hispanosida, in addition to setting up BCN Checkpoint, started promoting regular testing for MSM and implemented for the first time in Spain the rapid HIV t...

The ITACA cohort revealed a high and increasing HIV incidence among MSM, especially important among foreign-born men. The findings underscore the need to implement multilevel interventions for MSM taking into account different types of partners, cultural origins and the exposure to other sexually transmitted infections.

Background The introduction in 2006 of the rapid HIV test by BCN Checkpoint in a non‐clinical setting has been a successful step forwards in the uptake of testing. Nevertheless, HIV serostatus should be reported as HIV positive only when a reactive result has been tested again using a different assay (WHO guidelines 2015). The standard confirmation test has been the Western Blot (WB) test. However confirmation results take around 7 days to come back. Aims This study explores the possibility of Point of Care PCR testing for a same‐day confirmation. Materials and Methods Between March 2015 and September 2016 a POC PCR test (Xpert® HIV‐1 Qual) was performed in parallel to the Western Blot test after a reactive HIV rapid test (Alere Determine™ HIV‐1/2 Ag/Ab Combo and Alere™ HIV Combo). HIV confirmed positive cases received emotional support by peers, were informed and prepared for treatment initiation and rapidly linked to HIV clinic. Results During the study period 11 455 tests were performed to 7163 clients. A total of 249 reactive rapid HIV tests were found. For analysis a total of 33 cases were excluded due to the lack of PCR and/or WB test. Results of comparison of the 216 cases showed 194 concordant positive confirmations and 14 concordant negative results. In three cases PCR was positive and WB negative. In five cases PCR was negative and WB positive. Conclusion The POC PCR assay is easy to use and feasible in a community‐based center. Reducing time for confirmation to 90 min has been possible in 91.2% (197/216) of cases with positive PCR result. In cases of a negative PCR result an additional test (WB, Elisa or PCR quantitative) was needed to distinguish false positive results (6.5%) from viral load results below level of detection (2.3%). Clients expressed satisfaction with same‐day confirmation and less anxiety.