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Llibre JM, García F, Blanco JL, Peláez EP, de Cea ÁM, Cortés LL, Alonso MM, Bernáldez MP, Schroeder M, Sánchez SE, Alcántara FR. Prevalence of people living with multidrug-resistant HIV and limited treatment options in Spain. HIV Med 2024. [PMID: 38689512 DOI: 10.1111/hiv.13650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/15/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVES Our aim was to determine the prevalence and characteristics of people with HIV on antiretroviral therapy (ART) with multidrug resistance (MDR; confirmed resistance to three or more [or resistance to two or more plus contraindication to one or more] core ART classes) and limited treatment options (LTOs) in Spain. METHODS This was an observational, retrospective, multicentre, cross-sectional chart review study undertaken in five reference Spanish centres. Participants were people with HIV on ART with MDR and LTOs (detectable viral load [HIV-RNA >200 copies/mL], treatment-limiting drug-drug interaction [DDI], or intolerance precluding the use of one or more ART classes). Prevalence, demographic/clinical characteristics, and treatment options were assessed. Logistic regression analyses were used to identify MDR-associated variables. RESULTS Of 14 955 screened people with HIV, 69 (0.46%) presented with MDR and 23 (0.15%) had LTOs. The population analysed was 73.9% male with a median age of 54.0 years; the median time since HIV diagnosis was 26.5 years, and median CD4+ cell count was 511.0 cells/μL. The only factor significantly associated with MDR (univariate analysis) was CD4+ cell count. Injection drug use was the most common transmission route. Comorbidities (mainly endocrine and cardiovascular disorders; 34.8% affecting HIV management) and concomitant treatments were frequent. No recent opportunistic infections were reported. Patients had been exposed to the following ART: nucleoside analogue reverse transcriptase inhibitors (100%), protease inhibitors (95.6%), non-nucleoside analogue reverse transcriptase inhibitors (87.0%), and integrase strand transfer inhibitors (82.6%). The available fully active drugs were dolutegravir (39.1%), bictegravir (30.4%), and raltegravir (21.7%). CONCLUSIONS The prevalence of people with HIV with MDR and LTOs in Spain is very low, with approximately half of those studied not exhibiting virological suppression. Low CD4+ cell counts were associated with MDR. These findings may help address the impact and treatment needs of these patients and prevent clinical progression and transmission of MDR HIV.
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Affiliation(s)
- Josep M Llibre
- Infectious Diseases Service, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Federico García
- Microbiology Service, Hospital Universitario Clínico San Cecilio, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Granada, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - José Luis Blanco
- Infectious Diseases Service, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Álvaro Mena de Cea
- Internal Medicine Service-Infectious Diseases Unit-HIV, Hospital Universitario de A Coruña, La Coruña, Spain
| | - Luis López Cortés
- Infectious Diseases Service, Hospital Virgen del Rocio, Sevilla, Spain
| | - Marta Montero Alonso
- Internal Medicine Service-Infectious Diseases Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Lutz AB, Patel DV, Bibbo C, Hong IS, Hameed D, Dubin J, Mont MA. Total Hip Arthroplasty in Human Immunodeficiency Virus Positive Patients: A Systematic Review of Outcomes. J Arthroplasty 2024:S0883-5403(24)00143-8. [PMID: 38452861 DOI: 10.1016/j.arth.2024.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/04/2024] [Accepted: 02/11/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) has become a common intervention for human immunodeficiency virus (HIV)-positive patients who have osteonecrosis of the femoral head. This paper provides a systematic review to assess survivorships, patient-reported outcomes (PROMs), infection rates, other complications, and immune competence for patients who had THAs who did and did not have HIV. METHODS A comprehensive and systematic review of published studies investigating the outcomes of THA in HIV-positive patients (osteonecrosis and non-osteonecrosis patients) was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 10 studies with 9,534 HIV-positive patients fulfilled the inclusion and exclusion criteria. Manuscript quality was assessed on 2 scales: the Coleman Methodology Score and the level of evidence derived from Center for Evidence-Based Medicine criteria. Data were extracted from studies in the 5 key areas of interest: survivorships, PROMs, infection rates, complications, and clusters of differentiation-4 (CD4+) counts and viral loads. RESULTS Implant survivorship was between 95% and 100%. Postoperative Harris Hip Scores were significantly improved from preoperative values in HIV-positive patients. Postoperative PROMs and infections did not appear to be different between HIV-positive and HIV-negative patients. Many of the cohort studies demonstrate comparable complication rates to matched controls. Where described (7 reports), mean CD4+ counts ranged from 425 to 646 cells/mm3, with low viral loads (3 reports) and variations not found to influence outcomes. CONCLUSIONS THA is an effective treatment for HIV-positive patients, many of whom suffer from osteonecrosis of the femoral head. The results demonstrate excellent implant survivorship, improved quality of life, and a low risk of infections and complications.
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Affiliation(s)
- Alexandra Baker Lutz
- Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Deepak V Patel
- Seton Hall University School of Graduate Medical Education, South Orange, New Jersey
| | - Christopher Bibbo
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ian S Hong
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center - RWJ Barnabas Health, Jersey City, New Jersey
| | - Daniel Hameed
- Rubin Institute for Advanced Orthopedics at LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Jeremy Dubin
- Rubin Institute for Advanced Orthopedics at LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics at LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
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de Mendoza C, Carrizo P, Sauleda S, Richart A, Rando A, Miró E, Benito R, Ayerdi O, Encinas B, Aguilera A, Reina G, Rojo S, González R, Fernández-Ruiz M, Liendo P, Montiel N, Roc L, Treviño A, Pozuelo MJ, Soriano V. The slowdown of new infections by human retroviruses has reached a plateau in Spain. J Med Virol 2023; 95:e28779. [PMID: 37212269 DOI: 10.1002/jmv.28779] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/26/2023] [Accepted: 04/28/2023] [Indexed: 05/23/2023]
Abstract
The 2022 annual meeting of the HTLV & HIV-2 Spanish Network was held in Madrid on December 14. We summarize here the main information presented and discussed at the workshop and review time trends for human retroviral infections in Spain. As transmissible agents, infections by human retroviruses are of obligatory declaration. Until the end of 2022, the Spanish national registry had recorded 451 cases of HTLV-1, 821 of HTLV-2, and 416 of HIV-2. For HIV-1, estimates are of 150 000 people currently living with HIV-1 and 60 000 cumulative deaths due to AIDS. During year 2022, new diagnoses in Spain were of 22 for HTLV-1, 6 for HTLV-2, and 7 for HIV-2. The last updated figures for HIV-1 are from 2021 and counted 2786 new diagnoses. The slowdown in yearly infections for HIV-1 in Spain points out that new strategies are needed to achieve the United Nations 95-95-95 targets by 2025. For the remaining neglected human retroviral infections, their control might be pushed throughout four interventions: (1) expanding testing; (2) improving education and interventions aimed to reduce risk behaviors; (3) facilitating access to antiretrovirals as treatment and prevention, including further development of long-acting formulations; and (4) increasing vaccine research efforts. Spain is a 47 million population country in South Europe with strong migration flows from HTLV-1 endemic regions in Latin America and Sub-Saharan Africa. At this time universal HTLV screening has been implemented only in the transplantation setting, following the report of 5 cases of HTLV-associated myelopathy shortly after transplantation of organs from HTLV-1 positive donors. There are four target populations for expanding testing and unveiling asymptomatic carriers responsible for silent HTLV-1 transmissions: (1) migrants; (2) individuals with sexually transmitted infections; (3) pregnant women; and (4) blood donors.
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Affiliation(s)
- Carmen de Mendoza
- Puerta de Hierro University Hospital & Research Foundation-IDIPHISA, Madrid, Spain
| | - Paula Carrizo
- Puerta de Hierro University Hospital & Research Foundation-IDIPHISA, Madrid, Spain
| | | | | | | | - Elisenda Miró
- Santa Creu i Sant Pau University Hospital, Barcelona, Spain
| | - Rafael Benito
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Begoña Encinas
- Puerta de Hierro University Hospital & Research Foundation-IDIPHISA, Madrid, Spain
| | - Antonio Aguilera
- Department of Microbiology, University of Santiago, Santiago de Compostela, Spain
| | | | - Silvia Rojo
- Hospital Clínico Universitario, Valladolid, Spain
| | | | - Mario Fernández-Ruiz
- Hospital Universitario 12 de Octubre & Instituto de Investigación 12 de Octubre (imas12), CIBERINFEC, Madrid, Spain
| | | | - Natalia Montiel
- Department of Microbiology, University of Cadiz, Cádiz, Spain
| | | | - Ana Treviño
- UNIR Health Sciences School & Medical Center, Madrid, Spain
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Ramos-Rincon JM, Menchi-Elanzi M, Pinargote-Celorio H, Mayoral A, González-Alcaide G, de Mendoza C, Barreiro P, Gómez-Gallego F, Corral O, Soriano V. Trends in hospitalizations and deaths in HIV-infected patients in Spain over two decades. AIDS 2022; 36:249-256. [PMID: 34762389 DOI: 10.1097/qad.0000000000003105] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The prognosis of HIV infection dramatically improved after the introduction of triple antiretroviral therapy 25 years ago. Herein, we report the impact of further improvements in HIV management since then, looking at all hospitalizations in persons with HIV (PWH) in Spain. METHODS A retrospective study using the Spanish National Registry of Hospital Discharges. Information was retrieved since 1997-2018. RESULTS From 79 647 783 nationwide hospital admissions recorded during the study period, 532 668 (0.67%) included HIV as diagnosis. The mean age of PWH hospitalized increased from 33 to 51 years (P < 0.001). The rate of HIV hospitalizations significantly declined after 2008. Comparing hospitalizations during the first (1997-2007) and last (2008-2018) decades, the rate of non-AIDS illnesses increased, mostly due to liver disease (from 35.9 to 38.3%), cardiovascular diseases (from 12.4 to 28.2%), non-AIDS cancers (from 6.4 to 15.5%), and kidney insufficiency (from 5.4 to 13%). In-hospital deaths occurred in 5.5% of PWH, declining significantly over time. Although most deaths were the result from AIDS conditions (34.8%), the most frequent non-AIDS deaths were liver disease (47.1%), cardiovascular events (29.2%), non-AIDS cancers (24.2%), and kidney insufficiency (20.7%). CONCLUSION Hospital admissions in PWH significantly declined after 2008, following improvements in HIV management and antiretroviral therapy. Non-AIDS cancers, cardiovascular events and liver disease represent a growing proportion of hospital admissions and deaths in PWH.
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Affiliation(s)
- José-Manuel Ramos-Rincon
- Internal Medicine Department, General University Hospital of Alicante-ISABIAL & Miguel Hernández University of Elche
| | | | - Héctor Pinargote-Celorio
- Internal Medicine Department, General University Hospital of Alicante-ISABIAL & Miguel Hernández University of Elche
| | - Asunción Mayoral
- CIO Research Institute, Miguel Hernández University of Elche, Alicante
| | | | - Carmen de Mendoza
- Laboratory of Internal Medicine, Puerta de Hierro Research Institute & University Hospital, Majadahonda
| | - Pablo Barreiro
- Tropical Medicine Unit, Carlos III-La Paz University Hospital
| | | | - Octavio Corral
- UNIR Health Sciences School & Medical Center, Madrid, Spain
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Toxoplasma gondii infection in hospitalized people living with HIV in Spain, 1997 to 2015. Parasitol Res 2021; 120:755-761. [PMID: 33447884 DOI: 10.1007/s00436-020-07007-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
Toxoplasma gondii infection was one of the most frequent AIDS-defining conditions in HIV-infected individuals until the advent of combination antiretroviral therapy. We aimed to assess the clinical load, coinfection, and mortality, as well as time trends for people living with HIV and hospitalized with Toxoplasma gondii infection, in Spain from 1997 to 2015. Retrospective observational analysis using the Spanish National Registry of Hospital Discharges. Information was retrieved for the study period using the International Classification of Diseases, 9th revision. There were 66,451,094 hospital admissions in Spain from 1997 to 2015, including 472,269 (0.71%) in people living with HIV. Toxoplasma gondii infection was registered in 9006 of these (overall prevalence 1.91%), making it the fifth most common opportunistic infection in hospitalized HIV-positive patients. Prevalence of Toxoplasma gondii infection declined in this group from 4.2% in 1997 to 0.8% in 2015 (p < 0.001), while mean age increased, from 35 years in 1997 to 44 years in 2015. The overall in-hospital mortality rate declined from 13.5% in 1997 to 8.9% in 2015, and it was higher in the concomitant presence of bacterial pneumonia (28.9% vs. 10.2%, p < 0.001), cryptosporidiosis (26.9% vs. 11.5%; p = 0.03), cytomegalovirus disease (18.2% vs. 11.2%, p < 0.001), Pneumocystis jiroveci pneumonia (31.5% vs. 10.5%, p < 0.001), leukoencephalopathy (19.8% vs. 11.78% p < 0.001), and wasting syndrome (29.3% vs 10.9%; p < 0.001). Toxoplasma gondii infection prevalence has significantly declined among hospitalized HIV-infected patients in Spain during the last two decades, coinciding with the widespread use of combination antiretroviral therapy.
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Alonso F, Esteban C, Serge A, Tortosa M. Importance of Social- and Health-Related Problems: Do Spaniards Give Them the Significance They Actually Deserve? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214090. [PMID: 31652925 PMCID: PMC6861970 DOI: 10.3390/ijerph16214090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/04/2019] [Accepted: 10/20/2019] [Indexed: 12/28/2022]
Abstract
Social and health problems imply an impact on society. The main objective of this study is to provide an overview of how Spanish people perceive cancer, terrorism, cardiovascular diseases, crime, AIDS, drugs, and traffic accidents, finding out whether they assess the importance of these issues in correspondence with their actual severity. The study used a full sample of 1206 Spaniards (51.6% females and 48.4% males) who responded to a computer-assisted telephone interviewing (CATI) survey on the significance of these social and health-related problems, assessed through a zero to ten Likert scale. The perceived severity of the problems was considered taking into account the official data of deaths reported by governmental institutions. For the comparison of mean values, the One-way Analysis of Variance (ANOVA) test was used. Results show high average values for all the problems. The most concerning elements are cancer (M = 9.28 ± 1.24) and terrorism (M = 9.22 ± 1.47). Cardiovascular diseases have the lowest scores (M = 8.29 ± 1.64). There is a good adjustment between real and subjective perception, but some issues are either underestimated or overestimated. Women assessed all of them as more important than men, and people over 65 gave all the issues more value than younger people. It is important that Spaniards understand the objective severity of these issues, thus allowing for more interventions by governments, education, and mass media.
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Affiliation(s)
- Francisco Alonso
- DATS (Development and Advising in Traffic Safety) Research Group, INTRAS (University Research Institute on Traffic and Road Safety), University of Valencia, 46022 Valencia, Spain.
| | - Cristina Esteban
- DATS (Development and Advising in Traffic Safety) Research Group, INTRAS (University Research Institute on Traffic and Road Safety), University of Valencia, 46022 Valencia, Spain.
| | - Andrea Serge
- DATS (Development and Advising in Traffic Safety) Research Group, INTRAS (University Research Institute on Traffic and Road Safety), University of Valencia, 46022 Valencia, Spain.
| | - Macarena Tortosa
- PRECOVIR (Prevention of Risk Behaviour on the Road), INTRAS (Research Institute on Traffic and Road Safety), University of Valencia, 46022 Valencia, Spain.
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HIV co-infection in HTLV-1 carriers in Spain. Virus Res 2019; 266:48-51. [PMID: 30998953 DOI: 10.1016/j.virusres.2019.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Human retroviruses HIV and HTLV share transmission routes. HIV widely spread in Spain during the 80 s through injection drug use and sex, and nowadays HIV rates in Spain account for one of the largest in Europe. In contrast, HTLV-1 is not endemic in Spain, despite hosting huge numbers of migrants from highly endemic regions. Herein, we report the rate and main features of the HIV-HTLV co-infected population in Spain. METHODS A national registry exists in Spain for HTLV since year 1989. Data from standardized case report forms and one centralized lab repository were reviewed, especially for the subset with HTLV-HIV co-infection. RESULTS Up to December 2018, a total of 369 individuals with HTLV-1 had been diagnosed in Spain. 64% of the population were females, and Latin American individuals accounted for 64.5%. Classical HTLV-associated illnesses were found in 12.7% (myelopathy) and 7.6% (leukemia). HIV coinfection was found in 12 (3.2%). Of those, 3 patients (25%) were female and 39 (75%) were of non-Spanish origin. All but two harbored HIV-1 subtype B, being non-B variants found in the two West Africans. Exposure had been sexual in most cases, being 4 homosexual men. Seven HTLV-HIV co-infected patients had developed AIDS and two had developed myelopathy. There was no evidence for increased HTLV-1 clinical pathogenicity due to HIV coinfection. CONCLUSION HIV coinfection is infrequent (<5%) among HTLV-1 carriers in Spain. More than half of co-infected patients come from Latin America. Sexual contact is the most frequent risk behavior, being MSM one third of cases. Late diagnosis explains the high rate (9/12) of clinical manifestations in our HIV-HTLV co-infected population.
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Psomas C, Kinloch S, Sabin C, Soriano V, Solas C, Orkin C, Bernardino J, Curran A, Routy JP, Enel P, Philibert P, Lafeuillade A. Highlights from the 20th International Symposium on HIV and Emerging Infectious Diseases (ISHEID) 16-18 May 2018, Marseille, France: from HIV and comorbidities to global health. J Virus Erad 2018; 4:196-207. [PMID: 30050686 PMCID: PMC6038128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The 20th International Symposium on HIV and Emerging Infectious Diseases took place in Marseille, France. It had a refreshing European look with reinforced partnerships with the European AIDS Clinical Society and the British HIV Association and with international speakers and participants. Topics included HIV and global health, HIV and hepatitis cure, the microbiome and immunotherapies, clinical research and methodology, as well as chemsex, pre-exposure prophylaxis, sexually transmitted infections and emerging infectious diseases. Novel areas of research were also described, such as electronic technology in order to improve HIV management, and the expert patient.
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Affiliation(s)
| | - Sabine Kinloch
- Royal Free Hospital, NHS Trust and University College London, London, UK
| | - Caroline Sabin
- University College London, Royal Free Campus, London, UK
| | | | - Caroline Solas
- Department of Pharmacokinetics and Toxicology, APHM, Marseille, France
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Highlights from the 20th International Symposium on HIV and Emerging Infectious Diseases (ISHEID) 16–18 May 2018, Marseille, France: from HIV and comorbidities to global health. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30271-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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