1
|
Torralba M, Rodríguez G, González Gasca FJ, Cuadra F, Barberá J, Geijo P, Silva A, García MI, Ostaiza MA, García Pérez AM, Arroyo E, Larrubia JR, Gutiérrez A, Porras ML, Calvo Sánchez H, Peña-Asensio J, Arias JG, Mendoza I. Bictegravir/Emtricitabine/Tenofovir Alafenamide in a Multicentre Cohort: Real-Life Experience From Spain. Ann Pharmacother 2024; 58:140-147. [PMID: 37131300 DOI: 10.1177/10600280231168852] [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] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND The evaluation of bictegravir, emtricitabine, and tenofovir alafenamide (BIC/FTC/TAF) in clinical trials has shown high rates of virological suppression but information about its use in real-life settings is scarce. OBJECTIVE To evaluate the effectiveness, safety, durability, and predictive variables of therapeutic failure of BIC/FTC/TAF in a real-life cohort. METHODS This observational, retrospective, multicentered cohort study included treatment-naive (TN) and treatment-experienced (TE) adult patients living with HIV (PLWH) who started treatment with BIC/FTC/TAF from January 1, 2019, to January 31, 2022. Treatment effectiveness (based on intention-to-treat [ITT], modified ITT [mITT], and on-treatment [OT]), tolerability, and safety were evaluated in all patients who started BIC/FTC/TAF antiretroviral therapy. RESULTS We included a total of 505 PLWH of whom 79 (16.6%) were TN and 426 (83.4%) were TE. Patients were followed up for a median (interquartile range [IQR]) of 19.6 (9.6-27.3) months, and 76% and 56% of PLWH reached month 6 and month 12 of treatment, respectively. Rates of TN PLWH with HIV-RNA <50 copies/mL in the OT, mITT, and ITT groups were 94%, 80%, and 62%, respectively, after 12 months of BIC/FTC/TAF treatment. Rates of TE PLWH with HIV-RNA <50 copies/mL were 91%, 88%, and 75% at month 12. The multivariate analysis revealed that neither age, sex, CD4 cell count <200 cells/μL, or viral load >100 000 copies/mL were associated with therapeutic failure. CONCLUSION AND RELEVANCE Our real-life data showed that BIC/FTC/TAF is effective and safe for use in the treatment of both TN and TE patients in clinical practice.
Collapse
Affiliation(s)
- Miguel Torralba
- Servicio de Medicina Interna, Hospital Universitario de Guadalajara, Guadalajara, Spain
- Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Madrid, Spain
| | - Gema Rodríguez
- Servicio de Medicina Interna, Hospital General Universitario de Albacete, Albacete, Spain
| | | | - Fernando Cuadra
- Servicio de Medicina Interna, Hospital Universitario de Toledo, Toledo, Spain
| | - José Barberá
- Servicio de Medicina Interna, Hospital General La Mancha-Centro, Ciudad Real, Spain
| | - Paloma Geijo
- Servicio de Medicina Interna, Hospital General Virgen de la Luz, Cuenca, Spain
| | - Andrea Silva
- Servicio de Medicina Interna, Hospital Nuestra Señora del Prado, Talavera de la Reina, Spain
| | | | | | - Ana María García Pérez
- Servicio de Medicina Interna, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Esther Arroyo
- Servicio de Medicina Interna, Hospital General La Mancha-Centro, Ciudad Real, Spain
| | - Juan Ramón Larrubia
- Servicio de Gastroenterología, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Almudena Gutiérrez
- Servicio de Medicina Interna, Hospital General Universitario de Albacete, Albacete, Spain
| | - María Lourdes Porras
- Servicio de Medicina Interna, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Henar Calvo Sánchez
- Servicio de Gastroenterología, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Julia Peña-Asensio
- Departamento de Biología de Sistemas, Universidad de Alcalá, Alcala de Henares, Spain
| | - Julio Gabriel Arias
- Servicio de Medicina Interna, Hospital General Universitario de Albacete, Albacete, Spain
| | - Inés Mendoza
- Servicio de Farmacia Hospitalaria, Hospital Universitario de Guadalajara, Guadalajara, Spain
| |
Collapse
|
2
|
Corma-Gómez A, Macías J, Téllez F, Morano L, Rivero A, Serrano M, Ríos MJ, Vera-Méndez FJ, Santos M, Real LM, Palacios R, Santos IDL, Geijo P, Imaz A, Merino D, Galindo MJ, Reus-Bañuls S, López-Ruz MÁ, Galera C, Pineda JA. Kinetics of emergence of liver complications in hepatitis C virus infected patients and advanced fibrosis, with and without HIV-coinfection, after sustained virological response. AIDS 2021; 35:2119-2127. [PMID: 34049354 DOI: 10.1097/qad.0000000000002959] [Citation(s) in RCA: 2] [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: 02/07/2023]
Abstract
OBJECTIVE There is scarce available evidence on the distribution over time of liver complications emergence in hepatitis C virus (HCV)-infected patients who achieve sustained virological response (SVR) with direct-acting antiviral (DAA)-based therapy. Therefore, we aimed at describing the kinetics of liver-related events appearance in this setting. DESIGN A multicentric prospective cohort study. METHODS HCV-monoinfected and HIV/HCV-coinfected patients from GEHEP-011 cohort, whose inclusion criteria were had achieved SVR with DAA-based therapy; liver stiffness prior to starting treatment at least 9.5 kPa; and available liver stiffness measurement at SVR. SVR was considered as the baseline time-point. RESULTS One thousand and thirty-five patients were included, 664 (64%) coinfected with HIV. Before DAA-based therapy, 63 (6.1%) individuals showed decompensated cirrhosis. After SVR, 51 (4.9%) patients developed liver complications. Median (Q1-Q3) time to the emergence of hepatic events was hepatic encephalopathy 11 (7-24) months, ascites 14 (6-29) months, hepatocellular carcinoma (HCC) 17 (11-42) months and portal hypertension gastrointestinal bleeding (PHGB) 28 (22-38) months (P = 0.152). We define two profiles of liver complications: those emerging earlier (encephalopathy and ascites) and, those occurring continuously during the follow-up (HCC, PHGB) [median (Q1-Q3) time to emergence 12.7 (6.6-28.2) months vs. 25.4 (12.5-41.53) months, respectively (P = 0.026)]. CONCLUSION The vast majority of HCV-infected patients who develop liver complications after reaching SVR with DAA do it within 3 years after SVR time-point. Specifically, hepatic encephalopathy and ascites do not usually emerge after this period. Conversely, HCC and PHGB may occur in longer term. It is critical to identify patients at risk of developing hepatic events to continue performing surveillance for them.
Collapse
Affiliation(s)
- Anaïs Corma-Gómez
- Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme, Seville
| | - Juan Macías
- Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme, Seville
| | - Francisco Téllez
- Unit of Infectious Diseases, Hospital Universitario de Puerto Real, Faculty of Medicine, Cadiz
| | - Luis Morano
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo
| | - Antonio Rivero
- Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Córdoba
| | - Miriam Serrano
- Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria
| | - María José Ríos
- Unit of Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla
| | - Francisco Jesús Vera-Méndez
- Section of Infectious Medicine/Service of Internal Medicine, Hospital General Universitario Santa Lucía, Cartagena
| | - Marta Santos
- Unit of Internal Medicine, Hospital Universitario del SAS de Jerez, Cadiz
| | - Luis Miguel Real
- Unit of Immunology, Biochemistry, Molecular Biology and Surgery, Faculty of Medicine, Universidad de Málaga
| | - Rosario Palacios
- Unit of Infectious Diseases and Microbiology, Hospital Virgen de la Victoria, Málaga
| | | | - Paloma Geijo
- Unit of Infectious Diseases, Hospital Virgen de la Luz, Cuenca
| | - Arkaitz Imaz
- HIV and STI Unit, Department of Infectious Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona
| | - Dolores Merino
- Unit of Infectious Diseases, Hospital Juan Ramón Jiménez, Huelva
| | - Maria José Galindo
- Unit of Infectious Diseases, Hospital Clínico Universitario de Valencia, Valencia
| | - Sergio Reus-Bañuls
- Unit of Infectious Diseases, Hospital General Universitario de Alicante, Alicante
| | | | - Carlos Galera
- Unit of Infectious Diseases, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Juan A Pineda
- Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme, Seville
| |
Collapse
|
3
|
Teira R, Diaz-Cuervo H, Aragão F, Muñoz J, Galindo P, Merino M, de la Fuente B, Sepúlveda MA, Domingo P, García J, Castaño M, Ribera E, Geijo P, Romero A, Peraire J, Deig E, Roca B, Martínez E, Estrada V, Montero M, Berenguer J, Espinosa N. eGFR-EPI changes among HIV patients who switch from F/TDF to F/TAF while maintaining the same third agent in the Spanish VACH cohort. HIV Res Clin Pract 2021; 22:78-85. [PMID: 34410219] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background: Evidence from clinical practice on the effects of switching from emtricitabine/tenofovir disoproxil fumarate (F/TDF) to emtricitabine/tenofovir alafenamide (F/TAF)-based triple-therapy (TT) regimens on renal parameters is limited.Objective: This retrospective analysis evaluated the effects on renal function of switching from F/TDF to F/TAF-based TT regimens with no change in third agent among people living with HIV (PLWH).Methods: Data were from a multicenter Spanish PLWH cohort. Patients with a baseline estimated glomerular filtration rate (eGFR-EPI) measurement, ≥1 follow-up measurement, ≥30 days treatment with F/TAF, and who switched from F/TDF to F/TAF with no change in third agent were included. Multivariate mixed linear models were used to evaluate change from baseline over time in eGFR-EPI. eGFR-EPI changes before and after switch were analyzed in a matched patient subgroup.Results: Overall, 340 patients were included. Mean (95% CI) eGFR-EPI in patients with baseline eGFR-EPI <90 ml/min/1.73m2 (n = 125) was 79.6 (78.0; 81.2) ml/min/1.73m2 at baseline and 81.3 (79.9; 82.7) ml/min/1.73m2 at 12 months after switch. In the patient-matched subgroup (n = 175), median annual eGFR-EPI declined -4.24 ml/min/1.73m2 while on F/TDF and increased +0.93 ml/min/1.73m2 after switch to F/TAF (P < 0.0001). In patients with baseline eGFR-EPI <90 ml/min/1.73m2, median annual eGFR-EPI increased +4.19 mL/min/1.73m2 after switch (P < 0.0001).Conclusion: Switching from F/TDF to F/TAF-based TT regimens while maintaining the same third agent numerically improved eGFR-EPI in PLWH with baseline eGFR-EPI <90 mL/min/1.73m2. eGFR-EPI improved significantly when comparing progression while on F/TDF vs progression after switch, confirming beneficial renal effects of switching to F/TAF in a clinical practice setting.
Collapse
Affiliation(s)
- Ramón Teira
- Hospital Universitario de Sierrallana, Torrelavega, Spain
| | | | - Filipa Aragão
- Maple Health Group, LLC, New York, NY, USA
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Josefa Muñoz
- Hospital Universitario de Basurto, Bilbao, Spain
| | | | | | | | | | - Pere Domingo
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Josefina García
- Hospital General Universitario Santa Lucia, Cartagena, Spain
| | | | - Esteve Ribera
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | | | | | | | - Marta Montero
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Juan Berenguer
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | |
Collapse
|
4
|
Teira R, Diaz-Cuervo H, Aragão F, Marguet S, de la Fuente B, Muñoz MJ, Abdulghani N, Ribera E, Domingo P, Deig E, Peraire J, Roca B, Montero M, Galindo MJ, Romero A, Espinosa N, Lozano F, Merino MD, Martínez E, Geijo P, Estrada V, García J, Sepúlveda MA, Berenguer J. Real world effectiveness of standard of care triple therapy versus two-drug combinations for treatment of people living with HIV. PLoS One 2021; 16:e0249515. [PMID: 33831047 PMCID: PMC8031389 DOI: 10.1371/journal.pone.0249515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background Since 1996, the standard of care (SOC) therapy for HIV treatment has consisted of a backbone of two nucleoside analogue reverse transcriptase inhibitors (NRTI) paired with a third agent. Use of two-drug combinations (2DC) has been considered for selected patients to avoid toxicities associated with the use of NRTIs. This study aimed to compare the real-world outcomes of integrase strand transfer inhibitor (INSTI)-containing triple therapy (TT) to dolutegravir- (DTG) and/or boosted protease inhibitor (bPI)-based 2DC in a large Spanish cohort of HIV patients. Methods A retrospective analysis was performed using data from the VACH cohort, a prospective multicentre Spanish cohort of adult HIV patients. All treatment experienced patients initiating a TT of an INSTI combined with two NRTIs or a 2DC-containing DTG and/or a bPI between 01/01/2012 and 01/06/2017 were included. The unit of analysis was patient-regimens. The overall sample analysis was complemented with two sub-analyses. The first sub-analysis focused on patients treated with a backbone plus DTG compared to those treated with DTG+ one other antiretroviral. The second sub-analysis focused on patients with HIV RNA<50 copies/mL at baseline, irrespective of the regimen used. The following endpoints were assessed: time to discontinuation for any reason, time to switch due to virologic failure, and time to switch due to toxicity (reasons for discontinuation according to clinician report in the database). Time-to-event analyses were conducted using Kaplan–Meier survival curves and Cox regression models. Results Overall 7,481 patients were included in the analysis, contributing to 9,243 patient-regimens. Patient characteristics at baseline differed among groups, with the 2DC group being significantly older and having a higher proportion of women, a longer time on ART and a higher number of previous virologic failures. Median (95% Confidence Interval [C.I.]) time to switch was 2.5 years (2.3, 2.7) in 2DC group versus 2.9 years (2.7, 3.0) in TT. Adjusted hazard ratios (95% C.I.) for discontinuation due to any reason, virologic failure and toxicity in the 2DC vs TT group were 1.29 (1.15; 1.44), 2.06 (1.54; 2.77) and 1.18 (0.94; 1.48), respectively. Results were consistent in the two sub-analyses. Conclusion In this analysis, time to discontinuation and probability of remaining free of virologic failure were significantly higher in patients on INSTI-based TT compared to DTG- and/or bPI-containing 2DC, with no differences in toxicity.
Collapse
Affiliation(s)
| | | | - Filipa Aragão
- Maple Health Group, New York, New York, United States of America
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal
- * E-mail:
| | - Sophie Marguet
- Amaris Consulting, Health Economics and Market Access (HEMA), Levallois-Perret, France
| | | | | | | | | | - Pere Domingo
- Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | | | | | - Alberto Romero
- Hospital Universitario de Puerto Real, Puerto Real, Spain
| | | | | | | | | | | | | | | | | | - Juan Berenguer
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| |
Collapse
|
5
|
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.
Collapse
Affiliation(s)
- Bernardino Roca
- Department of Medicine, Hospital General of Castellon, University of Valencia, Castellon, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Podzamczer D, Rozas N, Domingo P, Miralles C, den Eynde EV, Romero A, Deig E, Knobel H, Pasquau J, Antela A, Clotet B, Geijo P, de Castro ER, Casado MA, Muñoz A, Casado A, For The Pro-Str Study Group. Real World Patient-reported Outcomes in HIV-infected Adults Switching to EVIPLERA®, Because of a Previous Intolerance to cART. PRO-STR Study. Curr HIV Res 2019; 16:425-435. [PMID: 30760189 PMCID: PMC6700757 DOI: 10.2174/1570162x17666190212163518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/18/2018] [Revised: 02/07/2019] [Accepted: 02/11/2019] [Indexed: 12/29/2022]
Abstract
Background: To investigate the impact of switching from stable Combined Antiretroviral Therapy (cART) to single-tablet regimen (RPV/FTC/TDF=EVIPLERA®/COMPLERA®) on patient-reported outcomes in HIV-infected adults who cannot tolerate previous cART, in a real-world setting. Methods: PRO-STR is a 48-week observational, prospective, multicenter study. Presence and magnitude of symptoms (main endpoint), health-related quality-of-life (HRQoL), adherence, satisfaction with treatment and patient preferences were assessed. Results: Three hundred patients with 48-week follow-up, who switched to EVIPLERA® (mean age: 46.6 years; male: 74.0%; 74.7% switched from a non-nucleoside reverse-transcriptase-inhibitor, 25.3% from a protease inhibitor + ritonavir) were included. There was no statistical difference in median CD4+ cell count (baseline: 678.5 cells/mm3; 48-week: 683.0 cells/mm3) neither in virological suppression (≤50 copies/mL) (baseline: 98.3%; 48-week: 95.3%). The most frequent reasons for switching were neuropsychiatric (62.3%), gastrointestinal (19.3%) and biochemical/metabolic (19.3%) events. Only 7.7% of patients permanently discontinued therapy. At 48-week, all outcomes showed an improvement compared to baseline. Overall, there was a significant decrease (p-value≤0.05) in number and magnitude of symptoms, while HRQoL, satisfaction and adherence improved significantly. Most patients prefered EVIPLERA® than previous cART. According to the type of intolerance, HRQoL was improved, but only significantly in patients with neuropsychiatric and gastrointestinal symptoms. Adherence improved significantly in patients with metabolic disturbances and satisfaction with EVIPLERA® was higher in the three groups. Conclusion: Switching to EVIPLERA® from non-nucleoside reverse-transcriptase-inhibitor or protease inhibitor-based regimens due to toxicity, improved the presence/magnitude of symptoms, HRQoL, and preference with treatment. EVIPLERA® maintained a virological response, CD4+ cell count and maintained or improved adherence.
Collapse
Affiliation(s)
- D Podzamczer
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - N Rozas
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - P Domingo
- Hospital de la Santa Creu y Sant Pau, Barcelona, Spain
| | - C Miralles
- Hospital Xeral de Vigo, Pontevedra, Spain
| | | | - A Romero
- Hospital de Especialidades de Puerto Real, Cadiz, Spain
| | - E Deig
- Hospital General de Granollers, Barcelona, Spain
| | - H Knobel
- Hospital del Mar, Barcelona, Spain
| | - J Pasquau
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - A Antela
- Complejo Hospitalario Universitario de Santiago, A Coruna, Spain
| | - B Clotet
- Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - P Geijo
- Hospital Virgen de la Luz, Cuenca, Spain
| | | | - M A Casado
- Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain
| | - A Muñoz
- Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain
| | - A Casado
- Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain
| | | |
Collapse
|
7
|
Corma-Gómez A, Morano L, Téllez F, Rivero-Juárez A, Real LM, Alados JC, Ríos-Villegas MJ, Vera-Méndez FJ, Muñoz RP, Geijo P, Macías J, Pineda JA. HIV infection does not increase the risk of liver complications in hepatitis C virus-infected patient with advanced fibrosis, after sustained virological response with direct-acting antivirals. AIDS 2019; 33:1167-1174. [PMID: 30845068 DOI: 10.1097/qad.0000000000002186] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the impact of HIV coinfection on the risk of developing liver-related complications in HCV-infected patients with advanced fibrosis treated with direct-acting antivirals (DAA) after sustained virological response (SVR). DESIGN Prospective cohort study. SETTING Multicenter. SUBJECTS Patients from the GEHEP and HEPAVIR cohorts were selected if they fulfilled the following criteria: treatment against HCV with all oral DAA combination; SVR achievement, defined as undetectable plasma HCV RNA 12 weeks after the end of therapy; pretreatment liver stiffness equal to or higher than 9.5 kPa; liver stiffness measurement at the time of SVR. MAIN OUTCOME MEASURE(S) The primary variable was the time until the development of a liver complication or requiring liver transplant. RESULTS Seven hundred and seventeen patients were included and 507 (71%) were coinfected with HIV. After a median follow-up time of 21 (14-25) months, 15 (2.1%) patients developed a liver complication and/or underwent a liver transplant and 15 (2.0%) died. The probability of remaining free of hepatic complications or transplant at 1 and 2 was, respectively, 99 and 96% in HCV-monoinfected patients and 99 and 98% in coinfected patients (P = 0.648). In a multivariate analysis, in which nonliver-related death was considered as a competing event, HIV coinfection was not associated with the appearance of hepatic complications or requiring liver transplant [hazard ratio = 0.24; 95% CI (0.03-1.93), P = 0.181]. Having presented hepatic decompensation prior to SVR [hazard ratio = 29.06; 95% CI (3.91-216.16), P < 0.001] and the value of liver stiffness at the SVR time-point (hazard ratio = 1.12; 95% CI (1.07-1.18), P < 0.001] were associated with a higher probability of development of liver events. CONCLUSION HIV coinfection is not associated with a higher probability of developing liver complications in HCV-infected patients with advanced fibrosis, who achieved SVR with interferon-free regimens.
Collapse
|
8
|
Berenguer J, Jarrín I, Pérez-Latorre L, Hontañón V, Vivancos MJ, Navarro J, Téllez MJ, Guardiola JM, Iribarren JA, Rivero-Juárez A, Márquez M, Artero A, Morano L, Santos I, Moreno J, Fariñas MC, Galindo MJ, Hernando MA, Montero M, Cifuentes C, Domingo P, Sanz J, Domíngez L, Ferrero OL, De la Fuente B, Rodríguez C, Reus S, Hernández-Quero J, Gaspar G, Pérez-Martínez L, García C, Force L, Veloso S, Losa JE, Vilaró J, Bernal E, Arponen S, Ortí AJ, Chocarro Á, Teira R, Alonso G, Silvariño R, Vegas A, Geijo P, Bisbe J, Esteban H, González-García J. Human Immunodeficiency Virus/Hepatits C Virus Coinfection in Spain: Elimination Is Feasible, but the Burden of Residual Cirrhosis Will Be Significant. Open Forum Infect Dis 2018; 5:ofx258. [PMID: 29354658 PMCID: PMC5767960 DOI: 10.1093/ofid/ofx258] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 09/05/2017] [Accepted: 12/19/2017] [Indexed: 12/13/2022] Open
Abstract
Background We assessed the prevalence of antibodies against hepatitis C virus (HCV-Abs) and active HCV infection in patients infected with human immunodeficiency virus (HIV) in Spain in 2016 and compared the results with those of similar studies performed in 2002, 2009, and 2015. Methods The study was performed in 43 centers during October-November 2016. The sample was estimated for an accuracy of 2% and selected by proportional allocation and simple random sampling. During 2016, criteria for therapy based on direct-acting antiviral agents (DAA) were at least significant liver fibrosis, severe extrahepatic manifestations of HCV, and high risk of HCV transmissibility. Results The reference population and the sample size were 38904 and 1588 patients, respectively. The prevalence of HCV-Abs in 2002, 2009, 2015, and 2016 was 60.8%, 50.2%, 37.7%, and 34.6%, respectively (P trend <.001, from 2002 to 2015). The prevalence of active HCV in 2002, 2009, 2015, and 2016 was 54.0%, 34.0%, 22.1%, and 11.7%, respectively (P trend <.001). The anti-HCV treatment uptake in 2002, 2009, 2015, and 2016 was 23.0%, 48.0%, 59.3%, and 74.7%, respectively (P trend <.001). In 2016, HCV-related cirrhosis was present in 7.6% of all HIV-infected individuals, 15.0% of patients with active HCV, and 31.5% of patients who cleared HCV after anti-HCV therapy. Conclusions Our findings suggest that with universal access to DAA-based therapy and continued efforts in prevention and screening, it will be possible to eliminate active HCV among HIV-infected individuals in Spain in the short term. However, the burden of HCV-related cirrhosis will continue to be significant among HIV-infected individuals.
Collapse
Affiliation(s)
- Juan Berenguer
- Hospital General Universitario Gregorio Marañón/Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Leire Pérez-Latorre
- Hospital General Universitario Gregorio Marañón/Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Víctor Hontañón
- Hospital Universitario La Paz/Instituto de Investigación Sanitaria La Paz, Madrid, Spain
| | | | | | | | | | | | - Antonio Rivero-Juárez
- Hospital Universitario Reina Sofia/Instituto Maimónides de Investigación Biomédica de Córdoba, Spain
| | | | | | - Luis Morano
- Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | | | | | - María C Fariñas
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - María A Hernando
- Universidad Europea/Instituto de Investigación Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Pere Domingo
- Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - José Sanz
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Lourdes Domíngez
- Hospital Universitario 12 de Octubre/ Instituto de Investigación Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sari Arponen
- Hospital Universitario de Torrejón, Torrejón de Ardoz, Spain
| | | | | | | | | | | | - Ana Vegas
- Hospital Infanta Elena, Valdemoro, Spain
| | | | | | | | - Juan González-García
- Hospital Universitario La Paz/Instituto de Investigación Sanitaria La Paz, Madrid, Spain
| | | |
Collapse
|
9
|
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.
Collapse
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
| | | | | |
Collapse
|
10
|
Ruiz-González A, Falguera M, Porcel JM, Martínez-Alonso M, Cabezas P, Geijo P, Boixeda R, Dueñas C, Armengou A, Capdevila JA, Serrano R. C-reactive protein for discriminating treatment failure from slow responding pneumonia. Eur J Intern Med 2010; 21:548-52. [PMID: 21111942 DOI: 10.1016/j.ejim.2010.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [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] [Received: 07/10/2009] [Revised: 03/12/2010] [Accepted: 09/13/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND The management of patients with community-acquired pneumonia (CAP) who fail to improve constitutes a challenge for clinicians. This study investigated the usefulness of C-reactive protein (CRP) changes in discriminating true treatment failure from slow response to treatment. METHODS This prospective multicenter observational study investigated the behavior of plasma CRP levels on days 1 and 4 in hospitalized patients with CAP. We identified non-responding patients as those who had not reached clinical stability by day 4. Among them, true treatment failure and slow response situations were defined when initial therapy had to be changed or not after day 4 by attending clinicians, respectively. RESULTS By day 4, 78 (27.4%) out of 285 patients had not reached clinical stability. Among them, 56 (71.8%) patients were cured without changes in initial therapy (mortality 0.0%), and in 22 (28.2%) patients, the initial empirical therapy needed to be changed (mortality 40.9%). By day 4, CRP levels fell in 52 (92.9%) slow responding and only in 7 (31.8%) late treatment failure patients (p<0.001). A model developed including CRP behavior and respiratory rate at day 4 identified treatment failure patients with an area under the Receiver Operating Characteristic curve of 0.87 (CI 95%, 0.78-0.96). CONCLUSION Changes in CRP levels are useful to discriminate between true treatment failure and slow response to treatment and can help clinicians in management decisions when CAP patients fail to improve.
Collapse
Affiliation(s)
- Agustín Ruiz-González
- Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida, Lleida, Spain.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Diaz A, Diez M, Bleda MJ, Aldamiz M, Camafort M, Camino X, Cepeda C, Costa A, Ferrero O, Geijo P, Iribarren JA, Moreno S, Moreno ME, Labarga P, Pinilla J, Portu J, Pulido F, Rosa C, Santamaría JM, Telenti M, Trapiella L, Trastoy M, Viciana P. Eligibility for and outcome of treatment of latent tuberculosis infection in a cohort of HIV-infected people in Spain. BMC Infect Dis 2010; 10:267. [PMID: 20840743 PMCID: PMC2945350 DOI: 10.1186/1471-2334-10-267] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 09/14/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated the efficacy of treatment for latent tuberculosis infection (TLTBI) in persons infected with the human immunodeficiency virus, but few studies have investigated the operational aspects of implementing TLTBI in the co-infected population.The study objectives were to describe eligibility for TLTBI as well as treatment prescription, initiation and completion in an HIV-infected Spanish cohort and to investigate factors associated with treatment completion. METHODS Subjects were prospectively identified between 2000 and 2003 at ten HIV hospital-based clinics in Spain. Data were obtained from clinical records. Associations were measured using the odds ratio (OR) and its 95% confidence interval (95% CI). RESULTS A total of 1242 subjects were recruited and 846 (68.1%) were evaluated for TLTBI. Of these, 181 (21.4%) were eligible for TLTBI either because they were tuberculin skin test (TST) positive (121) or because their TST was negative/unknown but they were known contacts of a TB case or had impaired immunity (60). Of the patients eligible for TLTBI, 122 (67.4%) initiated TLTBI: 99 (81.1%) were treated with isoniazid for 6, 9 or 12 months; and 23 (18.9%) with short-course regimens including rifampin plus isoniazid and/or pyrazinamide. In total, 70 patients (57.4%) completed treatment, 39 (32.0%) defaulted, 7 (5.7%) interrupted treatment due to adverse effects, 2 developed TB, 2 died, and 2 moved away. Treatment completion was associated with having acquired HIV infection through heterosexual sex as compared to intravenous drug use (OR:4.6; 95% CI:1.4-14.7) and with having taken rifampin and pyrazinamide for 2 months as compared to isoniazid for 9 months (OR:8.3; 95% CI:2.7-24.9). CONCLUSIONS A minority of HIV-infected patients eligible for TLTBI actually starts and completes a course of treatment. Obstacles to successful implementation of this intervention need to be addressed.
Collapse
Affiliation(s)
- Asuncion Diaz
- Unidad de Epidemiología del VIH/SIDA, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Mercedes Diez
- Secretaria del Plan Nacional sobre el sida, Ministerio de Sanidad y Política Social, Madrid, Spain
| | - Maria Jose Bleda
- Unidad de Epidemiología del VIH/SIDA, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Mikel Aldamiz
- Servicio Medicina Interna, Hospital Txagorritxu,Vitoria, Spain
| | - Miguel Camafort
- Servicio Medicina Interna, Hospital Mora d'Ebre, Instituto de Investigación Sanitaria "Pere Virgili", Universidad "Rovira i Virgili", Mora d'Ebre, Spain
| | - Xabier Camino
- Servicio de Enfermedades Infecciosas, Hospital Ntra Sra de Aranzazu, San Sebastián, Spain
| | | | | | - Oscar Ferrero
- Servicio Enfermedades Infecciosas, Hospital de Basurto, Bilbao, Spain
| | - Paloma Geijo
- Servicio Medicina Interna, Hospital Virgen de la Luz, Cuenca, Spain
| | - Jose Antonio Iribarren
- Servicio de Enfermedades Infecciosas, Hospital Ntra Sra de Aranzazu, San Sebastián, Spain
| | - Santiago Moreno
- Servicio de Enfermedades Infeccciosas, Hospital Ramón y Cajal, Madrid, Spain
| | - Maria Elena Moreno
- Servicio de Enfermedades Infeccciosas, Hospital Ramón y Cajal, Madrid, Spain
| | - Pablo Labarga
- Servicio de Medicina Interna, Hospital San Millán, Logroño, Spain
| | - Javier Pinilla
- Servicio de Medicina Interna, Hospital San Millán, Logroño, Spain
| | - Joseba Portu
- Servicio Medicina Interna, Hospital Txagorritxu,Vitoria, Spain
| | | | - Carmen Rosa
- Servicio Medicina Interna, Hospital Virgen de la Luz, Cuenca, Spain
| | | | - Mauricio Telenti
- Unidad de Enfermedades Infecciosas, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Luis Trapiella
- Unidad de Enfermedades Infecciosas, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Monica Trastoy
- Servicio Enfermedades Infecciosas, Hospital Virgen del Rocío, Sevilla, Spain
| | - Pompeyo Viciana
- Servicio Enfermedades Infecciosas, Hospital Virgen del Rocío, Sevilla, Spain
| |
Collapse
|
12
|
Teira R, Suárez-Lozano I, Lozano F, Viciana P, Domingo P, Galindo P, Geijo P, Terrón A, González J, Cosín J, Ribera E, Roca B, García-Alcalde ML, Sánchez T, Muñoz-Sánchez A, Vergara A, López-Aldeguer J, Pedrol E, Vidal F, Garrido M, Santamaría JM. Characteristics and outcome of HIV infection in gypsies in the Spanish VACH Cohort. Enferm Infecc Microbiol Clin 2010; 28:266-72. [PMID: 20129716 DOI: 10.1016/j.eimc.2009.04.018] [Citation(s) in RCA: 4] [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: 12/26/2006] [Accepted: 04/22/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To study the characteristics of HIV infection in the gypsy (Roma) population in Spain, as compared with those of the Caucasian, non-gypsy majority. DESIGN Cross-sectional, historical cohort study from the Spanish VACH Cohort. METHODS Patients attending VACH clinics between 1 June 2004 and 30 November 2004 were classified according to their racial and ethnic origin as "gypsies", Caucasian non-gypsy Spanish natives (CNGN), and "other" (the last being excluded from this study). Their sociodemographic and clinico-epidemiological characteristics were compared, as well as the Kaplan-Meier curves of time to AIDS, or death, or disease progression (either of the 2 outcomes). RESULTS 4819 (48%) of 10,032 cases included in the VACH database were eligible: 210 (4.2%) were gypsies and 4252 (84.8%) were CNGN. Differences were observed in age, household, academic, inmate, marital, and employment history. Injecting drug use had been the most frequent mechanism of transmission in both groups, but to a greater extent among gypsies (72% versus 50%; P<0.000). Sex distribution, CD4 cell counts, and viral loads at the first visit were similar in the 2 groups, as was the percentage of patients with previous AIDS, percentage receiving antiretrovirals, and percentage subsequently starting antiretroviral therapy. Up to 1 April 2005, 416 new AIDS cases and 85 deaths were recorded. The percentage of these outcomes did not differ between groups, but log-rank test showed a shorter time to AIDS and disease progression among gypsies. CONCLUSIONS The sociodemographic characteristics of gypsies, the largest minority in the VACH Cohort, show differences relative to those of CNGN. HIV-related outcomes suggest that gypsies have a poorer prognosis.
Collapse
Affiliation(s)
- Ramón Teira
- Hospital de Sierrallana, Torrelavega, Cantabria, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
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]
|
14
|
Díaz A, Diez M, Bleda MJ, Aldamiz M, Camafort M, Camino X, Cepeda C, Costa A, Ferrero O, Geijo P, Iribarren JA, Moreno S, Moreno ME, Labarga P, Pinilla J, Portu J, Pulido F, Rosa C, Santamaría JM, Telenti M, Trapiella L, Trastoy M, Viciana P. [Factors related to non-prescription of tuberculin skin testing in a cohort of HIV-infected people]. Enferm Infecc Microbiol Clin 2009; 28:215-21. [PMID: 19683364 DOI: 10.1016/j.eimc.2009.06.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Revised: 06/12/2009] [Accepted: 06/19/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Tuberculin skin testing (TST) for tuberculosis (TB) is recommended for all patients with HIV infection because of the known relationship between these two conditions. In this report we analyze the incidence and variables associated with non-prescription of TST in a cohort of HIV-infected people. PATIENTS AND METHODS Longitudinal study conducted between 2000 and 2002 at 10 HIV hospital-based clinics. All HIV-infected patients who had not been regularly followed-up previously in dedicated clinics were identified. Data about TST and other variables related to TB were obtained from the clinical records. We calculated the percentage of patients who did not undergo TST and the associated factors, using odds ratios (ORs) and the 95% CI to investigate associations. A multivariate logistic regression analysis was performed. RESULTS A total of 1242 patients met the inclusion criteria. TST was not performed in 185 patients (17.6% of those eligible). The fact of being an intravenous drug abuser was associated with a higher probability of TST non-prescription (OR: 2.6, 95% CI 1.1-6.5), whereas being unemployed (OR: 0.6, 95% CI 0.3-1.0), having a CD4 cell count >200 (CD4 200-499: OR 0.5, 95% CI 0.3-0.9. CD4> or =500: OR 0.3, 95% CI 0.2-0.6), and contact with persons with TB (OR 0.2, 95% CI 0.1-0.5) were associated with a lower probability. CONCLUSIONS In this study, the percentage of TST non-prescription was quite high. The results suggest that TST non-prescription in this population is related to the clinicians' expectations regarding the results of the test and the patients' adherence to treatment for latent TB infection.
Collapse
Affiliation(s)
- Asunción Díaz
- Unidad de Epidemiología del VIH/SIDA, Instituto de Salud Carlos III, Madrid, España.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
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
|
16
|
Gómez MC, Nieto JA, Rosa C, Geijo P, Escribano MA, Muñoz A, López C. Evaluation of seven tests for diagnosis of human brucellosis in an area where the disease is endemic. Clin Vaccine Immunol 2008; 15:1031-3. [PMID: 18448622 PMCID: PMC2446629 DOI: 10.1128/cvi.00424-07] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2007] [Revised: 12/04/2007] [Accepted: 04/17/2008] [Indexed: 11/20/2022]
Abstract
The results of seven serologic tests for diagnosis of human brucellosis were evaluated. The titrated Rose Bengal test, microagglutination test, microtiter-adapted Coombs test, and immunocapture-agglutination test (Brucellacapt) were positive for all sera from patients with acute brucellosis. The immunoglobulin G (IgG), IgM, and IgA commercial enzyme immunoassays (ELISAs) failed to show specific antibodies in 3 patients, 10 patients, and 1 patient, respectively. The sensitivity of ELISA is not higher than that of conventional tests.
Collapse
|
17
|
Domingo P, Suárez-Lozano I, Torres F, Teira R, Lopez-Aldeguer J, Vidal F, Muñoz A, Viciana P, Lozano F, Vergara A, Roca B, García Alcalde ML, Cosín J, Terrón A, Galindo MJ, Geijo P, Ribera E, Gonzalez J, Sanchez T, Lacalle JR, Garrido M. First-line antiretroviral therapy with efavirenz or lopinavir/ritonavir plus two nucleoside analogues: the SUSKA study, a non-randomized comparison from the VACH cohort. J Antimicrob Chemother 2008; 61:1348-58. [PMID: 18356150 DOI: 10.1093/jac/dkn121] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Efavirenz and lopinavir/ritonavir are both recommended antiretroviral agents for combination first-line therapy, although information on direct comparisons between them is scarce. A retrospective longitudinal study from the VACH cohort comparing both regimens was performed. METHODS Efficacy was examined comparing time to virological failure, CD4 recovery and clinical progression. Tolerability was examined comparing time to treatment discontinuation for any reason and for toxicity. Survival analysis was conducted using the Kaplan-Meier method, and standard and weighted Cox regression models. RESULTS A total of 1550 antiretroviral-naive patients starting a two-nucleoside reverse transcriptase inhibitor regimen plus either efavirenz (n = 1159) or lopinavir/ritonavir (n = 391) were included in the study. At baseline, patients starting lopinavir/ritonavir had higher HIV-1 RNA and lower CD4+ cell counts. There was no difference in the adjusted hazards of virological failure [efavirenz versus lopinavir/ritonavir hazard ratio (HR) = 0.93, 95% confidence interval (CI): 0.77-1.12, P = 0.43], CD4 recovery (HR = 1.11, 95% CI: 0.95-1.30, P = 0.19) and clinical progression (HR = 0.71, 95% CI: 0.39-1.31, P = 0.27). There was an increased risk of discontinuation for any reason or for toxicity for lopinavir/ritonavir (HR = 2.10, 95% CI: 1.40-3.15, P = 0.0003). CD4 recovery with both drugs was also similar in the lowest CD4 strata. A higher risk of early hypertriglyceridaemia was associated with lopinavir/ritonavir-based regimens. CONCLUSIONS Our study suggests similar virological efficacy for efavirenz- or lopinavir/ritonavir-based first-line antiretroviral regimens, but an increased risk of discontinuation because of toxicity in case of lopinavir/ritonavir-based therapy. Immunological outcome appeared similar with both regimens.
Collapse
Affiliation(s)
- Pere Domingo
- Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08025 Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Ferrer E, Minguez C, Mariño A, Geijo P, Brun F, Sanz J, Velasco M, Cortés C, Castro A, Ortí A, Force L, Barrufet P, Villalonga C, Podzamczer D. Cardiovascular risk estimation in Spanish HIV-infected patients: a multicenter cohort study. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p92] [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
|
19
|
Llibre JM, Domingo P, Blanco F, Clotet B, Ocampo A, García-Henarejos JA, Geijo P, Rosa C, Hernandez-Quero J, Castro A. Exposition and sequencing to antiretrovirals in HIV-1 patients with triple-class antiretroviral failure, and harbouring protease resistance mutations. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p42] [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
|
20
|
Teira R, Geijo P, Cosín J, Muñoz-Sanz A, Viciana P, Suarez-Lozano I, López-Aldeguer J, Pedrol E, Vidal F, Sanchez T, Lozano F, Terron A, Vergara A, Galindo MJ, Domingo P, Ribera E, Roca B, Garcia-Alcalde ML, Garrido M, Muñoz-Sanchez P. Risk factors for end-stage liver disease among HIV and hepatitis C virus co-infected patients in the Spanish VACH Cohort. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p134] [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
|
21
|
Diez M, Diaz A, Bleda MJ, Aldamiz M, Camafort M, Camino X, Cepeda C, Costa A, Ferrero O, Geijo P, Iribarren JA, Moreno S, Moreno ME, Labarga P, Pinilla J, Portu J, Pulido F, Rosa C, Santamaria JM, Telenti M, Trapiella L, Trastoy M, Viciana P. Prevalence of M. tuberculosis infection and tuberculosis disease among HIV-infected people in Spain. Int J Tuberc Lung Dis 2007; 11:1196-1202. [PMID: 17958981] [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: 05/25/2023] Open
Abstract
OBJECTIVE To study the prevalence of Mycobacterium tuberculosis infection (MTBI) and past/current tuberculosis (TB) among human immunodeficiency virus (HIV) infected persons in Spain. DESIGN Longitudinal study conducted between 2000 and 2003 at 10 HIV hospital-based clinics. Data were drawn from clinical records. Associations were measured using odds ratios (ORs) and their 95% confidence intervals (95%CI). RESULTS Of the 1242 persons who met the eligibility criteria, most were male (75%), aged <40 years (75%) and unemployed (40%). HIV infection occurred through intravenous drug use (53%), heterosexual sex (29%) and sex between men (16%). In the initial evaluation, 315 subjects had evidence of MTBI: 84 (6.8%) had a history of TB, 23 (1.8%) current TB and 208 (16.8%) latent tuberculosis infection (LTBI). MTBI was associated with male sex, age 30-49 years, contact with a TB case, homelessness, poor education, and negatively with CD4 <100 cells/mm(3). Among subjects with MTBI, past/current TB was associated with retirement/disability (OR 6, 95%CI 1.6-22.5), CD4 <200 cells/mm(3) (OR 9.7, 95%CI 3.8-24.6), viral load >55,000 copies (OR 5.3, 95%CI 1.4-20.0), and negatively, with skilled work (OR 0.4, 95%CI 0.1-1.0) or administrative/managerial/professional work (OR 0.05, 95%CI 0.01-0.4). CONCLUSION Social context has an impact on the effectiveness of HIV and TB control programmes even in industrialised countries with free access to health care.
Collapse
Affiliation(s)
- M Diez
- Instituto de Salud Carlos III, Unidad de Epidemiología del VIH/Sida, Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Teira R, Suárez-Lozano I, Muñoz P, Viciana P, Lozano F, Galindo MJ, Terrón A, Vergara A, Geijo P, Arribas JR, Cosín J, Domingo P, Ribera E, Roca B, García-Alcalde ML, Sánchez T, Muñoz-Sanz A. Patrón epidemiológico de la infección por el VIH en 15 hospitales españoles: casos de nuevo diagnóstico incluidos en la cohorte VACH en 2001 y 2002. Enferm Infecc Microbiol Clin 2005; 23:213-7. [PMID: 15826546 DOI: 10.1157/13073147] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 11/21/2022]
Abstract
BACKGROUND Studying the changing trends of HIV epidemics is a useful means of evaluating the results of current preventive plans as well as of defining future needs and objectives. METHODS We performed a cross-sectional study of the newly-diagnosed cases of HIV infection included in the Spanish VACH cohort. New HIV cases were defined as those diagnosed between January 2001 and December 2002. Their epidemiologic characteristics were compared with those of patients included in the same cohort who had been diagnosed between January 1998 and December 2000. RESULTS We studied 603 new cases (27% women). In 146 (24.4%) HIV infection had been acquired by sharing material for intravenous drug use (IVDU), 171 (28,6%) were men who had had sex with other men (MSM) and 247 (41.3%) acknowledged some risk for heterosexual HIV transmission. The median age was 36 years (range: 18-80). Only 1.5% of the patients were younger than 20 years while 32.1% were older than 40 years. This percentage was significantly higher than that corresponding to 1998-2000 (27.5%; p < 0,05). HIV infection was diagnosed simultaneously with an AIDS-defining condition in 13.3% of patients and an AIDS-defining disease was diagnosed in the first month after HIV-diagnosis in another 40 patients (6.6%). CONCLUSIONS We confirm the trends observed in previous studies: a growing proportion of newly diagnosed cases among women, a decreasing proportion of IVDU, a growth of MSM, and a trend toward diagnosis at a later age.
Collapse
Affiliation(s)
- Ramón Teira
- Servicio de Enfermedades Infecciosas, Hospital de Basurto, Bilbao, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Solera J, Geijo P, Largo J, Rodriguez-Zapata M, Gijón J, Martinez-Alfaro E, Navarro E, Macia MA. A randomized, double-blind study to assess the optimal duration of doxycycline treatment for human brucellosis. Clin Infect Dis 2004; 39:1776-82. [PMID: 15578399 DOI: 10.1086/426024] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2004] [Accepted: 08/02/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Human brucellosis is usually treated with a combination of tetracyclines and aminoglycosides. However, the optimal duration of therapy has not been clearly determined. METHODS We conducted a prospective, double-blind, randomized, multicenter study comparing treatment with doxycycline (100 mg po b.i.d.) for 30 days (30-day group) with the same dosage of doxycycline for 45 days (45-day group) in patients with brucellosis without endocarditis, spondylitis, or neurobrucellosis. All patients were treated with gentamicin (240 mg im once daily) for the first 7 days. Therapeutic outcome was evaluated by measuring relapse rates and drug safety. RESULTS Seventy-three patients were included in each group. During the first 45 days after treatment, the percentage of patients with relapse was significantly higher in the 30-day group than in the 45-day group (12.3% vs. 1.37%; relative risk, 9.00; 95% confidence interval [CI], 1.17-69.2; P=.017). Between day 45 after treatment and 12 months after treatment, no further significant differences were found in relapse rates between groups (9.38% in the 30-day group vs. 11.11% in the 45-day group; relative risk, 0.84; 95% CI, 0.31-2.30; P=.78). Overall, relapses occurred in 15 (20.55%) of 73 patients in the 30-day group and in 9 (12.33%) of 73 patients in the 45-day group (relative risk, 1.67; 95% CI, 0.78-3.56; P=.264). Compliance and adverse effects were comparable in the 2 groups. CONCLUSIONS Doxycycline treatment for 45 days significantly decreased early relapse rates among adults with brucellosis without increasing adverse effects.
Collapse
Affiliation(s)
- Javier Solera
- Servicio de Medicina Interna, Hospital General Universitario, Albacete, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Roca B, Suarez I, Gonzalez J, Garrido M, de la Fuente B, Teira R, Geijo P, Cosin J, Perez-Cortes S, Galindo MJ, Lozano F, Domingo P, Viciana P, Ribera E, Vergara A, Sánchez T. Hepatitis C virus and human immunodeficiency virus coinfection in Spain. J Infect 2003; 47:117-24. [PMID: 12860144 DOI: 10.1016/s0163-4453(03)00067-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [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: 11/28/2022]
Abstract
OBJECTIVE AND METHODS In a cross-sectional study, based on a cohort composed of HIV-infected patients of fifteen tertiary level institutions of Spain, the main data of the entire cohort are described, characteristics of patients with or without hepatitis C coinfection are compared, and the possible association of hepatitis C virus coinfection with socioeconomic, HIV-related, and hepatitis B-related variables is assessed. RESULTS A total of 4,709 patients are studied. Median of age is 37 years, 78.3% are male. HIV risk behaviours are: parenteral drug use in 63.8% of patients, heterosexual in 22.3%, and homosexual in 10.8%. Serology of hepatitis C is positive in 69.2% of participants. The following variables are associated with increased prevalence of hepatitis C coinfection, both in univariate and in multivariate analysis: HIV risk behaviour, positive anti-HBs, longer time elapsed since HIV infection diagnosis, younger age, lower social status, lower CD4 cell count increase between nadir and last available result, and lower educational level (all P<0.001). Patients with heterosexual behaviour are more frequently coinfected than patients with homosexual behaviour (P<0.001). CONCLUSION This study highlights that, in Spain, more than two thirds of patients with HIV infection are coinfected with hepatitis C virus.
Collapse
|
25
|
Suárez-Lozano I, Fajardo JM, Garrido M, Roca B, García-Alcalde ML, Geijo P, Selma D, Lozano F, Teira R, Viciana P, Pérez-Cortés S, Domingo P, Menchero A, Galindo MJ, Cosín J, Ribera E, Arribas JR, Lacalle JR. Epidemiological trends of HIV infection in Spain: preventative plans have to be oriented to new target populations (Spanish VACH Cohort). AIDS 2002; 16:2496-9. [PMID: 12461432 DOI: 10.1097/01.aids.0000042931.55529.82] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
26
|
Perez-Elias MJ, Garcia-Arata I, Muñoz V, Santos I, Sanz J, Abraira V, Arribas JR, González J, Moreno A, Dronda F, Antela A, Pumares M, Martí-Belda P, Casado JL, Geijo P, Moreno S. Phenotype or Virtual Phenotype for Choosing Antiretroviral Therapy after Failure: A Prospective, Randomized Study. Antivir Ther 2002. [DOI: 10.1177/135965350300800604] [Citation(s) in RCA: 10] [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: 11/16/2022]
Abstract
Background Resistance testing is useful in the management of virological failure patients, although the best method to be used in clinical practice has not been determined. Methods A prospective, randomized, double-blind, multicentre, controlled clinical trial was performed to compare the usefulness of drug resistance testing with a recombinant viral phenotype method or with a virtual phenotype, a genotyping interpretation system. Planned 300 HIV-infected adults failing their current antiretroviral therapy (HIV RNA >1000 copies/ml) were centrally randomized 1:1 to resistance testing with a recombinant viral phenotype method or with a virtual phenotype, after stratifying according to previous drug exposure (one or two versus three drug classes). Percent of patients with HIV RNA suppression (% <400 copies/ml) after 24 weeks was the primary outcome variable. Median HIV RNA concentration and change from baseline in HIV RNA concentration were also used to compare effectiveness. An extended analysis was performed at week 48. Results Of the 300 patients enrolled, a total of 276 patients could be analysed; 139 patients were randomized to the phenotype group and 137 patients were randomized to the virtual phenotype group. After 24 weeks of follow-up, 46.8 and 56.2% of patients had HIV RNA <400 copies/ml ( P=0.1) in the phenotype and virtual phenotype, respectively. Mean decrease from baseline in viral load was 1.0 and 1.3 log copies/ml in the phenotype and virtual phenotype groups, respectively ( P=0.017). In a multivariate linear regression analysis, after adjusting for baseline HIV RNA and adherence to treatment, the virtual phenotype was associated with a greater mean decrease in plasma HIV RNA ( P=0.0063). The results observed at week 48 were similar. Conclusions Virtual phenotype is at least as effective as phenotype when used to select an optimized treatment for patients who have failed one or more antiretroviral regimens.
Collapse
Affiliation(s)
- María Jesús Perez-Elias
- Infectious Diseases Service and Clinical Research Department, Ramón y Cajal Hospital, Madrid, Spain
| | - Isabel Garcia-Arata
- Infectious Diseases Service and Clinical Research Department, Ramón y Cajal Hospital, Madrid, Spain
| | - Vicente Muñoz
- Infectious Diseases Service and Clinical Research Department, Ramón y Cajal Hospital, Madrid, Spain
| | | | - José Sanz
- Príncipe de Asturias Hospital, Alcalá de Henares, Spain
| | - Víctor Abraira
- Infectious Diseases Service and Clinical Research Department, Ramón y Cajal Hospital, Madrid, Spain
| | | | | | - Ana Moreno
- Infectious Diseases Service and Clinical Research Department, Ramón y Cajal Hospital, Madrid, Spain
| | - Fernando Dronda
- Infectious Diseases Service and Clinical Research Department, Ramón y Cajal Hospital, Madrid, Spain
| | - Antonio Antela
- Infectious Diseases Service and Clinical Research Department, Ramón y Cajal Hospital, Madrid, Spain
| | - María Pumares
- Infectious Diseases Service and Clinical Research Department, Ramón y Cajal Hospital, Madrid, Spain
| | - Paloma Martí-Belda
- Infectious Diseases Service and Clinical Research Department, Ramón y Cajal Hospital, Madrid, Spain
| | - Jose L Casado
- Infectious Diseases Service and Clinical Research Department, Ramón y Cajal Hospital, Madrid, Spain
| | | | - Santiago Moreno
- Infectious Diseases Service and Clinical Research Department, Ramón y Cajal Hospital, Madrid, Spain
| | | |
Collapse
|
27
|
Martínez Alfaro EM, Cuadra F, Solera J, Maciá MA, Geijo P, Sánchez Martínez PA, Rodríguez Zapata M, Largo J, Sepúlveda MA, Rosa C, Sánchez L, Espinosa A, Mateos F, Blanch JJ. [Evaluation of 2 tuberculosis chemoprophylaxis regimens in patients infected with human immunodeficiency virus. The GECMEI Group]. Med Clin (Barc) 2000; 115:161-5. [PMID: 10996870 DOI: 10.1016/s0025-7753(00)71496-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [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: 11/22/2022]
Abstract
OBJECTIVE To assess the compliance, tolerance and efficacy of a short chemoprophylaxis regimen (IR) for tuberculosis using isoniazid (INH) plus rifampin (RIF) during 3 months versus a standard regimen (I) of isoniazid during 12 months in HIV positive patients. MATERIAL AND METHODS Prospective, comparative, randomized and open clinical trial in four general hospitals and one prison hospital of Castilla-La Mancha. Prophylaxis was administered to PPD-positive patients and to anergic patients according to the CDC recommendations (1991). Patients were randomized in two treatment groups: regimen IR, isoniazid 300 mg daily and rifampin 600 mg daily; regimen I, isoniazid 300 mg during 12 months. RESULTS 133 patients were included, 64 to regimen I and 69 to regimen IR. Regimen IR had a better tolerance with a 28% of adverse effects versus 55% in regimen I. Hepatotoxicity was more frequent in regimen I with a RR = 2.2 (CI 95% 1.23-4.01). Severe hepatotoxicity leading to treatment withdrawal was related to drug administration time and was more frequent in the 12 months regimen group. Short regimen showed a better compliance, without significant differences. Tuberculosis incidence rate was a 4.23 cases/100 persons--year for regimen I and 2.08 in regimen IR, with a relative risk for developing tuberculosis with regimen IR group of 0.51 (CI 95% 0.09-2.8) versus regimen I group, without statistical significance. Prison stay was associated to a significant risk for tuberculosis, regardless of both regimens (RR = 9.2 CI 95%, 1.06-80.2). CONCLUSIONS In HIV-infected patients with PPD(+) or anergic, regimen with IR is at least as effective as regimen I for preventing the development of tuberculous disease, and has less adverse effects.
Collapse
|
28
|
Gómez MC, Rosa C, Geijo P, Escribano MA. [Comparative study of the Brucellacapt test versus the Coombs test for Brucella]. Enferm Infecc Microbiol Clin 1999; 17:283-5. [PMID: 10439538] [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: 02/13/2023]
Abstract
BACKGROUND To compare the results obtained by Brucella Coombs' test with those obtained by Brucellacapt. MATERIAL AND METHODS 145 serum samples from 112 patients with brucellosis or with brucellar infection suspected on clinical grounds and a history of occupational exposure were analyzed. All serum samples were tested for Rose Bengal, agglutinations whenever Rose Bengal was positive, Brucella Coombs' test and Brucellacapt. RESULTS There was a direct correlation between both methods (p < 0.01). Negative serum samples and most serum samples with titers between 1/40 and 1/2,560 as tested by Brucella Coombs' test showed similar results into a range of one to two dilutions by Brucellacapt. However, serum samples with titres between 1/5,120 and 1/40,960 by Brucella Combs' test yielded also higher titres by Brucellacapt and for this reason we were unable to define a titre. CONCLUSIONS Brucellacapt is a rapid assay to exclude infection and yield results comparable to Brucella Coombs' test in range 1/40 to 1/2,560. Significantly higher and more rapid titres were obtained in acute brucellosis by Brucellacapt as compared with those obtained by Brucella Coombs' test. Titre's evolutions by Brucellacapt is similar to Brucella Coombs' test. Unfortunately it was difficult the titres definition of Brucellacapt at high titres.
Collapse
Affiliation(s)
- M C Gómez
- Sección de Microbiología, Hospital Virgen de la Luz, Cuenca
| | | | | | | |
Collapse
|
29
|
Abstract
Demographic, clinical, and laboratory data from 200 consecutive patients with acute brucellosis were analysed with univariate and multivariate methods to identify correlates of relapse. A risk score for predicting relapse was then calculated by using Cox proportional hazard model. The independent predictors of relapse were temperature of 38.3 degrees C or higher, positive blood cultures at baseline, and the duration of symptoms before treatment <10 days. Stratification according to the risk score demonstrated that rates of relapse were significantly different between risk groups (P<0.0001). The low-risk group had a 4.5% probability (6 of 135) of relapse at 12 months. In contrast, relapse was present in 15 of 47 patients in the medium-risk group (P<0.0017); and in 12 of 18 patients in the high-risk group (P<0.0001). This study provides a rational basis for estimating the risk of relapse in patients with acute brucellosis, and may be helpful in deciding what subjects might benefit from extra attention.
Collapse
Affiliation(s)
- J Solera
- Department of Medicine, Unit of Infectious Diseases, Hospital of Albacete, Spain
| | | | | | | | | | | |
Collapse
|
30
|
Solera J, Espinosa A, Martínez-Alfaro E, Sánchez L, Geijo P, Navarro E, Escribano J, Fernández JA. Treatment of human brucellosis with doxycycline and gentamicin. Antimicrob Agents Chemother 1997; 41:80-4. [PMID: 8980759 PMCID: PMC163664 DOI: 10.1128/aac.41.1.80] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [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: 02/03/2023] Open
Abstract
The objective of the present prospective, noncomparative, multicenter study was assess the safety and efficacy of gentamicin and doxycycline therapy for human brucellosis. In the first part of the study, a cohort of 17 patients received 100 mg of doxycycline (or 50 mg/kg of body weight per day if the body weight was < 40 kg) orally every 12 h for 45 days (cohort 1). In the second part of the study a subsequent cohort of 35 patients was treated with doxycycline at the same dosage for 30 days (cohort 2). All patients were treated intramuscularly with gentamicin at 240 mg (or 5 mg/kg per day if the body weight was < 50 kg) once daily for the first 7 days. Both cohorts showed a favorable response during therapy, and there were no therapeutic failures. Relapse was noted in 1 (5.9%; 95% confidence interval [95% CI], 0.15 to 28.7%) of the 17 patients in cohort 1 and in 8 (22.9%; 95% CI, 10.4 to 40.1%) of the 35 patients in cohort 2. Nineteen patients (36.5%; 95% CI, 23.6 to 51.0%) had adverse effects, with no differences between cohorts, and no patients had a treatment-limiting adverse effect. The study indicates that the combination of doxycycline for 45 days and gentamicin for 7 days is an effective and well-tolerated therapy for human brucellosis. The relapse rates obtained with doxycycline treatment for 30 days appear to be higher than those obtained with doxycycline treatment for 45 days.
Collapse
Affiliation(s)
- J Solera
- Department of Medicine, Albacete General Hospital, Spain
| | | | | | | | | | | | | | | |
Collapse
|
31
|
López R, Redondo MP, Ruiz D, Geijo P. [Pulmonary infection by Mycobacterium malmoense in a patient with AIDS]. Enferm Infecc Microbiol Clin 1997; 15:47-8. [PMID: 9147514] [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: 02/04/2023]
|
32
|
Solera J, Espinosa A, Geijo P, Martínez-Alfaro E, Sáez L, Sepúlveda MA, Ruiz-Ribó MD. Treatment of human brucellosis with netilmicin and doxycycline. Clin Infect Dis 1996; 22:441-5. [PMID: 8852960 DOI: 10.1093/clinids/22.3.441] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [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: 02/02/2023] Open
Abstract
We conducted a prospective, noncomparative, multicenter study to assess the safety and efficacy of doxycycline and netilmicin in the treatment of human brucellosis. The study included 64 patients who had acute brucellosis without endocarditis or neurobrucellosis. The treatment schedule consisted of the administration of 100 mg of doxycycline (or 5 mg/[kg.d] if body weight < or = 40 kg) twice a day orally for 45 days, plus 300 mg of netilmicin (6 mg/[kg.d] if body weight < or = 50 kg) intramuscularly once daily for 7 days. Therapeutic failure was noted in 5 patients (7.7%; 95% confidence interval [CI], 2.5%-17.1%), of whom 2 had spondylitis, 1 had sacroiliitis, and 1 had a splenic abscess that required splenectomy. Relapse was noted in eight patients (12.5%; 95% CI, 5.6%-23.2%). When relapse was considered in combination with initial lack of efficacy, 13 patients (21.9%; 95% CI, 12.3%-33.9%) failed to respond to therapy. Fifteen patients (23%; 95% CI, 13.5%-35.2%) had adverse effects, and one patient (1.5%) had a treatment-limiting adverse effect. Combination therapy with netilmicin/doxycycline may be effective in treating acute brucellosis. However, prospective controlled trials must confirm these results.
Collapse
Affiliation(s)
- J Solera
- Department of Medicine, Albacete Hospital, Spain
| | | | | | | | | | | | | |
Collapse
|
33
|
Solera J, Rodríguez-Zapata M, Geijo P, Largo J, Paulino J, Sáez L, Martínez-Alfaro E, Sánchez L, Sepulveda MA, Ruiz-Ribó MD. Doxycycline-rifampin versus doxycycline-streptomycin in treatment of human brucellosis due to Brucella melitensis. The GECMEI Group. Grupo de Estudio de Castilla-la Mancha de Enfermedades Infecciosas. Antimicrob Agents Chemother 1995; 39:2061-7. [PMID: 8540716 PMCID: PMC162881 DOI: 10.1128/aac.39.9.2061] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.6] [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: 01/31/2023] Open
Abstract
Brucellosis is a common zoonosis in many parts of the world; the best regimen for the treatment of brucellosis has not been clearly determined. We have carried out a multicenter, open, controlled trial in five general hospitals in Spain to compare the efficacy and safety of doxycycline and rifampin (DR) versus doxycycline and streptomycin (DS) for the treatment of human brucellosis. The study included 194 ambulatory or hospitalized patients with acute brucellosis, without endocarditis or neurobrucellosis. The diagnostic criterion was isolation of Brucella species from blood or other tissues (n = 120) or a standard tube agglutination titer of 1/160 or more for anti-Brucella antibodies with compatible clinical findings (n = 74). Patients were randomly assigned to receive either 100 mg of doxycycline twice daily plus rifampin, 900 mg/day, in a single morning dose for 45 days (DR group) or the same dose of doxycycline for 45 days plus streptomycin, 1 g/day, intramuscularly for 14 days (DS group). A lack of therapeutic efficacy developed in 8 of the 100 patients in the DR group (8%) and in 2 of the 94 patients in the DS group (2%)(P = 0.10). Relapses occurred in 16 of the 100 patients in the DR group (16%) but in only 5 of the 94 patients in the DS group (5.3%) (P = 0.02). When relapse was considered in combination with initial lack of efficacy, 26 patients in the DR group (24%) and 7 patients in the DS group (7.45%) failed to respond to therapy (P = 0.0016). In general, therapy was well tolerated and only four patients (4%) in the DR group and two (2%) in the DS group had episodes of adverse effects necessitating discontinuation of treatment (P> 0.2). We conclude that a doxycycline-and-rifampin regimen is less effective than the doxycycline-and-streptomycin regimen in patients with acute brucellosis.
Collapse
Affiliation(s)
- J Solera
- Department of Medicine, Hospital of Albacete, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Geijo P, Santiago M, Ruiz D, de Benito L. [Disseminated herpes zoster with pneumonitis in an HIV-positive patient]. Enferm Infecc Microbiol Clin 1995; 13:128-9. [PMID: 7711126] [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: 01/26/2023]
|
35
|
Solera J, Paulino J, Rodríguez-Zapata M, Medrano F, Geijo P, Jiménez F, de Juan L. [Brucellar sacroiliitis. A detailed review with an analysis of treatment efficacy]. Rev Clin Esp 1992; 191:13-8. [PMID: 1631354] [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: 12/28/2022]
Abstract
All patients diagnosed of brucellosis in 4 regional hospitals during a period of nine years were reviewed, in an attempt to evaluate the efficacy of different antimicrobic regimens and also the clinical features. Evolution and complications of brucellar sacroiliitis. Of a total of 548 patients, 12% had been diagnosed of sacroiliitis and, of theme, 49 had complete data available with efficacy of different treatments, the time elapsed until fever and pain ceased was evaluated, together with initial therapeutic failures, relapses and length of hospital stay. Brucellar sacroiliitis is the most frequent osteoarthral complication of Brucella sp. in our setting. Keeping an stable incidence. It is predominant among young male (82%) population (mean age 25 +/- 12 years). The illness evolution is acute and less frequently subacute with a evolution mean-time before referral of 38 +/- 44 days (minimum 4 days, maximum 180 days). Fever (81%) and pain on gluteus and low lumbar localizations (100%) are the more frequent clinical features. Time elapsed until pain ceased was longer with doxycycline plus rifampicin (68 +/- 86) than with doxycycline plus streptomycin (28 +/- 43) (less than 0.05) and length of hospital stay was also longer with said treatment (p less than 0.05). There were no differences concerning time frame until fever ceased, initial therapy failures and relapses. Sequelae are infrequent and consist in persistency of pain. In resume response to treatment with usual regimens, doxycycline plus streptomycin of doxycycline rifampicin is good, being however time elapsed until pain ceases of mean length in hospital stay shorter in the group receiving doxycycline plus streptomycin. Control studies to confirm these data are need.
Collapse
Affiliation(s)
- J Solera
- Servicio de Medicina Interna, Hospitales Generales de Albacete, Guadalajara y Cuenca
| | | | | | | | | | | | | |
Collapse
|
36
|
Solera J, Medrano F, Rodríguez M, Geijo P, Paulino J. [A comparative therapeutic and multicenter trial of rifampicin and doxycycline versus streptomycin and doxycycline in human brucellosis]. Med Clin (Barc) 1991; 96:649-53. [PMID: 1905372] [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: 12/29/2022]
Abstract
BACKGROUND Comparison and evaluation of the efficacy and safety of two treatment schedules in human brucellosis. METHODS A comparative, randomized, multicentric, open study of 45 days doxycycline plus rifampin in the initial 21 days (group A) versus 45 doxycycline plus streptomycin in the initial 14 days (group B). 42 were included in each group. The diagnosis of brucellosis was based on blood culture or consistent clinical findings and a Wright's serum agglutination titer of 1/160 or greater. Clinical and laboratory monitoring was carried out, including blood cultures on the days 7 and 48 and after 3, 6, and 12 months. RESULTS 38 patients in each group were evaluable at the end of treatment. 3 group A patients and 1 group B patient had initial therapeutic failure. 31 group A patients and 35 group B patients could be followed up during 6 months or more (mean follow up of 10.5 and 11.5 months, respectively). 9 relapses (29%) developed in group A and 2 (6%) in group B (p less than 0.05). 22 patients of the 34 finally evaluated in group A (65%) were considered as cured, versus 33 of the 36 in group B (92%) (p less than 0.01). Side effects not requiring withdrawal of the treatment developed in 12 patients, without differences between the two groups. CONCLUSIONS In the therapy of human brucellosis, the association of doxycycline (45 days) and rifampin (21 days) is less effective than the classical association of doxycycline and streptomycin.
Collapse
Affiliation(s)
- J Solera
- Servicio de Medicina Interna, Hospitales Generales de Albacete, Cuenca
| | | | | | | | | |
Collapse
|
37
|
Affiliation(s)
- G Munoz
- Department of Pathology, Hospital Virgen de la Luz, Cuenca, Spain
| | | | | | | | | | | |
Collapse
|