Background Assessing the burden of COVID-19 on the basis of medically attended case numbers is suboptimal given its reliance on testing strategy, changing case definitions, and disease presentation. Population-based serosurveys measuring anti-severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2) antibodies provide one method for estimating infection rates and monitoring the progression of the epidemic. Here, we estimate weekly seroprevalence of anti-SARS-CoV-2 antibodies in the population of Geneva, Switzerland, during the epidemic.Methods The SEROCoV-POP study is a population-based study of former participants of the Bus Santé study and their household members. We planned a series of 12 consecutive weekly serosurveys among randomly selected participants from a previous population-representative survey, and their household members aged 5 years and older. We tested each participant for anti-SARS-CoV-2-IgG antibodies using a commercially available ELISA. We estimated seroprevalence using a Bayesian logistic regression model taking into account test performance and adjusting for the age and sex of Geneva's population. Here we present results from the first 5 weeks of the study. FindingsBetween April 6 and May 9, 2020, we enrolled 2766 participants from 1339 households, with a demographic distribution similar to that of the canton of Geneva. In the first week, we estimated a seroprevalence of 4•8% (95% CI 2•4-8•0, n=341). The estimate increased to 8•5% (5•9-11•4, n=469) in the second week, to 10•9% (7•9-14•4, n=577) in the third week, 6•6% (4•3-9•4, n=604) in the fourth week, and 10•8% (8•2-13•9, n=775) in the fifth week. Individuals aged 5-9 years (relative risk [RR] 0•32 [95% CI 0•11-0•63]) and those older than 65 years (RR 0•50 [0•28-0•78]) had a significantly lower risk of being seropositive than those aged 20-49 years. After accounting for the time to seroconversion, we estimated that for every reported confirmed case, there were 11•6 infections in the community.Interpretation These results suggest that most of the population of Geneva remained uninfected during this wave of the pandemic, despite the high prevalence of COVID-19 in the region (5000 reported clinical cases over <2•5 months in the population of half a million people). Assuming that the presence of IgG antibodies is associated with immunity, these results highlight that the epidemic is far from coming to an end by means of fewer susceptible people in the population. Further, a significantly lower seroprevalence was observed for children aged 5-9 years and adults older than 65 years, compared with those aged 10-64 years. These results will inform countries considering the easing of restrictions aimed at curbing transmission.

In persons infected with HIV, HAART use may prevent most excess risk of KS and non-Hodgkin lymphoma, but not that of Hodgkin lymphoma and other non-acquired immunodeficiency syndrome-defining cancers. No cancers of the lip, mouth, pharynx, or lung were observed in nonsmokers.

OBJECTIVE To explore the levels and determinants of loss to follow-up (LTF) under universal lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women (“Option B+”) in Malawi. DESIGN, SETTING, and PARTICIPANTS We examined retention in care, beginning at date of ART initiation and up to six months, for women in the Option B+ program. We analysed nation-wide facility-level data on women who started ART at 540 facilities (n=21 939). The study included individual-level data on patients who started ART at 19 large facilities (n=11 534). RESULTS Of the women who started ART under Option B+ (n=21 939), 17% appeared to be LTF six months after start. Most losses occurred in the first 3 months of therapy. Option B+ patients who started therapy during pregnancy were five times more likely than women who started ART in WHO stage 3/4 or with a CD4 cell count ≤350 cells/μl, to never return after their initial clinic visit (odds ratio 5.0, 95% CI 4.2-6.1). Option B+ patients who started therapy while breastfeeding were twice as likely to miss their first follow-up visit (odds ratio 2.2, 95% CI 1.8-2.8). LTF was highest in pregnant Option B+ patients who began ART at large clinics on the day they were diagnosed with HIV. LTF varied considerably between facilities, ranging from 0% to 58%. CONCLUSION Decreasing LTF will improve the effectiveness of the Option B+ approach. Tailored interventions, like community- or family-based PMTCT models could improve its effectiveness.

CYP2B6 516TT was associated with greater plasma and intracellular exposure to EFV, and greater plasma exposure to NVP. Intracellular drug concentration, and CYP2B6 genotype were predictors of EFV neuropsychological toxicity. CYP2B6 genotyping may be useful to complement an individualization strategy based on plasma drug determinations to increase the safety and tolerability of EFV.

Leigh Johnson and colleagues estimate the life expectancies of HIV positive South African adults who are taking antiretroviral therapy by using information from 6 programmes between 2001 and 2010.

Background: The advent of highly active antiretroviral therapy (HAART) in 1996 led to a decrease in the incidence of Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL), but not of other cancers, among people with HIV or AIDS (PWHA). It also led to marked increases in their life expectancy. Methods: We conducted a record-linkage study between the Swiss HIV Cohort Study and nine Swiss cantonal cancer registries. In total, 9429 PWHA provided 20 615, 17 690, and 15 410 person-years in the pre-, early-, and late-HAART periods, respectively. Standardised incidence ratios in PWHA vs the general population, as well as age-standardised, and age-specific incidence rates were computed for different periods. Results: Incidence of KS and NHL decreased by several fold between the pre- and early-HAART periods, and additionally declined from the early- to the late-HAART period. Incidence of cancers of the anus, liver, non-melanomatous skin, and Hodgkin's lymphoma increased in the early- compared with the pre-HAART period, but not during the late-HAART period. The incidence of all non-AIDS-defining cancers (NADCs) combined was similar in all periods, and approximately double that in the general population. Conclusions: Increases in the incidence of selected NADCs after the introduction of HAART were largely accounted for by the ageing of PWHA.

Objectives To assess the proportion of patients lost to programme (died, lost to follow-up, transferred-out) between HIV diagnosis and start of antiretroviral therapy (ART) in sub-Saharan Africa, and determine factors associated with loss to programme. Methods Systematic review and meta-analysis. We searched PubMed and EMBASE databases for studies in adults. Outcomes were the percentage of patients dying before starting ART, the percentage lost to follow-up, the percentage with a CD4 cell count, the distribution of first CD4 counts and the percentage of eligible patients starting ART. Data were combined using random-effects meta-analysis. Results 29 studies from sub-Saharan Africa including 148,912 patients were analysed. 6 studies covered the whole period from HIV diagnosis to ART start. Meta-analysis of these studies showed that of 100 patients with a positive HIV test, 72 (95% CI 60–84) had a CD4 cell count measured, 40 (95% CI 26–55) were eligible for ART and 25 (95% CI 13–37) started ART. There was substantial heterogeneity between studies (p<0.0001). Median CD4 cell count at presentation ranged from 154 cells/μl to 274 cells/μl. Patients eligible for ART were less likely to become lost to programme (25% versus 54%, p<0.0001) but eligible patients were more likely to die (11% versus 5%, p<0.0001) than ineligible patients. Loss to programme was higher in men, in patients with low CD4 cell counts and low socio-economic status, and in recent time periods. Conclusions Monitoring and care in the pre-ART time period needs improvement, with greater emphasis on patients not yet eligible for ART.

Background Prognostic models have been developed for HIV-1 infected patients who start combination antiretroviral therapy (ART) in high-income countries, but not for patients treated in sub-Saharan Africa. Methods We included 10,331 adult patients who started ART between 2004 and 2007 in ART scale-up programmes in Côte d’Ivoire, South Africa and Malawi. Data were analysed by intention-to-continue-treatment, ignoring treatment changes and interruptions. We used Weibull survival models to construct two prognostic models: one that included baseline CD4 count and one that did not, since in many African settings CD4 count is not routinely measured. Findings During the first year after starting ART, 912 (8.2%) patients died. Baseline CD4 cell count (adjusted hazard ratio 0.21 [95% CI 0.17–0.27] comparing ≥200 with <25 cells/μL), WHO clinical stage (3.45 [2.43–4.90] comparing stages III/IV with I/II), body weight (0.23 [0.18–0.30] comparing ≥60 with <45kg) and anaemia (0.27 [0.20–0.36] comparing none with severe) were strongly associated with mortality. Other independent risk factors were low total lymphocyte count, advanced age and male sex. The CD4 model included CD4 count, clinical stage, body weight, age and sex (160 risk strata). In the alternative model CD4 count was replaced by total lymphocyte count and degree of anaemia (288 risk strata). With the CD4 model the probability of death ranged from 0.9% (95% CI 0.6–1.4) in patients in the lowest risk stratum to 53% (44–62) in patients in the highest risk stratum. The corresponding probabilities for the total lymphocyte/haemoglobin model were 0.9% (0.5–1.4) and 60% (48–71). Interpretation Prognostic models based on the CD4 cell count, or total lymphocytes and haemoglobin provide similarly strong discrimination in predicting early mortality in patients starting ART in sub-Saharan Africa. These models are useful for counselling patients, planning health services and predicting outcomes at the population level.