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Álvarez H, Gutiérrez-Valencia A, Mariño A, Saborido-Alconchel A, Calderón-Cruz B, Pérez-González A, Alonso-Domínguez J, Martínez-Barros I, Gallego-Rodríguez M, Moreno S, Aldamiz T, Montero-Alonso M, Bernal E, Galera C, Llibre JM, Poveda E. IP-10 and MIG are sensitive markers of early virological response to HIV-1 integrase inhibitors. Front Immunol 2023; 14:1257725. [PMID: 37920466 PMCID: PMC10619723 DOI: 10.3389/fimmu.2023.1257725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/12/2023] [Indexed: 11/04/2023] Open
Abstract
Background Interferon-inducible protein-10 (IP-10) and monokine induced by interferon-gamma (MIG) are chemokines recognized as inflammatory biomarkers during HIV-1 infection. We assessed their early and long-term dynamics after initiation of antiretroviral treatment (ART). Methods Persons with HIV-1 (PWH) aged>18 years starting their first ART in 2015-2021 in a prospective cohort (n=73) were included. IP-10 and MIG plasma levels were quantified using a multiplexed bead-based assay. Results IP-10 and MIG plasma levels showed a significant and consistent reduction following ART (80% integrase inhibitor [INSTI]-based) initiation, starting at day 20 and maintained throughout the study period (48 months), paralleling the HIV-1 RNA decay and CD4+ count recovery (p<0·001). At baseline, PWH≥ 50 years, CDC stage C and CD4+ count<350cells/mm3 had higher levels of IP-10 (p=0·022, p=0·001 and p=0·002, respectively) and MIG (p<0·001, p=0·024 and p=0·069, respectively). All of them matched their counterparts several months following ART initiation. MIG levels showed a greater decrease at day 10 in those treated with INSTI (p=0·038). Low-level HIV-1 viremia did not impact MIG or IP-10 levels. Conclusion Plasma IP-10 and MIG showed an early significant decline following ART initiation, with greater early declines in MIG levels in INSTI-based regimens. These findings suggest a strong impact of HIV-1 viremia on IP-10 and MIG levels.
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Affiliation(s)
- Hortensia Álvarez
- Infectious Diseases Unit, Department of Internal Medicine, Complexo Hospitalario Universitario de Ferrol, Servicio Galego de Saúde (SERGAS)-A Coruña, A Coruña, Spain
- Department of Biochemistry, Genetics and Immunology, Universidade de Vigo, Vigo, Spain
| | - Alicia Gutiérrez-Valencia
- Clinical Unit of Infectious Diseases and Microbiology, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, Spanish National Research Council (CSIC), University of Seville, Seville, Spain
| | - Ana Mariño
- Infectious Diseases Unit, Department of Internal Medicine, Complexo Hospitalario Universitario de Ferrol, Servicio Galego de Saúde (SERGAS)-A Coruña, A Coruña, Spain
| | - Abraham Saborido-Alconchel
- Clinical Unit of Infectious Diseases and Microbiology, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, Spanish National Research Council (CSIC), University of Seville, Seville, Spain
| | - Beatriz Calderón-Cruz
- Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, Servicio Galego de Saúde-Universidade de Vigo (SERGAS-U, Vigo), Vigo, Spain
| | - Alexandre Pérez-González
- Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, Servicio Galego de Saúde-Universidade de Vigo (SERGAS-U, Vigo), Vigo, Spain
| | - Jacobo Alonso-Domínguez
- Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, Servicio Galego de Saúde-Universidade de Vigo (SERGAS-U, Vigo), Vigo, Spain
| | - Inés Martínez-Barros
- Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, Servicio Galego de Saúde-Universidade de Vigo (SERGAS-U, Vigo), Vigo, Spain
| | - María Gallego-Rodríguez
- Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, Servicio Galego de Saúde-Universidade de Vigo (SERGAS-U, Vigo), Vigo, Spain
| | - Santiago Moreno
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Teresa Aldamiz
- Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marta Montero-Alonso
- Infectious Diseases Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Enrique Bernal
- Infectious Diseases Unit, Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Carlos Galera
- Internal Medicine Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Josep M. Llibre
- Infectious Diseases Division and Fight Infections Foundation, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Eva Poveda
- Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, Servicio Galego de Saúde-Universidade de Vigo (SERGAS-U, Vigo), Vigo, Spain
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2
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Poveda E, Fitzgerald W, Reglero C, Pérez-González A, Mariño A, Álvarez H, Valcarce N, Llibre JM, Guillén SM, Fernández MAM, Ruiz-Mateos E, Margolis L, Lederman MM, Freeman ML. IL-18 and IL-3 in Extracellular Vesicles: Biomarkers for Durable Elite Control of HIV-1. J Infect Dis 2023:7040365. [PMID: 36790818 DOI: 10.1093/infdis/jiad042] [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] [Received: 10/24/2022] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
Plasma extracellular vesicle (EV)-associated cytokines were quantified in people with HIV (PWH) with different virological control status, including elite controllers (EC) who maintain persistent control (PC) or not (TC). Cytokine signatures and pathways were determined for each group. Median EV-associated cytokine levels were higher among PWH than HIV-uninfected. EC showed the highest levels of EV-associated cytokines among PWH with PC levels higher than TC levels. IL-18 levels best distinguished PWH from uninfected controls, and EC from ART-treated, and IL-3 distinguished PC from TC. The role of EV-cytokines in intercellular communication and endogenous control of HIV expression should be investigated further.
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Affiliation(s)
- Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Spain
| | - Wendy Fitzgerald
- Section on Intercellular Interactions, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Cristina Reglero
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Spain
| | - Alexandre Pérez-González
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Spain
| | - Ana Mariño
- Infectious Diseases Unit, Complexo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | - Hortensia Álvarez
- Infectious Diseases Unit, Complexo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | - Nieves Valcarce
- Infectious Diseases Unit, Complexo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | - Josep Maria Llibre
- Infectious Diseases Division, University Hospital Germans Trias and Fight Infections Foundation, Badalona, Spain
| | - Santiago Moreno Guillén
- Department of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain; Ramón y Cajal Institute for Health Research (IRICYS), Madrid, Spain; Department of Infectious Diseases, Ramón y Cajal University Hospital, Madrid, Spain; Infectious Diseases Networking Biomedical Research Centre (CIBERINFEC)
| | | | - Ezequiel Ruiz-Mateos
- Laboratory of Immunovirology. Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, CSIC, University of Seville, Seville, Spain
| | - Leonid Margolis
- Section on Intercellular Interactions, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael M Lederman
- Rustbelt Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Michael L Freeman
- Rustbelt Center for AIDS Research, Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, Cleveland, OH, USA
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Cañada-García JE, Delgado E, Gil H, Benito S, Sánchez M, Ocampo A, Cabrera JJ, Miralles C, García-Bodas E, Mariño A, Ordóñez P, Gude MJ, Ezpeleta C, Thomson MM. Viruses Previously Identified in Brazil as Belonging to HIV-1 CRF72_BF1 Represent Two Closely Related Circulating Recombinant Forms, One of Which, Designated CRF122_BF1, Is Also Circulating in Spain. Front Microbiol 2022; 13:863084. [PMID: 35694315 PMCID: PMC9185580 DOI: 10.3389/fmicb.2022.863084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Circulating recombinant forms (CRFs) are important components of the HIV-1 pandemic. Those derived from recombination between subtype B and subsubtype F1, with 18 reported, most of them of South American origin, are among the most diverse. In this study, we identified a HIV-1 BF1 recombinant cluster that is expanding in Spain, transmitted mainly via heterosexual contact, which, analyzed in near full-length genomes in four viruses, exhibited a coincident BF1 mosaic structure, with 12 breakpoints, that fully coincided with that of two viruses (10BR_MG003 and 10BR_MG005) from Brazil, previously classified as CRF72_BF1. The three remaining Brazilian viruses (10BR_MG002, 10BR_MG004, and 10BR_MG008) previously identified as CRF72_BF1 exhibited mosaic structures highly similar, but not identical, to that of the Spanish viruses and to 10BR_MG003 and 10BR_MG005, with discrepant subtypes in two short genome segments, located in pol and gp120env. Based on these results, we propose that the five viruses from Brazil previously identified as CRF72_BF1 actually belong to two closely related CRFs, one comprising 10BR_MG002, 10BR_MG004, and 10BR_MG008, which keep their CRF72_BF1 designation, and the other, designated CRF122_BF1, comprising 10BR_MG003, 10BR_MG005, and the viruses of the identified Spanish cluster. Three other BF1 recombinant genomes, two from Brazil and one from Italy, previously identified as unique recombinant forms, were classified as CRF72_BF1. CRF122_BF1, but not CRF72_BF1, was associated with protease L89M substitution, which was reported to contribute to antiretroviral drug resistance. Phylodynamic analyses estimate the emergence of CRF122_BF1 in Brazil around 1987. Given their close phylogenetic relationship and similar structures, the grouping of CRF72_BF1 and CRF122_BF1 in a CRF family is proposed.
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Affiliation(s)
- Javier E. Cañada-García
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Elena Delgado
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Horacio Gil
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Sonia Benito
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Mónica Sánchez
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Antonio Ocampo
- Department of Internal Medicine, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Jorge Julio Cabrera
- Department of Microbiology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
- Microbiology and Infectology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Celia Miralles
- Department of Internal Medicine, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Elena García-Bodas
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Ana Mariño
- Infectious Diseases Unit, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Patricia Ordóñez
- Department of Microbiology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - María José Gude
- Department of Microbiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Carmen Ezpeleta
- Department of Clinical Microbiology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Michael M. Thomson
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
- *Correspondence: Michael M. Thomson,
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Álvarez H, Rava M, Martínez C, Portilla J, Peraire J, Rivero A, Cervero M, Mariño A, Poveda E, Llibre JM. Predictors of low-level HIV viraemia and virological failure in the era of integrase inhibitors: A Spanish nationwide cohort. HIV Med 2022; 23:825-836. [PMID: 35234328 DOI: 10.1111/hiv.13265] [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] [Received: 08/30/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To pinpoint factors associated with low-level viraemia (LLV) and virological failure (VF) in people living with HIV in the era of high-efficacy antiretroviral treatment (ART) and widespread use of integrase strand transfer inhibitor (INSTIs)-based ART. METHODS We included adults aged > 18 years starting their first ART between 2015 and 2018 in the Spanish HIV/AIDS Research Network National Cohort (CoRIS). Low-level viraemia was defined as plasma viral load (pVL) of 50-199 copies/mL at weeks 48 and 72 and VF was defined as pVL ≥ 50 copies/mL at week 48 and pVL ≥ 200 copies/mL at week 72. Multivariable logistic regression models assessed the impact on LLV and VF of baseline CD4 T-cell count, CD4/CD8 T-cell ratio and pVL, initial ART classes, age at ART initiation, time between HIV diagnosis and ART initiation, gender and transmission route. RESULTS Out of 4186 participants, 3120 (76.0%) started INSTIs, 455 (11.1%) started boosted protease inhibitors (bPIs) and 443 (10.8%) started nonnucleoside reverse transcriptase inhibitors (NNRTIs), either of them with two nucleos(t)ide reverse transcriptase inhibitors (NRTIs). Low-level viraemia was met in 2.5% of participants and VF in 4.3%. There were no significant differences throughout the years for both virological outcomes. Baseline HIV-1 RNA > 5 log10 copies/mL was the only consistent predictor of higher risk of LLV [adjusted odds ratio (aOR) = 9.8, 95% confidence interval (CI): 2.0-48.3] and VF (aOR = 5.4, 95% CI: 1.9-15.1), even in participants treated with INSTIs. CONCLUSIONS The rates of LLV and VF were low but remained steady throughout the years. Baseline HIV-1 RNA > 5 log10 copies/mL showed a persistent association with LLV and VF even in participants receiving INSTIs.
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Affiliation(s)
- Hortensia Álvarez
- Infectious Diseases Unit, Department of Internal Medicine, University Hospital of Ferrol, A Coruña, Spain
| | - Marta Rava
- AIDS Research Network Cohort (CoRIS), National Center of Epidemiology (CNE), Health Institute Carlos III (ISCIII), Madrid, Spain
| | - Cristina Martínez
- Methodology and Statistics Unit, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Vigo, Spain
| | | | - Joaquim Peraire
- Hospital Universitari de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | | | - Miguel Cervero
- Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - Ana Mariño
- Infectious Diseases Unit, Department of Internal Medicine, University Hospital of Ferrol, A Coruña, Spain
| | - Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Vigo, Spain
| | - Josep M Llibre
- Infectious Diseases and "Fight AIDS and Infectious Diseases" Foundation, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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Poveda E, Tabernilla A, Fitzgerald W, Salgado-Barreira Á, Grandal M, Pérez A, Mariño A, Álvarez H, Valcarce N, González-García J, Bernardino JI, Gutierrez F, Fujioka H, Crespo M, Ruiz-Mateos E, Margolis L, Lederman MM, Freeman ML. Massive release of CD9+ microvesicles in HIV infection, regardless of virologic control. J Infect Dis 2020; 225:1040-1049. [PMID: 32603406 PMCID: PMC8922002 DOI: 10.1093/infdis/jiaa375] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/23/2020] [Indexed: 12/16/2022] Open
Abstract
Background The role of extracellular vesicles (EVs) in human immunodeficiency virus (HIV) pathogenesis is unknown. We examine the cellular origin of plasma microvesicles (MVs), a type of ectocytosis-derived EV, the presence of mitochondria in MVs, and their relationship to circulating cell-free mitochondrial deoxyribonucleic acid (ccf-mtDNA) in HIV-infected patients and controls. Methods Five participant groups were defined: 30 antiretroviral therapy (ART)-naive; 30 ART-treated with nondetectable viremia; 30 elite controllers; 30 viremic controllers; and 30 HIV-uninfected controls. Microvesicles were quantified and characterized from plasma samples by flow cytometry. MitoTrackerDeepRed identified MVs containing mitochondria and ccf-mtDNA was quantified by real-time polymerase chain reaction. Results Microvesicle numbers were expanded at least 10-fold in all HIV-infected groups compared with controls. More than 79% were platelet-derived MVs. Proportions of MVs containing mitochondria (22.3% vs 41.6%) and MV mitochondrial density (706 vs 1346) were significantly lower among HIV-infected subjects than controls, lowest levels for those on ART. Microvesicle numbers correlated with ccf-mtDNA levels that were higher among HIV-infected patients. Conclusions A massive release of platelet-derived MVs occurs during HIV infection. Some MVs contain mitochondria, but their proportion and mitochondrial densities were lower in HIV infection than in controls. Platelet-derived MVs may be biomarkers of platelet activation, possibly reflecting pathogenesis even in absence of HIV replication.
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Affiliation(s)
- Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Spain
| | - Andrés Tabernilla
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Spain
| | - Wendy Fitzgerald
- Section of Intercellular Interactions, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Ángel Salgado-Barreira
- Methodology and Statistics Unit, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Spain
| | - Marta Grandal
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Spain
| | - Alexandre Pérez
- Infectious Diseases Unit, Department of Internal Medicine, Complexo Hospitalario Universitario de Vigo, IIS Galicia Sur, SERGAS-UVigo, Spain
| | - Ana Mariño
- Infectious Diseases Unit, University Hospital Ferrol, Spain
| | | | | | | | | | - Félix Gutierrez
- Infectious Diseases Unit, Hospital General de Elche and Miguel Hernández University, Alicante, Spain
| | - Hisashi Fujioka
- Cryo-Electron Microscopy Core, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Manuel Crespo
- Infectious Diseases Unit, Department of Internal Medicine, Complexo Hospitalario Universitario de Vigo, IIS Galicia Sur, SERGAS-UVigo, Spain
| | - Ezequiel Ruiz-Mateos
- Clinical Unit of Infectious Diseases, Clinical Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, CSIC, University of Seville, Spain
| | - Leonid Margolis
- Section of Intercellular Interactions, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Michael M Lederman
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Michael L Freeman
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Blanco JR, Morillo R, Abril V, Escobar I, Bernal E, Folguera C, Brañas F, Gimeno M, Ibarra O, Iribarren JA, Lázaro A, Mariño A, Martín MT, Martinez E, Ortega L, Olalla J, Robustillo A, Sanchez-Conde M, Rodriguez MA, de la Torre J, Sanchez-Rubio J, Tuset M. Deprescribing of non-antiretroviral therapy in HIV-infected patients. Eur J Clin Pharmacol 2019; 76:305-318. [PMID: 31865412 DOI: 10.1007/s00228-019-02785-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 08/09/2019] [Accepted: 10/18/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE In recent decades, the life expectancy of HIV-infected patients has increased considerably, to the extent that the disease can now be considered chronic. In this context of progressive aging, HIV-infected persons have a greater prevalence of comorbid conditions. Consequently, they usually take more non-antiretroviral drugs, and their drug therapy are more complex. This supposes a greater risk of drug interactions, of hospitalization, falls, and death. In the last years, deprescribing has gained attention as a means to rationalize medication use. METHODS Review of the different therapeutic approach that includes optimization of polypharmacy and control and reduction of potentially inappropriate prescription. RESULTS There are several protocols for systematizing the deprescribing process. The most widely used tool is the Medication Regimen Complexity Index, an index validated in HIV-infected persons. Anticholinergic medications are the agents that have been most associated with major adverse effects so, various scales have been employed to measure it. Other tools should be employed to detect and prevent the use of potentially inappropriate drugs. Prioritization of candidates should be based, among others, on drugs that should always be avoided and drugs with no justified indication. CONCLUSIONS The deprescribing process shared by professionals and patients definitively would improve management of treatment in this population. Because polypharmacy in HIV-infected patients show that a considerable percentage of patients could be candidates for deprescribing, we must understand the importance of deprescribing and that HIV-infected persons should be a priority group. This process would be highly feasible and effective in HIV-infected persons.
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Affiliation(s)
- José-Ramón Blanco
- Hospital Universitario San Pedro - CIBIR de Logroño, Logroño, La Rioja, Spain.
| | | | - Vicente Abril
- Hospital General Universitario de Valencia, 46014, València, Valencia, Spain
| | - Ismael Escobar
- Hospital Infanta Leonor del Madrid, Universidad Complutense, 28040, Madrid, Spain
| | - Enrique Bernal
- Hospital General Universitario Reina Sofía de Murcia, 30003, Murcia, Spain
| | - Carlos Folguera
- Hospital Puerta de Hierro de Madrid, 28222, Majadahonda, Madrid, Spain
| | - Fátima Brañas
- Hospital Infanta Leonor del Madrid, Universidad Complutense, 28040, Madrid, Spain
| | | | - Olatz Ibarra
- Hospital de Urduliz, Bizkaia, 48610, Urduliz, Biscay, Spain
| | - José-Antonio Iribarren
- Hospital Universitario Donostia, Instituto BioDonostia de San Sebastián, 20014, San Sebastián, Spain
| | | | - Ana Mariño
- Complejo Hospitalario Universitario de Ferrol, 15405, Ferrol, A Coruña, Spain
| | | | | | | | - Julian Olalla
- Hospital Costa del Sol de Marbella, 29603, Marbella, Málaga, Spain
| | | | | | | | | | | | - Montse Tuset
- Hospital Clinic de Barcelona, 08036, Barcelona, Spain
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7
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Pérez-Valero I, Pasquau J, Rubio R, Rivero A, Santos J, Sanz J, Mariño A, Crespo M, Hernández-Quero J, Iribarren JA, Gutiérrez F, Terrón A, Esteban H, Pérez-Molina JA. Neurocognitive safety after 96 weeks on dual therapy with atazanavir/ritonavir plus lamivudine: results of the neurocognitive substudy of the SALT randomized clinical trial. J Antimicrob Chemother 2019; 73:2444-2451. [PMID: 29897573 DOI: 10.1093/jac/dky212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/09/2018] [Indexed: 01/03/2023] Open
Abstract
Background Concerns have been voiced over the capacity of deintensification strategies to preserve neurocognitive function and prevent neurocognitive impairment. Methods We present the 96 week results of a neurocognitive substudy nested within the SALT clinical trial: a randomized, open-label, non-inferiority trial that compares whether atazanavir/ritonavir + lamivudine is non-inferior to atazanavir/ritonavir + two NRTIs in HIV-suppressed patients on stable triple therapy. A global deficit score (GDS) for five neurocognitive tasks was used to assess neurocognitive function. Changes in neurocognitive function (GDS value) were determined at weeks 48 and 96. The effect of atazanavir/ritonavir + lamivudine, adjusted for significant confounders, on the change in neurocognitive function was determined using analysis of covariance (ANCOVA) at week 96. Results The per-protocol analysis included 92 participants (47 atazanavir/ritonavir + lamivudine and 45 atazanavir/ritonavir + two NRTIs). All baseline characteristics were comparable in both groups. At weeks 48 and 96, changes in GDS [week 48, atazanavir/ritonavir + lamivudine -0.3 (95% CI -0.5 to -0.1) versus atazanavir/ritonavir + two NRTIs -0.2 (95% CI -0.4 to 0.0), P = 0.39; week 96, atazanavir/ritonavir + lamivudine -0.3 (95% CI -0.5 to -0.1) versus atazanavir/ritonavir + two NRTIs -0.2 (95% CI -0.4 to -0.1); P = 0.471] were similar. This absence of differences was also observed in all cognitive tasks. Atazanavir/ritonavir + lamivudine did not impact the change in neurocognitive function at week 96; the adjusted effect of atazanavir/ritonavir + lamivudine on GDS change, considering atazanavir/ritonavir + two NRTIs as a reference, was 0.01 (95% CI -0.18 to 0.21) (P = 0.90). Conclusions Neurocognitive function remained stable after 96 weeks, both in the atazanavir/ritonavir + lamivudine and in the atazanavir/ritonavir + two NRTIs arms, provided HIV remained suppressed.
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Affiliation(s)
| | - Juan Pasquau
- Hospital Virgen de las Nieves, Internal Medicine, Granada, Spain
| | - Rafael Rubio
- H.U. Doce de Octubre, Internal Medicine, Madrid, Spain
| | | | - José Santos
- Hospital Virgen de la Victoria, Internal Medicine, Malaga, Spain
| | - Jesus Sanz
- Hospital de Alcala de Henares, Internal Medicine, Alcala de Henares, Spain
| | - Ana Mariño
- Hospital Arquitecto Marcide, Internal Medicine, O Ferrol, Spain
| | - Manel Crespo
- Hospital Vall d'Hebron, Internal Medicine, Barcelona, Spain
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8
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Toro-Trujillo E, Garcia E, Garcia-Peña AA, Muñoz-Velandia OM, Mariño A. Factors Related to the Acute Cellular Rejection During the First Year After Heart Transplant. Transplant Proc 2018; 50:3715-3719. [PMID: 30577261 DOI: 10.1016/j.transproceed.2018.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/29/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The acute cellular rejection is recognized as a factor related to the long-term viability of the heart graft. We intend to establish which factors are associated with the acute cellular rejection during the first year post heart transplant using a longitudinal model with repeated measures. METHODS A retrospective cohort study was performed with all the patients who underwent heart transplant between 2005-2018 at the Hospital Universitario San Ignacio in Bogota, Colombia. In order to determine the factors associated with the development of acute cellular rejection, a generalized estimating equation approach was used, with an interchangeable correlation structure. The lowest value of quasi-likelihood information criterion and P < .05 was considered significant. RESULTS Fifty-five patients (49.3 ± 11.1 years old) were included. The mortality during the first month was 16.3% and the accumulated mortality during the first year was 23.6%. The incidence of the acute cellular rejection was higher during the third month after the transplant (79.9%); most of them were acute cellular rejection grade 1. The factors associated with the development of the rejection were the cyclosporine levels out of the therapeutic range in several periods of evaluation (P < .03) and the age of the receptor (P = .049). CONCLUSIONS Using advanced modeling methodologies of longitudinal data we identified that the factors associated with acute cellular rejection during the first year after the transplant are related to the therapeutic levels of the calcineurin inhibitor (cyclosporin) during the first 6 months of follow-up and the age of the receptor.
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Affiliation(s)
- E Toro-Trujillo
- Department of Internal Medicine, Pontificia Universidad Javeriana, Bogotá D.C., Colombia.
| | - E Garcia
- Department of Internal Medicine, Pontificia Universidad Javeriana, Bogotá D.C., Colombia
| | - A A Garcia-Peña
- Department of Internal Medicine, Pontificia Universidad Javeriana, Bogotá D.C., Colombia; Cardiology Unit, Heart Failure and Heart Transplant Clinic, Hospital Universitario San Ignacio, Bogotá D.C., Colombia
| | - O M Muñoz-Velandia
- Department of Internal Medicine, Pontificia Universidad Javeriana, Bogotá D.C., Colombia; Cardiology Unit, Heart Failure and Heart Transplant Clinic, Hospital Universitario San Ignacio, Bogotá D.C., Colombia
| | - A Mariño
- Department of Internal Medicine, Pontificia Universidad Javeriana, Bogotá D.C., Colombia; Cardiology Unit, Heart Failure and Heart Transplant Clinic, Hospital Universitario San Ignacio, Bogotá D.C., Colombia
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9
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Álvarez H, Mariño A, Valcarce N, García-González J, Díaz-Cambre H, Llibre JM. Overdose of elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide in an HIV-1-infected subject with attempted suicide. Infection 2018; 47:115-119. [PMID: 30145772 DOI: 10.1007/s15010-018-1201-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 07/04/2018] [Accepted: 08/21/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Data are lacking regarding overdose of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide (E/C/F/TAF). MATERIAL AND METHODS We present the first report of suicidal attempt with E/C/F/TAF in a Human Immunodeficiency Virus-infected subject. RESULTS A reversible acute renal failure with no proximal tubulopathy and neuropsychiatric issues are discussed. E/C/F/TAF withdrawal resulted in favourable renal and neuropsychiatric outcomes. The suicide attempt seemed unrelated to the integrase strand transfer inhibitor, being evenly explained within the context of stressful personal conflicts. CONCLUSION A suicidal attempt with an E/C/F/TAF overdose in an HIV-infected patient, resulted in a favourable outcome from a renal and neuropsychiatric standpoint.
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Affiliation(s)
- Hortensia Álvarez
- Infectious Diseases Unit, Internal Medicine Department, University Hospital of Ferrol, Avda. da Residencia, s/n, 15405, Ferrol, A Coruña, Spain.
| | - Ana Mariño
- Infectious Diseases Unit, Internal Medicine Department, University Hospital of Ferrol, Avda. da Residencia, s/n, 15405, Ferrol, A Coruña, Spain
| | - Nieves Valcarce
- Hospital Pharmacy, University Hospital of Ferrol, A Coruña, Spain
| | | | | | - Josep M Llibre
- Infectious Diseases and "Fight AIDS" Foundation, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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10
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Bravo I, Álvarez H, Mariño A, Clotet B, Moltó J. Recurrent coronary disease in HIV-infected patients: role of drug-drug interactions. Br J Clin Pharmacol 2018; 84:1617-1619. [PMID: 29663482 DOI: 10.1111/bcp.13583] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/25/2018] [Accepted: 03/05/2018] [Indexed: 01/11/2023] Open
Affiliation(s)
- Iria Bravo
- Internal Medicine Department, University Hospital of Ferrol, A Coruña, Spain
| | - Hortensia Álvarez
- Infectious Diseases Unit, Internal Medicine Department, University Hospital of Ferrol, A Coruña, Spain
| | - Ana Mariño
- Infectious Diseases Unit, Internal Medicine Department, University Hospital of Ferrol, A Coruña, Spain
| | - Bonaventura Clotet
- Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Fundació IrsiCaixa, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
| | - José Moltó
- Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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11
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Grandal M, Pernas B, Tabernilla A, Mariño A, Álvarez H, Valcarce N, Mena A, Castro-Iglesias A, Pérez AB, Delgado M, Poveda E. Prevalence of NS5A resistance associated substitutions in patients with hepatitis C virus genotypes 1a and 3: Impact on current therapeutic strategies. J Med Virol 2018; 90:1094-1098. [PMID: 29427437 DOI: 10.1002/jmv.25048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 09/18/2017] [Accepted: 12/18/2017] [Indexed: 11/06/2022]
Abstract
The presence of resistance-associated substitutions (RASs) at NS5A region might compromise the efficacy of Direct Acting Antiviral agents (DAAs). HCV resistance at NS5A region is mainly focused on patients with hepatitis C virus (HCV) genotypes 1a (G1a) and 3 (G3) with other factors of poor treatment response (ie cirrhosis, prior treatment-exposure, or HCV-RNA >800 000 IU/mL). Herein, we evaluated in a cohort of HCV G1a and G3 infected patients the prevalence of RASs at domain I NS5A using population-based sequencing and the impact of RASs on the optimization of current therapeutic strategies. The RASs considered as clinically relevant were: M28A/G/T, Q30D/E/H/G/K/L/R, L31M/V/F, H58D, and Y93C/H/N/S for G1a and Y93H for G3. A total of 232 patients naïve to NS5A inhibitors were included (166 G1a, 66 G3). The overall prevalence of NS5A RASs for G1a and G3 patients was low (5.5%) or null, respectively. A high proportion of patients harbored, at least, one factor of poor response (78.9% for G1a, and 75.8% for G3). Overall, the rates of patients harboring NS5A RASs in combination with any of the other factors were low and the vast majority of patients (G1a> 94% and G3 100%) could be treated with standard treatments of 12 weeks without ribavirin. In conclusion, testing NS5A RASs in specific HCV-infected populations (ie G1a & G3, cirrhosis, prior treatment experienced, HCV-RNA >800 000 IU/mL) might be useful to optimize current NS5A-based therapies avoiding ribavirin-related toxicities, and shortening treatment duration in the majority of patients.
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Affiliation(s)
- Marta Grandal
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas. Universidade da Coruña (UDC), A Coruña, Spain
| | - Berta Pernas
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas. Universidade da Coruña (UDC), A Coruña, Spain
| | - Andrés Tabernilla
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas. Universidade da Coruña (UDC), A Coruña, Spain
| | - Ana Mariño
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Complexo Hospitalario Universitario de Ferrol (CHUF), Sergas, Ferrol, Spain
| | - Hortensia Álvarez
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Complexo Hospitalario Universitario de Ferrol (CHUF), Sergas, Ferrol, Spain
| | - Nieves Valcarce
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Complexo Hospitalario Universitario de Ferrol (CHUF), Sergas, Ferrol, Spain
| | - Alvaro Mena
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas. Universidade da Coruña (UDC), A Coruña, Spain
| | - Angeles Castro-Iglesias
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas. Universidade da Coruña (UDC), A Coruña, Spain
| | - Ana B Pérez
- Servicio de Microbiología Clínica, Instituto de Investigación IBS, Granada, Spain
| | - Manuel Delgado
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas. Universidade da Coruña (UDC), A Coruña, Spain
| | - Eva Poveda
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas. Universidade da Coruña (UDC), A Coruña, Spain
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12
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Álvarez H, Mariño A, Valcarce N, Khoo S, Bhagani S, Schapiro J, Llibre JM. Cure of chronic hepatitis C virus infection in an HIV-coinfected patient with multiple comorbidities and drug interaction challenges. Int J STD AIDS 2018; 29:933-936. [PMID: 29466917 DOI: 10.1177/0956462418755537] [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: 11/15/2022]
Abstract
Curing hepatitis C virus (HCV) infection in patients harbouring multiple severe comorbidities is a medical challenge. Evidence-based data are lacking regarding HCV treatment with direct-acting antiviral regimens in particular populations of HCV/HIV-coinfected patients with cirrhosis and chronic kidney disease on haemodialysis. Here, we present the HCV treatment challenges facing a patient with HIV coinfection, prior failure of both HIV-1 and HCV therapy, cirrhosis, end-stage renal failure on haemodialysis, as well as management of drug-drug interactions, especially given the need to receive long-term amiodarone therapy.
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Affiliation(s)
- Hortensia Álvarez
- 1 Infectious Diseases Unit, Internal Medicine Department, University Hospital of Ferrol, A Coruña, Spain
| | - Ana Mariño
- 1 Infectious Diseases Unit, Internal Medicine Department, University Hospital of Ferrol, A Coruña, Spain
| | - Nieves Valcarce
- 2 Hospital Pharmacy, University Hospital of Ferrol, A Coruña, Spain
| | - Saye Khoo
- 3 Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Sanjay Bhagani
- 4 Department of Infectious Diseases/HIV Medicine, Royal Free London Foundation Trust, London, UK
| | - Jonathan Schapiro
- 5 National Hemophilia Center, Sheba Medical Center, Ramat Gan, Israel
| | - Josep M Llibre
- 6 Infectious Diseases and "Lluita contra la SIDA" Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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13
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Grandal M, Pernas B, Mariño A, Álvarez H, Tabernilla A, Castro-Iglesias Á, Mena Á, Delgado M, Pértega S, Poveda E. Characterization of chronic HCV infection in Northwest Spain: Impact of the treatment strategic plan of the Spanish National Health Service on HCV cure. J Med Virol 2017; 89:1304-1308. [PMID: 28079256 DOI: 10.1002/jmv.24766] [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] [Received: 10/21/2016] [Accepted: 01/06/2017] [Indexed: 11/10/2022]
Abstract
The aim of the study was to characterize HCV infection in Northwest Spain and assess the impact of the Spanish Strategic Plan to cure HCV infection. Overall, 387 patients were included (60.9% HIV/HCV coinfected and 28.2% cirrhotic). Of these, 72.9% of patients that were recognized as priority for HCV treatment according to the Spanish Strategic Plan (≥F2, transplant or extrahepatic manifestations), initiated treatment during 2015. Globally, SVR12 was achieved in 96.5% of patients. The implementation of the Spanish Strategic Plan has been critical to advance in HCV cure, but 27.1% of priority patients still remain awaiting HCV treatment initiation.
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Affiliation(s)
- Marta Grandal
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña. A Coruña, Spain
| | - Berta Pernas
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña. A Coruña, Spain
| | - Ana Mariño
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Complejo Hospitalario Universitario de Ferrol (CHUF), SERGAS. Ferrol, Spain
| | - Hortensia Álvarez
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Complejo Hospitalario Universitario de Ferrol (CHUF), SERGAS. Ferrol, Spain
| | - Andrés Tabernilla
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña. A Coruña, Spain
| | - Ángeles Castro-Iglesias
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña. A Coruña, Spain
| | - Álvaro Mena
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña. A Coruña, Spain
| | - Manuel Delgado
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña. A Coruña, Spain
| | - Sonia Pértega
- Unidad de Epidemiología Clínica y Bioestadística, Instituto de Investigación Biomédica de A Coruña (INIIBC)-Complejo Hospitalario Universitario de A Coruña (CHUAC). A Coruña, Spain
| | - Eva Poveda
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña. A Coruña, Spain
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14
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Ferrer F, Pont A, Letelier H, Garin O, De Blas R, Boladeras A, Garcia E, Zardoya E, Najjari D, Gonzalo P, Castells M, Mariño A, Gutierrez C, Ventura M, Rojas F, Bavestrello P, Suarez J, Picon C, Guedea F. Early Experience and Quality of Life Comparison in Prostate Cancer Brachytherapy Versus Phase I-II Stereotactic Body Radiation Therapy Trials. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1285] [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: 11/25/2022]
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15
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Perez-Molina JA, Rubio R, Rivero A, Pasquau J, Suárez-Lozano I, Riera M, Estébanez M, Palacios R, Sanz-Moreno J, Troya J, Mariño A, Antela A, Navarro J, Esteban H, Moreno S. Simplification to dual therapy (atazanavir/ritonavir + lamivudine) versus standard triple therapy [atazanavir/ritonavir + two nucleos(t)ides] in virologically stable patients on antiretroviral therapy: 96 week results from an open-label, non-inferiority, randomized clinical trial (SALT study). J Antimicrob Chemother 2016; 72:246-253. [DOI: 10.1093/jac/dkw379] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/02/2016] [Accepted: 08/10/2016] [Indexed: 11/13/2022] Open
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16
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Vega Y, Delgado E, de la Barrera J, Carrera C, Zaballos Á, Cuesta I, Mariño A, Ocampo A, Miralles C, Pérez-Castro S, Álvarez H, López-Miragaya I, García-Bodas E, Díez-Fuertes F, Thomson MM. Sequence Analysis of In Vivo-Expressed HIV-1 Spliced RNAs Reveals the Usage of New and Unusual Splice Sites by Viruses of Different Subtypes. PLoS One 2016; 11:e0158525. [PMID: 27355361 PMCID: PMC4927154 DOI: 10.1371/journal.pone.0158525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/16/2016] [Indexed: 11/18/2022] Open
Abstract
HIV-1 RNAs are generated through a complex splicing mechanism, resulting in a great diversity of transcripts, which are classified in three major categories: unspliced, singly spliced (SS), and doubly spliced (DS). Knowledge on HIV-1 RNA splicing in vivo and by non-subtype B viruses is scarce. Here we analyze HIV-1 RNA splice site usage in CD4+CD25+ lymphocytes from HIV-1-infected individuals through pyrosequencing. HIV-1 DS and SS RNAs were amplified by RT-PCR in 19 and 12 samples, respectively. 13,108 sequences from HIV-1 spliced RNAs, derived from viruses of five subtypes (A, B, C, F, G), were identified. In four samples, three of non-B subtypes, five 3' splice sites (3'ss) mapping to unreported positions in the HIV-1 genome were identified. Two, designated A4i and A4j, were used in 22% and 25% of rev RNAs in two viruses of subtypes B and A, respectively. Given their close proximity (one or two nucleotides) to A4c and A4d, respectively, they could be viewed as variants of these sites. Three 3'ss, designated A7g, A7h, and A7i, located 20, 32, and 18 nucleotides downstream of A7, respectively, were identified in a subtype C (A7g, A7h) and a subtype G (A7i) viruses, each in around 2% of nef RNAs. The new splice sites or variants of splice sites were associated with the usual sequence features of 3'ss. Usage of unusual 3'ss A4d, A4e, A5a, A7a, and A7b was also detected. A4f, previously identified in two subtype C viruses, was preferentially used by rev RNAs of a subtype C virus. These results highlight the great diversity of in vivo splice site usage by HIV-1 RNAs. The fact that four of five newly identified splice sites or variants of splice sites were detected in non-subtype B viruses allows anticipating an even greater diversity of HIV-1 splice site usage than currently known.
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Affiliation(s)
- Yolanda Vega
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III. Majadahonda, Madrid, Spain
| | - Elena Delgado
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III. Majadahonda, Madrid, Spain
| | - Jorge de la Barrera
- Bioinformatics Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III. Majadahonda, Madrid, Spain
| | - Cristina Carrera
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III. Majadahonda, Madrid, Spain
| | - Ángel Zaballos
- Genomics Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III. Majadahonda, Madrid, Spain
| | - Isabel Cuesta
- Bioinformatics Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III. Majadahonda, Madrid, Spain
| | - Ana Mariño
- Hospital Arquitecto Marcide. Ferrol, A Coruña, Spain
| | - Antonio Ocampo
- Complejo Hospitalario Universitario de Vigo. Vigo, Pontevedra, Spain
| | - Celia Miralles
- Complejo Hospitalario Universitario de Vigo. Vigo, Pontevedra, Spain
| | | | | | | | - Elena García-Bodas
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III. Majadahonda, Madrid, Spain
| | - Francisco Díez-Fuertes
- AIDS Immunopathogenesis Unit. Centro Nacional de Microbiología, Instituto de Salud Carlos III. Majadahonda, Madrid, Spain
| | - Michael M. Thomson
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III. Majadahonda, Madrid, Spain
- * E-mail:
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17
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Delgado E, Cuevas MT, Domínguez F, Vega Y, Cabello M, Fernández-García A, Pérez-Losada M, Castro MÁ, Montero V, Sánchez M, Mariño A, Álvarez H, Ordóñez P, Ocampo A, Miralles C, Pérez-Castro S, López-Álvarez MJ, Rodríguez R, Trigo M, Diz-Arén J, Hinojosa C, Bachiller P, Hernáez-Crespo S, Cisterna R, Garduño E, Pérez-Álvarez L, Thomson MM. Phylogeny and Phylogeography of a Recent HIV-1 Subtype F Outbreak among Men Who Have Sex with Men in Spain Deriving from a Cluster with a Wide Geographic Circulation in Western Europe. PLoS One 2015; 10:e0143325. [PMID: 26599410 PMCID: PMC4658047 DOI: 10.1371/journal.pone.0143325] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 01/26/2015] [Accepted: 11/03/2015] [Indexed: 11/18/2022] Open
Abstract
We recently reported the rapid expansion of an HIV-1 subtype F cluster among men who have sex with men (MSM) in the region of Galicia, Northwest Spain. Here we update this outbreak, analyze near full-length genomes, determine phylogenetic relationships, and estimate its origin. For this study, we used sequences of HIV-1 protease-reverse transcriptase and env V3 region, and for 17 samples, near full-length genome sequences were obtained. Phylogenetic analyses were performed via maximum likelihood. Locations and times of most recent common ancestors were estimated using Bayesian inference. Among samples analyzed by us, 100 HIV-1 F1 subsubtype infections of monophyletic origin were diagnosed in Spain, including 88 in Galicia and 12 in four other regions. Most viruses (n = 90) grouped in a subcluster (Galician subcluster), while 7 from Valladolid (Central Spain) grouped in another subcluster. At least 94 individuals were sexually-infected males and at least 71 were MSM. Seventeen near full-length genomes were uniformly of F1 subsubtype. Through similarity searches and phylogenetic analyses, we identified 18 viruses from four other Western European countries [Switzerland (n = 8), Belgium (n = 5), France (n = 3), and United Kingdom (n = 2)] and one from Brazil, from samples collected in 2005–2011, which branched within the subtype F cluster, outside of both Spanish subclusters, most of them corresponding to recently infected individuals. The most probable geographic origin and age of the Galician subcluster was Ferrol, Northwest Galicia, around 2007, while the Western European cluster probably emerged in Switzerland around 2002. In conclusion, a recently expanded HIV-1 subtype F cluster, the largest non-subtype B cluster reported in Western Europe, continues to spread among MSM in Spain; this cluster is part of a larger cluster with a wide geographic circulation in diverse Western European countries.
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Affiliation(s)
- Elena Delgado
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - María Teresa Cuevas
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Francisco Domínguez
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Yolanda Vega
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Marina Cabello
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Aurora Fernández-García
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Marcos Pérez-Losada
- Centro de Investigação em Biodiversidade e Recursos Genéticos (CIBIO-InBIO), Vairão, Portugal
| | - María Ángeles Castro
- Department of Internal Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Vanessa Montero
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Mónica Sánchez
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Ana Mariño
- Infectious Diseases Unit, Department of Internal Medicine, Complejo Hospitalario Universitario Arquitecto Marcide, Ferrol, A Coruña, Spain
| | - Hortensia Álvarez
- Infectious Diseases Unit, Department of Internal Medicine, Complejo Hospitalario Universitario Arquitecto Marcide, Ferrol, A Coruña, Spain
| | - Patricia Ordóñez
- Department of Microbiology, Complejo Hospitalario Universitario Arquitecto Marcide, Ferrol, A Coruña, Spain
| | - Antonio Ocampo
- Department of Internal Medicine, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Celia Miralles
- Department of Internal Medicine, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Sonia Pérez-Castro
- Department of Microbiology, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | | | - Raúl Rodríguez
- Department of Internal Medicine, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Matilde Trigo
- Department of Microbiology, Complejo Hospitalario Provincial de Pontevedra, Pontevedra, Spain
| | - Julio Diz-Arén
- Department of Internal Medicine, Complejo Hospitalario Provincial de Pontevedra, Pontevedra, Spain
| | - Carmen Hinojosa
- Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Pablo Bachiller
- Department of Internal Medicine, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Silvia Hernáez-Crespo
- Department of Clinical Microbiology and Infection Control, Hospital Universitario de Basurto, Bilbao, Vizcaya, Spain
| | - Ramón Cisterna
- Department of Clinical Microbiology and Infection Control, Hospital Universitario de Basurto, Bilbao, Vizcaya, Spain
| | - Eugenio Garduño
- Department of Microbiology, Hospital Infanta Cristina, Badajoz, Spain
| | - Lucía Pérez-Álvarez
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Michael M Thomson
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- * E-mail:
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Perez-Molina JA, Rubio R, Rivero A, Pasquau J, Suárez-Lozano I, Riera M, Estébanez M, Santos J, Sanz-Moreno J, Troya J, Mariño A, Antela A, Navarro J, Navarro J, Esteban H, Moreno S. Dual treatment with atazanavir-ritonavir plus lamivudine versus triple treatment with atazanavir-ritonavir plus two nucleos(t)ides in virologically stable patients with HIV-1 (SALT): 48 week results from a randomised, open-label, non-inferiority trial. Lancet Infect Dis 2015; 15:775-84. [PMID: 26062881 DOI: 10.1016/s1473-3099(15)00097-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/18/2015] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Problems associated with lifelong antiretroviral therapy, such as need for strict adherence, drug-related toxic effects, difficulties with treatment schedules, and cost, mean that simplification strategies should be sought. We aimed to explore the efficacy and safety of dual treatment with atazanavir-ritonavir plus lamivudine as an option to switch to from standard combination antiretroviral therapy in patients with an HIV-1 infection who are virologically suppressed. METHODS In this randomised, open-label, non-inferiority trial, we recruited patients aged 18 years and older with chronic HIV-1 infection and no previous treatment failure or resistance, and with HIV-1 RNA of less than 50 copies per mL for at least 6 months, negative hepatitis B virus surface antigen, and good general health, from 30 hospitals in Spain. Exclusion criteria were switch in antiretroviral therapy during the previous 4 months, previous virological failure, pregnancy or breastfeeding, Gilbert's syndrome, use of contraindicated drugs, grade 4 laboratory abnormalities, and previous intolerance to any of the study drugs. We randomly assigned patients (1:1; stratified by active hepatitis C virus infection and previous treatment; computer-generated random number sequence) to dual treatment with oral atazanavir (300 mg once daily) and ritonavir (100 mg once daily) plus lamivudine (300 mg once daily) or triple treatment with oral atazanavir (300 mg once daily) and ritonavir (100 mg once daily) plus two nucleos(t)ide reverse transcriptase inhibitors at the discretion of the investigators. The primary endpoint was virological response, defined as HIV-1 RNA of less than 50 copies per mL at week 48, in the per-protocol population, with a non-inferiority margin of 12%. We included patients who received at least one dose of the study drug in the safety analysis. This study is registered at ClinicalTrials.gov, number NCT01307488. FINDINGS Between Sept 29, 2011, and May 2, 2013, we randomly assigned 286 patients (143 [50%] to each group). At week 48 in the per-protocol population, 112 (84%) of 133 patients had virological response in the dual-treatment group versus 105 (78%) of 135 in the triple-treatment group (difference 6% [95% CI -5 to 16%), showing non-inferiority at the prespecified level. 14 (5%) patients developed severe adverse events (dual treatment six [4%]; triple treatment eight [6%]), none of which we deemed related to the study drug. Grade 3-4 adverse events were similar between groups (dual treatment 77 [55%] of 140; triple treatment 78 [55%] of 141). Treatment discontinuations were less frequent in the dual-treatment group (three [2%]) than in the triple-treatment group (ten [7%]; p=0·047). INTERPRETATION In our trial, dual treatment was effective, safe, and non-inferior to triple treatment in patients with an HIV-1 infection who are virologically suppressed who switch antiretroviral therapy because of toxic effects, intolerance, or simplification. This combination has the potential to suppress some of the long-term toxic effects associated with nucleos(t)ide reverse transcriptase inhibitors, preserve future treatment options, and reduce the cost of antiretroviral therapy. FUNDING Bristol Myers-Squibb and Fundación SEIMC-GESIDA.
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Affiliation(s)
- José A Perez-Molina
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.
| | - Rafael Rubio
- HIV Clinic, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Antonio Rivero
- Infectious Diseases Unit, Hospital Universitario Reina Sofia, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Juan Pasquau
- Infectious Diseases Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Ignacio Suárez-Lozano
- Infectious Diseases Unit, Complejo Hospitalario Universitario de Huelva, Huelva, Spain
| | - Melcior Riera
- Infectious Diseases Unit, Hospital Son Espases, Mallorca, Spain
| | - Miriam Estébanez
- Internal Medicine Department, Hospital Universitario La Paz, Instituto de Investigation Sanitaria del Hospital Universitario La Paz, Madrid, Spain
| | - Jesús Santos
- Infectious Diseases Clinical Management Unit, Hospital Virgen de la Victoria, Málaga, Spain
| | - José Sanz-Moreno
- Infectious Diseases Unit, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Jesús Troya
- Internal Medicine Department, Hospital Infanta Leonor, Madrid, Spain
| | - Ana Mariño
- Infectious Diseases Unit, Internal Medicine Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Antonio Antela
- Infectious Diseases Unit, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | | | - José Navarro
- Infectious Diseases Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Herminia Esteban
- Fundación Spanish Society of Infectious Diseases and Clinical Microbiology-Fundación SEIMC-GESIDA, Madrid, Spain
| | - Santiago Moreno
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
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Affiliation(s)
- J. H. Quintero
- Materiales Nanoestructurados y Biomodelación; Universidad de Medellín; Medellín Colombia
| | - P. J. Arango
- Laboratorio de Física del Plasma - LAFIP; Universidad Nacional de Colombia; Manizales Colombia
| | - R. Ospina
- Laboratorio de Física del Plasma - LAFIP; Universidad Nacional de Colombia; Manizales Colombia
- Centro Brasileiro de Pesquisas Físicas - CBPF; Rio de Janeiro Brazil
| | - A. Mello
- Centro Brasileiro de Pesquisas Físicas - CBPF; Rio de Janeiro Brazil
| | - A. Mariño
- Laboratorio de Superconductividad y Nuevos Materiales; Universidad Nacional de Colombia; Bogotá D.C. Colombia
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Antela A, Ocampo A, Gómez R, López MJ, Mariño A, Losada E, Rodríguez R, Fernández R, Corredoira JC, Naval G, Rodríguez A, Miralles C, Prieto A. Liver Toxicity After Switching or Simplifying to Nevirapine-Based Therapy Is Not Related to CD4 Cell Counts: Results of the TOSCANA Study. HIV Clinical Trials 2015; 11:11-7. [DOI: 10.1310/hct1101-11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Polo Rodríguez R, Galindo Puerto MJ, Dueñas C, Gómez Candela C, Estrada V, Villar NGP, Locutura J, Mariño A, Pascua J, Palacios R, Von Wichmman MÁ, Álvarez J, Asensi V, Lopez Aldeguer J, Lozano F, Negredo E, Ortega E, Pedrol E, Gutiérrez F, Sanz Sanz J, Martínez Chamorro E. Executive summary of the consensus document on metabolic disorders and cardiovascular risk in patients with HIV infection. Enferm Infecc Microbiol Clin 2014; 33:41-7. [PMID: 25096166 DOI: 10.1016/j.eimc.2014.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 05/26/2014] [Indexed: 10/24/2022]
Abstract
The importance of the metabolic disorders and their impact on patients with HIV infection requires an individualized study and continuous updating. HIV patients have the same cardiovascular risk factors as the general population. The HIV infection per se increases the cardiovascular risk, and metabolic disorders caused by some antiretroviral drugs are added risk factors. For this reason, the choice of drugs with a good metabolic profile is essential. The most common metabolic disorders of HIV infected-patients (insulin resistance, diabetes, hyperlipidemia or osteopenia), as well as other factors of cardiovascular risk, such as hypertension, should also be dealt with according to guidelines similar to the general population, as well as insisting on steps to healthier lifestyles. The aim of this document is to provide a query tool for all professionals who treat HIV-patients and who may present or display any metabolic disorders listed in this document.
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Genebat M, Vera F, Hernández-Quero J, Domingo P, Guardiola JM, Martínez-Madrid O, Martínez L, de la Llana FG, Sánchez-Villegas J, Álvarez H, Mariño A, Lluch JF, Martínez-Pérez MA, Marín J, Ruiz-Mateos E, Leal M. Efficacy and tolerability after 24weeks of treatment with telaprevir, pegylated interferon and ribavirin in cirrhotic HIV–HCV coinfected subjects. Antiviral Res 2014; 104:59-61. [DOI: 10.1016/j.antiviral.2014.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/14/2014] [Accepted: 01/23/2014] [Indexed: 01/18/2023]
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Ferrer F, Guedea F, Pardo Y, Ferrer M, Suarez J, Hervás A, Mariño A, Herruzo I, Ortiz M, Sancho G. Quality of Life Impact of Treatments for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.982] [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: 10/26/2022]
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Fandiño J, Silva M, Izquierdo P, Candal A, Díaz I, Fernández C, Gesto C, Poncet M, Soto M, Triana G, Losada C, Mariño A. CBCT-guided RapidArc® for stereotactic ablative radiotherapy (SABR) in lung tumors. Rep Pract Oncol Radiother 2013. [DOI: 10.1016/j.rpor.2013.03.300] [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: 10/26/2022] Open
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Fandiño J, Triana G, Gesto C, Díaz I, Candal A, Fernández C, Izquierdo P, Poncet M, Silva M, Soto M, Losada C, Mariño A. RapidArc® for head and neck cancer (200 patients experience). Rep Pract Oncol Radiother 2013. [DOI: 10.1016/j.rpor.2013.03.760] [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: 11/29/2022] Open
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26
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Fandiño J, Gesto C, Candal A, Díaz I, Fernández C, Pilar I, Poncet M, Silva M, Soto M, Triana G, Losada C, Mariño A. Fast implementation of RapidArc® in a busy centre. Rep Pract Oncol Radiother 2013. [DOI: 10.1016/j.rpor.2013.03.605] [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: 10/26/2022] Open
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Gomez-Veiga F, Mariño A, Castelo L, Candal A, Pertega S, Fernadez C, Gomez I, Breijo S, Dacal J. Low-dose-rate Brachytherapy for the Treatment of Postprostatectomy Local Recurrence: A Phase II Trial. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1063] [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: 11/17/2022]
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Guedea F, Fernández P, Mariño A, Sancho G, Herruzo I, Hervás A, Ortiz M, Macías V, Suárez J, Ferrer M. PD-0119 QUALITY OF LIFE (QOL) FOR PROSTATE CANCER AFTER PROSTECTOMY VS BRACHYTHERAPY VS EBRT WITH A FOLLOW-UP OF 5 YEARS. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70458-9] [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: 11/24/2022]
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Santos JR, Llibre JM, Imaz A, Domingo P, Iribarren JA, Mariño A, Miralles C, Galindo MJ, Ornelas A, Moreno S, Schapiro JM, Clotet B. Mutations in the protease gene associated with virological failure to lopinavir/ritonavir-containing regimens. J Antimicrob Chemother 2012; 67:1462-9. [PMID: 22431669 DOI: 10.1093/jac/dks080] [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] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the most frequent resistance-associated mutations (RAMs) to lopinavir/ritonavir in a cohort of patients attended in daily practice. METHODS We retrospectively identified 195 multitreated subjects with virological failure. Patients were classified as follows: (i) 71 (36.4%) never received lopinavir/ritonavir (lopinavir/ritonavir naive); (ii) 75 (38.5%) had previously failed on lopinavir/ritonavir; and (iii) 49 (25.1%) were on lopinavir/ritonavir at failure. RAM patterns were assessed. Medians, IQRs, percentages, Kruskal-Wallis, χ(2) or Fisher's exact test, and multinomial logistic regression were used whenever appropriate. RESULTS L10I/F, K20R, L24I, L33F, M36I, M46I/L, I47V, G48V, F53L, I54V, A71V, G73S, V82A, I84V and L90M (all with P ≤ 0.037) were protease RAMs overexpressed in patients with lopinavir/ritonavir failure. L10I, M36I, M46I, I54V, L63P, A71V, V82A, I84V and L90M were the most common in lopinavir/ritonavir-naive patients. Other IAS-USA RAMs for lopinavir/ritonavir (L10R/V, K20M, V32I, I47A, I50V, I54L/A/M/T/S, A71T, L76V and V82F/T/S) were not associated with previous or current failure to lopinavir/ritonavir. Lopinavir/ritonavir failure was associated with the number of protease RAMs (OR = 1.146, 95% CI = 1.287, 1.626), higher exposure to protease inhibitors, and the presence of E44D, L33F, I54V and I84V. CONCLUSIONS In multitreated patients with previous or current lopinavir/ritonavir failure, some protease mutations are selected at significantly greater rates. L10I, M36I, I54V, L63P, A71V, V82A and L90M were found in >50% of cases. Thus, their presence should be expected when genotypic testing results are not available. The number of protease RAMs and higher prior exposures to protease inhibitors were significantly associated with lopinavir/ritonavir failure.
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Affiliation(s)
- José R Santos
- Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
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Bia D, Zócalo Y, Armentano RL, Pérez-Cámpos H, Fernández-Pin J, Panuncio A, Saldías M, Mariño A, Alvarez I. Post-implant evaluation of the anastomotic mechanical and geometrical coupling between human native arteries and arterial cryografts implanted in lower-limb. Cryobiology 2012; 64:50-9. [PMID: 21985768 DOI: 10.1016/j.cryobiol.2011.09.133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 09/12/2011] [Accepted: 09/21/2011] [Indexed: 11/18/2022]
Affiliation(s)
- Daniel Bia
- Physiology Department, School of Medicine, CUiiDARTE, Republic University, Montevideo, Uruguay.
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Parra J, Portilla J, Pulido F, Sánchez-de la Rosa R, Alonso-Villaverde C, Berenguer J, Blanco JL, Domingo P, Dronda F, Galera C, Gutiérrez F, Kindelán JM, Knobel H, Leal M, López-Aldeguer J, Mariño A, Miralles C, Moltó J, Ortega E, Oteo JA. Clinical utility of maraviroc. Clin Drug Investig 2011; 31:527-542. [PMID: 21595497 DOI: 10.2165/11590700-000000000-00000] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Maraviroc belongs to the family of chemokine (C-C motif) receptor 5 (CCR5) antagonists that prevent the entry of human immunodeficiency virus (HIV) into host CD4+ T cells by blocking the CCR5 co-receptor R5. Maraviroc is currently the only CC5R co-receptor inhibitor that has been approved for clinical use in HIV-1-infected patients carrying the CCR5 tropism who are antiretroviral-naïve or have experienced therapeutic failure following traditional antiretroviral therapies. This article is a review of the main characteristics of maraviroc and the latest data regarding its clinical application. Maraviroc is effective and well tolerated in pre-treated and antiretroviral-naïve patients with HIV-1 infections carrying the CCR5 tropism. Data from the phase III programme of maraviroc, which includes the MOTIVATE 1 and 2 studies and the MERIT study, indicate that maraviroc significantly (p < 0.001) increases CD4+ cell counts compared with placebo in pre-treated patients and to a similar extent as efavirenz in antiretroviral-naïve patients. Even in cases where viral load is not completely suppressed, maraviroc improves immunological response compared with placebo. In addition, promising research suggests that maraviroc has favourable pharmacokinetic and safety profiles in patients with high cardiovascular risk or those co-infected with tuberculosis or hepatitis and could be considered an option for treatment of HIV-infected patients with these co-morbidities. Resistance to maraviroc is low and mainly related to the presence of chemokine (C-X-C motif) receptor 4 (CXCR4) tropism HIV-1-infections or to mutations in the V3 region of glycoprotein (gp) 120; however, the exact mechanisms by which resistance is acquired and their genotypic and phenotypic pattern have not yet been established. It is recommended that a tropism test should be performed when considering maraviroc as an alternate drug in HIV-1-infected patients. Current tropism assays have increased sensitivity to reliably detect CXCR4 HIV with rapid turn-around and at a low cost. Improved detection together with positive data on the drug's efficacy and safety profiles should help physicians to identify more accurately the appropriate candidates for commencement of treatment with maraviroc. In summary, maraviroc improves immunological response and has shown favourable pharmacokinetic and safety profiles in patients with high cardiovascular risk or in those co-infected with tuberculosis or hepatitis. Long-term studies are needed to confirm whether therapeutic expectations resulting from clinical trials with maraviroc translate into a real benefit for HIV-1-infected patients for whom traditional antiretroviral therapies have failed or are not suitable.
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Affiliation(s)
- Jorge Parra
- Hospital Virgen de las Nieves, Granada, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ana Mariño
- Hospital Arquitecto Mancide, Ferrol, Spain
| | | | - José Moltó
- Hospital Germans Trials i Pujol, Badalona, Spain
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Revilla A, Delgado E, Christian EC, Dalrymple J, Vega Y, Carrera C, González-Galeano M, Ocampo A, de Castro RO, Lezaún MJ, Rodríguez R, Mariño A, Ordóñez P, Cilla G, Cisterna R, Santamaría JM, Prieto S, Rakhmanova A, Vinogradova A, Ríos M, Pérez-Álvarez L, Nájera R, Montefiori DC, Seaman MS, Thomson MM. Construction and phenotypic characterization of HIV type 1 functional envelope clones of subtypes G and F. AIDS Res Hum Retroviruses 2011; 27:889-901. [PMID: 21226626 DOI: 10.1089/aid.2010.0177] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Subtype G has been estimated to represent the fourth most prevalent clade in the HIV-1 pandemic and subtype F is widely circulating in parts of South America (frequently within BF recombinant forms) and in Romania. However, functional envelope clones of these subtypes are lacking, which are needed for studies on antibody-mediated neutralization, coreceptor usage, and efficiency of viral entry inhibitor drugs. Here we report the construction, neutralization properties, and coreceptor usage of HIV-1 functional envelope clones of subtypes G (n = 15) and F (n = 7). These clones were obtained through RT-PCR amplification of HIV-1 gp160 from plasma RNA, and were used for pseudovirus production. All 15 subtype G-enveloped pseudoviruses were resistant to neutralization by gp120-targeted broadly neutralizing monoclonal antibodies (MAbs) b12 and 2G12, while a majority were neutralized by gp41-targeted MAbs 2F5 and 4E10. With regard to the subtype F envelopes, all seven pseudoviruses were resistant to 2F5 and b12, six were resistant to G12, and six were neutralized by 4E10. Coreceptor usage testing revealed that 21 of 22 envelopes were CCR5-tropic, including all 15 subtype G envelopes, seven of which were from patients with CD4(+) T cell counts <200/ml. These results confirm the broadly neutralizing activity of 4E10 on envelope clones across all tested group M clades, including subtypes G and F, reveal the resistance of most subtype F-enveloped pseudoviruses to broadly neutralizing MAbs b12, 2G12, and 2F5, and suggest that, similarly to subtype C, CXCR4 tropism is uncommon in subtype G, even at advanced stages of infection.
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Affiliation(s)
- Ana Revilla
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Elena Delgado
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Elizabeth C. Christian
- Division of Viral Pathogenesis, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Justin Dalrymple
- Division of Viral Pathogenesis, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Yolanda Vega
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Cristina Carrera
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - María González-Galeano
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Antonio Ocampo
- Complejo Hospitalario Xeral-Cíes, Vigo, Pontevedra, Spain
| | | | | | | | - Ana Mariño
- Hospital Arquitecto Marcide, Ferrol, A Coruña, Spain
| | | | | | | | | | | | - Aza Rakhmanova
- Botkin's Infectious Diseases Hospital, St. Petersburg, Russia
| | | | - Maritza Ríos
- National Reference Center of HIV/AIDS, Public Health Institute of Chile, Santiago, Chile
| | - Lucía Pérez-Álvarez
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Rafael Nájera
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - David C. Montefiori
- Department of Surgery, Laboratory for AIDS Vaccine Research and Development, Duke University Medical Center, Durham, North Carolina
| | - Michael S. Seaman
- Division of Viral Pathogenesis, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michael M. Thomson
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
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Delgado G, Sánchez Y, Plaza D, Mariño A, Granados D. An experimental approach to studying the effectiveness and safety of meglumine antimoniate formulations. Biomed Pharmacother 2011; 65:569-77. [PMID: 21733656 DOI: 10.1016/j.biopha.2010.12.016] [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: 01/15/2009] [Revised: 09/25/2009] [Accepted: 12/14/2010] [Indexed: 11/25/2022] Open
Abstract
Among the problems associated to leishmaniasis, the two most outstanding ones are the lack of a vaccine and the adverse effects caused by drugs use for its control. Meglumine antimoniate compounds are the first-line drugs in the treatment for cutaneous leishmaniasis (the most prevalent form of the disease in Colombia); nevertheless, they are far from being ideal drugs due to their toxicity (not to mention the emergence of drug-resistant parasites), all of which has prompted current search for new strategies to improve their safety. This work assesses the effectiveness and safety (toxicity including new aspects related with immunotoxicity not reported previously) of two different meglumine antimoniate formulations using an in vitro and in vivo murine model. The results evidence that although both injectable formulations induce an equally efficient (clearance of intracellular parasites), both give rise to adverse effects, including a preferential immunomodulation on Balb/c mice and in a lesser proportion on ICR mice. These results are comparable to human trials reporting variable reactions when following the same treatment regimen. The model presented herein is proposed as a tool for evaluating the effectiveness and safety of meglumine antimoniate-based antileishmanial formulations.
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Affiliation(s)
- G Delgado
- Immunotoxicology Research Group, Pharmacy Department, Science Faculty, Universidad Nacional de Colombia, Oficina 206, Ciudad Universitaria, Carrera 30 No. 45-03, Edificio 450, Bogotá, D.C., Colombia.
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Vazquez C, Berrueta J, De Simone F, Tcheckmedyian A, Gonzalez N, Bernachin J, Perrota A, Curi J, Mariño A, Olano C. Small-intestinal bleeding due to metastatic renal cell cancer. Endoscopy 2011; 43 Suppl 2 UCTN:E13. [PMID: 21271517 DOI: 10.1055/s-0030-1255821] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- C Vazquez
- Gastroenterology Clinic Prof. H. Cohen, Hospital de Clínicas, Montevideo, Uruguay
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Pérez-Molina JA, Suárez-Lozano I, Del Arco A, Teira R, Bachiller P, Pedrol E, Martínez-Alfaro E, Domingo P, Mariño A, Ribera E, Antela A, de Otero J, Navarro V, González-García J. Late initiation of HAART among HIV-infected patients in Spain is frequent and related to a higher rate of virological failure but not to immigrant status. HIV Clin Trials 2011; 12:1-8. [PMID: 21388936 DOI: 10.1310/hct1201-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine whether immigrant status is associated with late initiation of highly active antiretroviral treatment (HAART) and/or poor response to antiretrovirals. METHODS GESIDA 5808 is a multicenter, retrospective cohort study (inclusion period January 2005 through December 2006) of treatment-naïve patients initiating HAART that compares HIV-infected patients who are immigrants with Spanish-born patients. A late starter (LS) was defined as any patient starting HAART with a CD4+ lymphocyte count <200 cells/μL and/or diagnosis of an AIDS-defining illness before or at the start of therapy. The primary endpoint was time to treatment failure (TTF), defined as virological failure (VF), death, opportunistic infection, treatment discontinuation/switch (D/S), or missing patient. Secondary endpoints were time to treatment failure as observed data (TTO; censoring missing patients) and time to virological failure (TVF; censoring missing patients and D/S not due to VF). RESULTS LS accounted for 56% of the patients. Lower educational and socioeconomic level and intravenous drug use (IVDU) were associated with categorization as LS, but immigrant status was not. Cox regression analysis (hazard ratio [HR]; 95% CI) between LS and non-LS patients showed no differences in TTF (0.97; 0.78-1.20) or TTO (1.18; 0.88-1.58), although it did reveal a difference in TVF (1.97; 1.18-3.29). CD4+ lymphocyte recovery was equivalent for both LS and non-LS patients (159 vs 173). CONCLUSIONS In our cohort, immigrant status was not shown to be related to late initiation of HAART. Although LS patients did not have a longer TTF for any reason, TVF was significantly shorter. Despite universal free access to HAART in Spain, measures to ensure early diagnosis and treatment of HIV infection are necessary.
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Affiliation(s)
- J A Pérez-Molina
- Servicio de Enfermedades Infecciosas, Medicina Tropical, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.
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Echeverría P, Negredo E, Carosi G, Gálvez J, Gómez J, Ocampo A, Portilla J, Prieto A, López J, Rubio R, Mariño A, Pedrol E, Viladés C, del Arco A, Moreno A, Bravo I, López-Blazquez R, Pérez-Alvarez N, Clotet B. Similar antiviral efficacy and tolerability between efavirenz and lopinavir/ritonavir, administered with abacavir/lamivudine (Kivexa®), in antiretroviral-naïve patients: A 48-week, multicentre, randomized study (Lake Study). Antiviral Res 2010; 85:403-8. [DOI: 10.1016/j.antiviral.2009.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 11/16/2009] [Accepted: 11/17/2009] [Indexed: 11/30/2022]
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Buño-Ramilo B, Fernández-Fernández FJ, Álvarez-Díaz H, Mariño A. Foliculitis por Candida en usuario de drogas por vía parenteral. Med Clin (Barc) 2009; 132:568. [DOI: 10.1016/j.medcli.2008.10.027] [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] [Received: 06/26/2008] [Accepted: 10/16/2008] [Indexed: 11/27/2022]
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Dalmau J, Puertas MC, Azuara M, Mariño A, Frahm N, Mothe B, Izquierdo-Useros N, Buzón MJ, Paredes R, Matas L, Allen TM, Brander C, Rodrigo C, Clotet B, Martinez-Picado J. Contribution of immunological and virological factors to extremely severe primary HIV type 1 infection. Clin Infect Dis 2009; 48:229-38. [PMID: 19093810 DOI: 10.1086/595704] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND During acute human immunodeficiency virus (HIV) infection, high viral loads and the induction of host immune responses typically coincide with the onset of clinical symptoms. However, clinically severe presentations during acute HIV type 1 (HIV-1) infection, including AIDS-defining symptoms, are unusual. METHODS Virus isolates were tested for clade, drug susceptibility, coreceptor use, and growth rate in 2 case reports of sexual transmission of HIV-1 infection. Human leukocyte antigen (HLA) genotype was determined, and HIV-1-specific cytotoxic T lymphocyte responses to an overlapping peptide set spanning the entire HIV clade A and clade B proteome were assayed. RESULTS The viruses isolated in the 2 unrelated case reports of severe primary HIV-1 infection showed R5/X4 dual-mixed tropism, belonged to clade B and CRF02-AG, and were highly replicative in peripheral blood mononuclear cell culture. Impaired humoral responses were paralleled by a profound absence of HIV-1-specific cytotoxic T lymphocyte responses to the entire viral proteome in the 2 case reports. In 1 case report for which the virus source was available, there was a remarkable HLA similarity between the 2 patients involved in the transmission event, because 3 of 4 HLA-A and HLA-B alleles had matched HLA supertype for both patients. CONCLUSIONS The data suggest that concurrence of viral and host factors contributes to the clinical severity of primary HIV-1 infection and that patients infected with highly replicative, dual-tropic viruses are more prone to develop AIDS-defining symptoms during acute infection if they are unable to mount humoral and cellular HIV-1-specific immune responses. The presence of concordant HLA supertypes might facilitate the preferential transmission of HLA-adapted viral variants, further accelerating disease progression.
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Affiliation(s)
- Judith Dalmau
- irsiCaixa Foundation, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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Martín-Carbonero L, Puoti M, García-Samaniego J, De Luca A, Losada E, Quinzan G, Bruno R, Mariño A, González M, Núñez M, Soriano V. Response to pegylated interferon plus ribavirin in HIV-infected patients with chronic hepatitis C due to genotype 4. J Viral Hepat 2008; 15:710-5. [PMID: 18637070 DOI: 10.1111/j.1365-2893.2008.01015.x] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Hepatitis C virus (HCV) genotypes 1 and 4 respond less well to pegylated interferon (pegIFN) plus ribavirin (RBV) therapy. For this reason most studies merge these two genotypes when assessing virological response. However, in most trials the HCV genotype 4 population is rather small, and conclusions are mainly derived from what occurs in HCV-1 patients. All HCV-4 patients coinfected with HIV who received pegIFN plus RBV in two different multicentre studies, PRESCO and ROMANCE, conducted respectively in Spain and Italy, were retrospectively analyzed. Baseline plasma HCV-RNA, proportion of patients with HCV-RNA <10 IU / mL at week 4 (rapid virological response), and HCV-RNA declines >2 logs at week 12 (early virological response, EVR) were all assessed as predictors of sustained virological response (SVR). Overall, 75 patients (60 men) were evaluated. Median age was 40 years and median CD4 count 598 cells / mm(3); 49% had plasma HIV-RNA <50 copies / mL; 71% had elevated liver enzymes and 31% had advanced liver fibrosis (Metavir F3-F4). Median serum HCV-RNA was 5.7 log IU / mL. Rapid virological response was attained by 10 (20%) patients and EVR by 26 (42%). Using intention-to-treat and on-treatment (OT) analyses, SVR was achieved by 21 / 75 (28%) and 21 / 62 (34%) of HCV-4 patients, respectively. In the multivariate analysis (OT), baseline HCV-RNA (OR 0.09 for every log increment; 95% CI: 0.01-0.7) and EVR (OR: 7.08; 95% CI: 1.8-27.2) were significantly and independently associated with SVR. This is the largest series of HIV-infected patients with chronic hepatitis C due to HCV-4 treated with pegIFN plus RBV examined so far and the results show that HCV-4 behaves similarly to HCV-1. Therefore, these patients should be considered as difficult to treat population. Baseline serum HCV-RNA and EVR are the best predictors of SVR in HCV-4 / HIV-coinfected patients.
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Panuncio A, Alba A, Bacigalupe C, Caorsi H, Schwedt E, Otatti G, Saralegui P, Mariño A. [C1q nephropathy. Report of one case]. Rev Med Chil 2008; 136:1307-1310. [PMID: 19194628] [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: 05/27/2023]
Abstract
Clq nephropathy (Clq N) is an infrequent disease and only about 100 cases have been reported. It is defined by a pattern of immunofluorescence (IF) with dominant or co-dominant complement Clq with electron-dense deposits in the mesangium, without clinical or serological features of Lupus Nephritis. The most common histopathological findings of ClqN are focal segmental glomerulosclerosis and Minimal Change Disease. We report a 17 year-old male patient with an isolated selective proteinuria found in a routine study. He had normal renal function and urine culture was negative. Serum lipids, liver enzymes an complement were all normal. Serum antinuclear and anti-DNA antibodies, antineutrophil cytoplasmic antibodies (ANCA), HIV, Hepatitis B and C serology, were negative. Renal and abdominal ultrasonography was normal. The histopathological study revealed segmental glomerular sclerosis, moderate increase of mesangial matrix, Bowmann capsule adhesions and fucsinophil deposits in mesangium. The IF was positive (dominant) for Clq (+++) and IgA, IgG, IgM, C3++, all of them with a granular mesangial distribution. Ultrastructural findings were pedicelar effacement and paramesangial electron-dense deposits. Tubular reticular inclusions (TRI) were not found. Remission of proteinuria was reached after 18 months of treatment with enalapril and losartan. The patient remains with normal renal function. Clinical findings, negative serology for Lupus, light microscopy IF with dominant positivity for Clq, absence of TRI and paramesangial electron-dense deposits in electron microscopy lead us to the diagnosis of ClqN. A poor response to steroid therapy was described in ClqN. Thus it was worthwhile to differentiate it from lupus nephritis, that is responsive to steroids.
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Affiliation(s)
- Ana Panuncio
- Departamento de Anatomía Patológica, Hospital de Clínicas de Montevideo, Montevideo, Uruguay.
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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
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Núñez M, Mariño A, Mariño A, Miralles C, Berdún MA, Sola J, Hernandez-Burruezo JJ, Galindo MJ, Barreiro P, Martin-Carbonero L, Soriano V. Baseline serum hepatitis C virus (HCV) RNA level and response at week 4 are the best predictors of relapse after treatment with pegylated interferon plus ribavirin in HIV/HCV-coinfected patients. J Acquir Immune Defic Syndr 2007; 45:439-44. [PMID: 17468669 DOI: 10.1097/qai.0b013e318061b5d9] [Citation(s) in RCA: 35] [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] [Indexed: 12/16/2022]
Abstract
BACKGROUND Relapse after achieving virologic response to anti-hepatitis C virus (HCV) treatment considerably reduces sustained virologic response rates. It is unclear what the main predictors of relapse in HCV/HIV-coinfected patients are. PATIENTS AND METHODS The Pegasys Ribavirina España Coinfección (PRESCO) study evaluated short and extended duration of treatment for chronic hepatitis C using pegylated interferon (peg-IFN)-alpha2a at a dose of 180 microg/wk plus weight-based ribavirin (RBV) at a dose of 1000 to 1200 mg/d in HIV-infected subjects. Patients with HCV-2/3 were treated for 6 or 12 months, and patients with HCV-1/4 were treated for 12 or 18 months. RESULTS Of 389 patients included in the trial, end-of-treatment response was achieved by 262 (67.3%): 106 with HCV-1 (55%), 137 with HCV-2/3 (90%), and 19 with HCV-4 (41%). Six patients were lost to follow-up after completing therapy. Of the remaining 256 patients, 62 (24%) relapsed: 33% of HCV-1 patients, 18% of HCV-2/3 patients, and 21% of HCV-4 patients. In multivariate logistic regression analysis, baseline serum HCV RNA level > or =500,000 IU/mL (relative risk [RR] = 4.81, 95% confidence interval [CI]: 1.52 to 15.22; P = 0.008) and lack of rapid virologic response, defined as undetectable HCV RNA level at week 4 (RR = 2.94, 95% CI: 1.22 to 7.09; P = 0.02) were the best independent predictors of HCV relapse. Use of concomitant antiretroviral therapy also predicted relapse (P = 0.04), and a trend toward a higher relapse rate was recognized for HCV genotypes 1 and 4 versus genotypes 2 and 3 (P = 0.08). Extended treatment did not result in a lower incidence of relapse, at least for HCV genotypes 2 and 3. CONCLUSION High baseline serum HCV RNA level and lack of undetectable viremia at week 4 are the most significant predictors of relapse in HCV/HIV-coinfected patients treated with peg-IFN plus weight-based RBV.
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Affiliation(s)
- Marina Núñez
- Department of Infectious Diseases. Hospital Carlos III, Calle Sinesio Delgado 10, 28029 Madrid, Spain
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Garcìa Rodrìguez J, Àlvarez H, Buño B, Mariño A, Rodrìguez M, Sesma P. P646 A prospective study of bloodstream infection in HIV-positive patients during a 15-year period. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70488-0] [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: 10/23/2022]
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Pérez-Alvarez L, Carmona R, Muñoz M, Delgado E, Thomson MM, Contreras G, Pedreira JD, Real RR, de Parga EV, Medrano L, Taboada JA, Nájera R, Agulla A, Mariño A, López-Calvo S, Pedreira JD, Aguilera A, Losada E, Prieto A, Corredoira J, López- Alvarez MJ, Rodríguez A, Bustillo M, García-Costa J, Fernández-Rodríguez R, Rodríguez R, Miralles C, Ocampo A, Rodríguez-Real R, Díz-Aren J, de Castro RO, Morano LE, Pérez-Rodríguez R, Rodríguez A, Torres J. High Incidence of Non-B and Recombinant HIV-1 Strains in Newly Diagnosed Patients in Galicia, Spain: Study of Genotypic Resistance. Antivir Ther 2003. [DOI: 10.1177/135965350300800413] [Citation(s) in RCA: 4] [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] [Indexed: 11/17/2022]
Abstract
The objectives of this study are to describe the incidence of non-B and recombinant HIV-1 strains in newly diagnosed HIV-1 infections in Galicia, northwest of Spain, during a 2-year period (May 2000 to June 2002), and the frequency of resistance-associated mutations in reverse transcriptase (RT) and protease (PR) genes, analysing the polymorphisms more frequently detected in non-B and recombinant viruses. All newly diagnosed HIV-1-infected patients attending the nine public hospitals of the seven main cities of Galicia were included in this study. RT, PR and V3 regions from HIV-1 RNA plasma were amplified and sequenced, being the corrected sequences sent to the Stanford HIV RT and Protease Sequence Database. Nineteen of 85 patients (22.3%) were infected by non-B or recombinant viruses: three subtype C, two G, one F1, one Dpol/A1V3, five CRF02_AG, one CRF14_BG, five BGpol/BV3 and one UKpol/UV3 (U, unknown fragment). Eleven of these 19 patients (57.9%) were foreign individuals living in Galicia infected through heterosexual contact, and the other eight (42.1%) were Spanish intravenous drug users who had shared injection equipment. Five of 85 patients (5.9%), all infected with B subtype viruses, showed resistance-associated mutations in RT (M184V, M41L, L210W, T215Y/D and K219Q). In one patient (1.2%) infected with a subtype G strain, resistance-associated mutations in PR (K20I+M36I+M46I+V82I) were detected. In subtype B viruses resistance mutations in PR were not detected. Several polymorphisms in RT: D123S, Q174K, D177E, T200A, V245Q, and PR: I13V, K20I, M36I, R41K, H69K, L89M were detected more frequently in non-B and recombinants than in B strains ( P<0.01 to P<0.001). This study reports a high incidence (22.3%) of newly diagnosed patients infected by different non-B and recombinant HIV-1 strains, in a geographical area of Spain, showing also a high frequency of polymorphisms in RT and PR genes.
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Affiliation(s)
- Lucía Pérez-Alvarez
- Area de Patogenia Viral, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Rocío Carmona
- Area de Patogenia Viral, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Mercedes Muñoz
- Area de Patogenia Viral, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Delgado
- Area de Patogenia Viral, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Michael M Thomson
- Area de Patogenia Viral, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Gerardo Contreras
- Area de Patogenia Viral, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - José D Pedreira
- Unidade de Seguimiento de VIH/SIDA, Hospital Juan Canalejo, La Coruña, Spain
| | | | - Elena Vázquez de Parga
- Area de Patogenia Viral, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Leandro Medrano
- Area de Patogenia Viral, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - José Antonio Taboada
- Consellería de Sanidade e Servicios Sociais, Dirección Xeral de Saúde Pública, Xunta de Galicia, Santiago de Compostela, Spain
| | - Rafael Nájera
- Area de Patogenia Viral, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - A Agulla
- Hospital Arquitecto Marcide, Ferrol (La Coruña)
| | - A Mariño
- Hospital Arquitecto Marcide, Ferrol (La Coruña)
| | | | | | - A Aguilera
- Complejo Hospitalario Universitario de Santiago (La Coruña)
| | - E Losada
- Complejo Hospitalario Universitario de Santiago (La Coruña)
| | - A Prieto
- Complejo Hospitalario Universitario de Santiago (La Coruña)
| | | | | | | | - M Bustillo
- Hospital Nuestra Señora del Cristal (Orense)
| | | | | | - R Rodríguez
- Hospital Provincial Santa María Madre (Orense)
| | | | - A Ocampo
- Hospital Xeral-Cíes, Vigo (Pontevedra)
| | | | | | | | - LE Morano
- Hospital Meixoeiro, Vigo (Pontevedra)
| | | | | | - J Torres
- Hospital Meixoeiro, Vigo (Pontevedra)
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Oliva J, Moreno S, Sanz J, Ribera E, Molina JAO, Rubio R, Casas E, Mariño A. Co-administration of rifampin and nevirapine in HIV-infected patients with tuberculosis. AIDS 2003; 17:637-8. [PMID: 12598789 DOI: 10.1097/00002030-200303070-00024] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Varo E, Lopez A, Castroagudin JF, Delgado M, Conde R, Ferrer E, Otero E, Tomé S, Bustamante M, Rivero C, Martinez J, Mariño A. Alternative immunosuppression for acute renal failure in liver transplantation: role of ultra-low dose tacrolimus and basiliximab. Transplant Proc 2002; 34:1533-4. [PMID: 12176471 DOI: 10.1016/s0041-1345(02)03008-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- E Varo
- Transplantation Unit, Hospital Clinico Universitario, 15706 Santiago de Compostela, Spain
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Varo E, Mella C, Martínez J, Tomé J, Otero E, Bustamante M, Castroagudin JF, Regueiro B, Mariño A, González-Quintela A. Incidence of cytomegalovirus infection and disease in orthotopic liver transplant patients immunosuppressed with cyclosporin versus tacrolimus. Transplant Proc 2002; 34:1567-8. [PMID: 12176488 DOI: 10.1016/s0041-1345(02)03025-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- E Varo
- Transplantation Unit, Hospital Clinico Universitario, 15706 Santiago de Compostela, Spain
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Thomson MM, Delgado E, Manjón N, Ocampo A, Villahermosa ML, Mariño A, Herrero I, Cuevas MT, Vázquez-de Parga E, Pérez-Alvarez L, Medrano L, Taboada JA, Nájera R. HIV-1 genetic diversity in Galicia Spain: BG intersubtype recombinant viruses circulating among injecting drug users. AIDS 2001; 15:509-16. [PMID: 11242148 DOI: 10.1097/00002030-200103090-00010] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [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: 01/04/2023]
Abstract
BACKGROUND The HIV-1 epidemics in Western Europe are dominated by B subtype viruses. Non-B subtype is largely restricted to individuals infected outside of Europe and to their direct contacts and is generally acquired by the heterosexual route. METHODS Protease and a segment of reverse transcriptase were amplified and sequenced from plasma RNA in 451 individuals from seven cities of Galicia, north-western Spain. Subtype sequence homologies were determined using the BLAST algorithm. Non-B sequences were examined by phylogenetic analysis and intersubtype recombination by bootscanning. The env V3 region was analysed in all non-B and in 38 B subtype viruses. RESULTS Ten different non-B genetic forms were identified in 20 (4.4%) individuals. Subtypes were concordant between pol and V3 in five viruses; 14 (70%) infections were with intersubtype recombinant viruses, and one individual had a dual B+G infection. Seven recombinant viruses were phylogenetically related to five reported recombinant forms. Three non-recombinant G and six recombinant BG viruses formed a monophyletic cluster for pol. All but three individuals with non-B infections were native Spanish. Only 6 of 16 individuals referred to sexual contacts with sub-Saharan Africans. Twelve (60%) non-B subtype infections, including all with G and BG viruses, were in injecting drug users (IDU). CONCLUSIONS Non-B subtype viruses were identified in 4.4%, with a high diversity of genetic forms, including 70% infections with intersubtype recombinant viruses. The majority of individuals with non-B infections were IDU, most of them without known contacts with non-European sources, and among whom BG recombinant viruses are circulating.
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Affiliation(s)
- M M Thomson
- Area de Patogenia Viral, Centro Nacional de Biología Fundamental, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
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José Fernández-Fernández F, Fernández-Rial Á, Mariño A, Mariño Pascual Sesma A. Fracaso terapéutico en la neumonía por Acinetobacter baumannii. Med Clin (Barc) 2000. [DOI: 10.1016/s0025-7753(00)71695-2] [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: 10/27/2022]
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