The incidence of syphilis in this cohort of men with HIV (predominantly MSM) was very high. In addition to maintaining high surveillance for early diagnosis and treatment, it is necessary to implement newer and more effective measures to prevent syphilis and other STIs in this population.

Background: Pyogenic vertebral osteomyelitis accounts for approximately 1-7% of all bone infections. It encompasses a spectrum of pathological conditions, including discitis, spondylitis, and spondylodiscitis. Objective: to investigate the epidemiology and describe their management.Methods & Materials: Seven year, retrospective cohort study of patients admitted to Madariagaś Hospital between June 1, 2010 and May 31, 2017, and diagnosed with acute vertebral osteomyelitis (AVO).Inclusion: patients≥18 years old, were included only if there was illness compatible with vertebral infection and evidence of spinal involvement on conventional radiographs or magnetic resonance images. Medical records were reviewed for demographic information, comorbidities, presenting symptoms, physical examination findings, diagnostic procedures, microbiology, and medical and surgical treatment.Results: 40 patients with AVO, male 28 (70%). Mean age 54.2 years (range 19 -84). Leading comorbidities: diabetes mellitus (9, 22%), chronic renal insufficiency (5, 12%), previous spinal surgery (>1 year) and spinal trauma (5, 12%). Frequently symptoms: back pain 38 (95%), motor weakness 16 (40%) and fever 13 (32%). Elevated white blood cell count 20 (50%) patients. ESR and CRP levels were elevated in 7 (17%) and 27 (67%) patients respectively. All patients underwent radiological evaluation. Lumbar spine was the most common location 27 (67%), thoracic 7 (17%) and thoracolumbar 7 (17%). Twenty-six (65%) patients had microbiological diagnosis made by bone biopsy and/or positive blood culture. Two of 40 patients had polymicrobial infections. Staphylococcus aureus was isolated 45% of the time, with 66% of these cases being MRSA. Twenty-four patients underwent needle or open surgical biopsy. Eighteen (75%) patients who underwent to histopathological analysis had signs of osteomyelitis. Seventeen (42%) patients had surgical procedure for therapeutic purposes. Most frequently duration of antibiotic therapy was 6 weeks.Conclusion: Only 65% of patients had microbiological diagnosis confirmed. MRSA was the most frequent agent, with important implications for empirical treatment in the absence of specific microbiological diagnosis. It is important to maintain a heightened level of suspicion for osteomyelitis in the setting of persistent back pain and changes in neurological exam to initiate appropriate laboratory and radiologic evaluations in order to make a timely diagnosis.

Background: The prevalence of hypovitaminosis D is variable in the general population, depending on age, gender, sun exposure and geographical area. Hypovitaminosis D has been well described in HIV population.HIV infection and certain ART (anti-retroviral treatment) regimens have been described as independent risk factors causing hypovitaminosis D.The prevalence of hypovitaminosis D in HIV patients is not well known in South America and especially in Argentina. The aim of this study was to determine the prevalence of hypovitaminosis D in a cohort of HIV infected patiens.Methods & Materials: We performed a retrospective review of 1134 subjects followed-up at our center between 2008 and 2016. Patients with vitamin D dosage were analyzed. The prevalence of hypovitaminosis D (insufficiency 30ng/ml -20 ng/ml, deficiency < 20 ng/ml) and the association with efavirenz or protease inhibitor treatment, CD4 lymphocyte count and viral load was analyzed by logistic regression.Results: A sample of 814 patients with at least 1 vitamin D dosage was analysed. Median age was 44 years (r: 21-80), 91.6% were men, 99% under ART, 98.7% had CD4 lymphocyte values greater than 200mm3, and 91.5% HIV-1 ARN less than 200 cop/ml. ART included efavirenz in 40.7% (n = 331) and a PI in 41.03% (n = 334).The prevalence of hypovitaminosis D was 79.7% (n = 649), of which 45.5% had values below 20ng/ml. 79.15% of patients receiving efavirenz and 79.94% of patients receiving PI had hypovitaminosis D. We did not found any association between hipovitaminosis D and efavirenz or PI regimens (p = 0.45 and p = 0.42, respectively). Neither we found an association between hipovitaminosis D and CD4 lymphocyte count or viral load (p = 0.39 and 0.49). Conclusion:The prevalence of hypovitaminosis D among HIV patients was 79.7% in our cohort patients. Approximately 80% of patients receiving both efavirenz and PI experienced hypovitaminosis D, although no significant association was found between antiretroviral therapy and vitamin D deficiency or insufficiency.

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Introducción: Cargas virales (CV) entre 20-200 copias/mL se consideran cargas virales de bajo grado (CVBG). Su implicancia clínica y manejo no han sido definidos. Objetivo: Evaluar el impacto de CVBG en el riesgo de desarrollo posterior de fallo virológico (FV). Pacientes y Métodos: Se incluyeron pacientes ≥ 18 años, desde enero de 2009 a diciembre de 2019, con infección por VIH-1 con CV< 20 copias/mL, por un mínimo de seis meses y/o en dos muestras consecutivas bajo tratamiento anti-retroviral. Se realizó seguimiento de las CV estratificándolas: CV < 20 copias/mL, CVBG (20-50 copias/mL y 51-200 copias/mL) y FV. Mediana de seguimiento 25 meses (IQR 15-31). Resultados: Fueron incluidos 1.416 pacientes con CV < 20 copias/ mL bajo TARV. De ellos, 797 permanecieron con CV< 20 copias/mL durante el seguimiento, 144 presentaron CV entre 20-50 copias/mL, 384 entre 51-200 copias/mL y 91 presentaron FV sin CVBG previa. De los 528 pacientes que tuvieron CVBG, 110 (20,1%) fallaron, riesgo 3,45 veces superior respecto a los que no tuvieron CVBG previa. El riesgo de FV fue 3,27 mayor para aquellos que tuvieron CVBG entre 51-200 copias/mL vs 20-50 copias/mL. Discusión: El estudio permite relacionar la CVBG con el FV posterior, siendo el mayor riesgo CVBG entre 51-200 copias/mL. Palabras clave: VIH; carga viral; fallo virológico; viremia de bajo grado.