1
|
Meira F, Albiach L, Carbonell C, Martín-Oterino JA, Martín-Ordiales M, Linares L, Macaya I, Agüero D, Ambrosioni J, Bodro M, Cardozo C, Chumbita M, De la Mora M, García-Pouton N, Garcia-Vidal C, González-Cordón A, Hernández-Meneses M, Inciarte A, Laguno M, Leal L, Morata L, Puerta-Alcalde P, Rico V, Letona L, Cózar-Llistó A, Dueñas G, Solá M, Torres B, Rojas J, Moreno A, Moreno-García E, Torres M, Martínez JA, Soriano A, García F. Experience with the use of siltuximab in patients with SARS-CoV-2 infection. Rev Esp Quimioter 2021; 34:337-341. [PMID: 33982984 PMCID: PMC8329576 DOI: 10.37201/req/045.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/04/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The study aims to describe characteristics and clinical outcome of patients with SARS-CoV-2 infection that received siltuximab according to a protocol that aimed to early block the activity of IL-6 to avoid the progression of the inflammatory flare. METHODS Retrospective review of the first 31 patients with SARS-CoV-2 treated with siltuximab, in Hospital Clinic of Barcelona or Hospital Universitario Salamanca, from March to April 2020 with positive polymerase-chain reaction (PCR) from a nasopharyngeal swab. RESULTS The cohort included 31 cases that received siltuximab with a median (IQR) age of 62 (56-71) and 71% were males. The most frequent comorbidity was hypertension (48%). The median dose of siltuximab was 800 mg ranging between 785 and 900 mg. 7 patients received siltuximab as a salvage therapy after one dose of tocilizumab. At the end of the study, a total of 26 (83.9) patients had been discharged alive and the mortality rate was 16.1% but only 1 out of 24 that received siltuximab as a first line option (4%). CONCLUSIONS Siltuximab is a well-tolerated alternative to tocilizumab when administered as a first line option in patients with COVID-19 pneumonia within the first 10 days from symptoms onset and high C-reactive protein.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - A Soriano
- Alex Soriano, Department of Infectious Diseases, Hospital Clínic of Barcelona. Carrer de Villarroel 170, 08036, Barcelona, Spain.
| | | |
Collapse
|
2
|
Moreno-García E, Rico E, Albiach L, Agüero D, Ambrosioni J, Bodro M, Cardozo C, Chumbita M, De la Mora M, García-Pouton N, Garcia-Vidal C, González-Cordón A, Hernández-Meneses M, Inciarte A, Laguno M, Leal L, Linares L, Macay I, Meira F, Mensa J, Moreno A, Morata L, Puerta-Alcalde P, Rojas J, Solá M, Torres B, Torres M, Tomé A, Tuset M, Castro P, Fernández S, Nicolás JM, Almuedo-Riera A, Muñoz J, Fernandez-Pittol M, Marcos MA, Soy D, Martínez JA, García F, Soriano A. Tocilizumab reduces the risk of ICU admission and mortality in patients with SARS-CoV-2 infection. Rev Esp Quimioter 2021; 34:238-244. [PMID: 33829722 PMCID: PMC8179941 DOI: 10.37201/req/037.2021] [Citation(s) in RCA: 5] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objectives In some patients the immune response triggered by SARS-CoV-2 is unbalanced, presenting an acute respiratory distress syndrome which in many cases requires intensive care unit (ICU) admission. The limitation of ICU beds has been one of the major burdens in the management around the world; therefore, clinical strategies to avoid ICU admission are needed. We aimed to describe the influence of tocilizumab on the need of transfer to ICU or death in non-critically ill patients. Material and methods A retrospective study of 171 patients with SARS-CoV-2 infection that did not qualify as requiring transfer to ICU during the first 24h after admission to a conventional ward, were included. The criteria to receive tocilizumab was radiological impairment, oxygen demand or an increasing of inflammatory parameters, however, the ultimate decision was left to the attending physician judgement. The primary outcome was the need of ICU admission or death whichever came first. Results A total of 77 patients received tocilizumab and 94 did not. The tocilizumab group had less ICU admissions (10.3% vs. 27.6%, P=0.005) and need of invasive ventilation (0 vs 13.8%, P=0.001). In the multivariable analysis, tocilizumab remained as a protective variable (OR: 0.03, CI 95%: 0.007-0.1, P=0.0001) of ICU admission or death. Conclusions Tocilizumab in early stages of the inflammatory flare could reduce an important number of ICU admissions and mechanical ventilation. The mortality rate of 10.3% among patients receiving tocilizumab appears to be lower than other reports. This is a non-randomized study and the results should be interpreted with caution.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - A Soriano
- Alex Soriano, Department of Infectious Diseases, Hospital Clínic of Barcelona. Carrer de Villarroel 170, 08036, Barcelona, Spain.
| |
Collapse
|
3
|
Inciarte A, Leal L, González E, León A, Lucero C, Mallolas J, Torres B, Laguno M, Rojas J, Martínez-Rebollar M, González-Cordón A, Cruceta A, Arnaiz JA, Gatell JM, García F. Tenofovir disoproxil fumarate/emtricitabine plus ritonavir-boosted lopinavir or cobicistat-boosted elvitegravir as a single-tablet regimen for HIV post-exposure prophylaxis. J Antimicrob Chemother 2018; 72:2857-2861. [PMID: 29091217 DOI: 10.1093/jac/dkx246] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 06/22/2017] [Indexed: 02/07/2023] Open
Abstract
Objectives To assess HIV-1 post-exposure prophylaxis (PEP) non-completion at day 28, comparing ritonavir-boosted lopinavir versus cobicistat-boosted elvitegravir as a single-tablet regimen (STR), using tenofovir disoproxil fumarate/emtricitabine with both of these therapies. Methods A prospective, open, randomized clinical trial was performed. Individuals attending the emergency room due to potential sexual exposure to HIV and who met criteria for PEP were randomized 1:3 into two groups receiving either 400/100 mg of lopinavir/ritonavir (n = 38) or 150/150 mg of elvitegravir/cobicistat (n = 119), with both groups also receiving 245/200 mg of tenofovir disoproxil fumarate/emtricitabine. Five follow-up visits were scheduled at days 1, 10, 28, 90 and 180. The primary endpoint was PEP non-completion at day 28. Secondary endpoints were adherence, adverse effects and rate of seroconversions. Clinical trials.gov number: NCT08431173. Results Median age was 32 years and 95% were males. PEP non-completion at day 28 was 36% (n = 57), with a trend to be higher in the lopinavir/ritonavir arm [lopinavir/ritonavir 47% (n = 18) versus elvitegravir/cobicistat 33% (n = 39), P = 0.10]. We performed a modified ITT analysis including only those patients who attended on day 1. PEP non-completion in this subgroup was higher in the lopinavir/ritonavir arm than in the elvitegravir/cobicistat arm (33% versus 15%, respectively, P = 0.04). Poor adherence was significantly higher in the lopinavir/ritonavir arm versus the elvitegravir/cobicistat arm (47% versus 9%, respectively, P < 0.0001). Adverse events were reported by 73 patients (59%), and were significantly more common in the lopinavir/ritonavir arm (90% versus 49%, P = 0.0001). A seroconversion was observed in the elvitegravir/cobicistat arm in a patient with multiple exposures before and after PEP. Conclusions A higher PEP non-completion, poor adherence and adverse events were observed in patients allocated to the lopinavir/ritonavir arm, suggesting that STR elvitegravir/cobicistat is a well-tolerated antiretroviral for PEP.
Collapse
Affiliation(s)
- A Inciarte
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - L Leal
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - E González
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - A León
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - C Lucero
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J Mallolas
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - B Torres
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - M Laguno
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J Rojas
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - M Martínez-Rebollar
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - A González-Cordón
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - A Cruceta
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J A Arnaiz
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J M Gatell
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - F García
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | |
Collapse
|
4
|
González-Cordón A, Doménech M, Camafort M, Martínez-Rebollar M, Torres B, Laguno M, Rojas J, Loncà M, Blanco JL, Mallolas J, Gatell JM, de Lazzari E, Martínez E. Subclinical cardiovascular disease in patients starting contemporary protease inhibitors. HIV Med 2018; 19:497-503. [PMID: 29745457 DOI: 10.1111/hiv.12619] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the study was to assess changes in and factors associated with anatomical [carotid artery intima-media thickness (CIMT)] and functional (arterial stiffness) markers of subclinical cardiovascular disease progression in antiretroviral-naïve patients starting triple combination antiretroviral therapy containing contemporary protease inhibitors. METHODS This was a planned substudy of the ATADAR (Metabolic Effects of Atazanavir/Ritonavir Versus Darunavir/Ritonavir in Combination With Tenofovir/Emtricitabine in naïve HIV-1 Infected Patients) clinical trial (ClinicalTrials.gov identifier NCT01274780). ATADAR is a multicentre, randomized, open-label clinical trial comparing the effects of ritonavir-boosted atazanavir and darunavir, both with tenofovir/emtricitabine, in antiretroviral-naïve HIV-infected patients. Common CIMT and aortic augmentation index (AIx@75) were measured at baseline and after 12 months of follow-up. Antiretroviral treatment, traditional cardiovascular risk factors and HIV-related factors were assessed as potential predictors of CIMT and Aix@75 changes using linear regression analysis. RESULTS Thirty-three patients were included in this pilot study. While CIMT significantly increased in the pooled population [median (interquartile range (IQR)) 68 (-13, 128) μm; P = 0.0511], AIx@75 did not [median (IQR) 1 (-6, 5)%; P = 0.8964]. Patients on darunavir showed a trend to faster CIMT progression than those on atazanavir [median change (IQR) 117 (-2, 143) vs. -6 (-58, 89) μm, respectively; P = 0.0917]. However, after adjustment in the multivariate analysis, a higher baseline Framingham score was the only factor associated with CIMT progression (coefficient 16.02; 95% confidence interval -1.04, 33.08; P = 0.064). AIx@75 change was not associated with any baseline factor. CONCLUSIONS CIMT was a more sensitive marker of subclinical vascular disease progression than arterial stiffness in antiretroviral-naïve patients starting antiretroviral therapy with contemporary protease inhibitors. Classical risk factors but not antiretroviral therapy were associated with faster CIMT progression.
Collapse
Affiliation(s)
- A González-Cordón
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - M Doménech
- Cardiovascular, Nutrition and Aging Group, Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M Camafort
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBEROBN, Instituto de Salud Carlos III, Madrid, Spain
| | - M Martínez-Rebollar
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - B Torres
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - M Laguno
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - J Rojas
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - M Loncà
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - J L Blanco
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - J Mallolas
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - J M Gatell
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - E de Lazzari
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - E Martínez
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| |
Collapse
|
5
|
Combalia A, To‐Figueras J, Laguno M, Martínez‐Rebollar M, Aguilera P. Direct‐acting antivirals for hepatitis C virus induce a rapid clinical and biochemical remission of porphyria cutanea tarda. Br J Dermatol 2017; 177:e183-e184. [DOI: 10.1111/bjd.15502] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. Combalia
- Dermatology Unit Hospital Clínic de Barcelona Universitat de Barcelona Barcelona Spain
| | - J. To‐Figueras
- Biochemistry and Molecular Genetics UnitHospital Clínic de Barcelona Universitat de Barcelona Barcelona Spain
| | - M. Laguno
- Infectious Diseases Unit Hospital Clínic de Barcelona Universitat de Barcelona Barcelona Spain
| | - M. Martínez‐Rebollar
- Infectious Diseases Unit Hospital Clínic de Barcelona Universitat de Barcelona Barcelona Spain
| | - P. Aguilera
- Dermatology Unit Hospital Clínic de Barcelona Universitat de Barcelona Barcelona Spain
| |
Collapse
|
6
|
Aguilera P, Laguno M, To-Figueras J. Treatment of chronic hepatitis with boceprevir leads to remission of porphyria cutanea tarda. Br J Dermatol 2014; 171:1595-6. [DOI: 10.1111/bjd.13376] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- P. Aguilera
- Department of Dermatology; Hospital Clinic; IDIBAPS; University of Barcelona; Barcelona Spain
| | - M. Laguno
- Department of Infectious Diseases ; Hospital Clinic; IDIBAPS; University of Barcelona; Barcelona Spain
| | - J. To-Figueras
- Department of Biochemistry and Molecular Genetics; Hospital Clinic; IDIBAPS; University of Barcelona; Barcelona Spain
| |
Collapse
|
7
|
Calvo-Sánchez M, Perelló R, Pérez I, Mateo MG, Junyent M, Laguno M, Blanco JL, Martínez-Rebollar M, Sánchez M, Mallolas J, Gatell JM, Domingo P, Martínez E. Differences between HIV-infected and uninfected adults in the contributions of smoking, diabetes and hypertension to acute coronary syndrome: two parallel case-control studies. HIV Med 2012; 14:40-8. [PMID: 23088307 DOI: 10.1111/j.1468-1293.2012.01057.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2012] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The aim of the study was to assess the separate contributions of smoking, diabetes and hypertension to acute coronary syndrome (ACS) in HIV-infected adults relative to uninfected adults. METHODS Two parallel case-control studies were carried out. In the first study, HIV-positive adults diagnosed with ACS between 1997 and 2009 (HIV+/ACS) were matched for age, gender and known duration of HIV infection with HIV-positive adults without ACS (HIV+/noACS), each individual in the HIV+/ACS group being matched with three individuals in the HIV+/noACS group. In the second study, each individual in the HIV+/ACS group in the first study was matched for age, gender and calendar date of ACS diagnosis with three HIV-negative individuals diagnosed with ACS between 1997 and 2009 (HIV-/ACS). Each individual in the HIV-/ACS group was then matched for age and gender with an HIV-negative adult without ACS (HIV-/noACS). After matching, the ratio of numbers of individuals in the HIV+/ACS, HIV+/noACS, HIV-/ACS and HIV-/noACS groups was therefore 1 : 3 : 3 : 3, respectively. We performed logistic regression analyses to identify risk factors for ACS in each case-control study and calculated population attributable risks (PARs) for smoking, diabetes and hypertension in HIV-positive and HIV-negative individuals. RESULTS There were 57 subjects in the HIV+/ACS group, 173 in the HIV+/noACS group, 168 in the HIV-/ACS group, and 171 in the HIV-/noACS group. Independent risk factors for ACS were smoking [odds ratio (OR) 4.091; 95% confidence interval (CI) 2.086-8.438; P < 0.0001] and a family history of cardiovascular disease (OR 7.676; 95% CI 1.976-32.168; P = 0.0003) in HIV-positive subjects, and smoking (OR 4.310; 95% CI 2.425-7.853; P < 0.0001), diabetes (OR 5.778; 95% CI 2.393-15.422; P = 0.0002) and hypertension (OR 6.589; 95% CI 3.554-12.700; P < 0.0001) in HIV-negative subjects. PARs for smoking, diabetes and hypertension were 54.35 and 30.58, 6.57 and 17.24, and 9.07 and 38.81% in HIV-positive and HIV-negative individuals, respectively. CONCLUSIONS The contribution of smoking to ACS in HIV-positive adults was generally greater than the contributions of diabetes and hypertension, and was almost twice as high as that in HIV-negative adults. Development of effective smoking cessation strategies should be prioritized to prevent cardiovascular disease in HIV-positive adults.
Collapse
Affiliation(s)
- M Calvo-Sánchez
- Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Leon A, Martinez E, Milinkovic A, Mora B, Mallolas J, Blanco JL, Larrousse M, Laguno M, Gallart T, Plana M, Gatell JM, Garcia F. Influence of repeated cycles of structured therapy interruption on the rate of recovery of CD4+ T cells after highly active antiretroviral therapy resumption. J Antimicrob Chemother 2008; 63:184-8. [DOI: 10.1093/jac/dkn461] [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: 11/13/2022] Open
|
9
|
Martínez E, Milinkovic A, Buira E, de Lazzari E, León A, Larrousse M, Loncá M, Laguno M, Blanco JL, Mallolas J, García F, Miró JM, Gatell JM. Incidence and causes of death in HIV-infected persons receiving highly active antiretroviral therapy compared with estimates for the general population of similar age and from the same geographical area. HIV Med 2007; 8:251-8. [PMID: 17461853 DOI: 10.1111/j.1468-1293.2007.00468.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Since the introduction of highly active antiretroviral therapy (HAART), the incidence of death in HIV-infected patients has dramatically decreased, and causes of death other than those related to HIV infection have increased, although it is unclear how these parameters compare with those in the age-matched general population living in the same geographical region. METHODS Consecutive HIV-infected adults who were prescribed HAART in our hospital were prospectively followed from January 1997 to December 2004 or until death, loss to follow-up or discontinuation of HAART. Estimations of the annual incidence and causes of death in the general population of similar age in Catalonia per calendar year in the study period were obtained and compared with those in the HIV-infected cohort. RESULTS There were 235 deaths among the 4471 patients on HAART (5%). The incidence of mortality decreased over time in HIV-infected patients (P<0.001; chi(2) test for trend), although it has remained approximately five times higher than that for the age-matched general population. AIDS-related events were the most common cause of death (n=95; 40%), although they significantly decreased over time (P<0.001; chi(2) test for trend), whereas liver diseases (P<0.001; chi(2) test for trend) and non-AIDS-defining infections (P=0.008; chi(2) test for trend) significantly increased over time. Infections in general (33 times higher), liver diseases (11 times higher) and non-Hodgkin lymphoma (5 times higher) were overrepresented as causes of death in the HIV-infected cohort compared with the age-matched general population. CONCLUSIONS Non-AIDS-defining infectious diseases, liver diseases, and non-Hodgkin lymphoma represent specific targets for efforts to further decrease mortality in HIV-infected patients receiving HAART.
Collapse
Affiliation(s)
- E Martínez
- Infectious Diseases Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic Universitari, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Ramos-Casals M, Forns X, Brito-Zerón P, Vargas A, Ruiz M, Laguno M, Yagüe J, Sánchez-Tapias JM, Gatell JM, Font J. Cryoglobulinaemia associated with hepatitis C virus: influence of HCV genotypes, HCV-RNA viraemia and HIV coinfection. J Viral Hepat 2007; 14:736-42. [PMID: 17875009 DOI: 10.1111/j.1365-2893.2007.00866.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
To determine whether the clinical and immunological expression of patients with cryoglobulinaemia associated with chronic hepatitis C virus (HCV) infection varied according to HCV-RNA load, HCV genotype or human immunodeficiency virus (HIV) coinfection. We studied 340 HCV patients (188 women and 152 men, with a mean age of 49 years) consecutively diagnosed with cryoglobulinaemia between 1993 and 2003 in our hospital. HCV infection was confirmed by serum HCV-RNA determination in all patients. Two hundred and forty-eight (73%) patients had asymptomatic cryoglobulinaemia and 92 (27%) presented cryoglobulinaemic symptoms. Patients with genotype 1 had a higher mean age at diagnosis of cryoglobulinaemia (48.2 vs 40.2 yrs, P < 0.001) and a higher prevalence of cryoglobulinaemic symptoms (25%vs 10%, P = 0.02), especially of vasculitic features (19%vs 5%, P = 0.014). In comparison with monoinfected HCV patients, those with HIV coinfection had a lower mean age at diagnosis of cryoglobulinaemia (40.4 vs 52.8 years, P < 0.001), a lower prevalence of cryoglobulinaemic symptoms (15%vs 34%, P < 0.001), vasculitis (10%vs 28%, P < 0.001), associated systemic autoimmune disease (3%vs 14%, P = 0.001), rheumatoid factor (30%vs 70%, P = 0.001) and hypocomplementaemia (50%vs 78%, P = 0.01). In HCV-HIV patients, a high viral load was associated with a high frequency of symptomatic cryoglobulinaemia, especially in patients with a high viral load of the two viruses (50%vs 7%, P = 0.001) A higher frequency of cryoglobulinaemic symptoms (especially vasculitis) was found in patients with HCV monoinfection and in those carrying HCV genotype 1. In contrast, patients with HIV coinfection presented a threefold lower prevalence of vasculitis. Associated HIV infection significantly attenuated the clinical and immunological expression of cryoglobulinaemia, except in coinfected patients with high viral loads for the two viruses.
Collapse
Affiliation(s)
- M Ramos-Casals
- Department of Autoimmune Diseases, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
León A, Martinez E, Sarasa M, López Y, Mallolas J, De Lazzari E, Laguno M, Milincovic A, Blanco JL, Larrousse M, Lonca M, Gatell JM. Impact of steady-state lopinavir plasma levels on plasma lipids and body composition after 24 weeks of lopinavir/ritonavir-containing therapy free of thymidine analogues. J Antimicrob Chemother 2007; 60:824-30. [PMID: 17712031 DOI: 10.1093/jac/dkm285] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To study the impact of lopinavir/ritonavir-containing therapy on plasma lipids and body fat of HIV-infected adults and to assess whether lopinavir plasma levels at steady state are correlated with plasma lipids and body fat after 24 weeks. METHODS Patients had their antiretroviral therapy switched to an antiretroviral regimen containing lopinavir/ritonavir plus one or two non-thymidine analogues. Body composition was assessed by dual energy X-ray absorptiometry at baseline and at week 24 and an intensive pharmacokinetic (PK) 12 h profile was performed at week 2. RESULTS Twenty-six patients were included. Plasma triglycerides (from 206 mg/dL to 261 mg/dL, P = 0.09) and total cholesterol (from 201 to 206 mg/dL, P = 0.03) increased from baseline to week 24. There was a significant rise in total fat (from 10.9 to 11.9 kg, P = 0.02) and limb fat (from 3.8 to 4.4 kg, P = 0.02) from baseline to week 24. We did not find any correlation between PK lopinavir levels and changes over time for triglycerides, cholesterol or body fat composition. CONCLUSIONS There was an increase in plasma triglycerides and total cholesterol levels and a gain in both total and limb fat at 24 weeks, but these changes were not correlated with lopinavir plasma levels.
Collapse
Affiliation(s)
- A León
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Blanco JL, Biglia A, Martinez E, Sánchez M, de Lazzari E, Leon A, Milinkovic A, Larrousse M, Lonca M, Laguno M, Mallolas J, Gatell JM. Intrathoracic fat in HIV-infected patients. HIV Med 2006; 7:213-7. [PMID: 16630033 DOI: 10.1111/j.1468-1293.2006.00361.x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The impact of HIV infection or antiretroviral therapy on the intrathoracic fat compartment is unknown. METHODS Consecutive clinically stable HIV-infected adult patients, irrespective of exposure to antiretroviral therapy, and non-HIV-infected healthy volunteers, both without clinical evidence of body fat changes consistent with lipodystrophy and adjusted for age, gender and body mass index, were recruited for this study. Thoracic and abdominal fat was assessed by computed tomography and compared between patients and controls. RESULTS There were nine women (33%) and 18 men (67%) in each group. Nineteen patients (70%) had been taking antiretrovirals for a median of 8 months (interquartile range: 6-11). Among the HIV-infected patients, intrathoracic fat (median; interquartile range) did not differ significantly between treated (6.7 cm(2); 4.5-8.3 cm(2)) and untreated (6.9 cm(2); 5.7-10.9 cm(2)) individuals (P=0.288). However, intrathoracic fat content (median; interquartile range) was higher in HIV-infected patients (6.8 cm(2); 5.6-10.5 cm(2)) than in controls (5.6 cm(2); 3.9-6.7 cm(2)) (P=0.025). Intrathoracic fat was positively correlated with intra-abdominal fat both in patients (rho=0.6, P=0.002) and in controls (rho=0.7, P=0.004). CONCLUSION In HIV-infected adults without clinical evidence of lipodystrophy, intrathoracic fat content was higher than in healthy persons and positively correlated with intra-abdominal fat content.
Collapse
Affiliation(s)
- J L Blanco
- Infectious Diseases Unit, Hospital Clinic-Institut d'Investigaciones Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Bäuerle J, Laguno M, Mauss S, Mallolas J, Murillas J, Miquel R, Schmutz G, Setzer B, Gatell JM, Walker UA. Mitochondrial DNA depletion in liver tissue of patients infected with hepatitis C virus: contributing effect of HIV infection? HIV Med 2005; 6:135-9. [PMID: 15807720 DOI: 10.1111/j.1468-1293.2005.00276.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES It has been suggested that chronic hepatitis C virus (HCV) infection depletes mitochondrial DNA (mtDNA) in the liver. Because decreased mtDNA levels were also found in humans infected with HIV, we investigated whether HIV may have aggravated hepatic mtDNA depletion in individuals with HCV infection. METHODS In this cross-sectional study, liver biopsies were performed in a total of 40 individuals prior to any antiviral therapy. The individuals were recruited from the Hospital Clinic, Barcelona and the HIV Centre, Dusseldorf. Seventeen patients were negative for HIV and HCV and were biopsied for liver enzyme elevation of unknown cause (controls), 14 individuals had chronic HCV but no HIV infection, and nine subjects were coinfected with both viruses. mtDNA and liver histology were centrally assessed. RESULTS The groups did not differ with respect to age, gender, liver function tests and HCV viral load, where applicable. mtDNA levels were decreased by 19% in the HCV-monoinfected group (P=0.03) and by 27% in the HIV/HCV-coinfected subjects (P=0.02) compared to controls. The mtDNA content, however, did not differ between individuals with HCV monoinfection and HCV/HIV coinfection (P=0.75). The degrees of liver fibrosis, inflammatory activity or steatosis did not correlate with mtDNA content. CONCLUSIONS Liver mtDNA content is reduced in both HCV-monoinfected and HIV/HCV-coinfected patients. Under the limitations of our study, we could demonstrate only a slight trend towards more pronounced mtDNA depletion in HIV/HCV-coinfected subjects.
Collapse
Affiliation(s)
- J Bäuerle
- Department of Clinical Immunology, Medizinische Universitätsklinik, Freiburg, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Laguno M, Queralt C, Casademont J. [Right pleural effusion as an isolated manifestation of ovarian hyperstimulation syndrome]. Med Clin (Barc) 2000; 115:438. [PMID: 11093850 DOI: 10.1016/s0025-7753(00)71583-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
15
|
Abstract
We report on 7 patients with pacemaker endocarditis diagnosed during the workup of long-standing fever. Persistent positive blood cultures and echocardiography led to the diagnosis in 6 patients whereas autopsy was diagnostic in another. Causative microorganisms were Staphylococcus epidermidis (3), Staphylococcus lugdunensis (1), Pseudomonas aeruginosa (1), Streptococcus bovis (1), and Streptococcus mitis-Streptococcus sanguis (1). Pulmonary embolism was present in nearly 50% of the cases, a figure clearly higher than previously reported. In all but 1 case the initial medical approach was not successful, and thus the pacing system was finally removed. None of the cases relapsed after the removal. We have reviewed the literature regarding pacemaker endocarditis, particularly with respect to treatment.
Collapse
Affiliation(s)
- M Laguno
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Spain
| | | | | | | |
Collapse
|
16
|
Abstract
OBJECTIVES To investigate the clinical presentation, histological findings, and outcome of patients with congenital and metabolic myopathies (CM and MM) in whom the disease was diagnosed in childhood or adulthood. PATIENTS AND METHODS We reviewed the diagnosis of all skeletal muscle biopsies performed by our group between 1984 and 1996 (13 years). All patients with CM and MM of childhood or adult onset were included in the study. Patients with mitochondrial myopathies were excluded because they are multisystemic disorders with a more distinct picture than that observed in other MM. We retrospectively reviewed the clinical history, with special emphasis on the clinical patterns of presentation, histological findings, and outcome. RESULTS Among 1,865 biopsies, 28 (1.5%) fulfilled the diagnostic criteria for CM (seven nemaline myopathies, four multicore myopathies, three centronuclear myopathies) or MM (five adult-onset acid maltase deficiency, three myophosphorylase deficiency, three phosphofructokinase deficiency, two carnitine palmitoyl transferase deficiency, and one carnitine deficiency). In nearly half of the patients, mild stable weakness was the major complaint, whereas in one third muscular symptoms were intermittent and related to exercise. In a small number of cases, a persistently raised serum creatine kinase in an asymptomatic patient was the reason for muscle biopsy. Histological examination of skeletal muscle was highly indicative of a specific muscle disease in 26 of the 28 cases. After a mean follow-up of 7 years, the outcome has generally been good, and in most patients the myopathy did not worsen, most remaining ambulatory. CONCLUSION CM and MM presenting in childhood or adulthood are infrequent; the symptoms are usually mild or moderate, and the prognosis generally is good.
Collapse
MESH Headings
- Adolescent
- Adult
- Age of Onset
- Aged
- Biopsy
- Carnitine/deficiency
- Carnitine O-Palmitoyltransferase/deficiency
- Child
- Child, Preschool
- Creatine Kinase/blood
- Female
- Follow-Up Studies
- Glycogen Storage Disease Type VII/metabolism
- Glycogen Storage Disease Type VII/pathology
- Humans
- Male
- Microscopy, Electron
- Middle Aged
- Muscle Fibers, Skeletal/enzymology
- Muscle Fibers, Skeletal/pathology
- Muscle Fibers, Skeletal/ultrastructure
- Muscle, Skeletal/enzymology
- Muscle, Skeletal/pathology
- Muscular Disorders, Atrophic/congenital
- Muscular Disorders, Atrophic/metabolism
- Muscular Disorders, Atrophic/pathology
- Myopathies, Nemaline/metabolism
- Myopathies, Nemaline/pathology
- Phosphorylases/deficiency
- Prognosis
- Recovery of Function
- Retrospective Studies
- alpha-Glucosidases/deficiency
Collapse
Affiliation(s)
- O Miró
- Department of Internal Medicine, Hospital Clínic, August Pi i Sunyer Biomedical Research Institute, Medical School, University of Barcelona, Catalonia, Spain
| | | | | | | | | | | |
Collapse
|
17
|
Miró O, Laguno M, Grau JM. Survival of patients with polymyositis/dermatomyositis and pulmonary involvement. J Rheumatol 1999; 26:1852-4. [PMID: 10451094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
|
18
|
|
19
|
Miró O, Laguno M, Alonso JR, Casademont J, Herrero C, Selva A, Urbano-Márquez A, Grau JM. [Clinical course of idiopathic inflammatory myopathies: complications, survival and prognostic factors]. Med Clin (Barc) 1999; 112:521-6. [PMID: 10363237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVES To describe the clinical and epidemiological characteristics, complications, survival and prognostic factors of a series of patients with idiopathic inflammatory myopathy (IIM) diagnosed with homogeneous criteria in the same center. PATIENTS AND METHODS Patients with the diagnosis of IIM during an inclusion period of 20 years were studied. They were classified following the criteria of Bohan and Peter, and Dalakas. Epidemiological, clinical and therapeutical data were obtained in all cases. Evolution and survival were analyzed with the Kaplan-Meier and Cox multiple regression models. RESULTS One-hundred thirty-five patients with IIM were included in the study: 32 polymyositis (PM), 90 dermatomyositis (DM) and 13 inclusion body myositis (IBM). Forty-six percent presented some complications attributed to the disease or treatment, and 10 with PM, 29 with DM and 3 with IBM died during the follow-up. The probabilities of survival were 86% the first year, 80% the second year, 71% the fifth year, and 57% the tenth year. Infections and cancer were the main death causes. While survival analyses did not show independent risk factors for PM, advanced age, presence of associated neoplasm, raised erythrocyte sedimentation rate (ESR) and muscle relapse were identified as a poor prognostic indicators for DM, whereas raised ESR and long lasting symptoms prior to diagnosis of the myopathy were for IBM. CONCLUSION In spite of the therapeutic advances, IIM are still diseases with high mortality and morbidity.
Collapse
Affiliation(s)
- O Miró
- Grup d'Investigació Muscular, Servei de Medicina Interna, Hospital Clínic i Provincial
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Miró O, Cebrián M, Laguno M, Pedrol E, Casademont J, Grau JM. ["Multicore" myopathy: report of 5 cases]. Med Clin (Barc) 1997; 108:739-43. [PMID: 9324599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Five cases (three of them from a same family) of multicore myopathy are presented. The age at diagnosis ranged from 4 to 38 years. In 2 cases muscle complaints developed early in childhood while in the remaining 3 cases raised CK serum levels lead to perform a muscle biopsy. Malignant hyperthermia occurred in a young boy among the three affected relatives. Other family members are probably affected, suggesting an autosomal dominant inheritance. In none of the patients progressive disabling myopathy has occurred after a long term follow-up. A review of the bibliography is included, and clinical and evolutive characteristics of this myopathy are commented.
Collapse
Affiliation(s)
- O Miró
- Grup d'Investigació Muscular, Servei de Medicina Interna, Hospital Clínic i Provincial, Universitat de Barcelona
| | | | | | | | | | | |
Collapse
|