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Hidalgo-Tenorio C, Sequera S, Vivancos MJ, Vinuesa D, Collado A, Santos IDL, Sorni P, Cabello-Clotet N, Montero M, Font CR, Terron A, Galindo MJ, Martinez O, Ryan P, Omar-Mohamed M, Iglesias HA, Javier R, Ruz MÁL, Romero A, Garcia-Vallecillos C. Bictegravir/emtricitabine/tenofovir alafenamide as first-line treatment in naïve HIV patients in a rapid-initiation model of care: BIC-NOW clinical trial. Int J Antimicrob Agents 2024; 63:107164. [PMID: 38574873 DOI: 10.1016/j.ijantimicag.2024.107164] [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: 01/22/2024] [Revised: 02/29/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Multiple strategies have been utilised to reduce the incidence of HIV, including PrEP and rapid antiretroviral therapy initiation. The study objectives were to evaluate the efficacy, safety, satisfaction, treatment adherence, and system retention obtained with rapid initiation of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) in naïve patients. METHODS This phase IV, multicenter, open-label, single-arm, 48-week clinical trial enrolled patients between January 2020 and June 2022. Adherence to treatment was evaluated with the SMAQ questionnaire and patient satisfaction with the EQ-5D. RESULTS Two hundred eight participants were enrolled with mean age of 35.6 years; 87.6% were males; mean CD4 count was 393.5 cells/uL (<200 cells/uL in 22.1%); viral load log was 5.6 (VL>100 000 cop/mL in 43.3%); 22.6% had AIDS, and 4.3% were coinfected with HBV. BIC/FTC/TAF was initiated on the day of their first visit to the HIV specialist in 98.6% of participants, and 9.6% were lost to follow-up. The efficacy at week 48 was 84.1 % by intention-to- treat (ITT), 94.6% by modified ITT, and 98.3% by per protocol analysis. The regimen was discontinued in two subjects (0.9%) during week 1 for grade 3 adverse events. Treatment adherence (weeks 4 [90%, IQR: 80-99%] vs. 48 [90%, IQR: 80-95%; P = 0.49]) and patient satisfaction (weeks 4 [90%, IQR: 80-99%] vs. 48 [90%, IQR: 80-95 P = 0.49]) rates were very high over the 48- week study period. CONCLUSIONS BIC/FTC/TAF is an appropriate option for rapid ART initiation in naïve HIV patients, offering high efficacy, safety, durability, treatment adherence, retention in the healthcare system, and patient satisfaction. Number Clinical Trial registration: NCT06177574.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Unit of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | - Sergio Sequera
- Unit of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - David Vinuesa
- Unit of Infectious Diseases, Hospital Universitario San Cecilio, Granada, Spain
| | - Antonio Collado
- Unit of Infectious Diseases, Hospital Universitario Torrecardenas, Almería, Spain
| | | | - Patricia Sorni
- Unit of Infectious Diseases, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - Noemi Cabello-Clotet
- Infectious Diseases Unit, Hospital Clínico San Carlos, Complutense University, Madrid, Spain
| | - Marta Montero
- Infectious Diseases Service, Hospital Universitario La Fe, Valencia, Spain
| | - Carlos Ramos Font
- Nuclear Medicine Service, Hospital Universitario Virgen de las Nieves Granada, Granada, Spain
| | - Alberto Terron
- Unit of Infectious Diseases, Hospital Universitario de Jerez, Cádiz, Spain
| | - Maria José Galindo
- Infectious Diseases Service, Hospital Universitario Clínico de Valencia, Spain
| | - Onofre Martinez
- Unit of Infectious Diseases, Hospital Universitario Santa Lucía, Cartagena, Spain
| | - Pablo Ryan
- Internal Medicine Service, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Helena Albendín Iglesias
- Department of Internal Medicine, HIV and STI Unit, Hospital Universitario Virgen de la Arrixaca, IMIB, Murcia, Spain
| | - Rosario Javier
- Unit of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Alberto Romero
- Unit of Infectious Diseases, Facultad de Medicina, Hospital Universitario Puerto Real, INIBICA, Universidad de Cadiz, Cádiz, Spain
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Corma-Gómez A, Cabello A, Orviz E, Morante-Ruiz M, Ayerdi O, Al-Hayani A, Muñoz-Gómez A, Santos IDL, Gómez-Ayerbe C, Rodrigo D, Riestra SDLR, Reus-Bañuls S, Silva-Klug A, Galindo MJ, Santos M, Serrano-Fuentes M, Faro-Míguez N, Pérez-Camacho I, Corona-Mata D, Morano L, López-Ruz MÁ, Montero M, Anaya-Baz B, Merino D, Castillo-Navarro A, Pineda JA, Macías J. Long or complicated mpox in patients with uncontrolled HIV infection. J Med Virol 2024; 96:e29511. [PMID: 38469884 DOI: 10.1002/jmv.29511] [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: 02/12/2024] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 03/13/2024]
Abstract
To date, former research about the impact of HIV infection on mpox poor outcomes is still limited and controversial. Therefore, the aim of this study was to assess the impact of HIV on the clinical course of mpox, in a large population of patients from Spain. Nationwide case-series study. Patients from 18 Spanish hospitals, with PCR-confirmed mpox from April 27, 2022 to June 30, 2023 were included in this study. The main outcome was the development of long or complicated (LC) mpox, defined as: (i) duration of the clinical course ≥ 28 days, or; (ii) disseminated disease, or: (iii) emergence of severe complications. One thousand eight hundred twenty-three individuals were included. Seven hundred eighty-six (43%) were people living with HIV (PLWH), of whom 11 (1%) had a CD4 cell count < 200 cells/mm3 and 33 (3%) <350 cells/mm3 . HIV viral load ≥ 1000 cp/mL was found in 27 (3%) PLWH, none of them were on effective ART. Fifteen (60%) PLWH with HIV-RNA ≥ 1000 cp/mL showed LC versus 182 (29%) PLWH with plasma HIV-RNA load < 1000 copies/mL and 192 (24%) individuals without HIV infection (p < 0.001). In multivariate analysis, adjusted by age, sex, CD4 cell counts and HIV viral load at the time of mpox, only plasma HIV-RNA ≥ 1000 cp/mL was associated with a greater risk of developing LC mpox [adjusted OR = 4.06 (95% confidence interval 1.57-10.51), p = 0.004]. PLWH with uncontrolled HIV infection, due to lack of ART, are at a greater risk of developing LC mpox. Efforts should be made to ensure HIV testing is carried out in patients with mpox and to start ART without delay in those tested positive.
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Affiliation(s)
- Anaïs Corma-Gómez
- Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain
- Grupo de Virología Clínica e ITS, Hospital Universitario Virgen de Valme, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Alfonso Cabello
- Unit of Infectious Diseases, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - Eva Orviz
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid
| | - Miguel Morante-Ruiz
- Unit of Infectious Diseases, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - Oskar Ayerdi
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid
| | - Aws Al-Hayani
- Unit of Infectious Diseases, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - Ana Muñoz-Gómez
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid
| | - Ignacio De Los Santos
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Servicio de Medicina Interna-Enfermedades Infecciosas, Hospital Universitario de la Princesa, Madrid, Spain
| | - Cristina Gómez-Ayerbe
- Unit of Infectious Diseases, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - David Rodrigo
- Unit of Infectious Diseases, Consorcio Hospital General de Valencia, Valencia, Spain
| | - Sandra De la Rosa Riestra
- Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena, Valencia, Spain
- Department of Medicine, School of Medicine, University of Sevilla, Sevilla, Spain
| | - Sergio Reus-Bañuls
- Unit of Infectious Diseases, Hospital General Universitario de Alicante, Sevilla, Spain
| | - Ana Silva-Klug
- Unit of Infectious Diseases, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Sevilla, Spain
| | - María José Galindo
- Unit of Infectious Diseases, Hospital Clínico Universitario de Valencia, Sevilla, Spain
| | - Marta Santos
- Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain
- Grupo de Virología Clínica e ITS, Hospital Universitario Virgen de Valme, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Miriam Serrano-Fuentes
- Servicio de Medicina Interna, Hospital de Gran Canaria Dr Negrín, Las Palmas De Gran Canaria, Spain
| | - Naya Faro-Míguez
- Unit of Infectious Diseases, Hospital Universitario San Cecilio, Granada, Spain
| | - Inés Pérez-Camacho
- Unit of Infectious Diseases· Hospital Regional Universitario Málaga, Sevilla, Spain
| | - Diana Corona-Mata
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Infectious Diseases Unit, Reina Sofía University Hospital of Córdoba, Spain
- Maimonides Institute of Biomedical Research of Córdoba (Instituto Maimónides de Investigación Biomédica de Córdoba IMIBIC), Cordoba, Spain
- Department of Medicine, University of Córdoba, Cordoba, Spain
| | - Luis Morano
- Unit of Infectious Diseases, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - Miguel Ángel López-Ruz
- Unit of infectious Diseases, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Marta Montero
- Unit of infectious Diseases, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Blanca Anaya-Baz
- Unit of Infectious diseases, Hospital Universitario Puerto Real, Spain
| | - Dolores Merino
- Unit of Infectious Diseases, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | | | - Juan A Pineda
- Department of Medicine, School of Medicine, University of Sevilla, Sevilla, Spain
| | - Juan Macías
- Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain
- Grupo de Virología Clínica e ITS, Hospital Universitario Virgen de Valme, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Department of Medicine, School of Medicine, University of Sevilla, Sevilla, Spain
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Cairoli V, Valle-Millares D, Terrón-Orellano MC, Luque D, Ryan P, Dominguez L, Martín-Carbonero L, De Los Santos I, De Matteo E, Ameigeiras B, Briz V, Casciato P, Preciado MV, Valva P, Fernández-Rodríguez A. MicroRNA signature from extracellular vesicles of HCV/HIV co-infected individuals differs from HCV mono-infected. J Mol Med (Berl) 2023; 101:1409-1420. [PMID: 37704856 PMCID: PMC10663177 DOI: 10.1007/s00109-023-02367-8] [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: 11/21/2022] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023]
Abstract
Hepatitis C virus (HCV) coinfection with human immunodeficiency virus (HIV) has a detrimental impact on disease progression. Increasing evidence points to extracellular vesicles (EVs) as important players of the host-viral cross-talk. The microRNAs (miRNAs), as essential components of EVs cargo, are key regulators of normal cellular processes and also promote viral replication, viral pathogenesis, and disease progression. We aimed to characterize the plasma-derived EVs miRNA signature of chronic HCV infected and HIV coinfected patients to unravel the molecular mechanisms of coinfection. EVs were purified and characterized from 50 plasma samples (21 HCV mono- and 29 HCV/HIV co-infected). EV-derived small RNAs were isolated and analyzed by massive sequencing. Known and de novo miRNAs were identified with miRDeep2. Significant differentially expressed (SDE) miRNA identification was performed with generalized linear models and their putative dysregulated biological pathways were evaluated. Study groups were similar for most clinical and epidemiological characteristics. No differences were observed in EVs size or concentration between groups. Therefore, HCV/HIV co-infection condition did not affect the concentration or size of EVs but produced a disturbance in plasma-derived EVs miRNA cargo. Thus, a total of 149 miRNAs were identified (143 known and 6 de novo) leading to 37 SDE miRNAs of which 15 were upregulated and 22 downregulated in HCV/HIV co-infected patients. SDE miRNAs regulate genes involved in inflammation, fibrosis, and cancer, modulating different biological pathways related to HCV and HIV pathogenesis. These findings may help to develop new generation biomarkers and treatment strategies, in addition to elucidate the mechanisms underlying virus-host interaction. KEY MESSAGES: HCV and HCV/HIV displayed similar plasma-EV size and concentration. EVs- derived miRNA profile was characterized by NGS. 37 SDE miRNAs between HCV and HCV/HIV were observed. SDE miRNAs regulate genes involved in inflammation, fibrosis and cancer.
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Affiliation(s)
- Victoria Cairoli
- Multidisciplinary Institute for Investigation in Pediatric Pathologies (IMIPP), CONICET-GCBA, Laboratory of Molecular Biology, Pathology Division, Ricardo Gutiérrez Children's Hospital, C1425EFD CABA, Buenos Aires, Argentina
| | - Daniel Valle-Millares
- Unit of Viral Infection and Immunity, Centro Nacional de Mirobiología, Instituto de Salud Carlos III (ISCIII), 28222, Majadahonda, Madrid, Spain
| | - María C Terrón-Orellano
- Unit of Electron Microscopy Scientific and Technical Central Units (UCCT), Health Institute Carlos III (ISCIII), 28222, Majadahonda, Madrid, Spain
| | - Daniel Luque
- Unit of Electron Microscopy Scientific and Technical Central Units (UCCT), Health Institute Carlos III (ISCIII), 28222, Majadahonda, Madrid, Spain
| | - Pablo Ryan
- Infectious Diseases Department, Internal Medicine Department HIV/Hepatitis, Infanta Leonor University Hospital, 28031, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28222, Madrid, Spain
| | - Lourdes Dominguez
- HIV Unit, Internal Medicine Department, Research Institute of the Hospital, 12 de Octubre (imas12), 28041, Madrid, Spain
| | - Luz Martín-Carbonero
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28222, Madrid, Spain
- Infectious Diseases Unit, Internal Medicine Department, La Paz University Hospital, IdiPAZ, 28046, Madrid, Spain
| | - Ignacio De Los Santos
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28222, Madrid, Spain
- Infectious Diseases Unit, Internal Medicine Department, La Princesa University Hospital, 28006, Madrid, Spain
| | - Elena De Matteo
- Multidisciplinary Institute for Investigation in Pediatric Pathologies (IMIPP), CONICET-GCBA, Laboratory of Molecular Biology, Pathology Division, Ricardo Gutiérrez Children's Hospital, C1425EFD CABA, Buenos Aires, Argentina
| | - Beatriz Ameigeiras
- Liver Unit, Ramos Mejía Hospital, C1221ADC CABA, Buenos Aires, Argentina
| | - Verónica Briz
- Viral Hepatitis Reference and Research Laboratory, Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28222, Majadahonda, Madrid, Spain
| | - Paola Casciato
- Liver Unit, Italian's Hospital of Buenos Aires, C1199 CABA, Buenos Aires, Argentina
| | - María Victoria Preciado
- Multidisciplinary Institute for Investigation in Pediatric Pathologies (IMIPP), CONICET-GCBA, Laboratory of Molecular Biology, Pathology Division, Ricardo Gutiérrez Children's Hospital, C1425EFD CABA, Buenos Aires, Argentina
| | - Pamela Valva
- Multidisciplinary Institute for Investigation in Pediatric Pathologies (IMIPP), CONICET-GCBA, Laboratory of Molecular Biology, Pathology Division, Ricardo Gutiérrez Children's Hospital, C1425EFD CABA, Buenos Aires, Argentina
| | - Amanda Fernández-Rodríguez
- Unit of Viral Infection and Immunity, Centro Nacional de Mirobiología, Instituto de Salud Carlos III (ISCIII), 28222, Majadahonda, Madrid, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28222, Madrid, Spain.
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera Majadahonda, Pozuelo, Km 2.2, 28220 Majadahonda, Madrid, Spain.
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4
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Gonzalez-Serna A, Corma-Gomez A, Tellez F, Corona-Mata D, Rios-Villegas MJ, Merino D, Galera C, Collado-Romacho AR, De Los Santos I, Cucurull J, Santos M, García-Martín S, Rivero A, Real LM, Macias J. Response to glecaprevir/pibrentasvir in HIV/HCV-coinfected patients in clinical practice. J Antimicrob Chemother 2023; 78:2591-2596. [PMID: 37671831 PMCID: PMC10775154 DOI: 10.1093/jac/dkad278] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/16/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVES HIV infection has been associated with lower rates of sustained viral response (SVR) with direct-acting antivirals (DAAs). There are few data on glecaprevir/pibrentasvir (G/P) in HIV/HCV coinfection outside clinical trials. METHODS The HEPAVIR-DAA cohort, which recruits HIV/HCV-coinfected patients (NCT02057003) and the GEHEP-MONO cohort (NCT02333292), including HCV-monoinfected individuals, are two concurrent ongoing multicentre cohorts of patients receiving anti-HCV treatment. Patients starting G/P included in those cohorts were analysed. Overall SVR (ITT), discontinuations due to adverse effects, and dropouts were evaluated and compared between both cohorts. RESULTS Of the 644 patients who started G/P with evaluable SVR, 132 were HIV/HCV coinfected. Overall SVR rates were 487/512 (95.1%) in HCV-monoinfected patients versus 126/132 (95.5%) in HIV/HCV-coinfected patients (P = 1.000). One patient (0.8%) relapsed, and another (0.8%) discontinued treatment due to side effects. SVR to 8 or 12 weeks of treatment with G/P was similar in HIV/HCV-coinfected versus HCV-monoinfected patients. The main reason for not reaching SVR among HIV/HCV-coinfected patients was premature dropout linked to active drug use. CONCLUSIONS G/P in HIV/HCV coinfection was highly effective and tolerable in clinical practice. SVR to 8 or 12 weeks of treatment with G/P was similar in HIV/HCV-coinfected compared with HCV-monoinfected patients but active drug use is still a barrier to reach HCV microelimination.
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Affiliation(s)
- Alejandro Gonzalez-Serna
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Avda Bellavista s/n, 41014 Seville, Spain
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC, GEHEP-001, Sevilla, Spain
| | - Anaïs Corma-Gomez
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Avda Bellavista s/n, 41014 Seville, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC, GEHEP-001, Sevilla, Spain
| | - Francisco Tellez
- Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC, GEHEP-001, Sevilla, Spain
- UGC Enfermedades Infecciosas, Departamento de Medicina, Universidad de Cádiz, Hospital Universitario de Puerto Real, Cádiz, Spain
| | - Diana Corona-Mata
- Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC, GEHEP-001, Sevilla, Spain
- Infectious Diseases Unit. Maimonides Institute of Biomedical Research of Córdoba (Instituto Maimónides de Investigación Biomédica de Córdoba IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain
| | - María Jose Rios-Villegas
- Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC, GEHEP-001, Sevilla, Spain
- Hospital Universitario Virgen Macarena, Unidad de Enfermedades Infecciosas, Sevilla, Spain
| | - Dolores Merino
- Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC, GEHEP-001, Sevilla, Spain
- Hospital Juan Ramón Jiménez, Unidad de Enfermedades Infecciosas, Huelva, Spain
| | - Carlos Galera
- Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC, GEHEP-001, Sevilla, Spain
- Hospital Universitario Virgen de la Arrixaca, Unidad de Medicina Interna, Murcia, Spain
| | - Antonio Ramon Collado-Romacho
- Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC, GEHEP-001, Sevilla, Spain
- Unidad de Enfermedades Infecciosas, Hospital Universitario Torrecárdenas, Almería, Spain
| | - Ignacio De Los Santos
- Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC, GEHEP-001, Sevilla, Spain
- CIBERINFEC, Hospital Universitario de La Princesa, Madrid, Spain
| | - Josep Cucurull
- Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC, GEHEP-001, Sevilla, Spain
- Medicina Interna, Fundació Salut Empordà, Figueres, Spain
| | - Marta Santos
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Avda Bellavista s/n, 41014 Seville, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC, GEHEP-001, Sevilla, Spain
| | - Sofía García-Martín
- Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC, GEHEP-001, Sevilla, Spain
- UGC Microbiología, Hospital Universitario de Puerto Real, Cádiz, Spain
| | - Antonio Rivero
- Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC, GEHEP-001, Sevilla, Spain
- Infectious Diseases Unit. Maimonides Institute of Biomedical Research of Córdoba (Instituto Maimónides de Investigación Biomédica de Córdoba IMIBIC), Reina Sofía University Hospital of Córdoba, University of Córdoba, Córdoba, Spain
| | - Luis Miguel Real
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Avda Bellavista s/n, 41014 Seville, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC, GEHEP-001, Sevilla, Spain
- Departamento de Especialidades Quirúrgicas, Bioquímica e Inmunología, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
| | - Juan Macias
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Avda Bellavista s/n, 41014 Seville, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC, GEHEP-001, Sevilla, Spain
- Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
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5
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Dueñas-Gutiérrez C, Buzón L, Pedrero-Tomé R, Iribarren JA, De Los Santos I, De la Fuente S, Pousada G, Moran MA, Moreno E, Ferreira E, Gómez J, Troya J. Efficacy and Safety of Two-Drug Regimens with Dolutegravir plus Rilpivirine or Lamivudine in HIV-1 Virologically Suppressed People Living with HIV. Viruses 2023; 15:v15040936. [PMID: 37112915 PMCID: PMC10145987 DOI: 10.3390/v15040936] [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: 03/11/2023] [Revised: 04/05/2023] [Accepted: 04/08/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The high effectiveness and safety of the two-drug (2DRs) strategy using dolutegravir (DTG) plus lamivudine (3TC) have led to international guidelines recommending their use for treatment-naive HIV patients. In virologically suppressed patients, de-escalating from 3DRs to DTG plus either rilpivirine (RPV) or 3TC has shown high rates of virological suppression. OBJECTIVES This study aimed to compare the real-life data of two multicenter Spanish cohorts of PLWHIV treated with DTG plus 3TC (SPADE-3) or RPV (DORIPEX) as a switch strategy, not only in terms of virological suppression, safety, and durability but also in terms of immune restoration. The primary endpoint was the percentage of patients with virological suppression on DTG plus 3TC and DTG plus RPV at weeks 24 and 48. The secondary outcomes included the proportion of patients who experienced the protocol-defined loss of virological control by week 48; changes in immune status in terms of CD4+ and CD8+ T lymphocyte counts and the CD4+/CD8+ ratio; the rate, incidence, and reasons for discontinuation of treatment over the 48-week study period; and safety profiles at weeks 24 and 48. METHODS We conducted a retrospective, observational, multicenter study of 638 and 943 virologically suppressed HIV-1-infected patients in two cohorts who switched to 2DRs with DTG plus RPV or DTG plus 3TC. RESULTS The most frequent reasons for starting DTG-based 2DRs were treatment simplification/pill burden or drug decrease. The virological suppression rates were 96.9%, 97.4%, and 99.1% at weeks 24, 48, and 96, respectively. The proportion of patients with virological failure over the 48-week study period was 0.01%. Adverse drug reactions were uncommon. Patients treated with DTG+3TC increased CD4, CD8, and CD4/CD8 parameters at 24 and 48 weeks. CONCLUSIONS We conclude that DTG-based 2DRs (combined with 3TC or RPV) in clinical practice were effective and safe as a switching strategy, with a low VF and high viral suppression rates. Both regimens were well tolerated, and ADR rates were low, including neurotoxicity and induced treatment discontinuations.
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Affiliation(s)
- Carlos Dueñas-Gutiérrez
- Infectious Diseases Division, Hospital Universitario Clínico de Valladolid, 47003 Valladolid, Spain
| | - Luis Buzón
- Infectious Diseases Division, Hospital Universitario de Burgos, 09006 Burgos, Spain
| | - Roberto Pedrero-Tomé
- Infanta Leonor University Hospital Research and Innovation Foundation, 28031 Madrid, Spain
| | - José A Iribarren
- Infectious Diseases Department, Hospital Universitario de Donostia, 20014 San Sebastián, Spain
| | - Ignacio De Los Santos
- Infectious Diseases Division, Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - Sara De la Fuente
- Infectious Diseases Division, Hospital Universitario Puerta de Hierro, 28222 Madrid, Spain
| | - Guillermo Pousada
- Infectious Diseases Division, Hospital Universitario de Txagorritxu, 01009 Vitoria, Spain
| | - Miguel Angel Moran
- Infectious Diseases Division, HospitalÁlvaro Cunqueiro, 36312 Vigo, Spain
| | - Estela Moreno
- Infectious Diseases Division, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Eva Ferreira
- Infectious Diseases Division, Hospital de Segovia, 47002 Segovia, Spain
| | - Julia Gómez
- Infectious Diseases Division, Hospital Universitario de Salamanca, 37007 Salamanca, Spain
| | - Jesús Troya
- Internal Medicine Department, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
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6
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Valle-Millares D, Brochado-Kith Ó, Gómez-Sanz A, Martín-Carbonero L, Ryan P, De Los Santos I, Castro JM, Troya J, Mayoral-Muñoz M, Cuevas G, Martínez-Román P, Sanz-Sanz J, Muñoz-Muñoz M, Jiménez-Sousa MÁ, Resino S, Briz V, Fernández-Rodríguez A. HCV eradication with DAAs differently affects HIV males and females: A whole miRNA sequencing characterization. Biomed Pharmacother 2021; 145:112405. [PMID: 34781145 DOI: 10.1016/j.biopha.2021.112405] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/31/2021] [Accepted: 11/03/2021] [Indexed: 12/12/2022] Open
Abstract
Gender-specific consequences after HCV eradication are unexplored. MicroRNAs (miRNAs) play a crucial role in the immune response against viral infections. However, few have highlighted miRNA role in sex-biased disease or therapy response. We aim to assess gender differences reflected in the miRNA expression of HIV/HCV-coinfected patients who achieve sustained virological response (SVR) with direct acting antivirals (DAAs). We conducted a prospective study of miRNA expression in PBMCs from 28 chronic HIV/HCV-coinfected patients (HIV/HCV) at baseline and after achieving SVR with DAAs. Sixteen HIV-monoinfected patients (HIV) and 36 healthy controls (HC) were used as controls. Identification of significant differentially expressed (SDE) miRNAs was performed with generalized linear model and mixed GLMs. We also explored putative dysregulated biological pathways. At baseline, the HIV/HCV patients showed differences in the miRNA profile concerning the HIV group (165 and 102 SDE miRNAs for males and females, respectively). Gender-stratified analysis of HIV/HCV group at baseline versus at SVR achievement showed higher differences in males (80 SDE miRNAs) than in females (55 SDE miRNAs). After SVR, HIV/HCV group showed similar values to HIV individuals, especially in females (1 SDE miRNA). However, ten miRNAs in males remained dysregulated, which were mainly involved in cancer, fatty acid, and inflammatory pathways. Taken together, our results show gender-biased dysregulation in the miRNA expression profile of PBMCs after HCV eradication with DAAs. These differences were normalized in females, while miRNA profile and their target-related pathways in males lack of normalization, which may be related to a high-risk of developing liver-related complications.
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Affiliation(s)
- Daniel Valle-Millares
- Unit of Viral Infection and Immunity, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | - Óscar Brochado-Kith
- Unit of Viral Infection and Immunity, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | - Alicia Gómez-Sanz
- Unit of Viral Infection and Immunity, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | | | - Pablo Ryan
- Internal Medicine Service, Infanta Leonor Teaching Hospital, Madrid, Spain
| | - Ignacio De Los Santos
- Servicio de Medicina Interna-Infecciosas, Hospital Universitario de La Princesa, Madrid, Spain
| | - Juan M Castro
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Jesús Troya
- Internal Medicine Service, Infanta Leonor Teaching Hospital, Madrid, Spain
| | | | - Guillermo Cuevas
- Internal Medicine Service, Infanta Leonor Teaching Hospital, Madrid, Spain
| | - Paula Martínez-Román
- Unit of Viral Infection and Immunity, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | - Jesús Sanz-Sanz
- Servicio de Medicina Interna-Infecciosas, Hospital Universitario de La Princesa, Madrid, Spain
| | - María Muñoz-Muñoz
- Department of Animal Breeding, Instituto Nacional de Investigación y Alimentación Agraria y Alimentaria (INIA), Madrid, Spain
| | - María Á Jiménez-Sousa
- Unit of Viral Infection and Immunity, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | - Salvador Resino
- Unit of Viral Infection and Immunity, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | - Verónica Briz
- Laboratory of Reference and Research on Viral Hepatitis, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | - Amanda Fernández-Rodríguez
- Unit of Viral Infection and Immunity, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain; Department of Medicine, Alfonso X el Sabio, Villanueva de la Cañada, 28691 Madrid, Spain.
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7
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Corma-Gómez A, Macías J, Morano L, Rivero A, Téllez F, Ríos MJ, Santos M, Serrano M, Palacios R, Merino D, Real LM, De Los Santos I, Vera-Méndez FJ, Galindo MJ, Pineda JA. Liver Stiffness-Based Strategies Predict Absence of Variceal Bleeding in Cirrhotic Hepatitis C Virus-Infected Patients With and Without Human Immunodeficiency Virus Coinfection After Sustained Virological Response. Clin Infect Dis 2021; 72:e96-e102. [PMID: 33211801 DOI: 10.1093/cid/ciaa1726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In the setting of hepatitis C virus (HCV) active infection, liver stiffness (LS)-based strategies identify patients with low risk of developing esophageal variceal bleeding (VB) episodes, in whom unnecessary upper esophagogastroduodenoscopy (UGE) screening can be safely avoided. However, after sustained virological response (SVR), data on the accuracy of the criteria predicting this outcome in HCV-infected patients with cirrhosis, with or without human immunodeficiency virus (HIV) coinfection, are very limited. METHODS This was a multicenter prospective cohort study, where HCV-monoinfected patients and HIV/HCV-coinfected individuals were included if they had (1) SVR with direct-acting antiviral-based therapy; (2) LS ≥9.5 kPa previous to treatment; and (3) LS measurement at the SVR time-point ≥14 kPa. Diagnostic accuracy of HEPAVIR, expanded Baveno VI, and HIV cirrhosis criteria, at the time of SVR, was evaluated. Missed VB episodes, negative predictive values (NPVs), and number of spared UGEs were specifically assessed. RESULTS Four hundred thirty-five patients were included, 284 (65%) coinfected with HIV. Seven (1.6%) patients developed a first episode of VB after SVR. In patients without a previous VB episode, HEPAVIR, expanded Baveno VI and HIV cirrhosis criteria achieved NPV for first VB episode after SVR of 99.5% (95% confidence interval [CI], 97.1%-100%), 100% (95% CI 97.8%-100%), and 100% (95% CI 98%-100%) while sparing 45%, 39%, and 44% of UGEs, respectively. When considering HIV coinfection, the performance of the 3 criteria was similar, both in HCV-monoinfected and HIV/HCV-coinfected individuals. CONCLUSIONS After SVR, predictive LS-based strategies accurately identify HCV-infected patients, HIV coinfected or not, with low risk of developing VB during follow-up. In these specific patients, using HIV cirrhosis criteria maximize the number of spared UGEs while missing no VB episode.
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Affiliation(s)
- Anaïs Corma-Gómez
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - Juan Macías
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - Luis Morano
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - Antonio Rivero
- Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Instituto Maimonides de Investigación Biomedica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | - Francisco Téllez
- Unit of Infectious Diseases, Hospital Universitario de Puerto Real, Facultad de Medicina, Universidad de Cadiz, Cádiz, Spain
| | - Maria José Ríos
- Unit of Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Marta Santos
- Unit of Internal Medicine, University Hospital Jerez, Cadiz, Spain
| | - Miriam Serrano
- Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Rosario Palacios
- Unit of Infectious Diseases and Microbiology, Hospital Virgen de la Victoria, Málaga, Spain
| | - Dolores Merino
- Unit of Infectious Diseases, Hospital Juan Ramón Jiménez, Huelva, Spain
| | - Luis Miguel Real
- Unit of Immunology, Biochemistry, Molecular Biology and Surgery, Faculty of Medicine, University of Malaga, Málaga, Spain
| | - Ignacio De Los Santos
- Unit of Internal Medicine and Infectious Diseases, Hospital La Princesa, Madrid, Spain
| | - Francisco J Vera-Méndez
- Section of Infectious Medicine/Service of Internal Medicine, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - Maria José Galindo
- Unit of Infectious Diseases, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Juan A Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
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8
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López-Huertas MR, Palladino C, Garrido-Arquero M, Esteban-Cartelle B, Sánchez-Carrillo M, Martínez-Román P, Martín-Carbonero L, Ryan P, Domínguez-Domínguez L, Santos IDL, Moral SDLF, Benito JM, Rallón N, Alcamí J, Resino S, Fernández-Rodríguez A, Coiras M, Briz V. HCV-coinfection is related to an increased HIV-1 reservoir size in cART-treated HIV patients: a cross-sectional study. Sci Rep 2019; 9:5606. [PMID: 30944340 PMCID: PMC6447590 DOI: 10.1038/s41598-019-41788-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 02/19/2019] [Indexed: 12/21/2022] Open
Abstract
In HIV-1/HCV-coinfected patients, chronic HCV infection leads to an increased T-lymphocyte immune activation compared to HIV-monoinfected patients, thereby likely contributing to increase HIV-1 reservoir that is the major barrier for its eradication. Our objective was to evaluate the influence of HCV coinfection in HIV-1 viral reservoir size in resting (r) CD4+ T-cells (CD25-CD69-HLADR-). Multicenter cross-sectional study of 97 cART-treated HIV-1 patients, including 36 patients with HIV and HCV-chronic co-infection without anti-HCV treatment, 32 HIV patients with HCV spontaneous clearance and 29 HIV-monoinfected patients. rCD4+ T-cells were isolated and total DNA was extracted. HIV viral reservoir was measured by Alu-LTR qPCR. Differences between groups were calculated with a generalized linear model. Overall, 63.9% were men, median age of 41 years and Caucasian. Median CD4+ and CD8+ T-lymphocytes were 725 and 858 cells/mm3, respectively. CD4+ T nadir cells was 305 cells/mm3. Proviral HIV-1 DNA size was significantly increased in chronic HIV/HCV-coinfected compared to HIV-monoinfected patients (206.21 ± 47.38 vs. 87.34 ± 22.46, respectively; P = 0.009), as well as in spontaneously clarified HCV co-infected patients when compared to HIV-monoinfected individuals (136.20 ± 33.20; P = 0.009). HIV-1/HCV co-infected patients showed a larger HIV-1 reservoir size in comparison to HIV-monoinfected individuals. This increase could lead to a greater complexity in the elimination of HIV-1 reservoir in HIV-1/HCV-coinfected individuals, which should be considered in the current strategies for the elimination of HIV-1 reservoir.
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Affiliation(s)
- Maria Rosa López-Huertas
- Department of Infectious Diseases, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Claudia Palladino
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Marta Garrido-Arquero
- Unit of Viral Infection and Immunity, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | - Beatriz Esteban-Cartelle
- Unit of Viral Infection and Immunity, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | - Marta Sánchez-Carrillo
- Unit of Viral Infection and Immunity, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | - Paula Martínez-Román
- Unit of Viral Infection and Immunity, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | | | - Pablo Ryan
- Department of Infectious Diseases, Infanta Leonor Hospital, Madrid, Spain
| | - Lourdes Domínguez-Domínguez
- Unidad VIH. Servicio de Medicina Interna. Instituto de Investigación Biomédica del Hospital Doce de Octubre (imas12), Madrid, Spain
| | - Ignacio De Los Santos
- Servicio de Medicina Interna-Infecciosas. Hospital Universitario de La Princesa, Madrid, Spain
| | | | - José Miguel Benito
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid, Spain.,Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | - Norma Rallón
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid, Spain.,Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | - José Alcamí
- AIDS Immunopathology, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Salvador Resino
- Unit of Viral Infection and Immunity, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | - Amanda Fernández-Rodríguez
- Unit of Viral Infection and Immunity, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain.
| | - Mayte Coiras
- AIDS Immunopathology, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Verónica Briz
- Unit of Viral Infection and Immunity, National Center for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain.
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9
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Soriano V, Miralles C, Berdún MA, Losada E, Aguirrebengoa K, Ocampo A, Arazo P, Cervantes M, De Los Santos I, Joaquín IS, Echeverria S, Galindo MJ, Asensi V, Barreiro P, Sola J, Hernandez-Burruezo JJ, Guardiola J, Blanco F, Martin-Carbonero L, García-Samaniego J, Nuñez M. Premature Treatment Discontinuation in HIV/HCV-Coinfected Patients Receiving Pegylated Interferon plus Weight-Based Ribavirin. Antivir Ther 2007. [DOI: 10.1177/135965350701200402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Chronic hepatitis C therapy in HIV patients is often penalized by more frequent premature treatment discontinuations. It is unclear what the relative contribution of more adverse events and/or early virological failures are. Methods PRESCO was a prospective, multicentre, comparative trial, in which 389 HIV/HCV-coinfected patients with CD4+ T-cell counts >300 cells/ml and elevated aminotransferases received pegylated interferon-α2a (peg IFN-α2a) 180 mg per week plus ribavirin (RBV) 1,000–1,200 mg daily. Patients with HCV genotypes 1 or 4 were treated for 48 or 72 weeks while HCV genotypes 2 or 3 carriers were treated for 24 or 48 weeks. Use of didanosine was not allowed. Results Sustained virological response (SVR) was achieved by 193 (49.6%), and was significantly greater in HCV-2/3 than in HCV-1/4 patients (72.4% versus 35%; P<0.0001). Premature treatment discontinuations occurred in 174 patients (44.7%). This was due to early virological failure in 66 (17%), serious adverse events in 32 (8.2%), loss-to-follow-up in 12 (3.1%) and voluntary withdrawal in 64 (16.4%). Only 10 patients (2.6%) stopped HCV therapy due to severe anaemia. Two patients stopped HCV medication due to symptomatic mitochondrial toxicity. There were no episodes of hepatic decompensation. Conclusions Treatment with RBV 1,000–1,200 mg/day plus peg IFN-α2a is relatively safe and provided SVR in nearly half of the HIV/HCV-coinfected patients, twice as many amongst the HCV-2/3 than HCV-1/4 carriers. Avoidance of didanosine, limited use of zidovudine and therapy restricted to patients with CD4+ T-cell counts >300 cells/ml most probably explains the lower and different spectrum of serious adverse events in PRESCO compared with prior trials conducted in coinfected patients.
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