Patients with preserved immunity performed well on IHDS. It didn't seem to be any difference between patients on and off HAART regarding neurocognitive status.

Hyperbilirubinemia is the most frequently described adverse affect of atazanavir (ATV). ATV is a competitive inhibitor of the enzyme UGT1A1, and can thus create a reversible, dose-dependent increase predominantly of unconjugated bilirubin. 1 In previous studies, the incidence of Grade III [ > 2.5 times the upper limit of normality (ULN) according to the AIDS Clinical Trials Group definition] and Grade IV (> 5 times ULN) hyperbilirubinemia ranged from < 20% to 52%. 2-7 In the largest study, involving 2,404 patients in Italy, 44.6% of patients had Grade III or higher, and 7.2% had Grade IV hyperbilirubinemia. According to this study, several factors increased the risk of hyperbilirubinemia during ATV therapy: elevated basal bilirubin, higher basal CD4 cell counts, and concurrent use of ritonavir booster. 7 In a multicenter study of 400 patients, concurrent use of ritonavir also increased the incidence of Grade III/IV hyperbilirubinemia: 59% among patients receiving ATV/r compared to 20% of patients receiving ATV. 8 Overall, the incidence of clinical jaundice in patients receiving ATV in dosages currently used in clinical practice has been reported as being 7-11%. 9,10 In multiple studies, hyperbilirubinemia and jaundice led to discontinuation of therapy for a small subset (1%) of patients. 8,9,11 There were no reported instances of permanent liver damage but jaundice may be cosmetically unacceptable. The aim of this study was to determine the prevalence of Grade III (or higher) hyperbilirubinemia and of clinical jaundice in a cohort of Hispanic patients receiving ATV. We also tried to determine the consequences of the mentioned adverse event on this population, and to determine if it is associated with liver damage. We performed a retrospective review of medical records from patients attending three infectious diseases centers in Buenos Aires, Argentina (two private practices and a public hospital), who were at that time or previously on an antiretroviral regimen that included ATV (with or without ritonavir), regardless of antiretroviral backbone or the number of previous treatment failures. Patients who were identified as not being Hispanic were excluded. The values of total and indirect bilirubin were retrieved for the period in which ATV was taken. Highest values and times of occurrence were recorded. The following variables were analyzed: demographic variables, time to bilirubin (total and indirect) highest values, use of ritonavir, CD4 cell count at ATV initiation

Unconjugated hyperbilirubinemia resulting from therapy with atazanavir is physiologically related to hyperbilirubinemia in Gilbert's syndrome (GS). In patients with GS, changes in diet have a significant impact on bilirubinemia. Our aim was to investigate whether changes in diet affect the level of serum bilirubin in patients receiving atazanavir. Thirty patients on stable therapy with ritonavir-boosted atazanavir without evidence of GS were enrolled. Hemolysis and chronic hepatitis were excluded. After a baseline period of normal intake of calories, the patients were randomized to follow a 24-h 400-calorie diet (fasting), then a 48-h period of normal calorie intake and, afterward, a 24-h period of a high-calorie diet, or the same interventions in inverse order. Serum bilirubin concentrations were measured before and after each intervention. A high adherence to the recommended diet was observed. The mean unconjugated bilirubin concentration before the high-calorie diet was 2.79±1.53 mg/dl and after such intervention it was 2.70±1.40 mg/dl. The mean difference between preintervention and postintervention was -0.08±0.69 mg/dl (p=NS). The mean unconjugated bilirubin concentration before the fasting diet was 2.31±1.23 mg/dl and it was 3.84±1.90 mg/dl after. The mean difference between prefasting and postfasting was 1.53±1.17 mg/dl (p=0.001). According to these results, short periods of fasting seem to increase the unconjugated bilirubin concentration in patients on atazanavir. A high-calorie diet did not have any impact in bilirubin probably because most patients follow similar diets in their everyday life.

BackgroundIn the last years, there has been an increase in incidence of cases of measles in high and middle-income countries. In Argentina, measles elimination was achieved in 2000, with no circulation of measles virus since then; vaccination iscompulsory (two doses MMR vaccine) and coverage is reported to be roughly 85%. The aim of this study was to determine seroprevalence of antibodies to measles in adults, analyzed according to HIV status.MethodsCross-sectional study. All serologic tests requested for measles antibodies in patients aged >18 years between January 2015 and December 2017 in an Infectious Diseases Reference Center in Buenos Aires were retrieved and analyzed according to HIV status and age group. All determinations were done with VIDAS¨ Measles IgG, Biomeriex. Chi-squared and Fisher’s exact tests were used for comparisons.ResultsWe included 2,663 patients with determinations for measles performed in the mentioned period. Of those, 348 were HIV(+), with mean (±SD) age: 34.7(±6.2) years, 85% male (86% MSM), mean (±SD) nadir CD4 (cells/mm3): 369.6(±219.5); 89% VL< 50 copies/mL; and 2,315 were HIV(–), with mean age(±SD): 31(±5.9) years, 67% female. There was a high proportion of seronegative subjects to measles in both groups, but significantly higher in HIV+ patients (40.8% vs. 33.2%; P = 0.005). However, when analyzed by age group, in those <40 years the proportion of seronegativity to measles was higher (HIV+: 45.3% vs. 31.3%, P = 0.02; HIV-: 38.3% vs. 20.2%, P < 0.001; Figure 1). Patients older than 50 years (the most prone to having beenexposed to measles virus) had the highest prevalence of measles antibodies (>92% in both groups; Figure 2); and those younger than 40, the lowest (55% in HIV+ and 62% in HIV−). Stratification by gender did not change any of these findings. In HIV+ persons, seronegativity to measles was not associated with nadir of CD4 < 200 (P = NS). ConclusionWe found a very high proportion of subjects without protective antibodies to measles among those <40 years (higher in HIV+ patients). This is interesting since in Argentina the vast majority of people <40 should have been vaccinated atleast once. Lack of circulation of measles might accelerate waning of antibodies. There might be an increased risk of measles in young people, especially in HIV+ persons; measures to evaluate this situation and eventually (re)vaccinate susceptiblepersons is warranted.Disclosures E. Bissio, MSD: Employee, Salary. M. E. Perez Carrega, MSD: Employee, Salary. J. L. Montes, MSD: Employee, Salary.