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Corma-Gómez A, Macías J, Lacalle-Remigio JR, Téllez F, Morano L, Rivero A, Serrano M, Ríos MJ, Vera-Méndez FJ, Alados JC, Real LM, Palacios R, Santos IDL, Imatz A, Pineda JA. HIV infection is associated with lower risk of hepatocellular carcinoma after sustained virological response to direct-acting antivirals in hepatitis C infected-patients with advanced fibrosis. Clin Infect Dis 2020; 73:e2109-e2116. [PMID: 32766891 DOI: 10.1093/cid/ciaa1111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the impact of HIV infection on the risk of developing hepatocellular carcinoma (HCC) in HCV-infected patients who achieve sustained virological response (SVR) with direct-acting antiviral (DAA). METHODS Multisite prospective cohort study, where HCV-monoinfected patients and HIV/HCV-coinfected individuals were included if they met: 1) SVR with DAA-based combination; 2) Liver stiffness (LS) ≥9.5 kPa previous to treatment; 3) LS measurement at the SVR time-point. The main endpoint was the occurrence of HCC. Propensity score (PS) was calculated to address potential confounders due to unbalanced distribution of baseline characteristics of HIV/HCV-coinfected and HCV-monoinfected patients. RESULTS 1035 HCV-infected patients were included, 667 (64%) coinfected with HIV. After a median (Q1-Q3) follow-up time of 43 (31-49) months, 19 (1.8%) patients developed HCC [11 (3.0%) HCV-monoinfected, 8(1.2%) HIV/HCV-coinfected individuals; p=0.013]. In the multivariable analysis, HIV co-infection was associated with a lower adjusted risk of developing HCC [sHR=0.27, 95% IC (0.08-0.90); p=0.034]. Predictors of HCC emergence were: HCV genotype 3 [sHR=7.9 (2.5-24.9); p<0.001], MELD score at SVR>10 [sHR=1.37 (1.01-1.86); p=0.043] and LS value at SVR [sHR=1.03 (1.01-1.06) for 1 kPa increase; p=0.011]. Using inverse probability weighting method on the PS, HIV-infected patients had a lower risk of HCC [powered HR=0.33 (0.11-0.85)]. CONCLUSIONS Among HCV-infected patients with advanced fibrosis, who achieve SVR with DAA, HIV-coinfection seems to be associated with a lower risk of HCC occurrence. The underlying causes for this finding need to be investigated.
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Affiliation(s)
- A Corma-Gómez
- Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme. Seville. Spain
| | - J Macías
- Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme. Seville. Spain
| | - J R Lacalle-Remigio
- Division of Preventive Medicine and Public Health, Faculty of Medicine, Universidad de Sevilla, Spain
| | - F Téllez
- Unit of Infectious Diseases, Hospital Universitario de Puerto Real, Faculty of Medicine, Cadiz, Spain
| | - L Morano
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - A Rivero
- Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Córdoba, Spain
| | - M Serrano
- UnitofInfectiousDiseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - M J Ríos
- Unit of Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - F J Vera-Méndez
- Section of Infectious Medicine/Service of Internal Medicine, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - J C Alados
- Unit of Clinical Microbiology, University Hospital Jerez, Cadiz, Spain
| | - L M Real
- Unit of Immunology, Biochemistry, Molecular Biology and Surgery, Faculty of Medicine, University of Malaga, Spain
| | - R Palacios
- Unit of Infectious Diseases and Microbiology, Hospital Virgen de la Victoria, Málaga, Spain
| | - I De Los Santos
- Unit of Internal Medicine and Infectious Diseases, Hospital La Princesa, Madrid, Spain
| | - A Imatz
- Unit of Infectious Diseases, Hospital Universitario Bellvitge, Barcelona, Spain
| | - J A Pineda
- Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme. Seville. Spain
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2
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Corma-Gómez A, Macías J, Téllez F, Freyre-Carrillo C, Morano L, Rivero-Juárez A, Ríos MJ, Alados JC, Vera-Méndez FJ, Merchante N, Palacios R, Granados R, Merino D, De Los Santos I, Pineda JA. Liver Stiffness at the Time of Sustained Virological Response Predicts the Clinical Outcome in People Living With Human Immunodeficiency Virus and Hepatitis C Virus With Advanced Fibrosis Treated With Direct-acting Antivirals. Clin Infect Dis 2019; 71:2354-2362. [DOI: 10.1093/cid/ciz1140] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 11/20/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Some people living with hepatitis C virus (HCV) with sustained virological response (SVR) develop hepatic complications. Liver stiffness (LS) predicts clinical outcome in people living with human immunodeficiency virus (HIV) with active HCV coinfection, but information after SVR is lacking. We aimed to analyze the predictive ability of LS at SVR for liver complications in people living with HIV/HCV with advanced fibrosis treated with direct-acting antivirals (DAA).
Methods
In sum, 640 people living with HIV/HCV fulfilling the following criteria were included: (i) Achieved SVR with DAA-including regimen; (ii) LS ≥ 9.5 kPa before therapy; and (iii) LS measurement available at SVR. The primary endpoint was the occurrence of a liver complication—hepatic decompensation or hepatocellular carcinoma (HCC)—or requiring liver transplant after SVR.
Results
During a median (Q1–Q3) follow-up of 31.6 (22.7–36.6) months, 19 (3%) patients reached the primary endpoint. In the multivariate analysis, variables (subhazard ratio [SHR] [95% confidence interval]) associated with developing clinical outcomes were: prior hepatic decompensations (3.42 [1.28–9.12]), pretreatment CPT class B or C (62.5 [3.08–1246.42]) and MELD scores (1.37 [1.03–1.82]), CPT class B or C at SVR (10.71 [1.32–87.01]), CD4 cell counts <200/µL at SVR time-point (4.42 [1.49–13.15]), FIB-4 index at SVR (1.39 [1.13–1.70]), and LS at SVR (1.05 [1.02–1.08] for 1 kPa increase). None of the 374 patients with LS <14kPa at SVR time-point developed a liver complication or required hepatic transplant.
Conclusions
LS at the time of SVR after DAA therapy predicts the clinical outcome of people living with HIV/HCV with advanced fibrosis. These results suggest that LS measurement may be helpful to select candidates to be withdrawn from surveillance programs.
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Affiliation(s)
- A Corma-Gómez
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - J Macías
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - F Téllez
- Unit of Infectious Diseases, Hospital Universitario de Puerto Real, Facultad de Medicina, Universidad de Cadiz, Spain
| | - C Freyre-Carrillo
- Unit of Microbiology, Hospital Universitario de Puerto Real, Facultad de Medicina, Universidad de Cadiz, Spain
| | - L Morano
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - A Rivero-Juárez
- Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Instituto Maimonides de Investigación Biomedica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Spain
| | - M J Ríos
- Unit of Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - J C Alados
- Unit of Clinical Microbiology, University Hospital Jerez, Cadiz, Spain
| | - F J Vera-Méndez
- Section of Infectious Medicine/Service of Internal Medicine, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - N Merchante
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - R Palacios
- Unit of Infectious Diseases and Microbiology, Hospital Virgen de la Victoria, Málaga, Spain
| | - R Granados
- Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - D Merino
- Unit of Infectious Diseases, Hospitales Juan Ramón Jiménez e Infanta Elena, Huelva, Spain
| | - I De Los Santos
- Unit of Internal Medicine and Infectious Diseases, Hospital La Princesa, Madrid, Spain
| | - J A Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
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3
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Álvarez-Ossorio MJ, Sarmento E Castro R, Granados R, Macías J, Morano-Amado LE, Ríos MJ, Merino D, Álvarez EN, Collado A, Pérez-Pérez M, Téllez F, Martín JM, Méndez J, Pineda JA, Neukam K. Impact of interferon-free regimens on the glomerular filtration rate during treatment of chronic hepatitis C in a real-life cohort. J Viral Hepat 2018; 25:699-706. [PMID: 29377515 DOI: 10.1111/jvh.12867] [Citation(s) in RCA: 11] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 12/20/2017] [Indexed: 01/09/2023]
Abstract
Little data are available on renal toxicity exerted by direct-acting antivirals (DAAs) in real life. The aim of this study was to assess the impact of direct-acting antivirals against hepatitis C virus infection currently used in Spain and Portugal on the estimated glomerular filtration rate (eGFR) in clinical practise. From an international, prospective multicohort study, patients treated with DAAs for at least 12 weeks and with eGFR ≥30 mL/min per 1.73 m2 at baseline were selected. eGFR was determined using the CKD-EPI formula. A total of 1131 patients were included; 658 (58%) were HIV/HCV-coinfected patients. Among the 901 patients treated for 12 weeks, median (interquartile range) eGFR was 100 (87-107) at baseline vs 97 (85-105) mL/min per 1.73 m2 at week 12 of follow-up (FU12) post-treatment (P < .001). For HIV-coinfected subjects who received tenofovir plus a ritonavir-boosted HIV protease inhibitor (PI/r), baseline vs FU12 eGFR were 104 (86-109) vs 104 (91-110) mL/min per 1.73 m2 (P = .913). Among subjects receiving ombitasvir/paritaprevir with or without dasabuvir, eGFR did not show any significant change. Of 1100 subjects with eGFR >60 mL/min per 1.73 m2 at baseline, 22 (2%) had eGFR <60 mL/min per 1.73 m2 at FU12, but none presented with eGFR <30 mL/min per 1.73 m2 . In conclusion, eGFR slightly declines during therapy with all-oral DAAs and this effect persists up to 12 weeks after stopping treatment in subjects with normal to moderately impaired renal function, regardless of HIV status. Concomitant use of tenofovir plus PI/r does not seem to have an impact on eGFR.
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Affiliation(s)
- M J Álvarez-Ossorio
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | | | - R Granados
- Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - J Macías
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - L E Morano-Amado
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - M J Ríos
- Unit of Infectious Diseases, Hospital Universitario Virgen Macarena, Seville, Spain
| | - D Merino
- Unit of Infectious Diseases, Complejo Hospitalario Universitario de Huelva, Huelva, Spain
| | - E N Álvarez
- Infectious Diseases Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - A Collado
- Infectious Diseases Unit, Hospital Universitario Torrecárdenas, Almeria, Spain
| | - M Pérez-Pérez
- Unit of Infectious Diseases, Hospital La Línea, AGS Campo de Gibraltar, Cadiz, Spain
| | - F Téllez
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Puerto Real, Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz (INiBICA), Puerto Real, Spain
| | - J M Martín
- Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - J Méndez
- Unit of Infectious Diseases, Centro Hospitalar do Porto, Porto, Portugal
| | - J A Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - K Neukam
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
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4
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Pineda JA, Morano-Amado LE, Granados R, Macías J, Téllez F, García-Deltoro M, Ríos MJ, Collado A, Delgado-Fernández M, Suárez-Santamaría M, Serrano M, Miralles-Álvarez C, Neukam K. Week 4 response predicts sustained virological response to all-oral direct-acting antiviral-based therapy in cirrhotic patients with hepatitis C virus genotype 3 infection. Clin Microbiol Infect 2017; 23:409.e5-409.e8. [PMID: 28137633 DOI: 10.1016/j.cmi.2016.12.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/29/2016] [Accepted: 12/31/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to determine the predictive capacity of response at treatment week (TW) 4 for the achievement of sustained virological response 12 weeks after the scheduled end of therapy date (SVR12) to treatment against hepatitis C virus (HCV) genotype 3 (GT3) infection with all-oral direct-acting antiviral (DAA) -based regimens. PATIENTS AND METHODS From a prospective multicohort study, HCV GT3-infected patients who completed a course of currently recommended DAA-based therapy at 33 Spanish hospitals and who had reached the SVR12 evaluation time-point were selected. TW4 HCV-RNA levels were categorized as target-not-detected (TND), below the lower limit of quantification (LLOQTD) and ≥LLOQ. RESULTS A total of 123 patients were included, 86 (70%) received sofosbuvir/ daclatasvir±ribavirin, 27 (22%) received sofosbuvir/ ledipasvir/ ribavirin and 10 (8.1%) received sofosbuvir/ ribavirin, respectively. In all, 114 (92.7%) of the 123 patients presented SVR12 in an on-treatment approach, but nine (7.3%) patients relapsed, all of them had presented cirrhosis at baseline. In those who achieved TND, LLOQTD and ≥LLOQ, SVR12 was observed in 81/83 (98%; 95% CI 91.5%-99.7%), 24/28 (85.7%; 95% CI 67.3%-96%) and 9/12 (75%; 95% CI 42.8%-94.5%), respectively; p(linear association) 0.001. Corresponding numbers for subjects with cirrhosis were: 52/54 (96.3%; 95% CI 87.3%-95.5%), 14/18 (77.8%; 95% CI 52.4%-93.6%) and 7/10 (70%; 95% CI 34.8%-93.3%); p 0.004. CONCLUSIONS TW4-response indicates the probability of achieving SVR12 to currently used DAA-based therapy in HCV genotype 3-infected individuals with cirrhosis. This finding may be useful to tailor treatment strategy in this setting.
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Affiliation(s)
- J A Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - L E Morano-Amado
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - R Granados
- Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - J Macías
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain; Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - F Téllez
- Unit of Infectious Diseases and Microbiology, Hospital La Línea, AGS Campo de Gibraltar, La Linea de la Concepcion, Spain
| | - M García-Deltoro
- Unit of Infectious Diseases, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - M J Ríos
- Unit of Infectious Diseases, Hospital Virgen Macarena, Seville, Spain
| | - A Collado
- Unit of Infectious Diseases, Hospital Universitario Torrecárdenas, Almeria, Spain
| | | | - M Suárez-Santamaría
- Fundación Biomédica del Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | - M Serrano
- Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - C Miralles-Álvarez
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - K Neukam
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain; Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.
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5
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Núñez-Torres R, Macías J, Rivero-Juarez A, Neukam K, Merino D, Téllez F, Merchante N, Gómez-Mateos J, Rivero A, Pineda JA, Real LM. Fat mass and obesity-associated gene variations are related to fatty liver disease in HIV-infected patients. HIV Med 2017; 18:546-554. [PMID: 28116842 DOI: 10.1111/hiv.12489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Fatty liver disease (FLD) is frequently observed in HIV-infected patients. Obesity and type 2 diabetes mellitus (T2DM) are strongly associated with FLD. Because genetic variants within the fat mass and obesity-associated (FTO) gene have been associated with both pathologies, our aim was to evaluate the association of single nucleotide polymorphisms (SNPs) within the FTO, previously related to obesity or T2DM, with FLD in HIV-infected patients. METHODS FLD was defined as a value of the controlled attenuation parameter (CAP) ≥ 238 dB/m, obtained by transient elastography. Four SNPs within FTO intron 1 (rs11642841, rs8050136, rs9939609 and rs9940128) were genotyped in 421 individuals using a custom Golden Gate protocol. The results were replicated in a validation sample consisting of a further 206 HIV-infected patients. Multivariate logistic regression analyses were conducted in the entire population. RESULTS Three SNPs (rs8050136, rs9939609 and rs9940128) were associated with FLD, with rs9940128 showing the strongest association. This polymorphism also showed an association with FLD in the validation sample. In total, rs9940128 was genotyped in 627 HIV-infected patients, including 267 (42.6%) FLD-diagnosed individuals. The frequency of FLD among rs9940128 AA carriers was 55.7% (63 of 113 individuals) and that in patients without this genotype was 39.7% (204 of 514 individuals) [P = 0.009; adjusted odds ratio 1.88; 95% confidence interval (CI) 1.17-3.01]. CONCLUSIONS Variations within FTO may be predictors of FLD in HIV-infected patients independently of metabolic factors.
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Affiliation(s)
- R Núñez-Torres
- Unit of Infectious Diseases and Microbiology, Valme University Hospital, Seville, Spain
| | - J Macías
- Unit of Infectious Diseases and Microbiology, Valme University Hospital, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - A Rivero-Juarez
- Unit of Infectious Diseases, Reina Sofía University Hospital, Córdoba, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBC), University of Córdoba, Córdoba, Spain
| | - K Neukam
- Unit of Infectious Diseases and Microbiology, Valme University Hospital, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - D Merino
- Unit of Infectious Diseases, Huelva University Hospital, Huelva, Spain
| | - F Téllez
- Unit of Infectious Diseases, La Línea de la Concepción Hospital, Cadiz, Spain
| | - N Merchante
- Unit of Infectious Diseases and Microbiology, Valme University Hospital, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - J Gómez-Mateos
- Unit of Infectious Diseases and Microbiology, Valme University Hospital, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - A Rivero
- Unit of Infectious Diseases, Reina Sofía University Hospital, Córdoba, Spain
| | - J A Pineda
- Unit of Infectious Diseases and Microbiology, Valme University Hospital, Seville, Spain
| | - L M Real
- Unit of Infectious Diseases and Microbiology, Valme University Hospital, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
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Mira JA, Neukam K, López-Cortés LF, Rivero-Juárez A, Téllez F, Girón-González JA, de los Santos-Gil I, Ojeda-Burgos G, Merino D, Ríos-Villegas MJ, Collado A, Torres-Cornejo A, Macías J, Rivero A, Pérez-Pérez M, Pineda JA. Efficacy of and risk of bleeding during pegylated interferon plus ribavirin treatment in HIV/HCV-coinfected patients with pretreatment thrombocytopenia. Eur J Clin Microbiol Infect Dis 2015; 34:1879-84. [PMID: 26115631 DOI: 10.1007/s10096-015-2426-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 06/05/2015] [Indexed: 01/21/2023]
Abstract
The aim of this study was to assess the efficacy of and the risk of major bleeding during pegylated interferon (peg-IFN)/ribavirin (RBV) treatment among human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected patients according to the pretreatment platelet count. Two hundred and seventy-four HCV/HIV-coinfected, previously naïve individuals with compensated cirrhosis enrolled in one Spanish prospective cohort who received peg-IFN/RBV were included in this study. The frequency of severe bleeding and sustained virological response (SVR) rate were compared between patients with a pretreatment platelet count ≤70,000/mm(3) and >70,000/mm(3), respectively. Sixty-one (22 %) patients had a baseline platelet count ≤70,000/mm(3). The median (Q1-Q3) pretreatment platelet count was 58,000 (49,000-65,000) cells/mm(3) in the platelet ≤70,000 group and 129,000 (102,500-166,000) cells/mm(3) in the platelet >70,000 group (p < 0.0001). Seventeen (28 %) subjects of the platelet ≤70,000 group and 71 (33 %) patients of the platelet >70,000 group achieved SVR (p = 0.4). Only 2 (3.2 %) patients in the platelet ≤70,000 group developed a severe hemorrhagic event, specifically esophageal variceal bleeding. The efficacy of therapy with peg-IFN/RBV in HIV/HCV-coinfected patients with low pretreatment platelet counts is comparable to that found in the overall subset of subjects with compensated cirrhosis. The frequency of severe hemorrhagic events related with this therapy is low in this population.
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Affiliation(s)
- J A Mira
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Avenida de Bellavista S/N, 41014, Sevilla, Spain
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7
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Rodríguez-Baño J, López-Prieto MD, Portillo MM, Retamar P, Natera C, Nuño E, Herrero M, del Arco A, Muñoz A, Téllez F, Torres-Tortosa M, Martín-Aspas A, Arroyo A, Ruiz A, Moya R, Corzo JE, León L, Pérez-López JA. Epidemiology and clinical features of community-acquired, healthcare-associated and nosocomial bloodstream infections in tertiary-care and community hospitals. Clin Microbiol Infect 2011; 16:1408-13. [PMID: 19845694 DOI: 10.1111/j.1469-0691.2009.03089.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Classification of bloodstream infections (BSIs) as community-acquired (CA), healthcare-associated (HCA) and hospital-acquired (HA) has been proposed. The epidemiology and clinical features of BSI according to that classification in tertiary-care (TH) and community (CH) hospitals were investigated in a prospective cohort of 821 BSI episodes from 15 hospitals (ten TH and five CH hospitals) in Andalucía, Spain. Eighteen percent were CA, 24% were HCA and 58% were HA. The incidence of CA and HCA BSI was higher in CH than in TH (CA: 3.9 episodes per 1000 admissions vs. 2.2, p <0.01; HCA: 5.0 vs. 2.9, p <0.01), whereas the incidence of HA BSI was lower (7.7 vs. 8.7, p <0.01). In CA and HCA BSI, the respiratory tract was more frequently the source in CH than in TH (CA: 30% vs. 15%; HCA: 20% vs. 9%, p ≤0.03). In HCA BSI, chronic renal insufficiency and tunnelled catheters were less frequent in CH than in TH (11% vs. 26% and 7% vs. 19%, p ≤0.03), although chronic ulcers were more frequent (22% vs. 8%, p 0.008). BSIs as a result of methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa were very rare in CA episodes, although extended-spectrum b-lactamase-producing Escherichia coli (ESBLEC) caused a similar proportion of all BSIs in CA, HCA and HA episodes. Multivariate analysis revealed no significant difference in mortality rates in CH and TH. HCA infections should be considered as a separate class of BSI in both TH and CH, although differences between hospitals must be considered. CA BSIs were not caused by multidrug-resistant pathogens, except for ESBLEC.
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Affiliation(s)
- J Rodríguez-Baño
- Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Seville, Spain.
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8
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Rodríguez-Baño J, López-Prieto M, Portillo M, Retamar P, Natera C, Nuño E, Herrero M, del Arco A, Muñoz A, Téllez F, Torres-Tortosa M, Martín-Aspas A, Arroyo A, Ruiz A, Moya R, Corzo J, León L, Pérez-López J. Epidemiology and clinical features of community-acquired, healthcare-associated and nosocomial bloodstream infections in tertiary-care and community hospitals. Clin Microbiol Infect 2010. [DOI: 10.1111/j.1469-0691.2010.03089.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Chávez E, Téllez F, Pichardo J, Milán R, Cuéllar A, Carbajal K, Cruz D. On the protection by ketorolac of reperfusion-induced heart damage. Comp Biochem Physiol C Pharmacol Toxicol Endocrinol 1996; 115:95-100. [PMID: 8983173 DOI: 10.1016/s0742-8413(96)00058-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study shows that the nonsteroidal antiinflammatory drug, ketorolac, protects against myocardial damage induced by reperfusion. This effect was analyzed after 5 min of coronary occlusion in rat hearts. The results indicate that ketorolac, at a dose of 1 mg/kg, effectively protects the heart against reperfusion arrhythmias. Furthermore, it protects from the release of lactate dehydrogenase and creatine kinase to the plasma. We propose that the protective effect of the drug might be due to its chelating action on calcium ions, thus preventing the overload of such cation in myocardial cells.
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Affiliation(s)
- E Chávez
- Departamento De Bioquímica, Instituto Nacional De Cardiología, Ignacio Chávez, Tlalpam, México
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Téllez F, Carvajal K, García C, Vásquez C, Chávez E, Moreno-Sánchez R. [The biochemical and cellular bases of myocardial ischemia-reperfusion damage]. Arch Inst Cardiol Mex 1996; 66:162-81. [PMID: 8768635] [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] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In recent years evidence has accumulated indicating a possible myocardial injury secondary to reperfusion. However, it is not exactly known whether injury, at the time of reperfusion, merely represents an acceleration of the damage resulting from ischemia, or whether there is a specific additional injury caused by reperfusion itself. Some pathological events have been associated to reperfusion such as reperfusion arrhythmias, stunning myocardium and vascular damage with no reflow. In this review we discuss the hypotheses that explain the cellular events involved in reperfusion damage: calcium overload, free radical damage and others; also we describe both the experimental models commonly used and drugs assayed in recent years to lower the intensity of this phenomenon.
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Affiliation(s)
- F Téllez
- Departamento de Bioquímica, Instituto Nacional de Cardiología, México D.F
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Tamames S, Sánchez Vera M, Balibrea JL, Téllez F, Martín Judez V, Gómez Sánchez J, Tamayo FJ, Abad Rico JI. [Orthotopic and heterotopic heart transplantation (experimental study)]. Rev Clin Esp 1968; 108:105-14. [PMID: 4907440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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