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Crespo M. Formación del especialista de pediatría: viejos problemas, nuevos tiempos. An Pediatr (Barc) 2009; 70:409-12. [DOI: 10.1016/j.anpedi.2009.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 03/28/2009] [Indexed: 10/20/2022] Open
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Alvarez-Uria G, Falcó V, Martín-Casabona N, Crespo M, Villar Del Saz S, Curran A, Ocaña I, Ribera E, Pahissa A. Non-tuberculous mycobacteria in the sputum of HIV-infected patients: infection or colonization? Int J STD AIDS 2009; 20:193-5. [PMID: 19255269 DOI: 10.1258/ijsa.2008.008300] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
It can be difficult to establish the clinical significance of the isolation of non-tuberculous mycobacteria (NTM) from the sputum of HIV-infected patients. In this observational study, we have investigated factors associated with having NTM infection. During the period of the study, 10 patients had NTM infection and 14 had NTM colonization. Factors associated with having NTM infections were: CD4 lymphocyte count <50 cells/mL (odds ratio [OR] 10; 95% confidence interval [CI] 1.4-69.3), haemoglobin <11 g/dL (OR 7.2; 95% CI 1.08-47.9), weight loss (OR 9; 95% CI 1.3-63.9), duration of symptoms for more than a month (OR 54; 95% CI 4.2-692.5), the presence of acid fast bacilli (AFB) in sputum (OR 30.3; 95% CI 2.6-348.9) and repeated positive NTM cultures in other sputum samples (OR 4.3; 95% CI 1.6-11.7). In conclusion, we must suspect NTM infection in patients with long-standing symptoms, anaemia, low CD4 lymphocyte count, several positive sputum cultures and when AFB are seen.
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Shyu S, Dew M, De Vito Dabbs A, Crespo M, Zaldonis D, Johnson B, Studer S, Toyoda Y, Bermudez C, Hattler B, Pilewski J, McCurry K. 10: Long-Term Outcomes after Alemtuzumab Induction in Lung Transplantation. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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104
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Toyoda Y, Zaldonis D, Bermudez C, Speziali G, Gilbert S, Bhama J, Johnson B, Crespo M, Pilewski J. 204: 20-Year Experience of Lung Transplantation for Chronic Obstructive Pulmonary Disease. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Garcia-Covarrubias L, Toyoda Y, Crespo M, Pilewski J, Johnson B, Bhama J, Bermudez C. 625: Impact of Coronary Artery Disease in Lung Transplant Patients. A Single Center Experience. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Bermudez C, Girnita A, Avila F, Zeevi A, Crespo M, Pilewski J, Speziali G, Johnson B, Zaldonis D, Toyoda Y. 200: Clinical Experience with the Use of Virtual Crossmatch in Adult Lung Transplantation. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Crespo-Erchiga V, Gómez-Moyano E, Crespo M. [Pityriasis versicolor and the yeasts of genus Malassezia]. ACTAS DERMO-SIFILIOGRAFICAS 2008; 99:764-771. [PMID: 19091214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Although pityriasis versicolor is the only human disease for which Malassezia yeasts have been fully established as pathogens, it is still not clear which species are implicated. Most studies carried out in recent years support our hypothesis - proposed in 1999 - that Malassezia globosa is the predominant species in pityriasis versicolor lesions, at least in temperate climates. Confirmation of this hypothesis could help us understand the conditions, as yet unclear, that induce transformation of this yeast from the saprophytic form present in healthy skin to the parasitic form, characterized by the formation of pseudomycelium, and could also guide therapy. In addition, isolation of another species, Malassezia furfur, which seems to be predominant in the tropics, raises the possibility of a second etiologic agent confined to certain areas, as occurs with some other human mycoses.
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Crespo M, Ribera E, Suarez-Lozano I, Domingo P, Pedrol E, Lopez-Aldeguer J, Munoz A, Vilades C, Sanchez T, Viciana P, Teira R, Garcia-Alcalde ML, Vergara A, Lozano F, Galindo MJ, Cosin J, Roca B, Terron A, Geijo P, Vidal F, Garrido M. Effectiveness and safety of didanosine, lamivudine and efavirenz versus zidovudine, lamivudine and efavirenz for the initial treatment of HIV-infected patients from the Spanish VACH cohort. J Antimicrob Chemother 2008; 63:189-96. [DOI: 10.1093/jac/dkn450] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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109
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Rodriguez C, Caligara C, Prados N, Crespo M, Tocino A, Fernandez M. Impact of adding recombinant LH versus hMG to rFSH in controlled ovarian stimulation (COS) in embryo morphology and implantation rate: a prospective randomized study. Fertil Steril 2008. [DOI: 10.1016/j.fertnstert.2008.07.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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110
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Puig JM, Mir M, Hurtado S, Marin M, Ferrer M, Crespo M, Barbosa F, Barrios C, Rodriguez E, Lloveras J. STABLE TROUGH LEVELS BUT SIGNIFICANT REDUCTION OF THE AREA UNDER THE CURVE OF TACROLIMUS IN RENAL TRANSPLANTED PATIENTS CONVERTED FROM ASSOCIATED MYCOPHENOLATE MOFETIL TO EQUIMOLAR DOSES OF ENTERIC-COATED MYCOPHENOLATE SODIUM. Transplantation 2008. [DOI: 10.1097/01.tp.0000332147.56600.2b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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111
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Curran A, Falcó V, Crespo M, Martinez X, Ribera E, Villar del Saz S, Imaz A, Coma E, Ferrer A, Pahissa A. Bacterial pneumonia in HIV-infected patients: use of the pneumonia severity index and impact of current management on incidence, aetiology and outcome. HIV Med 2008; 9:609-15. [PMID: 18557951 DOI: 10.1111/j.1468-1293.2008.00603.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Despite a recent decrease, bacterial pneumonia (BP) is still the most common admission diagnosis in HIV patients. We analyse BP incidence, characteristics and prevention measures. METHODS Observational study of all patients hospitalized for BP in a tertiary hospital in Barcelona, Spain, from January 2000 to December 2005. Demographic and HIV-related data, BP risk factors, characteristics of BP and outcomes are analysed. RESULTS One hundred and eighty-six BP episodes in 161 patients were included; patients were mainly male (73.7%) and intravenous drug users (73.7%). A decrease in BP incidence was seen during the study period, especially in vaccinated patients. The most commonly isolated microorganism was Streptococcus pneumoniae (31.7%), followed by Legionella pneumophila (5.9%). Legionella pneumophila was more likely in patients with undetectable viral load, higher CD4 cell counts or prior vaccination. Highly active antiretroviral therapy, cotrimoxazole prophylaxis and pneumococcal vaccination did not have a significant influence on bacteraemia rate, in-hospital complications or BP mortality. High Pneumonia Severity Index (PSI) predicted mortality accurately [relative risk 15.2, 95% confidence interval 3.2-71.7; P=0.001]. Mortality was 9.1%, but was significantly higher in patients with CD4 counts under 200 cells/microL (P=0.022). CONCLUSIONS A decline in BP incidence was seen during the study period. Combining CD4 cell count and PSI score could become a good strategy in deciding which patients have to be hospitalized.
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Crespo M, Mira JA, Pineda JA, Eynde EVD, Rios-Villegas MJ, Collado A, Giron-Gonzalez JA, Lopez-Cortes LF, Gonzalez-Serrano M, Rivero A, Merino D, Esteban JI. Efficacy of pegylated interferon and ribavirin for retreatment of chronic HCV infection in HIV co-infected patients failing a previous standard interferon-based regimen. J Antimicrob Chemother 2008; 62:793-6. [DOI: 10.1093/jac/dkn262] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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113
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Zamora A, Vazquez G, Vilaseca M, Crespo M, Gibert A, Paluzie G, Fernandez-Real J, Massa J, Caballe I, Cuenca R, Fernandez V, Bron D, Coralli S. PREDICTORS OF BLOOD PRESSURE NON-DIPPING PATTERN IN ACUTE CORONARY SYNDROME. ATHEROSCLEROSIS SUPP 2008. [DOI: 10.1016/s1567-5688(08)70614-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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114
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Vilaseca M, Vazquez G, Zamora A, Crespo M, Gibert A, Cuenca R, Paluzie G, Massa J, Caballe I, Fernandez V, Coralli S, Bron D, DelMolino F, Costa N, Massa R, Campoamor C. CORRELATION BETWEEN ACCESS TO INVASIVE CORONARY APPROACH AND COMORBIDITY STATUS IN PATIENTS ADMITTED WITH ACUTE CORONARY SYNDROME. ATHEROSCLEROSIS SUPP 2008. [DOI: 10.1016/s1567-5688(08)70888-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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115
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Imaz A, del Saz SV, Rivas MA, Curran A, Caballero E, Falco V, Crespo M, Ocana I, Diaz M, de Gopegui ER, Riera M, Ribera E. Raltegravir, etravirine and darunavir-ritonavir: a safe and successful rescue regimen in highly treatment-experienced HIV1-infected patients. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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116
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Crespo-Erchiga V, Gómez-Moyano E, Crespo M. Pityriasis Versicolor and the Yeasts of Genus Malassezia. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s1578-2190(08)70364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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117
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Molina I, Falco V, Crespo M, Riera C, Ribera E, Curran A, Carrio J, Diaz M, Villar del Saz S, Fisa R, Lopez-Chejade P, Ocana I, Pahissa A. Efficacy of liposomal amphotericin B for secondary prophylaxis of visceral leishmaniasis in HIV-infected patients--authors' response. J Antimicrob Chemother 2007. [DOI: 10.1093/jac/dkm490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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118
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Brunet M, Crespo M, Millán O, Serón D, Torregrosa V, Jiménez O, Moreso F, Martorell J, Grinyo JM, Oppenheimer F. Pharmacokinetics and pharmacodynamics in renal transplant recipients under treatment with cyclosporine and Myfortic. Transplant Proc 2007; 39:2160-2. [PMID: 17889124 DOI: 10.1016/j.transproceed.2007.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Efficacious prophylaxis of acute rejection episodes (ARE) requires adequate exposure to each component of the immunosuppressive treatment from the first days after renal transplantation. The aim of the present study was to evaluate the correlation between cyclosporine (CsA) and mycophenolic acid (MPA) exposure based upon pharmacokinetics (PK) and pharmacodynamics (PD) and 6-month biopsy-proven acute rejection (BPAR) episodes and chronic allograft nephropathy on 6 month protocol biopsies. PATIENTS AND METHODS We examined twenty-two first or second de novo renal transplant recipients treated with steroids, Sandimmune Neoral (CsA) and Myfortic (720 mg twice a day). PK (C0, C2, and AUC(0-12h)) for both drugs were determined on days 7, 90, and 180. Calcineurin activity, interleukin-2 and interferon-gamma synthesis as well as %CEM were tested at days 7 and 180. CsA dosages were adjusted by C2 monitoring. Collected data included: BPAR during the first 6 months and Banff histological parameters on the 6-month protocol biopsies. RESULTS Eighteen of 22 patients completed 1 year follow-up under treatment. The 6-month BPAR was 18% (4/22). Six-month protocol biopsies in 50% of 14 recipients showed chronic allograft nephropathy 1. At day 7, CsA C2 and AUC median values were 138 ng/mL and 6377 ng x h/mL, while C0 MPA was 1.0 microg/mL and AUC = 23.9 microg x h/mL. CsA C2 medians at 3 and 6 months were 1468 and 1720 ng/mL. MPA-AUC reached therapeutic targets at 3 months (32.3 microg x h/mL) and was 48.3 microg x h/mL at 6 months. Patients with BPAR showed lower CsA AUC (P = .06) and a significantly lower baseline inhibition of calcineurin activity (P < .005) than patients with no BPAR. An increase in mesangial matrix in 6-month protocol biopsies correlated with higher CsA C2 (P = .01). All biomarkers evaluated were significantly inhibited compared with the standard population. CONCLUSIONS When Myfortic is administered together with CsA, it is advisable to begin with higher doses (720 mg x 3 days) to reach adequate PK targets and improve BPAR rates. To prevent chronic allograft nephropathy, lower CsA C2 should be targeted from 3 months.
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Crespo M. Commentary on "". Br J Sports Med 2007. [DOI: 10.1136/bjsm.2007.040055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Collado P, Naredo E, Calvo C, Crespo M. Assessment of the joint recesses and tendon sheaths in healthy children by high-resolution B-mode and power Doppler sonography. Clin Exp Rheumatol 2007; 25:915-921. [PMID: 18173930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To describe or determine reference values for the intracapsular cavity and its joint recess of the hip, knee and joints of the hand and for the tendon sheaths of fingers, examined with B-mode gray-scale ultrasonography (US) and power Doppler (PD) in healthy children. METHODS Sixty healthy children (31 boys and 29 girls; age range 2-16 years) were examined bilaterally with gray-scale and PD US (after obtaining the informed consent), using a standardized technique. The maximum distance from bone surface to the outer margin of the capsule (namely, intracapsular cavity) and its joint recess of hip, knee, wrist, non-thumb metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the hand were measured with US. Mean values +/- 2 SD (standard deviation) were indicated as reference values. RESULTS None of the children showed joint hip fluid. In 5% of the children younger than 5 years an intra-capsular PD flow signal was detected in the posterior layer of the hip capsule. Fluid was detected in 60 % of the suprapatellar recesses. A small amount of fluid was detected within synovial recesses of the fingers, most commonly in the 2 MCP and PIP joints. Less frequently, a hypoechoic rim was detected around the finger flexor tendons on the palmar surface of the metacarpal bone. CONCLUSION High-resolution US evidences a normal small amount of fluid located at the MCP and IFP joint recesses and/or the flexor tendon sheaths without any PD flow signal in healthy children, that is relevant for interpreting ultrasonographic findings in children with inflammatory diseases.
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Garcia-Ortega J, Prados N, Crespo M, Ruiz M, Hernaez M, Fernandez-Sanchez M. Parental influence on multinucleation in early human embryos. Fertil Steril 2007. [DOI: 10.1016/j.fertnstert.2007.07.1055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vime P, Prados N, Crespo M, Canales E, Garcia R, Fernandez-Sanchez M. Pronuclear morphology as a predictor for human embryo transfer selection on day 3 of culture: a prospective study. Fertil Steril 2007. [DOI: 10.1016/j.fertnstert.2007.07.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Reid M, Duffield R, Dawson B, Baker J, Crespo M. Quantification of the physiological and performance characteristics of on-court tennis drills. Br J Sports Med 2007; 42:146-51; discussion 151. [PMID: 17681984 DOI: 10.1136/bjsm.2007.036426] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the physiological responses and stroke characteristics of common on-court tennis training drills. METHODS Six high-performance players performed 1 x6 repetitions of four common on-court training drills on two separate occasions; once with 30:30 seconds work:rest, and once with 60:30 seconds work:rest. Heart rate (HR), blood lactate [La(-)], distance covered by the player (GPS) and rate of perceived exertion (RPE) were measured before the start of each drill and after the first and last repetition. Measures of shot count and accuracy and post-impact ball velocity per drill were also recorded. RESULTS Significant differences were observed between drills in measures of [La(-)] and RPE both during ([La(-)] 2.1-4.4 mmol/l; RPE 2.6-5.1) and after ([La(-)] 4.4-10.6 mmol/l; RPE 4.3-7.6) drills, yet individual HR responses (160-182 beats/minute) were similar. Increased work times (60 v 30 seconds) also produced consistently raised [La(-)] and RPE responses, yet players' average movement velocities and forehand ball speed and accuracy remained consistent. Significant decreases in forehand ball speed and accuracy were observed during higher-intensity training drills, whereas significantly lower mean movement velocities underpinned performance of less intensive drills. CONCLUSIONS The four drills produced physiological responses that reflect previously reported normal or maximal matchplay demands. These results point to the adaptations possible with adjustment of training drill type and load specific to matchplay demands or training phase.
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Molina I, Falcó V, Crespo M, Riera C, Ribera E, Curran A, Carrio J, Diaz M, Villar del Saz S, Fisa R, López-Chejade P, Ocaña I, Pahissa A. Efficacy of liposomal amphotericin B for secondary prophylaxis of visceral leishmaniasis in HIV-infected patients. J Antimicrob Chemother 2007; 60:837-42. [PMID: 17684055 DOI: 10.1093/jac/dkm294] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Visceral leishmaniasis (VL) is characterized by frequent relapses in HIV-infected patients, even in those who receive secondary prophylaxis. The aim of our study was to evaluate the efficacy of liposomal amphotericin B (L-AMB) for secondary prophylaxis of VL in HIV-infected patients. METHODS From January 2001 to December 2005, 17 HIV patients, with at least one previous episode of VL who received L-AMB as secondary prophylaxis for VL, were included in the study. Efficacy was measured as the proportion of patients remaining free (non-relapse) of VL at different time points. Relapses were analysed as time-to-relapse distribution and were evaluated by survival analysis using the Kaplan-Meier method. RESULTS Twenty-one episodes of VL were diagnosed and nine relapsed. The median follow-up time was 14 (5-44) months. The probability of remaining free of relapse at 6 months was 89.7% (95% CI, 76.2-100); at 12 months, the probability was 79.1% (95% CI, 61-97.2) and at 24 and 36 months, the probability was 55.9% (95% CI, 30.5-81.3). In the non-relapsing group, patients had a significant increase in CD4 cell levels of 102 (10-174) and 126 (4-159) cells/mm(3) at 12 and 24 months, respectively (P = 0.037), whereas in the relapsing group, no significant increase was observed. Prophylaxis with L-AMB was well tolerated and only three patients had a mild impairment of renal function without requiring any change in treatment. CONCLUSIONS L-AMB is well tolerated and useful for secondary prophylaxis of VL.
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Crespo M, Sauleda S, Esteban JI, Juarez A, Ribera E, Andreu AL, Falco V, Quer J, Ocaña I, Ruiz I, Buti M, Pahissa A, Esteban R, Guardia J. Peginterferon alpha-2b plus ribavirin vs interferon alpha-2b plus ribavirin for chronic hepatitis C in HIV-coinfected patients. J Viral Hepat 2007; 14:228-38. [PMID: 17381714 DOI: 10.1111/j.1365-2893.2006.00779.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Treatment of chronic hepatitis C in human immunodeficiency virus (HIV)-infected patients is associated with low response rates and high incidence of side effects. One hundred twenty-one hepatitis C virus (HCV)-HIV-coinfected patients were randomized to receive interferon alpha-2b (3 MU thrice weekly; n = 61) or peginterferon alpha-2b (1.5 microg/kg/week; n = 60), plus ribavirin (800 mg daily), for 24 (genotype 2 or 3) or 48 weeks (genotype 1 or 4). We assessed early virological response at 4, 8 and 12 weeks to predict sustained virological response (SVR). Safety assessment included frequent blood lactate measurement and relative quantitation of mitochondrial DNA (mtDNA) content in peripheral blood mononuclear cells. In intention-to-treat analysis, the SVR rate was higher in the peginterferon group (55%vs 26%; P = 0.002). The difference for HCV genotypes 1 and 4 was 45%vs 14% (P = 0.009) and 50%vs 27% (P = 0.387), respectively, and for genotype 2 or 3, 71%vs 43% (P = 0.12) Viral response at 4, 8 and 12 weeks of treatment was highly predictive of SVR. Among genotype 3 patients, 17 of 20 (85%) whose HCV RNA was already undetectable at 4 weeks had an SVR after 24 weeks of treatment. Hyperlactataemia occurred in 22 patients and was clinically significant in six, two of whom died. mtDNA decreased significantly 4-12 weeks after the start of treatment in patients developing clinically significant hyperlactataemia. Peginterferon alpha-2b plus ribavirin was more effective than interferon alpha-2b plus ribavirin in HIV-coinfected patients. Frequent monitoring of virological response may be very helpful to optimize treatment compliance, to tailor treatment duration and to minimize side effects.
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