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Gonzalez-Serna A, Macias J, Palacios R, Gómez-Ayerbe C, Tellez F, Rivero-Juárez A, Fernandez M, Santos J, Real LM, Gonzalez-Domenech CM, Gomez-Mateos J, Pineda JA. Incidence of recently acquired hepatitis C virus infection among HIV-infected patients in southern Spain. HIV Med 2020; 22:379-386. [PMID: 33369104 DOI: 10.1111/hiv.13039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/20/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Spain is close to HCV microelimination, so rates of recently acquired HCV infection (RAHC) should decrease. Nowadays, men who have sex with men (MSM) carry the highest risk of HCV acquisition. Our aim was to estimate the incidence of and the factors associated with RAHC, together with reinfection rates, among patients sexually infected by HIV. METHODS Primary RAHC infection was diagnosed when anti-HCV antibody seroconversion was documented. In anti-HCV positive patients, initially without HCV viraemia, a diagnosis of reinfection was established if plasma HCV RNA was detected. RESULTS All 350 patients tested negative for anti-HCV at baseline and had at least one follow-up visit. Among them, there were 16 RAHC cases from 2016 to 2019. RAHC incidence rates [IR (95% confidence interval, CI)] per 100 person-years were 3.77 (0.5-12.9) in 2016, 1.85 (0.6-4.3) in 2017, 1.49 (0.4-3.8) in 2018 and 1.98 (0.6-4.5) in 2019. Only previous sexually transmitted infections [incidence rate ratio (IRR) = 18.23, 95% CI: 1.93-172.1; P = 0.011], male sex (IRR = 8.33, 95% CI: 1.38-54.15; P = 0.026) and sharing chem-sex drugs (IRR: 4.93, 95% CI: 1.17-20.76; P = 0.030), were independently associated with RAHC. Four out of 42 (9.5%) patients became reinfected. CONCLUSIONS The incidence of RAHC among HIV-infected patients showed a decrease after 2016, although a lower but steady incidence of residual cases still remains. HCV reinfections showed a similar pattern. New infections were associated with sharing chem-sex drugs among MSM.
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Affiliation(s)
- A Gonzalez-Serna
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - J Macias
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - R Palacios
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - C Gómez-Ayerbe
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - F Tellez
- UGC Enfermedades Infecciosas, Departamento Medicina, Universidad de Cádiz, Hospital Universitario de Puerto Real, Cádiz, Spain
| | - A Rivero-Juárez
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - M Fernandez
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - J Santos
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - L M Real
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - C M Gonzalez-Domenech
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - J Gomez-Mateos
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - J A Pineda
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de Valme, Sevilla, Spain
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2
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Corma-Gómez A, Macías J, Téllez F, Freyre-Carrillo C, Morano L, Rivero-Juárez A, Ríos MJ, Alados JC, Vera-Méndez FJ, Merchante N, Palacios R, Granados R, Merino D, De Los Santos I, Pineda JA. Liver Stiffness at the Time of Sustained Virological Response Predicts the Clinical Outcome in People Living With Human Immunodeficiency Virus and Hepatitis C Virus With Advanced Fibrosis Treated With Direct-acting Antivirals. Clin Infect Dis 2019; 71:2354-2362. [DOI: 10.1093/cid/ciz1140] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 11/20/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Some people living with hepatitis C virus (HCV) with sustained virological response (SVR) develop hepatic complications. Liver stiffness (LS) predicts clinical outcome in people living with human immunodeficiency virus (HIV) with active HCV coinfection, but information after SVR is lacking. We aimed to analyze the predictive ability of LS at SVR for liver complications in people living with HIV/HCV with advanced fibrosis treated with direct-acting antivirals (DAA).
Methods
In sum, 640 people living with HIV/HCV fulfilling the following criteria were included: (i) Achieved SVR with DAA-including regimen; (ii) LS ≥ 9.5 kPa before therapy; and (iii) LS measurement available at SVR. The primary endpoint was the occurrence of a liver complication—hepatic decompensation or hepatocellular carcinoma (HCC)—or requiring liver transplant after SVR.
Results
During a median (Q1–Q3) follow-up of 31.6 (22.7–36.6) months, 19 (3%) patients reached the primary endpoint. In the multivariate analysis, variables (subhazard ratio [SHR] [95% confidence interval]) associated with developing clinical outcomes were: prior hepatic decompensations (3.42 [1.28–9.12]), pretreatment CPT class B or C (62.5 [3.08–1246.42]) and MELD scores (1.37 [1.03–1.82]), CPT class B or C at SVR (10.71 [1.32–87.01]), CD4 cell counts <200/µL at SVR time-point (4.42 [1.49–13.15]), FIB-4 index at SVR (1.39 [1.13–1.70]), and LS at SVR (1.05 [1.02–1.08] for 1 kPa increase). None of the 374 patients with LS <14kPa at SVR time-point developed a liver complication or required hepatic transplant.
Conclusions
LS at the time of SVR after DAA therapy predicts the clinical outcome of people living with HIV/HCV with advanced fibrosis. These results suggest that LS measurement may be helpful to select candidates to be withdrawn from surveillance programs.
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Affiliation(s)
- A Corma-Gómez
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - J Macías
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - F Téllez
- Unit of Infectious Diseases, Hospital Universitario de Puerto Real, Facultad de Medicina, Universidad de Cadiz, Spain
| | - C Freyre-Carrillo
- Unit of Microbiology, Hospital Universitario de Puerto Real, Facultad de Medicina, Universidad de Cadiz, Spain
| | - L Morano
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - A Rivero-Juárez
- Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Instituto Maimonides de Investigación Biomedica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Spain
| | - M J Ríos
- Unit of Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - J C Alados
- Unit of Clinical Microbiology, University Hospital Jerez, Cadiz, Spain
| | - F J Vera-Méndez
- Section of Infectious Medicine/Service of Internal Medicine, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - N Merchante
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - R Palacios
- Unit of Infectious Diseases and Microbiology, Hospital Virgen de la Victoria, Málaga, Spain
| | - R Granados
- Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - D Merino
- Unit of Infectious Diseases, Hospitales Juan Ramón Jiménez e Infanta Elena, Huelva, Spain
| | - I De Los Santos
- Unit of Internal Medicine and Infectious Diseases, Hospital La Princesa, Madrid, Spain
| | - J A Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
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3
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Merchante N, Aldámiz-Echevarría T, García-Álvarez M, Rivero-Juárez A, Macías J, Miralles P, Jiménez-Sousa MA, Mancebo M, Pérez-Latorre L, Pineda-Tenor D, Berenguer J, Resino S, Pineda JA. Bacterial translocation and clinical progression of HCV-related cirrhosis in HIV-infected patients. J Viral Hepat 2018; 25:180-186. [PMID: 28783247 DOI: 10.1111/jvh.12769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/24/2017] [Indexed: 12/18/2022]
Abstract
The aim of the study was to evaluate whether bacterial translocation (BT) predicts the clinical outcome in HIV/HCV-coinfected patients with compensated cirrhosis. A cohort of 282 HIV/HCV-coinfected patients with cirrhosis and no previous liver decompensation (LD) was recruited. Serum levels of the DNA sequences encoding the well-conserved 16S rRNA subunit (16S rDNA), the lipopolysaccharide (LPS) and soluble CD14 (sCD14) at diagnosis of cirrhosis were measured. Primary endpoint was the emergence of the first LD and/or death of any cause. Secondary endpoints were LD, liver-related death (LRD) and death of any cause. After a median (Q1-Q3) follow-up of 51 (27-72) months, 67 patients (24%; 95% CI: 19-29) developed their first LD or died during follow-up. Baseline levels of 16S rDNA, LPS and sCD14 were not associated with the probability of developing the primary endpoint of the study. The mean (SD) survival time free of LD and/or death according to levels of 16S rDNA (<83, 83-196, 197-355, >355 [copies/μL]) was 78 (5), 72 (5), 81 (4) and 82 (4) months, respectively (P = .5). The corresponding figures for LPS (<0.1, 0.1-0.6, 0.6-1.5, > 1.5 [IU/mL]) were 76 (5), 71 (5), 77 (5) and 81 (4) months, respectively (P = .4). Baseline levels of BT serum markers were not associated with any of the secondary endpoints analysed in the study. Thus, BT does not seem to be a relevant predictor of clinical outcome in HIV/HCV-coinfected patients with compensated cirrhosis.
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Affiliation(s)
- N Merchante
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario de Valme. Sevilla, Sevilla, Spain
| | - T Aldámiz-Echevarría
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M García-Álvarez
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - A Rivero-Juárez
- Unidad de Enfermedades Infecciosas, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO), Córdoba, Spain
| | - J Macías
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario de Valme. Sevilla, Sevilla, Spain
| | - P Miralles
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M A Jiménez-Sousa
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - M Mancebo
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario de Valme. Sevilla, Sevilla, Spain
| | - L Pérez-Latorre
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - D Pineda-Tenor
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - J Berenguer
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - S Resino
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - J A Pineda
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario de Valme. Sevilla, Sevilla, Spain
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4
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Macías J, Real LM, Rivero-Juárez A, Merchante N, Camacho A, Neukam K, Rivero A, Mancebo M, Pineda JA. Changes in liver steatosis evaluated by transient elastography with the controlled attenuation parameter in HIV-infected patients. HIV Med 2017; 17:766-773. [PMID: 27028546 DOI: 10.1111/hiv.12384] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES There are scant data on the progression of hepatic steatosis (HS) in HIV infection. We therefore evaluated changes in HS over time in HIV-infected patients using the controlled attenuation parameter (CAP). METHODS A prospective cohort of 326 HIV-infected patients was included in this study. All patients underwent a CAP measurement. Changes in steatosis were evaluated by calculating the median (Q1-Q3) difference between baseline and 12-month CAP values. RESULTS The median (Q1-Q3) CAP was 221 (196-252) dB/m at baseline and 224 (198-257) dB/m at the 12-month visit (P = 0.617). Significant steatosis, that is, CAP ≥ 238 dB/m, was observed in 76 individuals (37%) at baseline and in 80 (39%) at the 12-month visit (P = 0.683). The following variables were associated with ΔCAP: plasma HIV RNA [< 50 vs. ≥ 50 HIV-1 RNA copies/mL: median (Q1-Q3) ΔCAP, 4 (-21, 27) vs. -21 (-49, 4) dB/m, respectively; P = 0.024]; body mass index (BMI) [no increase vs. increase: -13 (-40, 4) vs. 14 (-6, 32) dB/m, respectively; P < 0.001]; triglycerides [no increase vs. increase: -1 (-30, 22) vs. 15 (-3, 40) dB/m, respectively; P = 0.001]; fasting plasma glucose [not impaired vs. impaired: -4 (-31, 16) vs. 30 (15, 49) dB/m, respectively; P < 0.001]; and raltegravir [no vs. yes: 5 (-20, 29) vs. -11 (-37.5, 15) dB/m, respectively; P = 0.018]. The only factor independently associated with ΔCAP was BMI [B (standard error): 9.03 (1.9); P < 0.001]. CONCLUSIONS Increases in CAP values over a period of 12 months in HIV-infected patients were strongly associated with elevations in BMI. Other metabolic factors and antiretroviral drugs were not predictors of CAP changes independent of BMI.
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Affiliation(s)
- J Macías
- Infectious Diseases and Microbiology Unit, Valme University Hospital, Seville, Spain. .,Institute of Biomedicine from Seville (IBiS), Seville, Spain.
| | - L M Real
- Infectious Diseases and Microbiology Unit, Valme University Hospital, Seville, Spain.,Institute of Biomedicine from Seville (IBiS), Seville, Spain
| | - A Rivero-Juárez
- Infectious Diseases Unit, Institute Maimónides of Biomedical Research from Cordoba, Cordoba, Spain
| | - N Merchante
- Infectious Diseases and Microbiology Unit, Valme University Hospital, Seville, Spain.,Institute of Biomedicine from Seville (IBiS), Seville, Spain
| | - A Camacho
- Infectious Diseases Unit, Institute Maimónides of Biomedical Research from Cordoba, Cordoba, Spain
| | - K Neukam
- Infectious Diseases and Microbiology Unit, Valme University Hospital, Seville, Spain.,Institute of Biomedicine from Seville (IBiS), Seville, Spain
| | - A Rivero
- Infectious Diseases Unit, Institute Maimónides of Biomedical Research from Cordoba, Cordoba, Spain
| | - M Mancebo
- Infectious Diseases and Microbiology Unit, Valme University Hospital, Seville, Spain.,Institute of Biomedicine from Seville (IBiS), Seville, Spain
| | - J A Pineda
- Infectious Diseases and Microbiology Unit, Valme University Hospital, Seville, Spain
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5
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Neukam K, Morano-Amado LE, Rivero-Juárez A, Macías J, Granados R, Romero-Palacios A, Márquez M, Merino D, Ortega E, Alados-Arboledas JC, Cucurull J, Omar M, Ryan-Murua P, Pineda JA. Liver stiffness predicts the response to direct-acting antiviral-based therapy against chronic hepatitis C in cirrhotic patients. Eur J Clin Microbiol Infect Dis 2016; 36:853-861. [PMID: 28004322 DOI: 10.1007/s10096-016-2871-x] [Citation(s) in RCA: 4] [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] [Received: 10/17/2016] [Accepted: 12/07/2016] [Indexed: 12/21/2022]
Abstract
The purpose of this investigation was to evaluate the impact of liver stiffness (LS) on the response to direct-acting antiviral (DAA)-based therapy against hepatitis C virus (HCV) infection in cirrhotic patients. Those patients included in two Spanish prospective cohorts of patients receiving therapy based on at least one DAA, who showed a baseline LS ≥ 12.5 kPa and who had reached the scheduled time point for sustained virological response evaluation 12 weeks after completing therapy (SVR12) were analysed. Pegylated interferon/ribavirin-based therapy plus an HCV NS3/4A protease inhibitor (PR-PI group) was administered to 198 subjects, while 146 received interferon-free regimens (IFN-free group). The numbers of patients with SVR12 according to an LS < 21 kPa versus ≥21 kPa were 59/99 (59.6%) versus 46/99 (46.5%) in the PR-PI group (p = 0.064) and 41/43 (95.3%) versus 90/103 (87.4%) in the IFN-free group (p = 0.232). Corresponding figures for the relapse rates in those who presented end-of-treatment response (ETR) were 3/62 (4.8%) versus 10/56 (17.9%, p = 0.024) and 1/42 (2.4%) versus 8/98 (8.2%, p = 0.278), respectively. In a multivariate analysis adjusted for age, sex and use of interferon, a baseline LS ≥ 21 kPa was identified as an independent predictor of relapse [adjusted odds ratio, AOR (95% confidence interval, CI): 4.228 (1.344-13.306); p = 0.014] in those patients with ETR. LS above 21 kPa is associated with higher rates of relapse to DAA-based therapy in HCV-infected patients with cirrhosis in clinical practice. LS could help us to tailor the duration and composition of DAA-based combinations in cirrhotic subjects, in order to minimise the likelihood of relapse.
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Affiliation(s)
- K Neukam
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain.
| | - L E Morano-Amado
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - A Rivero-Juárez
- Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Maimónides Institute of Biomedical Investigation of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain
| | - J Macías
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - R Granados
- Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - A Romero-Palacios
- Unit of Infectious Diseases, Hospital Universitario Puerto Real, Puerto Real, Spain
| | - M Márquez
- Unit of Infectious Diseases, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - D Merino
- Unit of Infectious Diseases, Complejo Hospitalario Universitario de Huelva, Huelva, Spain
| | - E Ortega
- Unit of Infectious Diseases, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - J C Alados-Arboledas
- Unit of Infectious Diseases and Microbiology, AGS Norte de Cádiz, Jerez de la Frontera, Spain
| | - J Cucurull
- Service of Internal Medicine, Hospital de Figueres-Fundació Salut Empordà, Figueres, Spain
| | - M Omar
- Unit of Infectious Diseases, Complejo Hospitalario de Jaén, Jaen, Spain
| | - P Ryan-Murua
- Internal Medicine Service, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - J A Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
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Frías M, Rodríguez-Cano D, Cuenca-López F, Macías J, Gordon A, Manzanares-Martín B, Pineda JA, Camacho Á, Torre-Cisneros J, Peña J, Rivero-Juárez A, Rivero A. HLA-B18 as risk factor of liver fibrosis progression in HIV/HCV treatment-experienced patients. Pharmacogenomics J 2016; 17:479-480. [DOI: 10.1038/tpj.2016.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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7
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Monje-Agudo P, Castro-Iglesias A, Rivero-Juárez A, Martínez-Marcos F, Ortega-González E, Real LM, Pernas B, Merchante N, Cid P, Macías J, Merino MD, Rivero A, Mena A, Neukam K, Pineda JA. Impact of HIV infection on sustained virological response to treatment against hepatitis C virus with pegylated interferon plus ribavirin. Eur J Clin Microbiol Infect Dis 2015; 34:1929-36. [PMID: 26155784 DOI: 10.1007/s10096-015-2434-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 01/03/2015] [Accepted: 06/22/2015] [Indexed: 12/18/2022]
Abstract
It is commonly accepted that human immunodeficiency (HIV) coinfection negatively impacts on the rates of sustained virological response (SVR) to therapy with pegylated interferon plus ribavirin (PR). However, this hypothesis is derived from comparing different studies. The aim of this study was to determine the impact of HIV coinfection on SVR to PR in one single population. In a multicentric, prospective study conducted between 2000 and 2013, all previously naïve hepatitis C virus (HCV)-infected patients who started PR in five Spanish hospitals were analyzed. SVR was evaluated 24 weeks after the scheduled end of therapy. Of the 1046 patients included in this study, 413 (39%) were coinfected with HIV. Three hundred and forty-one (54%) HCV-monoinfected versus 174 (42%) HIV/HCV-coinfected patients achieved SVR (p < 0.001). The corresponding figures for undetectable HCV RNA at treatment week 4 were 86/181 (47%) versus 59/197 (30%), p < 0.001. SVR was observed in 149 (69%) HCV genotype 2/3-monoinfected subjects versus 91 (68%) HIV/HCV genotype 2/3-coinfected subjects (p = 0.785). In the HCV genotype 1/4-infected population, 188 (46%) monoinfected patients versus 82 (30%) with HIV coinfection (p < 0.001) achieved SVR. In this subgroup, absence of HIV coinfection was independently associated with higher SVR [adjusted odds ratio (95% confidence interval): 2.127 (1.135-3.988); p = 0.019] in a multivariate analysis adjusted for age, sex, baseline HCV RNA load, IL28B genotype, fibrosis stage, and type of pegylated interferon. HIV coinfection impacts on the rates of SVR to PR only in HCV genotype 1/4-infected patients, while it has no effect on SVR in the HCV genotype 2/3-infected subpopulation.
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Affiliation(s)
- P Monje-Agudo
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Avda de Bellavista s/n, 41014, Sevilla, Spain
| | - A Castro-Iglesias
- Clinical Virology Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña, 15006, A Coruña, Spain
| | - A Rivero-Juárez
- Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - F Martínez-Marcos
- Unit of Infectious Diseases, Complejo Hospitalario de Huelva, Ronda Exterior Norte s/n, 21005, Huelva, Spain
| | - E Ortega-González
- Unit of Infectious Diseases, Consorcio Hospital General Universitario de Valencia, Av. Tres Cruces s/n, 46014, Valencia, Spain
| | - L M Real
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Avda de Bellavista s/n, 41014, Sevilla, Spain
| | - B Pernas
- Clinical Virology Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña, 15006, A Coruña, Spain
| | - N Merchante
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Avda de Bellavista s/n, 41014, Sevilla, Spain
| | - P Cid
- Clinical Virology Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña, 15006, A Coruña, Spain
| | - J Macías
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Avda de Bellavista s/n, 41014, Sevilla, Spain
| | - M D Merino
- Unit of Infectious Diseases, Complejo Hospitalario de Huelva, Ronda Exterior Norte s/n, 21005, Huelva, Spain
| | - A Rivero
- Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - A Mena
- Clinical Virology Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña, 15006, A Coruña, Spain
| | - K Neukam
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Avda de Bellavista s/n, 41014, Sevilla, Spain.
| | - J A Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Avda de Bellavista s/n, 41014, Sevilla, Spain
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Mira JA, Neukam K, López-Cortés LF, Rivero-Juárez A, Téllez F, Girón-González JA, de los Santos-Gil I, Ojeda-Burgos G, Merino D, Ríos-Villegas MJ, Collado A, Torres-Cornejo A, Macías J, Rivero A, Pérez-Pérez M, Pineda JA. Efficacy of and risk of bleeding during pegylated interferon plus ribavirin treatment in HIV/HCV-coinfected patients with pretreatment thrombocytopenia. Eur J Clin Microbiol Infect Dis 2015; 34:1879-84. [PMID: 26115631 DOI: 10.1007/s10096-015-2426-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 06/05/2015] [Indexed: 01/21/2023]
Abstract
The aim of this study was to assess the efficacy of and the risk of major bleeding during pegylated interferon (peg-IFN)/ribavirin (RBV) treatment among human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected patients according to the pretreatment platelet count. Two hundred and seventy-four HCV/HIV-coinfected, previously naïve individuals with compensated cirrhosis enrolled in one Spanish prospective cohort who received peg-IFN/RBV were included in this study. The frequency of severe bleeding and sustained virological response (SVR) rate were compared between patients with a pretreatment platelet count ≤70,000/mm(3) and >70,000/mm(3), respectively. Sixty-one (22 %) patients had a baseline platelet count ≤70,000/mm(3). The median (Q1-Q3) pretreatment platelet count was 58,000 (49,000-65,000) cells/mm(3) in the platelet ≤70,000 group and 129,000 (102,500-166,000) cells/mm(3) in the platelet >70,000 group (p < 0.0001). Seventeen (28 %) subjects of the platelet ≤70,000 group and 71 (33 %) patients of the platelet >70,000 group achieved SVR (p = 0.4). Only 2 (3.2 %) patients in the platelet ≤70,000 group developed a severe hemorrhagic event, specifically esophageal variceal bleeding. The efficacy of therapy with peg-IFN/RBV in HIV/HCV-coinfected patients with low pretreatment platelet counts is comparable to that found in the overall subset of subjects with compensated cirrhosis. The frequency of severe hemorrhagic events related with this therapy is low in this population.
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Affiliation(s)
- J A Mira
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Avenida de Bellavista S/N, 41014, Sevilla, Spain
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Herrero R, Real LM, Rivero-Juárez A, Pineda JA, Camacho Á, Macías J, Laplana M, Konieczny P, Márquez FJ, Souto JC, Soria JM, Saulle I, Lo Caputo S, Biasin M, Rivero A, Fibla J, Caruz A. Association of complement receptor 2 polymorphisms with innate resistance to HIV-1 infection. Genes Immun 2015; 16:134-41. [PMID: 25569262 DOI: 10.1038/gene.2014.71] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 11/10/2014] [Accepted: 11/12/2014] [Indexed: 11/09/2022]
Abstract
HIV-1 induces activation of complement through the classical and lectin pathways. However, the virus incorporates several membrane-bound or soluble regulators of complement activation (RCA) that inactivate complement. HIV-1 can also use the complement receptors (CRs) for complement-mediated antibody-dependent enhancement of infection (Ć-ADE). We hypothesize that hypofunctional polymorphisms in RCA or CRs may protect from HIV-1 infection. For this purpose, 139 SNPs located in 19 RCA and CRs genes were genotyped in a population of 201 Spanish HIV-1-exposed seronegative individuals (HESN) and 250 HIV-1-infected patients. Two SNPs were associated with infection susceptibility, rs1567190 in CR2 (odds ratio (OR) = 2.27, P = 1 × 10(-4)) and rs2842704 in C4BPA (OR = 2.11, P = 2 × 10(-4)). To replicate this finding, we analyzed a cohort of Italian, sexually HESN individuals. Although not significant (P = 0.25, OR = 1.57), similar genotypic proportions were obtained for the CR2 marker rs1567190. The results of the two association analyses were combined through a random effect meta-analysis, with a significant P-value of 2.6 x 10(-5) (OR = 2.07). Furthermore, we found that the protective CR2 genotype is correlated with lower levels CR2 mRNA as well as differences in the ratio of the long and short CR2 isoforms.
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Affiliation(s)
- R Herrero
- Immunogenetics Unit, Department of Experimental Biology, University of Jaen, Jaen, Spain
| | - L M Real
- Infectious Diseases and Microbiology Clinical Unit. Valme Hospital, Seville, Spain
| | - A Rivero-Juárez
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC)/Reina Sofia University Hospital, Cordoba, Spain
| | - J A Pineda
- Infectious Diseases and Microbiology Clinical Unit. Valme Hospital, Seville, Spain
| | - Á Camacho
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC)/Reina Sofia University Hospital, Cordoba, Spain
| | - J Macías
- Infectious Diseases and Microbiology Clinical Unit. Valme Hospital, Seville, Spain
| | - M Laplana
- Human Genetics Unit, Department of Basic Medical Sciences, University of Lleida IRBLleida, Lleida, Catalonia, Spain
| | - P Konieczny
- Immunogenetics Unit, Department of Experimental Biology, University of Jaen, Jaen, Spain
| | - F J Márquez
- Immunogenetics Unit, Department of Experimental Biology, University of Jaen, Jaen, Spain
| | - J C Souto
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i de Sant Pau, Barcelone, Spain
| | - J M Soria
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i de Sant Pau, Barcelone, Spain
| | - I Saulle
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | | | - M Biasin
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - A Rivero
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC)/Reina Sofia University Hospital, Cordoba, Spain
| | - J Fibla
- Human Genetics Unit, Department of Basic Medical Sciences, University of Lleida IRBLleida, Lleida, Catalonia, Spain
| | - A Caruz
- Immunogenetics Unit, Department of Experimental Biology, University of Jaen, Jaen, Spain
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Caruz A, Neukam K, Rivero-Juárez A, Herrero R, Real LM, Camacho A, Barreiro P, Labarga P, Rivero A, Pineda JA. Association of low-density lipoprotein receptor genotypes with hepatitis C viral load. Genes Immun 2014; 15:16-24. [PMID: 24173146 DOI: 10.1038/gene.2013.56] [Citation(s) in RCA: 13] [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] [Received: 07/22/2013] [Revised: 09/26/2013] [Accepted: 09/27/2013] [Indexed: 01/03/2023]
Abstract
Several data suggest that low-density lipoprotein receptor (LDLR) is a co-receptor for hepatitis C virus (HCV). Soluble LDLR can inhibit HCV infectivity; greater plasma low-density lipoprotein levels are associated with treatment success; LDLR genotypes have a synergistic impact on the likelihood of achieving SVR with Peg-IFN plus RBV, as well as on viral kinetics after starting treatment. The objective of this study was to assess the impact of genetic polymorphisms in genes related to cholesterol synthesis and transport pathways on pre-treatment plasma HCV viral load (VL). A total of 442 patients infected with HCV and treatment naive were prospectively recruited. One hundred forty-four SNPs located in 40 genes from the cholesterol synthesis/transport and IL28B were genotyped and analyzed for genetic association with pre-treatment plasma HCV VL. SNPs rs1433099 and rs2569540 of LDLR showed association with plasma HCV VL (P=4 × 10(-4) and P=2 × 10(-3)) in patients infected with genotypes 1 and 4. A haplotype including the last three exons of LDLR showed association with the cutoff level of 600 000 IU ml(-1) VL for genotypes 1 and 4 (OR=0.27; P=8 × 10(-6)), as well as a quantitative VL (mean±s.d.: 6.19±0.9 vs CC+CG 5.58±1.1 logIU ml(-1), P=8 × 10(-5)). LDLR genotypes are a major genetic factor influencing HCV VL in patients infected with genotypes 1 and 4.
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Affiliation(s)
- A Caruz
- Immunogenetics Unit, Department of Experimental, Biology Faculty of Sciences, Universidad de Jaén, Jaén, Spain
| | - K Neukam
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - A Rivero-Juárez
- Unit of Infectious Diseases, Maimonides Institute for Biomedical Research (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
| | - R Herrero
- Immunogenetics Unit, Department of Experimental, Biology Faculty of Sciences, Universidad de Jaén, Jaén, Spain
| | - L M Real
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - A Camacho
- Unit of Infectious Diseases, Maimonides Institute for Biomedical Research (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
| | - P Barreiro
- Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain
| | - P Labarga
- Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain
| | - A Rivero
- Unit of Infectious Diseases, Maimonides Institute for Biomedical Research (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
| | - J A Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
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