MPOX (monkeypox) is a zoonotic viral disease, endemic in some Central and West African countries. However, in May 2022, cases began to be reported in non-endemic countries, demonstrating community transmission. Since the beginning of the outbreak, different epidemiological and clinical behaviors have been observed. We conducted an observational study at a secondary hospital in Madrid to characterize suspected and confirmed cases of MPOX epidemiologically and clinically. Besides the general descriptive analysis, we compared data between HIV-positive and HIV-negative subjects; 133 patients were evaluated with suspected MPOX, of which 100 were confirmed. Regarding positive cases, 71.0% were HIV positive, and 99.0% were men with a mean age of 33. In the previous year, 97.6% reported having sex with men, 53.6% used apps for sexual encounters, 22.9% practiced chemsex, and 16.7% went to saunas. Inguinal adenopathies were significantly higher in MPOX cases (54.0% vs. 12.1%, p < 0.001), as the involvement of genital and perianal area (57.0% vs. 27.3% and 17.0% vs. 1.0%, p = 0.006 and p = 0.082 respectively). Pustules were the most common skin lesion (45.0%). In HIV-positive cases, only 6.9% had a detectable viral load, and the mean CD4 count was 607.0/mm³. No significant differences were observed in the disease course, except for a greater tendency towards the appearance of perianal lesions. In conclusion, the MPOX 2022 outbreak in our area has been related to sexual intercourse among MSM, with no severe clinical cases nor apparent differences in HIV and non-HIV patients.

BACKGROUND: Hepatitis C virus (HCV) microelimination among at-risk migrants supports global elimination goals. AIM: To evaluate risk factors, prevalence and trends of active HCV infection among at-risk migrants screened for HCV in Madrid from 2019–23. METHODS: At-risk migrants (born outside Spain, living in country < 10 years regardless of legal status), were screened for HCV via mobile units with rapid antibody testing, and confirmed by RNA testing. Recruitment of this convenience sample focused on migrant centres, shelters, harm reduction centres and social service sites. Primary outcome was active HCV prevalence. Risk factors analysed included origin, alcohol use, no stable income, drug use and sexual behaviour. Data were analysed using general linear models with negative binomial distribution and p values adjusted for multiple comparisons (q values). RESULTS: Among 2,288 migrants, 6.5% (149/2,288) had anti-HCV antibodies, 47.0% (70/149) of whom tested positive for HCV-RNA; 81.4% (57/70) began antiviral therapy. Overall prevalence of active HCV infection was 3.1% (70/2,288). Injection drug use (non-active vs never used (aIRR: 7.3; 95% CI: 2.7–12.7) and active (aIRR: 14.7; 95% CI: 6.7–32.1)), European origin (vs non-European; aIRR: 5.8; 95% CI: 2.7–12.7) and alcohol misuse (vs no misuse; aIRR: 1.8; 95% CI: 1.1–2.9) were main risk factors. Prevalence showed no significant change during 2019–23 in the overall population and across risk groups. CONCLUSION: At-risk migrants screened in Madrid had a high prevalence of active HCV infection. This is higher than reported estimates for the general Spanish population and supports the need to enhance targeted HCV prevention, screening and treatment strategies among migrant populations.

Marginalized urban populations experience a high burden of HIV and HCV. We assessed the prevalence and risk factors for both infections and characterized the care cascades in a cohort of vulnerable individuals in Madrid, Spain. We conducted a cross-sectional study (2019-2023) of 4582 individuals via mobile units in high-risk hotspots, offering integrated rapid HIV/HCV testing with point-of-care HCV-RNA confirmation. Multivariable logistic regression identified independent HIV risk factors. HIV prevalence was 6.3% (95% CI: 5.6-7.0). Among people with HIV (PWH), 17.0% of known cases were not receiving antiretroviral therapy; PrEP uptake was zero among HIV-negative individuals. A history of injecting drug use was the primary HIV risk factor (adjusted odds ratio[aOR] 6.6; 95% CI: 4.6-9.5), followed by age >50 years, Spanish origin, and alcohol/benzodiazepine misuse (all P < 0.05). Active HCV prevalence was 5.5% (95% CI: 4.9-6.2); 15.7% in PWH vs 4.8% in people without HIV (P < 0.001). Among confirmed cases, HCV linkage (≥95.2%) and treatment (≥88.6%) were high; however, 16.8% of all antibody-positive individuals (23.2% among PWH) missed confirmatory RNA testing. HIV and HCV remain prevalent, characterized by discontinuities in retention rather than diagnosis. Integrated, low-threshold strategies combining harm reduction with social support are required to address this syndemic.

Background/Objectives: People with HIV (PWH) often have a suboptimal response to vaccines, raising concerns regarding the efficacy of coronavirus disease 2019 (COVID-19) vaccines in this population. We aimed to evaluate the humoral immune response to the B.1 lineage and Omicron variant in PWH on antiretroviral therapy (ART) following COVID-19 vaccination. Methods: We conducted a prospective study of 19 PWH on ART who received a two-dose series of the COVID-19 mRNA vaccine and a booster six months later. Participants without HIV infection (n = 25) were included as a healthy control (HC) group. The humoral response to the COVID-19 vaccine (anti-SARS-CoV-2 S IgG levels and ability to block ACE2-S interaction) against both the original B.1 lineage and the Omicron variant was assessed using immunoassays. Results: The humoral response in PWH was very strong (geometric mean fold rise, GMFR > 8) after the second dose and strong (GMFR > 4) after the booster dose for both the B.1 lineage and the Omicron variant. We found comparable humoral responses to the B.1 lineage and Omicron variant between PWH and HC groups after the second and booster doses (q-value > 0.05). The COVID-19 vaccine generated a significantly weaker humoral response against the Omicron variant compared to the B.1 lineage in both groups (q-value < 0.05). However, this response improved after the booster dose, although it remained weaker in PWH. Conclusions: PWH showed a strong humoral response to the COVID-19 vaccine against B.1 and Omicron, though the Omicron response was weaker than B.1. Booster doses in PWH improved the Omicron response, but it stayed lower than B.1. Findings confirm vaccine effectiveness in PWH, stressing the critical role of boosters and potential need for updated vaccines for variants like Omicron.

The recent increase in Latin American asylum seekers in Spain has been accompanied by a rise in HIV diagnoses. However, their clinical profile, particularly regarding antiretroviral resistance, is poorly characterized. We aimed to assess the prevalence of resistance-associated mutations and their impact on treatment management in this vulnerable population. We conducted a prospective cohort study (2022-2023) with six-month follow-up, enrolling Latin American asylum seekers living with HIV, attending their first HIV consultation in Spain. Individuals with a viral load > 1,000 copies/mL, regardless of prior ART exposure, underwent genotypic resistance testing. Mutations were identified using the WHO Surveillance Drug Resistance Mutations (SDRM) list, and resistance was interpreted via the Stanford HIV Drug Resistance Database algorithm. Of 653 participants, 153 met inclusion criteria, and 141 (21.6%) had valid resistance results. Overall, 22.7% harbored SDRMs to NNRTIs, NRTIs, or PIs (15.0% ART-naïve vs. 32.8% ART-experienced). NNRTI mutations were most frequent (21.3%), particularly in ART-experienced individuals (31.1%). NRTI mutations were present in 7.1% overall (13.1% ART-experienced). The most common mutations were K103N/S (19.1%), P225H (5.0%), and M184V (4.3%). Among ART-experienced individuals, resistance to efavirenz, nevirapine, and rilpivirine was 31.1%, 32.7%, and 19.7%, respectively; 11.4% showed lamivudine resistance. Notably, 82.3% of ART-experienced participants reported barriers to healthcare access, with a 90% rate of treatment discontinuation. In this cohort of Latin American asylum seekers, resistance to NNRTIs was alarmingly high, especially among those with prior ART exposure and interrupted treatment. These findings underscore the need for optimized treatment strategies and improved healthcare access for migrant populations with HIV.

Sex workers on HIV pre-exposure prophylaxis (PrEP) experience high bacterial sexually transmitted infection (STI) rates. We assessed associations between gender identity and first/recurrent STI incidence to inform risk-stratified screening. This prospective cohort study (Madrid, 2022-2026) evaluated sex workers initiating PrEP. Participants underwent quarterly screening for Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum. We used Cox and Prentice-Williams-Peterson models to evaluate first and recurrent STIs, adjusting for confounders. We included 147 sex workers (71 transgender women, 48 cisgender men, 28 cisgender women) with ≥3 months follow-up and ≥1 STI screening. First STI incidence was 5.14/100 person-months (cisgender men: 6.90; cisgender women: 2.13). Recurrent STI incidence was 3.26/100 person-months. Most incident STIs (93.1%) were asymptomatic. In multivariable analyses (reference: cisgender women), cisgender men had higher hazards for first (adjusted hazard ratio [aHR], 3.20; 95% CI, 1.47-6.99) and recurrent STIs (aHR, 4.04; 95% CI, 1.83-8.95). Transgender women also had higher hazards for first (aHR, 2.08; 95% CI, 1.02-4.22) and recurrent STIs (aHR, 2.25; 95% CI, 1.10-4.61). STI incidence during PrEP differs by gender identity, being highest in cisgender men and lowest in cisgender women. These findings support evaluating risk-stratified screening approaches over uniform quarterly guidelines.