Tenofovir disoproxil fumarate/emtricitabine plus ritonavir-boosted lopinavir or cobicistat-boosted elvitegravir as a single-tablet regimen for HIV post-exposure prophylaxis

Objectives

To assess HIV-1 post-exposure prophylaxis (PEP) non-completion at day 28, comparing ritonavir-boosted lopinavir versus cobicistat-boosted elvitegravir as a single-tablet regimen (STR), using tenofovir disoproxil fumarate/emtricitabine with both of these therapies.

Methods

A prospective, open, randomized clinical trial was performed. Individuals attending the emergency room due to potential sexual exposure to HIV and who met criteria for PEP were randomized 1:3 into two groups receiving either 400/100 mg of lopinavir/ritonavir (n = 38) or 150/150 mg of elvitegravir/cobicistat (n = 119), with both groups also receiving 245/200 mg of tenofovir disoproxil fumarate/emtricitabine. Five follow-up visits were scheduled at days 1, 10, 28, 90 and 180. The primary endpoint was PEP non-completion at day 28. Secondary endpoints were adherence, adverse effects and rate of seroconversions. Clinical trials.gov number: NCT08431173.

Results

Median age was 32 years and 95% were males. PEP non-completion at day 28 was 36% (n = 57), with a trend to be higher in the lopinavir/ritonavir arm [lopinavir/ritonavir 47% (n = 18) versus elvitegravir/cobicistat 33% (n = 39), P = 0.10]. We performed a modified ITT analysis including only those patients who attended on day 1. PEP non-completion in this subgroup was higher in the lopinavir/ritonavir arm than in the elvitegravir/cobicistat arm (33% versus 15%, respectively, P = 0.04). Poor adherence was significantly higher in the lopinavir/ritonavir arm versus the elvitegravir/cobicistat arm (47% versus 9%, respectively, P < 0.0001). Adverse events were reported by 73 patients (59%), and were significantly more common in the lopinavir/ritonavir arm (90% versus 49%, P = 0.0001). A seroconversion was observed in the elvitegravir/cobicistat arm in a patient with multiple exposures before and after PEP.

Conclusions

A higher PEP non-completion, poor adherence and adverse events were observed in patients allocated to the lopinavir/ritonavir arm, suggesting that STR elvitegravir/cobicistat is a well-tolerated antiretroviral for PEP.

[Javier Sádaba: A bioethics against suffering]

The philosopher Javier Sádaba (Portugalete, 1940) is the author of an extensive work in the field of bioethics. It is a procedural bioethics (based on the agreement between the participants, not on absolute truths), casuistry (is based on the analysis of specific problem cases), social (evaluates the context in decision-making), gradual (considers other species, is not "narcissistically human"), and secular (autonomous with respect to religion). Sádaba has also opted for an affirmative bioethics, which seeks to improve the living conditions of humans (in medicine, the quality of life). This is difficult to construct because, for the philosopher, the duty and to establish limits are infinitely easier to elaborate than the specific good and to pursue happiness. In its application to medicine, Sádaba's bioethics focuses on avoiding unnecessary suffering, because suffering does not contribute anything positive and hinders happiness. Likewise, he strives to extract the best of science and open the doors to everything that can bring improvements for the human being, but without ceasing to mention responsibility, because man is capable of the best and the worst. From this perspective, the author is faced with the bioethical issues, leaving the greatest possible margin to freedom of choice.

Efecto de la genética y de la dieta sobre el lomo fresco del cerdo Ibérico (m. Longissimus dorsi)

El objetivo de este estudio fue evaluar el efecto de la línea genética, la dieta y su interacción sobre el peso, rendimiento, contenido en grasa intramuscular y color del lomo (m. Longissimus dorsi) del cerdo Ibérico. Se utilizaron un total de 96 cerdos Ibéricos machos y castrados, que fueron divididos en 12 lotes (n=8) siguiendo un diseño factorial 4×3, con dos líneas genéticas (Retinto, RR, y Torbiscal, TT) y sus cruces recíprocos (R×T y T×R). Los cerdos fueron cebados en intensivo con tres tipos de piensos enriquecidos con tres niveles de ácido oleico (bajo, L, medio, M y alto, H). Se observó un efecto significativo (P

Efecto de la línea genética y de dietas enriquecidas en ácido oleico sobre los parámetros productivos del cerdo Ibérico

La genética y la alimentación son dos de los principales factores que afectan a la producción del cerdo Ibérico, así como a la calidad de su carne y de sus productos cárnicos. El objetivo de este estudio fue evaluar el efecto de la línea genética y de la alimentación durante el cebo, así como su interacción, sobre los parámetros productivos del cerdo Ibérico. Para ello, se utilizaron un total de 96 cerdos Ibéricos machos y castrados, que fueron divididos en 12 lotes (n=8) siguiendo un diseño factorial 4×3 con dos líneas genéticas (Retinto, RR, y Torbiscal, TT) y sus cruces recíprocos (R×T and T×R). Los cerdos fueron cebados en intensivo con tres tipos de piensos enriquecidos con tres niveles de ácido oleico (bajo, L, medio, M y alto, H). Los resultados mostraron un menor (p

Photosynthetic bacteria-based membrane bioreactor as post-treatment of an anaerobic membrane bioreactor effluent

Anaerobic membrane bioreactors have attracted increasing interest in the field of wastewater treatment. However, significant amounts of organic matter, nitrogen and sulphide in the effluent may limit its reuse. A photosynthetic bacteria-based membrane bioreactor is proposed for the further treatment of this effluent. A pilot-scale unit was run outdoor for over 900h to assess the process performance at short hydraulic retention time. After an initial biomass development, simultaneous removal of soluble organic matter and nitrogen was achieved (65% and 39%, respectively). In addition, a significant concentration of sulphate was detected in the permeate, revealing an evident sulphide oxidation. Despite the accumulation of biopolymer clusters in the biological suspension, membrane fouling was effectively mitigated by air-aided backwashing, allowing a sustainable operation. Several strains of bacteria were identified including the photoheterotrophic bacteria Rhodopseudomonas sp. and the nitrifying and denitrifying bacteria Chryseobacterium sp.

BLOC-1 deficiency causes alterations in amino acid profile and in phospholipid and adenosine metabolism in the postnatal mouse hippocampus

Biogenesis of lysosome-related organelles complex-1 (BLOC-1) is a protein complex involved in the formation of endosomal tubular structures that mediates the sorting of protein cargoes to specialised compartments. In this study, we present insights into the metabolic consequences caused by BLOC-1 deficiency in pallid mice, which carry a null mutation in the Bloc1s6 gene encoding an essential component of this complex. The metabolome of the hippocampus of pallid mice was analysed using an untargeted, liquid chromatography-coupled mass spectrometric approach. After data pre-treatment, statistical analysis and pathway enrichment, we have identified 28 metabolites that showed statistically significant changes between pallid and wild-type control. These metabolites included amino acids, nucleobase-containing compounds and lysophospholipids. Interestingly, pallid mice displayed increased hippocampal levels of the neurotransmitters glutamate and N-acetyl-aspartyl-glutamic acid (NAAG) and their precursor glutamine. Expression of the sodium-coupled neutral amino acid transporter 1 (SNAT1), which transports glutamine into neurons, was also upregulated. Conversely, levels of the neurotransmitter precursors phenylalanine and tryptophan were decreased. Interestingly, many of these changes could be mapped to overlapping metabolic pathways. The observed metabolic alterations are likely to affect neurotransmission and neuronal homeostasis and in turn could mediate the memory and behavioural impairments observed in BLOC-1-deficient mice.