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Suárez-García I, Gutierrez F, Pérez-Molina JA, Moreno S, Aldamiz T, Valencia Ortega E, Curran A, Gutiérrez González S, Asensi V, Amador Prous C, Jarrin I, Rava M. Mortality due to non-AIDS-defining cancers among people living with HIV in Spain over 18 years of follow-up. J Cancer Res Clin Oncol 2023; 149:18161-18171. [PMID: 38008809 PMCID: PMC10725373 DOI: 10.1007/s00432-023-05500-9] [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: 10/30/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE Our aim was to describe non-AIDS-defining cancer (NADC) mortality among people living with HIV (PLWH), to compare it with that of the general population, and to assess potential risk factors. METHODS We included antiretroviral-naive PLWH from the multicentre CoRIS cohort (2004-2021). We estimated mortality rates and standardised mortality ratios (SMRs). We used cause-specific Cox models to identify risk factors. RESULTS Among 17,978 PLWH, NADC caused 21% of all deaths observed during the follow-up. Mortality rate due to NADC was 1.58 (95%CI 1.36, 1.83) × 1000 person-years and lung and liver were the most frequent cancer-related causes of death. PLWH had 79% excess NADC mortality risk compared to the general population with the highest SMR found for Hodgkin lymphoma, anal and liver cancers. The SMRs decreased with age and were the highest in age groups under 50 years. The most important prognostic factor was low CD4 count, followed by smoking, viral hepatitis and HIV transmission through heterosexual contact or injection drug use. CONCLUSION Non-AIDS cancers are an important cause of death among PLWH. The excess mortality related to certain malignancies and the association with immunodeficiency, smoking, and coinfections highlights the need for early detection and treatment of cancer in this population.
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Affiliation(s)
- I Suárez-García
- Grupo de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, FIIB HUIS HHEN, Madrid, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Félix Gutierrez
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Hospital General Universitario de Elche and Universidad Miguel Hernández, Alicante, Spain
| | - José A Pérez-Molina
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Santiago Moreno
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Teresa Aldamiz
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Hospital Gregorio Marañón Servicio de Enfermedades Infecciosas/Microbiología Clínica Instituto de Investigación Gregorio Marañón, Madrid, Spain
| | | | - Adrián Curran
- Infectious Diseases Department, Vall d'Hebron Research Institute (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sara Gutiérrez González
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Víctor Asensi
- Infectious Diseases Unit, Hospital Universitario Central de Asturias and Group of Translational Research in Infectious Diseases, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | | | - Inma Jarrin
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Rava
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
- Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain.
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Suárez-García I, Alejos B, Hernando V, Viñuela L, Vera García M, Rial-Crestelo D, Pérez Elías MJ, Albendín Iglesias H, Peraire J, Tiraboschi J, Díaz A, Moreno S, Jarrín I. Effectiveness and tolerability of dolutegravir/lamivudine for the treatment of HIV-1 infection in clinical practice. J Antimicrob Chemother 2023:7143330. [PMID: 37099559 DOI: 10.1093/jac/dkad102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/17/2023] [Indexed: 04/27/2023] Open
Abstract
OBJECTIVES To assess the effectiveness and tolerability of dolutegravir (DTG)/lamivudine (3TC) among treatment-naive and virologically suppressed treatment-experienced individuals in the multicentre cohort of the Spanish HIV/AIDS Research Network (CoRIS) during the years 2018-2021. METHODS We used multivariable regression models to compare viral suppression (VS) [HIV RNA viral load (VL) <50 copies/mL] and the change in CD4 cell counts at 24 and 48 (±12) weeks after initiation with dolutegravir/lamivudine or other first-line ART regimens. RESULTS We included 2160 treatment-naive subjects, among whom 401 (18.6%) started with dolutegravir/lamivudine. The remaining subjects started bictegravir (BIC)/emtricitabine (FTC)/tenofovir alafenamide (TAF) (n = 949, 43.9%), DTG + FTC/tenofovir disoproxil fumarate (TDF) (n = 282, 13.1%), DTG/3TC/abacavir (ABC) (n = 255, 11.8%), darunavir (DRV)/cobicistat(COBI)/FTC/TAF (n = 147, 6.8%) and elvitegravir (EVG)/COBI/FTC/TAF (n = 126, 5.8%). At 24 and 48 weeks after starting dolutegravir/lamivudine, 91.4% and 93.8% of the subjects, respectively, achieved VS. The probability of achieving VS with dolutegravir/lamivudine was not significantly different compared with any other regimen at 24 or 48 weeks, with the exception of a lower chance of achieving VS at 24 weeks for DRV/COBI/FTC/TAF (adjusted OR: 0.47; 95% CI: 0.30-0.74) compared with dolutegravir/lamivudine.For the analysis of treatment-experienced virally suppressed subjects we included 1456 individuals who switched to dolutegravir/lamivudine, among whom 97.4% and 95.5% maintained VS at 24 and 48 weeks, respectively. During the first 48 weeks after dolutegravir/lamivudine initiation, 1.0% of treatment-naive and 1.5% of treatment-experienced subjects discontinued dolutegravir/lamivudine due to an adverse event. CONCLUSIONS In this large multicentre cohort, effectiveness and tolerability of dolutegravir/lamivudine were high among treatment-naive and treatment-experienced subjects.
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Affiliation(s)
- Inés Suárez-García
- Infectious Diseases Group, Department of Internal Medicine, Hospital Universitario Infanta Sofía, FIIB HUIS HHEN, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Department of Medicine, Universidad Europea, Madrid, Spain
| | | | - Victoria Hernando
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- HIV, STI and Hepatitis Surveillance Unit, National Center of Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Laura Viñuela
- Department of Microbiology, Hospital Universitario Clínico San Cecilio, Granada, Spain
- Instituto de Investigación Biosanitaria Granada, Granada, Spain
| | - Mar Vera García
- Centro Sanitario Sandoval, IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - David Rial-Crestelo
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- David Rial-Crestelo, HIV Unit, Hospital Universitario 12 de Octubre-Imas12, Madrid, Spain
| | - María Jesús Pérez Elías
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Helena Albendín Iglesias
- HIV and STI Unit, Department of Internal Medicine, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Joaquim Peraire
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Hospital Universitari de Tarragona Joan XXIII, IISPV, Tarragona, Spain
- Universitat Rovira i Virgili, Tarragona, Spain
| | - Juan Tiraboschi
- HIV Unit, Department of Infectious Diseases, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Asunción Díaz
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- HIV, STI and Hepatitis Surveillance Unit, National Center of Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Santiago Moreno
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Inma Jarrín
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- National Centre of Epidemiology, Institute of Health Carlos III, Madrid, Spain
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3
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Navarro J, Curran A, Raventós B, García J, Suanzes P, Descalzo V, Álvarez P, Espinosa N, Montes ML, Suárez-García I, Amador C, Muga R, Falcó V, Burgos J. Prevalence of non-alcoholic fatty liver disease in a multicentre cohort of people living with HIV in Spain. Eur J Intern Med 2023; 110:54-61. [PMID: 36764905 DOI: 10.1016/j.ejim.2023.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is one of the most important liver comorbidities in people living with HIV (PLWH). Factors that could lead to a higher prevalence of NAFLD or ease the onset of fibrosis are unclear. METHODS Cohort study of the Spanish HIV Research Network, which comprehends 46 hospitals and more than 15,000 PLWH. Primary objectives were to assess NAFLD prevalence and liver fibrosis according to hepatic steatosis index (HSI) and NAFLD fibrosis score, respectively. Factors associated with both were analysed. RESULTS A total of 4798 PLWH were included of whom 1461 (30.5%) showed an HSI>36; these patients had higher risk for significant fibrosis (OR 1.91; 95%CI 1.11-3.28). Factors associated with NAFLD were body mass index (OR 2.05; 95%CI 1.94-2.16) and diabetes (OR 4.68; 95%CI 2.17-10.08), while exposure to integrase strand transfer inhibitors showed a lower risk (OR 0.78; 95%CI 0.62-0.97). In patients with HSI>36, being female (OR 7.33; 95%CI 1.34-40), age (OR 1.22; 95%CI 1.11-1.34), body mass index (OR 1.35; 95%CI 1.18-1.54) and exposure to thymidine analogues (OR 75.4, 95%CI 6.9-823.5) were associated with a higher risk of significant fibrosis. However, exposure to non-nucleoside reverse transcriptase inhibitors (OR 0.12, 95%CI 0.02-0.89) and time of exposure to protease inhibitors (OR 0.97, 95%CI 0.95-1) showed a lower risk. CONCLUSION NAFLD prevalence was high in our cohort. Patients exposed to INSTI showed a lower risk of NAFLD. In patients with hepatic steatosis, exposure to thymidine analogues had 75-fold more risk of significant fibrosis while exposure to NNRTIs reduced this risk.
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Affiliation(s)
- Jordi Navarro
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Institut de Recerca Vall d'Hebron, Barcelona, Spain.
| | - Adrian Curran
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Institut de Recerca Vall d'Hebron, Barcelona, Spain.
| | - Berta Raventós
- Institut de Recerca Vall d'Hebron, Barcelona, Spain; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Jorge García
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Institut de Recerca Vall d'Hebron, Barcelona, Spain
| | - Paula Suanzes
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Institut de Recerca Vall d'Hebron, Barcelona, Spain
| | - Vicente Descalzo
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Institut de Recerca Vall d'Hebron, Barcelona, Spain
| | - Patricia Álvarez
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Institut de Recerca Vall d'Hebron, Barcelona, 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
| | - Marisa Luisa Montes
- Unidad VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - Inés Suárez-García
- Infectious Diseases Group, Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Concha Amador
- Unidad de Enfermedades Infecciosas, Hospital de la Marina Baixa, Alicante, Spain
| | - Roberto Muga
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol - IGTP, Badalona, Spain
| | - Vicenç Falcó
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Institut de Recerca Vall d'Hebron, Barcelona, Spain
| | - Joaquín Burgos
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Institut de Recerca Vall d'Hebron, Barcelona, Spain
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Ruiz-Algueró M, Alejos B, García Yubero C, Riera Jaume M, Antonio Iribarren J, Asensi V, Pasquau F, Galera CE, Pascual-Carrasco M, Muñoz A, Jarrín I, Suárez-García I, Moreno S, Jarrín I, Dalmau D, Navarro ML, González MI, Blanco JL, Garcia F, Rubio R, Iribarren JA, Gutiérrez F, Vidal F, Berenguer J, González J, Alejos B, Hernando V, Moreno C, Iniesta C, Garcia Sousa LM, Perez NS, Muñoz-Fernández MÁ, García-Merino IM, Fernández IC, Rico CG, de la Fuente JG, Concejo PP, Portilla J, Merino E, Reus S, Boix V, Giner L, Gadea C, Portilla I, Pampliega M, Díez M, Rodríguez JC, Sánchez-Payá J, Gómez JL, Hernández J, Alemán MR, del Mar Alonso M, Inmaculada Hernández M, Díaz-Flores F, García D, Pelazas R, Lirola AL, Moreno JS, Caso AA, Hernández Gutiérrez C, Novella Mena M, Rubio R, Pulido F, Bisbal O, Hernando A, Domínguez L, Crestelo DR, Bermejo L, Santacreu M, Antonio Iribarren J, Arrizabalaga J, Aramburu MJ, Camino X, Rodríguez-Arrondo F, von Wichmann MÁ, Tomé LP, Goenaga MÁ, Bustinduy MJ, Azkune H, Ibarguren M, Lizardi A, Kortajarena X, Gutiérrez F, Masiá M, Padilla S, Navarro A, Montolio F, Robledano C, Gregori Colomé J, Adsuar A, Pascual R, Fernández M, García E, García JA, Barber X, Muga R, Sanvisens A, Fuster D, Berenguer J, de Quirós JCLB, Gutiérrez I, Ramírez M, Padilla B, Gijón P, Aldamiz-Echevarría T, Tejerina F, José Parras F, Balsalobre P, Diez C, Latorre LP, Vidal F, Peraire J, Viladés C, Veloso S, Vargas M, López-Dupla M, Olona M, Rull A, Rodríguez-Gallego E, Alba V, Montero Alonso M, López Aldeguer J, Blanes Juliá M, Tasias Pitarch M, Hernández IC, Calabuig Muñoz E, Cuéllar Tovar S, Salavert Lletí M, Navarro JF, González-Garcia J, Arnalich F, Arribas JR, de la Serna JIB, Castro JM, Escosa L, Herranz P, Hontañón V, García-Bujalance S, López-Hortelano MG, González-Baeza A, Martín-Carbonero ML, Mayoral M, Mellado MJ, Micán RE, Montejano R, Luisa Montes M, Moreno V, Pérez-Valero I, Rodés B, Sainz T, Sendagorta E, Stella Alcáriz N, Valencia E, Ramón Blanco J, Antonio Oteo J, Ibarra V, Metola L, Sanz M, Pérez-Martínez L, Arazo P, Sampériz G, Dalmau D, Jaén A, Sanmartí M, Cairó M, Martinez-Lacasa J, Velli P, Font R, Xercavins M, Alonso N, Repáraz J, de Alda MGR, de León Cano MT, de Galarreta BPR, Segura F, José Amengual M, Navarro G, Sala M, Cervantes M, Pineda V, Calzado S, Navarro M, de los Santos I, Sanz Sanz J, Aparicio AS, Sarriá Cepeda C, Garcia-Fraile Fraile L, Martín Gayo E, Moreno S, Luis Casado J, Dronda F, Moreno A, Jesús Pérez Elías M, Gómez Ayerbe C, Gutiérrez C, Madrid N, del Campo Terrón S, Martí P, Ansa U, Serrano S, Jesús Vivancos M, Cano A, García AA, Bravo Urbieta J, Muñoz Á, Jose Alcaraz M, Villalba MDC, García F, Hernández J, Peña A, Muñoz L, Casas P, Alvarez M, Chueca N, Vinuesa D, Martinez-Montes C, Romero JD, Rodríguez C, Puerta T, Carlos Carrió J, Vera M, Ballesteros J, Ayerdi O, Antela A, Losada E, Riera M, Peñaranda M, Leyes M, Ribas MA, Campins AA, Vidal C, Fanjul F, Murillas J, Homar F, Santos J, Ayerbe CG, Viciana I, Palacios R, González CM, Viciana P, Espinosa N, López-Cortés LF, Podzamczer D, Ferrer E, Imaz A, Tiraboschi J, Silva A, Saumoy M, Ribera E, Curran A, Olalla J, del Arco A, de la torre J, Prada JL, de Lomas Guerrero JMG, Stachowski JP, Martínez OJ, Vera FJ, Martínez L, García J, Alcaraz B, Jimeno A, Iglesias AC, Souto BP, de Cea AM, Muñoz J, Zubero MZ, Baraia-Etxaburu JM, Ugarte SI, Beneitez OLF, de Munain JL, López MMC, de la Peña M, Lopez M, Galera C, Albendin H, Pérez A, Iborra A, Moreno A, Merlos MA, Vidal A, Amador C, Pasquau F, Ena J, Benito C, Fenoll V, Anguita CG, Rabasa JTA, Suárez-García I, Malmierca E, González-Ruano P, Rodrigo DM, Seco MPR, Vidal MAG, de Zarraga MA, Pérez VE, Molina MJT, García JV, Moreno JPS, Górgolas M, Cabello A, Álvarez B, Prieto L, Sanz Moreno J, Arranz Caso A, Gutiérrez CH, Novella Mena M, Galindo Puerto MJ, Fernando Vilalta R, Ferrer Ribera A, Román AR, Brieva Herrero MT, Juárez AR, López PL, Sánchez IM, Martínez JP, Jiménez MC, Perea RT, Ruiz-Capillas JJJ, Pineda JA. Use of Generic Antiretroviral Drugs and Single-Tablet Regimen De-Simplification for the Treatment of HIV Infection in Spain. AIDS Res Hum Retroviruses 2022; 38:433-440. [PMID: 35357907 DOI: 10.1089/aid.2021.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The present study sought to describe the use of generic drugs and single-tablet regimen (STR) de-simplification for the treatment of human immunodeficiency virus (HIV) infection among 41 hospitals from the cohort of the Spanish HIV/AIDS Research Network (CoRIS). In June 2018, we collected information on when generic antiretroviral drugs (ARVs) were introduced in the different hospitals, how the decisions to use them were made, and how the information was provided to the patients. Most of the nine available generic ARVs in Spain by June 2018 had been introduced in at least 85% of the participating hospitals, except for zidovudine (AZT)/lamivudine (3TC) and AZT. The time difference between the effective marketing date of each generic ARV and its first dispensing date in the hospitals was much shorter for the more recently approved generic ARV since the year 2017. However, only up to 20% of the hospitals de-simplified efavirenz (EFV)/tenofovir disoproxil (TDF)/emtricitabine (FTC), dolutegravir (DTG)/abacavir (ABC)/3TC, and rilpivirine (RPV)/TDF/FTC (to generic EFV+TDF/FTC, DTG+generic ABC/3TC, and RPV+generic TDF/FTC, respectively), whereas the generic STR EFV/TDF/FTC was introduced in 87.8% of the centers. The median times between the date of effective marketing of generic TDF/FTC and the date of de-simplification of EFV/TDF/FTC and RPV/TDF/FTC were 723 [interquartile range (IQR): 369-1,119] and 234 (IQR: 142-264) days, respectively; this time was 155 (IQR: 28-287) days for de-simplification of DTG/ABC/3TC. In conclusion, despite the widespread use of generic ARVs, STRs de-simplification was only undertaken in <20% of the hospitals. There was wide variability in the timing of the introduction of each generic ARV after they were available in the market.
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Affiliation(s)
- Marta Ruiz-Algueró
- National Center for Epidemiology, Institute of Health Carlos, Madrid, Spain
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
| | - Belén Alejos
- National Center for Epidemiology, Institute of Health Carlos, Madrid, Spain
| | | | | | - José Antonio Iribarren
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, Instituto de Investigación BioDonostia, San Sebastián, Spain
| | - Víctor Asensi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Mario Pascual-Carrasco
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
- Unidad de Investigación en Telemedicina y Salud Digital (UITes), Instituto de Salud Carlos III, Madrid, Spain
| | - Adolfo Muñoz
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
- Unidad de Investigación en Telemedicina y Salud Digital (UITes), Instituto de Salud Carlos III, Madrid, Spain
| | - Inmaculada Jarrín
- National Center for Epidemiology, Institute of Health Carlos, Madrid, Spain
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
| | - Inés Suárez-García
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain
- Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, Spain
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5
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Pérez-González A, Suárez-García I, Ocampo A, Poveda E. Two-Drug Regimens for HIV-Current Evidence, Research Gaps and Future Challenges. Microorganisms 2022; 10:433. [PMID: 35208887 PMCID: PMC8880461 DOI: 10.3390/microorganisms10020433] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 02/04/2023] Open
Abstract
During the last 30 years, antiretroviral treatment (ART) for human immunodeficiency virus (HIV) infection has been continuously evolving. Since 1996, three-drug regimens (3DR) have been standard-of-care for HIV treatment and are based on a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside reverse transcriptase inhibitors (NRTIs). The effectiveness of first-generation 3DRs allowed a dramatic increase in the life expectancy of HIV-infected patients, although it was associated with several side effects and ART-related toxicities. The development of novel two-drug regimens (2DRs) started in the mid-2000s in order to minimize side effects, reduce drug-drug interactions and improve treatment compliance. Several clinical trials compared 2DRs and 3DRs in treatment-naïve and treatment-experienced patients and showed the non-inferiority of 2DRs in terms of efficacy, which led to 2DRs being used as first-line treatment in several clinical scenarios, according to HIV clinical guidelines. In this review, we summarize the current evidence, research gaps and future prospects of 2DRs.
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Affiliation(s)
- Alexandre Pérez-González
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur), Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, 36213 Vigo, Spain;
- Infectious Diseases Unit, Department of Internal Medicine, Galicia Sur Health Research Institute (IIS Galicia Sur), Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, 36213 Vigo, Spain;
| | - Inés Suárez-García
- Infectious Diseases Group, Internal Medicine Department, Hospital Universitario Infanta Sofía, FIIB HUIS HHEN, 28703 San Sebastián de los Reyes, Spain;
- Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, 28670 Madrid, Spain
- CIBER de Enfermedades Infecciosas, 28029 Madrid, Spain
| | - Antonio Ocampo
- Infectious Diseases Unit, Department of Internal Medicine, Galicia Sur Health Research Institute (IIS Galicia Sur), Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, 36213 Vigo, Spain;
| | - Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur), Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, 36213 Vigo, Spain;
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6
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Martín-Vicente M, Berenguer J, Muñoz-Gómez MJ, Díez C, Micán R, Pérez-Elías MJ, García-Fraile LJ, Peraire J, Suárez-García I, Jiménez-Sousa MÁ, Fernández-Rodríguez A, Vázquez M, Ryan P, González-García J, Jarrín I, Mas V, Martínez I, Resino S. Similar humoral immune responses against the SARS-CoV-2 spike protein in HIV and non-HIV individuals after COVID-19. J Infect 2021; 84:418-467. [PMID: 34752819 PMCID: PMC8574204 DOI: 10.1016/j.jinf.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022]
Affiliation(s)
- María Martín-Vicente
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain..
| | - Juan Berenguer
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.; Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain.
| | - María José Muñoz-Gómez
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain..
| | - Cristina Díez
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.; Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain.
| | - Rafael Micán
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Medicina Interna, Hospital Universitario La Paz, IdiPaz, Madrid, Spain.
| | - María Jesús Pérez-Elías
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain.
| | - Lucio Jesús García-Fraile
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, Spain.
| | - Joaquin Peraire
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Medicina Interna, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain..
| | - Inés Suárez-García
- Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain; Universidad Europea, Villaviciosa de Odón, Madrid, Spain..
| | - María Ángeles Jiménez-Sousa
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain..
| | - Amanda Fernández-Rodríguez
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain..
| | - Mónica Vázquez
- Unidad de Biología Viral, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.
| | - Pablo Ryan
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Medicina Interna, Hospital Infanta Leonor, IiSGM, Madrid, Spain.
| | - Juan González-García
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Medicina Interna, Hospital Universitario La Paz, IdiPaz, Madrid, Spain.
| | - Inmaculada Jarrín
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.; Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.
| | - Vicente Mas
- Unidad de Biología Viral, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.
| | - Isidoro Martínez
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain..
| | - Salvador Resino
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain..
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7
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Suárez-García I, Perales-Fraile I, González-García A, Muñoz-Blanco A, Manzano L, Fabregate M, Díez-Manglano J, Aizpuru EF, Fernández FA, García AG, Gómez-Huelgas R, Ramos-Rincón JM. In-hospital mortality among immunosuppressed patients with COVID-19: Analysis from a national cohort in Spain. PLoS One 2021; 16:e0255524. [PMID: 34343222 PMCID: PMC8330927 DOI: 10.1371/journal.pone.0255524] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/16/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Whether immunosuppressed (IS) patients have a worse prognosis of COVID-19 compared to non-IS patients is not known. The aim of this study was to evaluate the clinical characteristics and outcome of IS patients hospitalized with COVID-19 compared to non-IS patients. METHODS We designed a retrospective cohort study. We included all patients hospitalized with laboratory-confirmed COVID-19 from the SEMI-COVID-19 Registry, a large multicentre national cohort in Spain, from March 27th until June 19th, 2020. We used multivariable logistic regression to assess the adjusted odds ratios (aOR) of in-hospital death among IS compared to non-IS patients. RESULTS Among 13 206 included patients, 2 111 (16.0%) were IS. A total of 166 (1.3%) patients had solid organ (SO) transplant, 1081 (8.2%) had SO neoplasia, 332 (2.5%) had hematologic neoplasia, and 570 (4.3%), 183 (1.4%) and 394 (3.0%) were receiving systemic steroids, biological treatments, and immunosuppressors, respectively. Compared to non-IS patients, the aOR (95% CI) for in-hospital death was 1.60 (1.43-1.79) for all IS patients, 1.39 (1.18-1.63) for patients with SO cancer, 2.31 (1.76-3.03) for patients with haematological cancer and 3.12 (2.23-4.36) for patients with SO transplant. The aOR (95% CI) for death for patients who were receiving systemic steroids, biological treatments and immunosuppressors compared to non-IS patients were 2.16 (1.80-2.61), 1.97 (1.33-2.91) and 2.06 (1.64-2.60), respectively. IS patients had a higher odds than non-IS patients of in-hospital acute respiratory distress syndrome, heart failure, myocarditis, thromboembolic disease and multiorgan failure. CONCLUSIONS IS patients hospitalized with COVID-19 have a higher odds of in-hospital complications and death compared to non-IS patients.
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Affiliation(s)
- Inés Suárez-García
- Infectious Diseases Group, Department of Internal Medicine, Hospital Universitario Infanta Sofía, FIIB HUIS HHEN, Madrid, Spain
- Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, Spain
| | - Isabel Perales-Fraile
- Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, Spain
- Department of Internal Medicine, Hospital Universitario Infanta Sofía, FIIB HUIS HHEN, Madrid, Spain
| | - Andrés González-García
- Unidad de Enfermedades Sistémicas Autoinmunes y Minoritarias, Servicio de Medicina Interna, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Arturo Muñoz-Blanco
- Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Luis Manzano
- Servicio de Medicina Interna, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Martín Fabregate
- Servicio de Medicina Interna, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Alejandra García García
- Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Málaga, Spain
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8
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Díez C, Del Romero-Raposo J, Mican R, López JC, Blanco JR, Calzado S, Samperiz G, Portilla J, García-Fraile LJ, Gutiérrez F, Gómez-Sirvent JL, Suárez-García I, Amador C, Novella M, Arribas JR, Moreno S, González-García J, Jarrín I, Berenguer J. COVID-19 in hospitalized HIV-positive and HIV-negative patients: A matched study. HIV Med 2021; 22:867-876. [PMID: 34324783 PMCID: PMC8444663 DOI: 10.1111/hiv.13145] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/28/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES We compared the characteristics and clinical outcomes of hospitalized individuals with COVID-19 with [people with HIV (PWH)] and without (non-PWH) HIV co-infection in Spain during the first wave of the pandemic. METHODS This was a retrospective matched cohort study. People with HIV were identified by reviewing clinical records and laboratory registries of 10 922 patients in active-follow-up within the Spanish HIV Research Network (CoRIS) up to 30 June 2020. Each hospitalized PWH was matched with five non-PWH of the same age and sex randomly selected from COVID-19@Spain, a multicentre cohort of 4035 patients hospitalized with confirmed COVID-19. The main outcome was all-cause in-hospital mortality. RESULTS Forty-five PWH with PCR-confirmed COVID-19 were identified in CoRIS, 21 of whom were hospitalized. A total of 105 age/sex-matched controls were selected from the COVID-19@Spain cohort. The median age in both groups was 53 (Q1-Q3, 46-56) years, and 90.5% were men. In PWH, 19.1% were injecting drug users, 95.2% were on antiretroviral therapy, 94.4% had HIV-RNA < 50 copies/mL, and the median (Q1-Q3) CD4 count was 595 (349-798) cells/μL. No statistically significant differences were found between PWH and non-PWH in number of comorbidities, presenting signs and symptoms, laboratory parameters, radiology findings and severity scores on admission. Corticosteroids were administered to 33.3% and 27.4% of PWH and non-PWH, respectively (P = 0.580). Deaths during admission were documented in two (9.5%) PWH and 12 (11.4%) non-PWH (P = 0.800). CONCLUSIONS Our findings suggest that well-controlled HIV infection does not modify the clinical presentation or worsen clinical outcomes of COVID-19 hospitalization.
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Affiliation(s)
- Cristina Díez
- Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM, Madrid, Spain
| | | | - Rafael Mican
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain.,Instituto de Investigación Hospital Universitario La Paz (IdiPAZ, Madrid, Spain
| | - Juan C López
- Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM, Madrid, Spain
| | - José R Blanco
- Servicio de Medicina Interna, Hospital Universitario San Pedro - CIBIR de Logroño, Logroño, Spain
| | - Sonia Calzado
- Unidad de Enfermedades Infecciosas, Hospital Universitario Parc Tauli, Sabadell, Spain
| | - Gloria Samperiz
- Unidad de Enfermedades Infecciosas, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Joaquín Portilla
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, Alicante, Spain
| | - Lucio J García-Fraile
- Sección de Enfermedades Infecciosas, Hospital Universitario La Princesa, Madrid, Spain
| | - Félix Gutiérrez
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Elche, Spain
| | | | - Inés Suárez-García
- Grupo de Enfermedades Infecciosas, Departamento de Medicina Interna, Hospital Universitario Infanta Sofía, Madrid, Spain.,Facultad de Medicina, Universidad Europea de Madrid, Madrid, Spain
| | - Concha Amador
- Unidad de Enfermedades Infecciosas, Hospital de la Marina Baixa, Alicante, Spain
| | - María Novella
- Unidad de Enfermedades Infecciosas, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Jose R Arribas
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain.,Instituto de Investigación Hospital Universitario La Paz (IdiPAZ, Madrid, Spain
| | - Santiago Moreno
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Facultad de Medicina, Universidad de Alcalá, Madrid, Spain.,Instituto Ramón y Cajal de Investigación Sanitaria (irycis, Madrid, Spain
| | - Juan González-García
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain.,Instituto de Investigación Hospital Universitario La Paz (IdiPAZ, Madrid, Spain
| | - Inmaculada Jarrín
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Berenguer
- Unidad de Enfermedades Infecciosas/VIH, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM, Madrid, Spain
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9
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Berenguer J, Díez C, Martín-Vicente M, Micán R, Pérez-Elías MJ, García-Fraile LJ, Vidal F, Suárez-García I, Podzamczer D, Del Romero J, Pulido F, Iribarren JA, Gutiérrez F, Poveda E, Galera C, Izquierdo R, Asensi V, Portilla J, López JC, Arribas JR, Moreno S, González-García J, Resino S, Jarrín I. Prevalence and factors associated with SARS-CoV-2 seropositivity in the Spanish HIV Research Network Cohort. Clin Microbiol Infect 2021; 27:1678-1684. [PMID: 34186209 PMCID: PMC8267776 DOI: 10.1016/j.cmi.2021.06.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 03/09/2021] [Revised: 06/08/2021] [Accepted: 06/12/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We aimed to assess the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and factors associated with seropositivity and asymptomatic coronavirus disease 2019 (COVID-19) among people with HIV (PWH). METHODS This was a cross-sectional study carried out within the cohort of the Spanish HIV Research Network. Participants were consecutive PWH with plasma collected from 1st April to 30th September 2020. We determined SARS-CoV-2 antibodies (Abs) in plasma. Illness severity (NIH criteria) was assessed by a review of medical records and, if needed, participant interviews. Multivariable logistic regression analysis was used to identify predictors of seropositivity among the following variables: sex, age, country of birth, education level, comorbidities (hypertension, chronic heart disease, diabetes mellitus, non-AIDS-related cancer, chronic kidney disease, cirrhosis), route of HIV acquisition, prior AIDS, CD4+ cell count, HIV viral load, nucleoside/nucleotide reverse transcriptase inhibitor (N [t]RTI) backbone, type of third antiretroviral drug, and month of sample collection. RESULTS Of 1076 PWH (88.0% males, median age 43 years, 97.7% on antiretroviral therapy, median CD4+ 688 cells/mm3, 91.4% undetectable HIV viral load), SARS-CoV-2 Abs were detected in 91 PWH, a seroprevalence of 8.5% (95%CI 6.9-10.3%). Forty-five infections (45.0%) were asymptomatic. Variables independently associated with SARS-CoV-2 seropositivity were birth in Latin American countries versus Spain (adjusted odds ratio (aOR) 2.30, 95%CI 1.41-3.76, p 0.001), and therapy with tenofovir disoproxil fumarate plus emtricitabine (TDF/FTC) versus tenofovir alafenamide (TAF)/FTC as the N(t)RTI backbone (aOR 0.49, 95%CI 0.26-0.94, p 0.031). CONCLUSIONS Many SARS-CoV-2 infections among PWH were asymptomatic, and birth in Latin American countries increased the risk of SARS-CoV-2 seropositivity. Our analysis, adjusted by comorbidities and other variables, suggests that TDF/FTC may prevent SARS-CoV-2 infection among PWH.
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Affiliation(s)
- Juan Berenguer
- Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain.
| | - Cristina Díez
- Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain
| | | | - Rafael Micán
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | | | | | - Francisco Vidal
- Hospital Universitari de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | - Inés Suárez-García
- Hospital Universitario Infanta Sofía, FIIB HUIS HHEN, San Sebastián de los Reyes, Universidad Europea de Madrid, Spain
| | | | | | - Federico Pulido
- Hospital Universitario 12 Octubre, imas12, Universidad Complutense de Madrid, Madrid, Spain
| | - José A Iribarren
- Hospital Universitario Donostia, II BioDonostia, San Sebastián, Spain
| | - Félix Gutiérrez
- Hospital Universitario de Elche, Universidad Miguel Hernández, Elche, Spain
| | - Eva Poveda
- Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Spain
| | - Carlos Galera
- Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - Víctor Asensi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Juan C López
- Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain
| | | | - Santiago Moreno
- Hospital Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | | | - Salvador Resino
- Centro Nacional de Microbiología (ISCIII), Majadahonda, Spain
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10
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Alejos B, Suárez-García I, Rava M, Bautista-Hernández A, Gutierrez F, Dalmau D, Sagastagoitia I, Rivero A, Moreno S, Jarrín I. Effectiveness and safety of first-line antiretroviral regimens in clinical practice: a multicentre cohort study. J Antimicrob Chemother 2021; 75:3004-3014. [PMID: 32667674 DOI: 10.1093/jac/dkaa246] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/30/2020] [Accepted: 05/03/2020] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES We compared 48 week effectiveness and safety of first-line antiretroviral regimens. METHODS We analysed HIV treatment-naive adults from the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) starting the most commonly used antiretroviral regimens from 2014 to 2018. We used multivariable regression models to assess the impact of initial regimen on: (i) viral suppression (VS) (viral load <50 copies/mL); (ii) change in CD4 cell count; (iii) CD4/CD8 normalization (>0.4 and >1); (iv) CD4 percentage normalization (>29%); (v) multiple T-cell marker recovery (MTMR: CD4 > 500 cells/mm3 plus CD4 percentage >29% plus CD4/CD8 > 1); (vi) lipid, creatinine and transaminase changes; and (vii) discontinuations due to adverse events (AE). RESULTS Among 3945 individuals analysed, the most frequently prescribed regimens were ABC/3TC/DTG (34.0%), TAF/FTC/EVG/CBT (17.2%), TDF/FTC + DTG (11.9%), TDF/FTC/EVG/CBT (11.7%), TDF/FTC/RPV (11.5%), TDF/FTC + bDRV (8.3%) and TDF/FTC + RAL (5.3%). At 48 weeks, 89.7% of individuals achieved VS with no significant differences by initial regimen. CD4 mean increase was 257.8 (249.3; 266.2) cells/mm3, and it was lower with TAF/FTC/EVG/CBT and TDF/FTC/RPV compared with ABC/3TC/DTG. CD4 percentage normalization was less likely with TAF/FTC/EVG/CBT, and MTMR was less likely with TAF/FTC/EVG/CBT and TDF/FTC + RAL. The proportion of discontinuations due to AE was higher with TDF/FTC + bDRV (9.7%), followed by TDF/FTC/EVG/CBT (9.5%) and TDF/FTC + DTG (7.9%). Compared with ABC/3TC/DTG, cholesterol and LDL mean increases were higher with TAF/FTC/EVG/CBT and lower with TDF/FTC + DTG, TDF/FTC/RPV and TDF/FTC + RAL. Higher mean increases in triglycerides were significantly associated with TAF/FTC/EVG/CBT. Regimens containing DTG showed higher creatinine increases. CONCLUSIONS The significantly greater immunological response and safety of some combinations may be useful for making decisions when initiating treatment.
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Affiliation(s)
- Belén Alejos
- Institute of Health Carlos III, Centro Nacional de Epidemiología, Madrid, Spain
| | | | - Marta Rava
- Institute of Health Carlos III, Centro Nacional de Epidemiología, Madrid, Spain
| | | | | | - David Dalmau
- Hospital Universitari MutuaTarrassa, Tarrasa, Spain
| | | | | | | | - Inma Jarrín
- Institute of Health Carlos III, Centro Nacional de Epidemiología, Madrid, Spain
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11
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Suárez-García I, Ruiz-Algueró M, García Yubero C, Moreno C, Belza MJ, Estébanez M, de Los Santos I, Masiá M, Samperiz Abad G, Muñoz Sánchez J, Omar M, Jarrín I. Physicians' opinions on generic antiretroviral drugs and single-tablet regimen de-simplification for the treatment of HIV infection: a multicentre survey in Spain. J Antimicrob Chemother 2021; 75:466-472. [PMID: 31665404 DOI: 10.1093/jac/dkz439] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the attitudes and opinions about generic antiretroviral drugs (ARVs) and single-tablet regimen (STR) de-simplification among physicians prescribing HIV treatment in the cohort of the Spanish HIV/AIDS Research Network (CoRIS). METHODS An online questionnaire with 27 structured questions was sent to all physicians (n=199) who prescribed ARVs among the 45 centres participating in the cohort. RESULTS A total of 169 (84.9%) physicians answered the questionnaire. Only 4.1% of the physicians would never prescribe generic ARVs, but 53.3% would not prescribe them if the number of pills per day increased and 89.3% would not prescribe them if the number of doses per day increased. However, 84.0% of the physicians agreed to prescribe generic ARVs if doing so would decrease costs for the public healthcare system. The percentages of physicians stating that generic ARVs (compared with branded ones) would be associated with worse adherence, more adverse effects or more probability of virological failure, provided that the number of pills and doses per day would not change, were low: 0.6%, 7.7% and 3.6%, respectively. However, these percentages were much higher if the generic ARV entailed breaking an STR: 63.9%, 18.9% and 42.0%, respectively. Most physicians stated that they needed more information about the effectiveness and safety of generic ARVs and the price difference compared with their branded equivalents. CONCLUSIONS Although most physicians were confident about prescribing generic ARVs, the majority had strong concerns about de-simplifying STR, and they also needed more information about generic drugs.
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Affiliation(s)
- Inés Suárez-García
- Infectious Diseases Group, Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain.,Facultad de Ciencias Biomédicas, Universidad Europea, Madrid, Spain
| | - Marta Ruiz-Algueró
- National Epidemiology Centre, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Cristina Moreno
- National Epidemiology Centre, Instituto de Salud Carlos III, Madrid, Spain
| | - María José Belza
- National School of Health, Instituto de Salud Carlos III, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain
| | - Miriam Estébanez
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario 'Gómez Ulla', Madrid, Spain.,Facultad de Medicina, Universidad de Alcalá de Henares, Madrid, Spain
| | | | - Mar Masiá
- Infectious Diseases Unit, Hospital General Universitario de Elche, Alicante, Spain
| | | | - Josefa Muñoz Sánchez
- Department of Infectious Diseases, Hospital Universitario Basurto, Bizkaia, Spain
| | - Mohamed Omar
- Infectious Diseases Unit, Complejo Hospitalario de Jaén, Jaén, Spain
| | - Inma Jarrín
- National Epidemiology Centre, Instituto de Salud Carlos III, Madrid, Spain
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Alejos B, Suárez-García I, Bernardino JI, Blanco JR, Peñaranda M, Bautista A, Gutiérrez F, Jarrín I, Hernando V. Effectiveness and safety of antiretroviral treatment in pre- and postmenopausal women living with HIV in a multicentre cohort. Antivir Ther 2021; 25:335-340. [PMID: 33470219 DOI: 10.3851/imp3380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND To compare effectiveness and safety of initial antiretroviral therapy (ART) among premenopausal and postmenopausal women living with HIV aged 45-60 years from the cohort of the Spanish HIV/AIDS Research Network (CoRIS) who initiated ART between 2004 and 2015. METHODS Multivariable regression models were used to compare post- versus premenopausal women regarding viral suppression (≤50 copies/ml), change in CD4+ T-cell count and time to treatment change (TC) at 48 and 96 weeks after ART initiation. RESULTS Among 230 women, 154 (67%) were premenopausal at ART initiation. The most frequent initial regimen was tenofovir disoproxil fumarate/emtricitabine/efavirenz prescribed in 49 (32%) premenopausal and 22 (29%) postmenopausal women. The proportion of TC was 35.7% and 30.3% at 48 weeks and 51.3% and 47.4% at 96 weeks, for pre- and postmenopausal women, respectively. There were no significant differences in CD4+ T-cell count changes from ART initiation, viral load suppression, time to TC or reason for TC between both groups. The main reason for TC was occurrence of an adverse event, followed by simplification, in both groups. CONCLUSIONS ART effectiveness and safety did not differ significantly between pre- and postmenopausal women.
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Affiliation(s)
- Belén Alejos
- AIDS Research Network, Centro Nacional de Epidemiologia, Institute of Health Carlos III, Madrid, Spain
| | - Inés Suárez-García
- Department of Internal Medicine, Infectious Diseases Group, Hospital Universitario Infanta Sofia, FIIB HUIS HHEN, Madrid, Spain.,Universidad Europea de Madrid, Madrid, Spain
| | | | - José Ramón Blanco
- Department of Infectious Diseases, Hospital San Pedro, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Maria Peñaranda
- Department of Infectious Diseases, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Azucena Bautista
- Department of Infectious Diseases, Hospital Universitario La Princesa, Madrid, Spain
| | - Félix Gutiérrez
- Department of Internal Medicine, Hospital General Universitario de Elche, Elche, Spain
| | - Inma Jarrín
- AIDS Research Network, Centro Nacional de Epidemiologia, Institute of Health Carlos III, Madrid, Spain
| | - Victoria Hernando
- HIV Surveillance Unit, Centro Nacional de Epidemiologia, Institute of Health Carlos III, Madrid, Spain
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13
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Abenza-Abildúa MJ, Novo-Aparicio S, Moreno-Zabaleta R, Algarra-Lucas MC, Rojo Moreno-Arcones B, Salvador-Maya MÁ, Navacerrada-Barrero FJ, Ojeda-Ruíz de Luna J, Pérez-López C, Fraile-Vicente JM, Suárez-García I, Suarez-Gisbert E, Palacios-Castaño JA, Ramirez-Prieto MT. Encephalopathy in severe SARS-CoV2 infection: Inflammatory or infectious? Int J Infect Dis 2020; 98:398-400. [PMID: 32712426 PMCID: PMC7378010 DOI: 10.1016/j.ijid.2020.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/05/2020] [Accepted: 07/19/2020] [Indexed: 11/23/2022] Open
Abstract
Concerning the letter by Moriguchi et al., we describe our experience with a case of encephalopathy with and atypical damage on magnetic resonance imaging (MRI) in a patient with severe infection due to the SARS-CoV2 virus. A 56-year-old woman, without previous pathologies, developed cough, fever, and respiratory failure for five days, after returning from a 6-day trip to Venice. Chest radiography shows a large bilateral interstitial infiltrate. In the first 24 hours, she was admitted to the Intensive Care Unit (ICU) for severe respiratory failure and positive protein chain reaction-PCR in nasal exudate. She needed intubation for ten days. In the first 48 hours outside the ICU, she developed an acute confusional syndrome (hyperactive delirium). Neurological examination showed temporal-spatial disorientation and incoherent fluent speech. An electroencephalogram (EEG) showed generalized hypovoltaic activity. Cranial magnetic resonance imaging showed a bilateral and symmetrical increase in the supratentorial white matter's signal intensity, with a discrete thickening of both temporal lobes, with a slight increase in signal intensity and a sequence of normal diffusion. The lumbar puncture showed no changes (glucose 71 mg/dL, protein 30 mg/dL, 1 leukocyte). Within 72 hours of starting symptoms, she was neurologically asymptomatic. Our final diagnosis was an inflammatory encephalopathy related to a SARS-CoV2 infection.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Inés Suárez-García
- Internal Medicine-Infectious Diseases Department, Infanta Sofia University Hospital, Madrid, Spain.
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14
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Suárez-García I, Martínez de Aramayona López MJ, Sáez Vicente A, Lobo Abascal P. SARS-CoV-2 infection among healthcare workers in a hospital in Madrid, Spain. J Hosp Infect 2020; 106:357-363. [PMID: 32702465 PMCID: PMC7371579 DOI: 10.1016/j.jhin.2020.07.020] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [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: 06/07/2020] [Accepted: 07/15/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Healthcare workers (HCWs) are especially vulnerable to infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). AIM The aim of this study was to describe the epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) among HCWs from February 24th to April 30th, 2020, in a hospital in Madrid, Spain. METHODS This was a retrospective cohort study. Cumulative COVID-19 incidence was calculated for all HCWs and categorized according to presumed level of COVID-19 exposure (high, medium, and low). FINDINGS Among 1911 HCWs, 213 (11.1%) had COVID-19 during the study period. Cases increased gradually from March 8th, peaking on March 17th and declining thereafter. The peak of cases among HCWs was reached 14 days before the peak in admitted COVID-19 cases in the hospital. There were no significant differences in the proportion of COVID-19 cases according to level of occupational exposure (P = 0.123). There were five departments and two professions in which >20% of the workers had confirmed COVID-19. Temporal clusters were identified in three of these departments and one profession, with most of the cases occurring over a period of less than five days. The prevalence of comorbidities was low and 91.5% of patients had mild or moderate symptoms. Eleven patients were admitted to the hospital and one patient needed intensive care. None of the patients died. The median time of sick leave was 20 (interquartile range: 15-26) days. CONCLUSION The results suggest that HCW-HCW transmission accounted for part of the cases. In spite of a low prevalence of comorbidities and a mild clinical course in most cases, COVID-19 caused long periods of sick leave.
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Affiliation(s)
- I Suárez-García
- Infectious Diseases Group, Department of Internal Medicine, Hospital Universitario Infanta Sofía, FIIB HUIS HHEN Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain.
| | | | - A Sáez Vicente
- Department of Dermatology, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - P Lobo Abascal
- Universidad Europea de Madrid, Madrid, Spain; Department of Obstetrics and Gynaecology, Hospital Universitario Infanta Sofía, Madrid, Spain
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15
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Suárez-García I, Moreno C, Ruiz-Algueró M, Pérez-Elías MJ, Navarro M, Díez Martínez M, Viciana P, Pérez-Martínez L, Górgolas M, Amador C, de Zárraga MA, Jarrín I, Moreno S, Jarrín I, Dalmau D, Navarro ML, González MI, Garcia F, Poveda E, Iribarren JA, Gutiérrez F, Rubio R, Vidal F, Berenguer J, González J, Muñoz-Fernández MÁ, Jarrin I, Alejos B, Moreno C, Iniesta C, Sousa LMG, Perez NS, Rava M, Muñoz-Fernández MÁ, Fernández IC, Merino E, García G, Portilla I, Agea I, Portilla J, Sánchez-Payá J, Rodríguez JC, Gimeno L, Giner L, Díez M, Carreres M, Reus S, Boix V, Torrús D, Lirola AL, García D, Díaz-Flores F, Gómez JL, del Mar Alonso M, Pelazas R, Hernández J, Alemán MR, Hernández MI, Asensi V, Valle E, Carmenado MER, Secades TSZ, Is LP, Rubio R, Pulido F, Bisbal O, Hernando A, Domínguez L, Crestelo DR, Bermejo L, Santacreu M, Iribarren JA, Arrizabalaga J, Aramburu MJ, Camino X, Rodríguez-Arrondo F, von Wichmann MÁ, Tomé LP, Goenaga MÁ, Bustinduy MJ, Azkune H, Ibarguren M, Lizardi A, Kortajarena X, Oyaga MPC, Igartua MU, Gutiérrez F, Masiá M, Padilla S, Navarro A, Montolio F, Robledano C, Colomé JG, Adsuar A, Pascual R, Fernández M, García E, García JA, Barber X, Muga R, Sanvisens A, Fuster D, Berenguer J, de Quirós JCLB, Gutiérrez I, Ramírez M, Padilla B, Gijón P, Aldamiz-Echevarría T, Tejerina F, Parras FJ, Balsalobre P, Diez C, Latorre LP, Fanciulli C, Vidal F, Peraire J, Viladés C, Veloso S, Vargas M, Olona M, Rull A, Rodríguez-Gallego E, Alba V, Castellanos AJ, López-Dupla M, Alonso MM, Aldeguer JL, Juliá MB, Pitarch MT, Hernández IC, Muñoz EC, Tovar SC, Lletí MS, Navarro JF, González-Garcia J, Arnalich F, Arribas JR, de la Serna JIB, Castro JM, Escosa L, Herranz P, Hontañón V, García-Bujalance S, López-Hortelano MG, González-Baeza A, Martín-Carbonero ML, Mayoral M, Mellado MJ, Micán RE, Montejano R, Montes ML, Moreno V, Pérez-Valero I, Rodés B, Sainz T, Sendagorta E, Alcáriz NS, Valencia E, Blanco JR, Oteo JA, Ibarra V, Metola L, Sanz M, Pérez-Martínez L, Arazo P, Sampériz G, Dalmau D, Jaén A, Sanmartí M, Cairó M, Martinez-Lacasa J, Velli P, Font R, Xercavins M, Alonso N, Marcotegui MR, Repáraz J, de Alda MGR, de León Cano MT, de Galarreta BPR, Amengual MJ, Navarro G, Garcia MC, Isbert SC, Vilasaro MN, de los Santos I, Sanz JS, Aparicio AS, Cepeda CS, Fraile LGF, Gayo EM, Moreno S, Osorio JLC, Nuñez FD, Zamora AM, Elías MJP, Gutiérrez C, Madrid N, del Campo Terrón S, Villar SS, Gallego MJV, Sanz JM, Urroz UA, Velasco T, Bernal E, Sanchez AC, García AA, Urbieta JB, Perez AM, Alcaraz MJ, del Carmen Villalba M, García F, Quero JH, Medina LM, Alvarez M, Chueca N, García DV, Martinez-Montes C, Beltran CG, de Salazar Gonzalerz A, Lopez AF, Utrilla MR, Del Romero J, Rodríguez C, Puerta T, Carrió JC, Vera M, Ballesteros J, Ayerdi O, Antela A, Losada E, Riera M, Peñaranda M, Leyes M, Ribas MA, Campins AA, Vidal C, Fanjul F, Murillas J, Homar F, Santos J, Ayerbe CG, Viciana I, Palacios R, López CP, Gonzalez-Domenec CM, Viciana P, Espinosa N, López-Cortés LF, Podzamczer D, Imaz A, Tiraboschi J, Silva A, Saumoy M, Prieto P, Ribera E, Curran A, Sierra JO, Stachowski JP, del Arco A, de la torre J, Prada JL, de Lomas Guerrero JMG, Martínez OJ, Vera FJ, Martínez L, García J, Alcaraz B, Jimeno A, Iglesias AC, Souto BP, de Cea AM, Muñoz J, Zubero MZ, Baraia-Etxaburu JM, Ugarte SI, Beneitez OLF, de Munain JL, López MMC, de la Peña M, Lopez M, Azkarreta IL, Galera C, Albendin H, Pérez A, Iborra A, Moreno A, Merlos MA, Vidal A, Meca M, Amador C, Pasquau F, Ena J, Benito C, Fenoll V, Anguita CG, Rabasa JTA, Suárez-García I, Malmierca E, González-Ruano P, Rodrigo DM, Seco MPR, Mohamed-Balghata MO, Vidal MAG, de Zarraga MA, Pérez VE, Molina MJT, García JV, Moreno JPS, Górgolas M, Cabello A, Álvarez B, Prieto L, Moreno JS, Caso AA, Gutiérrez CH, Mena MN, Puerto MJG, Vilalta RF, Ribera AF, Román AR, Juárez AR, López PL, Sánchez IM, Casas MF, Espejo AC, Jiménez MC, Perea RT, Pineda JA, Mayo PR, Sanchez JM, Gutierrez NM, Real LM, Gomez AC, Fuertes MF, Gonzalez-Serna A, Poveda E, Pérez A, Crespo M, Morano L, Miralles C, Ocampo A, Pousada G. Effectiveness of the combination elvitegravir/cobicistat/tenofovir/emtricitabine (EVG/COB/TFV/FTC) plus darunavir among treatment-experienced patients in clinical practice: a multicentre cohort study. AIDS Res Ther 2020; 17:45. [PMID: 32690099 PMCID: PMC7372769 DOI: 10.1186/s12981-020-00302-2] [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] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the effectiveness and tolerability of the combination elvitegravir/cobicistat/tenofovir/emtricitabine plus darunavir (EVG/COB/TFV/FTC + DRV) in treatment-experienced patients from the cohort of the Spanish HIV/AIDS Research Network (CoRIS). METHODS Treatment-experienced patients starting treatment with EVG/COB/TFV/FTC + DRV during the years 2014-2018 and with more than 24 weeks of follow-up were included. TFV could be administered either as tenofovir disoproxil fumarate or tenofovir alafenamide. We evaluated virological response, defined as viral load (VL) < 50 copies/ml and < 200 copies/ml at 24 and 48 weeks after starting this regimen, stratified by baseline VL (< 50 or ≥ 50 copies/ml at the start of the regimen). RESULTS We included 39 patients (12.8% women). At baseline, 10 (25.6%) patients had VL < 50 copies/ml and 29 (74.4%) had ≥ 50 copies/ml. Among patients with baseline VL < 50 copies/ml, 85.7% and 80.0% had VL < 50 copies/ml at 24 and 48 weeks, respectively, and 100% had VL < 200 copies/ml at 24 and 48 weeks. Among patients with baseline VL ≥ 50 copies/ml, 42.3% and 40.9% had VL < 50 copies/ml and 69.2% and 68.2% had VL < 200 copies/ml at 24 and 48 weeks. During the first 48 weeks, no patients changed their treatment due to toxicity, and 4 patients (all with baseline VL ≥ 50 copies/ml) changed due to virological failure. CONCLUSIONS EVG/COB/TFV/FTC + DRV was well tolerated and effective in treatment-experienced patients with undetectable viral load as a simplification strategy, allowing once-daily, two-pill regimen with three antiretroviral drug classes. Effectiveness was low in patients with detectable viral loads.
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Suárez-García I, Alejos B, Delgado E, Rivero M, Pineda JA, Jarrin I. How well are we performing the initial assessment of HIV-positive patients? Results from a multicentre cohort in Spain. HIV Med 2019; 21:128-134. [PMID: 31702111 DOI: 10.1111/hiv.12817] [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: 07/23/2019] [Revised: 09/07/2019] [Accepted: 10/03/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate adherence to the recommendations of the Spanish guidelines for the initial assessment of patients with HIV infection in the multicentre Cohort of the Spanish HIV/AIDS Network (CoRIS) during the years 2004-2017. METHODS We calculated the percentage of patients who had each of 11 clinical and analytical recommended examinations performed in their initial evaluation. We evaluated the factors associated with not performing each examination with multivariable logistic regression models. RESULTS We included 13 612 patients in the study. In the initial assessment, CD4 count and viral load were determined in more than 98.0% of the patients. Serologies for hepatitis A, B and C and syphilis were determined in 55.8%, 66.4%, 89.8% and 81.7% of the patients, respectively. Total cholesterol and creatinine were determined in 78.7% and 78.9% of the patients, respectively. The lowest proportions of examinations were observed for blood pressure, smoking status and latent tuberculosis screening, which were performed in 43.2%, 50.6% and 53.9% of the patients, respectively. Injecting drug users and heterosexual patients (compared to men who have sex with men) and patients with a lower educational level had a higher risk of having an incomplete initial assessment for a substantial number of examinations. Latent tuberculosis screening was less likely in patients with CD4 counts < 200 cells/µL. CONCLUSIONS The initial assessment of HIV-infected patients is suboptimal for the evaluation of cardiovascular risk, smoking status, screening of syphilis and viral hepatitis, and diagnosis of latent tuberculosis: adherence to the guidelines was low for these examinations.
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Affiliation(s)
- I Suárez-García
- Infectious Diseases Unit, Department of Internal Medicine, Infanta Sofía University Hospital, Madrid, Spain.,European University, Madrid, Spain
| | - B Alejos
- National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain
| | - E Delgado
- Son Espases Hospital, Palma de Mallorca, Spain
| | - M Rivero
- Navarra Hospital Complex, Pamplona, Spain
| | - J A Pineda
- Nuestra Señora de Valme Hospital, Sevilla, Spain
| | - I Jarrin
- National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain
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17
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Alejos B, Suárez-García I, Bisbal O, Iribarren JA, Asensi V, Górgolas M, Muga R, Moreno S, Jarrín I. Choice of the initial antiretroviral treatment for HIV-positive individuals in the era of integrase inhibitors. PLoS One 2019; 14:e0221598. [PMID: 31449566 PMCID: PMC6709901 DOI: 10.1371/journal.pone.0221598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/10/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We aimed to describe the most frequently prescribed initial antiretroviral therapy (ART) regimens in recent years in HIV-positive persons in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) and to investigate factors associated with the choice of each regimen. METHODS We analyzed initial ART regimens prescribed in adults participating in CoRIS from 2014 to 2017. Only regimens prescribed in >5% of patients were considered. We used multivariable multinomial regression to estimate Relative Risk Ratios (RRRs) for the association between sociodemographic and clinical characteristics and the choice of the initial regimen. RESULTS Among 2874 participants, abacavir(ABC)/lamivudine(3TC)/dolutegavir(DTG) was the most frequently prescribed regimen (32.1%), followed by tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)/elvitegravir(EVG)/cobicistat(COBI) (14.9%), TDF/FTC/rilpivirine (RPV) (14.0%), tenofovir alafenamide (TAF)/FTC/EVG/COBI (13.7%), TDF/FTC+DTG (10.0%), TDF/FTC+darunavir/ritonavir or darunavir/cobicistat (bDRV) (9.8%) and TDF/FTC+raltegravir (RAL) (5.6%). Compared with ABC/3TC/DTG, starting TDF/FTC/RPV was less likely in patients with CD4<200 cells/μL and HIV-RNA>100.000 copies/mL. TDF/FTC+DTG was more frequent in those with CD4<200 cells/μL and HIV-RNA>100.000 copies/mL. TDF/FTC+RAL and TDF/FTC+bDRV were also more frequent among patients with CD4<200 cells//μL and with transmission categories other than men who have sex with men. Compared with ABC/3TC/DTG, the prescription of other initial ART regimens decreased from 2014-2015 to 2016-2017 with the exception of TDF/FTC+DTG. Differences in the choice of the initial ART regimen were observed by hospitals' location. CONCLUSIONS The choice of initial ART regimens is consistent with Spanish guidelines' recommendations, but is also clearly influenced by physician's perception based on patient's clinical and sociodemographic variables and by the prescribing hospital location.
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Affiliation(s)
- Belén Alejos
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
- * E-mail: (BA); (ISG)
| | - Inés Suárez-García
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Infanta Sofia, Madrid, Spain
- Universidad Europea, Madrid, Spain
- * E-mail: (BA); (ISG)
| | - Otilia Bisbal
- Hospital Universitario Doce de Octubre, Madrid, Spain
| | | | - Víctor Asensi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Miguel Górgolas
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Roberto Muga
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Inma Jarrín
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
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Suárez-García I, Echevarría J, Cervera F, Gómez-Barroso D, Fine P. The decline of autochthonous leprosy in the Valencia Region of Spain: patterns and trends 1940–2015. LEPROSY REV 2017. [DOI: 10.47276/lr.88.2.162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Suárez-García I, Sobrino-Vegas P, Dalmau D, Rubio R, Iribarren JA, Blanco JR, Gutierrez F, Montero Alonso M, Bernal E, Vinuesa García D, Del Amo J. Clinical outcomes of patients infected with HIV through use of injected drugs compared to patients infected through sexual transmission: late presentation, delayed anti-retroviral treatment and higher mortality. Addiction 2016; 111:1235-45. [PMID: 26890155 DOI: 10.1111/add.13348] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 06/13/2015] [Revised: 11/30/2015] [Accepted: 02/08/2016] [Indexed: 11/30/2022]
Abstract
AIMS To compare patients who acquired HIV infection through use of injected drugs (HIV-IDU) with patients who acquired HIV by sexual transmission (HIV-ST) in terms of late presentation (LP), delay in anti-retroviral treatment (ART) initiation, virological and immunological response to ART, mortality and progression to AIDS. DESIGN Prospective multi-centre cohort study of HIV-infected subjects naive to ART at entry (Cohort of the Spanish HIV Research Network: CoRIS). SETTING Thirty-one centres from the Spanish public health-care system. PARTICIPANTS A total of 9355 patients were included (1064 HIV-IDU and 8291 HIV-ST) during 2004-13. MEASUREMENTS We compared LP (defined as presentation for care with a CD4 cell count < 350/μl and/or AIDS-defining illness), delayed ART initiation (defined as initiating treatment more than 6 months after the date when treatment was indicated by the guidelines, or not initiating treatment at all when it was indicated), virological and immunological response to ART (defined as viral load < 50 HIV-1 RNA copies/ml and a CD4 count increase of at least 100 cells/μl, respectively, after 1 year of treatment), mortality and progression to AIDS in HIV-IDU and HIV-ST. FINDINGS Compared with HIV-ST, HIV-IDU had higher risk of LP [odds ratio (OR) = 1.76; 95% confidence interval (CI) = 1.41-2.18], delayed ART initiation (OR 1.87; 95% CI = 1.46-2.40) and higher mortality [hazard ratio (HR) = 1.43; 95% CI = 1.03-2.01] and risk of progression to AIDS [subhazard ratio (SHR) = 1.68; 95% CI = 1.29-2.18]. Virological suppression due to ART was lower in HIV-IDU than in patients with HIV-ST only among patients without hepatitis C virus (HCV) infection [adjusted OR (aOR) = 0.59; 95% CI = 0.36-0.95]; among patients with HCV infection, virological suppression due to ART did not show significant differences between HIV-IDU and HIV-ST. There were no significant differences in immunological response after adjusting by HCV (aOR = 0.74; 95% CI = 0.52-1.06). CONCLUSIONS In Spain, patients who acquire HIV infection through use of injected drugs appear to have a higher risk of late presentation, delayed initiation of anti-retroviral treatment and progression to AIDS and death than patients who acquire HIV by sexual transmission.
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Affiliation(s)
- Inés Suárez-García
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Paz Sobrino-Vegas
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - David Dalmau
- Hospital Universitari Mutua Terrassa, Terrassa, Spain
| | - Rafael Rubio
- Unidad Infección VIH, Hospital Universitario Doce de Octubre, Madrid, Spain
| | | | - José Ramón Blanco
- Department of Infectious Diseases, Hospital San Pedro-CIBIR, Logroño, Spain
| | - Félix Gutierrez
- Infectious Diseases Unit, Hospital General de Elche and Universidad Miguel Hernández, Alicante, Spain
| | - Marta Montero Alonso
- Department of Infectious Diseases, Hospital Universitario La Fe, Valencia, Spain
| | | | - David Vinuesa García
- Unidad de Gestion Clínica de Microbiología y Enfermedades Infecciosas, Hospital Clínico San Cecilio, Granada, Spain
| | - Julia Del Amo
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
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Suárez-García I, Sobrino-Vegas P, Tejada A, Viciana P, Ribas MA, Iribarren JA, Díaz Menéndez M, Rivero M, Arazo P, del Amo J, Moreno S. Compliance with national guidelines for HIV treatment and its association with mortality and treatment outcome: a study in a Spanish cohort. HIV Med 2013; 15:86-97. [DOI: 10.1111/hiv.12078] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2013] [Indexed: 11/29/2022]
Affiliation(s)
- I Suárez-García
- Infectious Diseases Unit; Infanta Sofía Hospital; Madrid Spain
| | | | - A Tejada
- Ramón y Cajal Hospital; Madrid Spain
| | - P Viciana
- Virgen del Rocío Hospital; Sevilla Spain
| | - MA Ribas
- Son Espases Hospital; Palma de Mallorca; Spain
| | | | | | - M Rivero
- Navarra Hospital; Pamplona Spain
| | - P Arazo
- Miguel Servet Hospital; Zaragoza Spain
| | - J del Amo
- National Epidemiology Center; Madrid Spain
| | - S Moreno
- Ramón y Cajal Hospital; Madrid Spain
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Suárez-García I, Jarrín I, Iribarren JA, López-Cortés LF, Lacruz-Rodrigo J, Masiá M, Gómez-Sirvent JL, Hernández-Quero J, Vidal F, Alejos-Ferreras B, Moreno S, Del Amo J. Incidence and risk factors of AIDS-defining cancers in a cohort of HIV-positive adults: Importance of the definition of incident cases. Enferm Infecc Microbiol Clin 2013; 31:304-12. [DOI: 10.1016/j.eimc.2012.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 02/22/2012] [Accepted: 03/16/2012] [Indexed: 10/26/2022]
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Díaz-Menéndez M, Pérez-Molina JA, Serre N, Treviño B, Torrús D, Matarranz M, Martín E, Rojo-Marcos G, Aguilera P, Rico A, Suárez-García I, López-Vélez R. Infecciones importadas por inmigrantes y viajeros: resultados de la Red Cooperativa para el estudio de las Enfermedades Importadas por Inmigrantes y Viajeros +Redivi. Enferm Infecc Microbiol Clin 2012; 30:528-34. [DOI: 10.1016/j.eimc.2012.01.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 01/23/2012] [Accepted: 01/24/2012] [Indexed: 11/25/2022]
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Suárez-García I, Sánchez-García A, Soler L, Malmierca E, Gómez-Cerezo J. Lactobacillus jensenii bacteremia and endocarditis after dilatation and curettage: case report and literature review. Infection 2011; 40:219-22. [PMID: 21866337 DOI: 10.1007/s15010-011-0182-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 08/09/2011] [Indexed: 01/20/2023]
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Suárez-García I, Rodríguez-Blanco A, Vidal-Pérez JL, García-Viejo MA, Jaras-Hernández MJ, López O, Noguerado-Asensio A. Risk factors for multidrug-resistant tuberculosis in a tuberculosis unit in Madrid, Spain. Eur J Clin Microbiol Infect Dis 2008; 28:325-30. [PMID: 18830725 DOI: 10.1007/s10096-008-0627-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Accepted: 08/27/2008] [Indexed: 11/29/2022]
Abstract
The setting for this retrospective cohort study was a specialised tuberculosis unit in Madrid, Spain. The objective was to describe the risk factors for multidrug-resistant tuberculosis (MDR-TB). The medical records of all patients admitted to the unit were reviewed retrospectively to identify factors associated with multidrug resistance. Patients with positive culture for M. tuberculosis and with available drug-susceptibility tests were included. The variables assessed were age, gender, country of origin, homelessness, alcohol consumption, intravenous drug use, methadone substitution therapy, contact with a tuberculosis patient, sputum smear, site of disease, previous tuberculosis treatment, HIV infection, history of imprisonment, diabetes mellitus and chronic obstructive pulmonary disease. Thirty patients with MDR-TB and 666 patients with non-MDR-TB were included from the years 1997 to 2006. The only factors associated with MDR-TB in multivariate analysis were previous tuberculosis treatment (OR: 3.44; 95% CI: 1.58-7.50; p = 0.003), age group 45-64 years (OR: 3.24; 95% CI: 1.34-7.81; p = 0.009) and alcohol abuse (OR: 0.12; 95% CI: 0.03 to 0.55; p = 0.003). In our study, patients who had had previous treatment for tuberculosis, who were 45-64 years of age or who had no history of alcohol abuse were more likely to have MDR-TB.
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Affiliation(s)
- I Suárez-García
- Department of Internal Medicine, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain.
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