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Palacios R, Gómez-Ayerbe C, Casado JL, Tejerina F, Montes ML, Castaño M, Ocampo A, Rial D, Ribera E, Galindo MJ, Hidalgo C, Fariñas C, Montero M, Payeras T, Fanjul F, de la Torre J, Santos J. Efficacy and safety of dolutegravir/rilpivirine in real-world clinical practice. GeSIDA study 1119. HIV Med 2023; 24:933-937. [PMID: 37016556 DOI: 10.1111/hiv.13489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/14/2023] [Indexed: 04/06/2023]
Abstract
INTRODUCTION Dolutegravir/rilpivirine (DTG/RPV) is an effective antiretroviral (ART) regimen endorsed by clinical trials as a switch therapy. The aim of our study was to analyse the efficacy and safety of DTG/RPV in real-world clinical practice. METHODS Observational, multicentre study of patients who started DTG/RPV. Efficacy, adverse events and metabolic changes at 48 weeks were analysed. RESULTS A total of 348 patients were included; median time of HIV infection was 21.1 years, 33.7% were AIDS cases; median nadir CD4 was 160 cells/μL; 90.5% had received ≥3 lines of ART and 179 (53.8%) had prior virological failure. Convenience (43.5%), toxicity/intolerance (28.4%) and interactions (17.0%) were the main reasons for starting DTG/RPV. Previous regimens were protease inhibitors (PI) (31.6%), non-nucleoside reverse transcriptase inhibitors (NNRTI) (20.4%) and integrase strand transfer inhibitors (INSTI) (14.9%). Efficacy (HIV-RNA <50 copies/mL) at 48 weeks was 89.7% (95% CI 86.1-92.6) by intention-to-treat (ITT) and 94.2% (95% CI 91.3-96.4) by on treatment (OT); 10 patients (3.1%) were not suppressed (3 had abandoned ART). There was a mean decrease in triglycerides, total cholesterol, low-density lipoprotein-cholesterol, glutamic-pyruvic transaminase (GPT), gamma-glutamyl transferase (GGT) and alkaline phosphatase; creatinine increased with a decrease in glomerular filtration rate. CONCLUSIONS This study confirms the effectiveness, tolerability and safety of DTG/RPV in real-world clinical practice in a different population from clinical trials, with many years of infection, low CD4 nadir, several previous treatment lines, more than half with virological failures, and one-third diagnosed with AIDS. The switch to DTG/RPV was safe with few discontinuations due to adverse effects. Modifications of the lipid and liver profiles were favourable. There were no relevant changes in kidney function.
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Affiliation(s)
- R Palacios
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - C Gómez-Ayerbe
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - J L Casado
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - F Tejerina
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M L Montes
- Hospital Universitario La Paz, Madrid, Spain
| | - M Castaño
- Hospital Regional Universitario de Málaga, Málaga, Spain
| | - A Ocampo
- Hospital Alvaro Cunqueiro, Vigo, Spain
| | - D Rial
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E Ribera
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M J Galindo
- Hospital General de Valencia, Valencia, Spain
| | - C Hidalgo
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - C Fariñas
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - M Montero
- Hospital Universitario La Fe, Valencia, Spain
| | - T Payeras
- Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - F Fanjul
- Hospital Universitari Son Espaces, Palma de Mallorca, Spain
| | | | - J Santos
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
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Podzamczer D, Micán R, Tiraboschi J, Portilla J, Domingo P, Llibre JM, Ribera E, Vivancos MJ, Morano L, Masiá M, Gómez C, Fanjul F, Payeras A, Inciarte A, Estrada V, Rivero A, Castro Á, Bernal E, Vinuesa D, Knobel H, Troya J, Macías J, Montero M, Sanz J, Navarro-Alcaraz A, Caicedo A, Fernández G, Martínez E, Moreno S. Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Versus Dolutegravir/Abacavir/Lamivudine in Antiretroviral-Naive Adults (SYMTRI): A Multicenter Randomized Open-Label Study (PReEC/RIS-57). Open Forum Infect Dis 2021; 9:ofab595. [PMID: 35237700 PMCID: PMC8883591 DOI: 10.1093/ofid/ofab595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) is the reference for combination therapy based on protease inhibitors due to its efficacy, tolerability, and convenience. Head-to-head randomized comparisons between D/C/F/TAF and combination therapy based on integrase inhibitors in antiretroviral-naive patients are lacking. Methods Adult (>18 years old) human immunodeficiency virus-infected antiretroviral-naive patients (HLA-B∗5701 negative and hepatitis B virus negative), with viral load (VL) ≥500 c/mL, were centrally randomized to initiate D/C/F/TAF or dolutegravir/abacavir/lamivudine (DTG/3TC/ABC) after stratifying by VL and CD4 count. Clinical and analytical assessments were performed at weeks 0, 4, 12, 24, and 48. The primary endpoint was VL <50 c/mL at week 48 in the intention-to-treat (ITT)-exposed population (US Food and Drug Administration snapshot analysis, 10% noninferiority margin). Results Between September 2018 and 2019, 316 patients were randomized and 306 patients were included in the ITT-exposed analysis (151 D/C/F/TAF and 155 DTG/3TC/ABC). Almost all (94%) participants were male and their median age was 35 years. Forty percent had a baseline VL >100 000 copies/mL, and 13% had <200 CD4 cells/μL. Median weight was 73 kg and median body mass index was 24 kg/m2. At 48 weeks, 79% (D/C/F/TAF) versus 82% (DTG/3TC/ABC) had VL <50 c/mL (difference, −2.4%; 95% confidence interval [CI], −11.3 to 6.6). Eight percent versus four percent experienced virologic failure but no resistance-associated mutations emerged. Four percent versus six percent had drug discontinuation due to adverse events. In the per-protocol analysis, 94% versus 96% of patients had VL <50 c/mL (difference, −2%; 95% CI, −8.1 to 3.5). There were no differences in CD4 cell count or weight changes. Conclusions We could not demonstrate the noninferiority of D/C/F/TAF relative to DTG/ABC/3TC as initial antiretroviral therapy, although both regimens were similarly well tolerated.
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Affiliation(s)
- D Podzamczer
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - R Micán
- Hospital La Paz, Madrid, Spain
| | - J Tiraboschi
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - J Portilla
- Hospital General Universitario de Alicante, Alicante, Spain
| | - P Domingo
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J M Llibre
- Hospital Germans Trias i Pujol, Barcelona, Spain
| | - E Ribera
- Hospital Universitario de la Vall d’Hebrón, Barcelona, Spain
| | - M J Vivancos
- Hospital Universitario Ramón y Cajal, Madrid, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - L Morano
- Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - M Masiá
- Hospital General Universitario de Elche, Elche, Spain
| | - C Gómez
- Hospital Universitario Virgen de la Victoria-IBIMA, Málaga, Spain
| | - F Fanjul
- Hospital Universitario Son Espases, Palma, Spain
| | - A Payeras
- Hospital Universitario Son Llàtzer, Palma, Spain
| | | | - V Estrada
- Hospital Clínico San Carlos-IdiSSC, Madrid, Spain
| | - A Rivero
- Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Á Castro
- Complejo Hospitalario Universitario, A Coruña, Spain
| | - E Bernal
- Hospital Universitario Reina Sofía, Murcia, Spain
| | - D Vinuesa
- Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - H Knobel
- Hospital del Mar, Barcelona, Spain
| | - J Troya
- Hospital Universitario Infanta Leonor, Madrid, Spain
| | - J Macías
- Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - M Montero
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - J Sanz
- Hospital Universitario de La Princesa, Madrid, Spain
| | | | - A Caicedo
- RIS Red de Investigación en SIDA, Madrid, Spain
| | - G Fernández
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - S Moreno
- Hospital Universitario Ramón y Cajal, Madrid, Universidad de Alcalá, IRYCIS, Madrid, Spain
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Albasanz-Puig A, Suanzes P, Esperalba J, Fernández C, Sellarès-Nadal J, Torrella A, Planas B, Segura A, Burgos J, Ribera E, Cañas-Ruano E, García JN, Navarro J, Curran A, Len Ó, Falcó V. Low frequency of cytomegalovirus (CMV) disease despite high prevalence of CMV viraemia in patients with advanced HIV infection: a clinical and immunological 48-week follow-up study. HIV Med 2021; 22:682-689. [PMID: 33998115 DOI: 10.1111/hiv.13115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of the study was to investigate the dynamics of cytomegalovirus (CMV) replication and CMV-specific immune response recovery after antiretroviral treatment (ART) initiation in patients with advanced HIV infection. METHODS A prospective observational study of patients with HIV infection and CD4 counts of < 100 cells/µL was carried out (September 2015 to July 2018). HIV viral load (VL), CD4 count and CMV VL were determined by quantitative polymerase chain reaction (PCR) at baseline and at 4, 12, 24 and 48 weeks, and CMV-specific immune response was determined by QuantiFERON-CMV assay at baseline and 48 weeks. All patients were started on ART but only those with CMV end-organ disease (EOD) received anti-CMV treatment. RESULTS Fifty-three patients with a median age of 43.6 [interquartile range (IQR) 36.7-52.4] years were included in the study. At baseline, the median CD4 count was 30 cells/µL (IQR 20-60 cells/µL) and the median HIV VL was 462 000 HIV-1 RNA copies/mL (IQR 186 000-1 300 000 copies/mL). At baseline, 32% patients had detectable CMV viraemia but none had detectable CMV viraemia at 48 weeks. Only one of 53 (1.9%) patients developed EOD during follow-up. Seven (13.2%) patients were lost to follow-up and six (11.3%) died; none of the deaths was related to CMV. Similar percentages of patients had a CMV-specific immune response at baseline (71.7%) and at 48 weeks (70.0%). The magnitude of this response tended to increase over time [median 1.63 (IQR 0.15-5.77) IU/mL at baseline vs. median 2.5 (IQR 0.1-8.325) IU/mL at 48 weeks; P = 0.11]. We did not find any risk factors associated with 48-week mortality. CONCLUSIONS Although the prevalence of CMV viraemia in patients with advanced HIV infection remains high, achieving a good immunological recovery through ART is enough to suppress CMV viraemia, without an increased risk of CMV EOD. The prevalence of a CMV-specific immune response was high and endured over time.
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Affiliation(s)
- A Albasanz-Puig
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - P Suanzes
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - J Esperalba
- Microbiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - C Fernández
- Microbiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - J Sellarès-Nadal
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Torrella
- Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - B Planas
- Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Segura
- Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - J Burgos
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - E Ribera
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Cañas-Ruano
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - J N García
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - J Navarro
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Curran
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ó Len
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - V Falcó
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Infectious Diseases Research Group, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
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4
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Roca B, Teira R, Domingo P, Geijo P, Galindo MJ, Lozano F, Terron A, Garrido M, Suarez-Lozano I, Vidal F, Muñoz-Sanchez P, Viciana P, Ribera E, Castaño M, Martinez E, Puig T, Estrada V, Deig E, de la Fuente B, Montero M, Muñoz-Sanz A, Sanchez T, Romero-Palacios A, Lacalle JR. Factors Associated with Nonsuppression of HIV Infection in the Spanish VACH Cohort. AIDS Res Hum Retroviruses 2020; 36:927-932. [PMID: 32772710 DOI: 10.1089/aid.2020.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We aim to determine the prevalence of HIV nonsuppression and factors associated with it. This is a cross-sectional multicenter study carried out in January 2016 with data of the VACH Cohort, a registry participated by 23 hospitals from most regions of Spain. The prevalence of HIV nonsuppression, defined as HIV RNA ≥200 copies/mL, is documented. The possible association of HIV nonsuppression with sociodemographic and clinical variables is assessed with a logistic regression analysis. A total of 30,843 adult patients are included; 7,358 of them (23.86%) have nonsuppressed HIV. An association is found between nonsuppression of HIV and the following variables: lower body mass index, lower age of patients in their last registered visit, lower number of visits carried out during follow-up, lower last available CD4 cell count, higher age of patients at the time of their HIV infection diagnosis, higher lowest available CD4 cell count, higher highest available HIV RNA, enrolment in the Cohort in first years of the HIV epidemic, region of Spain where the patient is attended other than Andalusia, HIV risk factor other than sexual, occurrence of death during follow-up, hepatitis C coinfection, being a smoker, pertaining to groups A1 or A2 of the CDC groups classification, and not taking antiretroviral treatment, p < .001 in all cases. HIV nonsuppression is still common with the effective antiretroviral treatment nowadays available. HIV nonsuppression is associated with HIV risk factor other than sexual, hepatitis C coinfection, and being a smoker, among other factors.
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Affiliation(s)
- Bernardino Roca
- Department of Medicine, Hospital General of Castellon, University of Valencia, Castellon, Spain
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Pérez Elías MJ, Alejos B, Vivancos MJ, Ribera E, Galindo MJ, Vilanova-Trillo L, García-Fraile Fraile LJ, de La Fuente Moral S, Garcia De Lomas J, Lozano F, Mateo García MG, Tasias Pitarch M, Diez Martinez M, Rojas J, Raya-Cruz M, Sepúlveda MA, Troya J, Del Campo S, Martinez E. Outcomes by sex following treatment initiation with darunavir/cobicistat in a large Spanish cohort of the CODAR study (GeSIDA 9316). J Antimicrob Chemother 2020; 74:3044-3048. [PMID: 31236601 DOI: 10.1093/jac/dkz254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/07/2019] [Accepted: 05/22/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Few women have been included in darunavir/cobicistat clinical development studies, and hardly any of them were antiretroviral experienced or treated with anything other than triple-based therapies. OBJECTIVES Our aim was to increase our knowledge about women living with HIV undergoing darunavir/cobicistat-based regimens. METHODS A multicentre (21 hospitals), retrospective study including a centrally selected random sample of HIV-1 patients starting a darunavir/cobicistat-based regimen from June 2014 to March 2017 was planned. Baseline characteristics, 24 and 48 week viral load response (<50 copies/mL), CD4+ lymphocyte count increase, time to change darunavir/cobicistat and adverse event occurrence were all compared by sex. The study was approved by each of the 21 ethics committees, and patients signed informed consent. RESULTS Out of 761 participants, 193 were women. Similar characteristics were found for both sexes, except that the women had a longer duration of HIV infection (P = 0.001), and were less frequently pre-treated with darunavir/cobicistat in their previous regimen (P = 0.02). The main reason for using a darunavir/cobicistat-based regimen was simplification, without differences by sex, while monotherapy seems to be more frequently prescribed in women than in men (P = 0.067). The main outcomes, HIV viral load response, CD4+ lymphocyte count increase at 24 or 48 weeks, occurrence of adverse events, main reasons for changing and time to the modify darunavir/cobicistat regimen, did not show differences between the sexes. CONCLUSIONS No sex disparities were found in the main study outcomes. These results support the use of a darunavir/cobicistat-based regimen in long-term pre-treated women. Clinical Trial.gov No. NCT03042390.
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Affiliation(s)
- M J Pérez Elías
- Hospital Ramón y Cajal, IRYCIS, Infectious Diseases, Madrid, Spain
| | - B Alejos
- Instituto de Salud Carlos III, Madrid, Spain
| | - M J Vivancos
- Hospital Ramón y Cajal, IRYCIS, Infectious Diseases, Madrid, Spain
| | - E Ribera
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M J Galindo
- Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | | | | | | | - F Lozano
- Hospital Virgen de Valme, Sevilla, Spain
| | | | | | | | - J Rojas
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | - J Troya
- Hospital Infanta Leonor, Madrid, Spain
| | - S Del Campo
- Hospital Ramón y Cajal, IRYCIS, Infectious Diseases, Madrid, Spain
| | - E Martinez
- Hospital Clinic de Barcelona, Barcelona, Spain
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Sadurní LM, Grifell M, Galindo L, Ezquiaga I, Quintana P, Ventura M, Fornís I, Palma Á, Angelats M, Ribera E, Torrens M, Farré M. Methylone consumption characterized through samples handled by users. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2016.01.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionIn recent years, the increasing use tendency of NPS has motivated both awareness and concern about their identification and potential harmfulness. Synthetic cathinones represent a significant proportion of the NPS available and methylone is one of the most frequently found in Europe.ObjectivesThe aim of the present study is to determine methylone presence and characteristics from the samples analyzed by Energy Control between the years 2009 and 2015 in Spain.MethodsFrom all 21,198 samples analyzed from august 2009 to august 2015, only those in which methylone was found are studied (n = 140). The samples have been analyzed by Energy Control, a spanish harm-reduction NGO that offers to users the possibility of analyzing the substances they intend to consume. The analysis is done by gas chromatography–mass spectrometry.ResultsFrom the 140 samples containing methylone, 87 were handled as methylone, 20 as MDMA, 8 as other synthetic cathinones and 25 as other substances. The peak of consume was registered in 2011 with 41 samples then the number decreased until 10 samples in 2015.ConclusionsResults suggest that methylone is most frequently handled as methylone or as MDMA and that its consumption could be decreasing. Further pharmacokinetic, pharmacodynamic, clinical and epidemiological studies should be conducted to enhance the knowledge not only about methylone consumption, but also about synthetic cathinones in general in order to assess their potential risk and study the complications and its management.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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7
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Ezquiaga I, Grifell M, Galindo L, Martínez L, Palma Á, Quintana P, Ventura M, Ribera E, Pujol L, Fornís I, Torrens M, Farré M. 25I-NBOMe: The legal LSD. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2016.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionNovel psychoactive substances (NPS) use is progressively increasing year on year. A new group of phenethylamines sold as legal stimulants and hallucinogens is being reported increasingly since 2012. Within this group, 25I-NBOMe is an outstanding substance with powerful effects and high affinity with the serotonin 2a (5HT2a) receptor. Several toxicity cases have been reported so far.ObjectivesTo describe the presence of 25I-NBOMe and its characteristics in samples delivered to Energy Control from 2009 to 2015 in Spain.MethodsAmong the samples, 21,198 analyzed from august 2009 to august 2015 and only those samples containing 25I-NBOMe were studied (n = 56). Samples were analyzed by Energy Control, a Spanish harm-reduction NGO that offers users the possibility of analyzing the substances they intend to consume. Analysis was done by Gas Chromatography–Mass Spectrometry.ResultsFrom 56 samples were 25I-NBOMe was found, 24 were bought as LSD (42.8%), 12 as 25I-NBOMe (21.4%), 4 as 25C-NBOMe (7.1%), 4 as 25I-NBOH (7.1%) and 12 as other substances (21.4%), gummy bears included. All samples were received from 2012 on, having the highest peak on 2013 (19 samples).Conclusions25I-NBOMe consumption represents an emerging issue with potential harmful effects, especially when the substance used is not the expected. Further pharmacokinetic, pharmacodynamic, clinical and epidemiological researches should be conducted to deepen knowledge about 25I-NBOMe and the management of its possible toxic effects. Physicians should be aware of NPS, their increasing use and the clinical differences between them.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Perez-Molina JA, Pulido F, Di Giambenedetto S, Ribera E, Moreno S, Zamora J, Coscia C, Alejos B, Pitch J, Gatell JM, De Luca A, Arribas JR. Individual patient data meta-analysis of randomized controlled trials of dual therapy with a boosted PI plus lamivudine for maintenance of virological suppression: GeSIDA study 9717. J Antimicrob Chemother 2019; 73:2927-2935. [PMID: 30085184 DOI: 10.1093/jac/dky299] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/26/2018] [Indexed: 12/24/2022] Open
Abstract
Background Dual therapy (DT) with a ritonavir-boosted PI (PI/r) plus lamivudine has proven non-inferior (12% margin) to triple therapy (TT) with PI/r plus two nucleos(t)ide reverse transcriptase inhibitors [N(t)RTIs] in four clinical trials. It remains unclear whether DT is non-inferior based on the US FDA endpoint (virological failure with a margin of 4%) or in specific subgroups. Methods We performed a systematic search (January 1990 to March 2017) of randomized controlled trials that compared switching of maintenance ART from TT to DT. The principal investigators were contacted and agreed to share study databases. The primary endpoint was non-inferiority of DT to TT based on the current FDA endpoint (4% non-inferiority margin for virological failure at week 48). We also analysed whether efficacy was modified by gender, active HCV infection and type of PI. Effect estimates and 95% CIs were calculated using generalized estimating equation-based models. Results We found 881 references that yielded eight articles corresponding to four clinical trials (1051 patients). At week 48, 4% of patients on DT versus 3.04% on TT had experienced virological failure (difference 0.9%; 95% CI -1.2% to 3.1%), and 84.7% of patients on DT versus 83.2% on TT had <50 copies of HIV RNA/mL (FDA snapshot algorithm) (difference 1.4%; 95% CI -2.8% to 5.8%). Gender, active HCV infection and type of PI had no effect on differences in treatment efficacy between DT and TT. Conclusions DT was non-inferior to TT using both current and past FDA endpoints. The efficacy of DT was not influenced by gender, active HCV infection status, or type of PI.
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Affiliation(s)
- J A Perez-Molina
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - F Pulido
- HIV Unit, Hospital Universitario Doce de Octubre, imas12, UCM, Madrid, Spain
| | - S Di Giambenedetto
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - E Ribera
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - S Moreno
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - J Zamora
- Clinical Biostatistics Unit and CIBERESP, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.,Queen Mary University, London, UK
| | - C Coscia
- Clinical Biostatistics Unit and CIBERESP, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - B Alejos
- Centro Nacional de Epidemiología, Instituto Carlos III, Madrid, Spain
| | - J Pitch
- Hospital Clínic/Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - J M Gatell
- Hospital Clínic/Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - A De Luca
- UOC Malattie Infettive, Azienda Ospedaliera Universitaria Senese, and Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - J R Arribas
- Hospital Universitario La Paz, IDIPAZ, Madrid, Spain
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Pérez Elías MJ, Alejos B, Vivancos MJ, Ribera E, Galindo MJ, Vilanova-Trillo L, García-Fraile Fraile LJ, de La Fuente Moral S, Garcia De Lomas J, Lozano F, Mateo García MG, Tasias Pitarch M, Diez Martinez M, Rojas J, Raya-Cruz M, Sepúlveda MA, Troya J, Del Campo S, Martinez E. Outcomes by sex following treatment initiation with darunavir/cobicistat in a large Spanish cohort of the CODAR study (GeSIDA 9316). J Antimicrob Chemother 2019; 74:3124. [DOI: 10.1093/jac/dkz331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Grifell M, Galindo L, Ventura M, Ribera E, Quintana P, Palma A, Carbón X, Gonzalez L, San-Emeterio L, Diez-Aja C, Caudevilla F, Torrens M. The cat and the mouse game: Is there a shift towards more dangerous substances in the cathinone illicit market? Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.1726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionAfter mephedrone's ban in March 2010 new cathinones proliferated widely, even a new branch of atypical derivatives was launched into the market, represented by MDPV. The cardiovascular and central nervous system toxicity draws attention to this new family of cathinones, also known as pyrovalerones. MDPV was scheduled in 2011, leading to the apparition of Alpha-PVP from which there is little information.ObjectivesThe aim of the present study is to describe the evolution of different cathinones in the samples delivered for analysis to the harm reduction NGO energy control from March 2009 to March 2016 in Spain.MethodsEnergy control is a Spanish harm reduction NGO that offers to drug users the possibility of analyzing the substances they intend to consume. From March 2009 to March 2016 a total of 24,528 samples were analyzed by the NGO from which 760 contained cathinones. Substance analysis was done by gas chromatography–mass spectrometry.ResultsFrom 2009 to 2016, cathinones represented a 2.82% from all analyzed samples. From March 2009 to March 2010, only 5 different cathinones were detected, in this same period methylone (n = 16; 37.20%) and mephedrone (n = 17; 39.53%) represented 76% of analyzed cathinones (n = 43). From March 2015 to March 2016, 132 cathinones were detected: methylone and mephedrone represented only 19.69%, giving prominence to clephedrone (n = 25; 18.93%) and Alpha-PVP (n = 24; 18.18%).ConclusionsThe evolution of synthetic cathinones detected by energy control is consistent with the evolution described in the literature. From 2009 to 2016, the cathinones detected diversify and new substances with higher toxicity potential appear.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Ribera E, Martínez L, Pujol L, Angelats M, Ezquiaga I, Grifell M, Palma Á, Belmonte E, Pérez L, Pérez-Solá V, Salgado P. Is there a relationship between morbid obesity and depression? Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionA considerable proportion of patients with morbid obesity require treatment with antidepressants.ObjectivesThe aim of this study is to determine the incidence of patients who are in antidepressant treatment and identify risk factors for the need of this treatment in patients with morbid obesity.Materials and methodsRetrospective cohort study of 292 patients with morbid obesity who underwent bariatric surgery at Hospital del Mar from January 2010 to November 2015. The incidence of antidepressant treatment was analyzed, and also its possible relationship with the following variables: age, sex, BMI, tobacco smoking, alcohol consumption and age of onset of obesity. Chi2 test for categorical variables and Student t-test for quantitative variables were applied. Afterwards, a multivariate analysis was performed using logistic regression.ResultsThe mean age is 43.1 years. Most of the patients (76.4%) are women. Seventy-seven patients (26.4%) are receiving treatment with antidepressants. There is a statistically significant relationship between age and the need of treatment with antidepressants (P < 0.001). This relationship is still present when the variables are analyzed using logistic regression (P < 0.005, OR 1.049). We have not found any significant relationship with the rest of the variables.ConclusionsDespite the large number of patients in the study, there are limitations, such as being a retrospective study and not being adjusted for confounding factors. From all the variables that have been analyzed we have found that as the age of the patients increase, there is a higher number of patients that receive treatment with antidepressants.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Teira R, Vidal F, Muñoz-Sánchez P, Geijo P, Viciana P, Ribera E, Domingo P, Castaño M, Martínez E, Roca B, Puig T, Estrada V, Deig E, Galindo MJ, de la Fuente B, Lozano F, Montero M, Muñoz-Sanz A, Sanchez T, Terrón A, Romero-Palacios A, Lacalle JR, Garrido M, Suárez-Lozano I. Very low level viraemia and risk of virological failure in treated HIV-1-infected patients. HIV Med 2016; 18:196-203. [PMID: 27476742 DOI: 10.1111/hiv.12413] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of the study was to investigate whether very low level viraemia (VLLV) (20-50 HIV-1 RNA copies/mL) was associated with increased risk of virological failure (VF) as compared with persistent full suppression (< 20 copies/mL). METHODS From the VACH Cohort database, we selected those patients who started antiretroviral therapy (ART) after January 1997 and who achieved effective viral suppression [two consecutive viral loads (VLs) < 50 copies/mL] followed by full suppression (at least one VL <20 copies/mL). We carried out survival analyses to investigate whether the occurrence of VLLV rather than maintaining full suppression at < 20 copies/mL was associated with virological failure (two consecutive VLs > 200 copies/mL or one VL > 200 copies/mL followed by a change of ART regimen, administrative censoring or loss to follow-up), adjusted for nadir CD4 cell count, sex, age, ethnicity, transmission group, type of ART and time on effective suppression at < 50 copies/mL. RESULTS Of 21 480 patients who started ART, 13 674 (63.7%) achieved effective suppression at < 50 copies/mL, of whom 4289 (31.4%) further achieved full suppression at < 20 copies/mL after May 2009. A total of 2623 patients (61.1%) remained fully suppressed thereafter, while 1666 had one or more episodes of VL detection > 20 copies/mL (excluding virological failure). A total of 824 patients had VLLV after suppression at < 20 copies/mL. VLLV was not associated with virological failure as compared with persistent full suppression [hazard ratio (HR) 0.67; 95% confidence interval (CI) 0.44-1.00], independently of the number of blips recorded (from one to 18). CONCLUSIONS In our population of HIV-infected patients on ART who achieved viral suppression at < 20 copies/mL, the risk of virological failure was no different for patients who remained fully suppressed compared with those who experienced subsequent episodes of VLLV.
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Affiliation(s)
- R Teira
- Sierrallana Hospital, Torrelavega, Spain
| | - F Vidal
- Tarragona University Hospital Joan XXIII, Tarragona, Spain
| | | | - P Geijo
- Virgen de la Luz Hospital, Cuenca, Spain
| | - P Viciana
- Virgen del Rocío Hospital, Sevilla, Spain
| | - E Ribera
- Vall d'Hebrón Hospital, Barcelona, Spain
| | - P Domingo
- Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | | | | | - B Roca
- General Hospital, Castellón, Spain
| | - T Puig
- Arnau de Vilanova Hospital, Lleida, Spain
| | - V Estrada
- San Carlos Clinical Hospital, Madrid, Spain
| | - E Deig
- General Hospital, Granollers, Spain
| | | | | | | | | | | | - T Sanchez
- Virgen de Rosell Hospital, Cartagena, Spain
| | - A Terrón
- SAS Hospital, Jérez de la Frontera, Spain
| | | | | | - M Garrido
- VACH Medical Association, Cartaya, Spain
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Crespo M, Navarro J, Martinez-Rebollar M, Podzamczer D, Domingo P, Mallolas J, Saumoy M, Mateo GM, Curran A, Gatell J, Ribera E. Improvement of BMD after Switching from Lopinavir/R Plus Two Nucleos(T)ide Reverse Transcriptase Inhibitors to Lopinavir/R Plus Lamivudine: OLE-LIP Substudy. HIV Clin Trials 2016; 17:89-95. [PMID: 27125363 DOI: 10.1080/15284336.2016.1149929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare 48-week changes in bone mineral density (BMD) and body fat distribution between patients continuing lopinavir/ritonavir and two NRTIs and those switching to lopinavir/ritonavir and lamivudine. METHODS Substudy of a randomized, open-label, multicenter OLE study was carried out. Adult HIV-infected patients with <50 copies/mL for ≥6 months were randomized (1:1) to continue lopinavir/ritonavir and two NRTIs or switching to lopinavir/ritonavir and lamivudine. Dual-energy X-ray absorptiometry (DXA) was performed at baseline and after 48 weeks to measure bone composition and body fat distribution in both the groups. RESULTS Forty-one patients (dual-therapy, n = 23; triple-therapy, n = 18) of 239, who received at least one dose of study medication, completed the study: median age, 42 years, 71% male, 73% Caucasian. At week 48, total BMD increased by 1.04% (95% CI, 0.06 to 2.01%) among patients switching to dual-therapy, whereas no significant changes occurred in patients maintaining triple-therapy. Dual-therapy and older age were independently associated with total BMD increase. Among patients discontinuing tenofovir-DF, a significant increase was seen in total BMD (1.43; 95% CI, -0.04 to 2.91) and total hip (1.33%; 95% CI, 0.44 to 2.22%). A non-statistically significant decrease in femoral and spinal BMD was observed in patients who discontinued abacavir and in those continuing triple-therapy. Regarding fat distribution, no significant changes were seen in both the treatment groups. DISCUSSION BMD increased following switching to lopinavir/ritonavir plus lamivudine in HIV-infected patients on suppressive triple-therapy with lopinavir/ritonavir and two NRTIs including tenofovir-DF.
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Affiliation(s)
- M Crespo
- a Hospital Universitari Vall d'Hebrón , Autonomous University of Barcelona , Barcelona , Spain.,b Vall d'Hebron Research Institute , Barcelona , Spain
| | - J Navarro
- a Hospital Universitari Vall d'Hebrón , Autonomous University of Barcelona , Barcelona , Spain.,b Vall d'Hebron Research Institute , Barcelona , Spain
| | | | - D Podzamczer
- d Hospital Universitario de Bellvitge , Barcelona , Spain
| | - P Domingo
- e Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - J Mallolas
- c Hospital Clínic/IDIBAPS , University of Barcelona , Barcelona , Spain
| | - M Saumoy
- d Hospital Universitario de Bellvitge , Barcelona , Spain
| | - G M Mateo
- e Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - A Curran
- a Hospital Universitari Vall d'Hebrón , Autonomous University of Barcelona , Barcelona , Spain
| | - J Gatell
- c Hospital Clínic/IDIBAPS , University of Barcelona , Barcelona , Spain
| | - E Ribera
- a Hospital Universitari Vall d'Hebrón , Autonomous University of Barcelona , Barcelona , Spain
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Ribera E, Grifell M, Campillo M, Ezquiaga I, Martínez L, González L, Palomo A, Pérez V, Galindo L. Evolution of bipolar disorder over 12 years in a psychiatric hospital. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IntroductionBipolar disorder is a leading cause of hospitalization in psychiatric hospitals. It is known that early detection of bipolar disorder is associated with a better prognosis.ObjectivesThe aim of this study is to conduct a demographic analysis of patients hospitalized for bipolar disorder in a single center between 2003 to 2014.MethodsRetrospective cohort study of 1230 patients admitted with bipolar disorder diagnosis from 2003 to 2014 at Centre Assistencial Emili Mira i López of Parc Salut Mar of Barcelona. We divided the study in two periods: 2003–2008 and 2009–2014. We analyzed the following variables: frequency of admissions, age, sex and days of hospital stay, comparing both periods. Chi-square test for categorical variables and Student t test for quantitative variables were applied.ResultsThe mean ages at the first and second period are 52 and 47, respectively (P < 0.001). There are no significant differences in sex and days of hospitalization. The frequency of admissions on the first and third trimesters is higher than in the second and fourth, although the differences are not statistically significant.ConclusionsDespite the large number of patients in the study, there are limitations, such as being a retrospective study and not being adjusted for confounding factors. The average age of patients in the second period is lower than in the first. This could suggest an improvement in early detection of bipolar disorder in the last years. Further research is needed to confirm this hypothesis.Disclosure of interestLG is funded by the Instituto de Salud Carlos III(CM14/00111).
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Burgos J, Curran A, Landolfi S, Navarro J, Tallada N, Guelar A, Crespo M, Ocaña I, Ribera E, Falcó V. The effectiveness of electrocautery ablation for the treatment of high-grade anal intraepithelial neoplasia in HIV-infected men who have sex with men. HIV Med 2015; 17:524-31. [PMID: 26688291 DOI: 10.1111/hiv.12352] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Electrocautery is one of the main treatment options for high-grade anal intraepithelial neoplasia (HGAIN). However, data regarding its efficacy are scarce. The aim of the study was to evaluate the effectiveness of electrocautery for the treatment of HGAIN. METHODS An observational study of HIV-infected men who have sex with men (MSM) who underwent screening for anal dysplasia was carried out. The on-treatment effectiveness of electrocautery was evaluated (according to biopsy findings measured 6-8 weeks after treatment) in patients with HGAIN. A complete response was defined as resolution of anal intraepithelial neoplasia (AIN), a partial response as regression to low-grade AIN and recurrence as biopsy-proven HGAIN during follow-up. RESULTS From May 2009 to November 2014, 21.9% (126 of 576) of patients screened were found to have HGAIN. Electrocautery effectiveness was evaluated in 83 patients. A complete response was observed in 27 patients [32.5%; 95% confidence interval (CI) 23.4-53.2%], a partial response in 28 patients (33.7%; 95% CI 24.5-44.4%) and persistence in 28 patients (33.7%; 95% CI 24.5-44.4%). The patients with the most successful results (81.8%) required two to four sessions of electrocautery. After a mean follow-up of 12.1 months, 14 of 55 patients with a response (25.4%; 95% CI 15.8-38.3%) developed recurrent HGAIN within a mean time of 29.9 months (95% CI 22-37.7 months). No patient progressed to invasive cancer during the study or developed serious adverse events after treatment. No factors associated with poor response or recurrences were observed. CONCLUSIONS Although electrocautery is the standard treatment for anal dysplasia, almost 50% of patients with HGAIN in our study did not respond or relapsed. New treatment strategies are necessary to optimize the management of anal dysplasia.
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Affiliation(s)
- J Burgos
- Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - A Curran
- Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - S Landolfi
- Anatomical Pathology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - J Navarro
- Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - N Tallada
- Anatomical Pathology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - A Guelar
- Internal Medicine Department, Mar University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - M Crespo
- Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - I Ocaña
- Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - E Ribera
- Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - V Falcó
- Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
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Hofstra LM, Sauvageot N, Albert J, Alexiev I, Garcia F, Struck D, Van de Vijver DAMC, Åsjö B, Beshkov D, Coughlan S, Descamps D, Griskevicius A, Hamouda O, Horban A, Van Kasteren M, Kolupajeva T, Kostrikis LG, Liitsola K, Linka M, Mor O, Nielsen C, Otelea D, Paraskevis D, Paredes R, Poljak M, Puchhammer-Stöckl E, Sönnerborg A, Staneková D, Stanojevic M, Van Laethem K, Zazzi M, Zidovec Lepej S, Boucher CAB, Schmit JC, Wensing AMJ, Puchhammer-Stockl E, Sarcletti M, Schmied B, Geit M, Balluch G, Vandamme AM, Vercauteren J, Derdelinckx I, Sasse A, Bogaert M, Ceunen H, De Roo A, De Wit S, Echahidi F, Fransen K, Goffard JC, Goubau P, Goudeseune E, Yombi JC, Lacor P, Liesnard C, Moutschen M, Pierard D, Rens R, Schrooten Y, Vaira D, Vandekerckhove LPR, Van den Heuvel A, Van Der Gucht B, Van Ranst M, Van Wijngaerden E, Vandercam B, Vekemans M, Verhofstede C, Clumeck N, Van Laethem K, Beshkov D, Alexiev I, Lepej SZ, Begovac J, Kostrikis L, Demetriades I, Kousiappa I, Demetriou V, Hezka J, Linka M, Maly M, Machala L, Nielsen C, Jørgensen LB, Gerstoft J, Mathiesen L, Pedersen C, Nielsen H, Laursen A, Kvinesdal B, Liitsola K, Ristola M, Suni J, Sutinen J, Descamps D, Assoumou L, Castor G, Grude M, Flandre P, Storto A, Hamouda O, Kücherer C, Berg T, Braun P, Poggensee G, Däumer M, Eberle J, Heiken H, Kaiser R, Knechten H, Korn K, Müller H, Neifer S, Schmidt B, Walter H, Gunsenheimer-Bartmeyer B, Harrer T, Paraskevis D, Hatzakis A, Zavitsanou A, Vassilakis A, Lazanas M, Chini M, Lioni A, Sakka V, Kourkounti S, Paparizos V, Antoniadou A, Papadopoulos A, Poulakou G, Katsarolis I, Protopapas K, Chryssos G, Drimis S, Gargalianos P, Xylomenos G, Lourida G, Psichogiou M, Daikos GL, Sipsas NV, Kontos A, Gamaletsou MN, Koratzanis G, Sambatakou H, Mariolis H, Skoutelis A, Papastamopoulos V, Georgiou O, Panagopoulos P, Maltezos E, Coughlan S, De Gascun C, Byrne C, Duffy M, Bergin C, Reidy D, Farrell G, Lambert J, O'Connor E, Rochford A, Low J, Coakely P, O'Dea S, Hall W, Mor O, Levi I, Chemtob D, Grossman Z, Zazzi M, de Luca A, Balotta C, Riva C, Mussini C, Caramma I, Capetti A, Colombo MC, Rossi C, Prati F, Tramuto F, Vitale F, Ciccozzi M, Angarano G, Rezza G, Kolupajeva T, Vasins O, Griskevicius A, Lipnickiene V, Schmit JC, Struck D, Sauvageot N, Hemmer R, Arendt V, Michaux C, Staub T, Sequin-Devaux C, Wensing AMJ, Boucher CAB, van de Vijver DAMC, van Kessel A, van Bentum PHM, Brinkman K, Connell BJ, van der Ende ME, Hoepelman IM, van Kasteren M, Kuipers M, Langebeek N, Richter C, Santegoets RMWJ, Schrijnders-Gudde L, Schuurman R, van de Ven BJM, Åsjö B, Kran AMB, Ormaasen V, Aavitsland P, Horban A, Stanczak JJ, Stanczak GP, Firlag-Burkacka E, Wiercinska-Drapalo A, Jablonowska E, Maolepsza E, Leszczyszyn-Pynka M, Szata W, Camacho R, Palma C, Borges F, Paixão T, Duque V, Araújo F, Otelea D, Paraschiv S, Tudor AM, Cernat R, Chiriac C, Dumitrescu F, Prisecariu LJ, Stanojevic M, Jevtovic D, Salemovic D, Stanekova D, Habekova M, Chabadová Z, Drobkova T, Bukovinova P, Shunnar A, Truska P, Poljak M, Lunar M, Babic D, Tomazic J, Vidmar L, Vovko T, Karner P, Garcia F, Paredes R, Monge S, Moreno S, Del Amo J, Asensi V, Sirvent JL, de Mendoza C, Delgado R, Gutiérrez F, Berenguer J, Garcia-Bujalance S, Stella N, de Los Santos I, Blanco JR, Dalmau D, Rivero M, Segura F, Elías MJP, Alvarez M, Chueca N, Rodríguez-Martín C, Vidal C, Palomares JC, Viciana I, Viciana P, Cordoba J, Aguilera A, Domingo P, Galindo MJ, Miralles C, Del Pozo MA, Ribera E, Iribarren JA, Ruiz L, de la Torre J, Vidal F, Clotet B, Albert J, Heidarian A, Aperia-Peipke K, Axelsson M, Mild M, Karlsson A, Sönnerborg A, Thalme A, Navér L, Bratt G, Karlsson A, Blaxhult A, Gisslén M, Svennerholm B, Bergbrant I, Björkman P, Säll C, Mellgren Å, Lindholm A, Kuylenstierna N, Montelius R, Azimi F, Johansson B, Carlsson M, Johansson E, Ljungberg B, Ekvall H, Strand A, Mäkitalo S, Öberg S, Holmblad P, Höfer M, Holmberg H, Josefson P, Ryding U. Transmission of HIV Drug Resistance and the Predicted Effect on Current First-line Regimens in Europe. Clin Infect Dis 2015; 62:655-663. [PMID: 26620652 PMCID: PMC4741360 DOI: 10.1093/cid/civ963] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 11/06/2015] [Indexed: 11/13/2022] Open
Abstract
Transmitted human immunodeficiency virus drug resistance in Europe is stable at around 8%. The impact of baseline mutation patterns on susceptibility to antiretroviral drugs should be addressed using clinical guidelines. The impact on baseline susceptibility is largest for nonnucleoside reverse transcriptase inhibitors. Background. Numerous studies have shown that baseline drug resistance patterns may influence the outcome of antiretroviral therapy. Therefore, guidelines recommend drug resistance testing to guide the choice of initial regimen. In addition to optimizing individual patient management, these baseline resistance data enable transmitted drug resistance (TDR) to be surveyed for public health purposes. The SPREAD program systematically collects data to gain insight into TDR occurring in Europe since 2001. Methods. Demographic, clinical, and virological data from 4140 antiretroviral-naive human immunodeficiency virus (HIV)–infected individuals from 26 countries who were newly diagnosed between 2008 and 2010 were analyzed. Evidence of TDR was defined using the WHO list for surveillance of drug resistance mutations. Prevalence of TDR was assessed over time by comparing the results to SPREAD data from 2002 to 2007. Baseline susceptibility to antiretroviral drugs was predicted using the Stanford HIVdb program version 7.0. Results. The overall prevalence of TDR did not change significantly over time and was 8.3% (95% confidence interval, 7.2%–9.5%) in 2008–2010. The most frequent indicators of TDR were nucleoside reverse transcriptase inhibitor (NRTI) mutations (4.5%), followed by nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations (2.9%) and protease inhibitor mutations (2.0%). Baseline mutations were most predictive of reduced susceptibility to initial NNRTI-based regimens: 4.5% and 6.5% of patient isolates were predicted to have resistance to regimens containing efavirenz or rilpivirine, respectively, independent of current NRTI backbones. Conclusions. Although TDR was highest for NRTIs, the impact of baseline drug resistance patterns on susceptibility was largest for NNRTIs. The prevalence of TDR assessed by epidemiological surveys does not clearly indicate to what degree susceptibility to different drug classes is affected.
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Affiliation(s)
- L Marije Hofstra
- Luxembourg Institute of Health, Luxembourg.,Department of Virology, University Medical Center Utrecht, The Netherlands
| | | | - Jan Albert
- Karolinska Institute, Solna.,Karolinska University Hospital, Stockholm, Sweden
| | - Ivailo Alexiev
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Federico Garcia
- Complejo Hospitalario Universitario de Granada, Instituto de Investigación IBS Granada; on behalf of Cohorte de Adultos de la Red de Investigación en SIDA, Spain
| | | | | | | | - Danail Beshkov
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | | | - Diane Descamps
- AP-HP Groupe hospitalier Bichat-Claude Bernard, IAME INSERM UMR 1137, Université Paris Diderot Sorbonne Paris Cité, Paris, France
| | | | | | | | | | | | | | - Kirsi Liitsola
- Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki, Finland
| | - Marek Linka
- National Reference Laboratory for HIV/AIDS, National Institute of Public Health, Prague, Czech Republic
| | - Orna Mor
- National HIV Reference Laboratory, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Dan Otelea
- National Institute for Infectious Diseases "Prof. dr. Matei Bals", Bucharest, Romania
| | | | | | - Mario Poljak
- Faculty of Medicine, Slovenian HIV/AIDS Reference Centre, University of Ljubljana, Slovenia
| | | | - Anders Sönnerborg
- Karolinska Institute, Solna.,Karolinska University Hospital, Stockholm, Sweden
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Martínez E, Ribera E, Clotet B, Estrada V, Sanz J, Berenguer J, Rubio R, Pulido F, Larrousse M, Curran A, Negredo E, Arterburn S, Ferrer P, Álvarez ML. Switching from zidovudine/lamivudine to tenofovir/emtricitabine improves fat distribution as measured by fat mass ratio. HIV Med 2014; 16:370-4. [PMID: 25496141 DOI: 10.1111/hiv.12210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Fat mass ratio (FMR) has been suggested as an objective indicator of abnormal body fat distribution in HIV infection. Although it could provide more comprehensive information on body fat changes than limb fat mass, FMR has scarcely been used in clinical trials examining body fat distribution in HIV-infected patients. METHODS A subanalysis of a controlled, randomized clinical trial in virologically suppressed HIV-1-infected men switching from zidovudine (ZDV)/lamivudine (3TC) to emtricitabine (FTC)/tenofovir (TDF) versus continuing on ZDV/3TC was carried out. FMR was assessed by dual X-ray absorptiometry (DEXA) for a period of 72 weeks. Lipoatrophy was defined as FMR ≥ 1.5. Multivariate linear regression models for the change in FMR from baseline were fitted. RESULTS Sixty-five men were randomized and treated (28 in the FTC/TDF arm and 37 in the ZDV/3TC arm), and 57 completed the study (25 and 32 in each arm, respectively). In the FTC/TDF arm, adjusted mean FMR decreased by 0.52 at week 72 (P = 0.014), and in the ZDV/3TC arm it increased by 0.13 (P = 0.491; P between arms = 0.023). Among subjects with lipoatrophy (baseline FMR ≥ 1.5), adjusted FMR decreased by 0.76 (P = 0.003) in the FTC/TDF arm and increased by 0.21 (P = 0.411; P between arms = 0.009) in the ZDV/3TC arm. Baseline FMR and treatment group were significant predictors (P < 0.05) of post-baseline changes in FMR. CONCLUSIONS Switching from ZDV/3TC to FTC/TDF led to an improvement in FMR, compared with progressive worsening of FMR in subjects receiving ZDV/3TC, showing that fat mass not only increased but was also distributed in a healthier way after the switch.
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Affiliation(s)
- E Martínez
- Hospital Clinic IDIBAPS, University of Barcelona, Barcelona, Spain
| | - E Ribera
- Hospital Universitari Vall d'Hebron, Infectious Diseases Division, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - B Clotet
- IrsiCaixa Foundation, Institut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - V Estrada
- Instituto de Investigación Biomédica del Hospital Clínico San Carlos, Hospital Clínico San Carlos, Madrid, Spain
| | - J Sanz
- Hospital Universitario de la Princesa, Instituto de Investigación Princesa, Madrid, Spain
| | - J Berenguer
- Infectious Diseases/HIV Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R Rubio
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - F Pulido
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - A Curran
- Hospital Universitari Vall d'Hebron, Infectious Diseases Division, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - E Negredo
- IrsiCaixa Foundation, Institut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | | | - P Ferrer
- Gilead Sciences SL, Madrid, Spain
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Berenguer J, Zamora FX, Aldámiz-Echevarría T, Von Wichmann MA, Crespo M, López-Aldeguer J, Carrero A, Montes M, Quereda C, Téllez MJ, Galindo MJ, Sanz J, Santos I, Guardiola JM, Barros C, Ortega E, Pulido F, Rubio R, Mallolas J, Tural C, Jusdado JJ, Pérez G, Díez C, Álvarez-Pellicer J, Esteban H, Bellón JM, González-García J, Miralles P, Cosín J, López J, Padilla B, Parras F, Carrero A, Aldamiz-Echevarría T, Tejerina F, Gutiérrez I, Ramírez M, Carretero S, Bellón J, Berenguer J, Alvarez-Pellicer J, Rodríguez E, Arribas J, Montes M, Bernardino I, Pascual J, Zamora F, Peña J, Arnalich F, Díaz M, González-García J, Bustinduy M, Iribarren J, Rodríguez-Arrondo F, Von-Wichmann M, Blanes M, Cuellar S, Lacruz J, Montero M, Salavert M, López-Aldeguer J, Callau P, Miró J, Gatell J, Mallolas J, Ferrer A, Galindo M, Van den Eynde E, Pérez M, Ribera E, Crespo M, Vergas J, Téllez M, Casado J, Dronda F, Moreno A, Pérez-Elías M, Sanfrutos M, Moreno S, Quereda C, Jou A, Tural C, Arranz A, Casas E, de Miguel J, Schroeder S, Sanz J, Condés E, Barros C, Sanz J, Santos I, Hernando A, Rodríguez V, Rubio R, Pulido F, Domingo P, Guardiola J, Ortiz L, Ortega E, Torres R, Cervero M, Jusdado J, Rodríguez-Zapata M, Pérez G, Gaspar G, Barquilla E, Ramírez M, Moyano B, Aznar E, Esteban H. Comparison of the Prognostic Value of Liver Biopsy and FIB-4 Index in Patients Coinfected With HIV and Hepatitis C Virus. Clin Infect Dis 2014; 60:950-8. [DOI: 10.1093/cid/ciu939] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Juan Berenguer
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | - Francisco X. Zamora
- Hospital Universitario La Paz
- Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid
| | - Teresa Aldámiz-Echevarría
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | | | | | | | - Ana Carrero
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | - Marisa Montes
- Hospital Universitario La Paz
- Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid
| | | | | | | | - José Sanz
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares
| | | | | | | | | | - Federico Pulido
- Hospital Universitario 12 de Octubre
- Instituto de Investigación Hospital 12 de Octubre
(i+12), Madrid
| | - Rafael Rubio
- Hospital Universitario 12 de Octubre
- Instituto de Investigación Hospital 12 de Octubre
(i+12), Madrid
| | | | | | | | | | - Cristina Díez
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | - Julio Álvarez-Pellicer
- Hospital Universitario La Paz
- Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid
| | | | - José M. Bellón
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | - Juan González-García
- Hospital Universitario La Paz
- Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid
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Gonzalez FA, Van den Eynde E, Perez-Hoyos S, Navarro J, Curran A, Burgos J, Falcó V, Ocaña I, Ribera E, Crespo M. Liver stiffness and aspartate aminotransferase levels predict the risk for liver fibrosis progression in hepatitis C virus/HIV-coinfected patients. HIV Med 2014; 16:211-8. [PMID: 25234826 DOI: 10.1111/hiv.12197] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The aim of the study was to investigate liver fibrosis outcome and the risk factors associated with liver fibrosis progression in hepatitis C virus (HCV)/HIV-coinfected patients. METHODS We prospectively obtained liver stiffness measurements by transient elastography in a cohort of 154 HCV/HIV-coinfected patients, mostly Caucasian men on suppressive antiretroviral treatment, with the aim of determining the risk for liver stiffness measurement (LSM) increase and to identify the predictive factors for liver fibrosis progression. To evaluate LSM trends over time, a linear mixed regression model with LSM level as the outcome and duration of follow-up in years as the main covariate was fitted. RESULTS After a median follow-up time of 40 months, the median increase in LSM was 1.05 kPa/year [95% confidence interval (CI) 0.72-1.38 kPa/year]. Fibrosis stage progression was seen in 47% of patients, and 17% progressed to cirrhosis. Aspartate aminotransferase (AST) levels and liver fibrosis stage at baseline were identified as independent predictors of LSM change. Patients with F3 (LSM 9.6-14.5 kPa) or AST levels ≥ 64 IU/L at baseline were at higher risk for accelerated LSM increase (ranging from 1.45 to 2.61 kPa/year), whereas LSM change was very slow among patients with both F0-F1 (LSM ≤ 7.5 kPa) and AST levels ≤ 64 IU/L at baseline (0.34 to 0.58 kPa/year). An intermediate risk for LSM increase (from 0.78 to 1.03 kPa/year) was seen in patients with F2 (LSM 7.6-9.5 kPa) and AST baseline levels ≤ 64 IU/L. CONCLUSIONS AST levels and liver stiffness at baseline allow stratification of the risk for fibrosis progression and might be clinically useful to guide HCV treatment decisions in HIV-infected patients.
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Affiliation(s)
- F A Gonzalez
- Internal Medicine Department, Garcia de Orta Hospital, Lisbon, Portugal
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20
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Curran A, Monteiro P, Domingo P, Villar J, Imaz A, Martinez E, Fernandez I, Knobel H, Podzamczer D, Iribarren JA, Penaranda M, Crespo M, Curran A, Ribera E, Navarro J, Crespo M, Monteiro P, Martinez E, Fernandez I, Domingo P, Villar J, Knobel H, Imaz A, Podzamczer D, Ibarguren M, Iribarren JA, Penaranda M, Riera M. Effectiveness of ritonavir-boosted protease inhibitor monotherapy in the clinical setting: same results as in clinical trials? The PIMOCS Study Group. J Antimicrob Chemother 2014; 69:1390-6. [DOI: 10.1093/jac/dkt517] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Curran A, Guiu JM, Ribera E, Crespo M. Darunavir and telaprevir drug interaction: total and unbound plasma concentrations in HIV/HCV-coinfected patients with cirrhosis. J Antimicrob Chemother 2013; 69:1434-6. [DOI: 10.1093/jac/dkt509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Ribera E, Larrousse M, Curran A, Negredo E, Clotet B, Estrada V, Sanz J, Berenguer J, Rubio R, Pulido F, Ferrer P, Alvarez ML, Arterburn S, Martínez E. Impact of switching from zidovudine/lamivudine to tenofovir/emtricitabine on lipoatrophy: the RECOMB study. HIV Med 2013; 14:327-36. [DOI: 10.1111/hiv.12011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2012] [Indexed: 11/30/2022]
Affiliation(s)
- E Ribera
- Infectious Diseases Division; Hospital Universitari Vall d'Hebron; Autonomous University of Barcelona; Barcelona; Spain
| | - M Larrousse
- Infectious Diseases Unit; Hospital Clinic-IDIBAPS; University of Barcelona; Barcelona; Spain
| | - A Curran
- Infectious Diseases Division; Hospital Universitari Vall d'Hebron; Autonomous University of Barcelona; Barcelona; Spain
| | - E Negredo
- IrsiCaixa Foundation; Institut Germans Trias i Pujol; Diseases Division; Autonomous University of Barcelona; Badalona; Spain
| | - B Clotet
- IrsiCaixa Foundation; Institut Germans Trias i Pujol; Diseases Division; Autonomous University of Barcelona; Badalona; Spain
| | - V Estrada
- Hospital Clínico San Carlos; Madrid; Spain
| | - J Sanz
- Hospital Universitario de la Princesa; Instituto de Investigación Princesa; Madrid; Spain
| | - J Berenguer
- Infectious Diseases/HIV Unit; Hospital General Universitario Gregorio Marañón; Madrid; Spain
| | - R Rubio
- Hospital Universitario 12 de Octubre; Madrid; Spain
| | - F Pulido
- Hospital Universitario 12 de Octubre; Madrid; Spain
| | - P Ferrer
- Gilead Sciences SL; Madrid; Spain
| | | | - S Arterburn
- Gilead Sciences Inc.; Foster City; California; USA
| | - E Martínez
- Infectious Diseases Unit; Hospital Clinic-IDIBAPS; University of Barcelona; Barcelona; Spain
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Podzamczer D, Tiraboschi JM, Mallolas J, Curto J, Cárdenes MA, Casas E, Castro A, Echevarría S, Leal M, Lopez Bernaldo de Quirós JC, Moreno S, Puig T, Ribera E, Villalonga C, Gómez-Sirvent JL, García-Henarejos JA, Lopez-Aldeguer J, Barrufet P, Force L, Santos I, Sanz J. Long-term benefits of nevirapine-containing regimens: multicenter study with 506 patients, followed-up a median of 9 years. Curr HIV Res 2012; 10:513-20. [PMID: 22716109 DOI: 10.2174/157016212802429820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 04/29/2012] [Accepted: 06/11/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate long-term outcomes in patients maintaining a nevirapine (NVP)-based regimen. METHODS Retrospective, multicenter, cohort study including patients currently receiving an NVP regimen that had been started at least 5 years previously. Demographic, clinical, and analytical variables were recorded. RESULTS Median follow-up was 8.9 (5.7-11.3) years. Baseline characteristics: 74% men, 47 years old, 36% drug users, 40% AIDS, 40% HCV+, 51.4% detectable HIV-1 viral load, CD4 count 395 (4-1,421)/μL, 19% CD4 < 200/μL, 27% ALT grade 1-2, 36% AST grade 1-2. Thirty percent ART-naive, 83%received NVP associated with 2 nucleoside analogues during the study period, and 17% a protease inhibitor. A significant improvement was observed in general health status markers, including hemoglobin, platelets, and albumin, regardless of HCV coinfection. CD4 cell gain was +218 and +322/μL after 6 and 9 years, respectively (+321 and +391 in naive patients). Triglycerides significantly decreased in pretreated patients, whereas the percentage of patients with HDLc < 1.03 mmol/L and LDL-c > 3.37 mmol/L significantly decreased in a subsample with available values. A significant decrease in transaminases, alkaline phosphatase, and Fib4 score was observed, mainly in HCV+ and ARV-naive patients. CONCLUSIONS In patients who tolerate NVP therapy, (even those with HCV coinfection), long term benefits may be significant in terms of a progressive improvement in general health status markers and CD4 response, a favorable lipid profile, and good liver tolerability.
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Affiliation(s)
- D Podzamczer
- HIV Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, c/Feixa Llarga s/n. L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
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Riveiro-Barciela M, Falcó V, Burgos J, Curran A, Van den Eynde E, Navarro J, Villar del Saz S, Ocaña I, Ribera E, Crespo M, Pahissa A. Neurological opportunistic infections and neurological immune reconstitution syndrome: impact of one decade of highly active antiretroviral treatment in a tertiary hospital. HIV Med 2012; 14:21-30. [DOI: 10.1111/j.1468-1293.2012.01033.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2012] [Indexed: 11/26/2022]
Affiliation(s)
- M Riveiro-Barciela
- Infectious Diseases Department; University Hospital Vall d'Hebron, Autonomous University of Barcelona; Barcelona; Spain
| | - V Falcó
- Infectious Diseases Department; University Hospital Vall d'Hebron, Autonomous University of Barcelona; Barcelona; Spain
| | - J Burgos
- Infectious Diseases Department; University Hospital Vall d'Hebron, Autonomous University of Barcelona; Barcelona; Spain
| | - A Curran
- Infectious Diseases Department; University Hospital Vall d'Hebron, Autonomous University of Barcelona; Barcelona; Spain
| | - E Van den Eynde
- Infectious Diseases Department; University Hospital Vall d'Hebron, Autonomous University of Barcelona; Barcelona; Spain
| | - J Navarro
- Infectious Diseases Department; University Hospital Vall d'Hebron, Autonomous University of Barcelona; Barcelona; Spain
| | - S Villar del Saz
- Infectious Diseases Department; University Hospital Vall d'Hebron, Autonomous University of Barcelona; Barcelona; Spain
| | - I Ocaña
- Infectious Diseases Department; University Hospital Vall d'Hebron, Autonomous University of Barcelona; Barcelona; Spain
| | - E Ribera
- Infectious Diseases Department; University Hospital Vall d'Hebron, Autonomous University of Barcelona; Barcelona; Spain
| | - M Crespo
- Infectious Diseases Department; University Hospital Vall d'Hebron, Autonomous University of Barcelona; Barcelona; Spain
| | - A Pahissa
- Infectious Diseases Department; University Hospital Vall d'Hebron, Autonomous University of Barcelona; Barcelona; Spain
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Burgos J, Crespo M, Falco V, Curran A, Navarro J, Imaz A, Domingo P, Podzamczer D, Mateo MG, Villar S, Van den Eynde E, Ribera E, Pahissa A. Simplification to dual antiretroviral therapy including a ritonavir-boosted protease inhibitor in treatment-experienced HIV-1-infected patients. J Antimicrob Chemother 2012; 67:2479-86. [DOI: 10.1093/jac/dks227] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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26
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Romero A, Gonzalez V, Esteve A, Martro E, Matas L, Tural C, Pumarola T, Casanova A, Ferrer E, Caballero E, Ribera E, Margall N, Domingo P, Farre J, Puig T, Sauca M, Barrufet P, Amengual M, Navarro G, Navarro M, Vilaro J, Ortin X, Orti A, Pujol F, Prat JM, Massabeu A, Simo JM, Villaverde CA, Benitez MA, Garcia I, Diaz O, Becerra J, Ros R, Sala R, Rodrigo I, Miro JM, Casabona J. Identification of recent HIV-1 infection among newly diagnosed cases in Catalonia, Spain (2006-08). Eur J Public Health 2011; 22:802-8. [DOI: 10.1093/eurpub/ckr179] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Berenguer J, von Wichmann MA, Quereda C, Miralles P, Mallolas J, Lopez-Aldeguer J, Alvarez-Pellicer J, De Miguel J, Crespo M, Guardiola JM, Tellez MJ, Galindo MJ, Arponen S, Barquilla E, Bellon JM, Gonzalez-Garcia J, Miralles P, Cosin J, Lopez JC, Padilla B, Sanchez Conde M, Bellon JM, Gutierrez I, Ramirez M, Carretero S, Aldamiz-Echevarria T, Tejerina F, Berenguer J, Alvarez-Pellicer J, Rodriguez E, Arribas JR, Montes ML, Bernardino I, Pascual JF, Zamora F, Pena JM, Arnalich F, Gonzalez-Garcia J, Bustinduy MJ, Iribarren JA, Rodriguez-Arrondo F, Von-Wichmann MA, Blanes M, Cuellar S, Lacruz J, Montero M, Salavert M, Lopez-Aldeguer J, Callau P, Miro JM, Gatell JM, Mallolas J, Ferrer A, Galindo MJ, Van den Eynde E, Perez M, Ribera E, Crespo M, Vergas J, Tellez MJ, Casado JL, Dronda F, Moreno A, Perez-Elias MJ, Sanfrutos MA, Moreno S, Quereda C, Jou A, Tural C, Arranz A, Casas E, de Miguel J, Schroeder S, Sanz J, Condes E, Barros C, Sanz J, Santos I, Hernando A, Rodriguez V, Rubio R, Pulido F, Domingo P, Guardiola JM, Ortiz L, Ortega E, Torres L:R, Cervero M, Jusdado JJ, Montes ML, Perez G, Gaspar G, Barquilla E, Mahillo B, Moyano B, Cotarelo M, Aznar E, Esteban H. Effect of accompanying antiretroviral drugs on virological response to pegylated interferon and ribavirin in patients co-infected with HIV and hepatitis C virus. J Antimicrob Chemother 2011; 66:2843-9. [DOI: 10.1093/jac/dkr362] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Imaz A, Llibre JM, Mora M, Mateo G, Camacho A, Blanco JR, Curran A, Santos JR, Caballero E, Bravo I, Gaya F, Domingo P, Rivero A, Falco V, Clotet B, Ribera E. Efficacy and safety of nucleoside reverse transcriptase inhibitor-sparing salvage therapy for multidrug-resistant HIV-1 infection based on new-class and new-generation antiretrovirals. J Antimicrob Chemother 2011. [DOI: 10.1093/jac/dkr287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pérez-Molina JA, Suárez-Lozano I, Del Arco A, Teira R, Bachiller P, Pedrol E, Martínez-Alfaro E, Domingo P, Mariño A, Ribera E, Antela A, de Otero J, Navarro V, González-García J. Late initiation of HAART among HIV-infected patients in Spain is frequent and related to a higher rate of virological failure but not to immigrant status. HIV Clin Trials 2011; 12:1-8. [PMID: 21388936 DOI: 10.1310/hct1201-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine whether immigrant status is associated with late initiation of highly active antiretroviral treatment (HAART) and/or poor response to antiretrovirals. METHODS GESIDA 5808 is a multicenter, retrospective cohort study (inclusion period January 2005 through December 2006) of treatment-naïve patients initiating HAART that compares HIV-infected patients who are immigrants with Spanish-born patients. A late starter (LS) was defined as any patient starting HAART with a CD4+ lymphocyte count <200 cells/μL and/or diagnosis of an AIDS-defining illness before or at the start of therapy. The primary endpoint was time to treatment failure (TTF), defined as virological failure (VF), death, opportunistic infection, treatment discontinuation/switch (D/S), or missing patient. Secondary endpoints were time to treatment failure as observed data (TTO; censoring missing patients) and time to virological failure (TVF; censoring missing patients and D/S not due to VF). RESULTS LS accounted for 56% of the patients. Lower educational and socioeconomic level and intravenous drug use (IVDU) were associated with categorization as LS, but immigrant status was not. Cox regression analysis (hazard ratio [HR]; 95% CI) between LS and non-LS patients showed no differences in TTF (0.97; 0.78-1.20) or TTO (1.18; 0.88-1.58), although it did reveal a difference in TVF (1.97; 1.18-3.29). CD4+ lymphocyte recovery was equivalent for both LS and non-LS patients (159 vs 173). CONCLUSIONS In our cohort, immigrant status was not shown to be related to late initiation of HAART. Although LS patients did not have a longer TTF for any reason, TVF was significantly shorter. Despite universal free access to HAART in Spain, measures to ensure early diagnosis and treatment of HIV infection are necessary.
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Affiliation(s)
- J A Pérez-Molina
- Servicio de Enfermedades Infecciosas, Medicina Tropical, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.
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Lejeune M, Miro JM, De Lazzari E, Garcia F, Claramonte X, Martinez E, Ribera E, Arrizabalaga J, Arribas JR, Domingo P, Ferrer E, Plana M, Valls ME, Podzamczer D, Pumarola T, Jacquet A, Mallolas J, Gatell JM, Gallart T. Restoration of T Cell Responses to Toxoplasma gondii after Successful Combined Antiretroviral Therapy in Patients with AIDS with Previous Toxoplasmic Encephalitis. Clin Infect Dis 2011; 52:662-70. [DOI: 10.1093/cid/ciq197] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Imaz A, Llibre JM, Mora M, Mateo G, Camacho A, Blanco JR, Curran A, Santos JR, Caballero E, Bravo I, Gaya F, Domingo P, Rivero A, Falco V, Clotet B, Ribera E. Efficacy and safety of nucleoside reverse transcriptase inhibitor-sparing salvage therapy for multidrug-resistant HIV-1 infection based on new-class and new-generation antiretrovirals. J Antimicrob Chemother 2010; 66:358-62. [DOI: 10.1093/jac/dkq432] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lazzarin A, Johnson M, Ribera E, Weitner L, Chen SS, Warren DR. 5-year safety and efficacy of the once-daily antiretroviral regimen of efavirenz (EFV)/emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF). J Int AIDS Soc 2010. [PMCID: PMC3113064 DOI: 10.1186/1758-2652-13-s4-p6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Casado JL, Domingo P, Rubio R, Antela A, Lopez-Ruz MA, Castro A, Portilla J, Ribera E, Podzamczer D, Oteo JA, Galindo J, Otero S, Lozano F, Estrada V, Moltó J, Moreno S. Switching from tipranavir (TPV) 500/ritonavir (RTV) 200 mg to TPV 500/RTV 100 mg in treatment-experienced patients (pts) with HIV RNA <50 copies/mL. J Int AIDS Soc 2010. [PMCID: PMC3113052 DOI: 10.1186/1758-2652-13-s4-p49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Martínez E, Arranz JA, Podzamczer D, Lonca M, Sanz J, Barragán P, Knobel H, Ribera E, Gutierrez F, Valero S, Clotet B, Dalmau D, Segura F, Arribas JR, Barrufet P, Santos I, Payeras A, de Lazzari E, Pich J, Gatell J. Long-term outcomes of switching to fixed-dose abacavir/lamivudine (ABC/3TC) or tenofovir/emtricitabine (TDF/FTC): 3-year results of the BICOMBO study. J Int AIDS Soc 2010. [PMCID: PMC3113046 DOI: 10.1186/1758-2652-13-s4-p43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Llibre JM, Martínez E, Barreiro P, Escrig R, Ribera E, Cervantes M, Imaz A, Gutierrez F, Knobel H, Ornelas A, Zamora FX, Clotet B. Reasons for using and efficacy of raltegravir in salvage regimens without protease inhibitors in clinical practice. J Int AIDS Soc 2010. [PMCID: PMC3113037 DOI: 10.1186/1758-2652-13-s4-p35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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del Saz SV, Sued O, Falcó V, Agüero F, Crespo M, Pumarola T, Curran A, Gatell JM, Pahissa A, Miró JM, Ribera E. Acute meningoencephalitis due to human immunodeficiency virus type 1 infection in 13 patients: clinical description and follow-up. J Neurovirol 2010; 14:474-9. [PMID: 19037815 DOI: 10.1080/13550280802195367] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of this study is to describe a series of cases of severe meningitis caused by human immunodeficiency virus type 1 (HIV-1) occurring during primary infection or after antiretroviral treatment interruption. In an observational cohort study, 13 patients with clinical diagnosis of meningitis or meningoencephalitis were reviewed. Ten cases occurred during primary HIV-1 infection and 3 after antiretroviral therapy (ART) withdrawal. Demographic parameters, clinical presentation and outcome, and laboratory and cerebrospinal fluid (CSF) parameters were recorded. The risk factor for HIV-1 infection acquisition was sexual transmission in all cases. The most frequent systemic symptoms were fever (12/13) and headeache (9/13). Among neurologic symptoms, focal signs appeared in seven patients (53.8%), confusion in six (46.2%), and agitation in five (38.5%). The median CD4 cell count was 434 cells/mm3. In all cases, CSF was a clear lymphocytaire fluid with normal glucose levels. Cranial computerized tomography was performed in seven patients, with a normal result in all of them; brain magnetic resonance in eight patients was normal in five cases and showing cortical atrophy, limbic encephalitis, and leptomeningeal enhancement in one patient each. The electroencephalographs (EEG) just showed diffuse dysfunction in three cases. ART was started in 11 patients. HIV RNA load at 12 months was <50 copies/ml in all treated patients. The 13 patients recovered without neurologic sequela. Meningitis or meningoencephalitis during primary HIV-1 infection or after ART cessation are unusual but sometimes a life-threatening manifestation. Although all patients tend to recover and the necessity of ART is not well established, some data suggest its potential benefit in these patients.
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Affiliation(s)
- S Villar del Saz
- Hospital Universitari Vall d'Hebron, Infectious Diseases Department, Autonomous University of Barcelona, Barcelona, Spain.
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Rubio R, Serrano O, Carmena J, Asensi V, Echevarría S, Flores J, Ribera E, Zarraga M, Ocampo A, De La Fuente B, Sepúlveda MA, Mariño AI, Minguez C, Vicent R, Cartón JA, Moyano B, Esteban H, Mahillo B, Serrano L, González-García J. Effect of simplification from protease inhibitors to boosted atazanavir-based regimens in real-life conditions. HIV Med 2010; 11:545-53. [DOI: 10.1111/j.1468-1293.2010.00827.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Curran A, Gutirerrez M, Deig E, Mateo G, Lopez RM, Imaz A, Crespo M, Ocana I, Domingo P, Ribera E. Efficacy, safety and pharmacokinetics of 900/100 mg of darunavir/ritonavir once daily in treatment-experienced patients. J Antimicrob Chemother 2010; 65:2195-203. [DOI: 10.1093/jac/dkq295] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Florence E, De Wit S, Castagna A, Ribera E, Hill A, Vanaken H, van Delft Y, Marks S. HIV RNA suppression rates after 24 weeks of treatment with etravirine, darunavir/ritonavir and raltegravir in the etravirine early access programme. Int J STD AIDS 2010; 21:224-5. [DOI: 10.1258/ijsa.2009.009425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- E Florence
- Prince Leopold Institute of Tropical Medicine, Antwerp
| | - S De Wit
- St Pierre University Hospital, Brussels, Belgium
| | - A Castagna
- Department of Infectious Diseases, IRCCS, San Raffaele Hospital, Milan, Italy
| | - E Ribera
- Hopital Vall d'Hebron, Barcelona, Spain
| | - A Hill
- University of Liverpool, Liverpool, UK
| | | | - Y van Delft
- Janssen-Cilag B.V., Tilburg, The Netherlands
| | - S Marks
- Janssen-Cilag B.V., Tilburg, The Netherlands
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Suarez-Lozano I, Viciana P, Lacalle JR, Teira R, Lozano F, Lopez-Aldeguer J, Pedrol E, Domingo P, Cosin J, Roca B, Geijo P, Fuente B, Vergara A, Ribera E, Galindo MJ, Zapata A, Sanchez T, Vidal F, Munoz-Sanz A, Munoz-Sanchez J, Garrido M. The relationship between antiretroviral prescription patterns and treatment guidelines in treatment-naïve HIV-1-infected patients. HIV Med 2009; 10:573-9. [DOI: 10.1111/j.1468-1293.2009.00731.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Alvarez-Uria G, Falcó V, Martín-Casabona N, Crespo M, Villar Del Saz S, Curran A, Ocaña I, Ribera E, Pahissa A. Non-tuberculous mycobacteria in the sputum of HIV-infected patients: infection or colonization? Int J STD AIDS 2009; 20:193-5. [PMID: 19255269 DOI: 10.1258/ijsa.2008.008300] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
It can be difficult to establish the clinical significance of the isolation of non-tuberculous mycobacteria (NTM) from the sputum of HIV-infected patients. In this observational study, we have investigated factors associated with having NTM infection. During the period of the study, 10 patients had NTM infection and 14 had NTM colonization. Factors associated with having NTM infections were: CD4 lymphocyte count <50 cells/mL (odds ratio [OR] 10; 95% confidence interval [CI] 1.4-69.3), haemoglobin <11 g/dL (OR 7.2; 95% CI 1.08-47.9), weight loss (OR 9; 95% CI 1.3-63.9), duration of symptoms for more than a month (OR 54; 95% CI 4.2-692.5), the presence of acid fast bacilli (AFB) in sputum (OR 30.3; 95% CI 2.6-348.9) and repeated positive NTM cultures in other sputum samples (OR 4.3; 95% CI 1.6-11.7). In conclusion, we must suspect NTM infection in patients with long-standing symptoms, anaemia, low CD4 lymphocyte count, several positive sputum cultures and when AFB are seen.
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Affiliation(s)
- G Alvarez-Uria
- Infectious Diseases Department, Vall Hebron University Hospital, Barcelona, Spain.
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Imaz A, Falcó V, Peñaranda M, Jordano Q, Martínez X, Nadal C, Curran A, Planes AM, Dalmau D, Ribera E, Riera M, Ruiz de Gopegui E, Pahissa A. Impact of prior pneumococcal vaccination on clinical outcomes in HIV-infected adult patients hospitalized with invasive pneumococcal disease. HIV Med 2009; 10:356-63. [PMID: 19490180 DOI: 10.1111/j.1468-1293.2009.00695.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Recent studies in hospitalized patients with community-acquired pneumonia have found a lower risk of bacteraemia and better clinical outcomes in patients who had previously received the 23-valent pneumococcal polysaccharide vaccine (PPV) in comparison with unvaccinated individuals. The aim of this study was to assess the influence of prior PPV on clinical outcomes in HIV-infected adult patients hospitalized with invasive pneumococcal disease (IPD). METHODS This was an observational study of all consecutive HIV-infected adults hospitalized with IPD from January 1996 to October 2007 in three hospitals in Spain. Baseline characteristics and clinical outcome-related variables were compared according to prior PPV vaccination status. RESULTS A total of 162 episodes of IPD were studied. In 23 of these (14.2%), patients had previously received PPV. In both vaccinated and unvaccinated patients, most of the causal serotypes were included in the 23-valent PPV (76.9% and 84.1%, respectively). Overall, 25 patients (15.4%) died during hospitalization, 21 patients (13%) required admission to an intensive care unit (ICU) and 34 patients (21%) reached the composite outcome of death and/or admission to the ICU. None of the 23 patients who had previously received PPV died or required ICU admission, in comparison with 25 (18%; P=0.026) and 21 (15.1%; P=0.046), respectively, of the unvaccinated patients. The length of hospital stay for vaccinated patients was significantly shorter (8.48 vs. 13.27 days; P=0.011). CONCLUSIONS Although 23-valent PPV failed to prevent IPD in some HIV-infected patients, vaccination produced beneficial effects on clinical outcomes by decreasing illness severity and mortality related to IPD.
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Affiliation(s)
- A Imaz
- Infectious Disease Department, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, P Vall d'Hebron 119-129, Barcelona 08035, Spain.
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Bruschi G, Colombo T, Trunfio S, Ribera E, Russo C, Turazza F, Oliva F, Frigerio M, Martinelli L. 218: It There Still a Role for Undersized Mitral Annuloplasty for Mitral Regurgitation in End-Stage Dilated Cardiomyopathy: Single Centre Long Term Follow-Up. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ribera E, Bruschi G, Austoni P, Vignati G, Corato A, Marianeschi S, Paino R, Firgerio M, Martinelli L, Santoro F. 372: Heart Transplantation in Adults with Congenital Heart Disease. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Romero A, Gonzalez V, Granell M, Matas L, Esteve A, Martro E, Rodrigo I, Pumarola T, Miro JM, Casanova A, Ferrer E, Tural C, del Romero J, Rodriguez C, Caballero E, Ribera E, Casabona J. Recently acquired HIV infection in Spain (2003-2005): introduction of the serological testing algorithm for recent HIV seroconversion. Sex Transm Infect 2008; 85:106-10. [DOI: 10.1136/sti.2008.031864] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Crespo M, Ribera E, Suarez-Lozano I, Domingo P, Pedrol E, Lopez-Aldeguer J, Munoz A, Vilades C, Sanchez T, Viciana P, Teira R, Garcia-Alcalde ML, Vergara A, Lozano F, Galindo MJ, Cosin J, Roca B, Terron A, Geijo P, Vidal F, Garrido M. Effectiveness and safety of didanosine, lamivudine and efavirenz versus zidovudine, lamivudine and efavirenz for the initial treatment of HIV-infected patients from the Spanish VACH cohort. J Antimicrob Chemother 2008; 63:189-96. [DOI: 10.1093/jac/dkn450] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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47
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Curran A, Falcó V, Crespo M, Martinez X, Ribera E, Villar del Saz S, Imaz A, Coma E, Ferrer A, Pahissa A. Bacterial pneumonia in HIV-infected patients: use of the pneumonia severity index and impact of current management on incidence, aetiology and outcome. HIV Med 2008; 9:609-15. [PMID: 18557951 DOI: 10.1111/j.1468-1293.2008.00603.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Despite a recent decrease, bacterial pneumonia (BP) is still the most common admission diagnosis in HIV patients. We analyse BP incidence, characteristics and prevention measures. METHODS Observational study of all patients hospitalized for BP in a tertiary hospital in Barcelona, Spain, from January 2000 to December 2005. Demographic and HIV-related data, BP risk factors, characteristics of BP and outcomes are analysed. RESULTS One hundred and eighty-six BP episodes in 161 patients were included; patients were mainly male (73.7%) and intravenous drug users (73.7%). A decrease in BP incidence was seen during the study period, especially in vaccinated patients. The most commonly isolated microorganism was Streptococcus pneumoniae (31.7%), followed by Legionella pneumophila (5.9%). Legionella pneumophila was more likely in patients with undetectable viral load, higher CD4 cell counts or prior vaccination. Highly active antiretroviral therapy, cotrimoxazole prophylaxis and pneumococcal vaccination did not have a significant influence on bacteraemia rate, in-hospital complications or BP mortality. High Pneumonia Severity Index (PSI) predicted mortality accurately [relative risk 15.2, 95% confidence interval 3.2-71.7; P=0.001]. Mortality was 9.1%, but was significantly higher in patients with CD4 counts under 200 cells/microL (P=0.022). CONCLUSIONS A decline in BP incidence was seen during the study period. Combining CD4 cell count and PSI score could become a good strategy in deciding which patients have to be hospitalized.
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Affiliation(s)
- A Curran
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, P1 Valld'Hebron, Barcelona, Spain.
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Ribera E, Antela A, Henarejos JAG, Arribas JR, Oteo JA, Gomez ML, Ferrer E. Positive predictive factors in HIV-1 patients treated with enfuvirtide plus an OB that include an active boosted PI. Preliminary FastFuz study results. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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49
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Imaz A, del Saz SV, Rivas MA, Curran A, Caballero E, Falco V, Crespo M, Ocana I, Diaz M, de Gopegui ER, Riera M, Ribera E. Raltegravir, etravirine and darunavir-ritonavir: a safe and successful rescue regimen in highly treatment-experienced HIV1-infected patients. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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50
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Ribera E, Florence E, De Wit S, Castagna A, Ryan B, Vanaken H, Hill AM, Marks S. Switching from enfuvirtide to etravirine – efficacy results from the etravirine expanded access programme. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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