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Gasca-Capote C, Lian X, Gao C, Roseto IC, Jiménez-León MR, Gladkov G, Camacho-Sojo MI, Pérez-Gómez A, Gallego I, Lopez-Cortes LE, Bachiller S, Vitalle J, Rafii-El-Idrissi Benhnia M, Ostos FJ, Collado-Romacho AR, Santos J, Palacios R, Gomez-Ayerbe C, Muñoz-Medina L, Ruiz-Sancho A, Frias M, Rivero-Juarez A, Roca-Oporto C, Hidalgo-Tenorio C, Rull A, Olalla J, Lopez-Ruz MA, Vidal F, Viladés C, Mastrangelo A, Cavassini M, Espinosa N, Perreau M, Peraire J, Rivero A, López-Cortes LF, Lichterfeld M, Yu XG, Ruiz-Mateos E. The HIV-1 reservoir landscape in persistent elite controllers and transient elite controllers. J Clin Invest 2024; 134:e174215. [PMID: 38376918 PMCID: PMC11014653 DOI: 10.1172/jci174215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/13/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUNDPersistent controllers (PCs) maintain antiretroviral-free HIV-1 control indefinitely over time, while transient controllers (TCs) eventually lose virological control. It is essential to characterize the quality of the HIV reservoir in terms of these phenotypes in order to identify the factors that lead to HIV progression and to open new avenues toward an HIV cure.METHODSThe characterization of HIV-1 reservoir from peripheral blood mononuclear cells was performed using next-generation sequencing techniques, such as full-length individual and matched integration site proviral sequencing (FLIP-Seq; MIP-Seq).RESULTSPCs and TCs, before losing virological control, presented significantly lower total, intact, and defective proviruses compared with those of participants on antiretroviral therapy (ART). No differences were found in total and defective proviruses between PCs and TCs. However, intact provirus levels were lower in PCs compared with TCs; indeed the intact/defective HIV-DNA ratio was significantly higher in TCs. Clonally expanded intact proviruses were found only in PCs and located in centromeric satellite DNA or zinc-finger genes, both associated with heterochromatin features. In contrast, sampled intact proviruses were located in permissive genic euchromatic positions in TCs.CONCLUSIONSThese results suggest the need for, and can give guidance to, the design of future research to identify a distinct proviral landscape that may be associated with the persistent control of HIV-1 without ART.FUNDINGInstituto de Salud Carlos III (FI17/00186, FI19/00083, MV20/00057, PI18/01532, PI19/01127 and PI22/01796), Gilead Fellowships (GLD22/00147). NIH grants AI155171, AI116228, AI078799, HL134539, DA047034, MH134823, amfAR ARCHE and the Bill and Melinda Gates Foundation.
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Affiliation(s)
- Carmen Gasca-Capote
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Xiaodong Lian
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Ce Gao
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Isabelle C. Roseto
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - María Reyes Jiménez-León
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Gregory Gladkov
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - María Inés Camacho-Sojo
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Alberto Pérez-Gómez
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Isabel Gallego
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Luis E. Lopez-Cortes
- Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Seville, Spain
- Department of Medicine and Microbiology, School of Medicine and
- IBiS, Virgen Macarena University Hospital, CSIC, University of Seville, Seville, Spain
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Sara Bachiller
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
- Department of Medical Biochemistry, Molecular Biology, and Immunology, School of Medicine, University of Seville, Seville, Spain
| | - Joana Vitalle
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Mohamed Rafii-El-Idrissi Benhnia
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
- Department of Medical Biochemistry, Molecular Biology, and Immunology, School of Medicine, University of Seville, Seville, Spain
| | - Francisco J. Ostos
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
- Department of Medical Biochemistry, Molecular Biology, and Immunology, School of Medicine, University of Seville, Seville, Spain
| | | | - Jesús Santos
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Rosario Palacios
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Cristina Gomez-Ayerbe
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Leopoldo Muñoz-Medina
- Unit of Infectious Diseases, San Cecilio University Hospital, Biohealth Research Institute, IBS-Granada, Granada, Spain
| | - Andrés Ruiz-Sancho
- Unit of Infectious Diseases, San Cecilio University Hospital, Biohealth Research Institute, IBS-Granada, Granada, Spain
| | - Mario Frias
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Service of Infectious Diseases, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba University, Cordoba, Spain
| | - Antonio Rivero-Juarez
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Service of Infectious Diseases, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba University, Cordoba, Spain
| | - Cristina Roca-Oporto
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Carmen Hidalgo-Tenorio
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, Biohealth Research Institute, IBS-Granada, Granada, Spain
| | - Anna Rull
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Joan XXIII University Hospital of Tarragona, IISPV, University of Rovira i Virgili, Tarragona, Spain
| | - Julian Olalla
- Internal Medicine Department, Costa Del Sol Hospital, Marbella, Spain
| | - Miguel A. Lopez-Ruz
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, Biohealth Research Institute, IBS-Granada, Granada, Spain
| | - Francesc Vidal
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Joan XXIII University Hospital of Tarragona, IISPV, University of Rovira i Virgili, Tarragona, Spain
| | - Consuelo Viladés
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Joan XXIII University Hospital of Tarragona, IISPV, University of Rovira i Virgili, Tarragona, Spain
| | | | - Matthias Cavassini
- Service of Infectious Diseases, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Nuria Espinosa
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Matthieu Perreau
- Service of Immunology and Allergy, Lausanne University Hospital and
| | - Joaquin Peraire
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Joan XXIII University Hospital of Tarragona, IISPV, University of Rovira i Virgili, Tarragona, Spain
| | - Antonio Rivero
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Service of Infectious Diseases, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba University, Cordoba, Spain
| | - Luis F. López-Cortes
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Mathias Lichterfeld
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Xu G. Yu
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Ezequiel Ruiz-Mateos
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
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Saborido-Alconchel A, Serna-Gallego A, Lopez-Cortes LE, Trujillo-Rodriguez M, Praena-Fernandez JM, Dominguez-Macias M, Lozano C, Muñoz-Muela E, Espinosa N, Roca-Oporto C, Sotomayor C, Herrero M, Gutierrez-Valencia A, Lopez-Cortes LF. Decay kinetics of HIV-1-RNA in seminal plasma with dolutegravir/lamivudine versus dolutegravir plus emtricitabine/tenofovir alafenamide in treatment-naive people living with HIV. J Antimicrob Chemother 2023; 78:2354-2360. [PMID: 37545387 PMCID: PMC10477137 DOI: 10.1093/jac/dkad245] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND This was a substudy of a Phase IV, randomized clinical trial (ClinicalTrials.gov identifier: NCT04295460) aiming to compare the activity of dolutegravir/lamivudine versus dolutegravir plus tenofovir alafenamide/emtricitabine (DTG + TAF/FTC) in the male genital tract. METHODS Participants were asymptomatic adults without sexually transmitted diseases, treatment-naive people living with HIV (PLWH), with CD4+ T cell counts >200 cells/mm3 and plasma HIV-1-RNA levels >5000 and <500 000 copies/mL, randomized (1:1) to DTG + TAF/FTC or dolutegravir/lamivudine. Blood plasma (BP) and seminal plasma (SP) were collected at baseline and Weeks 4, 8, 12 and 24. HIV-1-RNA was measured in BP and SP using the Cobas 6800 system (Roche Diagnostics) with a lower detection limit of 20 copies/mL. The primary efficacy endpoint was the proportion of subjects with undetectable SP HIV-1-RNA at Week 12 by intention-to-treat analysis. RESULTS Fifteen participants in the DTG + TAF/FTC and 16 in the dolutegravir/lamivudine arms were analysed, with basal SP viral load of 4.81 (4.30-5.43) and 4.76 (4.09-5.23), P = 0.469, respectively. At Week 12, only one participant in each treatment arm had a detectable SP HIV-1-RNA (DTG + TAF/FTC, 141 copies/mL; dolutegravir/lamivudine, 61 copies/mL). Based on the estimated means, there was no significant difference in the decay of HIV-1-RNA in both BP and SP over time between the two arms of treatment (F = 0.452, P = 0.662, and F = 1.147, P = 0.185, respectively). CONCLUSIONS After 12 weeks of treatment, there were no differences in the percentage of undetectable SP HIV-1-RNA in naive PLWH who started dolutegravir/lamivudine compared with DTG + TAF/FTC.
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Affiliation(s)
- Abraham Saborido-Alconchel
- Infectious Diseases and Microbiology Clinical Unit. Instituto de Biomedicina de Sevilla/University Hospital Virgen del Rocío/CSIC/Universidad de Sevilla. Sevilla. Spain
| | - Ana Serna-Gallego
- Infectious Diseases and Microbiology Clinical Unit. Instituto de Biomedicina de Sevilla/University Hospital Virgen del Rocío/CSIC/Universidad de Sevilla. Sevilla. Spain
| | - Luis E Lopez-Cortes
- Infectious Diseases and Microbiology Clinical Unit (Department of Medicine, School of Medicine). Instituto de Biomedicina de Sevilla/University Hospital Virgen. Seville. Spain. Macarena/CSIC/Universidad de Sevilla. CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - María Trujillo-Rodriguez
- Infectious Diseases and Microbiology Clinical Unit. Instituto de Biomedicina de Sevilla/University Hospital Virgen del Rocío/CSIC/Universidad de Sevilla. Sevilla. Spain
| | | | - Montserrat Dominguez-Macias
- Infectious Diseases and Microbiology Clinical Unit. Instituto de Biomedicina de Sevilla/University Hospital Virgen del Rocío/CSIC/Universidad de Sevilla. Sevilla. Spain
| | - Carmen Lozano
- Infectious Diseases and Microbiology Clinical Unit. Instituto de Biomedicina de Sevilla/University Hospital Virgen del Rocío/CSIC/Universidad de Sevilla. Sevilla. Spain
| | - Esperanza Muñoz-Muela
- Infectious Diseases and Microbiology Clinical Unit. Instituto de Biomedicina de Sevilla/University Hospital Virgen del Rocío/CSIC/Universidad de Sevilla. Sevilla. Spain
| | - Nuria Espinosa
- Infectious Diseases and Microbiology Clinical Unit. Instituto de Biomedicina de Sevilla/University Hospital Virgen del Rocío/CSIC/Universidad de Sevilla. Sevilla. Spain
| | - Cristina Roca-Oporto
- Infectious Diseases and Microbiology Clinical Unit. Instituto de Biomedicina de Sevilla/University Hospital Virgen del Rocío/CSIC/Universidad de Sevilla. Sevilla. Spain
| | - Cesar Sotomayor
- Infectious Diseases and Microbiology Clinical Unit. Instituto de Biomedicina de Sevilla/University Hospital Virgen del Rocío/CSIC/Universidad de Sevilla. Sevilla. Spain
| | - Marta Herrero
- Infectious Diseases and Microbiology Clinical Unit. Instituto de Biomedicina de Sevilla/University Hospital Virgen del Rocío/CSIC/Universidad de Sevilla. Sevilla. Spain
| | - Alicia Gutierrez-Valencia
- Infectious Diseases and Microbiology Clinical Unit. Instituto de Biomedicina de Sevilla/University Hospital Virgen del Rocío/CSIC/Universidad de Sevilla. Sevilla. Spain
| | - Luis F Lopez-Cortes
- Infectious Diseases and Microbiology Clinical Unit. Instituto de Biomedicina de Sevilla/University Hospital Virgen del Rocío/CSIC/Universidad de Sevilla. Sevilla. Spain
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3
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Jimenez-Leon MR, Gasca-Capote C, Tarancon-Diez L, Dominguez-Molina B, Lopez-Verdugo M, Ritraj R, Gallego I, Alvarez-Rios AI, Vitalle J, Bachiller S, Camacho-Sojo MI, Perez-Gomez A, Espinosa N, Roca-Oporto C, Rafii-El-Idrissi Benhnia M, Gutierrez-Valencia A, Lopez-Cortes LF, Ruiz-Mateos E. Toll-like receptor agonists enhance HIV-specific T cell response mediated by plasmacytoid dendritic cells in diverse HIV-1 disease progression phenotypes. EBioMedicine 2023; 91:104549. [PMID: 37018973 PMCID: PMC10106920 DOI: 10.1016/j.ebiom.2023.104549] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Plasmacytoid dendritic cells (pDCs) sense viral and bacterial products through Toll-like receptor (TLR)-7 and -9 and translate this sensing into Interferon-α (IFN-α) production and T-cell activation. The understanding of the mechanisms involved in pDCs stimulation may contribute to HIV-cure immunotherapeutic strategies. The objective of the present study was to characterize the immunomodulatory effects of TLR agonist stimulations in several HIV-1 disease progression phenotypes and in non HIV-1 infected donors. METHODS pDCs, CD4 and CD8 T-cells were isolated from 450 ml of whole blood from non HIV-1 infected donors, immune responders (IR), immune non responders (INR), viremic (VIR) and elite controller (EC) participants. pDCs were stimulated overnight with AT-2, CpG-A, CpG-C and GS-9620 or no stimuli. After that, pDCs were co-cultured with autologous CD4 or CD8 T-cells and with/without HIV-1 (Gag peptide pool) or SEB (Staphylococcal Enterotoxin B). Cytokine array, gene expression and deep immunophenotyping were assayed. FINDINGS pDCs showed an increase of activation markers levels, interferon related genes, HIV-1 restriction factors and cytokines levels after TLR stimulation in the different HIV-disease progression phenotypes. This pDC activation was prominent with CpG-C and GS-9620 and induced an increase of HIV-specific T-cell response even in VIR and INR comparable with EC. This HIV-1 specific T-cell response was associated with the upregulation of HIV-1 restriction factors and IFN-α production by pDC. INTERPRETATION These results shed light on the mechanisms associated with TLR-specific pDCs stimulation associated with the induction of a T-cell mediated antiviral response which is essential for HIV-1 eradication strategies. FUNDING This work was supported by Gilead fellowship program, the Instituto de Salud Carlos III (Fondo Europeo de Desarrollo Regional, FEDER, "a way to make Europe") and the Red Temática de Investigación Cooperativa en SIDA and by the Spanish National Research Council (CSIC).
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Jimenez-Rodriguez RM, Martín-Gutiérrez G, Jiménez-Jorge S, Rosso-Fernández CM, Tallón-Aguilar L, Roca-Oporto C, Padillo J, Luckey A, Cano A, López-Ruiz J, Gómez-Zorrilla S, Bonnín-Pascual J, Boix-Palop L, Montejo JM, Torre-Cisneros J, Cisneros JM. Factors associated with recruitment success in the phase 2a study of aztreonam-avibactam development programme: a descriptive qualitative analysis among sites in Spain. BMJ Open 2022; 12:e051187. [PMID: 35115349 PMCID: PMC8814749 DOI: 10.1136/bmjopen-2021-051187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Successful clinical trials are subject to recruitment. Recently, the REJUVENATE trial, a prospective phase 2a open-label, single-arm interventional clinical trial conducted within the Innovative Medicines Initiative-supported Combatting Bacterial Resistance in Europe-Carbapenem Resistance project, was published, with 85% of the recruitment performed in Spain. We analysed the recruitment success in this trial by establishing a model of recruitment practice. METHODS A descriptive qualitative study was performed from May 2016 to October 2017 at 10 participating Spanish centres. Data were extracted from: (1) feasibility questionnaires to assess the centre's potential for patient enrolment; (2) delegation of responsibility records; (3) pre-screening records including an anonymised list of potentially eligible and (4) screening and enrolment records. A descriptive analysis of the features was performed by the participating centre. Pearson's and Spearman's correlation coefficients were calculated to determine factors of recruitment success. RESULTS The highest recruitment rate was observed in Hospitals 3 and 6 (58.8 and 47.0 patients per month, respectively). All the study teams were multidisciplinary with a median of 15 members (range: 7-22). Only Hospitals 3, 5 and 6 had dedicated nursing staff appointed exclusively to this study. Moreover, in those three hospitals and in Hospital 9, the study coordinator performed exclusive functions as a research planner, and did not assume these functions for the other hospitals. The univariate analysis showed a significant association between recruitment success and months of recruitment (p=0.024), number of staff (p<0.001), higher number of pharmacists (p=0.005), infectious disease specialists (p<0.001), the presence of microbiologist in the research team (p=0.018) and specifically dedicated nursing staff (p=0.036). CONCLUSIONS The existence of broad multidisciplinary teams with staff dedicated exclusively to the study as well as the implementation of a well-designed local patient assessment strategy were the essential optimisation factors for recruitment success in Spain. TRIAL REGISTRATION NUMBER NCT02655419; EudraCT 2015-002726-39; analysis of pre-screened patients.
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Affiliation(s)
| | | | - Silvia Jiménez-Jorge
- Clinical Research and Clinical Trials Unit, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Clara M Rosso-Fernández
- Clinical Research and Clinical Trials Unit, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Luis Tallón-Aguilar
- Department of Surgery, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Cristina Roca-Oporto
- Department of Infectious Diseases, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Javier Padillo
- Department of Surgery, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Alison Luckey
- Global Antibiotic R&D Partnership (GARDP), Geneva, Switzerland
| | - Angela Cano
- Department of Infectious Diseases, Reina Sofia University Hospital, Cordoba, Spain
| | - José López-Ruiz
- Department of Surgery, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Jaime Bonnín-Pascual
- Department of Surgery, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Lucía Boix-Palop
- Department of Infectious Diseases, MutuaTerrassa Group, Terrassa, Spain
| | - José Miguel Montejo
- Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Spain
| | | | - José Miguel Cisneros
- Department of Infectious Diseases, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Cordero E, Goycochea-Valdivia W, Mendez-Echevarria A, Allende LM, Alsina L, Bravo García-Morato M, Gil-Herrera J, Gudiol C, Len-Abad O, López-Medrano F, Moreno-Pérez D, Muñoz P, Olbrich P, Sánchez-Ramón S, Soler-Palacín P, Aguilera Cros C, Arostegui JI, Badell Serra I, Carbone J, Fortún J, Gonzalez-Granado LI, López-Granados E, Lucena JM, Parody R, Ramakers J, Regueiro JR, Rivière JG, Roca-Oporto C, Rodríguez Pena R, Santos-Pérez JL, Rodríguez-Gallego C, Neth O. Executive Summary of the Consensus Document on the Diagnosis and Management of Patients with Primary Immunodeficiencies. Enferm Infecc Microbiol Clin 2021; 38:438-443. [PMID: 33161954 DOI: 10.1016/j.eimc.2020.07.001] [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: 05/31/2020] [Revised: 07/01/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
Primary immunodeficiencies (PIDs) are rare, undiagnosed and potentially fatal diseases. Clinical manifestations of PID can be fatal or leave sequelae that worsen the quality of life of patients. Traditionally, the treatment of PIDs has been largely supportive, with the exception of bone marrow transplantation and, more recently, gene therapy. The discovering of new affected pathways, the development of new molecules and biologics, and the increasing understanding of the molecular basis of these disorders have created opportunities in PIDs therapy. This document aims to review current knowledge and to provide recommendations about the diagnosis and clinical management of adults and children with PIDs based on the available scientific evidence taking in to account current practice and future challenges. A systematic review was conducted, and evidence levels based on the available literature are given for each recommendation where available.
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Affiliation(s)
- Elisa Cordero
- Clinical Unit of Infectious Diseases University Hospital Virgen del Rocio, Institute of Biomedicine, CSIC, University of Seville, Seville, Spain; Department of Medicine, University of Seville, Seville, Spain.
| | - Walter Goycochea-Valdivia
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, University Hospital Virgen del Rocio, Institute of Biomedicine, Seville, Spain
| | - Ana Mendez-Echevarria
- Servicio de Pediatría y Enfermedades Infecciosas, Hospital Universitario La Paz, Madrid, Spain
| | - Luis M Allende
- Servicio de Inmunología, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12, Universidad Complutense de Madrid, Madrid, Spain
| | - Laia Alsina
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Institut de Recerca Sant Joan de Déu, Clinical Immunology Unit Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Maria Bravo García-Morato
- Servicio de Inmunología, Hospital Universitario La Paz, Instituto de Investigación Biomédica del Hospital La Paz (IdiPAZ), Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Juana Gil-Herrera
- Department of Immunology, Hospital General Universitario and Health Research Institute Gregorio Marañón, School of Medicine, Univerisdad Complutense, Madrid, Spain
| | - Carlota Gudiol
- Infectious Diseases Department, Hospital Universitari de Bellvitge and Institut Català d'Oncologia (ICO), Hospital Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oscar Len-Abad
- Infectious Diseases Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Francisco López-Medrano
- Infectious Diseases University Unit, Hospital 12 de Octubre, Instituto de Investigación Biomédica i+12, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - David Moreno-Pérez
- Pediatric Infectology and Immunodeficiencies Unit, Department of Pediatrics, Hospital Regional Universitario de Málaga, IBIMA, RECLIP, University of Malaga, Málaga, Spain
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Peter Olbrich
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, University Hospital Virgen del Rocio, Institute of Biomedicine, Seville, Spain
| | - Silvia Sánchez-Ramón
- Department of Immunology, IML and IdSSC, Hospital Clínico San Carlos, Madrid, Spain
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
| | - Clara Aguilera Cros
- Department of Rheumatology, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Juan Ignacio Arostegui
- Department of Immunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Isabel Badell Serra
- Unidad de Hematología, Oncología y Trasplante Hematopoyético, Servicio de Pediatría, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Carbone
- Servicio de Inmunología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jesús Fortún
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Luis I Gonzalez-Granado
- Primary Immunodeficiencies Unit, Pediatrics, Hospital 12 de Octubre, Research Institute Hospital 12 octubre (i+12), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Eduardo López-Granados
- Servicio de Inmunología, Instituto de Investigación Biomédica del Hospital La Paz (IdiPAZ), Hospital Universitario La Paz, Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | | | - Rocío Parody
- Servicio de Hematología Clínica, Institut Català d'Oncologia H. Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jan Ramakers
- Department of Pediatrics, Pediatric Rheumatology and Immunology, Son Espases University Hospital, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - José R Regueiro
- Department of Immunology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Jacques G Rivière
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
| | - Cristina Roca-Oporto
- Clinical Unit of Infectious Diseases University Hospital Virgen del Rocio, Institute of Biomedicine, CSIC, University of Seville, Seville, Spain
| | - Rebeca Rodríguez Pena
- Servicio de Inmunología, Instituto de Investigación Biomédica del Hospital La Paz (IdiPAZ), Hospital Universitario La Paz, Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Juan Luis Santos-Pérez
- Infectious Diseases and Immunodeficiencies Unit, Service of Pediatrics, University Hospital Virgen de las Nieves, Granada, Spain
| | - Carlos Rodríguez-Gallego
- Department of Immunology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain; University Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain.
| | - Olaf Neth
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, University Hospital Virgen del Rocio, Institute of Biomedicine, Seville, Spain
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Milanés-Guisado Y, Gutiérrez-Valencia A, Muñoz-Pichardo JM, Rivero A, Trujillo-Rodriguez M, Ruiz-Mateos E, Espinosa N, Roca-Oporto C, Viciana P, López-Cortés LF. Is immune recovery different depending on the use of integrase strand transfer inhibitor-, non-nucleoside reverse transcriptase- or boosted protease inhibitor-based regimens in antiretroviral-naive HIV-infected patients? J Antimicrob Chemother 2021; 75:200-207. [PMID: 31617904 DOI: 10.1093/jac/dkz421] [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: 06/13/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To analyse whether integrase inhibitor (InSTI)-based regimens achieve better immunological recovery than NNRTI- or boosted PI (bPI)-based regimens as initial ART. METHODS In a retrospective analysis, we selected patients who initiated ART with two NRTIs plus an InSTI, an NNRTI or a bPI and maintained both the same 'third drug' and an HIV-RNA <50 copies/mL in ≥95% of determinations once undetectable viral load had been achieved. We compared CD4+ count, %CD4+ and CD4+/CD8+ ratio recovery over 2 years. Data were analysed using mixed-effects regression models for repeated measures. RESULTS Of the 836 patients included, 208, 481 and 147 initiated with InSTI, NNRTI and bPI, respectively. For CD4+, %CD4+ and CD4+/CD8+ two main slopes were identified: from month 0 to month 6, with the highest increments; and from month 6 to month 24, with smaller increases every semester. Although the patients on InSTI achieved undetectable viral load faster, for CD4+ and %CD4+ there were no differences in the slopes of change according to the third drug either for the first phase (P=0.137 and P=0.393, respectively) or from month 6 onwards (P=0.834 and P=0.159, respectively). The increase in CD4+/CD8+ was slightly higher for bPI compared with InSTI (difference of 0.0119, 95% CI 0.0020-0.0205; P=0.018), but clinically negligible. From month 6 onwards, no differences were found between treatment groups (P=0.176). CONCLUSIONS Immune restoration measured as CD4+ count, %CD4+ and CD4+/CD8+ increases was independent of the third antiretroviral drug class used when given with two NRTIs.
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Affiliation(s)
- Yusnelkis Milanés-Guisado
- Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Alicia Gutiérrez-Valencia
- Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | | | - Antonio Rivero
- Hospital Universitario Reina Sofía/Instituto Maimonides de Investigación Biomédica de Córdoba/Universidad de Córdoba, Córdoba, Spain
| | - Maria Trujillo-Rodriguez
- Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Ezequiel Ruiz-Mateos
- Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Nuria Espinosa
- Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Cristina Roca-Oporto
- Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Pompeyo Viciana
- Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Luis F López-Cortés
- Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
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7
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Espinosa-Solano M, Gonzalez-Vergara D, Ferrer-Galvan M, Asensio-Cruz MI, Lomas JM, Roca-Oporto C, Navarro-Amuedo MD, Paniagua-Garcia M, Sotomayor C, Espinosa N, Garcia-Gutierrez M, Molina Gil-Bermejo J, Aguilar-Guisado M, Poyato M, Praena-Segovia J, Palomo A, Borrero-Rodriguez M, Cordero E, Caballero-Eraso C, Jara-Palomares L. Repeated Pulses of Methyl-Prednisolone in Adults Hospitalized With COVID-19 Pneumonia and Acute Respiratory Distress Syndrome: A Preliminary Before-After Study (CortiCOVID Study). Open Respir Arch 2021; 3:100086. [PMID: 38620829 PMCID: PMC7977067 DOI: 10.1016/j.opresp.2021.100086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/11/2020] [Accepted: 02/11/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction The use of systemic corticosteroids in severely ill patients with coronavirus disease 2019 (COVID-19) is controversial. We aimed to evaluate the efficacy and safety of corticosteroid pulses in patients with COVID-19 pneumonia. Methods A quasi-experimental study, before and after, was performed in a tertiary referral hospital, including admitted patients showing COVID-19-associated pneumonia. The standard treatment protocol included targeted COVID-19 antiviral therapy from 23rd March 2020, and additionally pulses of methylprednisolone from 30th March 2020. The primary outcome was a composite endpoint combining oro-tracheal intubation (OTI) and death within 7 days. Results A total of 24 patients were included. Standard of care (SOC) (before intervention) was prescribed in 14 patients, while 10 received SOC plus pulses of methylprednisolone (after intervention). The median age of patients was 64.5 years and 83.3% of the patients were men. The primary composite endpoint occurred in 13 patients (92.9%) who received SOC vs. 2 patients (20%) that received pulses of methylprednisolone (odds ratio, 0.02; 95% confidence interval, 0.001 to 0.25; p = 0.019). Length of hospitalization in survivors was shorter in the corticosteroids group (median, 14.5 [8.5-21.8] days vs. 29 [23-31] days, p = 0.003). There were no differences in the development of infections between both groups. There were 3 deaths, none of them in the corticosteroids group. Conclusions In patients with severe pneumonia due to COVID-19, the administration of methylprednisolone pulses was associated with a lower rate of OTI and/or death and a shorter hospitalization episode.
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Affiliation(s)
| | | | | | - Maria Isabel Asensio-Cruz
- Respiratory Department, Virgen del Rocio Hospital, Sevilla, Spain
- Instituto de Biomedicina, Sevilla; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose M. Lomas
- Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocio-Institute of Biomedicine of Seville, Sevilla, Spain
| | - Cristina Roca-Oporto
- Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocio-Institute of Biomedicine of Seville, Sevilla, Spain
| | - Maria Dolores Navarro-Amuedo
- Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocio-Institute of Biomedicine of Seville, Sevilla, Spain
| | - Maria Paniagua-Garcia
- Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocio-Institute of Biomedicine of Seville, Sevilla, Spain
| | - Cesar Sotomayor
- Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocio-Institute of Biomedicine of Seville, Sevilla, Spain
| | - Nuria Espinosa
- Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocio-Institute of Biomedicine of Seville, Sevilla, Spain
| | - Manuel Garcia-Gutierrez
- Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocio-Institute of Biomedicine of Seville, Sevilla, Spain
| | - Jose Molina Gil-Bermejo
- Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocio-Institute of Biomedicine of Seville, Sevilla, Spain
| | - Manuela Aguilar-Guisado
- Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocio-Institute of Biomedicine of Seville, Sevilla, Spain
| | - Manuel Poyato
- Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocio-Institute of Biomedicine of Seville, Sevilla, Spain
| | - Julia Praena-Segovia
- Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocio-Institute of Biomedicine of Seville, Sevilla, Spain
| | | | | | - Elisa Cordero
- Departments of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocio-Institute of Biomedicine of Seville, Sevilla, Spain
| | - Candela Caballero-Eraso
- Respiratory Department, Virgen del Rocio Hospital, Sevilla, Spain
- Instituto de Biomedicina, Sevilla; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Jara-Palomares
- Respiratory Department, Virgen del Rocio Hospital, Sevilla, Spain
- Instituto de Biomedicina, Sevilla; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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8
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Cordero E, Goycochea-Valdivia W, Mendez-Echevarria A, Allende LM, Alsina L, Bravo García-Morato M, Gil-Herrera J, Gudiol C, Len-Abad O, López-Medrano F, Moreno-Pérez D, Muñoz P, Olbrich P, Sánchez-Ramón S, Soler-Palacín P, Aguilera Cros C, Arostegui JI, Badell Serra I, Carbone J, Fortún J, Gonzalez-Granado LI, López-Granados E, Lucena JM, Parody R, Ramakers J, Regueiro JR, Rivière JG, Roca-Oporto C, Rodríguez Pena R, Santos-Pérez JL, Rodríguez-Gallego C, Neth O. Executive Summary of the Consensus Document on the Diagnosis and Management of Patients with Primary Immunodeficiencies. J Allergy Clin Immunol Pract 2020; 8:3342-3347. [PMID: 33161963 DOI: 10.1016/j.jaip.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 10/23/2022]
Abstract
Primary immunodeficiencies (PIDs) are rare, undiagnosed and potentially fatal diseases. Clinical manifestations of PID can be fatal or leave sequelae that worsen the quality of life of patients. Traditionally, the treatment of PIDs has been largely supportive, with the exception of bone marrow transplantation and, more recently, gene therapy. The discovering of new affected pathways, the development of new molecules and biologics, and the increasing understanding of the molecular basis of these disorders have created opportunities in PIDs therapy. This document aims to review current knowledge and to provide recommendations about the diagnosis and clinical management of adults and children with PIDs based on the available scientific evidence taking in to account current practice and future challenges. A systematic review was conducted, and evidence levels based on the available literature are given for each recommendation where available.
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Affiliation(s)
- Elisa Cordero
- Clinical Unit of Infectious Diseases University Hospital Virgen del Rocio, Institute of Biomedicine, CSIC, University of Seville, Seville, Spain; Department of Medicine, University of Seville, Seville, Spain.
| | - Walter Goycochea-Valdivia
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, University Hospital Virgen del Rocio, Institute of Biomedicine, Seville, Spain
| | - Ana Mendez-Echevarria
- Servicio de Pediatría y Enfermedades Infecciosas, Hospital Universitario La Paz, Madrid, Spain
| | - Luis M Allende
- Servicio de Inmunología, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12, Universidad Complutense de Madrid, Madrid, Spain
| | - Laia Alsina
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Institut de Recerca Sant Joan de Déu, Clinical Immunology Unit Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Maria Bravo García-Morato
- Servicio de Inmunología, Hospital Universitario La Paz, Instituto de Investigación Biomédica del Hospital La Paz (IdiPAZ), Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Juana Gil-Herrera
- Department of Immunology, Hospital General Universitario and Health Research Institute Gregorio Marañón, School of Medicine, Univerisdad Complutense, Madrid, Spain
| | - Carlota Gudiol
- Infectious Diseases Department, Hospital Universitari de Bellvitge and Institut Català d'Oncologia (ICO), Hospital Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oscar Len-Abad
- Infectious Diseases Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Francisco López-Medrano
- Infectious Diseases University Unit, Hospital 12 de Octubre, Instituto de Investigación Biomédica i+12, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - David Moreno-Pérez
- Pediatric Infectology and Immunodeficiencies Unit, Department of Pediatrics, Hospital Regional Universitario de Málaga, IBIMA, RECLIP, University of Malaga, Málaga, Spain
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Peter Olbrich
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, University Hospital Virgen del Rocio, Institute of Biomedicine, Seville, Spain
| | - Silvia Sánchez-Ramón
- Department of Immunology, IML and IdSSC, Hospital Clínico San Carlos, Madrid, Spain
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
| | - Clara Aguilera Cros
- Department of Rheumatology, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Juan Ignacio Arostegui
- Department of Immunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Isabel Badell Serra
- Unidad de Hematología, Oncología y Trasplante Hematopoyético, Servicio de Pediatría, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Carbone
- Servicio de Inmunología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jesús Fortún
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Luis I Gonzalez-Granado
- Primary Immunodeficiencies Unit, Pediatrics, Hospital 12 de Octubre, Research Institute Hospital 12 octubre (i+12), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Eduardo López-Granados
- Servicio de Inmunología, Instituto de Investigación Biomédica del Hospital La Paz (IdiPAZ), Hospital Universitario La Paz, Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | | | - Rocío Parody
- Servicio de Hematología Clínica, Institut Català d'Oncologia H. Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jan Ramakers
- Department of Pediatrics, Pediatric Rheumatology and Immunology, Son Espases University Hospital, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - José R Regueiro
- Department of Immunology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Jacques G Rivière
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
| | - Cristina Roca-Oporto
- Clinical Unit of Infectious Diseases University Hospital Virgen del Rocio, Institute of Biomedicine, CSIC, University of Seville, Seville, Spain
| | - Rebeca Rodríguez Pena
- Servicio de Inmunología, Instituto de Investigación Biomédica del Hospital La Paz (IdiPAZ), Hospital Universitario La Paz, Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Juan Luis Santos-Pérez
- Infectious Diseases and Immunodeficiencies Unit, Service of Pediatrics, University Hospital Virgen de las Nieves, Granada, Spain
| | - Carlos Rodríguez-Gallego
- Department of Immunology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain; University Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain.
| | - Olaf Neth
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, University Hospital Virgen del Rocio, Institute of Biomedicine, Seville, Spain
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Salto-Alejandre S, Roca-Oporto C, Martín-Gutiérrez G, Avilés MD, Gómez-González C, Navarro-Amuedo MD, Praena-Segovia J, Molina J, Paniagua-García M, García-Delgado H, Domínguez-Petit A, Pachón J, Cisneros JM. A quick prediction tool for unfavourable outcome in COVID-19 inpatients: Development and internal validation. J Infect 2020; 82:e11-e15. [PMID: 32987098 PMCID: PMC7518180 DOI: 10.1016/j.jinf.2020.09.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Sonsoles Salto-Alejandre
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Cristina Roca-Oporto
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Guillermo Martín-Gutiérrez
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | | | | | - María Dolores Navarro-Amuedo
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Julia Praena-Segovia
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - José Molina
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - María Paniagua-García
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | | | | | - Jerónimo Pachón
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain; Department of Medicine, University of Seville, Seville, Spain behalf of the Virgen del Rocío Hospital COVID-19 working team.
| | - José Miguel Cisneros
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain; Department of Medicine, University of Seville, Seville, Spain behalf of the Virgen del Rocío Hospital COVID-19 working team
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10
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Cisneros JM, Rosso-Fernández CM, Roca-Oporto C, De Pascale G, Jiménez-Jorge S, Fernández-Hinojosa E, Matthaiou DK, Ramírez P, Díaz-Miguel RO, Estella A, Antonelli M, Dimopoulos G, Garnacho-Montero J. Colistin versus meropenem in the empirical treatment of ventilator-associated pneumonia (Magic Bullet study): an investigator-driven, open-label, randomized, noninferiority controlled trial. Crit Care 2019; 23:383. [PMID: 31779711 PMCID: PMC6883535 DOI: 10.1186/s13054-019-2627-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/27/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Colistin is recommended in the empirical treatment of ventilator-associated pneumonia (VAP) with a high prevalence of carbapenem-resistant gram-negative bacilli (CR-GNB). However, the efficacy and safety of colistin are not well defined. METHODS A multicenter prospective randomized trial conducted in 32 European centers compared the efficacy and safety of colistin (4.5 million unit loading dose followed by a maintenance dose of 3 million units every 8 h) versus meropenem (2 g every 8 h), both in combination with levofloxacin (500 mg every 12 h) for 7-14 days in patients with late VAP. Between May 2012 and October 2015, 232 patients were randomly assigned to the 2 treatment groups. The primary endpoint was mortality at 28 days after randomization in the microbiologically modified intention-to-treat (mMITT) population. Secondary outcomes included clinical and microbiological cure, renal function at the end of the treatment, and serious adverse events. The study was interrupted after the interim analysis due to excessive nephrotoxicity in the colistin group; therefore, the sample size was not achieved. RESULTS A total of 157 (67.7%) patients were included in the mMITT population, 36 of whom (22.9%) had VAP caused by CR-GNB. In the mMITT population, no significant difference in mortality between the colistin group (19/82, 23.2%) and the meropenem group (19/75, 25.3%) was observed, with a risk difference of - 2.16 (- 15.59 to 11.26, p = 0.377); the noninferiority of colistin was not demonstrated due to early termination and limited number of patients infected by carbapenem-resistant pathogens. Colistin plus levofloxacin increased the incidence of renal failure (40/120, 33.3%, versus 21/112, 18.8%; p = 0.012) and renal replacement therapy (11/120, 9.1%, versus 2/112, 1.8%; p = 0.015). CONCLUSIONS This study did not demonstrate the noninferiority of colistin compared with meropenem, both combined with levofloxacin, in terms of efficacy in the empirical treatment of late VAP but demonstrated the greater nephrotoxicity of colistin. These findings do not support the empirical use of colistin for the treatment of late VAP due to early termination. TRIAL REGISTRATION ClinicalTrials.gov, NCT01292031. Registered 9 February 2011.
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Affiliation(s)
- José M Cisneros
- Department of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBIS), University Hospital Virgen del Rocio CSIC, University of Seville, Avenida Manuel Siurot s/n, 41013, Seville, Spain.
| | - Clara María Rosso-Fernández
- Clinical Trial Unit, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n, 41013, Seville, Spain
| | - Cristina Roca-Oporto
- Department of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBIS), University Hospital Virgen del Rocio CSIC, University of Seville, Avenida Manuel Siurot s/n, 41013, Seville, Spain
| | | | - Silvia Jiménez-Jorge
- Clinical Trial Unit, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n, 41013, Seville, Spain
| | - Esteban Fernández-Hinojosa
- Intensive Care Clinical Unit, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n, 41013, Seville, Spain
| | - Dimitrios K Matthaiou
- Department of Critical Care, University Hospital ATTIKON, National and Kapodistrian University of Athens, Athens, Greece
| | - Paula Ramírez
- Intensive Medicine Unit, Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Ramón Ortiz Díaz-Miguel
- Intensive Medicine Unit, Hospital General Universitario de Ciudad Real, Calle Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain
| | - Angel Estella
- Intensive Care Unit, Hospital Universitario de Jerez, Carretera Nacional IV s/n, 11407, Jerez de la Frontera, Cádiz, Spain
| | - Massimo Antonelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - George Dimopoulos
- Department of Critical Care, University Hospital ATTIKON, National and Kapodistrian University of Athens, Athens, Greece
| | - José Garnacho-Montero
- Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Calle Dr. Fedriani, 3, 41009, Seville, Spain
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Roca-Oporto C, Cebrero-Cangueiro T, Gil-Marqués ML, Labrador-Herrera G, Smani Y, González-Roncero FM, Marín LM, Pachón J, Pachón-Ibáñez ME, Cordero E. Prevalence and clinical impact of Streptococcus pneumoniae nasopharyngeal carriage in solid organ transplant recipients. BMC Infect Dis 2019; 19:697. [PMID: 31387529 PMCID: PMC6685160 DOI: 10.1186/s12879-019-4321-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/23/2019] [Accepted: 07/26/2019] [Indexed: 01/21/2023] Open
Abstract
Background S. pneumoniae is the leading cause of community-acquired pneumonia in the solid organ transplant recipient (SOTR); nevertheless, the prevalence of colonization and of the colonizing/infecting serotypes has not been studied in this population. In this context, the aim of the present study was to describe the rate, characteristics, and clinical impact of S. pneumoniae nasopharyngeal carriage. Methods A prospective observational cohort of Solid Organ Transplant recipients (SOTR) was held at the University Hospital Virgen del Rocío, Seville, Spain with the aim to evaluate the S. pneumoniae colonization and the serotype prevalence in SOTR. Two different pharyngeal swabs samples from 500 patients were included in two different seasonal periods winter and spring/summer. Optochin and bile solubility tests were performed for the isolation of thew strains. Antimicrobial susceptibility studies (MICs, mg/l) of levofloxacin, trimethoprim-sulfamethoxazole, penicillin, amoxicillin, cefotaxime, ceftriaxone, erythromycin, azithromycin and vancomycin for each isolate were determined by E-test strips. Capsular typing was done by sequential multiplex PCR reactions. A multivariate logistic regression analysis of factors potentially associated with pneumococcal nasopharyngeal carriage and disease was performed. Results Twenty-six (5.6%) and fifteen (3.2%) patients were colonized in winter and spring/summer periods, respectively. Colonized SOT recipients compared to non-colonized patients were more frequently men (79.5% vs. 63.1%, P < 0.05) and cohabitated regularly with children (59% vs. 32.2%, P < 0.001). The most prevalent serotype in both studied periods was 35B. Forty-five percent of total isolates were included in the pneumococcal vaccine PPV23. Trimethoprim-sulfamethoxazole and macrolides were the less active antibiotics. Three patients had non-bacteremic pneumococcal pneumonia, and two of them died. Conclusions Pneumococcal colonization in SOTR is low with the most colonizing serotypes not included in the pneumococcal vaccines. Electronic supplementary material The online version of this article (10.1186/s12879-019-4321-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cristina Roca-Oporto
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine Infectious Diseases Research Group Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain.,Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio Seville, Seville, Spain
| | - Tania Cebrero-Cangueiro
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine Infectious Diseases Research Group Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain.,Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain
| | - María Luisa Gil-Marqués
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine Infectious Diseases Research Group Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain.,Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio Seville, Seville, Spain
| | - Gema Labrador-Herrera
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine Infectious Diseases Research Group Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain.,Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio Seville, Seville, Spain
| | - Younes Smani
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine Infectious Diseases Research Group Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain.,Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio Seville, Seville, Spain
| | | | - Luis Miguel Marín
- Clinical Unit of General Surgery, University Hospital Virgen del Rocío, Seville, Spain
| | - Jerónimo Pachón
- Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain
| | - María Eugenia Pachón-Ibáñez
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine Infectious Diseases Research Group Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain. .,Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio Seville, Seville, Spain. .,Department of Medicine, University of Seville, Seville, Spain.
| | - Elisa Cordero
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine Infectious Diseases Research Group Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain.,Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio Seville, Seville, Spain
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Cordero E, Roca-Oporto C, Bulnes-Ramos A, Aydillo T, Gavaldà J, Moreno A, Torre-Cisneros J, Montejo JM, Fortun J, Muñoz P, Sabé N, Fariñas MC, Blanes-Julia M, López-Medrano F, Suárez-Benjumea A, Martinez-Atienza J, Rosso-Fernández C, Pérez-Romero P. Two Doses of Inactivated Influenza Vaccine Improve Immune Response in Solid Organ Transplant Recipients: Results of TRANSGRIPE 1-2, a Randomized Controlled Clinical Trial. Clin Infect Dis 2017; 64:829-838. [PMID: 28362949 DOI: 10.1093/cid/ciw855] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [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: 09/26/2016] [Accepted: 12/14/2016] [Indexed: 12/17/2022] Open
Abstract
Background Influenza vaccine effectiveness is not optimal in solid organ transplant recipients (SOTR). We hypothesized that a booster dose might increase it. Methods TRANSGRIPE 1-2 is a phase 3, randomized, controlled, multicenter, open-label clinical trial. Patients were randomly assigned (1:1 stratified by study site, type of organ, and time since transplantation) to receive 1 dose (control group) or 2 doses (booster group) of the influenza vaccine 5 weeks apart. Results A total of 499 SOTR were enrolled. Although seroconversion at 10 weeks did not meet significance in the modified intention-to-treat population, seroconversion rates were significantly higher in the booster arm for the per-protocol population (53.8% vs 37.6% for influenza A(H1N1)pdm; 48.1% vs 32.3% for influenza A(H3N2); and 90.7% vs 75% for influenza B; P < .05). Furthermore, seroprotection at 10 weeks was higher in the booster group: 54% vs 43.2% for A(H1N1)pdm; 56.9% vs 45.5% for A(H3N2); and 83.4% vs 71.8% for influenza B (P < .05). The number needed to treat to seroprotect 1 patient was <10. The clinical efficacy (99.2% vs 98.8%) and serious adverse events (6.4% vs 7.5%) were similar for both groups. Conclusions In SOTR, a booster strategy 5 weeks after standard influenza vaccination is safe and effective and induces an increased antibody response compared with standard influenza vaccination consisting of a single dose. Clinical Trials Registration EudraCT (2011-003243-21).
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Affiliation(s)
- Elisa Cordero
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, University Hospitals Virgen del Rocío/CSIC/University of Seville
| | - Cristina Roca-Oporto
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, University Hospitals Virgen del Rocío/CSIC/University of Seville
| | - Angel Bulnes-Ramos
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, University Hospitals Virgen del Rocío/CSIC/University of Seville
| | - Teresa Aydillo
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, University Hospitals Virgen del Rocío/CSIC/University of Seville
| | | | | | - Julián Torre-Cisneros
- Maimonides Biomedical Research Institute of Cordoba, Reina Sofia University Hospital (Clinic Unit of Infectious Diseases and Clinic Unit Preventive Medicine and Public Health), University of Cordoba
| | | | | | - Patricia Muñoz
- Gregorio Marañón University Hospital, Instituto de Investigación Sanitaria Hospital Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES, and Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Spain Hospital Majadahonda, Madrid
| | - Nuria Sabé
- University Hospital of Bellvitge, Infectious Diseases Research Group, L'Hospitalet de Llobregat, Barcelona
| | | | | | | | | | - Juliana Martinez-Atienza
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, University Hospitals Virgen del Rocío/CSIC/University of Seville
| | - Clara Rosso-Fernández
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, University Hospitals Virgen del Rocío/CSIC/University of Seville
| | - Pilar Pérez-Romero
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, University Hospitals Virgen del Rocío/CSIC/University of Seville
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Roca-Oporto C, Pachón-Ibañez ME, Pachón J, Cordero E. Pneumococcal disease in adult solid organ transplantation recipients. World J Clin Infect Dis 2015; 5:1-10. [DOI: 10.5495/wjcid.v5.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 08/26/2014] [Accepted: 11/10/2014] [Indexed: 02/06/2023] Open
Abstract
In solid organ transplant (SOT) recipients, Streptococcus pneumoniae can cause substantial morbidity and mortality ranging from non-invasive to invasive diseases, including pneumonia, bacteremia, and meningitis, with a risk of invasive pneumococcal disease 12 times higher than that observed in non-immunocompromised patients. Moreover, pneumococcal infection has been related to graft dysfunction. Several factors have been involved in the risk of pneumococcal disease in SOT recipients, such as type of transplant, time since transplantation, influenza activity, and nasopharyngeal colonization. Pneumococcal vaccination is recommended for all SOT recipients with 23-valent pneumococcal polysaccharides vaccine. Although immunological rate response is appropriate, it is lower than in the rest of the population, decreases with time, and its clinical efficacy is variable. Booster strategy with 7-valent pneumococcal conjugate vaccine has not shown benefit in this population. Despite its relevance, there are few studies focused on invasive pneumococcal disease in SOT recipients. Further studies addressing clinical, microbiological, and epidemiological data of pneumococcal disease in the transplant setting as well as new strategies for improving the protection of SOT recipients are warranted.
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Bellido-Muñoz F, Giráldez-Gallego A, Roca-Oporto C, García-Cayuela T, Pascasio-Acevedo JM, Sousa-Martín JM. Monitoring the natural evolution and response to treatment of post liver transplant recurrent hepatitis C using transient elastography: preliminary results. Transplant Proc 2013; 44:2082-6. [PMID: 22974917 DOI: 10.1016/j.transproceed.2012.07.090] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To perform a prospective analysis of changes in liver stiffness (LS) using transient elastography (TE) in a consecutive series of patients with post-liver transplant (LT) recurrent hepatitis C, either left to their natural evolution or receiving antiviral treatment. METHODS We examined the results from 17 comparisons of TE (baseline vs follow-up) from 11 patients. We evaluated: (1) upon inclusion in the study: age, sex, genotype, time transpired since LT, and baseline fibrosis (F0-4; Scheuer), and (2) during the follow-up period: time elapsed between the two TE and either specific treatment (B) or absence of treatment (A). RESULTS Mean patient age was 56.8 ± 7.9 years, with a male/female ratio of 10:1. Ten of the eleven patients had genotype 1b. The median time transpired between the LT and inclusion in the study was 28 months (range: 6-142 months). The mean time transpired between the two TE was 11.3 ± 4.5 months. In the 11 patients from group A (9 F1/2 F2; 13 "paired" TE), a predictable increase in LS was produced in 10 cases and a paradoxical result was produced in 3 cases. In the four patients in group B (3 F2/1 F1; 4 "paired" TE), a decrease in LS was produced in 3 cases and a paradoxical result in 1 case. CONCLUSIONS In our study of patients left to their natural evolution, a slow increase of LS was normal. However, antiviral treatment appeared to decrease LS. TE can be very useful as a complementary test to biopsy for monitoring post-LT recurrent hepatitis C. A longer follow-up period and larger sample size could confirm these preliminary results.
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Affiliation(s)
- F Bellido-Muñoz
- Hepatology Section, Gastrointestinal and Hepatical Department, Virgen del Rocío University Hospital, Seville.
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