BACKGROUND: The World Health Organization’s definition of health focuses on health-related quality of life in all domains, not just the “absence of disease or infirmity”. We investigated various treatment challenges among People living with HIV (PLHIV) in Portugal.METHODS: We analyzed data for n=60 adult PLHIV with a confirmed diagnosis and on anti-retroviral therapy (ART) who participated in the 2019 Positive Perspectives Survey. Descriptive analyses were performed using R Version 3.6.1.RESULTS: Most participants were virally suppressed (97%), male (67%); <50 years (51%); and had ≥1 non-HIV comorbidity (70%). Overall, 15% reported trouble swallowing pills, 35% experienced ART side effects, 22% felt daily oral ART limited their life, 25% were stressed by their dosing schedule, 33% said daily oral dosing cued bad memories, while 63% said daily dosing reminded them of their HIV. These challenges were associated with treatment-avoidance behaviors; PLHIV reported missing ≥1 ART dose within the past month because of food requirements 27%, side effects 12%, concerns about long-term ART impacts 10%, and problems swallowing 5%. Overall, 73% were open to taking long-acting, nondaily ART if they remained virologically controlled. Only 35% overall perceived no communication barriers with their HCPs; these individuals had higher prevalence of optimal physical (86% vs. 49%, p=0.011) and mental health (86% vs. 36%, p<0.001) than those with a perceived barrier.CONCLUSION: For some PLHIV, taking pills daily was linked with diverse emotional challenges, including pill fatigue and anxiety. Clinicians should consider patient preferences when prescribing ART and engage PLHIV in treatment decisions.

Tuberculosis (TB) was explicitly recognized as a major global public health problem in the early 1990s and, if it is to be eliminated, it is essential that every country organize control activities in line with its own epidemiological situation. Portugal still remains among the countries with intermediate incidence, with 2756 cases of TB diagnosed in 2009. The incidence of multidrug-resistant (MDR) TB has been decreasing, representing an average of 1.7% of the total number of TB cases, with about 25% of extensively drug-resistant (XDR) TB, and with more than two thirds residing in the region of Lisbon and Vale do Tejo (LVT). The aim of this study is to evaluate risk factors and treatment outcomes associated with MDR and XDR-TB in LVT during the time period of 2008-2010. In 50 (2.4%) out of 2093 culture-positive TB cases from patients diagnosed in the LVT region, Mycobacterium tuberculosis (MTB) isolates were identified as MDR-TB; 12 (24%) met the criteria for XDR-TB. It was noted that HIV-positive status and retreatment cases are still closely associated with drug-resistant TB. Although the WHO target of about 75% treatment success rates for MDR-TB was not yet achieved, extensive drug susceptibility testing and the availability of second- and third-line drugs under strictly supervised treatment conditions permitted relatively good treatment success rates in MDR and XDR-TB cases in Lisbon.

We conducted a molecular epidemiology study of Mycobacterium tuberculosis strains isolated from patients in Lisbon hospitals. We used restriction fragment length polymorphism (RFLP) to detect Lisbon family strains and to determine the genetic diversity of Mycobacterium tuberculosis strains isolated in Lisbon, through identification of the most important risk factors of tuberculosis transmission analysis, with the insertion sequence IS6110 as a probe to fingerprint isolates of Mycobacterium tuberculosis. 64.8% of the 290 Mycobacterium tuberculosis isolates were grouped in clusters. This figure was 60.7% if we excluded strains with five or fewer IS6110 copies. Multidrug-resistance was observed in 4.1% of the strains and they were all in clusters. Forty-five (18.2%) strains were included in the Lisbon family. Considering the relatively high percentage of strains in cluster detected in this study, we believe that active transmission is still taking place in Lisbon. Moreover, clusters of Lisbon strains represent the predominant strains circulating in Lisbon and are still related to drug resistance although presenting a lower percentage than that observed in previous studies.

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