Equatorial Guinea is endemic for HIV-1. This country borders to the north with Cameroon, where different subtypes belonging to group M, as well as group O strains, are circulating simultaneously. To assess the molecular epidemiology of HIV-1 in Equatorial Guinea we analyzed 76 plasma samples collected throughout 1999 from seropositive individuals. Phylogenetic analysis of the gp41 region revealed that 53 were of subtype A, with 64% of these sequences clustering with CRF02_AG reference strains; 11 were of subtype C; 4 were of subtype D; 2 (closely related to subtype F2) were of subtype F; 3 were of subtype G, two of them forming a separate cluster with the recombinant circulating forms CRF06_cpx; 1 was of subtype H; and 2 were unclassifiable. Although subtype A is predominant, the presence of 14% of subtype C is also noteworthy. This work represents the first HIV-1 subtype distribution study in Equatorial Guinea.

Diarrhea is still a prevalent health issue in HIV patients. Our objective was to characterize the different diarrheagenic E. coli (DEC) groups in stools from adult HIV patients. Cross sectional study: We enrolled HIV-positive and -negative patients with and without diarrhea from a tertiary-care center of Lima, Peru. Clinical data was recorded and a stool sample per patient was cultured. Multiplex PCR was used to detect different DECs. One hundred eighty-four participants were enrolled. The frequency of having at least one DEC was more common in HIV-positive than HIV-negative patients with diarrhea (42% versus 20%, P < 0.05). The enterotoxigenic E. coli (ETEC) was the most common DEC in patients with diarrhea, 13% in HIV patients. The diffusely adherent E. coli (DAEC) was only present in HIV positive patients with diarrhea (10.1%). Different types of DEC are frequent in stools from HIV-positive patients.

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Drug-drug interactions between orally-administered antiretroviral therapy (ART) and hormones released from an intravaginal ring (IVR) are not known. We hypothesized that efavirenz-based ART and atazanavir/ritonavir-based ART would alter plasma concentrations of vaginally-administered etonogestrel/ethinyl estradiol, yet ART concentrations would be unchanged during IVR use. Methods: We conducted a parallel, three-group, pharmacokinetic evaluation at clinical research sites in Asia, South America, sub-Saharan Africa, and the United States between December 30, 2014 and September 12, 2016 (NCT01903031). We enrolled women with HIV who were either ART-naïve (Control group; n=25), receiving efavirenz-based ART (n=25), or receiving atazanavir/ritonavir-based ART (n=24). An IVR releasing etonogestrel/ethinyl estradiol was inserted at entry. Single plasma samples for hormone concentrations were collected 7, 14, and 21 days after IVR insertion. The primary outcome was the plasma concentration of etonogestrel and ethinyl estradiol on Day 21. Etonogestrel and ethinyl estradiol concentrations were compared between each ART group and the Control group by geometric mean ratio (GMR) with 90% confidence intervals (CI) and Wilcoxon Rank-Sum test. Secondarily, efavirenz or atazanavir/ritonavir concentrations were assessed by 8-hour intensive pharmacokinetic sampling at entry before IVR insertion and before IVR removal on Day 21. Antiretroviral areas under the concentrationtime curve (AUC0-8h) were compared before and after IVR insertion by GMR (90% CI) and Wilcoxon Signed-Rank test. Findings: On Day 21 of IVR use, participants receiving efavirenz had 79% lower etonogestrel [GMR 0•21 (0•16-0•28); p<0•0001] and 59% lower ethinyl estradiol [GMR 0•41 (0•32-0•52); p<0•0001] concentrations compared to the Control group. In contrast, participants receiving atazanavir/ritonavir had 71% higher etonogestrel [GMR 1•71 (1•37-2•14); p<0•0001], yet 38% lower ethinyl estradiol [GMR 0•62 (0•49-First Name (middle initial) Last Name

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